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Policy Briefing
July 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. Southern Health admit they caused Connor Sparrowhawk’s death
Connor Sparrowhawk died on 4th July 2013 when he was being looked after by the short term assessment and treatment unit at Slade House.
Southern Health NHS Foundation Trust have admitted they breached Connor Sparrowhawk’s human rights and that it caused his death.
They have accepted full responsibility for the death of Connor and has admitted that it was negligent and violated both Connor’s and his family’s human rights and did not give Connor the care the Law says it should have provided. They have said that:
- They should have kept Connor alive.
- Connor died when people made mistakes and they should have not made those mistakes
- There was problems in the way the unit and trust was run
Verita, an independent company who look at problems in health trusts said:
- Connor should have been kept safe
- Connor should not have died
- The care was not good enough
- The trust did not treat Connor’s Epilepsy properly
The trust agrees that Verita are right. The Inquest into how Connor died found some things that the Unit did wrong. The trust agrees that:
- Connor suffered neglect because the doctors did not help people to do a good job
- The nurses did not have enough training for Epilepsy
- Staff did not think about the risks to Connor
- Staff did not talk or listen to Connor’s family about his Epilepsy
The trust have produced a statement which can be found at: http://tiny.cc/99xpcy
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A2. Transforming Care Assurance Board Monitoring Report
The National Forum of People with Learning Disabilities and the National Valuing Families Forum have been working together to find out how transforming care is working for people and their families across the country.
They have been funded to do this work regionally by the Local Government Association. They will be producing four reports for the Transforming Care Assurance Board, which is co-chaired by Scott Watkin, self-advocate, and Alistair Burt, Minister for Care. The Board check the work that is happening around transforming care.
You can find their first easy read summary and full report here: http://tiny.cc/xmypcy
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A3. People with a learning disability denied care close to home
The government’s Transforming Care programme aims to move people with learning disabilities out of long-stay units a long way from their family, and into the community nearer to home.
Learning Disability Voices, who are a group of care providers working together, think this will not work because they say providers do not have the means to move people into the community safely and effectively. Learning Disability Voices have released their Care Crisis Manifesto.
You can find out more in on Learning Disability Voices website here: http://tiny.cc/ptypcy
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A4. Voluntary, Community and Social Enterprise Review
The final report of the VCSE Review has been published. The report, based on the largest ever review of the voluntary sector’s involvement in statutory health and social care, urges local hospitals, clinical commissioning groups and councils to do more to involve expert charities in the design and delivery of services of all kinds.
The report includes 28 recommendations which have been jointly agreed by the Department of Health, Public Health England and NHS England.
The full report and a short version comprising the vision and recommendations can be accessed at:
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A5. CQC Five Year Strategy
The CQC has published its strategy for 2016-21. Over the next five years it will focus on four priorities:
1. Encourage improvement, innovation and sustainability in care
CQC will work with others to support improvement, adapt our approach as new care models develop, and publish new ratings of NHS trusts' and foundation trusts' use of resources.
2. Deliver an intelligence-driven approach to regulation
CQC will use information from the public and providers more effectively to target resources where the risk to the quality of care is greatest and to check where quality is improving, and introduce a more proportionate approach to registration.
3. Promote a single shared view of quality
CQC will work with others to agree a consistent approach to defining and measuring quality, collecting information from providers, and delivering a single vision of high-quality care.
4. Improve efficiency and effectiveness
CQC will work more efficiently, achieving savings each year, and improving how we work with the public and providers.
The strategy can be accessed at http://tiny.cc/nwzpcy
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A6. More mental health patients sent hundreds of miles for care due to local bed shortages
Despite repeated calls to end the practice, the number of patients sent away from their local areas for acute admissions is rising. More than 5,400 mental health patients had to travel out of area for a psychiatric bed last year, research by Community Care and BBC News has found.
Figures obtained from 42 of England’s 56 NHS mental health trusts under the Freedom of Information Act revealed 5,411 patients were sent to out-of-area hospitals in 2015-16, up 13% from 4,093 in 2014-15. Some patients are being sent almost 300 miles for care due to their local units being full. One trust had to declare a major incident due to bed shortages. Half of the 56 trusts provided figures over five years. Among this group use of out-of-area placements rose 236% over the period, from 1,215 in 2011-12 to 4,093 in 2015-16.
