Adult Care Blog: February 2011 Archives

Think-tank casts doubt over insurance role in long-term care funding

By Jeremy Dunning, senior adult beat journalist on February 28, 2011 3:31 PM | No Comments

There's a new report out today looking into possible role for pre-funded consumer insurance in the long-term funding of social care in England and Wales.

The report, from the Strategic Society Centre, argues that even if the UK were in the future to achieve a level of take-up of 15% for pre-funded care insurance - equivalent to France (which has the highest take-up in the world) - this would still result in a social care system that was under-funded, means-tested, excessively rationed, and with many households confronting ʻcatastrophicʼ bills for paid care.

The report concludes that there are many other roles that the financial services industry
could take in long-term care funding reform, particularly around delivering and servicing a
state-sponsored insurance scheme for long-term care. The report cites case studies such as
ʻElderShieldʼ in Singapore and the long-term care insurance scheme of the Netherlands.

This comes as various stakeholders have consistently advocated a central role for financial services, and pre-funded consumer insurance in particular.

Recently Lord Warner, one of the members of the Dilnot Commission which is looking into this area, dropped heavy hints that a voluntary approach towards insurance would form part of the solution.

Warner sees the solution as a partnership between the state and the individual. The question is the balance between the two.

However Stephen Burke, director of the social enterprise, United for All Ages, said the commission should consider fair levies on estates.

Council axes hundreds of jobs and cuts services to save £200m

By Jeremy Dunning, senior adult beat journalist on February 28, 2011 1:01 PM | No Comments

Councils across the country are now beginning the grim task of ratifying plans for a broad swathe of public spending cuts.

In today's Guardian, Patrick Butler, writes of how Liverpool is set to face its toughest budget yet as five town halls ratify savings of £200m.

Butler writes of how it will mean the closure of children's centres, welfare charities and youth clubs while care for thousands of older or disabled people will be reduced and services for mentally ill and homeless people depleted.

In terms of job losses Liverpool council has estimated it will shed up to 1,500 jobs over the next three years, on top of 600 that have disappeared over the past few months through early retirement and voluntary redundancy.

The city's voluntary sector estimates that 500 charity workers will lose their jobs this year.

More than 600 NHS jobs are under threat in Liverpool alone, say trade unions.

Butler also writes on his blog of how councils are prioritising their cuts with one council, Sefton, having produced an online cuts consultation that places everything it provides into one of four categories: critical, regulatory, frontline and other services.

Documentary exposes failures in end of life care

By Vern Pitt, journalist, on February 28, 2011 10:57 AM | No Comments

The poor state of end of life care will be exposed tonight in an undercover Channel 4 documentary.

The Dispatches show uses hidden cameras to show the gap between the care you might hope to receive and the reality of dying.

Previous studies have shown wide variation in the standard of end of life care provided across the country.

In October last year the Kings Fund warned there had been a loss of momentum in improvements in end of life care.

Dispatches will be shown at 8pm tonight.

CQC's gold standard for care providers - separating facts from claims

By Mithran Samuel, adults' editor, on February 28, 2011 10:47 AM | No Comments

You may have come across some very big claims being made in The Independent and The Daily Telegraph about the planned excellence standard for care providers that will be introduced next year to separate the best from the rest, namely that:-

Only care providers that meet the standard are likely to be publicly-funded in future.
That this represents government getting tough with failing care providers and poor standards.
That what the standard will mean in practice is that all staff at "excellent" care providers will have to be registered with workforce regulator the Care Professions Council (currently the Health Professions Council) meaning they would need to meet minimum standards of practice and conduct.

I think the best that can be said for these claims is that the third - which relates to proposals to open a voluntary register of care staff - may well turn out to be true in the goodness of time.

The other claims arise from an interview care services minister Paul Burstow gave to the Independent, in which he said: "The new ratings will provide further pressure within the sector to improve. So it creates another lever for the commissioner to pull, to say we are only going to place people with you if you are excellent."

This is pretty far from saying that only providers that meet the excellence standard will receive public funding in future. The standard, by its nature, will only be something for a minority of services. Limiting public funding for care only to these providers will leave many users without a service.

Here's what we know about the excellence standard, which was announced by government in November:-

It will be a voluntary award that providers can apply for (at their own cost) and is designed to separate the best providers from those who merely meet minimum standards.
As the Care Quality Commission makes clear today, it will not be running the scheme, but commissioning it (it will be inviting bids from the Spring).
No details have been published on what the standard will look like or what criteria will need to be met - this will be consulted upon from May ahead of the standard's implementation next April.

It is not an example of government getting tough with providers; instead it is about government (and CQC) offering providers an opportunity to show how good they are.

Indeed, as we have reported, there is a concern that the excellence standard will be a less tough regime for providers than what has gone before: the quality ratings system abolished last year, in which all providers received a rating of excellent, good, adequate or poor. Adult care directors have warned that the new system will leave self-funders and personal budget holders in particular with inadequate information with which to make choices about care.

There are also concerns that it will favour larger providers, who will have the infrastructure to apply for awards that smaller operators lack; providers in general are also concerned that they will have to fund the scheme (particularly given that their registration fees with the CQC have gone up overall).

All of this will be thrashed out when the consultation on the standard starts in May (rather than today, as is implied by the press reports). Till then we will have to treat today's big claims as just that.

(Image on Flickr by the Health Hotel)

Andrew Lansley warned of risks to health and social care links

By Mithran Samuel, adults' editor, on February 25, 2011 12:46 PM | No Comments

Health and social care leaders have written to health secretary Andrew Lansley, warning that joint working arrangements are at risk from his plans to cluster PCTs together, reports Local Government Chronicle (behind a pay wall).

The clusters are the first stage on the road to the abolition of PCTs by 2013, when GP consortia will take responsibility for commissioning healthcare, under the government's NHS reforms.

However, areas where there are close working relationships between individual PCTs and councils - including joint management appointments - are concerned that imposed clustering will upset these arrangements.

The letter has been signed by leaders from a number of areas where joint working is furthest forward: Southwark in London; Herefordshire; Knowsley and Blackburn, among them.

"The attempt to insist upon a single clustering arrangement across the country places these local arrangements at risk; this risk is made even greater by the pace at which the proposals are being driven through by the strategic health authorities," they say.

We've had the following response from the DH:

"Clustering of PCT management arrangements is an important transitional arrangement to allow new local working structures to develop, ensure continuity of essential functions and reduce administrative costs.

"Where there is local integration between current PCTs and local authorities the guidance makes it clear that we want such effective joint working to be sustained as structural change is implemented locally. Precisely how this happens varies from place to place, and Strategic Health Authorities and PCTs are working with local authorities to find these solutions within the framework of the guidance nationally."

Not sure if that will be enough to satisfy Lansley's critics.

(Image on Flickr from NHS Confederation annual conference)

News round-up: drug use; hospital bed numbers falling; stroke care

By Jeremy Dunning, senior adult beat journalist on February 25, 2011 11:12 AM | No Comments

Some interesting stories for readers from the nationals:

1) How the British fell out of love with drugs, from The Guardian

2) Hospital bed numbers set to fall by 20,000 in a year, from the Daily Telegraph

3) Stroke victims receive 'unequal care' under NHS, from the Daily Telegraph

The second is interesting as it makes the point that simple cutting of bed numbers needs to be coordinated with services provided elsewhere and there is little evidence of this of this increase in services being provided elsewhere currently.

Council plans to redeploy mental health practitioners to standard social work teams

By Jeremy Dunning, senior adult beat journalist on February 25, 2011 10:49 AM | No Comments

On the back of a cut in posts across mental health services it is reported that the Isle of Wight is planning on redeploying specialist mental health practitioners to carry out standard social work within the authority.

These are currently employed by the council but seconded to the NHS-led community healthcare teams.

Social workers have hit out at the plans, which they say could affect hundreds of vulnerable people.

More later....

It comes amid controversy over NHS plan to cut more than 50,000 posts over the next four years with mental health services taking the brunt.

Eight reasons why Europe matters for social care in the UK

By Mithran Samuel, adults' editor, on February 24, 2011 7:56 PM | No Comments

Phil Madden and Irina Papancheva argue that social care professionals in the UK should pay attention to what is happening in Brussels and in the continent more generally as it is increasingly relevant to services in this country.

1. Workforce development. Social care organisations across Europe are dependent on staff from other countries. The European Association of Service Providers for Persons with Disabilities is currently engaged in a EU-funded project to develop a European Care Certificate for this purpose.

2. Pan-European disability strategies. The UK is a party to the EU Disability Strategy 2010-2020, which has specific actions to improve health, accessibility, social protection and employment for disabled people.

3. Case law. The deprivation of liberty safeguards were drawn up by the UK government in direct response to the European Court of Human Rights' judgement in the Bournewood case in 2004. The court found that an autistic man had his human rights breached by being detained in hospital without recourse to challenge his confinement. There will be other cases.

4. Personalisation. This is also an agenda that is being developed across Europe, with experience of systems like direct payments and personal budgets available from countries such as the Netherlands.

5. EU Directives. These have the force of law in member states. Recent directives against discrimination in employment and transport have brought other countries up to standards in the UK, but this country is hardly perfect and these and other directives will force improvement here too.

6. Demography. The biggest social challenge across Europe is the increase in the number of older people, many of whom will have or acquire disability. This is an area where important lessons can be shared.

7. Funding. The EU is a significant source of funding, with calls for proposals issued every month. Sources include the European Social Fund. Projects it funds include the Coastal Project to promote employment opportunities for disabled or disadvantaged people in South Wales.

8. Twinning. UK social care organisations have developed twinning arrangements with fledgling non-governmental organisations in new EU member states. For example, Learning Disability Wales is active in the deinstitutionalisation programme for services for disabled people in Bulgaria. The benefits are two way: established organisations in the West can get lost in marketing and corporate speak and can be healthily refocused by seeing how new organisations survive in adversity.

Phil Madden is vice-president of the European Association of Service Providers for Persons with Disabilities and Irina Papancheva is an independent consultant in social inclusion and EU affairs.

Accusations of "scaremongering" over NHS cuts to mental health fail to stick

By Jeremy Dunning, senior adult beat journalist on February 24, 2011 3:57 PM | No Comments

Tory charges of scaremongering over 50,000 NHS job cuts do not apply to mental health trusts.

