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Policy Briefing
November / December 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. Institute for Public Policy Research: Uncapped Potential. The Fiscal and Economic Impact of Lifting the Public Sector Pay Cap
Earlier this month the IPPR published a report recommending that the public sector pay cap be lifted. This is on the basis that ‘real median (average) household incomes are today only five per cent higher than they were in 2007 and the country is in the worst period of pay growth in 150 years, exposing serious weaknesses in the UK’s economic model. The focus of government economic policy must now be to raise pay and productivity across the entire economy, and it is critical that the public sector is not left behind.’
The report briefing sets out the fiscal and economic impacts of lifting the public sector pay cap for the final two years of the pay squeeze up to 2019/20 and also sets out three principles to guide government and pay review bodies in lifting the public sector pay cap:
1. Over a medium-term horizon, government should budget to restore pay to its real terms level of 2010/11, the year prior to the formal pay freeze coming into effect. This process should be gradual, and responsive to the macro trends in the economy. As a minimum, government should commit to supporting a new ‘double lock’ for public sector pay. This would guarantee funds for public sector pay to rise by either CPI or private sector earnings, whichever is highest. The double lock should remain in place until public sector earnings return to 2010/11 levels.
2. Until 2010/11 pay levels are restored, pay review bodies, public sector employers and trade unions should consider recommending additional uplifts in pay on top of the double lock. This could be delivered through pay settlements that include higher percentage pay rises for workers on the lowest salary bands, such as through a cash element to increasing pay. Faster increases in pay should also be delivered through a public sector-wide commitment to the Living Wage.
3. All increases in public sector pay for years in the current Spending Review period should be paid for with additional funding outside current public service budgets. These funds should be raised through additional taxation on the highest income households in society.
The full report is available to download here: http://tiny.cc/0ht7oy
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A2. Institute for Public Policy Research: Lifting the cap: The fiscal and economic impact of lifting the NHS pay cap
In this recent report the IPPR examines the cost and benefits of lifting the NHS pay cap.
‘The UK government introduced a two-year pay freeze in 2011/12, affecting all public sector workers earning £21,000 or more. Announcing the freeze, the Chancellor explained that public sector workers “did not cause this recession – but they must share the burden as we pay to clean it up” (Osborne 2010).
The UK government has come under increasing pressure to abandon the pay cap, particularly following the 2017 general election. In October the Secretary of State for Health confirmed the government has abandoned the cap in the NHS. However, he has yet to set out what level of pay increase would be acceptable, and whether the cost of the increase over and above the planned 1 per cent would be funded (Hunt 2017).’
The report makes the following recommendations:
- The UK government should lift the NHS pay cap. It should revise its guidance to the NHS Pay Review Body and ensure its independence and integrity going forward, by making clear that it will accept their recommendations for pay. This should include accepting significant real terms increases in pay for NHS workers in order to reverse some of the real-terms decline seen since 2010/11, as well as differential uprating to boost pay most for areas of the NHS facing particular challenges with recruitment and retention, and for those on lower pay scales.
- Government should provide additional funding at the Autumn Budget to cover this additional expenditure, rather than requiring NHS trusts and boards to meet the cost from already over-stretched budgets.
- In the light of the potential impact of Brexit, government should develop a national NHS Workforce Strategy, in conjunction with NHS Employers and the NHS trade unions to ensure sustainable workforce pipeline for the future.
The full report containing detailed analysis is available here: http://tiny.cc/7it7oy
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A3.BUDGET 2017: ADASS Responds to Exclusion of Social Care Funding
Responding to the exclusion of social care funding from the Autumn Budget, Margaret Willcox, President of the Association of Directors of Adult Social said:
Services (ADASS), said:
“We are extremely disappointed that the Government has not addressed the need for extra funding for adult social care. This means that this winter and throughout next year we will continue to see more older and disabled people not getting the care and support – which they desperately need now.”
