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Policy Briefing
September 2016
This is a regular briefing for learning disability commissioners and other associated professionals in the northwest.
You are receiving this briefing because either your organisation subscribes to the North West Training and Development Team; or you subscribed to our policy briefing mailing list on our website. If you no longer wish to receive these briefings then please click on the ‘unsubscribe’ link at the bottom of this email.
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This briefing is compiled by Dr Laurence Clark from Pathways Associates CIC.
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A. HEALTH & SOCIAL CARE
A1. High numbers of social care complaints upheld by ombudsman
Most complaints to the Local Government Ombudsman about councils’ child protection and adult care planning functions were upheld during 2015-16. 70% of complaints related to adult care planning that were investigated in detail by the ombudsman were upheld. The ombudsman provides an independent review of local authority decision-making where the person concerned has exhausted internal complaints processes. Among all complaints about council-run adult social care services that were investigated, 58% were upheld, as were 53% of those concerning education and children’s services, above the average across all services of 51%.
Overall, 2,584 complaints about councils’ adult services were received, a rise of 4% on the previous year. The review said that:
- Assessment and care planning continued to attract most complaints, at 602 (up from 576 the previous year). It highlighted poor communication, inadequate involvement of families, delays in assessing and reviewing and insufficient provision of information to help families make choices as being common faults.
- Complaints about councils’ provision of home care rose steeply – by 29% – to 281, from 218 in 2014-15. Among such complaints, 67% were upheld after investigation. Common problems included failure to provide services, communication breakdowns between councils and care providers and medical assistance not being sought in a timely manner. The report acknowledged the sector’s awareness of some of the issues raised.
- The ombudsman registered 278 complaints and enquires about charging for care, upholding 62% after investigation and highlighting inconsistent information and guidance as causes for concern.
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A2. BILD Annual Conference 2016
14 October, Birmingham
BILD’s Annual Conference will offer a vibrant and thoughtful celebration of good practice. We will tackle the big issues in the field of learning disabilities at a national and local level providing opportunities to learn and share with delegates and BILD members.
Practice based workshops will highlight new ways of working that are making a real difference to the lives of people with learning disabilities. With a focus on planning and delivering support to ensure meaningful lives, the emphasis will be on taking good practice back into delegate's own work.
You can find more details here: http://tiny.cc/4l2oey
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A3. Council pays £2,500 for delay acting on best interests decision
A council has paid out £2,500 after it delayed an autistic man’s move from an unsuitable care home for nearly a year, blaming the failings on “workload pressures” in social work teams.
Herefordshire council apologised to the man and his mother after an ombudsman investigation found he was left in the home for 11 months after being assessed as needing to move. There was “no evidence” the council proactively searched for an alternative, the watchdog said. The council agreed to implement the ombudsman’s recommendations in full. These included making £2,000 available to the man to spend on activities he enjoys or possessions he’d like, a £500 payment to his mother, and a commitment to improve social work training.
Issuing its report, the ombudsman warned local authorities they had to ensure social workers got “adequate support” to meet their casework needs.
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A4. Warning over severe AMHP shortages as hundreds leave
Councils are struggling to replace more than 200 Approved Mental Health Professionals who have quit or retired in the past three years as demand for their services increases.
Figures obtained from 120 of 152 councils in England through Freedom of Information requests reveal the number of AMHPs, the group of mostly social workers qualified to carry out Mental Health Act assessments, fell 7 per cent from 3,139 in 2013-14 to 2,915 in 2015-16.
Councils are responsible under the Mental Health Act code of practice to make sure “sufficient AMHPs are available to carry out their roles” but several admit they’re short of what’s needed.
Some are struggling to tackle “severe” shortages, with councillors at one authority worried shrinking AMHP numbers pose a “significant threat” and another council warning of a “high risk” of its AMHP service facing “a crisis in the near future” unless more staff are found.
One council that had enough AMHPs “on paper” said its capacity had still reduced in recent years, as some AMHPs had gone on long term sick and several had cut their hours.
For more details access the Community Care article at http://tiny.cc/zb5oey
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A5. The Accessible Information Standard is now in force
The Accessible Information Standard aims to make sure that disabled people receive information that they can access and understand, and any communication support that they need.
All organisations that provide NHS care or adult social care are required to follow the new standard, including NHS Trusts and Foundation Trusts, and GP practices. As part of the accessible information standard, these organisations must do five things:
- Ask people if they have any information or communication needs, and find out how to meet their needs.
- Record those needs clearly and in a set way.
- Highlight or ‘flag’ the person’s file or notes so it is clear that they have information or communication needs and how those needs should be met.
- Share information about people’s information and communication needs with other providers of NHS and adult social care, when they have consent or permission to do so.
- Take steps to ensure that people receive information which they can access and understand, and receive communication support if they need it.
