Adult Care, Housing and Public Health Market Position Statement: Adult Care Market and Demand

Learning Disabilities, Autism and Preparation for Adulthood

Demographic

The population of people living with a primary need of a learning disability in Rotherham was estimated to be 5222 in 2023. This number is predicted to increase by approximately 100 people every 5 years, with an overall increase of 5% by 2032.

The popoulation of people predicted to have Autism Spectrum Disorders (ASD) in Rotherham in 2023, is 1553 people aged 18-64  and 514 people aged 65 and over. By 2030 the overall number will increase, this is expected to be drived by an increase in the number of older autistic people receiving a diagnosis as the number of younger autistic people remains static.

People Receiving Support

There are approximately 753 people with a primary need of a learning disability receiving a service (June 2023). Based on ONS predictions, this number will remain relatively static over the next 10 years, however the demographic of people receiving support will change. There will be a greater increase in young people with a learning disability (aged 15- 24), middle aged people (aged 35-49), people aged 60-69 and older adults 80+.

As of June 2023, there were 1278 people being supported by an Education Health Care Plan  (EHCP) aged 14-25, 194 of these young people received support provided by the Adult Social Care Transitions Team. This number is predicted to increase over the next 5 years as more young people are in receipt of an EHCP.

Transformation

Both the learning disability and autism offer has begun to transform across Rotherham following the creation of the My Front Door Project and the release of the All Age - Autism Strategy. The aim in Rotherham is for all autistic people and people with a learning disability to live a full and rich life, and access services that promote independence. However, further innovation is welcomed.

Table 3. Learning Disability and Autism All Ages (Cohort snapshot June 2023)

Support Service Type Existing Cohort (No) Predicted Demand for future Cohort Commissioning Intentions Summary
Personal Budgets
Direct Payment – Using a service provider 243 Increase The Council supports the use of direct payments for more flexible and personalised solutions.
Direct Payment – Employing a Personal Assistant 65 Increase The Council welcomes use of personal budgets to employ personal assistants.
Care Services
Home Care and Care Support Services 24 Increase The Council invites CQC registered specialist home care and support providers to apply for a place on its Home Care and Support Framework
Care Homes
Specialist Learning Disability Residential and Nursing Care 111 Neutral The Council aims to ensure that specialist learning disability residential and nursing care in the Borough is best in class and of sufficient number to reduce the use of out of area placements.
Out of Borough Specialist Residential and Nursing Care 24 Decrease The Council would like to provide the option to return to Rotherham, for people who would like to.
Other Accommodation
Supported Living 160 Increase The Council intends to increase the amount of supported living accommodation available throughout the Borough. Evidence shows that around 12 additional units of accommodation will be required annually over the next 10 years.
Shared Lives 128 Increase The Council is looking for local people to consider registering as shared lives carers to be able to offer this type of care and support option more widely in Rotherham
Extra Care Housing 3 Increase The Council is keen to expand extra care housing with care delivered by staff onsite.
Peer Support Networks 30 Increase The Council is keen to expand peer support networks across Rotherham with a range of providers.
Respite
Independent Sector Respite 42 Neutral Data indicates that there is currently sufficient capacity, within residential respite in Rotherham, to meet assessed need and also accommodatesome emergency respite. Data also suggests that the future needs for younger cohorts moving through into adult services is likely to require alternatives to the traditional provisions. The Council will continue to explore a range of alternatives to residential respite care. The development of a flexible purchasing system to attract providers offering innovative respite options is being developed and will be advertised to the market during 2022.
RMBC In-house Respite 55 Neutral
Day Opportunities
Independent Sector 72 Increase The Council will continue to increase day opportunities for people with complex needs.
RMBC In-house Service 28 Neutral The Council will continue to offer building-based support for day opportunities for people with complex needs.
Micro-enterprise Day Opportunity Services (non-commissioned) 275 Increase The Council is keen to encourage the development of micro enterprise services for the provision of day opportunities.

NB: People access multiple services

Preparing for Adulthood - Transitions

The number of young people with special educational needs and disability transitioning to adult services is set to increase. Transitions for young people is undergoing significant transformation within the Council to improve the experiences of young people transitioning to adult services. There is noted gaps in our current offer including supported living that is focused on younger adults.

A new website has been created to showcase the Rotherham Special Educational Needs and Disability (SEND) Local offer from 0-25 years, including resources of use for preparing for adulthood.

Rotherham SEND Local Offer

Current Services and Accommodation Requirements:

Accommodation-based service provision needs to expand across the whole of the Rotherham Borough to allow opportunities for people living with learning disabilities and autism to have choice about the location in which they live. The geographical areas of Wath and Maltby are sufficiently supplied with this type of accommodation.

The Council is keen to support the development of accomodation-based provision, which is future proofed, incorporates assistive technology and is bespoke to the needs of tenants.

Figure 3 map of current service provision supporting people with a learning disability or autism

Figure 3. Map of the current service provision supporting people with a learning disability and or autism

Direct Payments

Direct Payments are currently predominately used to purchase home care and support services, day opportunities and community support from agencies. A smaller number of people use their personal budget as a Direct Payment to employ a personal assistant. The Council encourages the use of direct payments in this way. 

Residential and Nursing Care Homes

There are 45 care homes that provide specialist support for people with a learning disability, autism, mental ill-health, or a combination of these. This includes the Council’s in-house residential care homes, offering a total of 483 beds. In June 2023 there were 44 vacancies within these services, a vacancy rate of 9.1% giving an occupancy rate of 90.9%.

The Council will explore whether a reposition of residential and nursing services may be needed to expand the suitability for certain cohorts of people, e.g., young people with complex needs accessing temporary care and specialist dementia care for people with learning disabilities who suffer from early onset dementia.

