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Alac pengelly thought leadership community settings

By Alac Pengelly, Lifeways’ Regional Operations Director for the South Region

“What can you offer the people you are assessing that we can’t?”

The private specialist hospital’s wood-panelled room seemed to quiver from its director’s booming voice. The year was 1993.

I can’t say I wasn’t intimidated. After all, what 23-year-old newly registered care home manager wouldn’t be?

However, my answer was clear – if rather hushed:

“We can offer a normal life in a community house,” I told the hospital director.

The private specialist hospital I was visiting at the time housed roughly 1,500 people. The two people at the private hospital I’d been assessing - who the director had been referring to - presented with a learning disability and mental health conditions.

These diagnoses meant they lived with 27 other people in one of the hospital’s various wards.


Tragically, over the years we’ve seen and been horrified by various scandals in private specialist hospitals - with the most notorious being Winterbourne View.

In 2011, when reports of the horrendous abuse and mistreatment at Winterbourne View came to light, we’ve seen a plethora of central government policy and local authority initiatives seeking to prevent parallel tragedies from ever happening again.

The key aim behind these initiatives discourages the use of private specialist hospital settings for long-term accommodation for people who live with autism or a learning disability.

Sadly, one decade later, we continue to see reports detailing incidents of mistreatment in private specialist hospitals.

Continued reductions

Yet it’s not all bad news. Encouragingly, in the past decade we’ve seen a reduction of 1,350 people who live in state-funded private specialist hospital inpatient beds, Learning Disability Today reported earlier this year. However, that still means there are 2,050 individuals who live in a private specialist hospital setting.

The question we in health and social care should ask is: do we think that figure is good enough?

We should acknowledge that the general level of support in hospitals in recent years may mean a better environment than we saw three decades ago.

Thankfully, private specialist hospitals in 2021 may be less intimidating, and they may be more personalised for the individual.

But what a hospital can never provide is a long-term home for a person, or a sense of belonging or community – both key elements to forming a life a person would choose.

Not easy

The task of supporting a person with complex support needs in the community can be tricky - and working in social care isn’t easy.

Yet with the right support package, most - if not all individuals - can live in community settings, not private specialist hospitals.

We’ve seen it here at Lifeways. The almost 5,000 adults we support thrive and are supported to grow their independence in open, non-restrictive settings, almost always connected to a community in a city, town, or village.

For example, we operate The Avenue, a large detached house which is a supported living service for four adults with complex needs. The service is just a 10-minute walk into the town of Tiverton, Devon.

Then there’s Loch Park in Moray, northeast Scotland, where adults who live with learning disabilities take part in ventures such as selling sustainably-sourced food and firewood to the community.

Tom, who we support at Loch Park, Moray, poses as our Safety Champion of the Month in summer 2021. In his role, Tom had made sure that everyone at Loch Park stayed safe during the pandemic. 

Both these services are hugely different – but what binds them is a commitment to take part in and be part of the local community.


Supported living settings are a win-win for the taxpayer, too. The average cost for a person’s support as an in-patient is £3,000 a week - or £156,000 a year.

Meanwhile in community settings, costs vary dramatically depending on the individual’s needs, but you’re generally looking at half that cost.

By the end of 2020, 3,730 incidents of restraint in NHS-funded inpatient beds were recorded in one month. This means over a year, there could be over 44,000 separate incidents of physical intervention.

And the reality of restraint-heavy care gets even more worrying. Of the 2,050 people who are currently inpatients in private specialist hospitals, each individual could be subject to a physical intervention 22 times a year. Although this figure would vary heavily from individual to individual – as not every person is subject to physical interventions – the number still shows a disquieting dynamic.

Talking louder

Of course, on occasion, private specialist hospital admittance may be the best-fitting environment for some people who live with autism or learning disabilities.

But for an overwhelming majority of individuals, I’m convinced that the social care sector can assist with providing community settings for individuals who currently live in private specialist hospitals.

While we at Lifeways don’t think that the model of community-based settings are a panacea, or fix-all solution, we know that people who receive support living in the community make social care better for everyone.

This means community-based settings benefit large swathes of society: individuals who need support, support teams, funders, community-members, and taxpayers.

Let’s rewind to the beginning. What happened to the two people I assessed back in 1993? They both moved into the community-based house I ran as registered manager. Thankfully, both individuals flourished in our independence-boosting setting they lived in.

Would I change anything I said to the private specialist hospital director I was talking to back then?

No, I wouldn’t - but I would say it a little louder.



About Lifeways:

Lifeways is the UK’s largest team of support professionals providing support for adults in the community.

We support adults with diverse and complex needs, including learning disabilities, autism, physical disabilities, acquired brain injuries, and mental health conditions. 

As the supported living sector’s largest team of professionals, Lifeways’ extensive experience and national reach mean we deliver extraordinary support to adults, enabling them to live fulfilling and independent lives in the community. 

Our 11,000 colleagues currently support almost 5,000 individuals who live in our 1,500 supported living and residential services across England, Scotland, and Wales. 

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