'Urgent' reforms needed in adult disability care, after report finds widespread failings

Strategic drift, poor planning, and restrictive practices identified across Manx Care’s adult services

A review of Manx Care’s Adult Learning Disability Service (ALDS) has identified significant failings in the Island’s approach to residential care for adults with learning disabilities, calling for wide-ranging reforms to address longstanding issues around planning, service quality, and person-centred support.

The report, commissioned by Manx Care and carried out by consultancy firm Cordis Bright, was prompted by safeguarding alerts and internal concerns raised in autumn 2024.

It concludes that the ALDS residential care model is 'outdated, overly reliant on institutional settings, and lacking the strategic vision needed to deliver modern, inclusive care'.

While acknowledging the dedication and compassion of frontline staff, the report warns that many residents experience care that is “not person-centred”, lacks meaningful choices, and in some cases imposes inappropriate restrictions on their freedoms.

Inspectors documented a number of homes where individuals were confined to their rooms, had limited access to communal spaces, or were subject to routines shaped more by staffing pressures than their own needs or preferences.

The review describes the absence of a clear strategic framework as a root cause of many challenges, with the existing 2020–25 strategy deemed inadequate and poorly implemented.

The service, it says, has “drifted”, with individual homes operating in silos and lacking coordination, forward planning, or shared purpose. Concerns over inappropriate placements, limited housing options, and insufficient service diversity were repeatedly highlighted by staff and families alike.

Cordis Bright warns that unless urgent action is taken, residents will continue to face poor quality care and unmet needs. It recommends that Manx Care:

• Resolve inappropriate resident placements and improve accommodation matching
• Commission a broader range of community-based options to reduce reliance on residential homes
• Develop a long-term property strategy to ensure housing meets changing support needs
• Co-produce a new strategic vision and commissioning plan with residents, families, and staff
• Reform workforce planning, training, and supervision to embed person-centred principles
• Improve family engagement and establish clearer boundaries to reduce conflict and increase trust

The review also suggests Manx Care consider transferring operational responsibility for the service to a specialist external provider with a proven track record in transforming learning disability services.

As of November 2024, 68 people were living in ALDS homes, with a further 36 in supported living.

The Isle of Man is found to be an outlier in its high reliance on residential care – commissioning more placements per capita than comparable regions in England – and spending a disproportionate share of its learning disability budget on residential provision, rather than community-based support.

Among the most serious findings are the continued use of restrictive practices, such as limiting access to spaces or interactions between residents, often due to poor matching or inadequate staffing.

In some homes, staff struggled to identify safeguarding concerns or lacked the training to provide safe, enabling care that promotes independence.

Workforce morale was found to be low, with high vacancy rates, inconsistent training, and fractured relationships between staff, managers and homes.

The report also describes poorly maintained buildings, some unsuitable for residents’ physical needs, with issues like damp, unsafe gardens, and inadequate accessibility.

Manx Care Chief Executive Teresa Cope acknowledges that while some improvements are already underway, “meaningful change cannot happen overnight”, and calls for “long-term commitment, the right mix of skills and expertise, and a collaborative approach”.

Meanwhile, Director of Manx Mencap Fran Tinkler says the findings "confirm what many families have known and experienced for years”, adding, “we do not want to see another report that gathers dust on a shelf. No more delays, no more excuses.”