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Policy Briefing
October 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. New £15 million grant scheme to improve mental healthcare
The Department of Health has launched a £15 million fund to better support people at risk of experiencing a mental health crisis.
The Beyond Places of Safety scheme will improve support services for those needing urgent and emergency mental healthcare. This includes conditions such as psychosis, bipolar disorder, and personality disorders that could cause people to be a risk to themselves or others.
The Beyond Places of Safety scheme will focus on:
- preventing people from reaching crisis point in the first place
- helping to develop new approaches to support people who experience a mental health crisis
Further information is available here:
https://www.gov.uk/government/news/new-15-million-grant-scheme-to-improve-mental-healthcare
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A2. New £15 million programme to help train one million in mental health first aid
A new £15 million programme will see up to 1 million people trained in basic mental health “first aid” skills. The programme will improve personal resilience and help people recognise and respond effectively to signs of mental illness in others.
The campaign, designed and delivered by Public Health England (PHE), will help people assess their own mental wellbeing and learn techniques to reduce stress.
There will be an online learning module designed to improve the public’s knowledge, skills and confidence on mental health.
These are skills for life, as most of us will at some point either experience poor mental health or care for a loved one trying to cope. The campaign will aim to build resilience and give people advice, based on what has been shown to work, so that we can all be better at supporting people experiencing poor mental health.
More information is available here:
https://www.gov.uk/government/news/new-15-million-programme-to-help-train-mental-health-first-aiders
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A3. Prime Minister announces review to tackle detention of those with mental ill health
Prime Minister Theresa May has announced plans for an independent review of mental health legislation and practice to tackle the issue of mental health detention.
There have been concerns that detention rates under the Mental Health Act – passed more than 3 decades ago – are too high. The number of detentions has been rising year on year. Last year on average there were 180 cases a day where people were sectioned under the terms of the act.
The Mental Health Act sets out rights and obligations that govern when and how the state can detain and treat someone in relation to their mental illness. It includes specific provision for individuals in contact with the criminal justice system.
People from black and minority ethnic populations are disproportionately affected, with black people in particular being almost 4 times more likely than white people to be detained.
The review will look at existing practice and evidence. It will consider the needs of service users and their families, in order to tackle injustices and improve how the system supports people during a mental health crisis.
In particular, the review will consider:
- why rates of detention are increasing – what can be done to reduce inappropriate detention and improve how different agencies respond to people in crisis
- reasons for the disproportionate number of people from certain ethnic backgrounds, in particular black people, being detained under the act, and what should be done about it
The review is part of a set of measures to improve mental health provision and tackle what the Prime Minister has described as the ‘burning injustice’ of mental illness.
Further detail is available here:
https://www.gov.uk/government/news/prime-minister-announces-review-to-tackle-detention-of-those-with-mental-ill-health
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A4. The Nuffield Trust: When the price isn't right: how cuts in hospital payments added up to the NHS deficit
NHS hospitals and other services ended the financial year 2016/17 with an underlying deficit of £3.7 billion. That is to say: they had £3.7 billion less reliable cash coming in than they had going out.
Hospitals are paid for each patient they treat, and the price they receive is set by a national tariff listing thousands of common procedures or types of care. But the prices on this list have been cut in real terms every year since 2009/10, and most years in cash terms too.
This means that a hospital will be given just £937 in cash this year to treat a patient they would have received £1,000 in cash to care for in 2009/10. Factor in eight years of inflation, and that £937 is more like £760.
Further detail is available here: http://tiny.cc/dooioy
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A5. The Nuffield Trust: What progress are large-scale GP practice organisations making across England?
Rapid shifts towards at-scale working have been underway in GP practices across the country in the last few years.
In 2015 The Nuffielfd Trust found that three-quarters of GP staff worked in practices that collaborated with others, with their aims focused on improving efficiencies in their practices and winning contracts to deliver more community-based care. But they also said that achieving these aims had taken them time. It took over two years for most collaborations to make progress beyond developing an organisational vision.
Two years on, The Trust sent out another survey to see how much progress has been made. Further information on what has changed and the current state of play is available here: http://tiny.cc/0qoioy
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A6. Association of Directors of Adult Social Services: Autumn Short Survey of Directors of Adult Social Services 2017
To find out more about in-year pressures on council adult social care budgets, ADASS circulated a short survey to all 152 directors in England. The survey was open for two weeks in September 2017 and 105 (69%) directors responded. There was a good spread of responses across all nine local government regions.