“A lack of extra funding will also lead to an even greater toll being placed on 6.5 million family members and other carers. By the end of this financial year, £6 billion will have been cut from councils’ adult social care budgets since 2010 - with need for our services growing all that time.”
“The extra funding for the NHS will not be as effective without extra money for adult social care, which remains in a perilously fragile state. Adult social care needs to be tackled as urgently and at least as equally as the needs of the NHS, in a way which recognises the inter-dependency of these services and encourages a collaborative approach.
The full press release is available here: http://tiny.cc/6mt7oy
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A4. The King's Fund responds to the 2017 Autumn Budget
The Director of Policy for The King’s Fund, said: ‘The additional money for the NHS is a welcome shot in the arm as the service struggles to meet rising demand for services. But it is still significantly less than the £4 billion we estimate the NHS needs next year. Even with this additional funding, the NHS will struggle to meet key targets and provide the investment needed in services such as general practice and mental health.’
‘We are disappointed, though, that the Chancellor did not find any extra funding for social care, which faces a £2.5 billion funding gap by 2019/20. While the forthcoming Green Paper offers the prospect of reform, any meaningful change is a long way off and will be of little comfort to the many people who need help now but cannot access it.’
The press release is available here: http://tiny.cc/oot7oy
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A5. Nuffield Trust response to the Autumn Budget 2017
Commenting on the NHS funding measures announced in the Autumn Budget, Nuffield Trust Chief Executive Nigel Edwards said:
“The Chancellor has committed to a sizeable extra funding boost of around £2bn to the NHS next year. This was the right decision and will bring respite for patients and NHS staff alike. For now at least, we have dodged the bullet.
But as we and two other leading think tanks calculated, the figure really needed next year to get the NHS on a permanently stable footing would have been at least £4bn.
Today’s pledges fill about half of this. The new money levels off fast: the year after next, the NHS will again face limited additional funding, and we may find ourselves staring down the barrel once again.”
“The reality is that we still need a more permanent shift in the amount of money Britain spends on health and social care if we are to give patients, now and in the future, continued access to timely care at the best international standards.”
The full press release can be viewed here: http://tiny.cc/qpt7oy
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A6. Government to set out proposals to reform care and support
On 16th November the First Secretary of State and Minister for the Cabinet Office, Damian Green, announced that the government will publish a green paper on care and support for older people by summer 2018. The paper will set out plans for how government proposes to improve care and support for older people and tackle the challenge of an ageing population.
Once the green paper is published in summer 2018, it will be subject to a full public consultation.
The government’s press release, containing names of independent experts invited by government to provide advice and support engagement in advance of the green paper, can be found here: http://tiny.cc/sst7oy
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A7. New sleep-in shift pay compliance scheme launched to support social care sector and identify back pay for workers
On November 1st government announced a new compliance scheme for social care providers that may have incorrectly paid workers below legal minimum wage hourly rates for sleep-in shifts.
Social care employers will be able to opt into the new Social Care Compliance Scheme (SCCS), giving them up to a year to identify what they owe to workers, supported by advice from HM Revenue and Customs (HMRC). Employers who identify arrears at the end of the self-review period will have up to three months to pay workers.
HMRC will write to social care employers who currently have a complaint against them for allegedly underpaying minimum wage rates for sleep-in shifts to encourage them to sign up to the scheme. Employers that choose not to opt into the scheme will be subject to HMRC’s normal enforcement approach.
Further detail and the updated guidance on sleep-in shifts are available here: http://tiny.cc/ett7oy
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A8. Mounting pressures lead councils to overspend on social care by £21bn
Public Sector Executive published an article on 21st November highlighting that over half of councils are expected to overspend on their adult social care budgets this year (Association of Directors of Adult Social Services) (ADASS) has claimed.
With each council exceeding their budgets by up to almost £21m, ADASS has urged for the long-term reform of adult social care to be brought forward. Despite a £2bn cash injection for social care over three years, the association has warned that the sector is experiencing “significant financial, workforce and quality pressures,” which must be addressed.