More details are available here: http://tiny.cc/j60pcy
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A7. Best interests assessor role could be axed to cut costs of deprivation of liberty system
The best interests assessor role could be axed, and independent oversight of deprivation of liberty cases scrapped, under proposals being developed by the Law Commission. The commission has rolled back on a previous commitment that the BIA role would “be central” to a proposed replacement for the Deprivation of Liberty Safeguards (DoLS) that is being developed for ministers.
The commission’s draft scheme, published last year, recommended developing a strengthened version of the BIA role, provisionally named the ‘approved mental capacity professional’ (AMCP). But this update opens the door for the BIA role, which provides independent scrutiny of care placements considered to be potential deprivations of liberty, to be radically pared back or even scrapped entirely.
The only commitment the commission makes is to “considering whether” a limited group of people should receive additional independent oversight of their care from an AMCP. At present every care placement within the DoLS receives independent oversight. This is coordinated by BIAs.
The move would leave it for local authority and NHS commissioners to determine whether a person had
been deprived of their liberty in care that those commissioners had arranged. The commissioners would have to produce evidence, including a capacity assessment and arrange advocacy.
The proposals would give anyone deprived of their liberty the right to seek reviews or bring a legal challenge against the deprivation. However, the prospect of losing BIAs will spark concerns that key human rights protections for vulnerable groups will be weakened given the role currently provides independent scrutiny of care arrangements amounting to deprivation of liberty.
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A8. People with a learning disability to design ‘quality checks’ for NHS services
People with a learning disability are being asked to contribute to new tests which will help improve NHS services ranging from dentistry to acute care, NHS England has announced today.
The NHS Quality Checkers programme sees people with a learning disability employed to inspect local NHS services critically, to provide advice on how they can better meet their needs and those of other patients.
More information can be accessed at http://tiny.cc/us2pcy
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A9. Government to face legal challenge over deprivation of liberty safeguards funding
Four councils have launched a legal challenge against the government on the grounds it has failed to provide sufficient funding for the Deprivation of Liberty Safeguards (DoLS). Nottinghamshire, Richmond, Shropshire and Liverpool councils have lodged a judicial review against health secretary Jeremy Hunt, arguing he has created “an unacceptable risk of illegality” by leaving councils without adequate funds to meet their statutory duties to vulnerable service users.
The councils also claim Hunt has breached the government’s “new burdens” doctrine by failing to increase the funding provided for DoLS despite the Supreme Court’s landmark ‘Cheshire West’ ruling in March 2014 triggering a tenfold rise in cases. The local authorities say government funding for DoLS has been maintained at around £34m a year. The Local Government Association has argued at least an additional £172m a year is needed to meet the costs of the Cheshire West judgment in relation to DoLS.
You can access the full Community Care article at: http://tiny.cc/kxyjby
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A10. Ruling on privately-funded care adds to deprivation of liberty caseloads
Councils could be forced to make hundreds of court applications to authorise the deprivation of liberty of people whose care is privately arranged through personal injury compensation deals, following a court ruling.
In the case of Staffordshire council and SRK, Justice Charles found the deprivation of liberty of a man [SRK] who received 24-hour specialist care from private providers was ultimately the state’s responsibility and needed to be authorised. The care package was funded from damages awarded as part of a compensation claim after the man sustained brain damage in a car accident.
There was no local authority or NHS commissioner involved in arranging the man’s care and the judge was asked to consider whether the care arrangements met the deprivation of liberty threshold, given a key element of the test is whether the care arrangements are the responsibility of the state.
You can access more details in the Community Care article at: http://tiny.cc/si3pcy
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A11. First case to be brought by CQC under powers to prosecute for health and safety incidents
A care provider has been fined £190,000 after it admitted failing to provide safe care for a severely disabled man who died after falling in a nursing home.
St Anne’s Community Services pleaded guilty to failing to provide safe care and treatment to Kevin McNally, 62, while he was a resident at the home in Birstall, West Yorkshire. McNally died in April last year.
