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Policy Briefing
August 2018
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. PATHWAYS ASSOCIATES NEWS
A1. Effectiveness of the new Care and Treatment Review policy
In 2017 NHS England asked Pathways Associates to look at how well the new Care and Treatment Review policy was working for people with a learning disability, autism or both. This review work shows what a positive difference a Care and Treatment Review can make to a person's life. NHSE have welcomed the recommendations made in the report and will use them to improve Care and Treatment Reviews now and beyond the end of March 2019.
The report can be accessed at:
https://gallery.mailchimp.com/fb87a0648757436c218703f51/files/2f51350b-492c-44e7-b099-dc80653963db/NHSE_PAC_feedback_report_v5.pdf
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A2. Greater Manchester Learning Disability Strategy
Greater Manchester Health and Social care Partnership asked NWTDT/ Pathways for support to write a Plan for Learning Disability for Greater Manchester. We were asked because of NWTDT 30 year history of working in partnership to support health and social care learning disability supports and services across the NW. NWTDT/ Pathways has worked to build positive relationships and partnerships with children and adults with learning disability, autism or both, families, friends, providers and commissioners across the NW.
To lead this work we reviewed, with the Greater Manchester Confirm and Challenge Group, all of the work that we have done over the years to identify the priorities together from the perspective of people with learning disabilities and families in Greater Manchester. 10 priorities were identified with an additional priority of strategic leadership and a short introduction to the plan which sets out the underpinning values for Greater Manchester.
We facilitated an event, Bee Here Now, in December 2017 to work collaborative to develop these priorities and identify some bold steps that people wanted to see to start to really make a difference.
The first draft of the plan was shared with the Greater Manchester Confirm and Challenge group and amended to make sure we had all listened properly before it was shared far and wide across Greater Manchester.
In July 2018 Lynn James-Jenkinson with the support of self-advocates and families representing the Greater Manchester Confirm and Challenge Group presented the Learning Disability Plan for Greater Manchester to the Greater Manchester Combined Authorities group chaired by Lord Peter Smith and attended also by John Rouse (Chief Officer of the Greater Manchester Health and Social Care Partnership), Andy Burnham (Mayor of Greater Manchester) and the CEX's of every Greater Manchester CCG and Local Authority where the plan was given unanimous support to move now to implementation. The Greater Manchester Combined Authorities group are keen to continue to be actively involved in leading and implementing the plan and have asked NWTDT/ Pathways to support self-advocates and families to regularly feedback progress and share any barriers to implementation that may need their support.
On reflection we believe that the content of the plan was so well received because the way the plan was written was so different - we started with the voices of people with a learning disability who live in Greater Manchester.
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B. HEALTH AND SOCIAL CARE NEWS
B1. Information for the health and care sector about planning for a potential no-deal Brexit
On 23rd August the Department of Health and Social Care released a collection of information and guidance relating to health and care organisations and industry with the advice that service providers should note the information when developing their business continuity plans.
The guidance covers the following topics:
Contingency planning:
The full suite of documents and links to further information can be found here: http://tiny.cc/372oxy
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B2. £76 million a year to build new homes
On 14th August the government announced an extra £76 million a year of funding to build homes for vulnerable people. The new homes will be built over the next 3 years and will be for disabled people, people with mental health issues and older people.
This supported or specialised housing is designed to be accessible and aid independent living by including features such as:
- an individual home with its own front door
- flexibility to adapt or install equipment or assistive technology in the home
- varying levels of personal care and support to residents, including access to a GP or other health services
- communal areas (for housing for older people)
Further detail is available here: http://tiny.cc/bi3oxy
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B3. Resources for NHS trusts to help manage overseas visitors and migrant charging
On 10th August the Department of Health and Social Care published updated forms, example letters and other information to help NHS trusts manage overseas visitors and migrant charging. The documents, developed with and tested by overseas visitor managers, are intended to help the NHS recover the costs of healthcare from visitors and migrants.
All related documents are available to download here: http://tiny.cc/lr3oxy
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B4. Social prescribing schemes to be funded by the Health and Wellbeing Fund: 2018
On 2nd August the government released guidance for 23 social prescribing projects in England that will receive a share of £4.5 million Health and Wellbeing Funding.