Campaigners warned yesterday that mental health services would suffer "particularly acute" losses with four mental health trusts set to face 15% job losses amid claims that total NHS cuts would hit 53,150 over four years.

This is despite the government's pledge to protect the NHS, which as a whole must save £20bn from 2011 to 2015 against an annual £100bn budget in England.

Not surprisingly coalition figures have come out fighting.

The Conservatives questioned the validity of the figures and accused the anti-cut campaign group, False Economy, of having published "deeply suspect" research that was "deeply irresponsible scaremongering" designed to unsettle NHS workers.

Carry on over the page....

Continue reading Accusations of "scaremongering" over NHS cuts to mental health fail to stick .

Female genital mutilation guidance out

By Mithran Samuel, adults' editor, on February 24, 2011 3:10 PM | No Comments

Government guidance has been published today to help practitioners safeguard girls and women from female genital mutilation.
It's a must-read for adult protection practitioners (as well as child protection social workers) and covers issues including multi-agency working, taking a victim-centred approach, confidentiality and links to forced marriage.

Judges critical of legal aid cuts

By Mithran Samuel, adults' editor, on February 24, 2011 11:56 AM | No Comments

Just spotted this - the Judiciary has given a co-ordinated response to the government's plans to cut legal aid by reducing access to litigants in welfare cases. And it's not positive.
As we have reported in the past there are serious concerns that vulnerable people will be robbed of access to justice and it seems judges are not happy about the plans. Have a read if you have a moment.

Carers Hub launched to improve commissioning of support

By Mithran Samuel, adults' editor, on February 24, 2011 11:31 AM | No Comments

Councils and health commissioners are being urged to take advantage of an online service showcasing good practice in carer support services and including tips on improving commissioning.
Launched by the Princess Royal Trust for Carers and Crossroads Care - the two biggest providers of carer support services - the Carers Hub takes commissioners through a series of steps (as shown below) to support commissioning of the most effective and personalised services. It includes a number of good practice examples.

Carers hub screenshot .jpg

The hub is based on the outcomes set out in the government's refresh of its Labour predecessor's carers' strategy:

Carers will be respected as expert care partners and will have access to the integrated and personalised services they need to support them in their caring role.
Carers will be able to have a life of their own alongside their caring role.
Carers will be supported so that they are not forced into financial hardship by their caring role.
Carers will be supported to stay mentally and physically well and treated with dignity. Children and young people will be protected from inappropriate caring and have the support they need to learn, develop and thrive and to enjoy positive childhoods.

It looks like something all commissioners should be looking at.

Big Society in action: The case for Homeshare

By Mithran Samuel, adults' editor, on February 24, 2011 10:55 AM | No Comments

Social work student Joanna Nabrzyyska shares 89-year-old Cilly Haar's home. Though Joanna pays no rent, the two are not related and until less than a year ago they were perfect strangers.
This is Homeshare in action - a version of the Big Society that involves older or disabled people with low-level support needs inviting younger people in housing need to share their homes. These matches are arranged by Homeshare schemes, who carry out relevant safeguarding checks too. Sounds good right? However, only a dozen schemes exist in the country.

Our feature on this issue this week is designed to coincide with revised guidance published today on Homeshare for commissioners, policy makers and practitioners.
The guidance, published by umbrella body Naaps, is designed to spark interest in Homeshare and try and promote its expansion - on the basis that this level of low-level support will help prevent older people's needs escalating, as Alex Fox, Naaps chief executive, argues in a column for us.
And it needn't cost councils a penny, beyond some pump-priming. The voluntary sector scheme we feature in our piece is entirely funded by user contributions.

(Image by Tom Parkes)

NHS chiefs join calls for assisted dying law

By Jeremy Dunning, senior adult beat journalist on February 24, 2011 9:54 AM | 1 Comment

One of England's largest health authorities has said it is not opposed to assisted suicide and called for a change in the law to give patients more "choice" over how they die, reports the Daily Telegraph.

Pauline Smith, the end of life care lead for the West Midlands NHS Strategic Health Authority, said it was "not good enough" that only those who could afford to travel to Dignitas suicide clinics in Switzerland were able to control their own deaths.

This means that West Midlands has become the first health authority to back calls for a change in the law to date.

The news comes as social workers are called upon to speak out on assisted dying by a commission charged with looking into the law in this area.

Guide launched to help mental health sufferers deal with debt

By Jeremy Dunning, senior adult beat journalist on February 24, 2011 12:01 AM | No Comments

It's well known that mental health problems can cause severe debt and that conversely severe debt can cause mental health problems, though the scale of the issue is somewhat hidden.

In a new poll of 6,700 people, 44% of those who've had mental health problems (or have partners who do) have had severe or crisis debt - five times as many as everyone else (9%). For those with mental health problems, big debts are the norm.

Today MoneySavingExpert.com is launching a campaign to tackle the problem including a major new free guide for sufferers and their carers.

It includes help on where to find free one-to-one debt counselling, working with banks, tips for bipolar and depression sufferers and how friends and carers can help.

The booklet can be downloaded free at www.moneysavingexpert.com/mentalhealth

Among tips:

1. There's no such thing as an unsolvable debt. If you start to sort it out, it does get better.

2. Know the early warning signs, eg: tension headaches, arguments at work, back pain or bad skin. This is the time to take steps to keep on top of debt and depression.

3. If in crisis, get free debt help. If you've not got enough to pay the bills, visit a non-profit free debt counsellor, whose job is to help you, not to make money out of you. Try Christians Against Poverty or agencies such as the Consumer Credit Counselling Service and Citizens Advice.

4. Stop borrowing. If you feel up to tackling your finances, the easy start point is to do a budget and work out where the money's going (free planner at www.moneysavingexpert.com/budget).

5. Consider informing your bank. Once a lender is aware that a customer has a mental health condition, it has to make adjustments. However telling your bank is a decision to discuss carefully with a case worker or debt counsellor.

6. Check if you qualify for DLA. Do benefitsandwork.co.uk's quick DLA test see if you qualify.

7. Banking control if you have bipolar. A few banks have minor procedures to allow you to register your mental health issues and stop your overdraft going beyond a certain amount.

8. Consider adding a note on your file. If you overspend when you are unwell, you can volunteer to add information on mental health problems to credit files in what is called a notice of correction, which alerts potential lenders so they don't lend further credit. This can be added or removed whenever you want.

9. Cut your interest rates. The lower your interest rate, the more of your repayment goes towards clearing the actual debt, rather than just servicing the interest.

10.Repay highest rates first.

Unison calls on minister to intervene in Supporting People row

By Jeremy Dunning, senior adult beat journalist on February 23, 2011 11:57 AM | No Comments

Unison has published evidence of the scale of the cuts to the Supporting People programme and is calling on Grant Shapps, the housing minister to intervene.

It also claims that despite the government pledge to have cut SP by an average of 1% many councils had suffered a much harsher cut in their SP grant from the government and is calling on Shapps to give back the difference if he saw evidence the cut from his own department was greater than 1%.

I'm not actually sure how it's managed to work this out considering all grants are now rolled into the general formula grant but it's clear some councils have been making huge cuts at the local level.

Social workers reduce costly hospital readmissions by homeless people

By Jeremy Dunning, senior adult beat journalist on February 23, 2011 11:38 AM | No Comments

The Guardian has a fascinating feature on a project for homeless people that helps prevent costly readmissions to A&E departments.

Now a project called the London Pathway for Homeless Patients has been set up at University College hospital, London. The multi-agency group, which features social workers, try to put together care packages for each homeless person in the ward.

This breaks the old cycle of readmission and discharge without proper planning.

According to the feature the £100,000-a-year London Pathway saves UCH at least £300,000 every year through reductions in hospital stays.

For anyone who works in the homeless field this is well worth a read and a follow-up.

Picture courtesy of Ed Yourdon on Flickr.com

Architect of incapacity benefit reform slams disability test

By Mithran Samuel, adults' editor, on February 23, 2011 11:26 AM | No Comments

Bad news for the government as one of the architects of the reforms to incapacity benefit (IB) has slammed its fitness to work test ahead of a nationwide roll-out of the assessment to existing claimants, reports The Guardian.

Professor Paul Gregg has called on the government to halt the reassessment process, which is currently being piloted and is due to start in April, until so-called work capability assessment (WCA) is fit for purpose. The importance of this is that Gregg helped design employment and support allowance (ESA), the replacement for IB, which the WCA tests eligibility for.

His intervention has been welcomed by online disability campaign Broken of Britain who, with others, has led criticism of the WCA for wrongly finding disabled people to be fit for work (an outcome that leaves people with reduced benefits and less employment support).

However, this is not Gregg's first criticism of the coalition on this issue.
And ministers will claim that they are reforming the WCA by accepting the recommendations of an independent review by expert Malcolm Harrington - though campaigners argue that other planned changes to the WCA will make things worse, not better for claimants, and the recommendations of Harrington's review go nowhere near far enough.

My sense is that ministers will stand firm on this - there is too much political capital tied up in incapacity benefit reform (see this Daily Mail article for how well it plays to the gallery) to step back.

50,000 NHS jobs at risk, says TUC

By Mithran Samuel, adults' editor, on February 23, 2011 12:00 AM | No Comments

Bad news for the government today as the TUC has revealed that 50,000 NHS jobs are at risk, despite ministers' commitment to protect the NHS from cuts (in actual fact, the health service is seeing its funding fall slightly in real terms from 2011-15).
There could be as many as 5,000 mental health jobs at risk if posts are lost in proportion to budget. And there will be a knock-on impact for the social care professionals who work closely - and sometimes alongside - NHS colleagues.
Unsurprisingly, Labour has gone on the attack that it calls into question the government's large-scale reorganisation of the NHS.

Opposition mounts to plans to give councils poverty fund

By Mithran Samuel, adults' editor, on February 22, 2011 8:30 PM | No Comments

We reported earlier in the week on the opposition to government plans to scrap national emergency grants and loans to poorer families to fund items such as fridges and call on - but not mandate - councils to perform the same service locally.
Welfare rights specialists are concerned that this will deepen poverty and expose social workers to greater hostility from families.

