Tag Archives: learning disabilities

Comprehensive spending review: little for social care

The months of rumours, leaks and speculation are over; the Comprehensive Spending Review has finally been announced. As expected, for social care, it does not make for fun reading.

Here are some of my immediate thoughts, based on Chancellor George Osborne’s speech and a (very) swift look at the spending review document. While the review obviously affects everyone in some way, I’m going to try to focus on the impact it could have on people with mental health issues and/or learning disabilities.

Firstly, it should be noted that there is very little geared specifically to people with learning disabilities and/or mental health issues. For instance, specific mentions of ‘learning disability’ (or disabilities) does not get one mention and ‘mental health’ only 2. I didn’t expect there to be; today is the day for grand statements, with the detail to come at a later date.

In terms of what was said, while Osborne promised an extra £2 billion for social care in the next five years, including £1 billion to aid joint working between health and social care, he mentioned that this would help older people – no mention of adults with disabilities.

Also, BBC health reporter Nick Triggle worries this could be more or less cancelled out by the increasing demand of the aging population.

Meanwhile, benefit reform will ensure that it “always pay to work”, according to Osborne. Benefits are to be capped at no more than the average net wage from 2013 – which will work out to about £500 per week for couple/lone parent household and £350 per week for single adult households – although people receiving Disability Living Allowance are exempt from this.

However, this may well hit people on incapacity benefit/Employment and Support Allowance and other benefits, especially those who are moved onto Jobseeker’s Allowance from ESA. The focus of the welfare reform is evidently on people getting jobs, with benefits cut to make it more of an incentive to work.

There is also a new 12-month time limit proposed for the one million people on ESA in the Work Related Activity Group to find work or face having their benefits cut.

But surely this will be dependent on the jobs being out there for people to take? Many people on ESA would like to take up jobs – part or full-time – but with many businesses not looking to take on employees, and the public sector set to shed 490,000 jobs, there are precious few available and competition for them will be fierce.

The reforms to housing benefit will also hit many people with learning disabilities and/or mental health issues, especially those living in London and the southeast, where property prices are generally higher than in the rest of the UK.

Potentially, the adverse impact of money worries on people with mental health issues or learning disabilities could be immense, as could the upheaval of having to move, if they now cannot afford the rent on their homes. For someone to have to move away from an area they know – including a network of informal support – to somewhere new could have a disastrous effect on a person.

Not all bad news

But the CSR wasn’t all bad for social care; there were a couple of positive notes from the Chancellor.

Firstly, personal budgets are to be extended to people with long-term health conditions, children with disabilities and special educational needs and adult social care. The commitment to personalisation is welcome and, for some people, personal budgets have made a tangible positive difference to their lives. Giving more people the option to do this is a good thing. Whether their budget will be enough to do this is another matter.

Likewise, the commitment to increase talking therapies for people with mental health issues is also to be welcomed.

The government is also going to take forward proposals to invest nationally in mental health liaison services at police stations and courts to intervene at an early stage, diverting mentally ill offenders away from the justice system and into treatment. However, it does carry the caveat ‘subject to business case approval’.

Nevertheless, this is a good move. Far too many people with mental health problems get stuck in the justice system and opportunities for them to access treatment are often lost.

Conclusion

From an initial assessment, people with learning disabilities and/or mental health issues do not fare well out of the CSR, especially in terms of welfare and housing reform. However, I don’t think anyone – regardless of who they are – fares well out of this review.

But there are some crumbs of comfort, especially with expanding personal budgets and talking therapies, although they are probably outweighed by the cuts.

However, to paraphrase Winston Churchill, this is not the end, it is not the beginning of the end, it is the end of the beginning. Next month, government departments will set out business plans to outline how they will implement cuts. This is where the real detailed information about cuts will come at a local level, and we will all find out which departments, services, projects, charities etc will retain funding, be closed, or face hard times.

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People with learning disabilities still face discrimination

Discrimination against people with learning disabilities is still rife in the UK, with a third of people still believing that they cannot get a job or live independently, according to a new survey.

Health and social care provider Turning Point has found that 9 out of 10 people believe people with learning disabilities are still discriminated against, with 51% saying they are the most discriminated against group in society.

This is not necessarily a revelation – everyone involved in the sector knows that it is rife – but does show how much still needs to be done if people with learning disabilities are to be truly integrated into society.

OK, while it is a survey of only 1,100 adults and nobody knows whether it was weighted to get certain results etc – I know some people are sceptical of statistics – but taking these on face value from a reputable source it nonetheless provides snapshot that can at least create a debate about the topic.

From looking at the survey results, a lot of this discrimination seems to be down to a lack of public understanding about people with learning disabilities and how they live.

For instance, the survey found that 8% still expect people with learning disabilities to be cared for in a secure out-of-town hospital, while 23% believe they live in care homes.

Whether these views are borne of ignorance or prejudice, all this shows that information campaigns about learning disabilities need to be redoubled. Some of the findings show a basic lack of knowledge – such as identifying mental illness as a learning disability – that needs to be addressed.

Adam Penwarden, Turning Point’s Director of Learning Disability Services, hits the nail on the head: “As a sector, we need to work together to challenge preconceptions and show what a positive contribution to society people with a learning disability can make. This includes working, living independently and playing an active role within the local community.”

