Introduction and statutory machineryCare and Support Statutory GuidanceValuing People guidanceValuing People strategyValuing People guidanceValuing People strategyValuing People guidanceValuing People strategyValuing People guidanceValuing People strategy
22.1Adults with a learning disability and/or autism may well have needs for care and support within section 9 of the Care Act 2014, and their carers may have well have needs for support within section 10 of the Care Act 2014, in which case those needs fall to be assessed and met on a similar basis as other adults’ and carers’ needs. Having said that, over the last 15 years or so, there has been a specific focus on adults with a learning disability and autism.
22.2The Autism Act 2009 came into force on the 12 January 2010:
•section 1 requires the Secretary of State to publish and keep under review an ‘autism strategy’,
•section 2 requires the Secretary of State to publish and keep under review guidance for the purpose of securing the implementation of the autism strategy; section 3 requires local authorities and NHS bodies to ‘act under’ this guidance.
22.3The current autism strategy is:
22.5As discussed above in at para 8.9, local authorities must ensure that every person undertaking assessments ‘has the skills, knowledge and competence to carry out the assessment in question’, ‘is appropriately trained’ and, where appropriate, seeks an expert view (regulation 5 of the Care and Support (Assessment) Regulations 2014. These provisions, together with the Care and Support Statutory Guidance in effect require persons who assess adults with autism to have specialist training:
6.85 When assessing particularly complex or multiple needs, an assessor may require the support of an expert to carry out the assessment, to ensure that the person’s needs are fully captured. Local authorities should consider whether additional relevant expertise is required on a case-by-case basis, taking into account the nature of the needs of the individual, and the skills of those carrying out the assessment. The local authority must ensure that the person is able to be involved as far as possible, for example by providing an interpreter where a person has a particular condition affecting communication – such as autism, blindness, or deafness.
7See also the Equality Act for necessary provisions around reasonable adjustments at www. legislation.gov.uk/ukpga/2010/15/contents.See the Equality Act 2010 for necessary provisions around reasonable adjustments.
6.86 Where the assessor does not have the necessary knowledge of a particular condition or circumstance, they must consult someone who has relevant expertise. This is to ensure that the assessor can ask the right questions relating to the condition and interpret these appropriately to identify underlying needs. A person with relevant expertise can be considered as somebody who, either through training or experience, has acquired knowledge or skill of the particular condition or circumstance. Such a person may be a doctor or health professional, or an expert from the voluntary sector, but there is no obligation for the local authority to source an expert from an outside body if the expertise is available in house.
6.87 The Department has published guidance for certain groups of adults that refer to their assessment for care and support. Two specific areas are for people who are deafblind and people with autism and these pieces of guidance should be read with this guidance. Think Autism 2014, the April 2014 update to Fulfilling and Rewarding Lives, the strategy for adults with autism in England (2010), sets out that local authorities should:
•make basic autism training available for all staff working in health and social care;
•develop or provide specialist training for those in roles that have a direct impact on access to services for adults with autism; and
•include quality autism awareness training within general equality and diversity training programmes across public services.
6.88 The Care Act strengthens this guidance in relation to assessors having specialised training to assess an adult with autism. The Act places a legal requirement on local authorities that all assessors must have the skills, knowledge and competence to carry out the assessment in question. Where an assessor does not have experience in a particular condition (such as autism, learning disabilities, mental health needs or other conditions), they must consult someone with relevant experience. This is so that the person being assessed is involved throughout the process and their needs, outcomes and the impact of needs on their wellbeing are all accurately identified.
22.6Learning disability strategy, emphasising the importance of ensuring that people with a learning disability have as much choice and control as possible over their lives, has been published in:
22.7One of the main initiatives of Valuing People, has been the setting up of local Learning Disability Partnership Boards, to implement aspects of the Valuing People programme.
22.9A key recommendation of Valuing People was that local authorities close day centres and provide flexible, individual community support instead:
7.21 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.
7.22 Local councils currently spend over £300 million a year on day services of which more than 80% goes on over 60,000 day centre places that often focus on large, group activities. The most severely disabled people often receive the poorest service and the particular cultural needs of people from minority ethnic communities are too often not addressed.
7.23 Some local councils have done much to modernise their day services, but overall progress has been too slow. The barriers standing in the way of change include:
•Difficulties in releasing resources tied up in buildings and staff;
•Slow development of links with other services (including supported employment) and support in the wider community;
•Tension between providing respite for families and fulfilling opportunities for the person;
•Slow progress in introducing person-centred approaches to planning.
7.24 The Government wishes to see a greater emphasis on individualised and flexible services which will:
•Support people in developing their capacity to do what they want;
•Help people develop social skills and the capacity to form friendships and relationships with a wider range of people;
•Enable people to develop skills and enhance their employability;
•Help communities welcome people with learning disabilities.
7.25 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.
22.10Although drafted with the best of intentions, this policy has coincided with a period of acute budgetary pressures on local authorities, with the result that those affected by this process have often been gravely concerned that local authorities will replace day centres with community provision that is (a) limited for persons with eligible needs only; and (b) in any event, inadequate. A number of judicial reviews have resulted (see chapter 16 on Care home and other service closures) and continue to result.
There are useful resources published by, among others: