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Policy Briefing
May 2016
This is a regular briefing for learning disability commissioners and other associated professionals in the northwest.
You are receiving this briefing because either your organisation subscribes to the North West Training and Development Team; or you subscribed to our policy briefing mailing list on our website. If you no longer wish to receive these briefings then please click on the ‘unsubscribe’ link at the bottom of this email.
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This briefing is compiled by Dr Laurence Clark from Pathways Associates CIC.
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A. HEALTH & SOCIAL CARE
A1. Seven Days of ATU Action
Monday 18th April 2016 saw the start of a campaign to raise awareness of the thousands of learning disabled people currently being held against their wishes in assessment and treatment units. Often, these units are hundreds of miles from the person’s home. The average time spent in an ATU is 5.5 years. The average cost per week for treatment in an ATU is £3500.
The campaign has been presenting a number of stories. Stories of people who have been trapped in their unit for years. Stories of people who have managed to be freed from their detention but still bear the scars of their experience. And sadly, stories of people who have died whilst in the care of their Unit.
To read about the campaign visit: https://theatuscandal.wordpress.com |
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A2. CQC review of how NHS trusts investigate and learn from deaths
The CQC is carrying out a review of how NHS trusts identify, report, investigate and learn from deaths of people using their services.
This follows a request from the Secretary of State for Health, which was part of the Government’s response to a report into the deaths of people with a learning disability or mental health problem in contact with Southern Health NHS Foundation Trust.
CQC’s review will consider the quality of practice in relation to identifying, reporting and investigating the death of any person in contact with a health service managed by an NHS trust; whether the person is in hospital, receiving care in a community setting or living in their own home. The review will pay particular attention to how NHS trusts investigate and learn from deaths of people with a learning disability or mental health problem.
Further detail can be found here: http://tiny.cc/j44iby
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A3. LGA warn funding needed to avoid National Living Wage pushing social care services to breaking point
Council leaders have warned that the introduction of the National Living Wage on April 1 may push care services towards breaking point and a care provider crisis closer to reality without new social care funding being provided.
The Local Government Association said councils support the new NLW but warns it risks destabilising the care provider market by adding a significant cost to the social care system. Councils have already had to close a £5 billion funding gap in social care since 2010 and are continuing to struggle with major ongoing pressures.
The LGA has previously estimated it could cost councils an absolute minimum of £330 million in 2016/17 to cover increased contract costs to home care and residential care providers but warn the true cost is likely to be much higher.
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A4. Equality Delivery System for the NHS (EDS2): Guide to Engagement with the Local Voluntary Sector
The Race Equality Foundation, in partnership with the LGBT Foundation, Disability Rights UK, and Mens Health Forum were commissioned by NHS England to produce the "Equality Delivery System for the NHS (EDS2): Guide to Engagement with the Local Voluntary Sector". This guide was developed in collaboration with service users, voluntary and community organistions, and key stakeholders from Foundation Trusts, Healthwatch England, NHS Employers, CCG and CQC.
This guide explores how the local voluntary and community sector can help NHS organisations to engage communities and, by extension, implement EDS2 better. The voluntary and community sector are often well-placed to help NHS organisations. They have links and expertise with specific communities that health services may have difficulties in engaging with.
The guide is available here: http://tiny.cc/4k7iby
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A5. Judge condemns government for ducking responsibilities on deprivation of liberty
A Court of Protection judgment has piled pressure on ministers to release funding to ensure vulnerable people in deprivation of liberty cases have access to appropriate representation. In the case of JM & others, Mr Justice Charles placed responsibility on health secretary Jeremy Hunt and justice secretary Michael Gove for ensuring sufficient resources are available so each person whose deprivation of liberty is considered by the Court of Protection has appropriate representation. The move was branded “unprecedented” by legal experts.
Councils must apply to the Court of Protection to authorise any deprivation of liberty in community settings, such as supported living, where the person lacks capacity to consent to their care arrangements. An independent representative must be appointed if the person does not have a family member or friend who is suitable to represent them. Paid advocates can fill the role but the funding pressures on advocacy services, combined with a surge in demand triggered by the Supreme Court’s landmark ‘Cheshire West’ ruling on deprivation of liberty in March 2014, has led to longstanding problems securing representatives for cases reaching court.
In JM & others, the judge ordered Hunt and Gove be added as parties in four test cases where no appropriate representative could be found for reasons that included a lack of funding for advocacy services. He also suggested all future similar cases should be adjourned until a workable solution is found. The government argued that councils were responsible for commissioning adequate advocacy provision locally. However, the judge said the government had sought to duck its responsibilities and pass them on to local authorities while ignoring the realities of the pressures facing frontline services.
Further information on this case is available here: http://tiny.cc/t57iby
In addition, a group of councils has threatened the government with legal action over ministers’ refusal to award ‘new burdens’ funding to cover a surge of deprivation of liberty cases - see http://tiny.cc/387iby for details. |
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A6. Care Act triggers surge in safeguarding cases
The latest LGA stocktake shows the number of cases adult safeguarding teams need to respond to doubled in the first six months of the Care Act.
Councils made 100,000 safeguarding enquiries between April 2015 and October 2015, the Local Government Association’s latest Care Act stocktake found. Official figures show councils handled 103,900 safeguarding referrals in the full 12-month period up until April 2015, when the Care Act came into force.
The figures strongly suggest safeguarding caseloads have increased substantially since the act introduced a statutory threshold for initiating safeguarding enquiries. Previously councils decided when an investigation should be initiated.
More details are available here: http://tiny.cc/ghajby
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A7. How can we improve support for carers? Call for evidence
The Government thinks that it needs a new strategy for carers setting out how it can do more. One which reflects their lives now, the health and financial concerns they have, and gives them the support they need to live well whilst caring for a family member or friend.
To help develop the strategy, they want to hear from carers, those who have someone care for them, business, social workers, NHS staff and other professionals that support carers.
To give evidence follow this link and fill out the survey by 30 June: http://tiny.cc/1cxjby
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A8. The Mazars Report
The long-awaited Mazars report was finally published last December. The report examined all deaths of people receiving care from Mental Health and Learning Disability services at Southern Health NHS Trust between April 2011 and March 2015. The report showed that the likelihood of a person with a learning disability’s unexpected death being investigated was just 1%. What’s more, even when investigations into unexpected deaths were carried out they were of a poor quality. 64% of investigations into unexpected deaths did not involve the family, and there was confusion in Southern Health about who should provide support to families.
The full report can be accessed at http://tiny.cc/vtyjby
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A9. Time for Change: the Challenge Ahead
On 22nd February, the third and final report from Sir Stephen Bubb was released. This follows two previous reports from Stephen Bubb, ‘Winterbourne View – Time to Change’ (November 2014), and ‘Winterbourne View – Time is Running Out’ (July 2015). Both reports detailed the urgent need for change, and the concerning lack of progress on the ground, despite the government’s stated commitment to closing down ATUs. This final report outlines the progress made and the challenges still faced.
You can access the full report at: http://tiny.cc/kxyjby
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A10. Deprivation of liberty court cases triple but fall short of Cheshire West predictions
The number of deprivation of liberty cases handled by the Court of Protection almost tripled last year but remained well short of the number councils believed was required to comply with a landmark Supreme Court ruling.
The cases rose from 525 in 2014 to 1,499 in 2015, figures published by the Ministry of Justice reveal. The figures included applications to the court from councils to authorise deprivation of liberty in community settings, such as supported living or shared lives schemes. They also included appeals against Deprivation of Liberty Safeguards orders, which apply to care placements in care homes or hospitals.
A breakdown of the numbers of each type of case was only available for the last six months of 2015. During this period more than two-thirds (68%) were applications to authorise deprivation of liberty in the community. Most were made through a streamlined process (Re X) introduced in November 2014 to allow uncontentious applications to processed without an oral hearing.