ADASS argues that while the £2bn boost will reduce delayed transfers of care from hospitals, it will not address the continued funding gap, increased support for people living longer with more complex needs or the costs of the National Living Wage.
It is concerned that these challenges threaten councils’ abilities to fulfil their statutory duty under the Care Act - with only 4% of directors confident in their abilities to do so this year - and impact on older and disabled people, and their families.
The full article is available here: http://tiny.cc/qvt7oy
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A9. Service user rights and resources must be at heart of Mental Health Act reform, say experts
This Community Care blog argues that the government’s review of the Mental Health Act must listen to people with experience of the system, or fail, say service users and AMHPs
It can be found here: http://tiny.cc/51t7oy
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A10. DoLS reform to take account of planned Mental Health Act changes
Planned reforms to the law on deprivation of liberty will take account of proposals to overhaul the Mental Health Act, the care minister has said.
Any changes arising from the Law Commission’s review of the law on deprivation of liberty, and proposed replacement, “will be undertaken in consideration of our work reforming mental health”, said Jackie Doyle-Price in a ministerial statement today.
The government has commissioned an independent review of the Mental Health Act, due to report next autumn, which may lead to replacement legislation.
Doyle-Price said the government would respond in detail to the Law Commission’s recommendations in next spring
More detail is available here: http://tiny.cc/v5t7oy
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A11. LGA responds to Government announcement on funding proposals for supported housing
Responding to the Government’s proposals on funding for supported housing, Lord Porter, Chairman of the Local Government Association, said:
“Today’s announcement demonstrates that the Government rightly sees councils as crucial when it comes to providing supported housing for some of their most vulnerable residents. Ensuring that no cap will be applied to housing benefit, and that funding will be kept at current levels for short-term accommodation, is a hugely positive first step towards putting all supported housing on a more secure footing.”
More detail is available here: http://tiny.cc/jmu7oy
Instead, the government has proposed a new model for funding sheltered housing and extra care housing available at: http://tiny.cc/49u7oy
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A12. English local authorities face average seven-month DoLS case backlog, official figures suggest
The annual DoLS report, published by NHS Digital, estimates that local authorities have accumulated uncompleted applications that would take on average about seven months to process, if no new applications were received. The largest estimated clearance time, according to the report, is 71 months.
The report covers the period from 1 April 2016 to 31 March 2017. While councils completed many more applications than in previous years, the overall reported backlog in cases rose by 7%, to 108,545.
This is, however, a far smaller rise than the previous year, when uncompleted cases jumped from 75,000 to almost 102,000.
More detail is available here: http://tiny.cc/nuu7oy
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A13. Refreshed Health Charter to tackle inequalities for people with learning disabilities
Public Health England and VODG (the Voluntary Organisations Disability Group), have launched the updated Health Charter for social care providers who support people with a learning disability. The Charter was developed with people with learning disabilities and their families to support providers to improve the overall health and wellbeing of people with learning disabilities. It is intended to raise awareness of the health inequalities that exist for people with a learning disability and act as a tool to enable staff to improve support given to enable people to embed healthy lifestyle.
This updated version of the Charter includes information on the STOMP healthcare campaign to stop the over-medication of people with learning disabilities and/or autism.
More detail is available here: http://tiny.cc/82u7oy
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A14. CQC Inspections to Include Questions on Love, Sex and Relationships
The Care Quality Commission (CQC) have now agreed to include questions relating to Love, Sex and Relationships in future inspections! This is thanks to the work of the Lancashire Friends and Relationships Group questioning and challenging CQC and making recommendations.
CQC told them ‘Many thanks for your suggestions for questions we could ask during inspections. I have liaised with colleagues in CQC and we are exploring options of how to integrate the questions into our inspections and will be developing guidance for staff.’
CQC have now confirmed ‘Your suggested questions have been taken on board as part of ‘additional questions’ for inspectors to ask whilst on inspections. They have only recently been devised as a set of questions alongside other questions and will be used as part of next phase of inspections.’
