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

Policy Briefing - November / December 2018

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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. Quality of Life Evaluation for People Who Have Moved from Hospital
B. HEALTH AND SOCIAL CARE NEWS
  1. Healthcare UK Annual Review April 2017 to March 2018
  2. Windrush generation' guidance for NHS staff and other providers of NHS-funded secondary and community care services
  3. ‘Purple Tuesday’ is the UK's first accessible shopping day
  4. Children’s Mental Health: A briefing by the Office of the Children’s Commissioner for England
  5. 'The lives we want to lead' – the LGA green paper for adult social care
  6. Government must make case for increases in national taxation to rescue adult social care
  7. Shifting the centre of gravity: Making place-based, person-centred health and care a reality
  8. How will our future relationship with the EU shape the NHS?
  9. New money will not lead to a big shift in services 
  10. Budget 2018: what it means for health and social care
  11. The health care workforce in England: make or break?
  12. Democracy Disability & Devolution - a women's project
  13. New Government prevention vision to help you live well for longer
  14. NHS Long Term Plan Update for Learning Disabilities & Autism
  15. ADASS president highlights effects of cuts to social care and urges ‘collective endeavour’ to tackle unmet need
  16. Significant changes to DoLS replacement scheme
C. RESEARCH
  1. Latest Learning Disability In-patient Statistics
  2. Mental Capacity Act DoLS Statistics 2017-18
  3. A Fair, Supportive Society: Summary Report
  4. Councils receiving more adult safeguarding concerns but investigating fewer cases
  5. Understanding the health care needs of people with multiple health conditions
D. RESOURCES
  1. Blog: ‘We are going backwards on learning disability – there needs to be a fresh narrative’
  2. Public Health England Reasonable Adjustment Guidance
  3. Royal Liverpool and Broadgreen Hospitals Learning Disabilities and Autism Team
A. PATHWAYS ASSOCIATES NEWS

A1. Quality of Life Evaluation for People Who Have Moved from Hospital
Pathways Associates CIC are working with Carolyn Brennan of NHSE Specialist Commissioning to evaluate the Quality of Life of approximately 12 people with learning disabilities in the North West of England who have moved from Hospital / ATU ideally over the past 6 to 18 months under the Transforming Care agenda. The work will take place between November and the end of December this year.
 
The intention is that once the project is complete, recommendations will be made by Pathways Associates CIC to those taking forward evaluation of the Transforming Care programme and NHS England about the ways in which the process of moving people into the community can be improved, as well as their quality of life.
 
The aim of this project is to evaluate the quality of life of four people from each sub region within the North West: Greater Manchester, Lancashire (and possibly South Cumbria) and Merseyside and Cheshire
 
An element of the work will be for trained Experts by Experience /Quality Checkers to support NHS England to discover the life outcomes and stories of people by spending time with them, their family, friends and paid staff to better understand the quality of life of people moving into the community.
 
A lot of the people we visit really like this work. One person said “The project was really good… I met a friend through doing the quality of life project”.
 
If you have details of potential participants and providers who are willing to take part or you would like to discuss this work further, please contact Dene Donalds: dene.donalds@pathwaysassociates.co.uk
Telephone: 07816 073334
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. Healthcare UKs Annual Review April 2017 to March 2018
Healthcare UK’s mission is to fully mobilise the best of UK Healthcare expertise to improve the economic and social well-being of the UK through global trade through increasing the UK’s access to fast-growing international markets for healthcare services.
 
Healthcare UK’s annual review provides an overview of:
  • its main achievements
  • its mission
  • its networks
  • the Healthcare UK Advisory Board
  • its objectives
  • the importance of the NHS to Healthcare UK
  • the UK’s strengths in healthcare
Healthcare UK is a joint initiative of the Department for International Trade (DIT), NHS England and the Department for Health and Social Care (DHSC).
 
The full report is available here: http://tiny.cc/ys2b1y
B2. Windrush generation' guidance for NHS staff and other providers of NHS-funded secondary and community care services
On 31st October the government published a document on eligibility for NHS-funded secondary care specifically considering the ‘Windrush generation’. Eligibilty is mainly based upon lawful, settled residence in the UK.
 
The ‘Windrush generation’ comprises Commonwealth citizens who settled in the UK before 1 January 1973 and those who arrived to live here between 1973 and 1988.
It should be read with the main guidance on implementing the overseas visitor regulations.
 
