A Citizenship Approach to Learning Disabilities - Rethinking Support and Inclusion Through Good Commissioning

A Citizenship Approach to Learning Disabilities - Rethinking Support and Inclusion Through Good Commissioning

For decades, support for people with learning disabilities and autistic people has been shaped by a care-based model that prioritises services over citizenship. Instead of enabling full participation in society, the system has too often segregated and managed people—placing them in residential care, limiting their choices, and failing to recognise their rights as citizens.

This needs to change.

A citizenship-based approach to commissioning ensures that housing, support, and services are designed to empower people, not restrict them. This means moving away from institutional care and towards community-based, self-directed support—underpinned by technology, personalised brokerage, and strong user-led systems.

This article outlines the core principles of good commissioning that can drive this transformation, ensuring that people with learning disabilities and autistic people have the right support, in the right place, at the right time—with full control over their lives.

The Core Principles of Good Commissioning for Citizenship

1. Using Data and Population Mapping to Inform Housing and Support Strategies

A good commissioning approach must be based on real data—not assumptions about need. This includes:

• Mapping the local population to understand where people with learning disabilities and autistic people live, what support they require, and how demand is changing.
• Assessing future needs to ensure housing and support services are planned proactively, rather than reacting to crises.
• Using data to shape local markets, ensuring there are diverse, flexible, and sustainable support options.

2. Prioritising Community-Based Living Over Institutional Care

Commissioning should actively reduce the reliance on residential care homes and institutional settings, shifting towards:

• Supported living and independent housing, where people have security of tenure and real choice over where they live.
• Live-in care options, enabling people to remain in their homes with personalised support.
• Funding models that support people to move out of institutions, ensuring they can live in their communities.

3. Creating a Vibrant Marketplace of Diverse and Specialist Providers

For people to have real choice and control, there must be a range of providers offering flexible, high-quality support. This means:

• Supporting small, innovative providers that focus on personalised approaches.
• Ensuring there is investment in specialist provision for people with complex needs.
• Recognising and valuing live-in carers and personal assistants, rather than relying solely on large organisations.

A healthy provider market is one that enables people to commission their own support—not one that forces them into pre-existing service models.

4. Making Self-Directed Support the Default Option

Self-directed support should not be an optional extra—it should be the default offer for everyone. This means:

• Providing personal budgets and direct payments to allow people to hire their own staff, choose their own services, and manage their support flexibly.
• Supporting families to navigate self-directed support, including access to personal assistants and peer networks.
• Ensuring that people have the skills and resources to manage their own support, rather than making self-directed support so complicated that people give up.

5. Commissioning Technology-Enabled Care and Personalised Technology

Technology should be seen as a core enabler of independence, not an afterthought. This includes:

• Personalised technology solutions that help people communicate, plan their lives, and stay independent.
• Technology-enabled care, such as smart home adaptations, assistive tech, and wearables that enhance safety and autonomy.
• Digital platforms that allow people to manage their own support, reducing paperwork and increasing flexibility.

Platforms like Alocura and Andor Cards are already proving how intelligent digital solutions can make self-direction easier, reducing barriers to choice and control.

6. Providing Good Information and Advice to Support Decision-Making

People can only make informed choices if they have clear, accessible information. Commissioning must ensure:

• High-quality, user-friendly information about support options.
• Peer support and mentoring networks, where people can learn from others with lived experience.
• Accessible digital platforms where people can compare providers, check reviews, and manage their own budgets.

This shifts the power from professionals to individuals, ensuring that people with learning disabilities and autistic people drive their own support decisions.

7. Embedding Quality Checkers and User-Led Organisations in Commissioning

User-led organisations must be at the heart of commissioning, ensuring real co-production. This includes:

• Employing people with lived experience as quality checkers, ensuring services meet real needs.
• Funding and supporting user-led advocacy groups to influence policy and practice.
• Embedding co-production into every commissioning decision, ensuring that people with learning disabilities and autistic people are designing the system, not just using it.

8. Developing a Personalised Brokerage System

Navigating support should be easy and personalised, not bureaucratic. A brokerage system should:

• Help individuals understand their options and tailor their support.
• Ensure people have a real say in how their funding is used.
• Be independent of providers, ensuring that people are not pressured into using particular services.
• Support better access to housing and bespoke supports

9. Providing Access to Life Planning and Specialised Brokerage for People Stuck in Hospitals

Too many people remain in hospitals long after they should have been discharged due to a lack of planning, housing, and appropriate support. To prevent this:

• Every individual in a hospital setting must have access to life planning that actively prepares them for discharge.
• Specialist brokerage services must be available to find the right community-based support and housing solutions.
• Funding should prioritise personalised discharge planning, ensuring people move into the right settings as quickly as possible.

10. Accelerating Discharges Using the Building Bridges Transitional Discharge Model

The Building Bridges model offers a proven approach to reducing hospital stays and ensuring safe, sustainable transitions into the community. Commissioning must:

• Embed the Building Bridges model into all hospital discharge processes.
• Ensure discharge plans start early, with clear steps towards independent living.
• Fund transitional support teams that work across health, social care, and housing to prevent people from being stuck in hospital unnecessarily.

By making accelerated discharge a priority, we can stop the cycle of institutionalisation and create real opportunities for people to live full lives in their communities. More info on this approach is available here: https://citizen-network.org/library/building-bridges.html

A New Vision: Commissioning for Citizenship, Not Just Services

Good commissioning is not just about procuring support—it is about creating a system that enables full citizenship.

This means moving beyond service-led models and embracing rights-based, person-centred commissioning that:

✅ Uses real data to plan for the future

✅ Invests in community-based housing and reduces institutions

✅ Develops a diverse and sustainable provider market

✅ Makes self-directed support the norm

✅ Leverages technology for personalised care and self-management

✅ Contracts for flexibility and quality, not just service delivery

✅ Empowers people with individual service funds and personal budgets

✅ Ensures life planning and personalised brokerage for hospital discharge

✅ Embeds the Building Bridges model to accelerate transitions into community living

By embedding these core principles into commissioning, we can create a system where people with learning disabilities and autistic people are not just service users, but full citizens—with the same rights, opportunities, and choices as anyone else. The future of support is not care-based dependency—it is citizenship-based empowerment.