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Policy Briefing
August 2017
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 and Colin Elliott from Pathways Associates CIC.
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A. HEALTH & SOCIAL CARE
A1. Thousands of new roles to be created in mental health workforce plan
Health Secretary Jeremy Hunt launched a plan on 31st July to expand the mental health workforce. The plan sets out measures to tackle the ‘historic imbalance’ in workforce capacity and fulfil ambitions to improve mental health services. The government committed £1.3 billion to transform mental health services, with a pledge to:
- treat an extra 1 million patients by 2020 to 2021
- provide services 7 days a week, 24 hours a day
- integrate mental and physical health services for the first time
The plan has been developed by Health Education England (HEE) together with NHS Improvement, NHS England, the Royal College of Psychiatrists and other key mental health experts.
It shows how the health service will dramatically increase the number of trained nurses, therapists, psychiatrists, peer support workers and other mental health professionals to deliver on this commitment and tackle mental illness and inadequate treatment.
By 2020 to 2021 local areas will need to create 21,000 new posts in priority growth areas to deliver the improvements in services and support set out in the NHS’s Five Year Forward View for Mental Health.
Further detail can be found by following the link above, and here: http://tiny.cc/mtmdny
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A2. Government response to consultation confirms expansion of undergraduate medical education in England.
The Department of Health has published the government response to the recent consultation on expanding undergraduate medical education. The government will increase the number of student places at medical schools in England by 1,500.
From next year, existing medical schools will be able to offer an extra 500 places to future doctors. Another 1,000 places will be allocated across the country, based on an open bidding process.
The bidding process will be supervised by Health Education England and the Higher Education Funding Council for England.
The extra places will be targeted at under-represented social groups such as lower income students, as well as regions that usually struggle to attract trainee medics.
Further detail is available here: http://tiny.cc/fumdny
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A3. Care Act statutory guidance updates
During August 2017 the Department of Health made some slight amendments to the Care Act statutory guidance for local authorities.
The updated guidance and detail of the amendments are available here: http://tiny.cc/kumdny
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A4. Adult personal social services: revenue funding 2017 to 2018
On 26th July the Department of Health published details of local authority grant allocations. The local authority social services letter clarifies local authority specific revenue funding for the financial year 2017 to 2018, which was subject to the 2015 Spending Review.
It provides information on funding for the third year of Care Act implementation, which comes from a range of sources, as well as details of parts of the Better Care Fund.
Further detail is available by following the links above and the letter confirming local authority funding allocations can be downloaded here: http://tiny.cc/wumdny
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A5. Suicide prevention: Government Response to Health Select Committee
Someone dies by suicide every 90 minutes in the UK and in England 13 people die by suicide each day. Although attempting suicide, or feeling suicidal, can affect anyone, it typically affects the most vulnerable people and those from the poorest backgrounds living in the most disadvantaged communities. For example, men living in the most deprived areas have an up to 10 times higher risk of suicide than men living in more affluent areas.
The government has responded to the Health Select Committee’s inquiry into suicide prevention (prepared by the Department of Health in consultation with other government departments and agencies, including NHS England, Public Health England and Health Education England). The committee set out recommendations for improving delivery of the cross-government suicide prevention strategy.
The full government response can be downloaded here: http://tiny.cc/hxmdny
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A6. Drug misuse and dependency: government responses to ACMD reports
On 25th July 2017 the Department of Health published the Government’s response to the Advisory Council on Misuse of Drugs (ACMD) reports on:
- opioid substitution therapy
- reducing opioid-related deaths in the UK
- diversion and illicit supply of medicines
- independent prescribing of controlled drugs by therapeutic radiographers
Detail is available here: http://tiny.cc/12mdny
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A7. What are the priorities for health and social care?
On 8th August 2017 The Kings Fund published an article setting out key issues faced by the Health and Social Care sectors, and therefore government.
Key messages include:
‘Rising demand for health care means that the NHS is treating more patients than ever before. Between 2003/4 and 2015/16, the number of admissions to hospital increased by 3.6 per cent a year. At the same time, the health service is enduring a prolonged slowdown in funding. Under current spending plans, the NHS budget will increase by an average of 1.1 per cent a year between 2009/10 and 2020/21, compared to a long-term average increase of nearly 4 per cent a year since the NHS was established.
The mismatch between demand and funding means that NHS services are struggling to maintain standards of care. All areas of care are affected, with acute hospitals, general practice, mental health and community services all under strain.