The standard can be accessed at http://tiny.cc/lx6oey
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A6. File on 4: 'Homes not Hospitals'
On Tues 13 September at 8pm Radio 4 will be broadcasting a File on 4 report on the progress of the 'Homes not Hospitals' plan.
Five years after shocking revelations about the abuse of patients at Winterbourne View, File on 4 asks what progress has been made on the promise to get people with learning disabilities and autism out of hospital units and into homes in the community with good support.
Families of those still stuck in these units say patients are trapped in the system with no clear plan or apparent will to get them home. For those eventually discharged, almost as many others are admitted - parents say, because there aren't enough community support services.
But if people are let out by the institutions, what's does so-called 'supported living' in the community look like? File on 4 hears concerns about the quantity and quality of this promised care. Parents describe living on the brink of a crisis that could land their children back in a cycle of being sectioned and locked up.
NHS England says the plans are taking shape. But families say it's like living in The Twilight Zone, in a limbo hidden from mainstream view and unable to find a way out.
So just how successful is the landmark 'Homes not Hospitals' plan, that aims to improve life for some of the most vulnerable patients in the NHS?
The programme can be accessed at http://tiny.cc/6nirey
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A7. National Audit Office study: Local support for people with a learning disability
The National Audit Office is conducting a study to find out how well the government is making progress in providing community support for people in hospitals settings. They are also broadly looking at what health and social care support is available to the wider population with a learning disability, and whether this support is improving outcomes.
It is really important they hear directly from people with a learning disability, family carers and professionals working in this field to get a true picture of what progress has been made, and what still needs to be done.
If you would like to share your experiences of health and social care support you can email the study team on LDstudy@nao.gsi.gov.uk. For more information please see http://tiny.cc/pcjrey.
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A8. Thousands of ‘unnecessary’ DoLS inquests causing families distress
Bereaved families are being caused distress by an “unwanted” duty for inquests to be carried out into deaths of anyone under a Deprivation of Liberty Safeguards order.
That was the message from the chief coroner in England and Wales, his honour judge Peter Thornton QC, in his 2015-16 annual report, which also warned the duty was causing “unnecessary” work for coroners and piling extra costs on councils.
The report revealed coroners held inquests for 7,183 people who died while under Deprivation of Liberty Safeguards (DoLS) authorisations in 2015. This is the first year figures have been made available, although Thornton said they reflected a “substantially increased” caseload for coroners.
Thornton said the rise was one of the “unanticipated and unwanted consequences of statute and case law combined”, most notably the interpretation of the Supreme Court’s landmark ‘Cheshire West’ ruling in March 2014.
For more information please see http://tiny.cc/aljrey
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B. INCOME AND BENEFITS
B1. Disabled people living in deprived areas are more likely to lose their benefits
Analysis of more than a million incapacity benefit claimants who have been re-assessed for employment and support allowance (ESA), the benefit for people too disabled or ill to work, shows the controversial work capability assessment is disproportionately removing benefits from people in more deprived regions.
At the same time, it found claimants in wealthier areas are more likely not only to retain their sickness benefits – and avoid being declared fit for work – but to be placed in the support group of ESA, in which claimants are not required to undertake any form of work preparation and receive the highest benefit rate.
The study in the journal Radical Statistics analyses government data from over 300 local authorities between 2007 and 2015. It further shows that, counterintuitively, healthier areas found claimants fit for work less often, and placed claimants into the support group more frequently, than areas with higher rates of disability and illness.
The Guardian article on the research can be accessed at http://tiny.cc/9z2oey
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C. RESEARCH & ANALYSIS
C1. For Us All: Redesigning social security for the 2020s
This Fabian Society report examines the long-term future of social security, as part of a strategic agenda for raising British living standards following the UK’s decision to leave the EU.
It considers that social security for pensioners is now on a strong and sustainable footing but that the system for non-pensioners will be worse in 2020 than it was in 2010 – and will carry on getting worse, unless policy changes.
The report proposes a “blended system” with four tiers:
- Universal: An ‘individual credit’ for adults and a ‘child credit’ for children
- Contributory: National insurance and employment based benefits that match the generosity of the state pension, a new system of post-19 education funding and the option of ‘time-credits’
- Private provision: Opt-out, match-funded savings accounts for all, and the piloting of income protection insurance
- Means-tested: Universal credit to become a generous household-based means-tested top-up to the other individual-based tiers of support.
The report also highlights ‘the problem of rent’ which cannot be solved by the social security system alone. It calls on the Government to take action to stabilise house prices and build more homes for social rent.
The report can be accessed at http://tiny.cc/cd6oey
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C2. #humanactivism
This research questions the reality of Big Society for people living with learning disabilities and the risks posed by welfare cuts and austerity. It asks:
- To what extent are people with learning disabilities participating in civil society of the 21st Century?
