Tuesday, 3 October 2017

A real return on investment - investing in people with learning disabilities

I’ve been following @garybourletLDE , @AliciaWood___ , @hillsideliz , @SScown , @LearningDisEng and others who have been subjecting themselves to the UK (English?) party political conference season, asking the questions that need to be asked and trying to direct politicians’ attention to the realities of the lives of people with learning disabilities.

When local authorities are considering where to put the money they are entrusted with, what are they looking for? Among other things, I think they’d be wanting: 1) improvements to the health and wellbeing of people in their local communities; 2) relatively stable, connected communities with good levels of employment in good jobs; 3) good, sustainable and affordable housing that matches the needs of local communities; 4) their investment to be recirculated within local businesses and enterprises; and 5) for their investment to be efficient and cost-effective.

I think a local authority investing in really good support for people with learning disabilities in their area will achieve everything I’ve listed above, in a maximally efficient and cost-effective virtuous circle. What do I mean by really good support? Something like the following:

  1.  First of all, use the resources that are available in your local area. Invest properly in vibrant self-advocacy organisations and family-led organisations. They will bring you expertise, creativity, and local knowledge of life’s realities. If you let them, they will generate cost-effective solutions rooted in local communities, at a far more reasonable rate than management consultants. And by investing properly in them, you will be helping to establish entrepreneurial local organisations that can offer vital support to a wide range of local organisations, such as training, consultancy and the production of accessible information for local health and social care services, leisure services, the police, transport and businesses.
  2. Invest in local communities to help people live connected, fulfilling lives locally – Community Circles being one example that also encourages local community cohesion. Shared Lives is another example of a living option that some people may choose which does not require additional housing, matching people with learning disabilities with others in their local community who have space and a willingness to share that space. These are really cost-effective, with the social care investment being kept and shared within local communities.
  3. With the support of self-advocacy, families and local enterprise, focus the commissioning of support for people with learning disabilities on small, local enterprises, developed through collaborative ideas generated from and by people with learning disabilities and families. This will develop efficient, cost-effective local enterprises with a genuine commitment to people with learning disabilities and the locality. Investment at a council level in supporting these small enterprises with pooled functions like HR, payroll, legal support etc will ensure they stay efficient and focused. Work to promote ‘scaling across’ rather than ‘scaling up’ – local small enterprises can encourage others to develop, rather than forcing them into expanding hugely into large enterprises that become sclerotic, remote and less efficient, with profits from local investment becoming siphoned out of the locality. Co-operatives, community interest companies and similar social enterprises are relevant here. Radically change bureaucratic procurement and tendering processes that stack the deck against small, innovative local entrepreneurs, and use the money saved to invest in ways to keep developing and maintaining local organisations.
  4. Ensure that you invest properly in these local support organisations, such that support workers can be decently paid. This will encourage a stable, skilled and committed workforce that will stay in the area and have money in their pockets to spend in local businesses, rather than ending up with a transient, unstable workforce.
  5. Support local businesses and organisations of all sorts to be hospitable to people with learning disabilities. They’re missing out on potential customers and contributors if they’re not.
  6. Invest heavily in good quality supported employment support with people with learning disabilities, developed and delivered locally. Many, many more people with learning disabilities want paid work than currently have the opportunity to do so, and on-the-job support and support to keep people working well in jobs is a highly cost-effective investment. Local employers gain a stable workforce with bespoke on-the-job training to do specific tasks they need doing, and ongoing support to keep people working well. Ensure that the paid work is good work at levels and with numbers of hours that pay people a decent wage. This will ensure that people with learning disabilities have disposable income, which they will spend overwhelmingly locally, recirculating the investment straight back into the locality. All sorts of other good things for people with learning disabilities and local communities follow from good work. Also encourage entrepreneurship and the development of enterprise amongst individuals and groups of people with learning disabilities.
  7. Invest in local, attractive, affordable housing that is accessible to everyone, including people with learning disabilities. Put the investment into supporting people with learning disabilities within local homes in local neighbourhoods to lead active lives as part of their local communities – belonging, contributing. This investment will again put money back into local businesses (as people maintain their homes, buy food and clothes, and enjoy themselves in local leisure facilities that help keep communities vibrant places to be). For many people, you will also be helping their families too, among other things in terms of their potential for paid employment themselves.
  8. Provide guaranteed minimum personal budgets (and personal health budgets, and integrated personalised commissioning) for people over long periods of time (5 years? 10 years? longer?). Strip away needless bureaucracy in assessing/reviewing/monitoring, and use the money saved to invest in supporting people and families with PBs in legal/HR/payroll issues, and in supporting people to really plan for their futures, individually and collectively. People are in the best position to invest their personal budget wisely and efficiently, without waste, and again will invest locally.
  9. Invest in social workers who have the time to get to know people properly, and who respect people in the decisions they make about their lives.