The case, which was heard at Bradford Magistrates Court, is the first brought against a social care provider by the Care Quality Commission (CQC) under powers to prosecute for health and safety incidents introduced in April 2015.
McNally had Down’s syndrome, epilepsy, dementia and severe learning disability. Two care workers were helping him to shower when the commode chair fell forwards.
Staff at the home attempted to resuscitate him after the accident but he was later pronounced dead in hospital.
The CQC told Bradford magistrates the accident was ‘avoidable’ and St Anne’s Community Services had failed to adequately control the risk of serious injuries.
You can access more details in the Community Care article at: http://tiny.cc/0o3pcy
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A12. A Vision for Integration
The Local Government Association has released a report with the NHS Confederation, the Association of Directors of Adult Social Services and the NHS Clinical Commissioners. It will be the first place-based vision for integration, signed up to by the whole health and care system.
It calls for a radical transformation of services in order to cater for the needs of a society with increasingly chronic and complex health needs. The vision paves the way for integration and transformation to happen faster and to go further so that integrated and person-centred care becomes the mainstream.
You can access more details at: http://tiny.cc/243pcy
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C. RESEARCH & ANALYSIS
C1. Better care in my hands: A CQC review of how people are involved in their care
Better Care In My Hands describes how well people are involved in their own care and what good involvement looks like. People’s right to being involved in their own care is enshrined in law in the fundamental standards of care. It is an essential part of person-centred care and leads to better and often more cost effective outcomes.
This report is based on newly analysed evidence from CQC national reports and inspection findings, as well as national patient surveys and a literature review. It identifies what enables people and their families to work in partnership with health and social care staff and illustrates this with good practice examples from our inspection findings.
Key findings
- Just over half of people asked say they feel definitely involved in decisions about their health care and treatment.
- Women who use maternity services are particularly positive about how well they are involved in decisions about their care.
- CQC found examples of good practice of people’s involvement in their care in our inspections over the last year.
- There has been little change in people’s perceptions of how well they are involved in their health or social care over the last five years.
- Some groups of people are less involved in their care than others. They are: adults and young people with long term physical and mental health conditions. people with a learning disability and people over 75 years old.
- CQC have also reported a lack of progress over the last six years in involving people in their care when they are detained under the Mental Health Act.
The report can be accessed at http://tiny.cc/lczpcy
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C2. Thought Leadership: How do disability organisations recruit, retain and develop the right workforce?
The social care sector will need to fill around 400,000 jobs by 2035. In the light of this reality, how can providers create a competitive edge in local labour markets and transform the sector into a career of choice?
Following a summit held with over 100 chief executives and senior directors in the sector alongside Skills for Care and Charityworks, VODG have launched a new report rising to these challenges.
The report can be accessed at http://tiny.cc/u2zpcy
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C3. Research on carers assessments
A survey of more than 6,000 carers carried out by Carers UK revealed nearly a third (29%) of all carers who’d been offered a carer’s assessment, or requested one, waited at least six months to be seen.
The percentage was higher (39%) for those supporting people who had a palliative or end-of-life condition, a finding the charity described as “alarming”.
The survey found just half of all carers had been offered (28%) or asked for (22%) a carer’s assessment since the legislation came into force.
Feedback from carers who had been assessed revealed a number of concerns over the quality of assessments:
- Only a third (36%) felt the assessment properly considered the support they needed for their own physical and mental health.
- A similar proportion (33%) felt their need for replacement care to allow respite from their caring duties was properly taken into account.
- One in five (21%) felt they received little or no helpful information after the assessment. A further 45% felt they got some but not all the information they needed.
Issues with the support provided to carers who also have paid jobs was highlighted in the survey. Almost a third (31%) of carers said the support they needed to manage working alongside caring was not properly assessed and half of those surveyed had given up work to care.
Carers cited more domiciliary support, help with tasks like shopping and support with coordinating care as key areas that would help them remain in or return to work.
Carers UK said the findings showed the promise of the Care Act “had not become a reality for all”. The charity called on local authorities to review how carers were supported.