‘Social prescribing’ aims to improve patients’ quality of life, health and wellbeing by recognising that health is affected by a range of social, economic and environmental factors. It has also been shown to reduce demand on NHS services.
The Health and Wellbeing Fund is part of the voluntary, community and social enterprise (VCSE) Health and Wellbeing Programme. The fund aims to reduce health inequalities by building the evidence base around good practice in social prescribing, sharing lessons and widening adoption of practices that are proven to work.
Schemes awarded funding in the North of England include Barnsley, Liverpool and Sheffield.
Further detail is available here: http://tiny.cc/ex3oxy
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B5. Think Autism strategy: governance refresh 2018
On 25th July the government announced that the way that the Department of Health and Social Care and other organisations monitor the progress of the autism strategy has been updated.
The 19 objectives of the Think Autism strategy have been grouped under the following headings:
- Measuring, understanding and reporting needs of autistic people
- Workforce development
- Health, care and wellbeing
- Specific support
- Participation in local community
There will be five Task and Finish Groups (TFG), one for each domain, which will be responsible for coordinating the delivery of the relevant objectives, and tracking progress of the associated actions.
Each TFG will be composed of members representing organisations which have the levers, authority and ability to take action to realise the objectives in each specific area. The Chair of each TFG represents the organisation best placed to facilitate overall progress in that domain, and they will be able to influence progress against their objectives. Additionally, at least two members of each group will be self-advocates to ensure that the voice of people affected ultimately by the work of the TFGs is represented. The terms of reference for each group clearly sets out each member’s role and responsibilities to drive forward progress in their area. A new Executive Group will oversee the progress of the TFGs, coordinate actions across the Strategy as a whole and monitor and report on the overall progress against the strategic objectives.
Further detail is available here: http://tiny.cc/v25oxy
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B6. Leadership in today's NHS: delivering the impossible
The King’s Fund recently published a report based on a survey of NHS trusts and foundation trusts carried out by NHS Providers in late 2017, qualitative interviews and a roundtable event with frontline leaders and national stakeholders. The survey showed that:
- Leadership vacancies are widespread, with director of operations, finance and strategy roles having particularly high vacancy rate and short tenures.
- A culture of blaming individuals for failure is making leadership roles less attractive. Organisations with the most significant performance challenges experience higher levels of leadership churn. National bodies need to do more to support leaders to take on and stay in these roles.
- To tackle high leadership churn, national programmes should target professional roles where concerns over the pipeline of future leaders is greatest. Regional talent management functions – largely absent since the abolition of strategic health authorities – should be rebuilt in the new joint NHS England and NHS Improvement regional teams.
- More attention should be given to addressing the environment NHS leaders operate in. To help ensure these roles are attractive in future, national bodies should better model the behaviours they expect in local leaders, the expectations of ‘what good looks like’ should be more clearly articulated, and NHS leaders themselves should be treated more humanely.
The full report is available here: http://tiny.cc/d1wpxy
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B7. What is happening to life expectancy in the UK?
On 15th August the King’s Fund published an analysis of long term mortality trends in the U.K. 2010 marked a turning point in long-term mortality trends in the UK, with improvements tailing off after decades of steady decline. The King’s Fund considers how overall life expectancy has changed over time, along with considerations such as the difference in life expectancy between males and females, geographical inequalities, how the UK compares with other countries, and possible factors in the more recent slowdown in mortality improvements in the UK.
Whilst many factors may contribute to the current position the recent report by the Office for National Statistics (August 3rd) showing that the UK has had the lowest rate of improvement in life expectancy since 2011 among western nations other than the USA has added to claims that austerity is the only credible explanation.
Some European countries such as Greece, Spain, Portugal and Ireland also experienced austerity-related cuts in public expenditure after the 2008 recession, and they show less slowing of mortality improvements than the UK. There have been calls for the government to undertake an urgent investigation, and there is now a review of mortality trends in England and Wales by Public Health England under way.
The full piece is available here: http://tiny.cc/h3wpxy
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B8. More than four fifths of MPs believe adult social care funding needs to be increased
A survey carried out by ComRes and commissioned by the Local Government Association shows that the overwhelming majority of MPs (84 per cent) and peers (76 per cent) agree that funding for adult social care should increase.
