Copy
This month's Policy Briefing by the NWTDT Research Centre
View this email in your browser

Policy Briefing

October 2018

Thank you for continuing to support North West Training and Development Team. This monthly policy bulletin is sent to subscribers as part of the subscription offer.
 
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.
 
If you are using Microsoft Outlook and want to make sure that you continue to receive this briefing, please add our email address info@nwtdt.com to your Safe Senders List in Outlook.  You can find out how to do this at: http://support.microsoft.com/kb/817883
 
This briefing is compiled by Dr Laurence Clark and Colin Elliott from Pathways Associates CIC.

In this issue:
 
A. PATHWAYS ASSOCIATES NEWS
  1. NHS Ten Year Plan
  2. Aviva Funding
B. HEALTH AND SOCIAL CARE NEWS
  1. Regional allocation of adult social care winter funding
  2. The future of healthcare: our vision for digital, data and technology in health and care
  3. £2 million investment to help NHS achieve zero inpatient suicide ambition
  4. Department of Health and Social Care Open Consultation: Directions for integrated care providers (ICPs)
  5. Framework agreement between DHSC and NHS Improvement
  6. National framework for NHS continuing healthcare and NHS-funded nursing care
  7. GP Partnership Review: interim report
  8. Update to Care Act Statutory Guidance for Local Authorities
  9. Number of completed DoLS cases up by 20% in past year but backlog continues to grow
  10. LGA Summary of Key Budget Announcements 2018
  11. The state of health care and adult social care in England 2017/18
  12. Leading social care interest groups warn government that its mental capacity reforms are not fit for purpose
  13. Government to amend deprivation of liberty scheme to cover 16- and 17-year-olds
  14. Peers assured DoLS replacement system will not reduce access to advocacy
  15. Use of Restraint on People with Learning Disabilities Rises
C. RESEARCH
  1. Latest NHS Learning Disability Statistics
  2. Majority of people unprepared for adult social care costs
  3. Doomed to repeat? Lessons from the history of NHS reform
  4. How could Brexit affect poverty in the UK?
  5. UN told one in five disabled Britons have their rights violated
  6. Accessible Housing in Local Plans 2018
D. RESOURCES
  1. New NHS social care and support guide available
  2. Making It Real refreshed
  3. A Parent’s Guide: Improving the well-being of young children with learning disabilities
  4. NICE guideline on decision-making and mental capacity
  5. Housing and disabled people: A toolkit for local authorities in England
A. PATHWAYS ASSOCIATES NEWS

A1. NHS Ten Year Plan
The NW Regional Forum and family forum were keen for their voices to be heard in advising on the priorities for the NHS ten year plan, particularly the priority for learning disabilities and autism.
 
We have supported LDE to deliver an event in the NW and Lynn James-Jenkinson and Vicki Buckingham represented the NW Regional Forum and family forum at 2 events in London with Ray James, David Gill and the national team. We have shared the plans we have in the NW:
  1. the GM learning disability plan
  2. the learning disability plan that we have started supporting cheshire/ Mersey coproduce
  3. the work that has been done at the Pan Lancs/ South Cumbria Confirm and Challenge group.
We are delighted to hear Ray James, on this video, talk about the health inequalities faces by people with learning disability, autism or both and their families and the unnecessary and preventable deaths of people.

From what we have seen through coproduction, the plan has nothing in it that we have not already identified as something important to us in the NW. We are confident that whatever the NHS 10 year plan says, it will sit easily and support the work we are already doing.
 
Well done NW - working together means that again we will be ahead of the game....
A2. Aviva Funding
You can current vote on Aviva’s website for funding for My Life My Way’s next music festival.
 
This project would fund them to host another music festival, continuing to build on the ideas and aspirations of young people who want the opportunity to try new things like camping and staying up late and live music with people who they feel confident have paid attention to their particular access needs.
 
The funding available through this programme is vitally important to making sure that young people with learning disabilities, their brothers and sisters and families as well as adults and older people with a learning disability, autism or both can come together and enjoy a live music in a festival atmosphere. The funding pays for all the things that a full access audit tells us we need e.g. adult changing spaces, viewing platform, accessible stage area to support people to perform and share their skills, volunteer expenses etc.
 
