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Policy Briefing
March 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. Spring Budget 2017 Health and Social Care Key Points
Philip Hammond has delivered his first Budget as chancellor. These are the key points in respect of Health and Social Care:
- £100m to place more GPs in accident and emergency departments for next winter
- Additional £325m to allow the first NHS Sustainability and Transformation Plans to proceed
- An extra £2bn for social care over next three years, with £1bn available in the next year
- Long-term funding options to be considered but so-called "death tax" on estates ruled out
- Most sugary soft drinks to be taxed at 24p per litre as part of plans to reduce childhood obesity
Further information is available here:
http://tiny.cc/jluxjy
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A2. The King’s Fund’s Response to the Spring Budget
The Chief Executive of The King’s Fund, said: ‘The additional money announced today is welcome recognition of the huge pressures facing social care. It will provide some short-term relief for older and disabled people, families and carers who are being let down by the current system.
‘The plan to publish a Green Paper on the future of social care funding is encouraging, but we have been here before. This time, the government must break the mould and deliver the radical reforms that are so badly needed.
‘A starting point for this should be the work of the Barker Commission, which recommends a new settlement for health and social care and a single budget to put them both on a sustainable footing for the future. This will need to be funded by reforms to existing benefits paid to older people, increases in national insurance and changes to taxation.
‘This winter the NHS has been buckling under the strain of meeting rising demand for services and maintaining standards of care. The Chancellor must address this in his autumn Budget or be honest with the public about the standards of care they can expect with the funding the NHS has been given.’
The full press release is available here:
http://tiny.cc/jmuxjy
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A3. The King’s Fund’s analysis of A & E Pressures
‘So far in 2016/17 the NHS has not met the four-hour standard, failing it every month of the year. The standard has now not been met for the past 17 months.
In quarter 3 2016/17 (October to December 2016), the proportion of patients spending longer than four hours in A&E reached its highest level for this time of year in more than a decade. Only 4 out of 139 hospitals with major type 1 A&E departments met the standard. It is now certain that 2016/17 will be the third year running that the NHS will miss the standard across the year as a whole.’
‘Trusts and CCGs remain pessimistic about future finances
Looking ahead, 53 per cent of trusts and 63 per cent of CCGs are fairly or very pessimistic about reaching financial balance in 2017/18. For CCGs, this has doubled from 30 per cent who were fairly or very pessimistic when they predicted their financial position for 2016/17 this time last year, underlining the spread of financial distress into the commissioning sector.’
Further information can be found here:
http://tiny.cc/gnuxjy
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A4. Independent report: Specialised health services recommendations
The Prescribed Specialised Services Advisory Group (PSSAG) is a Department of Health expert committee that was established in 2013 to provide ongoing advice to Ministers on whether services are specialised and should be nationally commissioned by NHS England, rather than locally commissioned by Clinical Commissioning Groups (CCGs).
Since its last report was published in March 2016, PSSAG has continued to provide advice to Ministers on specialised services and held meetings on 12 May 2016 and 28 October 2016. This report, published on 10th March 2017 presents PSSAG’s recommendations from both meetings and sets out Ministers’ decisions on each of the recommendations it made.
The full report can be found here:
http://tiny.cc/eouxjy
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A5. Consultation outcome: War pensions in social care financial assessments
This consultation response sets out how £14 million funding should be allocated to individual local authorities in 2017 to 2018. Regular payments made to veterans under the war pensions scheme will no longer be taken into account when conducting social care financial assessments.
Government’s response to the consultation and details of local authority financial allocations can be found here:
http://tiny.cc/8tuxjy
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A6. Updated Care Act Statutory Guidance
The updated edition of the guidance 24th February 2017supersedes the previous version. It takes account of regulatory changes, feedback from stakeholders and the care sector, and developments following the postponement of social care funding reforms to 2020. The revised guidance and a list of amendments are available here:
http://tiny.cc/yvuxjy
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A7. Department of Health Guidance on Adult social care: market shaping
This guidance (updated in February 2017) is aimed at people who buy social care services, including local authority and clinical commissioning group commissioners, as well as personal budget holders and people who fund their own care, care service providers and potential investors in the care sector.
Reference to the adult social care market includes independent care sector providers and support organisations – those that provide Care Quality Commission regulated services, such as care and home care, as well as unregulated care, such as personal assistants, volunteers and communities and informal family carers, and wider support services.