You can access more details at: http://tiny.cc/w6yjby
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A11. NHS to bankroll development of Shared Lives support for adults in England
The NHS is to spend £1.75m developing Shared Lives schemes in England. NHS England hopes that funding Shared Lives, a model that sees adults needing support moving in with or regularly visiting an approved carer, will enable more people to be cared for in the community rather than in hospitals.
NHS England will use the £1.75m to provide funding and support to 6 to 10 clinical commissioning groups on the development of Shared Lives schemes that:
- Aid the movement of people with learning disabilities out of medical institutions
- Offer live-in mental health support as an alternative to hospital treatment
- Free up hospital beds by providing ‘step down’ services for people who have had strokes or other health crises
- Provide dementia support including day support
You can access more details at: http://tiny.cc/1dzjby
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A12. Government to introduce national AMHP accreditation system
The government is set to introduce a national accreditation system for Approved Mental Health Professionals (AMHP) in response to concerns over variability in the quality of practice and approval processes used by councils.
A new national system of registration for AMHPs and overarching standards for services will be introduced by April 2018, if ministers accept the recommendations of a Department of Health and Care Quality Commission review. The process will be overseen by the new social work regulator and professional standards body announced by the government in January.
AMHPs coordinate Mental Health Act assessments. An estimated 95% are social workers by background, although nurses, occupational therapists and psychologists can also train in the role. AMHPs are currently approved and registered by individual local authorities, with each tasked with assessing AMHP competence.
However, the DH and CQC review concluded stronger national oversight was needed after it uncovered wide variation in the way AMHP services were run and the processes councils used to approve staff to take on the role.
You can access more details at: http://tiny.cc/ylzjby
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B. INCOME & BENEFITS
B1. Disability employment gap inquiry launched
The Work and Pensions Committee has launched an inquiry into the Government’s commitment to halve the "disability employment gap" – the difference in employment rates between disabled and non-disabled people. The inquiry assesses the scale of the challenge and the likely effectiveness of the Government’s employment support and benefit policies in achieving this goal. The employment rate among disabled people stood at 46.7% at the end of 2015, compared with 80.3% for non-disabled people. To halve this gap would require bringing an extra 1.2 million disabled people into work.
More information can be found at http://tiny.cc/zg7iby
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B2. Is spending on disability benefits going up or down?
Here is a brief fact check from Full Fact assessing the truth of claims made by politicians: http://tiny.cc/m89iby
Also here's a blog by Bernadette Meaden for Ekklesia looks at the breakdown of government spending on disabled people and the assumptions people often make about it: http://tiny.cc/ebajby
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C. RESEARCH & ANALYSIS
C1. Lords says Government is failing duty of care to disabled people
The House of Lords Select Committee on the Equality Act 2010 and Disability investigating the Act's impact on disabled people has concluded that the Government is failing in its duty of care to disabled people.
Key findings and recommendations in the report:
- Government should bring into force immediately provisions in the Act obliging taxi drivers to take passengers with wheelchairs.
- All new rail infrastructure must build into its design step-free access. Ministers must report on the progress made on all sports stadia, following the Premier League’s promise to upgrade all their stadia by August 2017.
- Many restaurants, pubs and clubs are difficult to access, with many not providing basic facilities such as a disabled toilet.
- Local authorities should be allowed to refuse to grant or renew licences to inaccessible premises until they make the necessary changes.
- Planning policies need to be revised so that new buildings are wheelchair accessible or adaptable
- All Government departments, local authorities and public bodies should review how they communicate with disabled people, and that disabled people must be involved in this process.
- Developments in recent years have made fighting discrimination more difficult for disabled people. New tribunal fees, less access to legal aid, and procedural changes have combined to create barriers to the effective enforcement of disabled people’s rights. Changes are recommended to combat this
You can find out more here: http://tiny.cc/bb5iby
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C2. Personal Health Budgets attract just one in twenty target patients
Two years after the government made Personal Health Budgets (PHBs) available to all patients receiving Continuing Healthcare from the NHS, barely five percent of those patients have chosen to take them up.
