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Policy Briefing
September 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. Government extends suspension of minimum wage enforcement in the social care sector
On 28th September the government announced a further one-month suspension of minimum wage enforcement concerning sleep-in shifts in the social care sector to minimise disruption to the sector and seek to ensure workers receive the wages they are owed.
This follows July’s decision to waive all historic penalties in the sector where employers incorrectly paid workers a flat-rate for sleep-in shifts instead of hourly rates. This was in response to concerns over the combined impact which financial penalties and arrears of wages could have on the stability and long-term viability of providers.
During this temporary pause, the government will develop a new enforcement scheme for the sector to encourage and support social care providers to identify back pay owed to their staff. This will help to minimise the impact of future minimum wage enforcement in the sector while seeking to ensure workers receive the arrears they are owed.
Exceptional measures announced in July will remain in place until guidelines on this new approach are outlined next month.
The full announcement is available here: http://tiny.cc/8qozny
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A2. New bill to improve patient safety
A safety organisation drawing on lessons from the airline industry will have new legal powers to investigate serious patient safety incidents in the NHS in England, under plans laid before parliament on 14 September 2017. The draft Health Service Safety Investigations Bill will establish and enshrine in law the powers of the Health Service Safety Investigations Body (HSSIB).
The HSSIB will take forward the work of the current Healthcare Safety Investigation Branch, which came into operation in April 2017 as a division of NHS Improvement.
Under the proposals, the HSSIB will be independent of the NHS and at arm’s length from government. It will have far-reaching access to investigate serious safety incidents or risks to patient safety.
After each investigation is completed, the HSSIB will publish detailed reports which will:
- make recommendations for system-wide learning across the NHS
- help develop national standards on investigations
- provide advice, guidance and training to improve investigative practice across the health service
Further detail is available here: http://tiny.cc/ttozny
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A3. A further 19 hospitals in England will benefit from extra funding for emergency care over winter.
On September 8th government announced that a further 19 hospitals across England have been given a cash injection of over £13 million for emergency care to improve patient flow through A&E, ensuring departments are prepared for busy times during winter. The additional funding brings the total given to hospitals since April to over £90 million, part of the dedicated funding announced in the Spring Budget.
Detail of the latest funding allocations can be found here: http://tiny.cc/kvozny
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A4. What does the public think about the NHS?
The Kings Fund has launched a project on the changing relationship between the public and the NHS, which will explore what the public thinks about the NHS. Over the next few months, The Kings Fund will be asking:
- what do the public think the NHS is for?
- how has this changed over time?
- what drives the relationship between the NHS and the public?
- are public expectations changing?
- where does the balance of responsibility for health lie between the NHS and the individual?
To begin this process the organisation commissioned Ipsos MORI to conduct a survey on the public’s attitude to the NHS, including; do the public believe the NHS should be maintained? Do they still believe in its founding principles? What do they see as their responsibility when it comes to their own health? Do they want a say in how decisions that affect the NHS are made? Do they think people’s expectations of the service are realistic and do they think those expectations are being met?
Further information on the project and the outcomes of the survey can be found here: http://tiny.cc/ywozny
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A5. The bottom line: Understanding the NHS deficit and why it won’t go away
On 31st August the Nuffield Trust produced a briefing revealing ‘the true underlying state of the NHS’s finances today, and outlining prospects for the next three to four years.’
The Department of Health accounts, published in July, showed a nominal improvement in the NHS’s reported financial wellbeing in 2016/17, with a modest underspend of £560 million on its £118 billion budget for current expenditure in England – compared to an effective £200 million overspend in 2015/16.
But the Nuffield Trust concludes ‘there is little doubt those headline figures mask continued serious difficulties, particularly for the 238 separate NHS hospitals and other NHS provider trusts in England that provide the vast bulk of NHS-funded ‘secondary care’, comprising acute hospital, specialist, community and mental health care. Together those organisations consume well over two-thirds of the DH’s total spending. So when they catch cold, the rest of the NHS does too.’
The full briefing is available here: http://tiny.cc/gyozny
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A6. ‘Decisions are being taken out of our hands’ – social workers on care cuts
On September 19th Community Care published the findings of a survey of social workers. The survey was conducted by Community Care and the Care and Support Alliance, a coalition of over 80 charities representing older and disabled people and their carers.
More than two-thirds (68%) of the 469 social workers and other care assessors in England who responded to the survey said they were expected to cut people’s care because of budget pressures within their council.
More than a quarter of respondents (28%) also said they did not feel confident that the reductions they have made to care packages were fair or safe.
The survey also found that:
- Less than half of respondents (43%) felt decisions about a person’s care and support were being left to their professional judgements.
- More than a third (37%) said they felt unable to get people the care they need.
- Less than half (38%) felt supported to have difficult conversations with service users and their families about meeting needs and changes to their care.
Further detail is available here: http://tiny.cc/y0ozny
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A7. Councils warn of ‘catastrophic impact’ if government withholds social care funding
Community Care reports that thirteen West Midlands council leaders have written to health secretary Jeremy Hunt seeking 'urgent assurances' that cash linked to meeting delayed discharge targets will be released.
