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This month's Policy Briefing by the NWTDT Research Centre
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Policy Briefing

September 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.

In this issue:
 
A. PATHWAYS ASSOCIATES NEWS
  1. Creative Support Planning
B. HEALTH AND SOCIAL CARE NEWS
  1. Government response to the Learning Disabilities Mortality Review (LeDeR) Programme 2nd annual report
  2. Consultation announced to improve learning disabilities staff training
  3. National conversation with health and care staff begins
  4. Hospitals to receive £145 million to prepare for winter demand
  5. Government response to the Health and Social Care Committee’s report on integrated care
  6. Local area performance metrics - Assessing the flow of patients across the boundary between the NHS and social care
  7. Ordinary residence: anonymised determinations 2018
  8. Strain on unpaid carers putting adult social care at increased risk of collapse
  9. Civil Society Strategy: building a future that works for everyone
  10. Autism self-assessment 2018
  11. Increased funding announced for disabled people with the greatest barriers to work
  12. £450k announced to help patients have their say on health services
C. RESEARCH
  1. Latest NHS Learning Disability Statistics
  2. The state of the adult social care sector and workforce in England
  3. A year of integrated care systems: reviewing the journey so far
  4. Liberty Protection Safeguards – national survey results
  5. The hospital provision of reasonable adjustments for people with learning disabilities: Findings from Freedom of Information requests
D. RESOURCES
  1. Unlocking capacity: smarter together
  2. The only way is ethics: a new approach to outsourcing social care
  3. Why meeting disabled children’s needs must go beyond narrow safeguarding concerns
  4. Flu vaccinations  
  5. Commissioning for transition to adult services for young people with SEND
  6. NHS England - The importance of ‘reasonably adjusted’ care
  7. The WE CAN Game - a free download to explore gifts and capacities
A. PATHWAYS ASSOCIATES NEWS

A1. Creative Support Planning
Pathways was approached to independently support a family plan in order to enable the Local Authority/ Education Service and CCG support a young woman to remain at home rather than be admitted to a residential 52 week placement.
 
Pathways Associates worked closely with the young woman, her mum, sister and other family members to develop a plan that considered everyone’s health and support needs and the young person’s education needs.
 
Pathways Associates supported the young ladies mum to have different conversations with those around her who were recommending the move to a 52 week placement at an annual cost of £250.000 Eventually a personal budget of £30.000 and support plan was agreed - and 5 years on is still in place supporting this wonderful, feisty young woman remain at home with her family which is where everyone wanted her to be and where everyone close to her felt her very complex heath care needs could be better managed and supported.
 
The young lady we were supporting recently celebrated her 18th birthday and members of the team who had been involved were invited along to a room filled with friends and family, all of whom are in regular contact with her and her mum. Her sister decided on starting work within the health and social care sector as a result of this work and savings for the young person’s support allow money to be used purposefully not just for her but also for broad expenditure in health / education / social care .
 
This model of support/ risk management planning has been successfully used by the team on a number of occasions to support people successfully discharge from hospital settings or prevent an admission.
 
Thank you R for allowing us to share your story - roll on the 21st!
B. HEALTH AND SOCIAL CARE NEWS

B1. Government response to the Learning Disabilities Mortality Review (LeDeR) Programme 2nd annual report
The LeDeR 2nd annual report was published on in 4 May 2018. It gave 9 recommendations based on the evidence from 103 reviews of deaths of people with learning disabilities undertaken between July 2016 and November 2017.
 
On 12th September government issues a joint response from the Department of Health and Social Care and NHS England to the LeDeR 2nd annual report. It accepts the recommendations and sets out a plan of action for each one.
 
The actions are intended to help address the inequality in life expectancy between people with learning disabilities and the wider population by ensuring that staff supporting people with a learning disability understand their needs and can make adjustments to the way care is provided, to help people reach their full potential.
 
Standard text and easy read copies of the government’s response, along with a link to the LeDeR 2nd annual report are available here: http://tiny.cc/345gzy

Chris Hatton's blog on how the government has failed to grapple with the underlying reasons for the premature deaths of people with learning disabilities can be read here: http://tiny.cc/lw8gzy
B2. Consultation announced to improve learning disabilities staff training
The Department of Health and Social Care announced on 12th September that it will seek views on its plans to expand awareness training for health and care staff who work with people with learning disabilities.
 