The report can be found here: http://tiny.cc/tyoioy
Margaret Willcox, ADASS President, said:
“Our latest survey findings should act as a fresh wake-up call to government that adult social care is coming perilously close to becoming unsustainable.
“The extra £2 billion in funding, while welcome, is simply a short-term fix and cannot hide the fact that by the end of this financial year, £6 billion has been cut from councils’ adult social care budgets since 2010 - with demand for our services growing all that time.
“This is simply unacceptable and needs to be addressed, not only in the Autumn Budget, but also in the promised consultation on the future of adult social care, because we cannot continue without sufficient and sustainable resources.
“Our latest survey makes this clear and paints a bleak picture. More than half of councils are already forecasting an overspend in adult social care budgets for this financial year and their top two concerns are both funding-related.
Further detail can be found here: http://tiny.cc/9yoioy
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A7. Government delays decision on funding backdated sleep-in payments
The government has delayed its decision about whether to support care providers in paying owed sleep-in payments to care staff by a further month.
During this time, until the beginning of November, providers will not be subject to enforcement by HMRC for not paying the minimum wage to staff on sleep-in shifts.
The government has said the decision would “minimise disruption” to the sector while it decides whether the industry needs further support. This could involve the government providing the sector with money to fund backpay though any such support would need to comply with European Union rules on state aid to private organisations.
The issue of backdated payments for employees of care providers doing sleep-in care services arose following an employment tribunal in May, which ruled that workers were entitled to the national minimum wage for sleep-in hours, rather than a fixed rate.
Details are available here: http://tiny.cc/f2ozny
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A8. Review criticises transition services for autistic young woman killed in care home
A serious case review into the killing of an 18-year-old woman has pointed to problems with her transition from children’s to adults’ services, risk assessments, and out-of-area placements.
Melissa Mathieson, who had ADHD and autism, died four days after she was attacked by Jason Conroy, then also aged 18, in the Alexandra House private home in Bristol in October 2014.
The serious case review, published by Bristol Safeguarding Adults Board, said her death could have been prevented if “better processes had been in place”, and pointed to a “limited risk assessment” of Conroy carried out by Alexandra House, which houses adults with autism or Asperger’s Syndrome.
Melissa’s parents felt her placement at Alexandra House by Windsor and Maidenhead council was “inappropriate”, and the review said it “seems likely that Melissa might not have required an out of area placement had her needs been met by local services”.
She had been diagnosed with ADHD aged 10, then with autism. When she turned 18 she was moved almost 100 miles from her home in Windsor to Alexandra House, as there was nowhere available in her home area.
Further detail is available here: http://tiny.cc/wbpioy
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A9. Councils’ use of prepayment cards risks contravening Care Act
The use of prepayment cards by councils as a tool to manage personal social care budgets is constraining service users’ right to exercise choice and control, a study has claimed.
The research, carried out via Freedom of Information (FOI) requests by the Independent Living Strategy Group (ILSG), a network of disability organisations and their allies, found almost half of local authorities in England used the cards. Instead of making direct payments into service users’ bank accounts, councils load up the cards with funds, are able to monitor them – at an individual transaction level – and in many cases choose to restrict their use.
Across the 69 areas using them, 15% of all personal budgets – nearly 33,000 in total – were managed via prepayment cards, the study found, with three councils using them for all or nearly all of their personal budgets. Contravening statutory guidance, some councils were allocating cards as a default mechanism, rather than offering other options such as direct payments.
While nearly all councils using prepayment cards said they considered them direct payments, roughly a third prohibited service users from directly withdrawing cash, as they would be able to with a regular bank account. A similar proportion said they allowed cash withdrawals, while the remaining third permitted withdrawals in certain circumstances.
The vast majority of authorities placed some other kind of restriction on how funds were spent, though the research found considerable geographical variance, creating a postcode lottery.
“Most common was a stipulation that the funds must be used as described in the individual care and support plan and to meet assessed eligible needs,” the report said.
Councils frequently imposed blanket bans – including blocking cards at certain establishments – around things such as food, alcohol, and dating and escort services. They also flagged up their ability to monitor spend and suspend cards if they were unhappy with transactions.
Under the Care Act 2014, all people receiving long-term care and support are required to have control of their personal budget – including having agency over how funds are held and used to meet their desired outcomes.
The statutory guidance on the Care Act says prepaid cards “can be a good option for some people using direct payments, but must not be used to constrain choice or be only available for use with a restricted list of providers”.
It adds: “It is also important that where a pre-paid card system is used, the person is still free to exercise choice and control. For example, there should not be blanket restrictions on cash withdrawals from pre-paid cards which could limit choice and control.”