Figures sourced under the Freedom of Information Act show that across 162 CCGs in England, just 2,986 out of 53,611 Continuing Healthcare patients had opted to receive PHBs. Just 4,000 people in total have taken up PHBs in the 162 CCGs which provided data. That includes patients who have requested them despite not receiving Continuing Healthcare. Extrapolated across all 209 CCGs in England, this would indicate around 5,200 patients receiving PHBs – nowhere near NHS leaders’ target of 100,000 by 2020.
The report can be accessed at http://tiny.cc/t16iby
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C3. Social workers’ values influence assessment outcomes more than eligibility thresholds
A report written by John Bolton, visiting professor at the Institute for Public Care, says councils should focus on improving the consistency of social work assessments instead of cutting staff to make savings.
The report found reductions in social work numbers could increase the cost of care packages. It said the values and risk thresholds of practitioners were most likely to determine service user outcomes and the associated costs. It also pointed to previous research showing a link between high investment in assessment and care management staff and lower numbers of admissions to residential care.
Instead of cutting frontline assessment and care management staff, councils should focus on achieving consistent social work practice to ensure service users don’t receive higher care packages than necessary to meet their needs, the report said.
The report can be accessed at http://tiny.cc/7t7iby
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C4. NHS services turn away a quarter of children with mental health issues referred for treatment
Research from think tank CentreForum shows that a quarter of children under 16 referred to mental health services are being turned away.
Some areas were only able to provide assistance if the child concerned was in extreme crisis. On average children have to wait for 2 months to get seen, but this is far longer in some parts of the country. Maximum waiting times are now over twice those in 2013.
More information can be accessed at:http://tiny.cc/518iby
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C5. Me, My Family, My Home, My Friends, and My Life
Me My Family My Home is an ambitious project by in Control. It seeks to make significant improvements to the lives and support received by children, young people and their families, moving to a single 'whole life, whole family' approach.
Funded by the Department for Education, the project focused its energies on supporting six local authorities and their partners to develop new support packages for children and young people with complex needs and complicated home lives.
The report available sets out the work, the learning and key recommendations to getting started on tackling support for those in the most complicated of situations. We explain a very simple way of understanding how things need to fit together, 'A Framework for Keeping it Simple', and include an interview with one of the forerunners of this approach, Jenny Dalby from Middlesbrough.
More information can be accessed at:http://tiny.cc/518iby
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D. RESOURCES
D1. Hospitals not Homes booklets
The ‘Hospitals not Homes’ booklet tells you how to get involved in making Transforming Care happen in your area, and the questions you can ask.
The National Forum of People with Learning Disabilities and the National Valuing Families Forum wrote the ‘Hospitals not Homes’ booklets to help people with learning disability and autism and their families be part of this work.
The booklet can be accessed at http://tiny.cc/fj5iby
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D2. Discharge and Independence Pack
In 2015 CHANGE was asked to create an accessible Discharge Pack for people with learning disabilities and/or autism in Assessment and Treatment Units.
The purpose of the Independence Pack is to support people with learning disabilities to understand their rights and exercise choice and control over their care, treatment and every day quality of life.
The Independence Pack has been produced along with people with learning disabilities, self advocacy organisations, families and carers, health and social care organisations and legal professionals.
The pack can be accessed at: http://tiny.cc/bo5iby
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D3. Challenging Behaviour – A Unified Approach
This updated report has been produced by the Royal College of Psychiatrists and the British Psychological Society on behalf of the Learning Disabilities Professional Senate.
Challenging Behaviour: A Unified Approach is an updated set of guidelines for supporting children, young people and adults with learning disabilities who are at risk of receiving abusive or restrictive practice.
You can read the report at http://tiny.cc/735iby
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D4. Life Begins at Home
Life begins at home is a guide to housing for families and children and a training and development resource for housing, health and social care staff to help families with children with autism/learning disabilities that display challenging behaviour, to get the housing they need.