‘While performance held up well in the early years of the decade, it has now deteriorated with key targets being missed all year round. For example, the four-hour standard for treating patients in A&E has not been met since July 2015, the 62-day standard for beginning treatment for cancer following an urgent referral has not been met for more than three years, while the 18-week referral-to-treatment target for elective care has not been met for more than a year and has effectively been downgraded. The Commonwealth Fund’s report showed that the NHS continues to lag behind other countries on key health outcomes such as infant mortality and survival rates for cancer, heart attacks and strokes, although the gap is closing.’
‘Seven years of austerity have left health and social care services facing unprecedented challenges. In the NHS, this is manifesting itself in financial deficits, longer waiting times for treatment and moves to ration services. In social care, the system is failing older and disabled people, their families and carers. The public is increasingly aware of these pressures and the outcome of the general election signalled growing public dissatisfaction with austerity.’
Yet, the election campaign saw little meaningful debate about the NHS. While social care was a key issue during the campaign, the result has been to set back progress towards fundamental reforms identified as urgent two decades ago. This followed an EU referendum campaign during which the key claim was that Brexit would result in a huge funding dividend for the NHS.’
‘The public deserve better than this. Politicians must be honest about the reforms needed and the funding required to deliver services to the standard people expect. If the government does not believe this is economically or politically possible, it must be clear with the public about the consequences and the inevitable deterioration in services that will follow.’
The full report is available here: http://tiny.cc/1ymdny
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A8. Primary Care Home: Evaluating a new model of primary care
On 24th August 2017 the Nuffield Trust published its evaluation of the Primary Care Home model - a way of organising care for groups of up to 50,000 patients.
Key points raised by the evaluation included:
- Participating in the primary care home programme had strengthened inter-professional working between GPs and other health professionals, and stimulated new services and ways of working tailored to the needs of different patient groups – for example, through targeting frail patients at risk of hospital admission.
- Policy-makers must accept that these new working relationships will take time to establish, as widespread service change requires support from people at all levels and across organisational boundaries.
- Developing the PCH model needs significant investment in time, money and support to enable change: as well as the £40,000 start-up grant, all of the rapid test sites in the study channelled further money and/or professional time into the PCH. Additional funding for general practice will need to be balanced with investment in the kinds of at-scale multidisciplinary work underway in PCH sites.
- The complex external context in which PCHs are emerging – particularly with the development of Sustainability and Transformation Partnerships – could help or hinder their development. Sites will need local commissioners to buy in to the PCH vision and fund pilots of new services, which may be difficult with regional priorities restricting their clout to support enthusiastic sites.
- Good quality data – and the ability to use it – are essential for future evaluations of these models. During the evaluation, good progress had been made by the rapid test sites to select metrics and identify data but none had yet established a systematic process for tracking progress against a defined set of metrics or costs in the first six months. The lack of joined-up data between different parts of the NHS and social care could further impede progress.
The full report is available here:
https://www.nuffieldtrust.org.uk/research/primary-care-home-evaluating-a-new-model-of-primary-care
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A9. Will the NHS really need fewer beds in the future?
After a recent review of Sustainability and Transformation Plans (STPs) by London South Bank University, the Nuffield Trust uses hospital data to take a closer look at the scale of the task they face in reducing the number of beds, and where they might concentrate their efforts.
The article is available here:
https://www.nuffieldtrust.org.uk/news-item/will-the-nhs-really-need-fewer-beds-in-the-future
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A10. Emergency measures to ease DoLS pressures
Emergency reforms to the Deprivation of Liberty Safeguards are likely to be introduced to ease pressures as plans to replace the system have been shelved for at least two years, Community Care has learned.
Government officials are looking at ways to amend the regulations or the code of practice underpinning the DoLS that would help councils tackle the backlog of more than 100,000 cases that has built up since the Supreme Court’s 2014 ‘Cheshire West’ ruling.
This is because plans drawn up by the Law Commission for a full-scale replacement to the DoLS have been put on hold until at least 2019 because there is no space for it in the government’s programme due to Brexit.
Emergency measures under consideration include relaxing the statutory timescales for DoLS applications and the criteria for DoLS assessors, including best interests assessors (BIAs) and mental health assessors.
