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Policy Briefing
December 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 and Colin Elliott from Pathways Associates CIC.
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A. HEALTH & SOCIAL CARE
A1. Consultation on proposals to close Calderstones
On 1 December NHS England published proposals to close England's last long-stay learning disability hospital at Calderstones in Lancashire, while creating more community support for people with a learning disability and/or autism in the North West.
People in the region are being urged to have their say on the proposals that have been drawn up by local health and care leaders to modernise services. The proposals include the closure of Mersey Care Whalley site formerly called Calderstones hospital, as called for by Sir Stephen Bubb’s ‘Winterbourne View – Time for Change’ report and the Public Accounts Committee.
NHS England will be consulting widely across the North West and beyond to ensure that the views of people who both deliver and depend on these services are at the heart of how care is transformed across the region.
The announcement sets out proposals for delivering the reforms set out in Building the right support: A national implementation plan to develop community services and only use inpatient facilities for those people with a learning disability and/or autism, when absolutely necessary and for shorter periods of time.
The proposals ensure that people with learning disabilities and/or autism will:
- Have greater choice in their pathway of care with equal and fair access to services;
- Be able to live in a community setting;
- Continue to receive care and treatment, closer to home, at the appropriate level to meet their needs;
- Receive proactive healthcare to maintain health and wellbeing, and;
- Have access to acute assessment services/ inpatient provision when needed.
The North West currently has an over-dependence on institutional hospital care for people with a learning disability and/or autism compared to other areas of the country, due mainly to the historic lack of appropriate, high quality alternatives in the community.
This consultation proposes to reverse this trend so that care and support is available closer to people’s homes and in the community where they usually feel most comfortable – one of the aims set out in NHS England’s Five Year Forward View.
The full proposal can be found here: http://tiny.cc/jwbkhy
How to respond:
- The formal consultation will run until 23 February 2017
- Views will be collected via an online survey
- Alternative formats including hard copies are also available by contacting england.northspecialisedcorporate@nhs.net or via telephone number 0113 8254657
- Pathways are organising a number of events to support the consultation (details to follow).
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A2. ADASS Response to the Autumn Statement 2016
The Autumn Chancellor of the Exchequer’s autumn statement did not address the growing funding gap in social care. The Association of Directors of Adult Social Care responded as follows:
“The Government’s failure to provide desperately needed extra funding for adult social care means that this winter and throughout next year we will inevitably see more older and disabled people not getting the care and support they rely upon to survive each day, an even greater toll being placed on the 6.5 million family members and other carers, increasing delays in the NHS, and even more care homes closing and growing gaps and failures in the care market.”
“The Government has plainly ignored a wide range of respected voices; The Care Quality Commission, The National Audit Office, The Health Select Committee, professional bodies, charities, care providers, independent experts and leading figures in the NHS.”
“We urge the Chancellor to take immediate steps to bring forward the funding needed to ensure that older and disabled people can get the care and support they need each and every day of their lives.”
The full response is available here: http://tiny.cc/qfckhy
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A3. Adult Social Care Market Shaping
On 11th November 2016 the Department of Health published guidance for commissioners on shaping adult social care markets. The guidance is intended to be of benefit to:
- people who buy social care services which includes local authorities, clinical commissioning groups, personal budget holders and people who meet all or some of their own costs, commonly referred to as self-funders
- providers of social care services including those regulated by the Care Quality Commission (CQC) such as residential and nursing care providers, homecare providers, supported living services
- wider services which support well-being of local populations including community and voluntary services, micro and social enterprises, personal assistants, housing, leisure, transport, and information and advice services
- a range of potential investors in the social care market from corporate investors through to charitable or philanthropic donations
The document provides useful information and guidance on market shaping, market oversight and contingency planning, with analysis of trends and it sets out the statutory responsibilities of local government, NHS organisations and regulatory bodies for developing sustainable and effective social care provision.
The full report is available here: http://tiny.cc/pickhy
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A4. Office for National Statistics: Information on Excess Winter Deaths (2015/15 final and 2015/16 provisional)
The ONS has released its annual statistical bulleting on excess winter deaths in England and Wales by sex, age, region and cause, including figures on temperature and influenza.