- In the current climate what opportunities exist for people with learning disabilities to contribute to and benefit from the Big Society and, hence, civil society?
- What can be learnt about the realities of the Big Society in practice from current and emerging examples of civil society for people with learning disabilities?
The research found that:
- In Big Society, disabled people are often described as being 'dependent' or even as 'scroungers';
- The policy of Big Society is focused on individual active citizens - we think this is a problem because everybody needs other people to support them;
- We found that people who are living well do so because of their strong connections with other people;
- Disability is a good place to start thinking about the ways in which we live together;
- Everybody needs support from other people to be 'good citizens';
- Friendships between people are important whether or not they are disabled people or 'non-disabled' people;
The research can be accessed at http://humanactivism.org
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C3. Councils ‘levelling down’ care packages after ILF closure
More than half of local authorities in London have cut service users’ care packages following the closure of the Independent Living Fund (ILF), according to a report by Inclusion London.
Four councils have reduced support for more than half of former ILF recipients, a finding the charity described as “suggestive of a systematic approach to ‘levelling down’ packages”. The findings come from a Freedom of Information request, which received responses from all 33 councils in London. The charity said the cuts affected 185 former ILF recipients across the capital – around one in six.
The government closed the ILF in June 2015 and transferred responsibility for meeting ILF care and support needs to councils. Ministers said they would give local authorities funding to cover ILF needs until 2020 but did not require councils to ring-fence the money. The FOI found only seven of the 33 local authorities had committed to maintaining existing levels of support for ILF users over the next four years, while 18 had ring-fenced the money to their adult social care budget. Five said there would be no ring-fence in operation.
The report can be accessed at http://tiny.cc/7w4oey
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C4. TLAP Care Act survey for people with care and support needs, and carers
Think Local Act Personal (TLAP) is running a survey that asks how much of a difference the Care Act has made in the experience of people with care and support needs, and carers. There have been many Care Act surveys, but this one will be the first that specifically seeks their views.
The results of the survey will be used to help the Department of Health identify problems and find solutions to inform future work on the Care Act.
The closing date is the 4th October. It should take about 10 minutes to fill in and participants can enter a prize draw to win £100 of shopping vouchers.
The survey can be accessed at http://tiny.cc/r54oey
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C5. Solve Poverty strategy
Joseph Rowntree Foundation (JRF) has published two reports detailing a new strategy to solve poverty in the UK. It has produced a five-point plan that will:
- Boost incomes and reduce costs
- Deliver an effective benefit system
- Improve education standards and raise skills
- Strengthen families and communities
- Promote long-term economic growth benefiting everyone
The strategy has been developed from four years of investigation into what it would take to solve poverty in the UK. JRF is calling on national governments, business, communities and individuals to come together and play their part in solving poverty. JRF are committed to ensuring the strategy can be as influential as possible and hope it will generate action and commitment by those with the power to make a real difference to people and places in poverty across the UK. JRF hope to kick-start efforts to create a more prosperous society, built on decent living standards with the opportunity for everyone to fulfil their potential.
The strategy can be accessed at http://tiny.cc/ou5oey
The evidence can be accessed at http://tiny.cc/6v5oey
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C6. EHRC disability hate crime report
This report provides the latest data for England, Wales and Scotland against the following measures, with analysis of change over time:
- number of victims of hate crimes
- proportion of disability-related crime incidents reported to the police
- satisfaction with police handling of crime incidents
- experience of any crime in the previous 12 months
- worry about being a victim of crime
The analysis paints a general picture of improvements since the 2013 report. The total incidence of hate crime in England and Wales has declined at a time when crime incidence has fallen overall. Numbers of incidents of age hate crime or sexual orientation hate crime both fell, however it is not possible to say whether there has been a decrease in disability hate crime over the same period.
Despite the decrease in the incidence of crime overall, in most cases experience of crime remained higher for disabled people compared with non-disabled people of the same age. For instance, 22% of disabled young people in England and Wales aged 10-15 had been the victim of crime in the previous 12 months compared to 12% of non-disabled young people of the same age.
In England and Wales, more disabled than non-disabled people in every age group had experienced any crime in the previous 12 months. Similarly, in Scotland more disabled people than non-disabled people aged 16-44 or 65-74 had experienced any crime in the previous 12 months. Experience of any crime was higher overall for disabled adults in the younger age groups.
Experience of any crime was also higher for disabled people with certain impairments in England and Wales, in particular people with mental health conditions such as depression or social or behavioural impairments such as autism, attention deficit disorder or Asperger’s syndrome.
The report can be accessed at http://tiny.cc/d35oey
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C7. £48 billion saving on social care if DFGs fully funded
The government could have saved nearly £48 billion in social care costs over five years if it had funded all the work needed to make disabled people’s homes more accessible, according the Disability United website.