The proposed training could cover:
  • relevant legislation
  • making adjustments to the way care is provided
  • how to provide care that helps people reach their full potential
The consultation will ask for views from people who have experience of learning disabilities, NHS and social care providers and the general public.
The government announced the consultation as part of a series of measures in response to a report from the first national mortality review of learning disability published in May 2018, known as the Learning Disabilities Mortality Review (LeDeR) Programme. (Links to the report and government’s response are above).
 
The measures recognise a need for better awareness among health and care staff about making reasonable adjustments to the way that care or information is provided to people with learning disabilities.
Other measures announced include:
  • sharing the learning from the named social worker pilot, which explored one-to-one support for people with learning disabilities, autism and mental health needs
  • plans for a long-term study of the impact of integrated community support for people with learning disabilities
  • testing and developing a quality-of-life standard for people with learning disabilities that can be used to measure the effectiveness of support
Further detail is available here: http://tiny.cc/v55gzy
B3. National conversation with health and care staff begins
On 10th September government announced the launch of a new digital platform called ‘TalkHealthandCare’, which staff can use to post ideas, questions and challenges for government.
 
The platform will be available on computers, phones and tablets. It will continually update to reflect the views and ideas of staff. The platform will also include events, forums and webinars for staff across the country.
 
TalkHealthandCare has been launched following feedback from staff that too often they do not feel valued at work. Some of the known issues that TalkHealthandCare will seek views on include:
  • improving shift patterns and juggling home and work lives
  • speeding up the use of helpful technologies that cut out paperwork
  • training and development
While NHS England and NHS Improvement are developing more ways to prevent and reduce violence against health and care staff, TalkHealthandCare will also seek views on what needs to be done to make staff feel safe and secure at work. In addition the department is also launching a new workforce panel of staff who the Secretary of State will meet with as a sounding board on issues affecting health and care staff across the country.
 
Further detail can be found here: http://tiny.cc/l65gzy
B4. Hospitals to receive £145 million to prepare for winter demand
Government announced on 7th September that it will provide more than £145 million to NHS trusts across the country ahead of winter to improve emergency care.
 
The funding from the Department of Health and Social Care’s existing budget will be spent on 81 new schemes.
It will be spent on:
  • upgrading wards
  • redeveloping A&E departments
  • improving same-day emergency care
  • improving systems for managing the number of beds in use
  • an extra 900 beds
More detail can be found here: http://tiny.cc/165gzy
B5. Government response to the Health and Social Care Committee’s report on integrated care
On 11 June 2018, the House of Commons Health and Social Care Committee published its report Integrated care: organisations, partnerships and systems. The report included 42 conclusions and recommendations. The Committee launched this inquiry to examine the development of the new integrated ways of planning and delivering local health and care services which have arisen out of the NHS Five Year Forward View.
 
On September 5th government published its response to the report of the Health and Social Care Committee on Integrated care: organisations, partnerships and systems.
 
This is a joint response reflecting the views of the Department of Health and Social Care, NHS England, NHS Improvement, the Care Quality Commission and Health Education England. The response sets out how the government intends to address the committee’s recommendations as part of the long-term plan for the NHS.
 
The full response can be downloaded here: http://tiny.cc/z75gzy
B6. Local area performance metrics - Assessing the flow of patients across the boundary between the NHS and social care
The NHS social care interface dashboard provides a set of measures indicating how health and social care partners in every local authority area in England are performing at the interface between health and social care. The dashboard has been developed by the Department of Health and Social Care and the Ministry of Housing, Communities and Local Government working with stakeholders.
 
The dashboard includes a breakdown of delayed days attributable to social care per 100,000 of the population and the equivalent for NHS-attributable delays. The dashboard should allow areas to compare themselves to similar areas and then have conversations about good practice. It should also provide greater transparency in those local areas that are not performing well to enable improvement support to be targeted.
 
Updated information from the Department of Health and Social Care (September 4th) is available here: http://tiny.cc/p95gzy
B7. Ordinary residence: anonymised determinations 2018
In early September the Department of Health and Social Care published guidance to illustrate how the department resolves disputes in the health and social care sector when 2 or more local authorities cannot agree responsibility for meeting a person's eligible needs.
 