The guidance is available here: http://tiny.cc/112b1y
B3. ‘Purple Tuesday’ is the UK's first accessible shopping day
‘Purple Tuesday’ is supported by the government’s Office for Disability Issues. With the spending power of disabled people and their families estimated at £249 billion, ‘Purple Tuesday’ highlights the business benefits of welcoming disabled people into inclusive and accessible shops, restaurants, pubs and clubs. It is an opportunity for retailers to improve customer service for disabled customers now and in the future. Further information about Purple Tuesday and resources to support retailers can be found: More information is available here: http://tiny.cc/642b1y
B4. Children’s Mental Health: A briefing by the Office of the Children’s Commissioner for England
On 22nd November the Children’s Commissioner for England published a new analysis looking at the provision of children’s mental health services in England. 
 
The Commissioner’s briefing finds that Child and Adolescent Mental Health Services (CAMHS) are improving in most areas in the country, yet with the exception of eating disorder services, the provision of services in the youth justice system and in perinatal mental health care, the rate of progress is slow. A vast gap remains between what is provided and what children need. As a result, the current rate of progress is still not good enough for the majority of children who require help but are not receiving it.
 
Responding to the briefing the LGA said:
 
“These findings reinforce the urgent need for a root-and-branch overhaul of children’s mental health services and for the NHS to work with councils to develop a system that says yes, rather than no, to children when they ask for help.
 
Councils across the country work hard to ensure children and young people can access the support they need, however with children’s services facing a £3 billion funding gap by 2025, this is becoming increasingly difficult.  
 
Many councils are being forced to cut early intervention work, including youth services, which helps children avoid reaching crisis point, perform better at school and avoid mental health issues in later life.
 
This has been compounded by government cuts to councils’ public health funding, which also helps young people to get the best start in life. Our Bright Futures campaign is calling for councils and schools to be given the funding to offer independent mental health counselling so children have access to support as and when they need it. Government should also release the £1.7 billion promised for CAMHS services to ensure adequate and sustainable funding for local areas.”
 
More information is available here: http://tiny.cc/f82b1y and http://tiny.cc/y92b1y
B5. 'The lives we want to lead' – the LGA green paper for adult social care
On 13th November the Local Government Association (LGA) published its final report - which forms the basis of the Association’s 14 recommendations to government – and contains a summary of consultation responses, including an overwhelming recognition of the importance of adult social care and a consensus that the system is unsustainable in its current form.
 
The Association added 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, prompted local government to take action and publish its own green paper and public consultation.’
 
The report is available here: http://tiny.cc/xb3b1y
B6. Government must make case for increases in national taxation to rescue adult social care
On 14th November the Local Government Association (LGA) stated that over recent years of underfunding of councils ‘the response from different governments has been piecemeal and incremental hand outs to try and stave off the worst consequences of underfunding.
 
In parallel, efforts to fundamentally resolve the question of long-term funding for care and support have repeatedly failed. The LGA is now calling on the Government to abandon this short-term incrementalism and make the case for national tax rises so that current and future generations can be confident they will have the care and support they need to live the life they want to lead.
 
The scale of the overall funding picture for local government as a whole means adult social care services still face a £3.5 billion funding gap by 2025, just to maintain existing standards of care. This is leading to an ever more fragile provider market, growing unmet and under-met need, further strain on informal carers, less investment in prevention, and continued pressure on an already-overstretched workforce.’
 
The full story is available here: http://tiny.cc/1e3b1y
B7. Shifting the centre of gravity: Making place-based, person-centred health and care a reality
In 2016, the Association of Directors of Adult Social Services (ADASS), the Local Government Association (LGA), NHS Clinical Commissioners and the NHS Confederation published Stepping up to the place which set out a shared vision for transforming health, care and wellbeing and the key actions that national and local organisations should take to successfully integrate health and care.
 
Now, in 2018, joined by NHS Providers and the Association of Directors of Public Health (ADPH), the organisations have refreshed their vision and priorities to make sure they remain relevant for the next phase of transformation. Based on learning from the past two years, this report sets out a refreshed, shared vision and the actions that will help local systems to progress their work on system-wide transformation.
 
The report can be found here: http://tiny.cc/oh3b1y
B8. How will our future relationship with the EU shape the NHS?
On 7th November the Nuffield Trust published a report examining five key areas where the agreements that are made with the European Union will shape health and social care over the coming decades. For each one, it looks at the options, alternatives and workarounds that will be possible under different models of Brexit.
 