Well that opposition appears to be mounting. Here's Helen Dent, chief executive of family support charity Family Action, on the proposal, which is in the Welfare Reform Bill:

"Making grants and loans local and discretionary will create a post code lottery for families in crisis and will mean many could lose out. Encouraging local authorities to set up food banks is not a sustainable or intelligent option to just ensuring that families can replace broken cookers or fridges. Local authorities would do well to consider the administrative burden of making very large numbers of very small grants to people in desperate need on their overstretched resources and whether they think that an important income maintenance function is appropriately managed locally.
"We know from our welfare grants service how many people already fall through the cracks and rely on us for help when they have nowhere else to turn for financial support. Due to the rise in VAT and the poor return on investments as a result of the financial crisis our grants scheme is already stretched to breaking point. The fall out from these plans could be huge. The government needs to think again."

Benefits advice and campaigning body Disability Alliance is also concerned, seeing the potential for funding to be cut to vulnerable people, rather than simply be localised.

So far, local authorities don''t seem to be taking up cudgels against the government on this (see the Local Government Association response in this story) but watch this space as the bill goes through Parliament.

(Image on Flickr from Editor B)

Cocktails and bowls: what old and young can teach each other

By Mithran Samuel, adults' editor, on February 22, 2011 3:54 PM | No Comments

Not sure if anyone caught it but the BBC ran a programme yesterday about bringing four young people together with older people from a Surrey retirement village.
The point of When Teenage Meets Old Age (on iplayer for another 20 days) was to see what different age groups could learn from each other and challenge perceptions on both sides.
The results appear to have been pretty positive.
83-year-old Roy Hone, for whom a good night out was a trip to his local bowls club, experienced a gay bar, lethal cocktails and karaoke in the company of 24-year-old beautician Zoe Day, and confessed he had been given a new lease of life.
In return, he helped her through the grief of losing her father the previous year, drawing on his own experience of losing his wife.

Another example of intergenerational practice is Homeshare, which involves older people with low-level support needs sharing their homes with younger people in need of accommodation.
As well as providing potentially good outcomes for both sides, it can be a way of helping councils save money by delaying entry to residential care.
We have done a piece on one such scheme, which includes the case of a social work student sharing with an 89-year-old woman, who had previously considered residential care.

Paralysed Emmerdale character to die in assisted suicide

By Mithran Samuel, adults' editor, on February 22, 2011 1:03 PM | No Comments

Emmerdale is to run a story in which a disabled character - Jackson Walsh - ends his life through an assisted suicide, the Sun has reported.
This will be controversial (if it happens - Emmerdale is not commenting at this stage) as Jackson (from what I can gather) is not terminally ill, but a disabled man in despair.
He was paralysed in a road accident last year and will ask his boyfriend and mother to help him end his life, it appears.
Hopefully, this will be something that adds to, rather than detracts from, intelligent debate on assisted suicide, which is characterised by extreme polarisation.
The news comes as social workers are called upon to speak out on assisted dying by a commission charged with looking into the law in this area.

Why social workers must speak out on assisted dying

By Mithran Samuel, adults' editor, on February 22, 2011 9:47 AM | No Comments

By Denise Platt, member of the Commission on Assisted Dying and former chair of the Commission for Social Care Inspection

The Commission on Assisted Dying began its work last November and aims to examine whether it is possible to devise, in law, a safeguarded process for assisted dying that facilitates those people who wish to be assisted to die, while at the same time safeguarding those people living in vulnerable circumstances who might come under pressure to agree to such an act. The commission aims to produce an authoritative piece of work focusing on the current approach to assisted dying and making recommendations as to what, if any, changes should be implemented.

Social care workers help and support many people who are living with a terminal illness. Just as they have been used to exercising control over many things in their life, a number of these people sincerely want to have some control over their death and the right to seek an assisted death if the circumstances become more than they can bear.

Equally, there are many who are fearful, for themselves and for others, that any provision in law that formally permitted assisted death will put pressure on certain groups of people to be obliged to seek such an end. As one witness put it: "An opportunity may become an obligation." While legislation might only apply to people who are terminally ill, many believe that this would become a slippery slope. Witnesses tell us that society has such a poor view of the quality of life of disabled or older people that they and their families would come under considerable, albeit subtle, pressure to conform.

Some consider that if there was a legal framework that allowed assisted death, there would be no incentive to develop and improve palliative and other care services. People can become despairing and vulnerable when care services are poor, infrequent or badly co-ordinated and driven to 'seek a way out'. Resources might be diverted to implementing the framework not improving the service.

These are the complex ethical issues which the commission is debating. Social care workers have a unique insight into the daily lived experience of many older, ill or disabled people, which is why the commission will take evidence from health and social care professionals on 23 February, including from BASW - The College of Social Work and a frontline practitioner, Suzy Croft.

It may be that having heard all the evidence and learning from international experience it is not possible to devise a practical safeguarded process. But if it is possible, it is inconceivable that social workers as part of a multi-disciplinary team will not have a role to play to safeguard people's rights. That is why it is important for social care professionals to debate and contribute fully to this discussion.

So please submit your evidence by our deadline of 2 May, 2011.

Adult social care in Wokingham to be run through a local authority trading company

By Jeremy Dunning, senior adult beat journalist on February 21, 2011 9:39 AM | No Comments

Wokingham is the latest UK authority to look at hiving off its adult care staff to a local authority trading company.

Community Care recently revealed that at least 20 councils were considering going down this route.

If Wokingham's plans are approved the responsibility for adult social care provided services will be transferred to the council owned company, called Connect Community Care.

Keep personal budgets personal, say Scie

By Jeremy Dunning, senior adult beat journalist on February 18, 2011 6:26 PM | No Comments

I blogged about Scie's at a glance guide on people with mental health problems who have a personal budget yesterday, but its senior research analyst Sarah Carr explains it far better than I can so click here for her thoughts.

Real concerns remain about rising rough sleeper numbers, says St Mungo's

By Jeremy Dunning, senior adult beat journalist on February 18, 2011 6:07 PM | No Comments

Fears are growing over rising rough sleeper numbers, despite the government maintaining its priority towards combating the problems.

Homeless charity St Mungo's was responding to yesterday's data from the government showing that 1,768 people are forced to sleep on the streets each night.

The rise is partly as a result of a more "robust" estimate central government is now ordering councils to carry out.

At the same time it announced an £18.5m package of funding for the main national homelessness charities, and extra powers for the Mayor of London to run pan-London rough sleeping services.

The money is all very nice but as St Mungo's Chief Executive Charles Fraser points out they demonstrate "a very worrying rise in street homelessness in 2010, which look set to continue into 2011".

But thanks to council cuts across the country the help to homeless people is being scaled back by an average of 20% at a time when the ongoing recession many people are only two or three pay-packets away from serious housing difficulties.

So will this extra money solve the problem? I think unlikely unlikely in the current climate.

Picture courtesy of Ed Yourdon on Flickr.com

Council to run inquiry into mental health centre closure consultation

By Vern Pitt, journalist, on February 18, 2011 11:29 AM | No Comments

It's funny that in the week that we publish a feature looking at the inadequacies of some councils' consultation exercises, another one crops up.

Leeds council is to start an inquiry into the quality of consultation on the closure of a specialist mental health centre.

I understand that Unison may even be seeking a legal challenge to the proposals to close the centre, based on the consultation's quality.

It seems increasingly likely we can expect more of these over the coming months.

It never rains but it pours.

Rising bed blocking figures according to latest government statistics

By Jeremy Dunning, senior adult beat journalist on February 18, 2011 9:42 AM | No Comments

The latest figures for the numbers of patients experiencing delayed transfers of care have shown a rise from December to January from 3,881 to 4,640 patients.

This is also higher than November's figure of 4,492 patients.

Some of the other main findings for January 2011 were:

• There were 3,560 adult critical care beds available with 3,016 occupied in January 2011. This compares to 3,535 available and 3,088 occupied in December 2010.
• The number of urgent operations cancelled was 222 in January 2011. This compares with 322 urgent operations cancelled in December 2010.

It's obviously not possible to read anything into this currently, but it's worth noting for the time being.

The alarm bells will have to start sounding if there are rises from April onwards as that would indicate that council cuts are having an effect on patients when they are medically fit to leave hospital.

The hope is, of course, that joint working in this area will be thoroughly embedded, as Community Care showed in this feature on how Portsmouth is combating bed blocking.

NHS chief says no to price competition on services

By Mithran Samuel, adults' editor, on February 17, 2011 7:44 PM | No Comments

As we reported last month, there are many and various concerns about the government's NHS reforms but one issue stood out above others: the replacement of fixed prices for services (through a tariff) with maximum prices, seemingly enabling competition on price between providers for services.
This raised serious concerns that quality would suffer as commissioners chased the cheapest price, rather than the best service, including in areas such as mental health.
However, NHS chief executive David Nicholson today said price competition would not be introduced in the NHS, in a letter to senior health service executives.
He says that commissioners would only set prices below the maximum in "exceptional circumstances" and this would not be to facilitate price competition. Indeed, cheaper services would be expected to be as good as, if not better, than those charging the maximum price.
Though the Department of Health denies this, Nicholson's comments have been interpreted as a U-turn by the government, as Health Service Journal reported today (behind pay wall).

Personal budgets and users of mental health services

By Jeremy Dunning, senior adult beat journalist on February 17, 2011 2:35 PM | No Comments

There's a good briefing from Scie about people with a mental health problem who use personal budgets.

Among conclusions:

*Such users need consistent contact with a worker who knows their circumstances.

*Mental health providers need to provide better quality information on personal budget options available to service users.

*Users want choice but can sometimes find that the social care and support market is not developed enough to allow a wider choice.

*They are generally able to manage their budgets, but often welcome support from others in a similar position.

For those who want to know more about personal budgets I'd recommend having a look. We also have an expert guide, which is available here.

Local government chiefs call for urgent clarity on public health funding

By Jeremy Dunning, senior adult beat journalist on February 17, 2011 2:17 PM | No Comments

Ten public health organisations have called for "urgent" clarity on funding arrangements for public health under the new Health and Social Care Bill.

Public health is set to play an expanded role in the new health world, but it's still uncertain what powers councils will take on as part of this and how this will be funded.