The Community Care article can be accessed at http://tiny.cc/7e0pcy
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C4. How well is the Mental Capacity Act being used in care homes?
The Mental Capacity Act is not as embedded in practice as it should be across health and social care. Care homes, despite pockets of good practice, are no exception.
The Law Commission’s review of mental capacity and deprivation of liberty legislation, and the formation of the National Mental Capacity Forum, seeking to further embed the act in practice, drew to Care England’s attention that our sector didn’t really know how well-implemented the act was, or how care home managers were supporting their staff to implement it in their day-to-day work.
They wanted to discover the ‘how’ and the ‘how much’ of Mental Capacity Act (MCA) implementation in care homes. They designed a survey to answer these questions: using membership networks and social media, they surveyed 84 care home managers across over 50 local authority areas.
The Community Care article outlining the results can be accessed at http://tiny.cc/vq0pcy
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C5. Research warns cuts making it more difficult to achieve health and social care integration
Increasing financial constraints on councils and NHS bodies are making it harder to achieve integrated health and social care, government-funded research has warned.
The study also found that engaging frontline staff in initiatives to integrate care was proving challenging in a climate where they were “firefighting” to keep existing services running.
Health and social care were beset by an “integration paradox” in which the financial environment made it ever more important to integrate care but, at the same time, made it more difficult to make progress in doing so.
The findings came from an early evaluation of the integrated care and support pioneers programme, a Department of Health initiative set up in late 2013 to test new ways of integrating care for people who needed the support of multiple care services.
The study, by the Policy Innovation Research Unit, assessed the initial 14 pilots from January 2014 to July 2015 and was largely based on interviews with 140 council, clinical commissioning group (CCG), NHS trust and voluntary sector staff involved in pioneers.
More information can be accessed at http://tiny.cc/jv0pcy
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C6. Peer Support For Employment
This report is from Disability Rights UK and the Work Foundation looks at where peer support is being used in practice. They used surveys and interviews to do this - including with disabled people’s organisations.
It concludes that the time is right to scale up and further test peer support for employment:
- There is high demand for peer support from disabled people. Disabled people involved report that peer support for employment offers hope, new belief in possibilities, encouragement, role models, relationships of trust, a new balance of power, holistic support with connected life issues and a sustainable support network
- There is an appetite to facilitate it from Disabled People’s Organisations and organisations in other sectors
- Government is seeking new approaches to support employment of disabled people/people with long-term health conditions, to fulfil its commitment to halve the disability employment gap. Previous programmes like the Work Programme have had poor results with these groups. In health, the 5-year Forward View cites the importance of evidence-based patient-led initiatives, including peer support, for the future NHS
- Peer support goes with the grain of wider social and economic trends. Forbes’ top business trends for 2016 include a connecting economy, in which successful business leaders create value by connecting customers (as with Airbnb or Facebook). It may be possible to create human value by mobilising the expertise of lived experience
- The Practice Examples in this report show promising practice. There is some evidence for peer support generally demonstrating a positive Return on Investment: for instance, Self Management UK have found that for every £1 spent on self-management courses, £2.24 is saved in reduced health service usage. Research finds positive outcomes from peer support generally: for instance, The Work Foundation cite one randomised control trial showing significantly improved employment for people accessing peer support. A literature review by Repper and Carter (2011) found evidence that peer support workers in mental health services could lead to reduced admissions, an increased sense of independence and empowerment, and higher self-esteem, confidence, social connectedness and community integration. Peer support reviews on employment specifically show a range of positive results in terms of securing employment, self-employment and promotions, sometimes (as with Journey to Employment and the DR UK Leadership Academy Programme) with emerging evidence of cost-effectiveness
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C7. The need for community: A study of housing for adults with learning disabilities
This report from the Centre for Social Justice analyses to what degree the current system of residential care and supported living schemes offers autonomy and control to adults with learning disabilities.
It focusses on the housing and care situations of those with complex needs and the accommodation problems experienced to enable more independent living.
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D. RESOURCES
D1. Autistic Spectrum Disorders Toolkit
There is an urgent need to improve healthcare of people with autism. New research shows that autistic people die on average 16 years earlier than the general population and the gap in mortality increases if they also have learning disabilities.