The report is available here: http://tiny.cc/2k3b1y
B9. New money will not lead to a big shift in services 
On 22nd November the Nuffield Trust commented on the £3.5bn funding boost for primary and community services announced by the Prime Minister:

“This additional money amounts to annual increases that are broadly in line with the 3.4% overall that the NHS in England is getting over the next five years. That means that, far from representing a big shift in funding towards out-of-hospital services, this money will simply allow GPs and community services to keep up with demand over the next five years. That’s important, but it means the new money announced today is not going to lead to a significant change in the way that people experience healthcare.”
 
The full press release can be viewed here: http://tiny.cc/in3b1y
B10. Budget 2018: what it means for health and social care
On 9th November The King’s Fund, the Health Foundation and Nuffield Trust published and analysis of the 2018 Budget and what it means for health and social care.
 
The report is available to download here: http://tiny.cc/pp3b1y
B11. The health care workforce in England: make or break?
On 15th November The King’s Fund released a briefing, in advance of the publication of the NHS long-term plan, to highlight the scale of workforce challenges now facing the health service and the threat this poses to the delivery and quality of care over the next 10 years.
 
The briefing sets out the reasons why the long-term plan and supporting workforce strategy must address the urgent and mounting challenges facing the health care workforce. It will be followed in the coming weeks by a more in-depth report that explores five key levers available nationally and locally that could help ameliorate the workforce crisis affecting both health and social care.
 
The briefing is available here: http://tiny.cc/8q3b1y
B12. Democracy Disability & Devolution - a women's project
Winning the right to vote was such a massive milestone for women 100 years ago. However, there are still barriers in the way. For disabled women everywhere, the opportunities to get into politics are limited. Getting your voice heard either in political roles, or voting itself, means facing a host of barriers including transport, finance, access, caring, attitude, training and confidence.
 
Now thanks to a grant from the Government Equalities Office, Breakthrough UK is launching a project to support disabled women interested in taking part in political life.
 
The project will focus on Stockport, Salford and Trafford, as areas with low female representation in the Council.

More details available here: http://tiny.cc/ji4b1y
B13. New Government prevention vision to help you live well for longer
The Secretary of State for Health and Social Care has outlined his vision for the future health and care system.
 
This document sets out the government’s vision for putting prevention at the heart of the nation's health. The government aims to improve healthy life expectancy so that, by 2035, people in the UK are enjoying at least five extra years of healthy, independent life, while closing the gap between the richest and poorest.

Read about the vision and read case studies showing examples of good practice in preventing health problems here: http://tiny.cc/3x7b1y
B14. NHS Long Term Plan Update for Learning Disabilities & Autism
David Gill (NHS England Learning Disability Advisor) and Ray James (National Learning Disability Director), talk about the next steps in the NHS Long Term plan, and give feedback from the recent Long Term Planning events that were held last month across the country.
 
The video is available here: http://tiny.cc/gdbc1y
B15. ADASS president highlights effects of cuts to social care and urges ‘collective endeavour’ to tackle unmet need
Austerity has “gone too far” and is weakening the “availability and quality” of social care services, the Association of Directors of Adult Social Services (ADASS) has warned.
 
Speaking at the National Children and Adults Services Conference (NCASC) in Manchester, ADASS president Glen Garrod said cuts to social care funding had led to a decline in services and a reduction in standards, despite a show of “remarkable resilience” from care providers.
 
Garrod emphasised the social care market was looking “increasingly fragile” and insisted some areas of the country had already “reached their tipping point”.
 
“Both big and small-scale providers are clearly distressed and whilst many continue to survive, how many are thriving – too few. This is not a buoyant market,” Garrod said.
 
The consequences of this deterioration on individuals and their families was not yet “sufficiently well understood”, according to Garrod, who said in excess of 1.4 million people were struggling without help from councils.
 
“I worry that more people will lack the support they need, leading to a more rapid deterioration in their ability to stay independent, retain social contacts, contribute to society and feel good about life.”
 
Asking delegates to “challenge the shortfalls in the system”, he made reference to the upcoming green paper on adult social care as a crucial catalyst for change: “We have a watershed moment, a chance to change the legacy that has been left to us with a better one,” he said.

More details available here: http://tiny.cc/h5bc1y
B16.Significant changes to DoLS replacement scheme
Proposals to give care home managers a significant role in relation to applying the Liberty Protection Safeguards (LPS) – the scheme that would replace the DoLS – in their homes have been scaled back.
 
