Small supports - small is beautiful

A programme to help councils and systems to think differently about local markets of providers for people with a learning disability and autistic people

Partners in Care and Health banner

The LGA developed and commissioned the Small Supports programme since its conception in 2018, partnering with NDTI and NHSE.  Since then, two cohorts of councils and their health partners have joined the programme in 2019 and 2020, finding people who want to develop small, local, community focussed businesses supporting people with ‘hefty reputations’.

Through the programme the use of the language “hefty reputations” has evolved. NDTI say, “ we don’t like labels, but this is greatly affecting a group of people with what can best be described as having ‘hefty reputations’: people who are often labelled as having behaviour where they can hurt themselves or those around them. However, it is often the environment, individual communication and systems issues that lead people to develop reputations through their actions in response to this not being understood or recognised.”

This programme of work requires councils and systems to think differently about the way they engage with the care and support market, working with people who know what good looks like in developing something they can‘feel the sides of’.  This means that the provider is small enough to know the people, families and the team supporting them.  This usually means that the provider usually grows to support a maximum of around 30 to 40 people.

NDTi and LGA are currently recruiting a third cohort of councils and health partnerships to join the Small Supports programme. If you are interested in having a conversation to see if it would work for your local area. Find out more about the Small Supports Programme 2022/23.

Principles of the Small Supports approach

  1. From the first steps the person needing support (and their chosen family and friends) has as much control as possible and there is a commitment to their control growing over time.
  2. The starting point to developing great support is the person’s aspirations about where they want to live and the life they want to have. Conversation about support then follows from this. Compromising on control and aspirations is when things start to go wrong.
  3. Supporters (staff) are recruited by and around the person. They don’t work across services. Staff are not a substitute for friends, community peers, co-workers, and neighbours.
  4. People choose where they live and who, if anyone, they live with. People are the tenant or owner of their own home or perhaps live with family. There is a clear separation of the delivery of housing and support.
  5. Funding is sustainable and is designed around and used for the individual.
  6. Small supports organisations stay with people. Change and challenges are expected so they don’t withdraw support or “sell” services on to ensure continuity of support.
  7. In their work, leadership, recruitment and actions, small supports organisations are rooted in their local community.
  8. The organisations stay relatively small. Knowing each person well means not growing by more than three to five people a year and finding a natural size where people are known and valued, and the organisation is financially sustainable.
  9. Small supports organisations are developed around these principles. Transferring this approach to large, segregated services will not deliver the desired outcomes.

To find out more about Small Supports and hear some examples of the difference being made to outcomes for people, as well as how these bespoke organisations have upheld people’s human rights during a pandemic, visit the NDTI small supports area.

Bespoke support for people with learning disabilities and autism

We commissioned an evaluation on the impact consequence for local authorities and councils of delivering bespoke support to autistic people and people with a learning disability, including people who have been detained under the Mental Health Act (or at risk of being detained). This important piece of work draws on the voices, stories and experiences of people who have moved from institutional care to bespoke support and is part of the NTDi Small Supports Programme. Read the full report.