There have been high-profile anti-stigma campaigns for mental health in the past couple of years and perhaps the time has come for a similar campaign for people with learning disabilities.

Another way to break down stigma would be to have someone with learning disabilities become a regular member of the cast of one of the major soap operas. While this may sound flippant, it can work – the Stacey Slater bipolar storyline in Eastenders (which I blogged about previously here) has helped to bring the condition into the mainstream and increase understanding.

Yes, I know Billy and Honey Mitchell had baby Janet, who has Down’s syndrome, but that character has all been written out now. I am thinking more of an adult/teenage character.

While better information about learning disabilities would not be a panacea – stopping discrimination is an ideal only – it would at least eat into those statistics and provide a good basis for further work.

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NHS reform – impact on social care

Andrew Lansley’s much-vaunted white paper on the future of the NHS was published yesterday afternoon, promising widespread reform, including the abolition of PCTs and SHAs and giving commissioning power to GP consortiums. But what will it mean for social care? Here are a few of my initial thoughts.

Firstly, there are concerns that the reforms focus on general services and that people with learning disabilities, mental health problems and dementia have been largely ignored – this came through strongly on Twitter yesterday, from what I saw.

To test this, I did a quick word search of the white paper to gauge how many times certain phrases were mentioned; mental health is mentioned 8 times in the 61-page document, Alzheimers or dementia receives one mention [as @seetheperson pointed out to me], and learning disability – or learning disabilities – never crops up.

To me, this is shocking. Considering that people with learning disabilities, dementia and mental health issues make up a significant chunk of those that use NHS services, the lack of attention given to them is a worrying omission.

Specialist services are often a lifeline or those who use them and an acknowledgement of this – and preferably a commitment to give them at least some degree of protection – would have been reassuring to the many service users who are already distinctly nervous about what government cuts will mean for services.

Hopefully the government is planning for learning disability and mental health services separately…

Also, do GPs, who will now have power over which services are commissioned in their area, have the specialist knowledge that is often required in MH/LD to be able to give an authoritative view on what sorts of services are needed? Mental health charity Mind’s chief executive Paul Farmer has already questioned this and called on them to talk to experts and “tap in to the personal knowledge of patients and mental health charities about what works.” 

There is also cynicism over whether GP commissioning will work from some within the profession. For example, the GP for hire blog gives a distinctly lukewarm reaction to the proposals, saying it will put more pressure on salaried and locum GPs, and could lead to divided interests for those doctors involved on a consortium.

Also, will GP consortiums not exacerbate the postcode lottery, which was supposed to be got rid of? If commissioning a service depends on the decision of the GP consortium – a group of individuals with their own opinions – surely there is the risk that one consortium would approve it, but the one next door would not.

It hardly improves patient choice if they find that their needs are rejected in one area but available in another.

But there were some good points in the white paper. For instance, it talks of promoting the joining-up of health and social care services and promoting preventative action. I can’t argue with that principle – health and social care are closely linked, so that is a no-brainer and could help to reduce duplication of information and bring about efficiencies. Also, preventative action is generally accepted to reduce the need for costlier, more complex services down the line.

The white paper also says that the government’s vision for adult social care will be outlined later this year, and indicate that it will be a continuation of the current personalisation drive towards choice and control for service users. A white paper will follow next year. Nothing new there, but it is good to have the timeline in place.

In conclusion, the government’s reforms are certainly ambitious, but they are also risky. Social policy think-tank Civitas has warned that considerable resources will be needed to enact the restructuring – I’m not sure how that sits with the aim of saving £20 billion by 2014 – and if it is got wrong it could lead to a dip in the NHS’ performance for at least a year.

That will be the acid test of these reforms – will it make services better for service users? I’m sceptical, but only time will tell, as ever with any reforms.

This white paper provides so many points for discussion so it is more than likely that I will blog on aspects of it again later in the week.

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Big Care Debate – any closer to a solution?

The Big Care Debate closed last Friday (the 13th, ominously, for those of a superstitious bent) ending the consultation on the government’s green paper, Shaping the future of care together , which set out the government’s options for the future funding of adult social care.

Now, the Department of Health will go away and contemplate the results, before, in theory, coming back with a White Paper, possibly in early 2010.

But with an election looming, I wonder if any of it will actually get through and make it into law.  

A spokesperson from the DH told me earlier in the year that if there is no consensus from the Big Care Debate on the best way forward, then it may go to a further period of consultation.

Looking at the reactions to the green paper from various groups, there seems to be little consensus; there have been criticisms, notably from mental health and learning disability groups, that the green paper focused on too much on older people. Indeed, much of the media focus has been on old age care funding and people not having to sell their homes to pay for residential care costs.

But then, older people’s groups, such as the National Pensioners’ Convention, have also voiced dismay over the government’s dismissal of the option to pay for care from direct taxation.

This option also found favour in a Joseph Rowntree Foundation survey. But then other organisations have supported the partnership and comprehensive models of funding the government suggested, which involve insurance and some state provision or the creation of a National Care Service.

If this is reflected among the wider responses, then we could be in for further consultation, which neatly kicks the debate into election time, when nothing concrete will happen because every politician will be scrapping for votes.

So, it seems like the social care industry will be in limbo for some time to come. And all the while the current regime will continue to creak along, and the problems within it will continue to mount, and – crucially – service users will continue to suffer at the hands of a much-disliked and over-complicated funding system.

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