Learning disability commissioning relies on inaccurate data

Service planning relies heavily on estimates and the costs of residential care vary wildly, says David Brindle

Although most people with a learning disability live in the community, the balance of spending on services has never reflected that. So it is hugely significant that, according to official data just released, expenditure by English councils on residential care for learning disabled adults fell in 2009-10 for the first time.

The cost of learning disability services continues to be a major headache for councils. Even though we live in an ageing society, spending on services for older people has fallen as a proportion of adult social care budgets over the past five years. Spending on learning disability, by contrast, has reached £4bn of the £16.7bn total and is growing by 3% a year in real terms – three times as fast as the growth in support for older people.

This is unsustainable in the context of a planned 26% cut in government grant to English councils over the next four years, as authorities will be discovering this week as they examine their grant allocations and as care services minister Paul Burstow will today make clear when he addresses the annual Learning Disability Today event in London, which is supported by SocietyGuardian.

One of the minister’s key messages is likely to be that there is much room for improvement in the way services are commissioned. In a report last month for charity Mencap and the Learning Disability Coalition, the Institute of Public Care at Oxford Brookes University finds that learning disability appears to have been bypassed by the so-called “joint strategic needs assessment” process, supposedly now at the centre of how the NHS and local authorities commission health and social care locally. Few assessments of the health and wellbeing of local communities have had much to say about learning disability, the report says.

Commissioning suffers from the poor data quality that plagues the sector. Service planning relies heavily on estimates: there are an estimated 770,000 people in England with a learning disability, of which an estimated 108,000 have a “profound to moderate” disability and are assumed to be the bulk of the 128,000 in receipt of social care services of some kind. In truth, we don’t exactly know.

What we do know is that costs of residential care vary wildly. Although some councils are getting to grips with the bigger numbers, which explains the fall in spending last year, residential care still accounts for the lion’s share (38%) of total expenditure on learning disability.

Surrey spent £81m gross on residential care for learning disabled adults under 65 in 2009-10, while Hertfordshire, which has broadly the same population, spent £60m. Sunderland spent £13m, while Newcastle upon Tyne spent £5m. Gateshead, smaller than both, spent £15m.

Differing prevalence of learning disability is not an adequate explanation of these variations. Why should Norfolk be spending an average £1,861 a week gross on its residential placements, when the East Riding of Yorkshire spends just £695? Why is Warrington spending £2,006, compared to nearby Sefton’s £612? Granted you may – should – get better quality at the higher end of the scale, but £1,400 a week better?

If learning disability services are at particular risk of cuts, which they may very well be, figures like these need careful probing.