In a statement issued today the bodies, which include the Local Government Group, the Royal College of Physicians, the British Medical Association, and the Royal Society for Public Health, said the bill represented a major restructuring and that no action should be taken that threatened or undermined the work that already takes place across the country on integrated health and social care delivery.

It's rather suggestive of a bill that needs more work on it, though apparently health secretary Andrew Lansley spent years refining his policy.

Government bids to slash cost of sickness absence

By Mithran Samuel, adults' editor, on February 17, 2011 1:31 PM | No Comments

Amid the sound and fury over today's welfare reform plans, the government has today launched an independent review of sickness absence.
While the review is portrayed as a way of improving support for individuals so they do not fall out of work, this is very much, its key purpose is clear - to reduce costs estimated at £100bn a year in lost productivity and health provision.
Where have we heard this before? Oh yes, from the last government through its Work and Well-being programme that saw the replacement of sick notes by fit notes, which, unlike their predecessors, detail what a person can do in the workplace, not what they can't do.
Their is even continuity in the review with the appointment of Dame Carol Black, a doctor who led the last government's work in this area, to co-chair the review, alongside David Frost, director general of the British Chambers of Commerce.

All of this is not necessarily a bad thing if it means improved support for people to stay in work. However, the emphasis on cost is a worry, if it means reductions in sick pay of similar measures, as organisations such as the TUC have pointed out.

Anyway, here's some background on this area.

Sexual abuse at care home revealed

By Vern Pitt, journalist, on February 17, 2011 1:05 PM | No Comments

Dementia patients were subjected to repeated sexual abuse and assaults at a care home in Leicester, a serious case review has revealed.

There were 65 incidents of sexual or concerning behaviour involving an umber of residents between 2008 and 2009.

The review concludes that residents were failed by staff at the home in Leicester.

IDS drops hated plan to slash housing benefit for jobless

By Mithran Samuel, adults' editor, on February 17, 2011 8:51 AM | No Comments

With the Welfare Reform Bill due imminently, the government has dropped much-criticised plans to cut housing benefit by 10% for people who have been out of work for a year or more.
The plan - part of a package of cuts to housing benefit - was slated by housing and homelessness charities for risking a rise in homelessness and being unduly punitive.
Work and pensions secretary Iain Duncan Smith confirmed the U-turn in an interview on Radio 4's Today programme, and the news has been hailed as a victory for the Lib Dems (who opposed the plan).
The bill has now been published. And here's our initial story on it.

Call for personalisation as Welfare Reform Bill is published

By Mithran Samuel, adults' editor, on February 17, 2011 12:00 AM | No Comments

Today work and pensions secretary Iain Duncan Smith has published the government's Welfare Reform Bill.
As we and others have documented, there is a lot of opposition to the government's welfare plans because of their potentially devastating impact on disabled people.

However, there is a stated purpose to the reforms, whatever their impact, which is to improve work incentives and opportunities.

An interesting contribution to this debate has been issued today by the Centre for Economic
and Social Inclusion, in a report sponsored by the Shaw Trust, the largest third sector provider of welfare-to-work programmes.

The report points out that the government's new overarching welfare-to-work scheme Work Programme will have a large number of disabled clients, unlike the many programmes it replaces. This will pose a challenge to providers not used to working with this client group.
The report's answer is personalisation - giving welfare claimants a personal budget following an assessment of need and calling on them to devise a support plan to get them back to work. The report draws on experience from the Netherlands and the experience of personal budgets in social care.

The government is generally supportive of personalisation and consumerist approaches to public services; however it also is a strong supporter of conditionality in the welfare system - that people should undertake certain activities (such as training/interview practice/work experience) in return for their benefits. How free would they allow people to be in designing a support plan for themselves, and if the answer is not very, then would this be genuine personalisation?

Anyway, it's an idea worth conjuring with as we await what IDS has to say today.

Picture courtesy of Steve Punter on Flickr

Disability: OFT launches probe into wheelchair market

By Mithran Samuel, adults' editor, on February 16, 2011 9:06 PM | No Comments

The Office of Fair Trading today launched an inquiry into the market for mobility aids, such as wheelchairs, hoists and stair-lifts.

A consultation with disabled people and other interested parties has found that there are concerns that disabled people are being overcharged for products or are buying things that do not meet their needs.

The market study will ask these questions:

Are consumers able to access, assess and act on the right information so they can purchase the right mobility aid for them and help drive vigorous competition amongst firms?
Are consumers being treated fairly by traders and suppliers, and if not what can best be done to address this?
Is competition in the wheelchair sector working well for consumers?

The study is due to report in September.

To contribute views email mobilityaids@oft.gsi.gov.uk, or by write to:

Mobility Aids Team
Goods Group
Office of Fair Trading
Fleetbank House
2-6 Salisbury Square
London EC4Y 8JX

NHS Trust plans to evict elderly patients medically ready to leave hospital

By Jeremy Dunning, senior adult beat journalist on February 16, 2011 1:17 PM | No Comments

A health authority is planning to use anti-trespass powers normally used against "hoodies" in shopping centres against elderly patients who refuse to leave their hospital beds after being discharged.

NHS Sefton, in north Merseyside, points out that it would only take this action once all avenues had been explored, but that its priority had to be that hospital beds were available.

Having recently written a feature on bed-blocking and a good joint working initiative in Portsmouth this appears heavy-handed and as Michelle Miller points out this is a complex problem.

An open letter on disability benefit reform to Maria Miller

By Vern Pitt, journalist, on February 16, 2011 12:26 PM | No Comments

This very succinct and well written letter to minister for disabled people Maria Miller, neatly sums up the problems with the debate around reform of disability living allowance and employment and support allowance.

Now, to see if there is any response.

Providers feel the squeeze and care suffers

By Vern Pitt, journalist, on February 16, 2011 10:01 AM | No Comments

It is tempting for social workers in the public sector to feel little sympathy for private and third sector providers being squeezed by spending cuts to the point of going out of business, as Community Car reports today.

If you work in the public sector it's easy to caricature them as fat cat corporations gorging themselves at the teat of the public purse.

But if service users are to have choice and control which many in the public sector (in principle at least) support then they need a market to buy from and that's what these providers do. They would also point out they consistently do it cheaper and at a higher standard than in house council provision.

The real people who will lose out from providers closing or cutting services, as our survey finds, are service users, and that is something which we should all be concerned about.

Councils set to face wave of legal challenges to cuts

By Vern Pitt, journalist, on February 16, 2011 9:39 AM | No Comments

Councils are likely to see a wave of challenges to their decisions over the coming months as they firm-up budgets and subsequent service cut decisions, lawyers believe.

Having spoken to a number of community care lawyers over the past couple of days a consensus seems to emerging that councils will likely become tied-up in judicial reviews.

Their comments follow successful challenges to council funding decision in Pembrokeshire and London Councils.

There a number of grounds on which decisions can be challenged. Poor consultation is one, another is incorrect calculations or even on human rights grounds.

Of course, a judicial review doesn't oblige a council to change its mind, only to re-make the decision (which could in theory be worse for whoever is challenging it). But with the cuts cutting the margins of providers and the support of service users, there will be a long list of potential challengers.

Obviously this is unpleasant and unnecessarily stressful for those making a challenge, especially as they may be looking at a potential drop in standards of living if a decision goes through, but it may be seen as a calculated risk by councils. The average cost of a judicial review is somewhere between £25,000 and £100,000 and most of the cuts to service we are seeing are delivering saving above that (many councils will have insurance against inuring all of these costs anyway).

Tragically that means rushing through the process only carries minimal risk and maximum gain.

Image by Steve Punter on Flickr

Care funding commission to rule out compulsory insurance.

By Jeremy Dunning, senior adult beat journalist on February 16, 2011 9:25 AM | No Comments

The commission investigating long-term care funding appears to have ruled out compulsory insurance.

In an indication of its thinking commission member Lord Warner said that the idea of compulsion "doesn't feel to me as though it fits the public mood music at the moment, or the mood music for the foreseeable future".

Warner argues that the social support for compulsion is not there and that the latest social surveys indicate that people no longer expect the state to sort out all their problems.

As I mentioned in an earlier blog Warner sees the solution as a partnership between the state and the individual. The question is the balance between the two.

If this is path down which the commission is headed it would prove controversial as experts, such as the King's Fund, have warned that people will not voluntarily insure for the full cost of care.

Warner is probably correct in his belief that the "mood music" is not there. People do not appreciate being forced to do something against their will and there are too many economic pressures on people's budgets already.

However I agree with the King's Fund that there are dangers in going down this route. Maybe it is time for politicians to take the lead and to educate the public.

Such a decision could also prove controversial politically with the then Labour government being accused of trying to introduce a "death tax" by the Tories before the election.

However commission chairman Andrew Dilnot insisted at the time he took the job on that he did not feel compelled to introduce a politically acceptable solution.

Mental health: Good practice in stamping out age discrimination

By Mithran Samuel, adults' editor, on February 15, 2011 8:50 PM | No Comments

As some of you may know, age discrimination must be a thing of the past by next year - judging by today's report by the health ombudsman we could be some way off in the NHS - and information is being sought on achieving age equality in mental health.
The call comes from the National Development Team for Inclusion and the National Mental Health Development Unit.
The deadline for responses is 28 February.

Your profession needs you: Answer our caseloads survey

By Mithran Samuel, adults' editor, on February 15, 2011 8:41 PM | No Comments

Sorry to come across all Kitchener but we are running a survey about the pressures on social workers as part of our campaign to improve working conditions with Unison: the Social Work Contract.
Please take a moment to fill in our survey on supervision, caseloads and other matters so we can identify just how bad things are at the moment in order to argue for better conditions.

Ruling on sterilisation of pregnant learning disabled woman on hold

By Mithran Samuel, adults' editor, on February 15, 2011 8:31 PM | No Comments

An update on this tragic case about whether a learning disabled woman due to give birth by C-section tomorrow should be sterilised against her will: newspapers are reporting that the ruling has been put on hold as the Court of Protection says it has insufficient evidence on which to decide whether this action is in her best interests.
More detail in the report from The Guardian - it seems the woman's mother wants to ensure that she doesn't have any more children (she already has one). Giving evidence today, the mother argued that her daughter doesn't understand the consequences - including that, if she had a third child, it would be taken away.
The judge ruled that more evidence was needed to rule on the woman's capacity to decide on family planning and on what would be in her best interests. Another hearing is set for April.

