Market position statements - working age disabilities

In 2023/24, Luton Council funded long-term support services that supported 489 adults with a learning disability, plus short-term services for another 154 people. 1973 adults with a physical disability or mobility issues received support; 69% of these people were over 65, 31% were aged 18 to 64.

For people with a learning disability:

• 81.5% of people known to the council are living in their own home or with family
• 39% received a Direct Payment to choose their own care and support
• 12.4% of people who are known to the council are in paid employment.

For people supported for mobility issues or a physical disability:

• 84% of people are living in their own or with family
• 28% received a direct payment to choose their own care support

Alongside the wider adult social care strategy, and in partnership with Health colleagues, we also continue to deliver the priorities in Living a Good Life in Luton, the strategy for people with a learning disability and/or autism, 2019 to 2024, which include:

• changing the conversation - protecting a person’s independence, resilience and wellbeing and their ability to make choices by using a strengths-based approach
• personalisation - working with providers from all sectors we will prioritise the development of support services that are designed and developed with, and around a person with a focus on prevention and increasing participation in the community
• reshaping our accommodation and support offer - ensure that people can choose where they live and who they live with, including reducing the reliance on residential care and out-of-area placements
• building healthy, safe and fulfilling lives - supporting people to be active in their community and to be able to do things for themselves with their own friends and family, including ensuring that employment, meaningful occupation and leisure activities are made available for everyone irrespective of ability

Current services

Support at home

Equipment and minor adaptations

Our community equipment loan service loans equipment to people free of charge to help people in their day-to-day life so that they can stay living at home independently and reduce the need for hospital or care home admissions. About 50 people with mobility issues or physical disabilities benefit each year from equipment or small adaptations to their homes.

Home care

Luton commissions over 500,000 hours of domiciliary care each year from 11 providers to support approximately 900 people with a physical disability and 50 people with a learning disability. It is a cornerstone of our approach to supporting the majority of our population to live at home, and to have choice and control over their everyday life decisions.

Support at home includes a range of personal care and support services for individual adults in their own home. Support is personalised for people who have a range of care and support needs from low to complex and includes behaviour that may challenge or be viewed as people with hefty reputations. The service can support individuals through periods of recovery or enablement, reduce social isolation and provide support to carers. It aims to support people to do things for themselves, and gain or regain skills and confidence that may have been lost following a crisis or ill health.

In April 2024, the council launched a new framework agreement for domiciliary care, which is planned to run for at least five years. The home care framework is now closed and there are no plans to reopen it in the immediate future.

There are 11 providers on the framework, with 3 tiers and a maximum of up to four providers per tier:

• tier one: Providers take up to an average of 250 hours per week
• tier two: Providers take up to an average of 104 hours per week
• tier three: Providers take up to an average of 62 hours per week

Providers can move between tiers, enabling organisations to build and maintain sustainable business, which in turn will contribute to Luton’s 2040 vision of a thriving local economy.

Community activities

Around 300 people with a learning disability and another 130 people with physical disabilities access a diverse range of community and building based day services from at least 11 different providers. Nearly half of those individuals choose their own support through direct payments, and just over half are funded directly by the council. People are supported by the council locality teams to find a provider who can meet their needs and access meaningful and enjoyable activities.

Over 200 people with a physical disability and around 30 people with a learning disability use a direct payment to employ personal assistants to support them with personal care and/or access daily activities.

Supported living (including community support)

Luton council has a supported living contract for the support element of supported living with a graduated model, defining the support model across five Lots ranging from Lot 1 providing a low level of support to develop or maintain people’s independence to Lot 5 supporting people with very complex needs where support is likely to be 2:1 or higher:

• lot 1 – community support
• lot 2 – standard supported living with variable day hours
• lot 3 - standard supported living with variable day hours and night support
• lot 4 - enhanced/Intensive supported living with 24/7 support
• lot 5 - specialist/intensive supported living

In lots 2 to 5, care/support is delivered in an accommodation-based service, where some support is often shared with other people living in the same house, or in another nearby property. People living there hold a tenancy with the housing provider, who is a different organisation from the company providing the support. Support can be up to 24 hours a day, seven days a week and may include night care.

Lot 1, community support, is offered to people who need care/support but do not need supported accommodation, e.g. the individual lives with parents/carer; or is a tenant or owner in standard/general needs/mainstream accommodation.

Luton’s approach to supported living was launched in 2023 and will run for at least five years. This has brought new support providers into Luton to help address gaps in provision for people with complex needs, improve the quality of support and improve choice and control for people requiring support. There are currently over 80 people living in supported living, with 34 providers on the learning disability framework. We will re-open during 2024/25 to enable new providers to join and allow providers to be removed if they choose to. 

Residential and nursing care

Luton Council commissions residential care for about 70 people with a learning disability and 240 people with a physical disability (the majority of whom are older people) from a range of providers, including about 30 specialist disability care homes.

The council also commissions nursing care from 8 providers for 80 people with a physical disability and a small number of people with a learning disability. This has slightly increased in 2024, with more working age adults living in care homes than in 2023.

The chart shows the CQC ratings of these care homes (excluding homes where only one person is living).

Commissioning intentions

Demand and future need

In 2023/24, Luton council funded long-term support services that supported 489 adults with a learning disability, plus short-term services for another 154 people. 1973 adults with a physical disability or mobility issues received support; 69% of these people were over 65, 31% were aged 18 to 64.

The number of people with a disability supported by the council is increasing slowly over time, but the significant trend is the increased complexity of individuals’ needs, with people requiring higher levels of support, for example, needing more hours of care, or staff trained to support their health as well as social care needs.

Support at home

We want to work with providers so that

• we move from a time and task to an outcome model where two distinct sets of outcomes are measured, both individual and service outcomes 
• individuals are encouraged and supported to do things for themselves, so that people remain living with family, in their own home for as long as possible 

Community opportunities and day services

We want to work with providers so that:

• all services are based around peoples’ own communities and the enablement of long-term relationships and friendships.
• meaningful activity or employment is a focus for all community-based services, including making the right links with educational and employment services.
• more services are available for disabled adults with positive behaviour support needs, and those with profound and multiple learning disabilities.
• models that were developed during the pandemic, including on-line activities and outreach services, are part of the wider offer and services consider increased flexibility, for example provision in evenings and weekends.

Supported living

We want to work with providers so that:

• people are connected to their communities, engaging in meaningful activities and developing independent living skills. All providers should be considering how to support individuals to live completely independently where they can.
• more providers who can support people with complex needs join the Approved Provider List so that everyone with a learning disability can be offered the security of accommodation and control over their care provider, which is core to supported living. There is a particular gap in supported living provision for people with autism, behaviours that may challenge, and people who have complex physical and learning disabilities.
• there are suitable accommodation options available for people, including more self-contained accommodation with support provided by the same across several flats/bungalows. We recognise the need for more appropriate properties for supported living and are working with housing colleagues, developers and housing associations to build and redevelop accessible accommodation suitable for people with a range of disabilities.
• services are developed for younger people in transition with complex needs to help them build independent living skills and link with educational resources in preparation for adulthood and independent living.

Residential and nursing

We want to work with providers so that:

• care homes are connected with their communities, supporting the people who live in them to have relationships and engage with the wider population.
• all services are good quality; we will work with those providers rated Requires Improvement by CQC to improve and develop their provision.
• services offer flexible options, such as short-term respite or temporary stays, alongside long-term placements.
• there are more specialist services to meet the needs of:
  • older people with a learning disability, with frailty as the primary need
  • plus size people
  • people with complex health needs
  • people with profound and multiple disabilities.