The calculations have been made by Disability United’s editor Fleur Perry, who made the calculations after finding a reference to research carried out by Isle of Wight Council (pages 16 to 18).
The council concluded that for every £1 invested in the disabled facilities grants (DFG) scheme, a council could save more than £7 in social care costs over the next five years.
More details can be accessed at http://tiny.cc/ek6oey
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C8. Half of people in poverty are disabled or live with a disabled person
A detailed new report commissioned by the Joseph Rowntree Foundation finds that almost half of people in poverty in the UK are disabled or live in a household with a disabled person.
The New Policy Institute report - Disability and Poverty - says that disabled people are more likely than non-disabled people to be disadvantaged in the following multiple aspects of life: these are problems in of themselves and also contributing factors to poverty:
- employment - 46% of working-age disabled people are in employment, compared with 80% of non-disabled people;
- skills - there is a considerable ‘skills gap’ between disabled and non-disabled people (for example, only 15% of disabled people have a degree, compared with around 30% of non-disabled people);
- pay - low pay rates for disabled people are higher than those for non-disabled people, at 34% compared with 27%;
- costs - disabled people face higher costs than non-disabled people, (such as the cost of equipment to manage a condition) which means that the same level of income secures a lower standard of living than it would for a non-disabled person; and
- social security system - there is evidence that ‘extra costs’ benefits such as DLA and PIP do not cover these extra costs sufficiently: in the bottom fifth of the income distribution, disabled people are more likely to be materially deprived, whether they receive extra costs benefits or not.
The report recommends two approaches to reduce poverty among disabled people -
- maximise resources - this is partly about increasing employment, (such as the government’s ambition to halve the disability employment rate gap) and a focus on job retention rather than re-entry to work;
- reducing costs - high rates of material deprivation among disabled people suggest a failing of the social security system in mitigating these costs. In addition, the role of high housing costs in driving poverty for disabled people should be investigated, particularly for both private and social renters.
A summary of Disability and Poverty is available at http://tiny.cc/gr6oey
The full report is available at http://tiny.cc/ks6oey
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C9. My diabetes, my care: Community diabetes care review
Since 1996, the percentage of adults in England with diabetes has doubled. My diabetes, my care looks at people's experiences of diabetes care across England and the support they are given to self-manage their condition.
This review considers how well care services work together to deliver high-quality diabetes care. It also makes a number of recommendations for how health and social care commissioners, providers and professionals should work together to improve diabetes care and prevention. It includes including a specific focus on black and minority ethnic groups and people with a learning disability.
The full report is available at http://tiny.cc/1sirey
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D. RESOURCES
D1. Digital Resource for Carers
Carers UK has developed Digital Resource for Carers bringing together a number of digital products and online resources, to help organisations provide comprehensive information and support for carers.
With demand for care rising as budgets are being squeezed, they are all looking for effective and affordable ways to improve the lives of carers. They aim to use their 50 years' experience to help organisations deliver quality support services that will help carers manage caring responsibilities alongside work and family life.
It can be accessed at http://tiny.cc/5efddy
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D2. Accessible Information Standard Communication Card
To help people share their accessible information standard requirements Change have done a communication card. The aim of the standard is to make sure that disabled people are given information in a way they understand, and communication support if they need it. All organisations that offer NHS or Adult Social Care must now follow the standard by law.
The easy read guide about the accessible information can be found here http://tiny.cc/vk5oey
The communication card can be found here http://tiny.cc/hl5oey
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D3. Making reasonable adjustments to obesity and weight management services for people with learning disabilities
This guidance is for public health staff commissioning or running weight management services and other mainstream health professionals working to support people to lose weight. It is also for family carers, social care staff and learning disabilities professionals. It advises about specific aspects of weight management for people with learning disabilities.
The guidance can be found here http://tiny.cc/85irey
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D4. Making reasonable adjustments for people with learning disabilities in the management of constipation
This report is about constipation, its causes and how it can affect people. It describes recent research findings about bowel management to avoid constipation and the management of constipation if it occurs. We also present a holistic approach to bowel care and management of constipation. The report has links to resources as well as descriptions of bowel management work by groups that sent them to us. Stories from family carers show very acutely the extent to which this apparently simple issue can blight some people's lives.
The guidance can be found here http://tiny.cc/37irey
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D5. Registering the right support - easy read
This is an easy read version of the report called ‘Registering the right support: CQC’s policy on registration and variations to registration for providers supporting people with learning disabilities’. It says what the inspectors from the Care Quality Commission (CQC) look for to help them decide if they can allow a service that looks after people with learning disabilities, like a hospital or care home, to start running as a business.
The report can be found here http://tiny.cc/ohjrey
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