Tory MP accuses government of trying to silence her in battle over health reforms

By Jeremy Dunning, senior adult beat journalist on February 15, 2011 11:56 AM | No Comments

My colleague Mithran has commented on this being a bad day for the NHS as a result of the stinging rebuke from the health ombudsman into the care of older people.

It's also not a particularly good day for the health secretary Andrew Lansley who has been accused of losing GPs in the fight for his health and social care bill while former GP and Tory backbencher Dr Sarah Wollaston, who is critical of the bill, said that government whips attempted to gag her and prevent her from speaking out against the NHS reforms.

In an interview with Pulse, Dr Wollaston, the MP for Totnes in Devon, also accused ministers of ignoring GPs' concerns about key areas of the proposals, including the speed and scale of the reforms.

Hmm. Will Lansley and co. listen? Unlikely. It won a large majority on its first reading and also we're into political territory here. Any whiff of giving much ground will lead to dangerous claims by the opposition of backtracking on an important piece of government legislation.

NHS slammed for poor care of older people

By Mithran Samuel, adults' editor, on February 15, 2011 9:28 AM | No Comments

Bad day for the NHS today as a report from the health ombudsman has slammed its care of older people.

Investigations of ten cases found older people suffered unnecessary pain, indignity and distress while in the care of the NHS, and common failures in pain control, discharge arrangements, communication with patients and their relatives and ensuring adequate nutrition.

The stories are heartbreaking and inexplicable in equal measure:-

One man was left forgotten in a waiting room, denying him the chance to be with his wife when she died.
One woman was discharged to a care home soaked in urine, wearing someone else's clothes and bruised.

Ombudsman Ann Abraham said the problems she identified went much further than the 10 cases studied.

One of the fundamental points she made is that health staff failed to look beyond people's clinical conditions to address their social and emotional needs.

And she makes clear that the NHS will have to get better - much better - in this respect - as it seeks to cope with an ageing population and increasing numbers of people with long-term conditions.

Age UK has called for a system-wide review of the care of older people in the NHS and is concerned that the government's overhaul of the health service - at a time of resource constraints - could well make things worse.

From 2012, the NHS - like other services - will be under a duty to provide equality for older people in its practice and procedures. Judging from the ombudsman's report there is a mountain to climb.

(Image from Flickr by rileyroxx)

Council dementia service consultation 'farcical'

By Vern Pitt, journalist, on February 15, 2011 9:15 AM | No Comments

A council has had its complex consultation for dementia service users branded 'farcical' by the Alzheimer's society.

The Alzheimer's Society said that many dementia sufferers could not hope to respond in a meaningful way.

Sadly this isn't the first council to have problems like this.Kent Council was threatened with involvement of the audit commission over it's consultation over care home closures.

Pressure groups from various walks of social care have branded consultations of increases to charges for social care tokenistic in the past couple of months.

London Councils were even forced to re-examine a decision to cut £10m of funding from charities because, in part, its consultation on the decision had not been adequate.

It all raises the question of when are councils going to get this kind of thing right?

Campaign makes case for sheltered housing

By Mithran Samuel, adults' editor, on February 15, 2011 12:05 AM | No Comments

A campaign has been launched to make the case for sheltered housing - it comes from the trade body for the sector, ERoSH (the Essential Role of Sheltered Housing).
As befits the times, ERoSH is arguing that sheltered housing ticks both the Big Society box (as a community facility that can be used for a wide range of purposes) and the public sector efficiencies box (as a preventive service for older people that reduces pressures on the health and social care budgets).

Disability living allowance and Big Society

By Jeremy Dunning, senior adult beat journalist on February 14, 2011 10:58 AM | No Comments

I've been whipping through the papers and websites today and found this particularly powerful video and feature in The Guardian on the effects of the planned cuts to Disability Living Allowance on just one user.

Meanwhile the attempt to save David Cameron's pet project, the Big Society continues. Today he unveils plans on how he intends to attract capital into the social investment market, including £400m from dormant bank accounts and - eventually - further sums from individuals and institutions like pension funds that might be prepared to invest routinely in social enterprise.

Over the weekend he began his defence of his idea claiming the Big Society is on its way, though as Jackie Ashley points out, by cutting too far and too fast he is endangering any sense of a bigger society.

Court to rule on proposed sterilisation of learning disabled mother

By Mithran Samuel, adults' editor, on February 14, 2011 9:32 AM | No Comments

A pregnant woman with learning disabilities could be sterilised without her consent after giving birth to stop her becoming pregnant again, reports The Daily Telegraph today.

The case is going before the Court of Protection tomorrow and has been brought by a local authority and NHS trust, who is calling on the court to decide whether the woman has the capacity to decide on issues of contraception, and if not, whether she should be sterilised.

Mencap is - as you would expect - pretty appalled by this prospect, arguing that sterilisation should only be carried out for sound medical reasons, not as a method of contraception.

Given the nature of the case, no details can be published, however, the Court of Protection is planning to hold a rare open hearing given the level of public interest involved - though no identifying details of those involved can be published.

There are wider issues surrounding the support (or lack thereof) of learning disabled parents, as our columnist Alex Fox reported recently, though this is a pretty extreme and rare case, as Mencap's David Congdon points out in the Telegraph article.

Obviously there is a significant child protection dimension to these types of cases, but the role of adult social workers in these cases is crucial, particularly where capacity is in question (on this, see our interactive guide to mental capacity assessments, published last year).

DH fails to deliver for profoundly learning disabled, says expert

By Mithran Samuel, adults' editor, on February 11, 2011 5:20 PM | No Comments

Okay, here's a little something for the weekend:

A leading academic has slammed the Department of Health for its response to his report on improving care for people with profound and multiple learning disabilities.

Jim Mansell has accused the DH of simply listing a number of general policies in its response to his report and not provided any specific actions to address Mansell's recommendations, despite accepting all of them. He says there is too much emphasis on leaving implementation of these recommendations to local authorities and the NHS.

Mansell's report, Raising our sights, found that people with profound and multiple learning disabilities were being written off by services due to prejudice, discrimination and low expectations.

His recommendations included that:-

• Services for profoundly disabled people to be developed in line with the personalisation agenda.

• Councils to ensure that sufficient numbers of trained personal assistants are available to meet the needs of this client group.

• Councils and primary care trusts to keep up-to-date information on the number, needs and circumstances of profoundly disabled people.

Mansell - emeritus professor of learning disability at Kent University - is an expert in this field, having previously reported on the state of services for people with learning disabilities and challenging behaviour.

His critique of the DH's response to his recommendations seems to go to the heart of the government's localist philosophy: that the role of government is not to lead - let alone direct - policy implementation but simply to guide local agencies to do so, and encourage local people to hold them account for delivery.

I just spoke to Mansell about this and he summed up the problem of this approach neatly in the case of this client group: "The government's intention is that in particular local authorities should no longer be held to account by central government but by local populations. But that's some way off for these people. They have no voice locally, they are not on the radar."

I've had a response to his comments from the DH - it is pretty reflective of the department's response to Mansell's report:

"We fully support the Raising our sights report and have taken on board its central message that prejudice, discrimination and low expectations are major obstacles that all people with learning disabilities face.

"Our aim is to deliver the best outcomes for people who need support, enabling them to live as independently as possible. We have been clear that this requires a more personalised service and we will ensure that progress continues in this area so that more people benefit."

(Blog updated 9.25am 14 Feb)

New call for action issued for race equality in mental health services

By Jeremy Dunning, senior adult beat journalist on February 11, 2011 4:15 PM | No Comments

The Afiya Trust has put out a call for action on race equality as a result of the deafening silence in the new mental health strategy over the persistent over-representation of black and minority ethnic communities in the mental health system.

The trust points out that no BME organisation is in the strategy's "A call to action" document, and says BME communities are left in a position of disparity of esteem.

Afiya isn't totally damning. It says the cross-government approach is promising as is the mainstreaming of mental health alongside physical health.

But it says it is concerned that the social justice and race equality elements of New Horizons, the strategy's predecessor, are not included.

I myself was surprised at these omissions from No Health without Mental Health as there are a host of well-known problems specific to the BME community, which New Horizons recognised.

The difficulty is these problems are not just related to mental health services and have a wider socio-economic factor way beyond any mental health strategy.

Dealing with these issues requires a level of cross-departmental working that I don't think any British government has managed to achieve yet - though the coalition is talking a brave game about this and it may be that it sees this as part of the answer.

Personally I still think you need some kind of specific action plan or document as included within New Horizons.

The Afiya Trust says it plans to host a roundtable event to take the call to action on race equality in mental health forward.

Among the points under consideration is the diminishing role of Community Development Workers with a brief to work with BME communities, a post created under the national Delivering Race Equality action plan, which ended in 2010.

Also on the agenda is the survival of the Count Me In Census, which includes all in-patients in mental health services, which the Afiya Trust suspect might be axed.

This isn't the first criticism the mental health strategy has already received in its short life amid doubts over the deliverability of the coalition government pledge to roll-out talking therapies.

Commissioning Mental Wellbeing toolkit developed

By Jeremy Dunning, senior adult beat journalist on February 11, 2011 2:12 PM | No Comments

I should have blogged on this earlier but there's a Commissioning Mental Wellbeing for All toolkit out now to help commissioners across the UK.

Developed by two researchers from The University of Central Lancashire (UCLan) it emphasises the importance of investment in positive mental health and wellbeing.

It outlines ten steps for commissioning for mental health and wellbeing and lists key resources to support these commissioning processes:

Focus on the mental wellbeing of the population

Collaborate across sectors and levels

Develop and use methods to engage communities

Understand local factors and determinants of health and community assets and resources

Base decisions on evidence

Develop strategies and interventions across the life course

Put measures in place to ensure effective implementation

Identify opportunities to mainstream mental wellbeing into existing activities

Increase investments 'upstream' in prevention

Demonstrate accountability for outcomes

Dilnot commission on course for partnership model

By Jeremy Dunning, senior adult beat journalist on February 11, 2011 12:59 PM | No Comments

Lord Warner, a member of the Dilnot commission on care funding, says a lot of work will be needed to educate the public as he revealed that it would recommend a partnership model when it reports later this year.