Please vote for them at http://tiny.cc/12cl0y
B. HEALTH AND SOCIAL CARE NEWS

B1. Regional allocation of adult social care winter funding
On 17th October the Department of Health and Social Care announced an additional £240 million fund to help local areas ease winter pressures on the NHS. The extra funding is aimed at reducing delayed transfers of care and could pay for the following:
  • home care packages to help patients get out of hospital quicker
  • reablement packages, which support workers to help patients carry out everyday tasks and regain mobility and confidence
  • home adaptations, including new facilities for personal care, such as adapting a shower room if a patient has limited movement
Councils have been allocated the funding based on the adult social care relative needs formula. Detail of local allocations is available here: http://tiny.cc/94tk0y
B2. The future of healthcare: our vision for digital, data and technology in health and care
The Department of Health and Social Care published a document on 17th November setting out proposals for a modern technology architecture and a set of guiding principles that will together be the foundation for a new generation of digital services designed to meet the needs of all users – for the workforce and for patients and people who use care services.
 
The vision sets out how digital services and IT systems will need to meet a clear set of open standards to ensure they can talk to each other and be replaced when better technologies become available. A focus on putting user needs first and setting standards at the centre will enable local organisations to manage their use of technology and spread and support innovation wherever it comes from.
 
The document, along with a questionnaire to gain views on the proposals are available here: http://tiny.cc/r9tk0y
B3. £2 million investment to help NHS achieve zero inpatient suicide ambition
On 11th October the Prime Minister announced £2 million in funding for the Zero Suicide Alliance (ZSA) over the next 2 years. The funding will help to reduce suicides across the NHS, with the aim of achieving zero inpatient suicides.
It will be used to develop tools for the NHS and public and private partners. The tools will focus on:
  • training to prevent suicides
  • improving safety
  • ensuring lessons are learnt when suicides occur
The ZSA will also develop their digital suicide prevention resource, capturing best practice and learning from across the UK and abroad, and explore the use of analytics to predict suicide risk.
 
Further information is available here: http://tiny.cc/jcuk0y
B4. Department of Health and Social Care Open Consultation: Directions for integrated care providers (ICPs)
This consultation is aimed at GPs and others involved in the provision of primary medical services. It set outs the draft directions for those providing primary care as part of an ICP and asks if the draft provisions for a new ICP contract are effective and sufficient, and whether there are any other impacts the government should be aware of. The consultation closes on 7th December 2018.
 
The Directions for Integrated Care Providers and the consultation are available via the following links:
http://tiny.cc/qeuk0y
http://tiny.cc/5fuk0y

Separately, NHS England has consulted on the new ICP contract between 3 August and 26 October 2018. This would make a single organisation contractually responsible for delivering integrated care services and improved health outcomes for the population of an area.
B5. Framework agreement between DHSC and NHS Improvement
On 8th October the Department of Health and Social Care (DHSC) published a document setting out how DHSC and NHS Improvement will work together, setting out roles, responsibilities, governance and accountability arrangements.
The framework agreement should be read in conjunction with:
  • Annex A: wider guidance
  • Annex B: finance and accounting responsibilities
  • Annex C: public-facing communications
  • Annex D: relationships with other arm’s length bodies
All are available here: http://tiny.cc/fluk0y
B6. National framework for NHS continuing healthcare and NHS-funded nursing care
The delayed discharges (continuing care) directions 2013 detail the duties on NHS trusts in relation to hospital discharge and NHS continuing healthcare. NHS continuing healthcare is an ongoing package of health and social care that is arranged and funded solely by the NHS where an individual is found to have a primary health need. Such care is provided to an individual aged 18 or over to meet needs that have arisen as a result of disability, accident or illness.
 
 
The national framework for NHS continuing healthcare and NHS-funded nursing care sets out the principles and processes for deciding eligibility. The checklist, decision support tool and fast track pathway tool will help clinicians and practitioners with the decision-making process.
 
The 2018 version of the national framework document and the associated tools took effect on 1 October 2018. They supersede the 2012 versions; however the 2012 tool documents should still be used where appropriate. Relevant documents are available here: http://tiny.cc/bnuk0y
B7. GP Partnership Review: interim report
The partnership model of general practice has been the foundation of the NHS for over 70 years. General practice is at the very heart of primary care and, therefore, the NHS however General practice is facing some major challenges, with declining numbers of GPs (excluding locums and trainees), with low morale, increased levels of stress, mental health problems and burnout, working days getting longer and the complexity and intensity of work increasing. The traditional services that have, in the past, formed part of the primary care team are no longer part of the practice team in most areas, and the fragmentation has led to inefficiencies, duplication and less effective care delivered to patients.
 
This independent report identifies areas where the review will look for solutions to reinvigorate the partnership model and support the transformation of general practice. It invites GPs and others with an interest to continue to get involved with the review by sharing their experiences and ideas.
 