For this reason, GPs need to be aware of certain adaptations required when engaging with a patient who has autism so they can have the best health outcomes.
This Autism Toolkit aims to be a 'one stop shop', a user-friendly guide to autism for primary care professionals, people affected by autism, clinical commissioning groups, as well as interested members of the general public.
The toolkit has been developed in partnership with the Clinical Innovation And Research Centre. It can be accessed at http://tiny.cc/xhypcy
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D2. Best practice guides for young people with disabilities seeking employment
3 important resources have been launched that aim to help authorities, education providers and career advisers provide a more inclusive approach to employment for young adults following evidence that school leavers with special educational needs and disabilities (SEND) are finding it difficult to achieve their work ambitions.
Supported by the Department for Education (DfE), the National Development Team for inclusion (NDTi) and the British Association for Supported Employment (BASE) have worked to develop three guides that demonstrate best practice:
- A planning guide for schools, colleges and careers advisers on how to work with young people from year 9 onwards to understand the world of work and to think about their skills, interests and work aspirations.
- A guide for colleges on employer engagement on how to identify and work with local employers to understand their business needs and promote the skills and aspirations of individual young people.
- A guide for local authorities on how to connect with and understand employers and ensure that employment support for young people sits alongside authority-wide strategies for employment, housing and individual funding.
The guides can be accessed at: http://tiny.cc/0l0pcy
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D3. Dementia and housing: An assessment tool for local commissioning
Commissioned by Public Health England in partnership with Alzheimer's Society, the Local Government Association and the Housing LIN, this self-assessment tool focuses on local commissioning processes and decision-making. The main principle being applied in this tool is that all available assets and resources need to be combined, both to create the conditions that reduce the risk of developing dementia, and to develop a framework of support to help those with dementia, their families and carers, to have as good a quality of life as possible. Taking a system-wide approach, it:
- covers prevention and promotion of health and wellbeing at one end of the spectrum to specific targeted interventions for people with dementia at the other
- spans the whole commissioning cycle from analysing needs and supply/assets through to specific service procurement, as well as monitoring and review - it does not cover practice and procurement at an individual (customer/patient) level.
- targets all levels of the locality's market shaping and commissioning responsibilities for the local population, from the Health and Wellbeing Strategy, to local authority departmental strategies and plans. It is not intended to be used to review specific individual provisions or services.
You can access the tool at http://tiny.cc/735iby
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D4. New Integrated approach to assessing carers’ health and wellbeing
NHS England has published an “Integrated approach to identifying and assessing Carer health and wellbeing”. The toolkit:
- clarifies the new duties on NHS organisations under the Care Act 2014 and the Children and Families Act 2014
- provides a template Memorandum of Understanding (MOU) to support joined up working locally, and
- Includes numerous examples of positive practice of work that have proven successful in supporting carers and their families.
The toolkit will be invaluable in supporting the commissioning of Carer support services within new models of care.
Copies of the toolkit can be accessed online at: http://tiny.cc/q32pcy
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D5. Making it Real for Supported Housing
Making it Real for Housing is aimed at commissioners and service providers. It offers advice and case study examples to show how housing can be tailored to be person-centred and focussed on outcomes.
The guide is based around a set of ‘I’ statements that describes what good personalised care and support looks like from the perspective of people who use services.
The statements cover different areas of provision and activity that impact wellbeing. They are: information and advice, the role of active and supportive communities, flexible and integrated care and support, personal budgets and self-funding, workforce and risk enablement.
Making it Real guide for supported housing has been published by Think Local Act Personal (TLAP) and Sitra, part of Homeless link. The resource can be accessed at http://tiny.cc/lt3pcy
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D6. Free guide: People with Learning Disabilities in the Criminal Justice System
Family carers and learning disability providers are often asked to act as an 'Appropriate Adult' for a person with a learning disability whom they support, however, many are untrained and have little experience of the criminal justice system themselves.
This free downloadable guide explains the role of an 'Appropriate Adult' and provides information about the criminal justice system, explaining terms that we have often heard but not fully understood.
The resource can be accessed at http://tiny.cc/i13pcy
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