Education

Daytime opportunities

What does the 'Valuing People (2001)' white paper say about day service provision?

'For decades, services for people with learning disabilities have been heavily reliant on large, often institutional, day centres. These have provided much needed respite for families, but they have made a limited contribution to promoting social inclusion or independence for people with learning disabilities. People with learning disabilities attending them have not had opportunities to develop individual interests or the skills and experience they need in order to move into employment.' (7.21)

Day Centre Provision

Day centres were reported in the White Paper as accounting for more than 80 percent of the gross expenditure on day services. There are 60,000 full-time equivalent day centre places in England and Wales, catering for a larger number of individuals, as most service users attend a centre on a part-time basis. The cost of this provision in 2001 was around £300m. The Government estimates that there is a shortfall of 20,000 full-time day service places for people with severe or profound learning disabilities. A study by Mansell in 1997 suggested a higher shortfall of 30,000 places.

Who receives a day service?

A local authority has a legal obligation to provide day services, although not to cater for every individual with a learning disability. People are assessed for a service under the NHS and Community Care Act (1990), as to whether they may be in need of community care services and these will include day services. Generally, most of the people who receive day services from their Social Services Department are people with severe or profound learning disabilities. Those people with a moderate learning disability have become increasingly subject to a narrowing 'eligibility criteria'* and have found it more difficult to obtain a service from their local authorities. Services can be provided on a variable level, with some people receiving a service for five days each week, and others only one or two days, or even part of a day.
(*Eligibility criteria generally focus on vulnerability and risk to an individual if community care services were not to be provided.)

What are the key issues for current services?

Day services have evolved over the years providing a service to meet the needs of two distinct groups:

• Individuals with a learning disability
• An individual's carers

For individuals with a learning disability, service provision has often quite simply been 'somewhere to go during the day'. For family carers it provides respite from caring in the knowledge that their family member is spending some time away from their home, provided with activity and social stimulation in a safe and secure environment. Day services have therefore effectively appeared to provide activities during the day as an alternative to being at home. Good quality day services provide more than this.

Although there have been some smaller and community based services developed offering broader experiences, large segregated day centres still provide the bulk of day services to individuals with a learning disability. Traditional settings with well over 100 people attending can still be found.

Whilst such settings can offer a person numerous opportunities to follow different activities, most of these take place in the centre and are divorced from the community. People's experiences outside of the centre can be quite limited.

In their document 'A Life in a Day (2002)' MENCAP, offering a response to the 'Valuing People (2001)' white paper, talked about a historical lack of purpose, understanding of aims and strategic planning surrounding day services.

Such services without focus often resulted in people being involved in mundane activities, undertaken just to fill the time. Seldom were activities based on the interests and needs of the people who used the service. Care needs were met but it was likely that these would become the priority, rather than the establishment's creative activities. People with high support needs were even less likely to be involved in creative or constructive activity.

There have been and still are some concerns about quality and training levels of staff working at centres. With the demise of certain qualifications (DTMH, CSS) available to people who worked in centres in the past and a social work qualification now requiring degree level entry qualifications, there appears to have been little offered for a number of years in the way of basic formal training for staff. Recent initiatives with the British Institute of Learning Disability (BILD) and the establishment of a Learning Disabilities Awards Framework (LDAF) have helped, along with the requirements of the Care Standards Act 2000 for service providers to have and maintain a competent workforce.

Some individuals with a learning disability attend Colleges of Further Education. They can benefit from having these wider experiences if they don't become socially 'isolated' within the college. Routines may be different for their 'special' syllabus, which minimises mixing with the rest of the college. They may be geographically isolated in some wing of the campus and all their time, including breaks, may be spent solely with their learning disabled peers. Some people now also appear to be spending their whole life as college students on open ended courses instead of college becoming a means to an end.

Work opportunities for individuals with a learning disability have been generally limited and not seen as a possible natural progression for many people. Where they have existed in any significant number, it is usually in the form of sheltered workshops. Various supported employment initiatives have now been started to try and provide more opportunities in the open employment market. Currently only seven percent of individuals with a learning disability have a job, whilst the government would like to see the level approach 30 percent, as it is for people with other disabilities.

Day services also face a wider range of influences that have impacted upon their quality and delivery:

• A climate of local authority financial constraint, resulting in reduction or removal of services and narrowing of eligibility criteria. Removal of local authority day services for people who live in residential homes, claiming it is the provider's responsibility to provide daytime support
• Charging for services, i.e. a centre attendance fee, transport to centre charge

What does 'Valuing People (2001)' say about how to implement the modernising of day services?