These determinations are ‘anonymised’ because they do not name the individuals or councils involved.
 
The determinations are available to download here: http://tiny.cc/ua6gzy
B8. Strain on unpaid carers putting adult social care at increased risk of collapse
The Local Government Association (LGA), which represents 370 councils in England and Wales, and Carers UK say rising demand for care and the increasing costs of providing it is putting more pressure on families to look after loved ones, which is taking its toll on their health and wellbeing.
 
Many of the 5.7 million unpaid carers in England are unable to take a break from their demanding role looking after people with complex needs. Latest research shows that nearly three-quarters (72 per cent) of carers in England have suffered mental ill health, such as stress and depression, while 61 per cent have experienced physical ill health due to caring. But despite the demands of their role, a fifth (20 per cent) of carers in England responding to Carers UK’s State of Caring Survey, the majority of them caring well over 50 hours a week, have not received a carer’s assessment in the past year.
 
The full article is available here: http://tiny.cc/7d6gzy
B9. Civil Society Strategy: building a future that works for everyone
This Strategy sets out how government will work with and for civil society in the long-term to create a country that works for everyone. 
 
The Strategy is available here: http://tiny.cc/597gzy
B10. Autism self-assessment 2018
The Association of Directors of Adult Social Services (ADASS) has written a joint letter with the Department of Health and Social Care (DHSC) to directors of adult social services advising of the fifth autism self-assessment framework and to ask for continued support in undertaking the self-assessment exercise and commitment to raise the awareness and equality of autistic people. Responses are asked for by 10 December 2018.

The letter is available here: http://tiny.cc/lo9gzy

The questionnaire is available here: http://tiny.cc/wq9gzy
B11. Increased funding announced for disabled people with the greatest barriers to work
Secretary of State for Work and Pensions, Esther McVey, has announced increased funding to support businesses that provide extra employment support for disabled people with the greatest barriers to work. When the Work Choice employment programme ends in March 2019, ongoing support will be offered to individuals working in “supported businesses” through specially designed new elements of the government’s Access to Work scheme. For 2 years from April 2019, supported businesses will receive increased funding of £5,000 a year from Access to Work for each individual in a Work Choice Protected Place.
 
More details available here: http://tiny.cc/849gzy
B12. £450k announced to help patients have their say on health services
A windfall of £450,000 to support practical and innovative ways to help patients improve health services has been announced. The Building Health Partnerships programme has been awarded the money from NHS England and the National Lottery – through the Big Lottery Fund. The funding will provide tailored support for co-production to 10 areas, helping to more easily involve patients and carers in designing the services they use.
 
More details available here: http://tiny.cc/3dahzy
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 July 2018 show that:
  •  2,375 inpatients were in hospital at the end of the reporting period.
  • More inpatients were discharged (150) than admitted (120) to hospitals. Out of the 150 inpatients were discharged/ transferred from hospital in August 2018, 95 (64 percent) were discharged back into the community.
  • Many inpatients have been in hospital for a long time. Of those in hospital at the end of August 2018, 1,390 (59 percent) had a total length of stay of over 2 years.
  • At the end of August 2018 around half of the inpatients 1,215 (51 percent) were in a non-secure ward. There were 1,155 (49 percent) inpatients in a secure ward.
  • The largest proportion of inpatients (49 percent) were aged between 18-34 (1,165) and the lowest proportion (1 percent) were aged 65 and over (35).
  • There were more males (1,740) than females (625) in hospital this month (73 percent were male).
  • There were 120 admissions to hospital; of these 65 were first admissions, 25 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 (1,045 people).
  • Over half of the inpatients have a date planned for them to leave hospital (1,420).
  • Approximately 40 percent of inpatients in hospital in August 2018 travelled over 50km

