Tag Archives: Paul Farmer

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.

Advertisements

1 Comment

Filed under adult social care, health care, learning disabilities, Mental health, social care

Welfare reform plans worry disability groups

As the new government starts to get itself into gear, one of its key policies seems to be welfare reform and getting people into work – but getting it right, especially for people with disabilities or mental health problems will not be easy.

The idea of welfare reform and ending dependency on it is good – and some would say long overdue – but it has to be ensured that it is fair, especially for people with disabilities or mental health problems who are currently receiving Employment and Support Allowance (ESA)/Incapacity Benefit (IB).

While most people with disabilities or mental health problems want to either return to or gain paid employment, some are not capable of it. Others are capable, but only perhaps certain jobs or part-time hours.

However, the Work Capability Assessment, which determines if someone is capable of work – if they are deemed capable, they are moved onto the £25-a-week lower rate Jobseekers Allowance rather than ESA/IB – is flawed, some groups claim.

For instance, Neil Coyle of the Disability Alliance, calls the Work Capability Assessment ‘unfair and ineffective’ in today’s Daily Mirror.

Meanwhile, Paul Farmer, chief executive of mental health charity Mind, says “the current test is not up to the job of measuring whether people with mental health problems are fit for work.”

The test was trialled among new claimants at the end of 2008, and involves rigorous medical assessments carried out by an independent company. Of the 500,000 tested, only 9% remained on ESA. This test is now set to be rolled out to all 2.6 million claimants.

But this worries Farmer, fearing that people with mental health problems will be incorrectly assessed. “We urge our new Government to review the benefit assessment… so that people aren’t deprived of their benefit and forced to look for work they can’t do.

“Work can be good for mental health, but only when it is suited to the individual. The Government has proposed to sanction anyone turning down ‘reasonable offers of employment’, but people should not be forced to accept work that risks damaging their mental health, putting them back on benefits and back at square one. Sanctioning people who can’t secure an appropriate job misses the point about why they are locked out of work in the first place.”

There are other wrinkles in the government’s plan to get people into work; we are just coming out of a long and deep recession and jobs are scarce and very competitive – 2.5 million people are unemployed remember.

Despite all the efforts of various schemes to tackle stigma against people with disabilities, it does still exist; two thirds of employers are unwilling to offer someone with mental health issues a job, according to Farmer.

A solution that is fair for everyone will not be easy, but if the government is to stick to David Cameron’s quote that ‘that those who can should and those who can’t we will always help’, then this needs to be got right and concerns from such groups need to be considered, to avoid the problems that could arise from trying to get people into jobs that are not suited to them.

2 Comments

Filed under adult social care, learning disabilities, Mental health, Social care funding