The full guidance is available here:
http://tiny.cc/rwuxjy
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A8. Government support for more than 19,000 victims of domestic abuse
On 17th February 2017 Communities Secretary Sajid Javid confirmed that 76 projects across the country will receive a share of £20 million to support victims of domestic abuse, creating more than 2,200 new bed spaces in refuges and other specialist accommodation.
Further detail along with a full list of funding allocations is available here:
http://tiny.cc/gxuxjy
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A9. Lack of social care is piling pressure on surgeries and A&Es
According to the Care and Support Alliance (March 3rd 2017) ‘almost 9 out of 10 GPs (89%) think reductions in social care are leading to extra pressures in their surgeries. Even more (93%) think that the lack of social care is leading to extra pressure on A&Es and contributing to increased delayed discharges from hospital.’
‘The poll of over 1000 GPs reveals an overwhelming 92% of GPs think social care services are failing to give patients sufficient care. Currently at least 1.2 million older people and disabled people do not receive the care they need, a 48% increase since 2010. When people don’t get the basic care they need, they are more likely to fall into crisis and need more expensive medical attention.’
Further detail of the finding from the poll of GPs is available here:
http://tiny.cc/byuxjy
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A10. Law Commission reveals Deprivation of Liberty Safeguards replacement
The Law Commission has delivered its final recommendations to ministers on replacing the Deprivation of Liberty Safeguards, after concluding the current system is “in crisis”.
The government asked the commission to review the DoLS amid concerns councils were failing to cope with a tenfold rise in deprivation of liberty cases triggered by the Supreme Court’s landmark ‘Cheshire West’ ruling in March 2014.
The commission has now published its final report and draft legislation for a new system to authorise care placements involving deprivation of liberty for people lacking capacity. The commission believes its proposed Liberty Protection Safeguards (LPS) scheme will be less onerous than the DoLS while still offering human rights protections.
The LPS would cover a broader group of people than the DoLS, which is restricted to placements in care homes and hospitals.
Firstly, the LPS would apply to any setting that might give rise to a deprivation of liberty, including shared lives schemes and supported living. Secondly, it would also cover 16 and 17-year-olds, whereas the DoLs only applies to over 18s.
While the scope of the LPS is broader than the DoLS, it would involve a two-tier system of protections whereas the DoLS provides the same checks to all cases.
Under the current system, every DoLS case is coordinated by best interests assessors (BIAs), typically specially trained social workers. The BIAs must set up six assessments, the most significant of which is a ‘best interests assessment’.
Under the LPS, the BIA role would be revised to a new ‘Approved Mental Capacity Professional’ (AMCP) role and the requirement for a best interests assessment in every case is dropped. AMCPs would only be focused only on more “serious” cases where care arrangements are contrary to the person’s wishes.
When a potential deprivation of liberty is identified, the responsible body, in social care cases a local authority, would be required to arrange a capacity assessment, a medical assessment and a check that the proposed care placement is ‘necessary and proportionate’ (in effect the latter replaces the ‘best interests’ assessment). The council would be required to consult with friends or family of the person.
Every case would then be checked by an ‘independent reviewer’, an employee of the responsible body who is not involved in the person’s care.
If the reviewer felt the conditions for an authorisation are met then they could approve it. However, if there are concerns the proposed placement is against the person’s wishes then the case would be referred to an AMCP. The AMCP would be required to meet with the person and scrutinise the assessments carried out before determining whether to authorise the placement or not.
“The Approved Mental Capacity Professional would be expected to consider matters using their own professional judgment rather than simply to consider whether those conducting the assessments could reasonably reach the conclusions that they did. The obligations upon them are therefore more onerous than upon the independent reviewer,” the commission’s report said.
The commission said its system would ensure “greater prominence” is given to the person’s human rights during the care planning stages and help cut “unnecessary duplication” by taking previous assessments into account.
It said the widespread reports of case backlogs and breached statutory timescales since the Cheshire West ruling meant that any notion the DoLS could be “patched up to cope” was not sustainable.
“Article 5 rights must be practical and effective. It is not acceptable to continue with the current system where many people’s rights have become theoretical and illusory,” the report said.
The commission also recommended wider reforms to improve decision-making across the Mental Capacity Act, not just in cases involving deprivation of liberty. The MCA proposals would place a requirement on decision-makers to place greater weight on the person’s wishes and feelings when making decision under the act and confirm in writing that they had complied with the act.
It is now up to the government to decide whether to take the commission’s recommendations forward.
For more information please see http://tiny.cc/p0uxjy
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A11. Davey vs Oxfordshire Council judgement
Last month it was revealed a disabled man’s legal battle against a 40% cut to his personal budget had ended in failure.