MENTAL HEALTH SERVICES DATASET: LEARNING DISABILITY AND AUTISM STATISTICS
Data collected for LDA inpatients at the end of April 2018 show that:
  • There were 3,635 people with learning disabilities and/ or autistic spectrum disorders in hospital.
  • There were 173,125 referrals for people with learning disabilities and autism (LDA).
Of these inpatients:
  • 1,300 (36 percent) had been in hospital for over 2 years.
  • 165 (5 percent) had a delayed discharge.
  • The largest proportion (45 percent) were aged between 18-34 (1,620).
  • The lowest proportion (5 percent) were aged under 18 (190).
  • 71 percent were male (2,590) and 29 percent were female (1,040).
Findings based on ward stays data:
  • The majority were in a learning disabilities ward (45 percent), followed by an adult mental health ward (36 percent).
  • 1,665 (46 percent) were in a secure setting.
  • 1,855 (51 percent) were in a non-secure setting.
  • 555 (15 percent) travelled over 50km from home to get to the hospital for care or treatment.
More data can be accessed at http://tiny.cc/2t6gzy 
C2. The state of the adult social care sector and workforce in England
On 24th September Skills for Care published a report that offers comprehensive workforce characteristics about the entire adult social care workforce in England such as age, gender, ethnicty and specific job role information. It builds on the organisation’s ‘Size and Structure’ report published in August. 
 
Key findings for adult social care include:
  • A quarter of the workforce (25%) were on a zero-hours contract (335,000 jobs).
  • The staff turnover rate was 30.7%, equivalent to around 390,000 leavers in the previous 12 months.
  • Many of these leavers move to other roles within the sector as 67% of recruitment is from within adult social care.
  • Adult social care has an experienced 'core' of workers. Workers had, on average, 8.2 years of experience in the sector.
  • The vacancy rate was 8.0%, equivalent to around 110,000 vacancies at any given time. The majority of these vacancies (76,000) were care workers.
  • A fifth of all workers (320,000 jobs) were aged over 55 years old.
  • The majority (83%) of the adult social care workforce were British, 8% (104,000 jobs) had an EU nationality and 10% (130,000 jobs) a non-EU nationality. 
  • According to the Government’s “EU Settlement Scheme: statement of intent” the rights of EU citizens living in the UK will not change until after 31st December 2020.
Responding to the report the Nuffield Trust said "Last week’s seminal report from the Migration Advisory Committee warned that unless social care became a more attractive sector to work in, ongoing migration would be 'necessary to continue delivering these services'. Yet we are on a course to have neither of those factors. Today’s figures show social care is struggling even more to get the workers needed to provide vital services, with turnover and vacancy rates continuing to rise. Meanwhile, the Government is considering proposals to end less skilled migration from the EU.” 
 
"Either we address the financial crisis that has pushed social care providers too far into the red to pay decent wages, or we continue to allow migration to fill these gaps after Brexit. If the UK Government dodges these decisions in the next few months, it will mean directly endangering some of the most vulnerable people in our country.”
 
The Skills for Care report and supplementary information is available here: http://tiny.cc/ab6gzy
 
The Migration Advisory Committee report, referred to by the Nuffield Trust, is available to download here: http://tiny.cc/3b6gzy
C3. A year of integrated care systems: reviewing the journey so far
On 20th September the Kings Fund published a report based on interviews in eight of the ‘first wave’ of Integrated Care Systems in England. The purpose of the report is to understand how they are developing and to identify lessons for local systems and national policy-makers.
 
A summary and the full report are available to download here: http://tiny.cc/id6gzy
C4. Liberty Protection Safeguards – national survey results
A survey by Edge Training of over 900 people found the majority of care professionals are opposed to major planks of the government’s proposals to replace the Deprivation of Liberty Safeguards (DoLS) with a new system for authorising deprivations of liberty in care, according to a survey.
 
Key areas of concern with the proposed Liberty Protection Safeguards (LPS) include levels of safeguards provided to service users and the enhanced role of care homes in making decisions about people who may be deprived of their liberty. Nearly half of respondents were best interest assessors (BIAs), with most of the rest being social workers, health professionals and independent mental capacity advocate (IMCAs).
 
Key survey findings include:
  • 912 respondents: DoLS best interests assessor (43%), social worker who is not a BIA (8%), IMCA (7%)
  • 90% of people opposed plans to give care home managers responsibility for deciding if a resident needs an advocate if they lack capacity to request one
  • Respondents were split on whether the legislation should define what constitutes a deprivation of liberty, with 40% agreeing and the same proportion disagreeing
  • 71% of people rejected the use of the term “unsound mind” as one of the assessment criteria
  • 91% of respondents disagreed with proposals not to directly consult with an individual about being deprived of their liberty.
  • 70% of people agreed with plans to allow LPS be applied to any care setting
A full summary of the survey results can be found here: http://tiny.cc/pl7gzy
C5. The hospital provision of reasonable adjustments for people with learning disabilities: Findings from Freedom of Information requests
The Equality Act 2010 places a duty on service providers to make “reasonable adjustments” for disabled people. The aim of this study was to explore key aspects relating to the provision of reasonable adjustments for people with learning disabilities in hospitals.