The West Midlands leaders criticised the government’s targets for reducing DToC numbers as unrealistic.
“For many CCGs and local authorities, including over half in the West Midlands, this is simply unachievable,” their letter said. “These local authorities have instead submitted trajectories to meet the target over a longer timescale.”
The letter also raised questions over the accuracy of the government’s DToC data, which apportions blame for delayed discharges from hospital on health or social care services, or both.
Detail is available here: http://tiny.cc/f2ozny
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A8. NHS trust pleads guilty over Connor Sparrowhawk’s ‘entirely preventable’ death
The chief executive of an NHS trust responsible for the care of a teenager who drowned in a bath after an epileptic seizure has said she is “truly sorry” the organisation failed to keep him safe.
Southern Health NHS Foundation Trust pleaded guilty to breaching health and safety law at Banbury magistrates’ court on 18 September, following a criminal prosecution by the Health and Safety Executive relating to Connor Sparrowhawk’s death in 2013.
Further detail is available here: http://tiny.cc/83ozny
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A9. Community Care: How ‘personal’ are personal budgets in 2017?
The Care Act 2014 gave personal budgets a big push, stating for the first time that everyone with an eligible need for social care should be given one. This was in keeping with the view that personal budgets are an effective mechanism for putting the philosophy of ‘personalisation’ into practice.
However, comments from many respondents to a survey undertaken earlier this year by Community Care, supported by the Care and Support Alliance, suggest that the choice personal budgets are designed to offer is rapidly disappearing.
Further detail can be found here: http://tiny.cc/a7ozny
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A10. Disabled man loses landmark Care Act appeal over care package cut
A disabled man who lost a High Court challenge over cuts to his care package has had his case dismissed by the Court of Appeal.
Luke Davey, 41, had appealed Justice Morris’ ruling that there was “no relevant legal error” in Oxfordshire council’s decision to cut his weekly personal budget by 42%.
Davey appealed on the grounds that the judge made “very significant errors” when rejecting his argument that a risk to his wellbeing would arise as a result of the cut.
His case, believed to be the first dealing with the Care Act’s wellbeing principle, was dismissed in the Court of Appeal last week. The judges, Lord Justice McFarlane, Lord Justice Bean, and Lady Justice Thirlwall, concluded that the “very significant reduction” to Davey’s personal budget had been reached “at the end of a lawful process”.
More detail is available here: http://tiny.cc/qj4zny and http://tiny.cc/4n4zny
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A11. UN panel criticises UK failure to uphold disabled people's rights
The UK government is failing to uphold disabled people’s rights across a range of areas from education, work and housing to health, transport and social security, a UN inquiry has found.
The UN committee on the Rights of Persons with Disabilities examined the government’s progress in fulfilling its commitments to the UN convention on disabled people’s rights, to which the UK has been a signatory since 2007.
Its report concludes that the UK has not done enough to ensure the convention – which enshrines the rights of disabled people to live independently, to work and to enjoy social protection without discrimination – is reflected in UK law and policy.
More detail is available here: http://tiny.cc/xl4zny
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A12. MPs launch inquiry into children’s services thresholds as social workers struggle under budget cuts
MPs have launched an inquiry into children’s social care thresholds after social workers warned that the levels of need required before children can receive support have risen.
A survey by the National Children’s Bureau, in association with the British Association of Social Workers (BASW), found that 70% of 1,646 social workers said the threshold for qualifying as a child in need had risen over the past three years as financial considerations played a larger role in practice.
Six out of 10 social workers also felt that finances available to children’s services influenced decision making “very much” or “to a great extent”.
More detail is available here: http://tiny.cc/zt4zny
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A13. ‘Councils warn of ‘catastrophic impact’ if government withholds social care funding
Local authority leaders from across the West Midlands have written to health secretary Jeremy Hunt seeking “assurance as a matter of extreme urgency” that the government will release £150m intended for adult social care.
In a letter seen by Community Care, the 13 council bosses warn of “a catastrophic impact on local people” if any of the money is withheld.
In July, the government told councils that if they did not meet – by September – targets for reducing delayed transfers of care (DToC), their funding allocations could be cut. The number of delays attributed to social care services has repeatedly reached record levels during the past year.
Over the summer the Independent reported on a letter, sent by the Department of Health to councils responsible for delivering social care, warning that NHS England would hold authorities “to account” for delivering targets before the winter, and “take action” if they did not meet them.
More detail is available here: http://tiny.cc/ak5zny
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B. RESOURCES
B1. King’s Fund briefing: What is commissioning and how is it changing?
Commissioning is the process by which health and care services are planned, purchased and monitored. Here we look at the commissioning process in more detail, the organisations involved and how it is changing.
The briefing is available here: http://tiny.cc/6h5zny
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B2. Transforming Care: Our Stories
The CBF, National Autistic Society, Sense, Scope and Mencap have gathered the experiences of people with learning disabilities and/or autism who have been in inpatient settings. A report has now been published, containing the stories of 13 families and recommending actions for the Transforming Care programme and wider services.