More detail is available here: http://tiny.cc/5ipdny
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A11. The State of Adult Social Care Services & Mental Health Services 2014 to 2017
The CQC have published the State of Adult Social Care Services 2014 to 2017. They found that across nursing homes, residential homes, domiciliary care agencies and community social care, a higher proportion of learning disability services were rated as good as compared to non-learning disability services. Overall, community social care services were rated the most positively, with nursing homes remaining the biggest concern and smaller services tended to be rated better than larger services. You can find the full report here: http://tiny.cc/pqpdny
The CQC have also published their State of Mental Health Services 2014 to 2017 Report this month. The report highlights that in services for people with a learning disability or autism:
- Over one third of inpatient services for people with a learning disability or autism were rated as requiring improvement for safety
- Just under one third of inpatient services were rated as requires improvement for effectiveness
- In some inpatient services there is high use of restrictive interventions (including physical restraint and seclusion)
- CQC “frequently encountered patients who had been in hospital for a long time”
- In “too many” services staff were not following or applying the Mental Capacity Act appropriately
You can read the full report here and the CBF press release here. http://tiny.cc/orpdny
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A12. Man with learning disabilities wins damages after sex education delay
A local authority has agreed to pay £10,000 in damages to a man with learning disabilities after it breached his human rights by delaying him with the sex education required to help him gain capacity to consent to sexual relations.
In a Court of Protection ruling last month, judge Sir Mark Hedley said the case may be “unique” since it addressed the question of capacity to consent to sexual relations within a marriage, while other cases where the courts had made declarations of incapacity to consent generally concerned “restraining sexual disinhibition to protect from abuse or the serious likelihood of abuse”.
He found that the man was entitled to compensation since he did not start to receive sex education, which was recommended following a capacity assessment by a consultant psychologist, until more than a year after his wife had been told by the council to abstain from having sex with him.
More detail is available here: http://tiny.cc/wlqdny
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A13. ‘Flawed’ use of Mental Capacity Act key theme in safeguarding adults reviews
There are “fundamental flaws” in how the Mental Capacity Act is understood and applied in practice, a report on findings from safeguarding adults reviews (SARs) has concluded.
The analysis of 27 SARs completed by authorities in London found mental capacity was the area of practice where lessons most commonly needed to be learned.
Mental capacity was mentioned in 21 of the 27 reports, the analysis found, and much of the learning was around missing or poorly-performed capacity assessments, an absence of best interests decision-making, and a lack of scepticism and respectful challenge of decisions.
Four of the reviews commented on the difficulties practitioners experienced in reaching a “confident or agreed decision” in a mental capacity assessment, the report said.
Another two mentioned the use of advocacy services as a significant area of learning. In both cases, a referral for an independent advocate was made too late to be effective in supporting the individuals, who had no other source of support to take part in decisions.
There was an “occasional comment” in one case where mental capacity had been well addressed, the report said, but the majority of the evidence pointed to “fundamental flaws” in how the Mental Capacity Act 2005 was being understood and applied in practice.
Other common practice issues included:
- Inadequate or absent risk assessments, or the failure to recognise escalating risks.
- A lack of personalised care.
- A failure to involve carers and recognise their needs.
- A lack of understanding or curiosity about people’s history and behaviours.
- A failure to be persistent and flexible when working with people who are reluctant to engage with services, and to take the time to build trust.
More detail is available here: http://tiny.cc/cvqdny
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A14. Healthwatch England says care plans should be reviewed more than once a year
A report by Healthwatch, the service user watchdog, has said reviews of people’s care and support plans should be completed more frequently than once a year. The report said reviewing care plans should instead be a “continuous process”, particularly in cases where a person’s ability to do things for themselves might be changing rapidly. Under the Care Act, councils should review care plans no later than every 12 months.
More detail is available here: http://tiny.cc/2xqdny
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B. RESOURCES
B1. Better health for people with learning disabilities
This guidance document and an accompanying film has been commissioned by NHSE, and is designed to support social care providers who want to improve the health and therefore the lives of the people they support. Specifically, it is about the important role they can play to ensure that people with learning disabilities:
- are on the GP learning disability Quality and Outcomes Framework (QOF) register
- get annual health checks
- have additional information on their Summary Care Record that says what reasonable adjustments they need
The guide is available here: http://tiny.cc/vbndny
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B2. Personal Health Budgets for children and young people with complex needs
This report follows recent work by NDTi around Personal Health Budgets(PHBs) for children and young people in Plymouth, Hampshire and Derbyshire. It includes a supporting Top Tips document, which suggests the crucial 'building blocks' necessary to support developing PHBs. It includes key learning points;
- There has been some joint planning which has worked well. For example, one plan was developed in a mainstream school. An advocate was present, and lots of actions regarding preparing for adulthood were identified. It was reported that this process was leading to a better way of working as the conversations were ‘different’. However, although there is a clear link between this type of planning and Education, Health and Care Plans (EHCPs), planning is not currently well tied in with EHCPs.
- The role played by a third sector partner, the Enham Trust, and the skills around individual service design and support planning they possessed is particularly important for this type of work and should be embedded locally through the partnership.