More details here: http://tiny.cc/9puk0y
B8. Update to Care Act Statutory Guidance for Local Authorities
On 1st October the Department of Health and Social Care updated its statutory guidance for local authorities. The updates are as follows:
 
In Annex G paragraph 8, guidance for issuing an assessment notice has been expanded to include when NHS bodies can or must issue an assessment notice. In paragraph 9 guidance has been added on local agreements for assessment notices between NHS bodies and local authorities. In Annex H paragraph 26, guidance on accommodation as part of a package of care has been amended to clarify the process when an individual is placed in a care home with the local authority an individual is ordinarily resident in.
 
The guidance and a list of amendments are available here: http://tiny.cc/0tuk0y
B9. Number of completed DoLS cases up by 20% in past year but backlog continues to grow
An NHS Digital study has found the number of completed Deprivation of Liberty Safeguard (DoLS) applications rose by 20% in 2017-18 compared with the previous year,
 
The Mental Capacity Act 2005, Deprivation of Liberty Safeguards 2017-18 report showed the number of completed DoLS applications increased from 151,970 in 2016-17 to 181,785, representing a 19.6% rise.
 
While the the number of completed applications that were granted rose by 15.2%, there was a sharper, 27.3%, rise in the number that were not granted, from 55,630 to 70,805.
 
The results mean DoLS teams and assessors are getting through almost three times as many cases as they did in 2014-15, when they completed 62,645 applications.
 
Yet, despite the rise in completed applications, the backlog in cases that remained unfinished at the end of the year has continued to grow, from 108,545 in March 2017 to an estimated 137,065 in March 2018. This was because the number of new applications, 227,400, outstripped the number of completed cases and the number that were withdrawn during the year (17,090) combined.
 
More details available here: http://tiny.cc/7fwk0y
B10. LGA Summary of Key Budget Announcements 2018
The Local Government Association publishes an analysis of key points following each budget. In his October 2018 Budget the Chancellor announced the following:
 
An additional £240 million in 2018/19 and £240 million in 2019/20 for adult social care. The Budget provides a further £410 million in 2019/20 for adults and children’s social care.
 
An additional £55 million in 2018/19 for the Disabled Facilities Grant (DFG) to provide home aids and adaptations for disabled children and adults on low incomes.
 
Children’s social care: £84 million over 5 years for up to 20 local authorities, to help more children to stay at home safely with their families.
 
The NHS will invest up to £250 million a year by 2023/24 into new crisis services, including: 24/7 support through NHS 111; children and young people’s crisis teams in every part of the country; comprehensive mental health support in every major A&E by 2023/24; more mental health specialist ambulances; and more community services such as crisis cafes. The NHS will also prioritise services for children and young people, with schools-based mental health support teams and specialist crisis teams for young people across the country.
 
As also set out in June 2018, the Government will consider proposals from the NHS for a multi-year capital plan to support transformation, and a multi-year funding plan for clinical training places. The Government will also ensure that public health services help people live longer healthier lives. Budgets in these areas will be confirmed at Spending Review 2019.
 
To mark the centenary of the First World War Armistice and the sacrifices made by so many men and women, the Government will commit £10 million to support veterans with mental health needs.
 
The full LGA analysis and the Association’s response are available here: http://tiny.cc/hx8k0y
B11. The state of health care and adult social care in England 2017/18
The CQC’s yearly look of the quality of health and social care in England warns of growing ‘care injustice’, with access to good care becoming more dependent on how well local systems work together. It shows that most people are still getting good care – when they are able to get to it.
 
Overall, quality has been mostly the same as last year, and in some cases, even better.
 
This is in the face of the ongoing challenges around demand and funding, together with big workforce pressures as all sectors struggle to recruit and keep staff.
 
The hard work of staff, leaders and carers to make sure that people continue to get good, safe care despite these challenges must be recognised and celebrated.
 
But quality is not reliable, and access to good care is becoming more about where in the country you live and the type of help you need.
 
Some people can get to good care easily. Others cannot access what they need, they experience disorganised care, or only have access to providers with poor services.
 
People’s experiences are often determined by how well different parts of local systems work together.
 
Read the summary report here. http://tiny.cc/ld9k0y
Read the full report here. http://tiny.cc/oc9k0y
B12. Leading social care interest groups warn government that its mental capacity reforms are not fit for purpose
Leading social care interest groups from across the care sector are calling on the Government to urgently rethink its Mental Capacity (Amendment) Bill that is now at a crucial parliamentary stage.
 
Concerns about the legislation are outlined in a new paper ahead of the House of Lords committee stage when it will be scrutinised by peers. The paper reflects the views of a wide range of organisations that represent people using support services, their families, care provider organisations and infrastructure bodies.
 