Other changes to the Mental Capacity (Amendment) Bill would see the LPS extended to cover 16- and 17-year-olds, not just those over 18, and requirements inserted to ensure assessments were carried out by people of sufficient knowledge and experience.
 
The person at risk of deprivation must also be consulted in every case under a raft of changes made to the bill.
 
The government then suffered its first defeat on its bill to replace the Deprivation of Liberty Safeguards as peers voted to amend one of  the three conditions for authorising a deprivation under the proposed Liberty Protection Safeguards (LPS) system.
 
Labour, Liberal Democrat and crossbench peers outvoted the government on one of a number of amendments to the Mental Capacity (Amendment) Bill passed in the first day of the bill’s report stage in the House of Lords.
 
The bill originally stated that for care arrangements involving a deprivation of liberty to be authorised, the cared-for person must lack capacity to consent to the arrangements and be of unsound mind; and the arrangements must be necessary and proportionate.
 
The amendment, opposed by the government, altered the last criterion to state that it must be necessary “to prevent harm to the cared-for person”. An accompanying amendment that the authorisation be proportionate “in relation to the likelihood and seriousness of harm to the cared-for person” was then nodded through.
 
The revised wording restates part of the best interests requirement of an authorisation under the current DoLS system.

The government has also agreed to extend the approved mental capacity professional (AMCP) role to improve safeguards for service users under the  scheme that will replace the Deprivation of Liberty Safeguards (DoLS).

AMCPs will be practitioners with specialist training in the Mental Capacity Act – likely to be mostly social workers – whose role will be to provide an independent check, known as a pre-authorisation review, on whether the conditions for a deprivation of liberty under LPS have been met.

More details available here: http://tiny.cc/ftcc1y and http://tiny.cc/yucc1y and http://tiny.cc/mkec1y
C RESEARCH

C1. Latest Learning Disability In-patient 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 October 2018 show that:
  • 2,350 inpatients were in hospital at the end of the reporting period.
  • More inpatients were discharged (150) than admitted (125) to hospitals. Out of the 150 inpatients who were discharged/transferred from hospital in October 2018, 100 (68 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 October 2018, 1,355 (58 percent) had a total length of stay of over 2 years.
  • At the end of October 2018 around half of the inpatients 1,210 (52 percent) were in a non-secure ward. There were 1,140 (48 percent) inpatients in a secure ward.
  • The largest proportion of inpatients (28 percent), were aged between 25-34 (670) and the lowest proportion (2 percent) were aged 65 and over (35).
  • In line with previous months trends, there were more males (1,730) than females (610) in hospital this month (74 percent were male).
  • There were 125 admissions to hospital; of these 65 were first admissions, 25 were readmissions within a year of the previous discharge and 35 were transfers from other hospitals.
  • Under half of the inpatients (43 percent) last had a review of their care over 6 months ago (1,020).
  • Over half of the inpatients (58 percent) have a date planned for them to leave hospital (1,365).
MENTAL HEALTH SERVICES DATASET: LEARNING DISABILITY AND AUTISM STATISTICS
Data collected for LDA inpatients at the end of August 2018 show that:
  • There were 3,685 people with learning disabilities and/ or autistic spectrum disorders in hospital.
  • There were 1,325 admissions and 1,330 discharges, 87 percent of these were discharged back into the community.
  • There were 174,540 referrals for people with learning disabilities and autism (LDA).
More data can be accessed at http://tiny.cc/8t6b1y
C2. Mental Capacity Act DoLS Statistics 2017-18
This official statistics report provides the findings from the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) data collection for the period 1 April 2017 to 31 March 2018. The report looks at aspects of DoLS activity, including the profile of people for whom a DoLS application was received, applications completed and their outcome, and applications not completed. The data tables and interactive business intelligence tool published alongside the report present further analyses and breakdowns of the data, including breakdowns by local authority.
 
