The document contains 6 exhibits that discuss trends in supported living and residential care for individuals with intellectual disabilities in the UK. Exhibit 1 outlines 9 standards for true supported living. Exhibit 2 shows increasing home care volumes but decreasing annual spending per user from 2006-2013. Exhibit 3 estimates that most high acuity individuals entering care go to supported living, while residential care numbers have stabilized. Exhibit 4 discusses differing commissioner views on the cost-effectiveness of supported living models. Exhibit 5 outlines declining local authority budgets after 2010. Exhibit 6 shows that despite overall cuts, spending on learning disabilities has grown slightly from 2010-2014.

1. Mansfield
Advisors
1
Exhibit 1 Supported living packages have to offer ongoing choice and freedom to be
seen as truly different from residential care in group homes
THE ‘REACH’ STANDARDS
PROPOSED CHECK LIST FOR A TRUE SUPPORTED LIVING OFFERING
The 9 standards are:
 I choose who I live with
 I choose where I live
 I choose who supports me
 I choose how I am supported
 I choose what happens in my own home
 I have my own home
 I make friendships and relationships with
people on my terms
 I am supported to be healthy and safe on
my terms
 I have the same rights and
responsibilities as other citizens
Paradigm’s ‘Reach Standards in Supported Living’ 2002

2. Mansfield
Advisors
2
Exhibit 2 We see greater need reflected in more home care delivered
VOLUMES AND SPEND
Home care volumes
Individuals, ‘000s
Residential care volumes
Individuals, ‘000s
27 30 33
CAGR (%)
‘06-’13
37 38 40 40 42
7%
Annual
spend/use
r (£000’s)
40 39 38 38 36 36 37 36
UK Government datasources: NASCIS, RAP.PSSEX, RapP1, RapP2F
CAGR (%)
‘06-’13
-1.5%
12 12 13 14 16 16 40 42 44 44 56 56

3. Mansfield
Advisors
3
Exhibit 3 We estimate most high acuity entrants into care go supported living but
residential care numbers have stabilised
RESIDENTIAL CARE: PERMANENT ADMISSIONS
Number of 18-64 indiviuals in residential/nursing care, England only
CAGR
’04-’09
UK Government database NASCIS, Mansfield analysis
Additional estimated volume if 2% CAGR growth
has happened in people with intellectual
disabilities entering full-time care– this
additional volume has instead gone in to
supported living or adult fostering
2011/12 is anomalous - artificially
significant increase in volumes
following transfer of care from NHS
to LAs
3,000
2,650
2,450
2,170
1,990
1,780 1,690 1,730
1,910
3,160
1,740
410
671
1,014 1,257
1,532 1,688 1,716
1,605
425
1,917
2002/032003/042004/052005/062006/072007/082008/092009/102010/112011/122012/13
CAGR
’09-’13
-8.6% 0.7%
• “99% of young people [with
intellectual disabilities] coming in
to adult services would not
consider care homes…only 10%
[transitioning into adult services]
will end up in care homes. Some
people with the most complex
needs like autism do best in
supported living” – Yorkshire
Commissioner
2% growth rate
chosen to match
overall growth in
places over last decade

4. Mansfield
Advisors
4
Exhibit 4 There are differing views amongst commissioners on the value of supported
living models
UK COMMISIONER VIEWS
Supported living is less cost-effective
than residential care for some…
• “some behaviourally challenged
people who need 2:1, 24/7 care care
cheaper to look after in residential
care”
• "if supported living package was
greater than £3000 [per week] then I
will say have you looked at
residential care?”
• “cost would double if we closed all
care homes”
• “supported living is usually more
cost-effective [than residential care]
but there are exceptions”
Mansfield interviews – UK 2014
…but cost is not always important in
the decision-making process
• "we will not admit into residential on
financial grounds...only if needed in
terms of medical need”
• ”[residential] is a false
economy...short term financial
win...but in longer term it leads to
more hospital admissions and higher
healthcare costs" “Important not to
be too narrow in terms of cost-effectiveness"
• “we look at individuals who are
cheaper to move [to supported
living]…cost is an important factor”

5. Mansfield
Advisors
5
Exhibit 5 UK Local Authorities saw their budgets decline after the 2010 Comprehensive
Spending Review – (the UK government multi-year budget process)
LOCAL AUTHORITY INCOME TREND
£m
153,820
3.6% -3.0%
162,257 165,204 159,694 155,306
2008-09 2009-10 2010-11 2011-12 2012-13
Grant %
of income
62% 63% 65% 64% 63%
UK Department for Communities and Local Government

6. Mansfield
Advisors
6
Exhibit 6 UK local authority spending on learning (intellectual) disabilities has actually
grown slightly
LOCAL AUTHORITY SPENDING
% by Personal Social Services category, England
Other
Adult
Mental
Illness
Physical
Disability
Learning
Disability
Children’s
Services
Older People’s
Services
2.4% 2.2% 1.8% 1.9%
5.5% 5.2% 5.1% 5.0%
7.3% 7.0% 6.9% 6.9%
18.6% 23.0% 23.5% 24.0%
30.8%
29.7% 30.5% 31.1%
35.5% 32.9% 32.1% 31.1%
2010/11 2011/12 2012/13 2013/14
Department of Health, Mansfield
CAGR
(last 2 years only)
£21.1bn £21.4bn £21.5bn £21.6bn 0.37%
-6.43%
-1.31%
-0.49%
2.39%
2.78%
-2.41%
• 2014/15B will not be
available until late July
2014
• The non-ring fenced
grant in 2011-12 direct
from the Department of
Heatlh to Local
Authorities was £1.2bn