One major concern is that these proposals undermine the safeguards that protect people who lack capacity to make decisions about their care. The Bill introduces a conflict of interest for registered managers who would be responsible for carrying out assessments (providers may face allegations they are depriving someone of their liberty to fill a vacancy).
 
The group is also uneasy about the focus on how reforms will save an estimated £200m a year which calls into question the motives for change. There are also fears about the financial and practical impact of care providers fulfilling their new LPS responsibility at a time when the sector is already under enormous strain.
 
Other worrying aspects of the Bill include:
  • the lack of focus on the views of the person being assessed – people and their families are worried there is no requirement to consider the person’s own wishes
  • the implications of transferring responsibility for dealing with the backlog of DoLS assessments from local authorities to providers.
  • confusion arising from the creation of three disparate systems for managing the LPS, in care homes, community care settings and hospitals.
  • the lack of definition or acceptability of the term ‘unsoundness of mind’ – DoLS apply to people with a “mental disorder” but LPS apply to people of “unsound mind” – there is no definition of what this stigmatising term means.
More details available here: http://tiny.cc/2bal0y
B13. Government to amend deprivation of liberty scheme to cover 16- and 17-year-olds
The government will amend its planned replacement to the Deprivation of Liberty Safeguards (DoLS) so that it applies to 16- and 17-year-olds, not just those over 18, a minister has confirmed.
 
Junior health minister Lord O’Shaughnessy pledged to amend the Mental Capacity (Amendment) Bill so that the proposed Liberty Protection Safeguards applied to young people aged 16 and 17, in a House of Lords debate on the bill.
 
The government had been criticised for excluding 16- and 17-year-olds from the scheme, particularly as they had been included in 2017 Law Commission proposals to replace DoLS that form the blueprint for the government’s plans.
 
More details available here: http://tiny.cc/glal0y
B14. Peers assured DoLS replacement system will not reduce access to advocacy
The government has assured peers that the system to replace the Deprivation of Liberty Safeguards (DoLS) will not reduce access to advocacy for people deprived of their liberty.
 
Junior health minister Lord O’Shaughnessy told a House of Lords debate on Monday 22 October that the Liberty Protection Safeguards (LPS) was not written “to restrict people’s access to independent advocacy”.
 
“It must be the case that anybody who needs support to navigate these difficult and complex situations must be able to find the right support for them,” O’Shaughnessy said in the debate on the Mental Capacity (Amendment) Bill.
 
O’Shaughnessy was speaking on the final day of the bill’s committee stage in the House of Lords, during which the legislation, which would introduce the LPS to replace DoLS, was scrutinised in detail. No amendments were passed during the stage, and the bill will now proceed to the report stage, the penultimate phase of its passage through the Lords.
 
More details available here: http://tiny.cc/qpbl0y
B15. Use of Restraint on People with Learning Disabilities Rises
The use of restraints on adults with learning disabilities in hospital units in England rose by 50% between 2016 and 2017, figures show.
 
In 2017, restraints were used more than 22,000 times - once every half an hour. This was up from 15,000 times in 2016.
 
Former Social Care Minister Norman Lamb said the use of restraint was "shameful".
 
The Department of Health said it was committed to reducing the use of restrictive force in hospitals.
 
The data, which covers both adults and children, obtained from NHS digital by BBC Radio 4's File on 4 programme also found:
  • Patient on patient assaults rose from 3,600 to more than 9,000 over the same period and figures for January to May this year suggest they are continuing to rise
  • Instances of face-down or prone restraint - which should no longer be used according to government guidelines - also increased from more than 2,200 to 3,100
More details available here: http://tiny.cc/hocl0y
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 September 2018 show that:
  • 2,315 inpatients were in hospital at the end of the reporting period.
  • More inpatients were discharged (170) than admitted (100) to hospitals.
  • Out of the 170 inpatients that were discharged/transferred from hospital in September 2018, 110 (67 percent) were discharged back into the community.
MENTAL HEALTH SERVICES DATASET: LEARNING DISABILITY AND AUTISM STATISTICS
Data collected for LDA inpatients at the end of July 2018 show that:
  • There were 3,625 people with learning disabilities and/ or autistic spectrum disorders in hospital.
  • There were 1,340 admissions and 1,435 discharges, 77 percent of these were discharged back into the community.
  • There were 175,030 referrals for people with learning disabilities and autism (LDA).
More data can be accessed at http://tiny.cc/jbvk0y
C2. Majority of people unprepared for adult social care costs
The overwhelming majority of people have not made any plans for how they will pay for adult social care in older age, national public polling by the Local Government Association reveals.
 
