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The purpose of this paper is to examine trends over time in social care usage and expenditure for adults with learning disabilities in England.

Returns from councils with social services responsibilities in England concerning social care usage and expenditure were analysed to examine the national picture and trends over time for adults with learning disabilities.

In 2017/2018, 147,915 adults with learning disabilities were receiving long-term social care, an increase of 5.7 per cent from 2014/2015. Social care expenditure increased by 10.2 per cent from 2014/2015 to £5.54bn in 2017/2018; adjusted for inflation this was a 2.7 per cent increase. For adults with learning disabilities who receive social care, increasing numbers of people are living with families or in supported accommodation/living, with gradual declines in the number of people living in residential or nursing care. The number of adults with learning disabilities in temporary accommodation is small but increasing.

While councils appear to be attempting to protect social care for adults with learning disabilities in the face of cuts to council expenditure, social care expenditure and coverage are not keeping pace with likely increases in the number of adults with learning disabilities requiring social care.

This paper presents in one place statistics concerning long-term social care for adults with learning disabilities in England.

The purpose of this paper is to compare data from national social care statistics on day services and home care for people with learning disabilities across England, Scotland, Wales and Northern Ireland.

National social care statistics (England, Scotland, Wales and Northern Ireland) reporting the number of adults with learning disabilities accessing day services and home care were reviewed, with data extracted on trends over time and rate of service use.

Regarding day services, despite some variations in definitions, the number of adults with learning disabilities in England, Scotland and Wales (but not Northern Ireland) using building-based day services decreased over time. Data from Scotland also indicate that adults with learning disabilities are spending less time in building-based day services, with alternative day opportunities not wholly compensating for the reduction in building-based day services. Regarding home care, there are broadly similar rates of usage across the four parts of the UK, with the number of adults with learning disabilities using home care now staying static or decreasing.

Similar policy ambitions across the four parts of the UK have resulted (with the exception of Northern Ireland) in similar trends in access to day services and home care.

This paper is a first attempt to compare national social care statistics concerning day services and home care for adults with learning disabilities across the UK. With increasing divergence of health and social service systems, further comparative analyses of services for people with learning disabilities are needed.

This paper reports some preliminary lessons from a qualitative study of services that have cared for a person with learning disabilities during a terminal illness. It reflects current concern about access to health care as well as the national priority being placed on improvements in cancer services for all patients. The study documents how the service learned of the person's illness, how they mobilised services and made decisions, how agencies worked together (or not!) and what support staff needed in the person's last months and weeks. It also considers the way staff, as individuals and as teams, made sense of their experiences and evaluated the input of other professionals.

The purpose of this paper is to examine the early stages of change and the way that stories can open up forms of collaborative dialogue and creative thinking among divergent stakeholders on known but “intractable” problems by enabling multiple voices to be heard in the co-construction of future possibilities for change. The empirical focus is on a project undertaken by two organizations located in Australia. The organizations – AAC, a large aged care provider and Southern Disability Services, a disability support service – collaborated with the researchers in identifying and re-characterizing the nature of the problem in the process of storying new pathways for tackling the transitioning needs of people with intellectual disabilities into aged care services.

An action research approach was used in conducting interviews in the case organizations to ascertain the key dimensions of the presenting problem and to identify change options, this was followed by an ethnographic study of a Pilot Project used to trial the provision of disability day service programmes within an aged care setting.

A key finding of the study centres on the importance of stories at the early stages of change in widening the arena of innovative opportunities, in facilitating collective acceptance of new ideas and in initiating action to resolve problems. The paper demonstrates how stories are used not only in retrospective sensemaking of existing problems but also in giving prospective sense to the possibilities for resolving protracted problems through innovative solutions that in turn facilitates a level of collective acceptance and commitment to opening up new pathways for change.

The paper focuses on problem characterization during the early stages of change and bring to the fore the often hidden notion of time in utilizing concepts from a range of literatures in examining temporality, stories and sensemaking in a context in which future possibilities are made sense of in the present through restorying experiences and events from the past. On a practical and policy front, the paper demonstrates the power of stories to mobilize commitment and action and presents material for rethinking change possibilities in the delivery of aged and disability care.