Key findings include:
- Excess winter mortality in England and Wales was back in line with average trends in 2015/16. There were an estimated 24,300 excess winter deaths where 15% more deaths occurred in winter months than non-winter months.
- In 2015/16 excess winter mortality significantly decreased from 2014/15 when the number of excess winter deaths was uncommonly high.
- There were similar levels of excess winter mortality across all age groups, with those aged 0 to 64 affected more than in previous years and those aged 85 and over affected less than previous years.
- Following the pattern of previous years there were more excess winter deaths in females than males in 2015/16. Excess winter deaths for both sexes decreased from the 2014/15 period.
- More than one-third of all excess winter deaths were caused by respiratory diseases in England and Wales in 2015/16.
The full bulletin, containing more detailed analysis is available here: http://tiny.cc/5lckhy
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A5. Health Foundation Report: Final Report on the ‘Realising the Value’ Programme
In November 2016 the Health Foundation published the final report of the Realising the Value programme, an 18-month programme funded by NHS England, led by Nesta and the Health Foundation.
The programme was set up to support the NHS Five Year Forward View vision to develop a new relationship with people and communities. It sought to enable the health and care system to support people to have the knowledge, skills and confidence to play an active role in managing their own health and to work with communities and their assets.
The report sets out a vision the future and covers ‘what it means to put people and communities at the heart of health and wellbeing’, ‘the difference that person and community centred approaches can make’, it proposes ’10 actions to put people and communities at the heart of health and wellbeing’.
The report is available to download here: http://tiny.cc/btikhy
An accompanying report, ‘What the System Can Do’ is also available via the same link. The report reviews the wide range of mechanisms that national bodies use to achieve their policy objectives for health and care services. In particular, the report assesses the impact these mechanisms have on person- and community-centred approaches and suggests how national bodies can remove barriers and support the implem
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A6. Kings Fund Quarterly Monitoring Report
The King’s Fund published its first quarterly monitoring report (QMR) in April 2011 as part of its work to track, analyse and comment on the changes and challenges the health and care system is facing. The 21st QMR, released in November 2016 takes stock of what has happened over the past quarter and to assess the state of the health and care system.
It provides an update on how the NHS is coping as it continues to grapple with productivity and reform challenges under continued financial pressure. For the first time general practice is included in the report.
A summary of key findings and the full report are available here: http://tiny.cc/34ikhy
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A7. Public Health England publishes alcohol evidence review
On 2nd December 2016 Public Health England published a review looking at the evidence on alcohol harm and its impact in England. Findings include:
- most adults in England drink alcohol - more than 10 million people are drinking at levels that increase the risk of harming their health
- 5% of the heaviest drinkers account for one third of all alcohol consumed
- alcohol is the leading cause of death among 15 to 49 year olds and heavy alcohol use has been identified as a cause of more than 200 health conditions
- alcohol caused more years of life lost to the workforce than from the 10 most common cancers combined - in 2015 there were 167,000 years of working life lost
- the evidence strongly supports a range of policies that are effective at reducing harm to public health while at the same time reducing health inequalities - reducing the affordability of alcohol is the cost effective way of reducing alcohol harm
The full report, annexes and statistical data are available here: http://tiny.cc/3cjkhy
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A8. The digital patient: transforming primary care?
On 16th November 2016 The Nuffield Trust published its report reviewing the evidence that exists on digital technology and its impact on patients in primary care and the NHS. The report explores the impact of seven types of digital services offered by the NHS:
- Wearables and monitoring technology
- Online triage tools
- Online sources of health information and advice, targeted interventions and peer support
- Online appointment booking and other transactional services
- Remote consultations
- Online access to records and care plans
- Apps
The report finds that patient-facing technology is already showing promise that it can improve care for patients and reduce strain on the stretched health service – particularly for people with long-term conditions such as diabetes or COPD. However, this rapidly evolving market comes with risks. Many apps, tools and devices have not been officially evaluated, meaning that their effectiveness is unknown.
In some cases, technology can increase demand for services, disengage staff and have the potential to disrupt the way that patients access care.