The report can be downloaded here: http://tiny.cc/no5zny
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B3. Planning Your House
People with learning disabilities and behaviours described as challenging have
the same rights as everyone else to appropriate local housing and support. The CBF has recently published an updated ‘Planning Your House’ resource, which provides information and advice to families who are planning personalised living options for their relative.
This information pack gives guidance on what to consider when choosing a property for a person with learning disabilities, such as who to live with, the type of home, ideas for adapting existing homes and what help is available to support your relative living there.
View at: http://tiny.cc/1p5zny
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C RESEARCH
C1. Latest MH Learning Disability Statistics
Data collected at the end of August 2017 shows that:
- 2,460 patients were in hospital at the end of the reporting period.
- There were 105 admissions to hospital.
- There were 135 discharges/transfers from hospital
- In the past 8 months, more patients were discharged than admitted to specialist hospitals. 135 patients left hospital in August 2017, 90 (68 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 August 2017, 62 per cent had a total length of stay of over 2 years.
- Approximately 41 per cent of the 2,460 patients in hospital in August 2017 travelled over 50km to get to the specialist hospital.
More data can be accessed at http://tiny.cc/8e4zny
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C2. DWP Reports Suggest that Empathy Engages People Far More than Sanctions
These research reports commissioned by the DWP (Department for Work and Pensions) evaluate trials of three forms of ‘additional support’ for Employment and Support Allowance (ESA) claimants. The trials took place in 2015 and the additional support included:
- Voluntary early intervention.
- The Claimant Commitment.
- More intensive support.
Analysis of these reports from Disability Rights UK showed that “the reports place emphasis on empathy in relation to a claimant’s needs rather than the current ‘sanctions stick’ approach. In fact, many claimants did not see the voluntary or mandatory nature of participating in the trials as making a difference to their engagement and were least engaged by the mandatory trials.”
To read more, visit: http://tiny.cc/ke4zny
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C3. 'Someone Cares if I'm Not There' - Loneliness Report
A research report was recently launched by Sense in collaboration with the Jo Cox Commission on Loneliness. Working with 20 organisations, they found that half of disabled people are lonely, with reasons relating to a range of social barriers including poor access and negative attitudes towards disabled people. Their recommendations include:
- Tackling social attitudes - Voluntary sector organisations and the Office for Disability Issues (ODI) should deliver public awareness campaigns to promote increased understanding and acceptance of disabled people.
- Professional training - Professionals should be aware of the risk and impact loneliness, and provide specific support to help disabled people develop and maintain social networks.
- Improving access to services - Good quality social care support in the home and community can support people to remain independent and fully engaged in their communities.
- Investment in intervention services - Local authorities must recognise the importance of preventative intervention services.
- Accessible transport - The Department for Transport should ensure that transport is accessible to all, and local authorities should ensure that there is a sufficiency of accessible transport.
- Financial support - Department for Work and Pensions needs to ensure that rates of financial support provided by the welfare benefits system are set at a rate that allows people to remain independent, retain social connections and participate fully in society.
- Access to employment - Better support and access to employment opportunities can be a key way to prevent loneliness for disabled people. Disabled people should be able to access personalised and tailored employment support, which is optional and appropriate.
You can read the report here: http://tiny.cc/fh4zny
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C4. Home from hospital: How housing services are relieving pressure on the NHS
This National Housing Federation case study report showcases 12 examples of schemes where people get the care and support they need outside of hospital wards.
Written by the Housing LIN, it articulates the housing offer and the diverse housing and health services provided by housing associations and local authorities. These include:
- Temporary homes for people who cannot return to their own home immediately (known as a “step down” service);
- Extra care, and health and wellbeing services;
- Home improvements, including safety, sustainability and suitability of homes;
- Occupational therapists, telecare solutions and advice on housing options
With over 30% of their residents living with a disability or aged 60 or over, and given the predicted surge in this demographic, housing associations have stepped in to ensure patients are not stuck in hospital longer than necessary. This has freed up the NHS to deliver its services to those who need them most and prevent hospital re-admissions. However, this contribution is often small-scale and localised – and the report highlights what the significant cost-benefits that could be achieved if these services were extended.
More detail is available here: http://tiny.cc/2r4zny
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C5. Enabling People with Dementia to Remain at Home: A Housing Perspective
Published to coincide with World Alzheimer’s Month (opens new window) this report has been produced on behalf of the Dementia and Housing Working Group, and supported by partners Homeless Link (opens new window), Foundations (opens new window) and the Life Story Network (opens new window).
The report and the accompanying Executive Summary set out the key role housing providers, and in particular social housing providers, can play in supporting people living with dementia to stay independent in the home of their choice for as long as possible. Its findings are divided into ones directly relevant to those working in the housing sector and those that provide a platform for wider application; for example, to become more dementia-friendly
More detail is available here: http://tiny.cc/sz4zny
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