The purpose of this paper is to compare data from national social care statistics on the living situations of people with learning disabilities across England, Scotland, Wales and Northern Ireland.

National social care statistics (England, Scotland, Wales, Northern Ireland) reporting the living situations of adults with learning disabilities (residential and nursing care, living with family, other forms of accommodation) were accessed, with data extracted on trends over time and rate of service use.

There were substantial differences in the statistics collected across the UK. Overall, there were higher reported rates of adults with learning disabilities in residential/nursing accommodation in England than Scotland or Wales, but much lower reported rates of adults living in other forms of unsupported and supported accommodation and much lower reported rates of adults living with their families. In all three countries, trends over time suggest that reductions in residential care towards more independent living options may be stalling. In Northern Ireland reductions in currently extensive residential and nursing care services are continuing, unlike other parts of the UK.

Despite similar policy ambitions across the four parts of the UK, statistics on the living situations of adults with learning disabilities report substantial differences.

This paper is a first attempt to compare national social care statistics concerning the living situations of adults with learning disabilities across the UK. With increasing divergence of health and social service systems, further comparative analyses of services for people with learning disabilities are needed.

People with learning disabilities often have to cope with death, dying and bereavement without being fully informed of the circumstances and sometimes without being told that death is imminent or indeed has occurred. This paper explores the issues associated with death and dying from the perspective of people with learning disabilities, and considers proactive ways of working in this sensitive area.

The perceptions of disability conditions held by parents and immediate family members directly determine the types of treatments that are likely to opt for persons with disabilities whenever they are ill. Family level drivers of access to healthcare among persons with disabilities in the Bosomtwe district of Ghana.

A qualitative case study was conducted in which data were collected from 60 participants selected purposively. Face-to-face interviews were conducted, and the results were presented thematically.

The drivers identified have been categorized into positive and negative depending on how they influenced persons with disabilities’ access to health care. Payment of medical bills, physical access support, the narration of health condition to a health-care provider, spiritual support, care and love were the positives while perceived spiritual cause of disability, preference for alternative treatment centers, unwillingness to support reproductive and specialized health care.

This study had some limitations, and one of such is the non-inclusion of disabled people who had not been registered by the department of social welfare but resided in the district who could have provided rich information to the study. However, their exclusion did not affect the quality of data obtained, as those who were registered and selected for the study gave adequate information about the issues that were considered during the study.

Family members of persons with disabilities play key roles in promoting their access to health care; therefore, there is the need for stakeholders to put in measures that will limit misconceptions about disability not only for the general public but also for individuals like parents and immediate family members of persons with disabilities.

This chapter reports on a hybrid sector of disability provision in Australia and the changes to the sector due to the shift to person-centred care in Australia. It explains the significant changes to the way the sector will respond to government and to client demands and how the organisations are responding to this by re-structuring and building new performance measurement systems including Social Return on Investment.

The first part of the chapter is descriptive of the change to person-centred care in the Australian disability sector using public reports. The second part of the chapter looks at the change at a micro level using an analysis of the literature.

Findings illustrate how the National Disability Insurance Scheme has brought about significant change between sectors of government and between providers, both government and non-government. Organisations have had to make significant changes to adapt to the government’s policy and especially funding change. This includes setting new governance and leadership models, changed human resource management practices and performance measurement systems.

The paper is a report relatively early in the transition phases, and therefore, more evidence is needed as the system change progresses. Still, the Australian disability sector provides a powerful example of significant hybridisation changes as a result of a shift to person-centred care.

This is a dramatic change from the Australian government to impose person-centred care. The adaptations of Australian organisations provide an interesting insight for the international community.

The evidence suggests that the current delivery of primary care to people with a learning disability does not adequately meet their needs. In particular, individuals do not access adequate health promotion, are not having treatable illnesses identified and are not having more complex needs addressed. This review examines this evidence, highlights barriers to the effective delivery of health care and assesses these barriers, pilot projects and the few intervention studies published. Effective response to health needs will need a change in the working patterns of primary, secondary and social care providers. The contracting system and the move to locality‐based purchasing may be the ideal catalysts for these changes.