Coming Home Action Plan 2026

5. Strategic Context and Overarching Issues

Human rights

In January 2025, the SHRC published their report ‘Tick Tock… A human rights assessment of progress from institutionalisation to independent living in Scotland’ which set out to measure progress in moving people from institutional living to independent living, in line with human rights standards set out by the UN Convention of the Rights of Persons with Disabilities (UNCRPD). The SHRC report made nine recommendations to the Scottish Government focused on improvements to be made for people with learning disabilities and/or who are autistic who have been recognised as being in inappropriate hospital or out-of-area placements.

The Minister for Social Care and Mental Wellbeing has provided an initial response to the SHRC on their recommendations. Following a meeting with the Chair of the SHRC to discuss the report, COSLA officers arranged for the SHRC to present their report to a summit of system leaders organised by COSLA and the Scottish Government, where it was agreed to establish the Coming Home Short Life Working Group. The publication of this action plan seeks to deliver the practical aspects of the SHRC’s first recommendation.

Some of the recommendations extend beyond the remit of the Coming Home agenda and require wider consideration across the Scottish Government and with partners. Many actions will be considered beyond this Parliamentary term due to their complex nature. This includes recommendations around:

• developing a deinstitutionalisation plan
• wider mental health law and forensic reform
• remedies, reparations and redress

However, there are a number of actions that can be progressed in relation to the Coming Home agenda.

Strategic Aim 8: To ensure that the implementation of the Coming Home Action Plan is progressed within an appropriate human rights framework, and that effective support and scrutiny is in place.

Action 8.1 The Scottish Government and COSLA will invite the SHRC to be involved in an advisory capacity in the Coming Home Strategic Oversight Group, which will be established to support the implementation of the Coming Home Action Plan. This will support the development of a human rights framework that can be applied across further work on Coming Home.

Indicative timescale - short term

Action 8.2 The Scottish Government and COSLA will engage with HIS, the Care Inspectorate and the MWC to continue to build a collaborative approach to scrutiny and assurance in relation to people covered by the Coming Home agenda.

Indicative timescale - medium term

Action 8.3 The Scottish Government will further explore with partners the implications of including forensic patients, under 16s and autistic people without a learning disability on the Dynamic Support Register.

Indicative timescale - medium term

Funding

The aim in terms of funding should be to deliver outcomes for people to meet their needs and human rights, and to look across the system to ensure this can be delivered in a way that delivers best value for money. There is no doubt that meeting needs effectively in a community setting, rather than a hospital setting, is better in terms of outcomes for the individual and is more likely to be more cost-effective.

A deeper understanding is required of the cost impact across the system, including understanding:

• current costs and where they lie, and how more effective solutions can reduce cost (e.g. the opportunity to reduce levels of support when individuals are happy and settled in their home)
• the flow of funding between health and social care
• key areas of risk in terms of budget provision
• opportunities to provide higher quality, more cost-effective housing and support arrangements more locally, particularly where people are placed far from home
• opportunities to enhance working across integration authority boundaries (something which has been considered by the collaborative commissioning subgroup)

Some of these issues are wider strategic and system issues which are unlikely to be resolved within the context of the Coming Home agenda.

Strategic Aim 9: To ensure that funding across the system is used in a way that delivers best value.

Action 9.1 The Scottish Government will work with integration authorities to publish an account of how the Community Living Change Fund was spent in all integration authorities across the funded period 2021-2024. Information has been provided by HSCPs and is currently being reviewed.

Indicative timescale - short term

Action 9.2 The Scottish Government and COSLA will commission work to improve understanding of the costs across the system in relation to Coming Home and identify areas for targeted improvement in resource allocation across health and social care.

Indicative timescale - short term

Action 9.3 A Finance Working Group will be established under the Coming Home governance structure to progress actions on finance.

Indicative timescale - short term

Action 9.4 The Scottish Government and COSLA will ensure that Coming Home issues are reflected in wider discussions on sustainability, efficiency, quality, and accessibility of health and social care services in relation to the Health and Social Care Service Renewal Framework.

Indicative timescale - medium to long term

Workforce

A suitably skilled workforce was identified as a priority by the SLWG and a number of actions are set out in the ‘Skilling up and strengthening community services’ section above. Capacity in the social care workforce and the delivery of Fair Work for social care workers are key issues. Although there is no complete picture of the workforce across third sector and private providers, the lack of parity in pay and conditions compared with NHS staff doing equivalent work is well recognised. Addressing this gap is essential to attracting and retaining skilled staff in community‑based social care and is an important focus of future recruitment and retention policies at national and local levels.

Strategic Aim 10: To provide a clear understanding of workforce requirements and work within the wider system to enhance capacity to support the Coming Home agenda.

Action 10.1 The Scottish Government and COSLA, working closely with employers and professional bodies, will develop accurate data on the existing workforce supporting people with learning disabilities and complex needs across health and social care.

Indicative timescale - medium term

Action 10.2 The Scottish Government and COSLA will feed into wider social care workforce planning to develop opportunities for recruitment, retention and career progression.

Indicative timescale - medium term

Advocacy

Access to advocacy is essential for people within the Coming Home group. Professional advocates provide a bridge between the individual and their family or chosen representatives and a range of supports and services that are involved in the development of solutions to meet the individual’s needs. The Mental Health (Care and Treatment) (Scotland) Act 2003 (chapter 2, section 259) provides a legal right to independent advocacy for the Coming Home cohort and statutory service providers have a duty to secure the right services and ensure people can use them. Linking the Coming Home work into the National Transitions to Adulthood Strategy for Young Disabled People, which is owned jointly by the Scottish Government and COSLA, is particularly important given the risk of placement breakdown during this transition period.