Following the delay to the Government’s adult social care green paper, the LGA has launched its own nationwide consultation to kick-start a debate on how to pay for adult social care and rescue the services caring for older and disabled people from collapse. The LGA estimates that adult social care services face a £3.5 billion funding gap by 2025, just to maintain existing standards of care, while latest figures show that councils in England receive 1.8 million new requests for adult social care a year – the equivalent of nearly 5,000 a day.
The LGA also makes the point that increased spend on adult social care – which now accounts for nearly 40 per cent of total council budgets - is threatening the future of other vital council services, such as parks, leisure centres and libraries, which help to keep people well and from needing care and support and hospital treatment.
Further detail can be found here: http://tiny.cc/e7wpxy
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B9. 'The lives we want to lead' – the LGA green paper for adult social care
The Local Government Association states that:
‘Years of significant underfunding of councils, coupled with rising demand and costs for care and support, have combined to push adult social care services to breaking point. The Government’s recent decision to delay its long-awaited green paper on the issue until the autumn has prompted local government to take action and publish its own green paper and public consultation.’
‘Running until 26 September, the consultation seeks the views of people and organisations from across society on how best to pay for care and support for adults of all ages and their unpaid carers, as well as how to shift the overall emphasis of our care and health system to focus more on preventative, community-based personalised care, which helps maximise people’s health, wellbeing and independence and alleviates pressure on the NHS. The LGA will respond to the findings in the autumn to inform and influence the Government’s green paper and spending plans.’
The LGA Green Paper is available here: http://tiny.cc/bbxpxy
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B10. Annual report shows slight increase in complaints about adult social care
Complaints to the Local Government and Social Care Ombudsman about council adult social care rose by 2% last year but the number upheld slightly dropped, according to the watchdog’s annual complaints report.
The ombudsman’s Review of local government complaints showed 2602 complaints were made about adult social care between 2017-18. This was slightly higher than 2016-17, when it received 2555 complaints from the public about adult care.
Of the 2017-18 total, 61% of complaints were upheld, a fall from the 63% upheld in 2016-17, meaning there were slightly fewer upheld complaints in 2017-18 than the previous year.
The ombudsman investigates complaints against councils from people who claim they have suffered injustice as a result of service failure or maladministration, a general word for wrongdoing by authorities.
The complainant must exhaust the council’s own complaints process first before referring the issue to the ombudsman.
Further details are available here: http://tiny.cc/rm5qxy
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B11. Supported housing funding to be retained in welfare system
Housing benefit will continue to be provided for all those living in supported accommodation, the government has said.
Under proposals announced last October, local authorities were to be given control of funding for short-term supported housing, including grant funding for short-term provision, such as hostels and refugees.
However, a government statement this month said ministers had decided to scrap the plans after recognising supported housing as ”a vital service”, following a public consultation.
This means that residents will continue to claim housing benefit as usual, paying rent directly to their landlord.
More information is available here: http://tiny.cc/1z7qxy
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C RESEARCH
C1. Latest NHS Learning Disability Statistics
This publication noow brings together the LDA data from the Assuring Transformation collection and the LDA service specific statistics from the Mental Health Statistics Data Set (MHSDS).
There are differences in the inpatient figures between the MHSDS and AT data sets and work is underway to better understand these.
ASSURING TRANSFORMATION
Data collected for LDA inpatients at the end of June 2018 show that:
- 2,380 inpatients were in hospital at the end of the reporting period.
- More inpatients were discharged (175) than admitted (115) to hospitals. Out of the 175 inpatients were discharged/transferred³ from hospital in July 2018, 125 (72 per cent) were discharged back into the community.
- Many inpatients have been in hospital for a long time. Of those in hospital at the end of July 2018, 1,390 (58 per cent) had a total length of stay of over 2 years.
- At the end of July 2018 just under half of the inpatients 1,170 (49 per cent) were in a general security ward.
- The largest proportion of inpatients were aged between 18-34 (49 per cent) and the lowest proportion were aged 65 and over (1 per cent).
- There were more males than females in hospital this month (74 per cent were male).
- There were 115 admissions to hospital; of these 70 were first admissions, 20 were readmissions and 30 were transfers from other hospitals within a year of the previous discharge.
- Under half of the inpatients last had a review of their care over 6 months ago (1,010 people).