- Clear communication is critical to the success of this work. There is a need for clear information for children/young people and families about what Personal Health Budgets are, and what can be achieved. Stories of a local child/young person with a PHB can illustrate this.
- There is a need for a clear process around accessing Personal Health Budgets that can be shared with families so that they know what the steps to a PHB are, what will happen and when.
The report can be downloaded here: http://tiny.cc/7tndny
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B3. Housing and Learning Disability: Transforming care and support
In recent months, HACT and the Housing LIN have been working with NHS England and a select number of localities to help them explore how they might further develop their work within the Transforming Care Partnerships (TCP) and, in particular, how they could help the TCPs to work more closely with housing providers. As part of the programme, the Housing LIN has published an online portal that provides a comprehensive, free-to-use, ‘e-knowledge hub’ to enable TCPs and their housing and care partners access latest policy, research and practice on housing and care matters for people with a learning disability. View at: http://tiny.cc/40pdny
In addition, the Housing LIN has produced a video, made with Hayley Burwood, Chair of Opening Doors in Norfolk that captures her housing and care circumstances. She powerfully demonstrates the need to listen to people with a learning disability about their independent living aspirations as they are the ‘experts by experience’. View at: http://tiny.cc/v1pdny
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B4. Personalised health and care framework
The framework provides advice and practical guides for the NHS and local government to support progress with Integrated Personal Commissioning and personal health budgets. It updates the personal health budgets toolkit, building on learning from implementation since 2012 and from the Integrated Personal Commissioning programme.
View at: http://tiny.cc/06pdny
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B5. Quality matters
The quality of adult social care matters. It matters because people who use services should be able to expect person-centred care that is safe, effective, caring and responsive. This care should be supported by good leadership and sustained by good use of resources. This document sets out a shared commitment to high-quality, person-centred adult social care. It has been produced to make a difference in care services by working across the sector with people who use these services and carers.
The document can be downloaded here: http://tiny.cc/aaqdny
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B6. Care and Treatment Review (CTR) workbooks
These workbooks are for panel members to record their findings during a Care and Treatment Review (CTR) or Care, Education and Treatment Review (CETR), based on the key lines of enquiry in the Key line of enquiry templates (KLOE) template. The workbooks are easy to follow and support panel members to be involved in gathering the information needed.
The workbooks can be downloaded here: http://tiny.cc/8cqdny
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B7. Care and Treatment Reviews: a Family Survival Guide
This is a great resource from Bringing Us Together and was made by and for families. This guide has been written to help families understand and cope with the Care and Treatment Review process. The guide is available here.
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B8. Delivering high quality end of life care for people who have a learning disability
Resources and tips for commissioners, service providers and health and social care staff.
The guide is available here.
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C RESEARCH
C1. Latest MH Learning Disability Statistics
Data collected at the end of June 2017 shows that:
- 2,460 patients were in hospital at the end of the reporting period.
There were 115 admissions to hospital.
There were 160 discharges from hospital
In the past 6 months, more patients were discharged than admitted to specialist hospitals. 160 patients left hospital in June 2017, 100 (64 per cent) were discharged back into the community.
Many patients have been in specialist hospital for a long time. Of those in hospital at the end of June 2017, 62 per cent had a total length of stay of over 2 years.
At the end of June 2017, just under half of the patients (49 per cent) were in a General security ward.
More data can be accessed at http://tiny.cc/56mdny
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C2. Housing Choices for People with Support Needs
The National Development Team for Inclusion (NDTi) believe that people should have choice and control over where they live and the support that they receive. Although there are a lot of different housing options for older people, people with learning disabilities and people with mental health problems, we know that a lot of people are living in traditional forms of housing and support such as residential or nursing care. Part of the reason for this is a belief that they are cheaper than other options. To get people talking and thinking about all of the different alternatives, NDTi have looked at the costs and characteristics of different housing and support options. This Insight summarises this work.
The article is available here: http://tiny.cc/75mdny
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C3. A whole system approach to meeting housing, health and wellbeing outcomes for our older populations in North West England
The Housing LIN North West Leadership Set commissioned this vision document to assess the gap in the likely supply and demand for housing with care in the region by 2030. It sets out challenges – and hopes – around older people’s housing in the region.
The paper can be downloaded here: http://tiny.cc/9vpdny
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C4. Habinteg Accessible housing policy update
This Habinteg briefing highlights the significant accessible housing deficit, seeks to inform and update housing professionals about policy developments that may affect them, and makes the case for including accessibility amongst their top priorities.
The paper can be downloaded here: http://tiny.cc/nypdny
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