Further detail can be found here: http://tiny.cc/57pioy
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A10. NHS trusts have fined councils up to £280,000 for delayed discharges
NHS trusts have issues fines of up to £280,000 to councils for delayed hospital discharges since 2016, a survey of directors has revealed.
Fines of £2,280 to £280,540 were levied on 16 councils in 2016-17, with 10 paying up; in 2017-18, eight councils have faced fines, of between £3,000 and £99,970, and six have paid them.
The figures come from an Association of Directors of Adult Social Services (ADASS) survey carried out last month, answered by 105 directors, 69% of the total.
In response to the results, ADASS president Margaret Wilcox said: “The idea of imposing further sanctions on already cash-strapped councils seems frankly bizarre.”
More detail is available here: http://tiny.cc/maqioy
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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. The flu jab for people with learning disabilities
The Confidential Enquiry into the Deaths of people with a Learning Disability (CIPOLD) found that breathing problems were a big reason that people have died. They have looked at this and Public Health England Vaccination and Immunisation Team have updated their guide. People with a Learning Disability are included as people who should be helped to have the Flu Vaccine. This report includes
- Making reasonable adjustments and what these can be
- Nasal Spray Vaccine Where to find other information about
- Policy about the Flu Vaccine Programme
- Information sheets for families and healthcare workers
- Easy Read and Accessible Information
The information can be found here http://bit.ly/2zcJp2I
There is a short video about a person with a learning disability having the flu vaccine here http://bit.ly/2wLpJBE
There is an easy read booklet about the Flu Vaccine here http://bit.ly/2kEcn8p
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B2. The actors with learning difficulties who are treading the boards
Actors with learning difficulties often struggle to get more than a token role in films or on stage. Now a new play is about to break new ground by giving a woman with Down’s Syndrome a starring role. The play, Joy, has been specially written for actors with learning disabilities… and without.
Watch the Channel 4 news item at http://tiny.cc/tlqioy
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B3. Developing support and services for children and young people with a learning disability, autism or both
This document provides guidance for Transforming Care Partnerships (and their local partners Clinical Commissioning Groups / Local Authorities) in commissioning support and services for children and young people with learning disability, autism or both.
This document can be accessed at http://tiny.cc/bwqioy
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B4. NHS England Information for People with a Disability to Access Doctors (GP) Online Services
NHS England has some leaflets for people with a disability to help them to access their doctor’s online services. The guides are about
- How to sign up for online services
- How to keep safe using the online services
- How to get access to your online services for a carer
There are guides for healthcare workers and guides for people and their families and carers. The Easy Read guides are
- GP online services - quick, easy and safe (A5 leaflet)
- GP online services
- What you need to know about your GP record online
- Protecting your GP online record
- GP online services for carers, including young carers
- How to support people with a learning disabilities – a guide for GP surgery staff
- Giving employed carers access to your GP online services
- Giving another person access to your GP online services
- Young people’s access to GP online services
The guides are available here http://bit.ly/2yXDYE0
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C RESEARCH
C1. Latest MH Learning Disability Statistics
Data collected at the end of September 2015 show that:
- 2,595 patients were in hospital at the end of the reporting period;
- 2,540 patients were in care from the previous month;
- 50 admissions to hospital;
- 100 discharges/transfers from hospital;
- 5 patients who were admitted and discharged/transferred in the period.
More data can be accessed at http://tiny.cc/y5oioy
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C2. The King’s Fund: State of health and care in England
The annual assessment of health and social care by the Care Quality Commission (CQC) provides a veritable treasure trove of information about the state of services in England. Based on inspections of 21,256 adult social care services, 152 NHS acute trusts, 197 independent acute hospitals, 18 NHS community health trusts, 54 NHS mental health trusts, 226 independent mental health locations, 10 NHS ambulance trusts, and 7,028 primary care services over three years, the assessment offers grounds for concern and reassurance in equal measure.
Detail of the full King’s Fund article can be found here: http://tiny.cc/avoioy
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C3. The King’s Fund: NHS hospital bed numbers:past, present, future
Key messages:
- The total number of NHS hospital beds in England, including general and acute, mental illness, learning disability, maternity and day-only beds, has more than halved over the past 30 years, from around 299,000 to 142,000, while the number of patients treated has increased significantly.
- Most other advanced health care systems have also reduced bed numbers in recent years. However, the UK currently has fewer acute beds relative to its population than almost any other comparable health system.