Strategic Aim 11: To ensure that individuals are able to access the support and representation required to help them achieve a positive outcome.

Action 11.1 Local statutory service providers should ensure people are made aware of their legal right to advocacy and that this right is met.

Indicative timescale - short term

Action 11.2 The Scottish Government and COSLA should explore how data can be collected on the offer and uptake of advocacy support for those in the Coming Home population.

Indicative timescale - medium term

Complex Support Needs Pathway

This work has been commissioned and a project lead has been appointed to deliver a practical, evidence-based pathway that aims to support discharge from hospital for people with learning disabilities and complex support needs. By investing in this work, we will create a resource that improves quality of care, supports professionals, provides guidance on upholding human rights, and ensures involvement of and better outcomes for individuals and families.

The pathway will also underpin the work of the NSP by providing a structured approach for reviewing individuals on the DSR who are currently in hospital, measuring progress toward discharge, and ensuring consistent post discharge monitoring.

The pathway will aim to:

• Facilitate timely and well supported discharge for individuals with complex support needs
• Prevent delays in hospital placements and support the return of individuals to community living
• Uphold the human rights of people with learning disabilities and complex support needs by developing a pathway which supports choice and control in where they live
• Provide clear milestones and timescales for working towards discharge from hospital settings

This work will review and seek to incorporate any existing materials that have been developed to provide a single, comprehensive source of guidance and information. The project will work closely with people with lived experience and with professionals working in health and social care in order to develop and test the pathway.

Strategic Aim 12: To establish a clear framework that provides a route to community living

Action 12.1 This project will develop a complex support needs pathway in partnership with those involved in the delivery of this action plan.

Indicative timescale - medium term

Supporting Health and Wellbeing

Everyone with a learning disability aged 16 and over is eligible for an annual health check. This includes people with learning disabilities and complex needs who may be in hospital or out-of-area placements or at risk of support breakdown.

Annual health checks are a core element in supporting people to live independently, carry out daily activities and participate in society, ensuring people are as healthy as possible and have equal access to health care supports and services.

Addressing health inequalities and improving access to preventative health and wellbeing options are not only key to supporting a successful transition into the community, but are vital in preventing future support breakdowns or unnecessary admissions or re-admissions to hospital.

Learning disability annual health checks save and improve lives while addressing health inequalities. They provide vital opportunities for prevention, early intervention, treatment and support. Annual health checks have already been successfully used to identify issues with support and care in the community and to support people in the Coming Home group to transition back into community settings.

PBS is a person-centred framework which helps provide good quality support for people with learning disabilities and aims to respect, protect and fulfil people’s individual human rights. PBS is beneficial for people with learning disabilities who may behave in ways which are perceived to be complex and challenging, and which can prevent people from enjoying a good quality of life.

PBS uses behavioural approaches and other techniques to understand what someone might be trying to communicate through their behaviour. It aims to understand how to best support someone by focusing on adaptions to the environment and the support provided, to ensure the person’s needs are met. The PBS Community of Practice have developed a free online resource ‘Understanding PBS’ which has been utilised by a number of areas working with people from the Coming Home group to upskill staff and improve community services.

As well as improving outcomes for individuals, adopting PBS approaches can reduce the level of care and support required, making it easier to enable people to live in the community.

Strategic Aim 13: To create the conditions for people to thrive within their community.

Action 13.1 The Scottish Government will work with the national implementation group for learning disability annual health checks and key stakeholders to further explore the role of annual health checks in supporting transitions into the community and preventing admissions and re-admissions.

Indicative timescale - short term

Action 13.2 The Scottish Government and COSLA will engage with the PBS Community of Practice to further explore work already underway and options for sharing of best practice and learning to support people from the Coming Home group.

Indicative timescale - medium term

Engagement with People with Lived Experience

The SLWG has completed its work, which has drawn on previous engagement with people with lived experience who were involved in the development of the original Coming Home Report and Implementation Plan.

The Scottish Commission for Learning Disabilities (SCLD) sat on the SLWG and all members recognise the importance of lived experience involvement in the implementation of this action plan. In terms of the next phase of work, involving people with lived experience in a meaningful way is essential to making sure the experiences of individuals and families shape the approach and inform the development of specific action at a national level. Fully involving individuals and families is also essential to finding the right solutions locally.

Going forward we will establish a Lived Experience Hub that draws on existing lived experience networks and resources to inform the implementation of the action plan and support effective local solutions. This is covered in more detail in next steps, below.

In Control Scotland’s, New Routes Home Network, supports progressive approaches to keep people at the centre of plans and explore practical alternatives to achieve positive outcomes for individuals. The network aims to demonstrate that positive change is possible, no matter how challenging the context.

The network has created a set of toolkits aimed at supporting planning for transitions out of delayed discharge as well as improving people’s quality of life while they are in delayed discharge situations. The toolkits were piloted and resulted in interest from stakeholders looking for support to improve outcomes for people on the DSR.

In Control Scotland is already working with partners in some areas, using the toolkits to offer facilitation and support to answer 4 key questions:

1. What’s working, and not working?

2. What are some areas for improvement we could focus on that might give quick wins?

3. What are the trickier issues?

4. What would it take to move forward?

The Scottish Government is providing funding to enable this approach to be further tested as part of the implementation of this action plan. This will offer support on 3 levels: leadership surgeries, team member surgeries, and intensive support.

Strategic Aim 14: To ensure that people in the Coming Home population have a key role in shaping national approaches and local solutions.

Action 14.1 The Scottish Government will provide funding to further test and embed the New Routes Home toolkit as part of the overall delivery of this action plan.

Indicative timescale - short term