Neither are hardly surprising and it's well-known the current situation is not sustainable. Last year even before the commission met, its chairman Andrew Dilnot said any model would have to be a mixture of private and public funding and the only issue was the split.

Meanwhile Dilnot himself pointed to the need for the public to be made better aware of funding and care entitlements.

Yesterday at a Westminster Health Forum seminar on social care reform Warner said the commission planned to explore public attitudes soon but acknowledged: "This is a big mountain to climb," as he called for political leaders to be brave and address the work of educating the public.

Behan urges greater take-up of technology and prevention

By Jeremy Dunning, senior adult beat journalist on February 11, 2011 12:29 PM | No Comments

Social care director general David Behan says he is about to get "assertive" with local authorities who aren't making the best use of technology and preventive services in adult care.

Behan has been ploughing this argument for a long time now and during a seminar yesterday on social care reform he pointed to declining productivity in adult social care and said more needed to be done by local authorities in terms of take-up of cost-saving measures.

"I will be strong about it, assertive about it, but not heavy about it," he said.

It's surprising Behan is still having to shout out this message as it's well known that greater use of technology and preventive measures are cost saving and councils are generally strapped for cash currently. Why are these messages still not being heard universally?

Cornish campaigners prepare for sleepout against Supporting People cuts

By Jeremy Dunning, senior adult beat journalist on February 11, 2011 10:12 AM | No Comments

The controversy in Cornwall over the size of the council's cuts to the Supporting People budget is heating up.

Campaigners are sleeping outside County Hall in Truro overnight on Sunday (13th/14th Feb) to make their feelings known about their belief the 40% cuts are iniquitous.

They'll be joined by several opposition councillors and LibDem MP for Newquay and St Austell Steve Gilbert.

It'll be great if they do manage to change local policy, though I'm not optimistic. It's clear though that much like the protesters in Egypt they won't go away.

One thing that is increasingly clear is the tension over pure localism that this is exposing. Central government says Supporting People is a valuable policy we support so don't cut it. Local government says we've no choice. Something has to give.

Big Society won't take root in deprived areas at risk of cuts, warns Bishop

By Jeremy Dunning, senior adult beat journalist on February 11, 2011 9:34 AM | No Comments

Bishop of Oxford Rt Revd John Pritchard.jpg

David Cameron's pet project, the Big Society, is today coming under yet more attacks as evidence mounts that the speed of the cuts will damage the concept's effectiveness.

The Bishop of Oxford, the Rt Revd John Pritchard (left) said in the Oxford Mail that community groups in deprived areas would be less likely to take up the Big Society agenda if they were struggling to cope with slashed funding.

This adds to concerns he outlined in Community Care last year about the ability of faith groups to take on a greater responsibility in the running of public services as the state retracts. They can, he said, but only to a degree.

Meanwhile consultants Consulting Inplace warned that Big Society risked widening the gap between rich rural areas and deprived cities in the north and Midlands because of higher levels of volunteering in wealthier areas.

I doubt very much if these further warnings will do anything to slow Dave and the boys but it does seem they can't grasp that people in general like the concept of Big Society, but it can only really take root when economic conditions allow.

Withdraw huge amounts of funding immediately and it's seen as a cover for cuts, but slowly withdraw while at the same time building up volunteering capacity and third sector capacity and people will accept it.

People are willing to volunteer if they have the time and are not consistently worried about the threat of redundancy.

Why ADASS is like the Terminator

By Jeremy Dunning, senior adult beat journalist on February 10, 2011 3:57 PM | No Comments

You may think there's no link between Richard Jones, the president of the Association of Directors of Adult Social Services, and the Terminator.

However Jones' daughter appears to think he's a bad hombre.

Jones recounts this story:

"My daughter said 'Dad, it's great you're ADASS, but have you ever thought of becoming the British Association of Directors of Adult Social Services?'

"I said we're English."

So there you go. Adult social care directors being represented by a "BAD ASS".

It just makes me wonder whether ministers at the Department of Health fear face-to-face meetings with him.

Credit: Profiles/Rex Features

A short history of disability benefit reform

By Vern Pitt, journalist, on February 10, 2011 3:50 PM | No Comments

Next Friday is the deadline for submissions in the consultation on reform of disability living allowance.

To celebrate I've complied a timeline of disability benefit reform.

It focuses mainly on changes to DLA and employment and support allowance. If you think I've missed something please do contribute by emailing me with a link (unfortunately Dipity doesn't seem to provide a list of most recent updates making it impossible for Community Care to moderate submissions, or I'd just let you do it yourself).

Disabilit benefit reform on Dipity.

Inheritance tax not the be-all and end-all for the future funding of care

By Jeremy Dunning, senior adult beat journalist on February 9, 2011 4:27 PM | No Comments

This paper on the pros and cons of using a new inheritance tax to pay for an increase in social care combined with the abolishment of means testing rather passed me by.

It's worth a look in the context of the Commission on the Funding of Care and Support having just closed its call for evidence.

The paper, from the Strategic Society Centre, points out:

* Significant uncertainty as to what extent households would respond to the new tax by shifting wealth and reducing their liabilities.

* Issues around closely tying social care revenue streams to fluctuations in house prices.

*Imposing the tax on the estates of those who have only relied on informal care, frequently provided by carers who have foregone earnings to do so.

The paper also examines variations on the inheritance model, including:

*Providing exemptions for recipients of informal care.

*Directing inheritance tax revenue to a social insurance fund.

*Using an estate-charge, rather than a tax, to fund care and support.

Joint working in Portsmouth aids fight against bed-blocking

By Jeremy Dunning, senior adult beat journalist on February 9, 2011 11:19 AM | 2 Comments

The Christmas cold weather and the winter flu bug revived attention to the problem of bed-blocking and triggered a blame game between health and social care.

What is clear is that joint working between health and social care has been key in those areas that have had most success in ensuring that support packages are in place for people ready to leave hospital.

One such area is Portsmouth, where the council, the primary care trust and the Portsmouth Hospitals NHS Trust, which runs the Queen Alexandra Hospital, believe that a good joint working relationship has helped in reducing delays.

Click here for the feature, which is published online today, as is this video.

Five questions for Duncan Smith on carers benefits

By Vern Pitt, journalist, on February 9, 2011 9:56 AM | No Comments

As the secretary of state for work and pensions, Iain Duncan Smith (IDS), answers to questions of the work and pensions select committee on his plans for benefit reform today, Rosemary O'Neill a campaigner for Carer Watch gives her top five questions she would like to see him answer.

1. Does IDS agree that we as a society need carers identified as a group so resources can be targeted correctly in the future?

Carer Watch believe it is vital that carers allowance remains outside the universal credit. They provide a service this country cannot do without and actually save the country money, (£87 billion according to research by Carers UK).

*Update: IDS refused to give details of where carers allowance will sit within his welfare reform bill with regards to universal credit.

2. What does IDS plan to do to ensure that these groups are fully recognised for their social input and become eligible in the future?

The current restrictions surrounding carers allowance mean so many people do not qualify e.g. pensioners, students, overlapping benefit ruling. Reform is needed to ensure these carers are fully supported too.

3. Will the Personal Independence Payment be a passport benefit to Carers Allowance?

There has been no detail with regards carers and the Universal credit but now we also have the concerns of what will happen to carers if Disability Living Allowance is reformed to the personal independence payment.

4. If a carer moves onto the universal credit will they still be expected to work for a minimum of 35 hours per week, when all others on the universal credit will not be asked to work for their benefit. If "carers" still have to work for their benefit, and others don't, is that not discriminatory?

Family carers are not unemployed. Carers work and work damn hard.

5. If carers allowance is kept out of the universal credit, could the taper rules be applied to it to enable working carers to be treat fairly and keep more of their earnings too?

Report finds finds ongoing concerns for detainees with mental health problems

By Jeremy Dunning, senior adult beat journalist on February 8, 2011 4:46 PM | No Comments

I meant to have got around to this earlier, but the first annual report of the UK's National Preventive Mechanism (NPM) was published today.

This gives an overview of the state of detention in prisons, police custody, children's secure accommodation, immigration, military and mental health detention.

In its first year, some common themes have emerged. In particular, members were concerned about:

•   the need to divert detainees with mental health problems from the criminal justice system and the ineffective use of diversionary schemes;
•   whether restraint is being used safely, only when absolutely necessary and whether appropriate methods are used on children;
•   prison overcrowding having an adverse affect on all aspects of a prisoner's life, with prisons potentially increasingly unable to deal with problems caused by overcrowding because of decreasing resources;
•   the negative impact immigration detention can have on children's emotional wellbeing, mental health and ties with the community; and
•   the rights to dignity and privacy of people deprived of their liberty, particularly in social care and health settings.

The full report is available here:

Picture on Flickr.com courtesy of Tim Pearce, Los Gatos

Charity comes to the rescue of councils' poor advice services

By Vern Pitt, journalist, on February 8, 2011 2:24 PM | No Comments

Earlier today my colleague Mithran wrote about councils being slammed for delivering poor information and advice, well help may be at hand.

Counsel and care, a national charity which provides information and advice on social care, has today published a guide to choosing a care home in partnership with the Department of Health.

As their press release quotes, a recent advice service user said: "I called the advice line as my mother was very ill and I wasn't sure whether she might need to move in to a care home and I had no idea where to start.

"Someone from the advice team referred me to the Care Home Handbook and the information contained really helped resolve the problem my mother was experiencing, all the contacts addresses and phone numbers are so helpful.

"Now my mother is in a good care home and we felt that we got the best advice to make an informed choice."

The book is available to members of the public and social care professionals free of charge.

Image by hesterjenna on Flickr

Big Society in trouble

By Jeremy Dunning, senior adult beat journalist on February 8, 2011 1:19 PM | No Comments

David Cameron's Big Society is in trouble and as my colleague Mithran says is under scrutiny as never before.

We've seen problems for the Supporting People programme, where many councils are cutting SP budgets and are therefore reducing the amount paid to providers, most of them from the charity sector.

And now many commentators in the national papers have turned against it, arguing that it's a cover for cuts and that it could damage Cameron personally as he has attached so much political credibility to it.