Providers of residential care may wish to consider a change in registration to provide supported living services and proactive engagement with the Council is encouraged.

Providers should continue to build in day opportunities and maximise the use of assistive technology where appropriate to support greater independence.

The Council supports providers adopting a standardised breakdown of the cost of care.

Supported Living

Rotherham’s current offer consists of nomination rights to 196 units of supported living.

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The new Integrated Care System Market Position Statement (ICS MPS), launched in July 2022 sets out accommodation needs for people with learning disabilities and autism in South Yorkshire.

The ICS MPS is the result of extensive research and collaboration across the NHS South Yorkshire Integrated Care Board, endorsed by Rotherham, Doncaster, Barnsley, and Sheffield Councils, with the support and expertise of Campbell Tickell.

This research identified that, on average, Rotherham will require 12 new supported living units each year over the next 10 years, this will include core and cluster models, a community living model and bespoke accommodation where the need is identified for an individual.

The Council’s ambition is that all supported living properties fulfil the real tenancy test with a distinct separation between housing and support. Read here for more information (ndti.org.uk)

Rotherham is planning to develop a flexible purchasing system for the Care and Support delivered into supported living services to increase the number of providers working in Rotherham and support choice for the people accessing these types of accommodations.

The Council welcomes providers to join the framework when operational.

Peer Support Network

The Council recommissioned a local charity to provide peer support networks in Rotherham, these are currently based in Kimberworth, Thurcroft and Thrybergh supporting a minimum of 10 people in each area to continue to live independently in their own home.

This is seen as the next step towards independent living and a step down from traditional supported living. Each person lives in their own house/flat but is within walking distance to one another. This provides mutual support and companionship. Paid support workers promote the development of skills to facilitate independence and support access to a weekly drop in session providing additional support and opportunities for people to socialise with their peers.

The Council is keen to expand peer support networks across the whole of Rotherham.

Extra Care Housing

Three people with a primary need of learning disability and or autism are supported currently by extra care housing.

Extra care housing is currently provided in three areas across Rotherham. High quality accommodation paired with dedicated on-site support staff assist people with different levels of housing and support needs to remain living independently in a community setting for as long as possible.

Shared Lives

Shared Lives is a CQC registered service where adults with a learning disability and/ or autism can spend time with approved shared lives carers and their families. There are a variety of placements and a mixture of support including:

  • Short breaks
  • Respite
  • Long term placements
  • Day opportunities

As of June 2023, there were 86 shared lives carers registered with the Council, and 67 of these currently providing active support. Shared Lives have provided people with 30 long term placements, 30 respite placements and 68 day supports equating to 128 successful matches in total.

The Council welcomes discussions for individuals to register as shared lives carers and for shared lives carers to have closer links to peer support networks.

Respite

The respite offer has changed in Rotherham following the My Front Door Project, which encourages alternatives to traditional bed-based respite including supported holidays and shared lives options.

The Council currently commissions 12 external respite beds and in 2020 opened Conway Crescent a new in-house respite service providing 8 beds. Together, 97 people accessed respite over the last 12 months.

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The Council continues to encourage alternatives to traditional bed-based respite and will be looking to develop options for supported holidays and increasing the offer that shared lives can provide.

Day Opportunities

The Council began moving away from traditional day opportunities of building-based day centres in 2019.

The Council has continued to support the most complex people with a learning disability who still require building based provision through its in-house service, where 28 people are accessing day opportunities.

Independent sector providers are also commissioned to provide specialised complex needs day opportunities, both building based and in the community.

The Council’s in-house day services are currently undergoing significant transformation. A formal consultation process has recently closed, and an in-depth analysis from the consultation is currently taking place, ready to inform the future offer for customers.

Corresponding formal reports will be published in due course.

The Community Options Projects (now ended) established a strong partnership between the Council and social enterprise Community Catalysts. The Council is progressing with the learning from this, with a dedicated officer focusing on this.

The Council will continue to further strengthen the connections between people with a learning disability and their local community.

The Council will continue to commission services and opportunities that support social inclusion and promote social value through the development of micro and social enterprises, especially for people with a learning disability and/or autism with a focus on day opportunities.

The Council also welcomes providers who can support autistic people to access employment and skills opportunities.

The Council is planning to develop a Flexible Purchasing System for Day Opportunities for People with Complex Needs and/or Autism to increase and support choice. The Council welcomes providers to join the framework when operational.

Commissioning Intentions Summary

  • The Council will explore whether a reposition of residential and nursing services may be needed to expand the suitability for certain cohorts of people, e.g., young people with complex needs accessing temporary care and specialist dementia care for people with Learning Disability who suffer from early onset dementia.
  • New service provision, specifically future proofed accommodation incorporating assistive technology, to expand across the whole of the Rotherham Borough, with the exception of shared accommodation in Wath and Maltby due to the sufficient provision of shared accommodation in these areas.
  • The Council is keen to expand its supported living arrangements through core and cluster models and peer support networks.
  • The Council encourages new shared lives carers to register and to utilise shared lives as an alternative to residential care and bed-based respite.
  • The Council is keen to expand and increase timely planning for the provision of services and accommodation for the preparing for adulthood cohort. This aim will ensure that future support is ready for when a person reaches 18 and that the move to adult provisions are smooth effective transitions for all.
  • Rotherham aims to have a clear offer of the services that are available for young people transitioning to adult services with complex needs.
  • All day opportunities should promote social inclusion and social value with a focus on utilising micro and social enterprises.
  • Where appropriate opportunities for work like or work based opportunities are welcomed.
  • Two flexible purchasing systems will be developed, one for supported living and one for complex day opportunities and alternative respite.

Man cooking food on a bbq at home