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A combination of changing national policy frameworks and the impact of demographic changes in the learning disabled population requires changes in the commissioning approach.  Future commissioning needs to ensure services support overall well-being by promoting independence and choice, by developing flexible and individualized services that combine both natural and paid supports, and by developing services which are financially sustainable.  At the same time, commissioning will also have to demonstrate efficiency, effectiveness and quality.  This will be achieved by working with partners and achieving ‘best value’ through competitive procurement wherever possible.  The approaches and activities required to commission and develop the appropriate services for learning disabled people, to address the challenges and requirements identified, are detailed below. Preparatory steps are already being taken and/or these approaches and activities are being rolled out to deliver service models that reflect new policy frameworks, changing needs in the learning disabled population and which are designed to manage any financial pressures.

Personalisation

The delivery of personalisation requires:

• Increasing the number of people with learning disabilities receiving and using direct payments and budgets to promote choice-based, flexible and individualized packages for support and person-centered planning.
• Supporting the development of individually-responsive services, to reflect national policy frameworks and to manage budgetary pressures. 
• The possibility of commissioning less provision based on traditional service models.  This could include reduced commissioning of:
  
  • Out of area placements
  • Traditional daycare services
  • Services via block contracts
• Commissioning that supports the modernisation of day care services to realize government objective of ensuring that people with a learning disability have real choice in how they spend their days.  This suggests the commissioning activities should focus on developing day care services that:
  
  • Enable people with learning disabilities to learn new skills via access to adult and further education.
  • Provide access to social and leisure activities (not necessarily based in a day care setting).
  • Offer opportunities to undertake paid and voluntary work. 

Respite Services

The importance of personalised respite is critical in achieving positive outcomes for both those with care needs and carers.  In line with the overall principles of personalisation, commissioning should focus on securing an improved variety of respite services which:

• Offer greater choice and flexibility.
• Include breaks at home.
• Include provision of equipment or adaptations to facilitate respite.
• Provide access to mainstream activities and community based activities.
• Support ‘good neighbour' groups and 'shared lives' services.
• Offer self directed support for respite.  

Health

Service and delivery agencies need to consider the delivery of provision that improves the health of people with learning disabilities and which reduces the health inequalities experienced by the learning disabled. 

Housing & Support Services

Key next steps in relation to housing and support services include:

◊          Managing the cost of providing ISL service models as this is likely to be  a main growth area in learning disabilities provision.

◊    Delivering an appropriate range of accommodation and housing tenancy models that meet individual needs and which also provide greater choice, opportunities for independent living and suitable housing options for people with learning disabilities as they grow older.  This may include investigating and where possible progressing:

o       Shared ownership options.

o       Extra Care models as housing options for people with less severe learning difficulties to provide secure, yet independent and personalized services.

o       Concierge-plus models.

o       Investigating opportunities for using assistive technology in a range of housing settings to further facilitate independence and tailor support to individual need.

o       Increasing the use of telecare as a model of support to support people with learning disabilities to retain their independence wherever possible.

o       The development of flexible, low level floating support to respond to varying and fluctuating levels of need, which includes support appropriate to deal with crises.  This would also include support for those who are not eligible for social care, those who have settled or un-settled accommodation and those who have fluctuating levels of need. 

Residential Services & Day Care

Next steps, in relation to residential and day care services include:

·        Re-settling people with learning disabilities who may still be long-stay patients in specialist hospitals back into the community in line with the principles of “Valuing People”.

·        Reducing the use of out of areas placements, which can be both expensive and possibly unsuitable.

·        Investing in service models that provide appropriate alternatives to day care.  However, day care provision will remain an option for those for whom the model is appropriate. 

Transition for Young People

·        Develop effective transition arrangements for children and young people.  This is particularly important as demographic analysis suggests transition-related demand will increase in the near future. 

Partnership & Interagency Working

·        Build on consultation and partnerships already undertaken by service commissioners and providers outlined to improve co-ordination.