'These problems will be addressed through a five year programme to support local councils in modernising their day services. Our aim will be to ensure that the resources currently committed to day centres are focused on providing people with learning disabilities with new opportunities to lead full and purposeful lives. Securing the active involvement of people with learning disabilities and their families in redesigning services will be essential to the success of the programme. The Government recognises that, for many families, day centres have provided essential respite from the day to day demands of caring. The services that replace them must result in improvements for both users and their families. The needs of people with profound or complex disabilities will be carefully considered as part of the modernisation programme.' (7.25)

Modernising day centres will be one of the priority areas for the Learning Disability Development Fund, in order to provide bridging finance to support change. The Implementation Support Team will give early priority to supporting day service modernisation. (7.28)

What should be the important features of the new service?

MENCAP states in 'A Life in a Day (2002) - The Modernisation of Day Services for People with a Learning Disability' (4.1) that there are some key features that should underpin any modern and effective day service. They are:

• Person Centred Planning, with the full involvement of the service user and their advocate if appropriate
• Real choices
• Access to a variety of real activities, which enable people to develop their skills and potential
• Focus on genuinely inclusive and integrated activities based in the community
• Full and flexible service, covering at least the five day working week, with opportunities for activities in the evenings and at weekends
• Network of local resource centres to support community-based activities
• Individually tailored support for people
• Partnerships being formed between social services and other local agencies, such as supported employment and education providers

Person Centred Planning is of primary importance in the new development of modernised day services. It should be an opportunity for people using day services to express their individual wishes and to come to decisions about what they want to do with their days and their lives. It is also an appropriate way for people to identify support needs and how they can best be met.

Person Centred Planning should be the starting point for people to begin taking control of their own lives, expressing their views, being listened to, making everyday choices and considering taking risks.

Valuing People Support Team

The Valuing People Support Team, who are leading on the government initiative of the same name, have issued two sets of guidelines to assist local authorities in their transition to modernise their day services. These documents were produced by the National Development Team, authors being Bill Love, Peter Bates and Simon Whitehead.

The guidelines are called:

• Day Services Modernisation Tool Kit - Part 1
• Day Services Modernisation Tool Kit - Part 2

The Modernisation Tool Kit - Part 1 document contains:

(i) Outline Vision of a Modernised Day Service

(ii) Audit Tools

(iii) Short Resource Guide

(i) Outline Vision

In their vision, the Support Team describes what it considers are the values which should act as a foundation for change.

Modernised day opportunities should be based on a shared understanding of and commitment to:

• People with learning disabilities determining for themselves how they spend their days
• People with learning disabilities living, working, learning and participating in the community alongside other community members
• People with learning disabilities having opportunities to contribute to and benefit from community life and to be seen and valued as equal members
• People with learning disabilities having opportunities to build and sustain valued relationships
• An equality of access to community life for all people with learning disabilities regardless of their level of learning disability, physical and sensory impairments, ethnic community or health care support needs
• Clearly defined eligibility criteria to services which are person-centred, sustainable and that promote dignity, safety and independence

(ii) Audit Tools

This section has self-administer audit tools consisting of three parts:

• Part 1 - Uses questions and statements in a grid format in which scores are entered to assess as to how 'modern' day services are. There are four main topic areas and a total of 21 sub questions
• Part 2 - Examines 'Capacity for Change'
• Part 3 - Looks at 'Counting on Success / What Shall We Do Next'

(iii) Resource Guide

Resources are listed for the assistance of Partnership Boards.

Day Services Modernising Tool Kit - Part 2

This second document is 80 pages in length and aims to offer some practical supports for the modernisation process. Sections are included which offer practical advice on some of the key areas for delivery. There is a particularly helpful contribution on Person Centred Planning but there is guidance on all the following topics:

• Person Centred Planning
• Family carers
• The need for respite
• Community capacity building
• Including everyone in modernised day opportunities
• Finance
• Reproviding day centres
• Staffing
• Transport

Conclusion

In the introduction to the above mentioned tool kits, Rob Greig, the 'Valuing People' Director of Implementation says:

"When consulting people with learning disabilities during the development of Valuing People, there was a clear and consistent message that current day services were not what people want.
The changes needed are much more than a move from large day centres to small ones. People want lifestyle opportunities that are based on them being real and full members of communities, with the opportunity to have jobs, go to college, meet friends, relax and enjoy themselves. At the same time, the genuine need of families to have support to get on with their own lives must be recognised."

The Modernising Day Services initiative should result in the most significant service progress in recent time, to support a better understanding of individual needs.