The Independent's chief political commentator Steve Richards argues it is doomed to fail; Polly Toynbee in The Guardian says the same as a result of cuts, while her colleague Polly Curtis writes that communities secretary Eric Pickles blocked plans by Downing Street to reward councils for their contribution to the big society or force them to show they were cutting their own costs as much as their contracts with charities.

But Pickles rejected the proposals.

Meanwhile the Daily Telegraph's Philip Johnston says that Cameron must spell out what Big Society means or risk it dying.

Picture on Flickr.com courtesy of World Economic Forum

Councils slammed for poor online information on social care

By Mithran Samuel, adults' editor, on February 8, 2011 11:45 AM | No Comments

That is the message from a recent report from consultants BCD Care Associates (sorry, meant to blog this when it came out but I got waylaid with other things).

It is more grist to the mill of the debate around the quality of information and advice provided by councils to help people make decisions about their care, particularly self-funders (see this recent story).

The BCD report is based on an analysis of 50 council websites by seven people, three with experience of social care and four lay people.
Their conclusions included:-

That inaccurate information was found on half the websites.
Almost half were hard to navigate and complicated by confusion terminology.
Nearly a third did not provide clear information on eligibility criteria for residential care.
About a fifth did not provide information about the assessment process.
About a quarter relied on generalised leaflets from external agencies to provide information about residential care.

The report's recommendations for councils include to:-

Always start from the perspective of a potential service user.
Use terminology that ordinary people would use.
Eliminate confusing choices at each stage of searching.
Ensure information is up-to-date and accurate.
Identify significant omissions and rectify them.

BCD Care Associates is a relatively new consultancy but whose staff have been involved in the sector for many years.

Charities join the fight against the NHS reforms

By Jeremy Dunning, senior adult beat journalist on February 8, 2011 9:54 AM | No Comments

Andrew Lansley's plans for the NHS could risk patients having less of a say in the running of the NHS in England under the proposed shake-up, eight leading health charities say.

Under the plans GPs will have control of much of the NHS budget under the changes laid before Parliament last month.

Lansley argues this will provide more power to patients, but the groups said it could weaken their involvement. The eight signatories to the letter are the Alzheimer's Society, Asthma UK, Breakthrough Breast Cancer, Diabetes UK, National Voices, Rethink, the British Hearth Foundation and the Stroke Association.

The government insisted the changes would give patients "real clout".

The intervention by the health charities - in a letter published in the Times - follows widespread criticism of the reforms by health unions and MPs last month when the bill paving the way for the changes was published.

The letter also said the proposed scrutiny arrangements - local authorities are being put in charge of monitoring GP consortia - meant the lines of accountability were "too weak".

A Department of Health spokeswoman said the letter raised "constructive" points.

In yet more bad news for a government desperately trying to find support for the plans a poll by ComRes found that only 34% of Lib Dems agree with the plan to let private companies work alongside new GP consortiums across England, paid for by the NHS, while 45% were opposed.

Among Labour MPs, 64 were against it and 26% for, while 90% of Tories were in favour and only 2% against.

This is suggestive of stress points within the coalition and raises the prospect that many Lib Dems may ultimately rebel or sit on their hands when push comes to shove.

Campaigning against cuts is the new black

By Vern Pitt, journalist, on February 8, 2011 9:18 AM | No Comments

We've had campaigns against disability benefit reform, campaigns against redundancies and various national groups speaking out for their own section of the sector or clients.

Now, a group of charities, baronesses and academics have launched a consorted campaign against public sector funding cuts.

The Campaign for a Fairer Society says it "wants power and control to shift from government to citizens, families and communities. But we don't want the government's 'Big Society' if that means a loss of basic human rights and unfair cuts focused on the most vulnerable".

It has even got a list of seven principles for a fairer society.

Supporters include Alzheimer's Scotland, Baroness Campbell (herself a well known disability right campaigner) and Jim Mansell (an expert in learning disabilities).

Image by Northampton Museum on Flickr

Big Society goes under the microscope

By Mithran Samuel, adults' editor, on February 8, 2011 12:00 AM | No Comments

The Big Society is under scrutiny like never before at the moment.
To recap:

Voluntary sector grandee Dame Elizabeth Hoodless has warned that massive council cuts were undermining the Big Society by making it much harder for people to volunteer.
Liverpool Council has pulled out of the government's Big Society pilots because of the impact of cuts on local voluntary groups.
Big Society guru Nat Wei was forced to scale back his unpaid advisory role for government because it had left him struggling financially - oh, the irony of Mr Volunteering not being able to volunteer croaked the government's critics. All of which led Lord Wei to issue a statement dispelling myths about the Big Society and his role in it on his blog.

So you won't be surprised to hear that there are two further interventions in the debate today: one the government may like, the other it may not.

Perhaps predictably, the Trades Union Congress has joined forces with voluntary sector umbrella groups to campaign against the cuts they and others feel are destroying the Big Society. They are holding a seminar today on the issue and are keen to send a message to government about the deleterious effects of the cuts on the voluntary sector at a time when demand for its services from the vulnerable is growing.
More about the campaign is available on this site, which lists cuts already made to voluntary sector groups.

The other intervention comes from think-tank New Philanthropy Capital, which monitors and advises on the extent to which charities provide value for money.
In a report today, Impact networks, it sets out how charities need to work together to overcome the impact of the cuts.
The "impact networks" of the title are coalitions of charities who come together to maximise their impact.

The report details examples of good collaborative working but identifies some of the barriers to doing so: the need to build up trust, competition between charities and power imbalances between big and small bodies.

Despite these concerns, it seems a timely addition to the debate on the future of the voluntary sector and the Big Society.

Freedom of information request? That'll be a six month wait

By Vern Pitt, journalist, on February 7, 2011 3:50 PM | No Comments

I have previously written here expressing my scepticism about the government's move towards greater levels of transparency in social care in the absence of great central data collection.

Another perfect example of my concern dropped into my in-box on Friday.

Here is how it started: "Thank you for your email/letter dated 19 July 2010 in which you have requested among other matters what reablement services does Croydon Council offer within adult social care. We have considered your request under the terms of the Freedom of Information Act 2000 and apologise for the delay in replying which was due to an administrative error."

That's nearly six months to reply to a Freedom of Information (FOI) request.

Granted I did not chase this up as vigorously as I might have because I was surveying multiple councils, but the point is I shouldn't need to.

It's worth noting that this investigation, which found a fifth of councils charging for what should be a free service, resulted in the government instructing councils to pay the money back. I think that makes it a pretty worthwhile request and one that should be taken seriously.

At least it is part of my job to try and get this information, if I was doing this just for my own interest I might well be less on top of it, what with having to balance it with real work commitments.

I won't re-state my arguments from my previous post again but incidents like this (which are far from uncommon for those submitting these requests) highlight the problems of not collecting data nationally.

It's also worth pointing out that having the public run around trying to get information out of councils will not necessarily be cheaper than the councils reporting it systematically to central government. Although if all councils are to follow the example of Harrow, which is proposing to put all its information online, then this may counter that problem.

Image by wonderferret on Flickr

Minister set to answer questions on welfare reform

By Jeremy Dunning, senior adult beat journalist on February 7, 2011 2:36 PM | No Comments

Employment minister Chris Grayling is doing the equivalent of entering the lion's den when he takes part in a live web chat on Thursday.

The event, which is hosted by mental health charity Rethink, is likely to see the minister being quizzed over welfare reform and the way benefits are assessed.

As Rethink's director of communications Mark Davies points out: "Rethink has thousands of incredibly active online supporters who we speak to every day via Facebook, Twitter and our own online Forum RethinkTalk.

"Many of them feel very strongly about how upcoming changes the benefits system will affect people with a mental illness."

The web chat will be live from 11:30am on Thursday 10 February at www.rethink.org/talk

Picture on Flickr.com courtesy of Corey Leopold

Government trumpets extra 25p for carers

By Vern Pitt, journalist, on February 7, 2011 12:46 PM | No Comments

The government has announced it has set aside £1.39m to help carers groups across the UK today.

The Department of Health claims this will offer hidden carers a "helping hand", but as there are 5.67m carers in the UK that helping hand amounts to 25p each.

I don't expect they will be overly thrilled about that, especially as the silence over the future of carers allowance has been deafening.

To be fair to the government it did announce £400m extra support for carers last year and this new sum is designed specifically to reach hidden groups.

But until the government comes-up with an answer on carers allowance trumpeting funds like this can sound like a small noise in a big room.

Image by Eusebius@Commons on Flickr

Speed of funding changes for treatment of drug users criticised

By Jeremy Dunning, senior adult beat journalist on February 7, 2011 12:28 PM | No Comments

The speed and extent of planned changes to the funding of treatment for drug misuse may undermine services, warns independent drug policy body the UK Drug Policy Commission (UKDPC).

In a report published today, UKPDC warns that if introduced too quickly and without thorough evidence-led planning, this new system may not deliver the benefits expected and may even undermine service provision.

Among concerns:

•   The planned timetable for PbR may result in changes being introduced before their consequences have been fully understood and the system can be properly developed.

•   The challenge of moving to a new system will be compounded by the fact that the introduction overlaps with radical wider health service reforms, a new system of prison commissioning, the introduction of elected police commissioners, and restricted budgets for local councils.

•   In basing PbR for drug recovery on outcomes across four very different areas - crime, employment, drug use, and wellbeing - there will be enormous practical challenges for those delivering services and for the management of the system.

•   A key challenge will be to decide how the payments are triggered: there are no clear answers about what results are measured, what timescales are used, and how service users' own wishes are taken into account.

•   A significant bureaucracy may be needed to manage the new system, prevent providers from neglecting those who have the most complex problems, and ensure that people are able to access the types of care that meet their particular needs. This has the potential to create additional costs that outweigh any savings made by introducing PbR.

The government wants to extend PbR to adult social care so it would do well to heed this warning.

Why does this sound so much like the concerns being uttered over the breakneck NHS reforms, which the government appears to not be listening to?

Spending cuts are undermining volunteering, says outgoing charity head

By Jeremy Dunning, senior adult beat journalist on February 7, 2011 11:20 AM | No Comments

Further disconnect between Big Society and the reality of the spending cuts appeared today when the head of a leading charity said the cuts were "destroying" volunteering and undermining its "big society" vision.