The High Court dismissed ex-ILF user Luke Davey’s judicial review against Oxfordshire council. The judge acknowledged the cut could impose “unwelcome” limits on Davey’s life, but he ruled the council had acted lawfully and met its Care Act duties.
The case is the first High Court challenge to test a council’s compliance with the Care Act’s wellbeing principle. But the underlying issue of care package cuts is far from unusual as councils struggle to plug a social care funding gap sector leaders say will hit £2.6bn by 2020.
Read solicitor Belinda Schwehr’s analysis at http://tiny.cc/m6uxjy
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A12. How to stop locking up people with learning disabilities who offend
Secure care does not work for most people with learning disabilities who offend, but community options need time to develop, says Steph Palmerone in this Community Care blog: http://tiny.cc/n8uxjy
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A13. National Audit Office reports on Transforming Care's progress
A National Audit Office report on the transforming care programme says that good progress has been made by the Department of Health and NHS England in setting up a programme to close hospital beds for people with a learning disability, but the programme is not yet on track to achieve value for money. The report examines how the NHS in England and local authorities seek to improve the lives of the 129,000 people aged 18 to 64 who use local authority learning disability support services.
The NAO found that programme partners must resolve a number of complex challenges if they are to achieve the ambition of a substantial shift away from reliance on inpatient care.
According to the NAO, there have been some improvements, for example in the numbers of people with a learning disability in settled accommodation. Most of the national measures focus on activity, rather than outcomes, although there are encouraging signs of progress. The proportion of people living in their own home or with family has increased from 70% in 2011-12 to 75% in 2015-16.
However, the proportion of people with a learning disability in paid employment has remained consistently low, and is currently 5.8%, even though some local authorities have been able to secure employment rates of more than 15%.
The report can be accessed at http://tiny.cc/69uxjy
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A14. The Channel 4 Documentary 'Under Lock And Key'
This documentary starkly highlighted the issues of institutionalised care, and the benefits of care being provided within the community. We saw people in an environment where they were over-medicated and frequently subject to restraint and seclusion, much of this done to deal with their behavioural responses when understandably stressed by their treatment and environment. Within their treatment, their rights appeared to be completely ignored.
As Norman Lamb, the former Social Care minister made clear, “We’ve got lots of people with learning disabilities, with autism, with mental ill health, treated in effect like second class citizens, not having the same rights as other people enjoy, and that’s intolerable.”
The programme also showed the same people, after leaving St Andrews, being supported by small-scale person centred services in community environments, where they had a much better quality of life and no longer needed high levels of medication or the use of restraint.
It can be watched at http://tiny.cc/vdvxjy
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A15. Government scraps controversial social care exemptions plan
The government has scrapped controversial plans to allow councils to apply for exemptions from children’s social care law, the Department for Education has confirmed. Ministers have agreed to remove ‘exemption’ clauses from the Children and Social Work Bill, which is currently going through parliament.
The measures, which the government styled as ‘academy style freedoms’ for social care, would have allowed councils to seek exemptions from statutory duties for up to six years.
“We have listened to concerns raised about introducing the power to innovate, which would have meant councils could test new approaches in order to support the country’s most vulnerable children. In recognition of this we are not taking forward that particular aspect of the bill.”
More details can be accessed at: http://tiny.cc/8gvxjy
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B. RESOURCES
B1. Responding to domestic abuse: a resource for health professionals
This resource published by the Department of Health on 8th March 2017 looks at how health professionals can support adults and young people over 16 who are experiencing domestic abuse, and dependent children in their households.
It will help health staff to identify potential victims, initiate sensitive routine enquiry and respond effectively to disclosures of abuse.
Commissioners will gain insight into services to support people experiencing domestic violence and abuse, and the importance of joined-up local strategic planning.
The resource draws on the National Institute for Health and Care Excellence multi-agency guidelines on domestic violence and abuse, and provides:
- the legal and policy contexts of domestic abuse in England
- information for commissioners on effective integrated care pathways
- information for service providers on shaping service delivery
- what health practitioners need to know and do
- information to ensure the right pathway and services are in place locally
Full detail is available here:
http://tiny.cc/apuxjy
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B2. Substance misuse and people with learning disabilities: making reasonable adjustments to services
A new NDTI guide to help professionals in drug and alcohol teams or learning disability teams support people with learning disabilities who have substance misuse problems.
The guide can be accessed at http://tiny.cc/tmvxjy
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