Key Facts:
  • There were 227,400 applications for DoLS received during 2017-18, with almost three quarters relating to people aged 75 and over. This represents an increase of 4.7% on 2016-17 although the rate of increase is slowing compared to previous years.
  • There were more DoLS applications received than were completed (181,785) in 2017-18. The number of DoLS applications that were completed increased by 19.6% from 151,970 in 2016-17. The proportion of these that were granted was 61.1% in 2017-18.
  • The reported number of cases that were not completed as at year end was 125,630. Of these just under 40% (48,555) were received prior to 1 April 2017.
  • Analysis of the 2017-18 local authority data again shows a wide range of variation across the country in the volumes of DoLS applications, their outcomes and how they were administered.
More data can be accessed at http://tiny.cc/gg6b1y
C3. A Fair, Supportive Society: Summary Report
The IHE report A Fair, Supportive Society highlights that some people with learning disabilities will die 15-20 years sooner on average than the general population – that’s 1,200 people every year.
 
The report commissioned by NHSE highlights key facts, stats, and interventions. Much of the government action needed to improve life expectancy for people with disabilities is likely to reduce health inequalities for everyone. Action should focus on the ‘social determinants of health’, particularly addressing poverty, poor housing, discrimination and bullying.

The report is available here: http://tiny.cc/w79b1y

Also in easy read: http://tiny.cc/6dcc1y
C4. Councils receiving more adult safeguarding concerns but investigating fewer cases
The number of adult safeguarding concerns in England rose by 8% last year, yet councils conducted slightly fewer safeguarding enquiries in response, official figures have shown.
 
The Safeguarding Adults report by NHS Digital, which is based on data collected from councils with responsibility for adults’ social services, found 394,655 concerns regarding suspected abuse or neglect against adults were raised between 1 April 2017 to 31 March 2018 up from 364,605 in 2016-17.
 
But the number of safeguarding enquiries in response to concerns by councils and other bodies fell from 151,160 to 150,070, a drop of 0.7%, with a bigger 1.1% decrease in statutory enquiries under section 42 of the Care Act, from 133,265 to 131,860.
 
These take place when an adult has needs for care and support, whether a local authority is meeting them or not, is experiencing or at risk of abuse or neglect and, because of their needs, is unable to protect themselves against the abuse or neglect or their risk. The other 18,210 enquiries in 2017-18 were for cases that did not meet the section 42 criteria.
 
This means that the ‘conversion rate’ of concerns to enquiries fell from 41.5% in 2016-17 to 38% in 2017-18. The data gives no indication of why this happened, for example, whether at least some councils were operating higher thresholds for safeguarding enquiries or, on the other hand, whether a greater proportion of concerns were not suitable for an enquiry.

The report can be found here: http://tiny.cc/lzdc1y
C5. Understanding the health care needs of people with multiple health conditions
As the number of people with multiple health conditions grows, meeting their needs will be one of the biggest challenges facing the NHS. People with multiple conditions often have poorer quality of life and greater risk of premature death.
 
People with multiple conditions often have a range of consultations and treatments which can often be overwhelming for them to manage and they may need substantial support. Resourcing primary care so GPs and nurses have the time to work together with patients to manage their conditions, and ensuring that hospital care has more coordination between specialties is also important to consider.
  • Analysis of data from 2014 to 2016 for 300,000 people in England found that one in four adults had 2+ health conditions, equating to approximately 14.2 million people in England.
  • Over half (55%) of hospital admissions and outpatient visits and three-quarters (75%) of primary care prescriptions are for people living with 2+ conditions.
  • In the least-deprived fifth of areas, people can expect to have 2+ conditions by the time they are 71 years old, but in the most-deprived fifth, people reach the same level of illness a decade earlier, at 61 years of age.
The report can be accessed here: http://tiny.cc/58dc1y
D RESOURCES

D1.  Blog: ‘We are going backwards on learning disability – there needs to be a fresh narrative’

In this blog Rob Greig, former NDTI chief talks policy, politics and plans for the future, as he prepares to retire from his 36-year-long career in the health and social care sector.

It can be accessed here: http://tiny.cc/fv4b1y
D2. Public Health England Reasonable Adjustment Guidance
This series of Public Health England guidance shares information, ideas and good practice in making reasonable adjustments for people with learning disabilities in specific health service areas.
 
It is aimed at health and social care professionals and family members who provide support for, or plan services used by, people with learning disabilities. An easy read summary for each service area is also available.

It can be accessed at http://tiny.cc/imbc1y
D3. Royal Liverpool and Broadgreen Hospitals Learning Disabilities and Autism Team
This website from the Royal Liverpool and Broadgreen Hospitals Learning Disabilities and Autism Team contains resources for self-advocates and families living in Liverpool: http://tiny.cc/lsdc1y
Copyright © 2018 Pathways Associates, All rights reserved.


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