The paper can be accessed here: http://tiny.cc/n19gzy
D RESOURCES

D1.  Unlocking capacity: smarter together

A new digital resource promoting good quality, person-centred care through collaborative working across health and adult social care is out. The resource - Unlocking capacity: smarter together - aims to inspire local system leaders on their journey of collaborative working.

The tool can be downloaded here: http://tiny.cc/457gzy
D2. The only way is ethics: a new approach to outsourcing social care
There is a ‘daunting charge list’ against those who commission services in these difficult times with weak contracting, poor regulation and wholescale collapse not uncommon practice.  But how much attention has been given to the ethics of decision making? Bob Hudson argues the case for ethical commissioning in adult social care and how it should be part of a wider strategy affecting every aspect of public life.
 
The blog can be accessed at: http://tiny.cc/lc8gzy
D4. Flu vaccinations  
  • People with learning disabilities are more likely to become seriously ill or die if they get the flu 
  • The current mortality review into the deaths of people with a learning disabilities reported this year that 31% of deaths investigated had an underlying respiratory cause
  • People with learning disabilities and those who care for them are entitled to a free flu vaccination
We are working to increase uptake of the flu vaccination for people with learning disabilities and those who care for them this winter. Any support you can offer to promote this message would be very valuable indeed.
Importantly, paid carers who are employed by a registered care provider are eligible for a free flu vaccination this year, as well as primary family carers. If carers have the vaccination this improves protection for the people they care for.

An easy read information sheet (aimed at people with learning disabilities and their carers) has been developed with the National Development Team for Inclusion explaining this. We hope this will give people the information they need to get their vaccination at either their GP surgery or pharmacy, and overcome any barriers to that happening.  It is not yet well known enough that this group, and their carers, are eligible.  An easy read leaflet, suitable for GP surgeries, is available to order from PHE.

We have also published guidance about flu vaccinations for people with learning disabilities, aimed largely at health and social care professionals.
 
D5. Commissioning for transition to adult services for young people with SEND
This guide aims to help health commissioners and providers tackle the challenges involved in implementing the joint commissioning of services for children and young people with special educational needs and disability (SEND) introduced by Part 3 of the Children and Families Act 2014.

The guide can be accessed here: http://tiny.cc/bh9gzy
 
D6. NHS England - The importance of ‘reasonably adjusted’ care
The lead nurse for learning disabilities at Barts Health NHS Trust in London explains how ‘learning into action’ work is improving care for people with a learning disability, autism or both in an urgent or emergency situation, and is one of the key ways to making services accessible, keeping people safe and getting the best possible outcomes.
 
This blog can be accessed at http://tiny.cc/fuahzy
 
D7. The WE CAN Game - a free download to explore gifts and capacities
Cormac Russell has invented a captivating 'game' that can flip negativity into an exploration of possibility - quickly - with groups of all sizes. It is quite remarkable. And it can be played with everyone! All sizes, shapes, ages, abilities. Basically people work in small groups of about 10 ideally. There could be many groups playing simultaneously in a room.
 
Using a deck of 100 CAPACITY CARDS - people discover the wide range of skills and capacities they have in their 'team' - and there are ALWAYS hidden talents and possibilities that emerge.
 
The game can be played in as little as 30 minutes as a warmup, and as long as you choose. It is excellent as an early meeting starter as it puts everyone in a 'capacity' frame of mind.
 
Find out more at http://tiny.cc/wzahzy
 
D3. Why meeting disabled children’s needs must go beyond narrow safeguarding concerns
Barrister Steve Broach looks at a case which shows why local authority children's services create legal risks by taking a hands-off approach to supporting disabled children.

The blog can be accessed at http://tiny.cc/uz8gzy
Copyright © 2018 Pathways Associates, All rights reserved.


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