Half of English adults (48 per cent) say that they have little to no understanding of what the term ‘social care’ means, compared to just 13 per cent of people in England who said they did know what the term ‘social care’ means and feel that they have a good understanding of what it is. Staggeringly, 5 per cent of people have never heard of the term ‘social care’ at all. Forty-four per cent of people think that social care is provided by the NHS and 28 per cent think that it is free at the point of access.
 
The LGA is calling on the Government to lead a national campaign to heighten the profile and reputation of adult social care after the findings of the poll raised concerns about the public’s understanding and preparedness for the costs associated with adult social care.
 
Further detail is available here: http://tiny.cc/zyuk0y
C3. Doomed to repeat? Lessons from the history of NHS reform
Since 2000 the NHS in England has seen at least six major national plans, accompanied by at least ten reorganisations at various levels, they all aimed to create tangible, widespread changes in the health service that would give patients and taxpayers a fundamentally better deal.
 
Now the NHS is once more being asked to draw up a master plan for its future – one which will last for 10 years, and will be backed by £20 billion a year in extra funding on top of the largest budget of any public service.
 
On 16th October the Nuffield Trust published a series of essays bringing together research and analysis of the key questions that should inform the new NHS plan in the hope that the essays will start a debate about the lessons the long history of NHS reform can teach us today. The essays are available here: http://tiny.cc/91uk0y
C4. How could Brexit affect poverty in the UK?
This Joseph Rowntree Foundation (JRF) briefing analyses Brexit’s potential impact on families in poverty, along with other forces that could help or hinder efforts to solve UK poverty. It can be found here: http://tiny.cc/uwwk0y
C5. UN told one in five disabled Britons have their rights violated
One in five British people are suffering erosion of their rights because they are disabled, the government-backed Equality and Human Rights Commission has said in a damning report to the United Nations.
 
The body cites “deeply concerning” evidence that despite government pledges to improve conditions for the nearly 14 million disabled Britons, their situation is getting worse across the UK.
 
Its report to the UN committee on disability rights that “more and more disabled people are finding it difficult to live independently and be included, and participate, in their communities on an equal basis”.

The article can be accessed here: http://tiny.cc/wuzk0y
C6. Accessible Housing in Local Plans 2018
In 2018 Habinteg assessed accessible housing requirements in place in local planning authorities across England. The research was collated and recorded by looking at the accessibility requirements in local plans across 263 out of a possible 365 local planning authorities across England.
 
The research shows how many local planning authorities across England mention accessible housing, but more importantly how many have committed to providing a proportion of accessible housing within their local plans.                   

The research can be accessed here: http://tiny.cc/bk9k0y
D RESOURCES

D1.  New NHS social care and support guide available

NHS Digital has produced a new guide containing information to help those who may need social care, now or in the future, to understand options available to them and how to access services. Local authorities, NHS organisations and care providers can signpost people to the information. They can also reuse it on their own websites through a free syndication service which pulls up to date content directly from nhs.uk onto their website or mobile application. It can be accessed here: http://tiny.cc/0mwk0y
D2. Making It Real refreshed
Making it Real can support organisations to change the conversation to a far more people powered and citizen centred dynamic. Everybody across the sector needs to know what good care and support looks like and, more meaningfully, what it should look like from the perspective of people accessing health, social care or housing services. The refreshed version can be accessed at http://tiny.cc/m1zk0y
D3. A Parent’s Guide: Improving the well-being of young children with learning disabilities
The idea for this booklet was motivated by parents’ concerns about the lack of accessible guidance on how families can help promote the well-being of their child with a learning disability.

The guide can be accessed at http://tiny.cc/i1al0y
D4. NICE guideline on decision-making and mental capacity
This guideline covers decision-making in people 16 years and over who may lack capacity now or in the future. It aims to help health and social care practitioners support people to make their own decisions where they have the capacity to do so. It also helps practitioners to keep people who lack capacity at the centre of the decision-making process.
 
The guideline can be accessed at http://tiny.cc/bkbl0y
D5. Housing and disabled people: A toolkit for local authorities in England
Housing and Disabled People is a new toolkit from Habinteg and the Equalities and Human Rights Commission, for those involved in housing and planning in local authorities in England.
 
It includes information, checklists, questionnaires and best practice examples, with separate, downloadable guides for:
  • providing and managing housing adaptations
  • the allocation of housing
  • planning for accessible homes
  • strategic planning
  • supporting tenants
The guide can be accessed here: http://tiny.cc/8fcl0y
Copyright © 2018 Pathways Associates, All rights reserved.


unsubscribe from this list    update subscription preferences