Moreover, the report warns that policy-makers and politicians should avoid assuming that self-care-enabling technology will produce significant savings, at least in the short term. The report also presents a series of lessons and recommendations to NHS professionals, leaders and policy-makers about how best to harness the potential of technology and avoid the pitfalls.
The full report can be found here: http://tiny.cc/jgjkhy
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A9. Government to scrap Deprivation of Liberty Safeguards inquests duty
Coroners will no longer be required to hold an inquest for anyone who dies while subject to the Deprivation of Liberty Safeguards, under an amendment to the law backed by ministers.
The amendment to the Policing and Crime Bill will mean that a person who dies while subject to a DoLS order will no longer be considered to have died in state detention. In doing so it will remove an automatic requirement for coroners to hold an inquest.
The bill is currently going through the House of Lords. The amendment was raised by crossbench peer Baroness Finlay of Llandaff, who chairs the National Mental Capacity Forum.
It comes after a series of warnings, including from the chief coroner in England and Wales, that the automatic requirement for inquests had caused bereaved families distress and created unnecessary pressure on services.
For more details see http://tiny.cc/t6jkhy
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A10. Mental Health Act detentions rise again
Official figures reveal detentions under the Mental Health Act rose 9% last year.
An NHS Digital report published today shows there were 63,622 detentions under the act in 2015-16. This is up 9 per cent from the 58,399 detentions the previous year and 46% higher than the 43,461 detentions in 2005-06.
Almost a third of patients (30%) detained under the act at the end of March this year were being treated in private hospitals, the highest proportion on record.
The figures follow a survey of Approved Mental Health Professionals (AMHPs), the group of mostly social workers who coordinate Mental Health Act assessments, that revealed longstanding problems securing beds for patients in need were getting worse. Separate Community Care research found AMHP numbers dropped by 7% over the past three years with some councils reporting “severe” shortages, despite record demand.
Further information can be found here: http://tiny.cc/5fnkhy
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A11. Deprivation of liberty reforms postponed
The final report of a major government-commissioned review of deprivation of liberty legislation has been postponed until next year.
The Law Commission was due to hand ministers their final recommendations, including draft legislation, on a proposed replacement for the Deprivation of Liberty Safeguards (DoLS) by the end of this year. However, the project has been pushed back to March 2017.
In a statement issued today, the commission said: “The reason for the delay is the complexity of the task of drafting legislation on such an important issue. It is vitally important to get the law right here. Badly drafted, over-complicated law is a big part of the problem with the current DoLS, and we do not want to fall into the same trap again.”
The news will come as a blow to local authorities, with councils having struggled to meet their legal requirements under the current DoLS framework since the Supreme Court’s landmark ‘Cheshire West’ ruling in March 2014 triggered a surge in DoLs applications. A national case backlog hit more than 100,000 in April.
High hopes have been pinned on the Law Commission review delivering a system that can better handle current case numbers, while still protecting people’s human rights. The proposed replacement scheme is expected to cover both residential and community settings.
For more information please see http://tiny.cc/o2nkhy
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B. INCOME AND BENEFITS
B1. Work, health and disability: improving lives consultation
The plans proposed on 31 October include:
- a review of Statutory Sick Pay and GP fit notes to support workers back into their jobs faster, and for longer
- encouraging Jobcentre Plus work coaches to signpost claimants to therapy
- the launch of a consultation on Work Capability Assessment reform
- encouraging employers to work with their employees with long-term health conditions to stop them from falling out of work
- a wide-ranging debate about recognising the value of work as a health outcome
- the creation of a Disability Confident Business Leaders Group to work alongside Ministers and officials to increase employer engagement around disabled employment, starting with FTSE 250 companies
- a consultation on the Work Capability Assessment, the process for assessing Employment and Support Allowance (ESA) and Universal Credit claimants’ capability for work – the proposals would put an end to the binary ‘can work/can’t work’ groups
- developing large scale trials on how health-led services and support can help get disabled people and those with long-term conditions back into work – with a specific focus on mental health and musculoskeletal conditions
- working with Health Education England, Public Health England and others to make the benefits of work an ingrained part of the training and health workforce approach
The Green Paper also includes a new Personal Support Package. This includes:
- a new Health and Work Conversation between new people on ESA and their work coach, focusing on what they can do rather than what they cannot
- recruiting around 200 Community Partners into Jobcentre Plus, including expertise from the voluntary sector
- a trial voluntary work experience programme for young people with limited capability for work, enabling them to benefit from experience with a mainstream employer to build confidence and skills, enhance their CV and demonstrate their ability to perform a role
- extending ‘Journey to Employment’ job clubs to 71 Jobcentre Plus areas with the highest number of people receiving ESA with limited capability for work
Statutory Sick Pay will be reviewed so it better encourages supportive conversations and phased returns to work. Consideration is also being given to extending fit notes from doctors to other healthcare professionals to help ensure people receive more tailored support.