- Just over half of the inpatients have a date planned for them to leave hospital (1,450).
MENTAL HEALTH SERVICES DATASET: LEARNING DISABILITY AND AUTISM STATISTICS
Data collected for LDA inpatients at the end of April 2018 show that:
- There were 3,625 people with learning disabilities and/ or autistic spectrum disorders in hospital.
- There were 167,280 referrals for people with learning disabilities and autism (LDA) during May 2018.
Of these inpatients:
- 1,285 (35 per cent) had been in hospital for over 2 years.
- 155 (4 per cent) had a delayed discharge.
- Findings based on ward stays data:
- The largest proportion were aged between 18-34 (45 per cent).
- The lowest proportion were aged under 18 (5 per cent)
- 72 per cent were male and 28 per cent were female.
- The majority were in a learning disabilities ward (45 per cent), followed by an adult mental health ward (37 per cent).
- 1,645 (46 per cent) were in a secure setting.
- 545 (15 per cent) travelled over 50km from home to get to the hospital for care or treatment.
More data can be accessed at http://tiny.cc/yc6qxy
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C2. Findings of the Named Social Worker pilot
The findings of the DHSC-funded Named Social Worker pilot, which explored how the provision of a single point of contact can make a positive difference for individuals with learning disabilities, autism or mental health conditions, have been published.
The Department of Health and Social Care initiated the Named Social Worker programme in order to build an understanding of how having a named social worker can contribute to individuals with learning disabilities, autism or mental health needs achieving better outcomes, including avoiding lengthy hospital stays. The programme was delivered by Innovation Unit in partnership with the Social Care Institute for Excellence (SCIE).
Link to report and supporting resources: http://tiny.cc/355qxy
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C3. Joint Strategic Needs Assessments: including information about people with learning disabilities
People with learning disabilities suffer inequities in health which start early in life and die sooner than the general population. They should be specifically included in JSNAs to identify current and future health and wellbeing needs in a way that will inform future service planning.
In 2017, around two-thirds (65%) of JSNAs included a section on adults with learning disabilities, up from under half of JSNAs (48%) in 2013. Far fewer JSNAs in 2017 (18%, up from 9% of JSNAs in 2013) included a section on children with learning disabilities or a section on older adults with learning disabilities (11% of JSNAs in 2013 and 2017).
Public Health England are currently writing guidance about sources of potentially useful information for JSNAs based on our latest analysis of JSNAs in 2017. In advance of this guidance, this is a quick update on where Public Health England have got to so far.
How many people in your area have learning disabilities?
Although there is no national register of people with learning disabilities, the regularly updated Public Health England Learning Disability Profiles include local information on the number of children and adults with learning disabilities according to education, adult social care and GP records.
In 2017, over two-thirds of JSNAs (68%) had some information on the number of adults with learning disabilities in their local area, and over two-fifths of JSNAs (42%) included information about the number of children with learning disabilities.
Health issues
NHS Digital publish data showing what GPs record about various aspects of the health and healthcare of people with and (where relevant) without learning disabilities, broken down by age and gender. Health issues covered include:
- asthma
- cancer
- coronary heart disease
- chronic kidney disease
- constipation
- chronic obstructive pulmonary disease
- dementia
- depression
- diabetes
- dysphagia
- epilepsy
- gastro oesophageal reflux disorder
- heart failure
- hypertension
- hypothyroidism
- severe mental illness
- stroke or transient ischaemic attack
Data is available from 57% of GP practices and can be broken down by CCG locality using the interactive tool on the NHS digital website.
Annual health checks and cancer screening
Adults and young people with learning disabilities aged 14 or above should have an annual health check as part of a GP Enhanced Service scheme. In 2017, 16% of JSNAs provided information on annual health checks for people with learning disabilities. Information about the number of health checks completed in your area can be found in the regularly updated Public Health England Learning Disability Profiles.
Universal breast, bowel and cervical cancer screening are offered for populations in at risk groups. Relatively few JSNAs in 2017 (16%) included data on comparative screening rates on all three types of cancer screening for people with and without learning disabilities.