I’m sure there is much more to be said and I’ve ignored many vital things. My point is that from a local authority point of view these forms of investment are highly cost-effective and likely to form a virtuous circle, and help to achieve the vibrant, inclusive local communities local authorities are aiming for while supporting local business and supporting people with learning disabilities to live more active, fulfilled and healthier lives.

Which is why I find it weird that so many local authorities are throwing public money at large, quasi-institutional residential services for people with learning disabilities. Local authorities are paying for layers of bureaucracy, profits that are not transparent and are siphoned out of the locality as part of big companies’ profits, and buildings that do not improve or contribute to general housing or amenities in the locality. They are paying for a low waged, transient workforce. They are paying for people to be shut away, such that local businesses and enterprises see very little of the public money sunk into these places and don’t see the benefit of people with learning disabilities as employees and customers. Over time, local communities become less vibrant, less connected, less cohesive. And inactive, isolated people with learning disabilities are more likely to become seriously ill and experience abuse and neglect. A vicious and self-defeating cycle.

What are local authorities waiting for? Be smart – invest in people with learning disabilities.

With thanks/apologies to @neilmcrowther for unwittingly triggering this line of thought.


  1. There are a number of issues I have with this piece. Some of which aren't as formed but I feel uncomfortable about the tone which strikes me as whitewashing problems that exist for local authorities.

    Lets take point 6 as a starting point as there is lots of evidence that states for people with IQs below 85 (a lot higher than what we use for a definition of Learning Difficulties which is 70) are essentially being excluded from the workplace. This is an ongoing and accelerating trend.

    Workplace here meaning where skills/labour are rewarded with payment.

    What's the size of the UK population with IQs below 85? It is around 15%.

    We as a society and particularly politicians haven't got our heads around this problem. So you can talk about providing good quality employment support but if the jobs don't exist - what's the point? We're going to make LD people perform like Sisyphus so that the people providing the coaching have paid work and you feel some kind of beneficence?

    Or are you suggesting we have some kind of Soviet job creation scheme where we abandon productivity gains? I suppose that could be a consequence of Brexit as we head rapidly back towards the 70s.

    In short, if you want a participatory society where everyone is able to contribute then you need to do the thinking about what that looks like first and what are the trade-offs required. Otherwise you're indulging in cargo cult thinking that if we perform this then it makes it real. It doesn't.

    That's just one problem. This blog seriously underestimates the challenges facing local authorities, the lack of capacity within them and the financing/patience required to build and support the wishlist above.

    It is not remotely weird to want to put problems in a box. Also as the recent NDTi report admits, there is no evidence that alternatives are more cost effective. We think they are more cost effective and certainly more decent choices to make but there's no proof of that.

    I agree that current choices lead to a vicious and self-defeating cycle. Equally I think that whitewashing the complexities of changing that doesn't help either.

  2. Hi John. I do take your points about the complexity. The tone was an experiment - some local authorities seem to see spending on social care as something that disappears from their localities down a (socially necessary) drain, and if you're starting from that position then I can see why some local authorities, under financial pressure, would choose what they see as a cheaper drain of more congregate residential care services. I wanted to see if an investment case would be made in terms of people's lives, and also in terms of the consequences of investing in social care on localities more generally. So it absolutely simplifies (although I do think some local authorities hide behind complexity as a reason not to make changes, whilst they simultaneously preside over existing fiendishly complex ways of doing things).

    On the jobs front specifically, I think it's interesting that general employment statistics seem to be showing big increases in paid employment, and most of that in full-time jobs, although productivity is staying low and people are being poorly paid. In this environment, I think employers might be open to employing people with learning disabilities and autistic people as long as those people are decently trained on the job and supported by supported employment agencies - I think under these circumstances many people will do a good job and help to provide a stable workforce. Under Brexit uncertainties, maybe that's a good offer?

    So I agree - the blog is a massive simplification - it's seeing if a case can be made. And it may well be a failure on those terms - just thought it was worth trying it.


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