The guide and training resource can be accessed at http://tiny.cc/j85iby
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D5. Developing your local housing offer for health and care: Targeting outcomes
Jointly produced by Housing LIN and the CIH, this updated tool acknowledges the significance of housing as a partner and contributor to achieving the aims of health and social care services. With references to latest policy and practice, it is aimed at helping housing and support articulate and demonstrate the value of their services in terms of their partners’ targets and outcomes.
The resource can be accessed at http://tiny.cc/qzwjby
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D6. Serious Case Reviews, Amy and James - lessons for support and supported housing providers
This resource outlines the lessons for supported housing providers to be drawn from the preventable deaths of two people with learning disabilities. Both had lived in supported living schemes in Suffolk and died from complications arising from an untreated yet treatable medical condition – constipation.
The two Serious Case Reviews concerning these preventable deaths were published in October 2015.
The resource can be accessed at http://tiny.cc/lxwjby
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D7. Updated statutory guidance to support local authorities implement the Care Act 2014
The Department of Health has refreshed the Care and Support statutory guidance that supports implementation of part 1 of the Care Act 2014 by local authorities, the NHS, the police and other partners.
Most revisions have been made for reasons of accuracy or clarity. Some are more substantial, such as those around safeguarding and the previously announced postponement to the funding reforms. The changes reflect learning from the first period of implementation and feedback from stakeholders and partners.
Of note are updates to the safeguarding chapter highlighting the growing prevalence of internet and doorstep scams, and the role of professional and practice leadership in adult safeguarding. On this latter point, the guidance emphasises the need for expertise within organisations where practitioners and managers can go for advice and recommended courses of action.
There is also acknowledgement of the potential role of Principal Social Workers in this area of practice – a reflection of the growing importance of social work generally, as its inclusion in the tenets of the Care Act and other significant pieces of legislation testify.
The resource can be accessed at http://tiny.cc/w2xjby
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D8. Changing the culture of social work
TLAP, along with partners Skills for Care and Shared Lives Plus have released a new report that argues that the sector needs to reclaim social work so that it is community -focused and not constrained within a mechanistic case management approach.
The report shows that social workers need to be supported to change their working culture to focus on wellbeing, early intervention and prevention. This support must occur if social workers are to improve lives of people in adult social care and deliver sector efficiencies.
The report can be accessed at http://tiny.cc/ovxjby
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D9. Paving the Way
The Challenging Behaviour Foundation, together with the Council for Disabled Children (CDC), has launched a new website called ‘Paving the Way!’
‘Paving the Way’ is the new name for the Early Intervention Project, which is now in its third year. The project has centred on helping families who are raising children with learning disabilities and behaviour described as challenging to get the right information and support early on. The Paving the Way website aims to collect together the information and resources that the project has generated in one easy-to-navigate site.
The website aims to provide families with the information they need, and also to raise awareness of the fact that evidence-based early intervention, delivered locally, has the potential to reduce challenging behaviour and to improve wellbeing.
One section of the new website, titled ‘Learning From Families’, is dedicated to family stories. This section gives real life examples of what has been helpful for families of children with severe learning disabilities and behaviour that challenges.
The website is also intended to inspire professionals and commissioners to develop good services, and has a section giving examples of good practice, as well as a section of useful resources. The site also features a blog, which we will be updating regularly with new project information or related developments, as well as with contributions from guest bloggers.
You can visit the new website, and leave feedback, at: www.pavingtheway.works
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D10. Psychotropic drug prescribing for people with intellectual disability, mental health problems and/or behaviours that challenge: practice guidelines
There are ongoing concerns that psychotropic drugs are used inappropriately in people with learning disability.
This good prescribing practice guidance from The Royal College of Psychiatrists, aimed at primary and secondary healthcare clinicians, proposes standards for improving clinical practice in this area. It covers the prescription of any psychotropic medication, including antipsychotics, antidepressants, anxiolytics and mood stabilisers, and sets out a framework for clinicians on how to rationalise their prescribing practice and, where appropriate, taper and stop psychotropic drugs. It also serves as a resource for those providing a statutory second opinion.
The resource can be accessed at http://tiny.cc/tzzjby
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