NHS Digital publish data showing what GPs record about various preventive health approaches for people with and without learning disabilities, including:
- measurement of blood pressure
- BMI
- breast screening
- cervical screening
- colorectal cancer screening
- flu jabs
- in need of palliative care
Mortality
Two-fifths (40%) of JSNAs in 2017 included information on mortality and people with learning disabilities. The premature mortality of people with learning disabilities will be one of the priorities in the forthcoming NHS England 10-year plan, and is the focus of the Learning Disabilities Mortality Review Programme (LeDeR). This should, through local mortality review activity, provide important information for JSNAs.
Social determinants
Describing the social determinants of health inequalities is a vital component of a JSNA. In 2017, over half of JSNAs (58%) included some information about the social context of people with learning disabilities in their locality.
Information on the percentage of working age adults with learning disabilities getting long-term social care support who are in paid employment can be found in the Public Health England Learning Disability Profiles. Also available in these profiles are:
- the proportion of adults with learning disabilities who are getting their long-term social care support in the form of a direct payment
- the rate at which adults with learning disabilities are involved in Section 42 safeguarding enquiries
- the percentage of adults with learning disabilities getting long-term social care support who are in settled accommodation, unsettled accommodation, severely unsatisfactory accommodation and whose accommodation is not known to their local authority
The visibility and accessibility of JSNAs
Our analyses of JSNAs to date have flagged up that the following would help them be more accessible to people with learning disabilities and families:
- all information about people with learning disabilities, if distributed throughout different parts of the JSNA, should also be pulled together into one easy to find document that is clearly dated
- the information on people with learning disabilities in the JSNA should be easy to find by members of the public
- accessible summaries of those aspects of the JSNA concerning people with learning disabilities should be included
A copy of the most recent published report on the inclusion of people with learning disabilities in JSNAs is here:
https://gallery.mailchimp.com/fb87a0648757436c218703f51/files/0b41ee80-e5e2-4cd9-9867-8dd285246cbc/JSNA_report_learning_disabilities_FINAL.pdf
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C4. The ‘So what, what next?’ project
A local government report examines the findings from a project to help people with a learning disability or autism to play a bigger part in their communities after being discharged from hospital.
The report can be accessed at:
https://gallery.mailchimp.com/fb87a0648757436c218703f51/files/035f9d7e-31e9-4544-ab89-4eb45d6681df/2018_08_21_So_What_What_Next_LGA_REPORT_FINAL.pdf
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D RESOURCES
D1. Comprehensive geriatric assessment: needs assessment tool
The Nuffield Trust, in collaboration with clinical investigators at the Universities of Leicester, Southampton and Newcastle, is part of a National Institute for Health Research (NIHR)-funded project to research acute hospital care for frail older people.
The aim of the work is to inform NHS managers, clinicians, patients and the public about how best to organise hospital services for frail older people.
As part of this project, a tool has been designed for use by local providers (NHS acute trusts) and commissioners (local authorities) of care for older people (aged 75 years and older) in England. It aims to make information more accessible in order to help providers and commissioners describe hospital activity and frailty in people aged 75 years and older.
The needs assessment tool can be downloaded here: http://tiny.cc/t5wpxy
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D2. Quality Assurance Guide for Commissioners on Provision Post Discharge
This is a tool to help Commissioners provide the best after care post-discharge, taking into account personalisation, co-production and resources that they can work with people and their families to get the best life that people want and need in the community.
The tool can be accessed at:
https://gallery.mailchimp.com/fb87a0648757436c218703f51/files/5350424b-2ba0-406b-aea0-a282eacdf3b0/NHSE_QA_Guide_for_Commissioners_on_Provision_Post_Di....pdf
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D3. Ordinary residence guide: determining local authority responsibilities under the Care Act and the Mental Health Act
This guide has been created to support the ambitions of the Transforming Care programme to improve services and support for children, young people and adults with a learning disability, autism or both a learning disability and autism who may display behaviour that challenges, and significantly reduce the number of people in inpatient settings.
It is aimed at supporting partners to understand and apply the concepts of ordinary residence – in particular, recognising that many of the people supported have experienced complex care and support arrangements, over a number of years, in different geographical areas and where guidance and policy may have changed during this time.
This guide has been commissioned by the Transforming Care programme, which supports people with a learning disability, autism or both, and has been endorsed by the executive council of the Association of Directors of Adult Social Services in England (ADASS) for use with all adults.
The guide can be accessed at http://tiny.cc/fobrxy
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