The consultation closes on 17 February 2017. For more information please see http://tiny.cc/rzlkhy
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C. RESEARCH & ANALYSIS
C1. Individuals with dementia living in extra care housing: an initial exploration of the practicalities and possibilities
This Housing LIN Report draws together the responses from a national questionnaire sent earlier on in 2016, which aim was to gather a national picture of how organisations support people with dementia to move into or to stay within an extra care scheme.
The findings suggest a variable knowledge base about dementia design, but a strong commitment from individual managers and schemes to do their best for people with dementia. Future research resulting in best practice guidelines could be helpful for supporting all those involved in commissioning, designing, developing, and operating extra care housing schemes to appropriately support individuals with dementia to live as well as possible.
The report can be accessed at http://tiny.cc/1ujkhy
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C2. Care workers: building the future social care workforce
How can we recruit, train and retain future care staff? A new SCIE paper identifies actions that could help the sector to prepare for different hypothetical economic and political scenarios. Suggestions include: co-ordinating local recruitment campaigns across health and care, developing 'portfolio' careers, and introducing user-led training.
The paper can be accessed at http://tiny.cc/xlkkhy
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C3. Parents of children with learning disabilities miss social engagements due to fears
Almost two-thirds of parents of children with learning disabilities say they have missed social engagements in the past 12 months due to the fear of how other people will react to them, a new survey has found.
The survey of 1,000 parents of children with learning disabilities, carried out by Mencap, also found that 70% have felt unwelcome in public and 21% have been asked to leave public spaces because of behaviour resulting from their child’s learning disability.
In addition, respondents said they have missed their best friend’s wedding, had their child told he needed to stay in the garden away from other children, and others said the public are “are afraid of what they don’t understand.”
Other findings included 41% of parents saying they felt other parents were somewhat or very unhappy for their child to spend time with their children and 50% think public attitudes towards children with a learning disability are negative. Despite this, 43% believe attitudes towards people with a learning disability have improved.
The article can be accessed at |http://tiny.cc/0aokhy
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C4. Disability discrimination remains rife as young people branded ‘too disabled’ by services
Disability discrimination remains rife in the country as many parent carers of children and young people with learning disabilities encounter negative attitudes and struggle to access healthcare services, a new report has found.
The report, ‘Disability Matters in Britain 2016: Enablers and challenges to inclusion for disabled children, young people and their families,’ reflects the views of 10 young people, 123 parent carers of disabled children and adults and 128 professionals and volunteers who responded to the Disability Matters ‘call for evidence’ earlier this year. Key findings include:
- Out of 72 examples from parent carers, 30 experienced negative or unhelpful attitudes from others including other parents
- 22 parent carers said they found it difficult to access healthcare services
- 20 parent carers reported trouble in finding opportunities for their child or young person so socialise with others
- 19 parent carers said their child hadn’t accessed any social activities such as cinema, bowling and youth clubs in the past 12 months due to poor attitudes, inexperienced staff or inaccessible buildings and services
- 40% of 96 respondents in the health sector felt their organisation was average or below average at communicating with disabled children and young people.