- Since 1987/8, the largest percentage reductions in bed numbers have occurred in mental illness and learning disability beds as a result of long-term policies to move these patients out of hospital and provide care in the community.
- The number of general and acute beds has fallen by 43 per cent since 1987/8, the bulk of this fall due to closures of beds for the long-term care of older people. Medical innovation, including an increase in day-case surgery, has also had an impact by reducing the time that many patients spend in hospital.
- While the rate of decrease in bed numbers has slowed in recent years, there are opportunities to make better use of existing bed stock by preventing avoidable admissions, reducing variations in length of stay and improving the discharge of patients. Efforts to make better use of the existing stock should focus on the relatively small number of mainly older patients who stay in hospital a long time.
- There are promising signs that some initiatives are succeeding in this. Emerging evidence from vanguard sites suggests progress in slowing rates of increase in emergency admission.
- However, research shows that initiatives to moderate demand for hospital care often struggle to succeed. Progress depends on having sufficient capacity to provide appropriate care outside hospital, yet evidence suggests that intermediate care capacity is currently only enough to meet around half of demand and cuts in funding have led to significant reductions in publicly funded social care.
- Today there are signs of a growing shortage of beds. In 2016/17, overnight general and acute bed occupancy averaged 90.3 per cent, and regularly exceeded 95 per cent in winter, well above the level many consider safe. In this context, proposals put forward in some sustainability and transformation plans to deliver significant reductions in the number of beds are unrealistic.
- In some areas, it may be possible to reduce the number of beds. However, at a national level, with hospitals under real strain from rising demand and a prolonged slowdown in funding, further significant reductions are both unachievable and undesirable.
- How hospital beds are used depends on the availability of other services, yet national data does not provide a full picture of NHS bed capacity. It is essential that the national audit currently being undertaken by NHS England provides a transparent, accurate and comprehensive picture of bed capacity.
The full report is available here: http://tiny.cc/bxoioy
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C4. Do we need to re-think our approach to choice, and giving people with learning disabilities the choices that are spoken of?
This Housing LIN viewpoint no 88 considers whether there is a real choice if the housing solution promoted for people with learning disabilities is limited by supply?
And secondly questions whether there is real choice if we only offer one solution, thereby making an assumption about what the demand should be?
The paper is available here: http://tiny.cc/ogpioy
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C5. National survey finds more adult care users need help with daily living,
The study by NHS Digital, based on a survey of councils with adult social services responsibilities, found there was a “statistically significant” increase, of between 0.7 and 1.3 percentage points, in the proportion of those needing help with six of eight activities.
The six activities were getting in and out of a bed (or chair); self-feeding; dealing with finances and paperwork; bathing; getting dressed; and using the toilet.
There were also increases for the other two activities – getting around indoors, and washing face and hands.
The report also found that 70% of people receiving social services care feel “as safe as they want”, up almost one percentage point from 2015-16, while 86.4% said the care and support services they received helped them in feeling safe, up one percentage point.
Other findings included:
- 65% of service users were extremely or very satisfied with the care and support services they received.
- Two-thirds of service users in the community reported they had enough choice over the care and support services they received.
- 45% of service users reported they had as much social contact as they would like. A fifth said they did not have enough or had little social contact, 16% had some social contact but not enough, and almost 6% had little social contact and felt socially isolated.
The report used data collected from a sample of 72,600 service users who participated in the annual survey, which was conducted for the seventh time. The data was then weighted to estimate the questionnaire responses for the whole eligible population of 653,000 service users.
Almost 70% of eligible service users were in community support settings, with the remainder in residential or nursing care.
The primary support need for more than half was physical support, with learning disability support accounting for just over one fifth and mental health support 11.5%.
More detail is available here: http://tiny.cc/zxpioy
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C6. Fathers with learning disabilities and their experiences of adult social care services
Fathers with learning disabilities feel let down by adults’ services, according to research.
A study carried out by the University of Bristol found that statutory services were failing to provide parenting support for fathers, and interventions were often focused only on mothers.
The lack of support was exacerbating the stresses fathers’ already felt about parenthood, and in some cases was contributing to serious mental illness, the study found.
The research was based on interviews with eight fathers with learning disabilities, aged between 26 and 60, and nine adult social care practitioners.
The fathers, many of whom had already experienced difficult lives, said the support from adults’ services tended to focus on housing, finance, and independent living.
They also viewed children’s services as being motivated mainly by safeguarding concerns, and said any interventions on offer tended to focus support towards mothers.
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More detail is available here: http://www.sscr.nihr.ac.uk/wp-content/uploads/RF76.pdf
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