CQC inspections up and down the country are about to change. It is hoped this will have a huge impact and make a positive difference in ensuring that good ‘Love, Sex and Relationships’ support and services are provided by all health and social care commissioners and providers so that relationships opportunities, information and education are available for people with a learning disability.
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A15. Ombudsman upholding two-thirds of adult social care complaints
The local government and social care ombudsman upheld 63% of adult social care complaints in 2016-17, 10% higher than the average across all sectors, the watchdog’s annual review has revealed.
The proportion of investigations upheld during 2016-17 rose 5% year on year, while the number of investigations completed – 1,214 – was up 9%.
Complaints relating to adult safeguarding saw the steepest climb, up 27% from 2015-16. Meanwhile the number of complaints relating to independent care providers was up 16% to 447, continuing a steady rise from just 58 back in 2010-11.
Michael King, the local government and social care ombudsman, said the safeguarding figures were “worrying”. But he welcomed the rise in independent care complaints as evidence of a “learning culture” among providers, which he said were getting better at responding to complaints and encouraging people to refer them.
More detail is available here: http://tiny.cc/l7w7oy
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A16. Green Paper on adult social care
The Government has announced its intention to publish a Green Paper on reform of care and support for older people. The Government has also announced a new period of consultation and engagement with relevant stakeholders to inform the Green Paper. The scope is explicitly focused on older people rather than all recipients of social care, but will cover the role of carers and has a potentially wide scope. Separately, the Government has confirmed it will also run a parallel programme of work to consider the needs of working age adults. Within the Green paper, our understanding is that the 'cap on care costs' will now not proceed in April 2020 as previously planned (following the previous Government's delay to this part of the Care Act back in 2015) but we understand that the care cap will remain in scope for discussions during the pre-green paper consultation period.
More detail is available here: http://tiny.cc/opx7oy
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B. RESOURCES
B1. My Own Front Door
“My Own Front Door” is the story of a group of people with learning disabilities and their journey into independent living.
The video can be found here http://tiny.cc/oqv7oy
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B2. ADASS blog: Building the right home
This blog by Sean McLaughlin, Director of Housing and Adult Social Services, Islington Council, and joint chair of the national ADASS Learning Disability network was published by NHS England to coincide with their new housing guidance.
The blog can be found here: http://tiny.cc/cxv7oy
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C RESEARCH
C1. Latest MH Learning Disability Statistics
Data collected at the end of October 2017 show that:
- 2,445 patients were in hospital at the end of the reporting period.
- There were 80 admissions to hospital.
- There were 135 discharges/transfers from hospital
- In each of the last 10 months, more patients were discharged than admitted to specialist hospitals. 135 patients left hospital in October 2017, 105 (79 per cent) were discharged back into the community
- Many patients have been in specialist hospital for a long time. Of those in hospital at the end of October 2017, 1,500 had a total length of stay of over 2 years.
- At the end of October 2017 just under half of the patients (49 per cent) were in a General security ward.
More data can be accessed at http://tiny.cc/dix7oy
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C2. Families with disabled adult and child members worst hit by post-2010 government policies
Households containing at least one adult and one child with a disability have been hardest hit by the policy decisions of post-2010 governments, according to a report by the Equality and Human Rights Commission (EHRC).
The research, part of an ongoing study into the cumulative impacts of tax, social security and public spending policies, was released last week ahead of the autumn Budget. It found some families stood to lose at least 13% of their net incomes by 2022, largely because of welfare and tax reforms.
Households with at least one ‘core’ disabled adult (as defined by the Equality Act 2010) and at least one disabled child, are the biggest losers, with losses of over £5,500 per year, the report said. Families where children were not disabled, but at least one adult was, stood to lose £2,500.
Older people were also likely to be disproportionately hit, with those in the 65-74 age group facing average losses of around £1,450 per year, the study found. More broadly, it concluded that the poorest households stood to lose about 10% of their income by 2021-22 because of tax and social security changes, while the wealthiest lost less than 1%.
More detail can be found here: http://tiny.cc/jex7oy
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