The article can be accessed at http://tiny.cc/60okhy
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C5. Independent Living Survey 2016
This report, published by In Control on behalf of the Independent Living Strategy group, presents the findings of an online survey looking at what impact the Care Act is actually having on the day-to-day lives of disabled people living in England today. The key findings are:
Choice and control
- Just under half (48%) of all respondents reported that the choice and control they enjoyed over their support was poor or very poor.
- A third of respondents (33%) said that the level of choice and control they enjoyed over their support had reduced or reduced significantly.
- Significant numbers of people reported a range of different restrictions being placed on how they could use the money available for their support: for example 50% of respondents reported support was restricted to personal care tasks only.
Quality of life and wellbeing
- Well over half (58%) of respondents reported that their quality of life had reduced or reduced significantly over the past 12 months.
- A quarter of respondents (25%) said the hours of work or volunteering they could do had reduced or reduced significantly.
- Almost two out of five (38%) reported they are having to rely more on family and friends for support.
- More than a quarter (27%) of respondents reported an increase or a significant increase in the amount of money they have to contribute towards the cost of their support.
Quality and amount of support
- About the same numbers of respondents rated the quality of their support as good or very good (41%) as rated it poor or very poor (40%).
- However, the amount of support was rated as poor or very poor by 44% of respondents compared to 30% saying the amount of support they had was good or very good.
Experiences of assessments and reviews
- The majority (86%) of people reported that when their local authority had assessed their needs they had listened or partly listened to them.
- Of those respondents who said their support had been reviewed in the last 12 months, just under two thirds (63%) did not know how much money was available for their support.
- One in four people had been told their support would be reduced because of cuts/savings and/or there is a limit to the amount of money you can get for a particular service.
Experiences of former Independent Living Fund recipients
- Two out of five (41%) former Independent Living Fund recipients reported that the amount of their support had decreased or decreased a lot, and one third (33%) said that their quality of support had got worse or a lot worse.
- Around one third (34%) of former Independent Living Fund recipients reported new restrictions being placed on their support.
Information and advice
- Over a third of respondents (37%) struggle to find the information and advice they need.
- Most commonly people rely on friends and family (33%) and user led organisations (22%) for information and advice.
- Only 16% used their local authority's website for information.
- In terms of what people need advice and support with, just under a half (45%) said they needed help understanding their rights under the Care Act and a third (34%) solving problems with their local council.
- Over half (51%) of direct payment recipients reported that the information, advice and support they get to manage their direct payment was poor or very poor.
The report can be accessed at http://tiny.cc/qspkhy
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C6. People with Learning Disabilities in England Statistics 2015
National statistical information on the characteristics of people with learning disabilities, and the services and supports they and their families use, is collected by several government departments. The aim of this report is, within a single publication, to provide a concise summary of this information.
This report, the fifth in a series, reports the most recent data available at the time of writing (typically for 2014/15) for people with learning disabilities in England. The main report has an accompanying report of detailed data tables, and is in 12 chapters.
The report can be accessed at http://tiny.cc/guqkhy
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D. RESOURCES
D1. Easy Read BIHR My Human Rights resource
BIHR (British Institute of Human Rights) have drafted a number of resources on human rights, mental health and mental capacity. The resources aim to give people with mental health and/or mental capacity issues information about how human rights can help them have more control over their own lives and be treated with dignity and respect.
You can download pilot versions of the resources at http://tiny.cc/wmjkhy
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D2. New easy read information to help make sure the smart meter rollout works for everyone
It’s important that people have the right information so that they can decide to have a smart meter installed, or not.
A smart meter is a new type of gas and electricity meter. Smart meters will be fitted in 26 million homes by 2020 as part of the GB’s national rollout.
Smart meters show the amount of gas and electricity you’re using, and how much this is costing you in pounds and pence, on a handy portable screen. They also send meter readings directly to the energy supplier. This means no need for estimated bills, waiting to have your meter read or sending in readings yourself.
It’s important that people have the right information so that they can decide whether to have a smart meter installed or not.
BILD has partnered with Smart Energy GB to make sure that the right information and support is available for people with learning disabilities.
This information was developed with the support of self advocates from a number of advocacy organisations
Download the easy read information about the smart meter rollout at http://tiny.cc/u7pkhy
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