Costs and outcomes of skilled support for adults with complex needs in supported accommodation

Jim Mansell Completed   2012


Social care services provide support to many people with learning disabilities and complex needs who would formerly have lived in NHS long-stay institutions. However, care services often have difficulty meeting the wide-ranging needs of these people. The opportunities presented by more personalised service models require the support of skilled staff if they are to be realised by people with complex needs. The quality of staff support has been shown to be a critical factor in determining a person’s quality of life in small group homes and supported accommodation. In this context, firmer evidence is needed of the effects of skilled support on a range of user outcomes and on the costs of service provision. This will enable people with learning disabilities (and their advocates), service providers and commissioners to identify and promote the most appropriate skilled support and to achieve value for money in the provision of services.


This project aimed to evaluate the impact of skilled staff support on the lives of people with learning disabilities and complex needs, and to describe the nature of the support required and the implications of providing this support.


  • There was a wide range in terms of the outcomes of the people who participated– some people, often those with the most complex disabilities, spent almost the whole of the time observed doing nothing, other than in some cases self-stimulating
  • While others, often those who were more able, had much better outcomes
  • People were engaged on average 44% of the time
  • The quality of staff support was variable and only one third of people were receiving consistently good support in terms of active support
  • On average people spent 75% of their time with no contact from staff or other service users
  • Neither the accommodation and support costs nor the total costs were significantly higher for those receiving skilled support, despite more of these people being in supported living and smaller settings.