Dame Elisabeth Hoodless, who is retiring from the Community Service Volunteers (CSV) after 36 years, said there was no "strategic plan".

She told the Times the "massive" council cuts would make it harder for people to do more in their communities, while on BBC's Today she said the cuts are destroying volunteering.

Only last week the leader of Liverpool City Council wrote to the prime minister withdrawing its involvement from the plans - criticised as gesture politics by the government.

This adds to an exclusive survey by Community Care of 119 adult care and children's charities, which found that two-thirds have seen their total funding from councils cut and 41% have shed staff in 2010-11.

The situation is expected to worsen in 2011-12 with 89% expecting to see their overall funding reduced and 82% anticipating making job cuts.

The government has said it will be investing £470m over the next four years in charities and voluntary groups to give them independence from state money.

Prime minister David Cameron's "Big Society" initiative was one of the central themes in the Conservative election manifesto last year.

Government adviser sacked for questioning mental health strategy funding

By Jeremy Dunning, senior adult beat journalist on February 7, 2011 10:04 AM | No Comments

The government has sacked an independent national health adviser for questioning in the Guardian whether the money for its mental health strategy was new or came from the existing NHS budget.

The abrupt dismissal of Prof David Richards, who has been involved since 2006 in efforts to increase the numbers of trained therapists, raises further question marks over the deliverability of the new Mental Health Strategy, No Health without Mental Health.

In a letter today in The Guardian, Richards said this was "extremely disappointing" particularly as care services minister Paul Burstow (left) said additional monies would be added to PCT baselines on top of those already allocated.

His dismissal resulted from his continuing efforts to get answers to three questions, he says; namely to what extent is the promised money "real" and not to be met from cost pressures; what mechanisms have been put in place to ensure the money will be spent on training, employment and treatment costs and finally, what systems have been put in place to ensure existing funds being used to provide therapy services in England are not cut as part of the cost pressure actions required of NHS commissioners and providers.

He says: "Every pound which does not appear on the table or is siphoned off to other healthcare activities is another day of distress for someone somewhere."

This adds to growing fears that the earmarked money will be used to plug holes in budgets given that the NHS has to save £20bn in the next four years, which even the government admits is a risk.

In its impact assessment it said: "There is currently uncertainty over how funding for talking therapies will be allocated to PCTs (and later GP Consortia).

"It is likely that this will not be ring-fenced as has been the case in the past.

"If so, there is a risk that the NHS will not allocate the expected amount on talking therapies, as the allocation is likely to be subsumed into the general PCT allocation and funds could be diverted to other priority areas.

"This will need to be managed through the new NHS Operating Framework, which instructs PCTs to deliver talking therapies services."

At the same time the government admitted in this impact assessment that it risked undermining its plans to help one million people recover from mental health problems by 2014 because of massive cuts in civil service expertise.

Eleven of the 14 staff delivering IAPT will leave the Department of Health at the end of March, a government source told Community Care, as part of widespread cuts to DH support schemes to implement policy, which includes the closure of the National Mental Health Development Unit.

What do you think? Have your say on CareSpace

Picture of Paul Burstow on Flickr.com courtesy of The Health Hotel

Does slashing the number of social care providers undermine the Big Society?

By Vern Pitt, journalist, on February 7, 2011 9:58 AM | No Comments

Cardiff City Council will have its decision to cut the number of providers it deals with from 56 to 11 scrutinised by the national inspectorate, the Guardian reports.

The Care and Social Services Inspectorate Wales (CSSIW) will report on the decision with the aim of informing other neighbouring councils.

On one level reducing the number of providers makes sense if it saves councils money, Cardiff says it will save £1.5m through the plan. However, if you are to keep the amount of service the same and cut the number of providers this will surely mean the individual providers have to be larger.

On the face of it that would seem to disadvantage smaller providers, surely just the kind of businesses and social enterprises that the government's Big Society aims to support. We already know that voluntary sector providers are being squeezed endangering the Big Society agenda.

At this rate the government will be left with little foundation on which to build its Big Society.

Outrage at Labour backbench "heckling" of disabled Tory MP

By Jeremy Dunning, senior adult beat journalist on February 7, 2011 9:37 AM | No Comments

Labour MPs are being accused of having pulled faces at a Conservative MP who has cerebral palsy during a debate in the House of Commons.

Paul Maynard told the Times Labour MPs had pulled faces at him in the Commons, saying he felt they were "taking the mick out of my disability".

Now Trevor Phillips, the Government's equality chief, has stepped into the row, saying he felt "physically sick" at the allegations.

He compared the MPs to football hooligans, adding that he had found the claims "shocking" and called on John Bercow, the Commons Speaker, to investigate the heckling claims.

Labour MPs of course deny they singled out Maynard over his disability and that it was run-of-the-mill heckling.

Whatever took place is wrong and is at the very least discourteous and says little about a so-called grown-up debating chamber.

One of the comments I saw on the Daily Telegraph's article was particularly illuminating, particularly from so-called left wingers who are meant to be socially aware.

"The problem was that people didn't know Mr Maynard was disabled. The moment they were told about it, they stopped making jokes," said an unnamed colleague.

I have met Maynard and found him to be a witty, urbane and intelligent man and such treatment from his parliamentary colleagues is undeserved. It may be time for Labour leader Ed Miliband to put his backbenchers through equalities training.

Picture by Tom Parkes

Paying for care advice site launched

By Mithran Samuel, adults' editor, on February 7, 2011 7:50 AM | No Comments

A website has been launched with information for individuals and families on navigating the long-term care system. Paying for Care (as it is called) takes users through all stages of the process, including assessments, finding services and paying for them, and includes a facility for people to submit questions and get hold of financial advisers affiliated to the Society of Later Life Advisers.
Care insurance firm Partnership (for more on them see our interview with Chris Horlick, one of their managing directors) is behind the initiative but the site is unbranded and has the backing of sector bodies such as the English Community Care Association, Counsel and Care and the Registered Nursing Home Association, who see it as useful.
See what you think.

Disability charities gear up for week of action against benefit cut

By Mithran Samuel, adults' editor, on February 4, 2011 5:26 PM | No Comments

Disability charities begin a week of action tomorrow against the government's plan to cut £50 a week in benefits from publicly-funded care home residents and children in residential special schools. This - the mobility component of the disability living allowance - pays for individual transport for residents which, the charities say (along with just about everyone else), is vital to their independence.
The campaign is backed by Leonard Cheshire Disability, Mencap and Sense, and the week of action includes a lobby of Parliament on 9 February. The week is designed to coincide with the end of the consultation on the changes on 14 February.

As you probably know, this is part of a much wider reform to DLA, which will see many thousands of people lose support. While charities are focusing their energies on this particular cut, disabled campaigners - particularly those active online, such as the Broken of Britain campaign - are attacking the whole panoply of benefit cuts for disabled people, including the wider DLA reform.

It may be that the charities see a battle they can win with the mobility cut.

Personalisation and the Big Society

By Mithran Samuel, adults' editor, on February 4, 2011 5:10 PM | No Comments

That title may look like an attempt to throw together two popular concepts in social care in the pursuit of traffic but there is a more substantial reason: namely this report on the role of co-operatives and mutuals in the personalisation of social care.
Co-ops/mutuals are a big part of the government's Big Society agenda - notably in their plans to encourage public sector staff to take over the running of the services they work for, under contract from the relevant local authority, PCT or other body.
Within social care, this agenda also applies to user and carer-led organisations.
This report, by Manchester Metropolitan University and Co-operatives UK, which champions co-ops looks at the experience of two such bodies: one worker co-op and one user/care-led one.
There are some interesting messages in there:-

Co-ops are not well understood by social care commissioners.
Preferred provider lists - which commissioners often give to service users with personal budgets - are a significant barrier to co-ops gaining entry into the market.
There is anecdotal - though not robust - evidence for the effectiveness of co-ops.

It's worth a read if you have a second, particularly if you are keen to join this particular aspect of the Big Society.

Morning update: Helping ex-servicemen; cuts; mental health

By Jeremy Dunning, senior adult beat journalist on February 4, 2011 10:03 AM | No Comments

Among news you may have missed I found this fascinating story of how a former rear gunner on a Lancaster is now mentoring former members of the UK's armed forces who have recently left the military and are struggling to cope with civilian life.

John Hall, 89, has been attending group sessions in Sunderland that are run by Forces for Good, a project that is part of the About Turn charity for ex-servicemen who have recenly left the military.

Hall, who was awarded the Distinguished Flying Cross by King George VI in 1943, has also given presentations to group members and talked about his own wartime experiences and how he managed to deal with his own Post Traumatic Stress Disorder.

One story I meant to point readers towards yesterday is this from The Guardian where Amelia Gentleman has found women's groups and other niche groups struggling amid the cuts.

Finally a joint report by the NHS Confederation, Audit Commission and the soon-to-be-dissolved National Mental Health Development Unit has said that differences in the time mental health service users spend in inpatient units should be addressed to improve care and efficiency.

The report, Efficiency in Mental Health Services shows variation in some primary care trust areas regarding the average length of stay for all mental health admissions.

The study argues that tackling these regional variations could help the NHS improve the care it provides to service users as well as getting more value from the £6.3 billion spent per annum on adult mental health services.

The report argues that improvements can be found through greater co-operation between all agencies involved in the care of service users, in order to help facilitate more timely discharge, as well as through analysis of discharge data.

It suggests that trusts where bed occupancy is clearly high compared to others should seek to identify the reasons.

Picture on Flickr.com courtesy of Martin Pettitt

Row breaks out over Scots plan to integrate care and health

By Mithran Samuel, adults' editor, on February 4, 2011 9:37 AM | No Comments

You may remember this story from earlier in the week on the Scottish public health minister Shona Robison's plan to integrate health and social care, in order to tackle problems such as delayed discharges.
The idea is to for NHS Boards and councils to set up lead commissioning arrangements so that in each area, one body is responsible for commissioning the full range of care for designated client groups. This means that the council could commission social care services from the NHS or vice versa. Anyway this plan seems to have unleashed hell.

Here is Pat Watters, president of local government body Cosla, on the idea (in the Scotland Courier): "If this announcement is designed to be a serious contribution to the debate ... this is simply incompetent. We have been having that debate with this minister for almost four years and at no time has she raised this idea as the best way forward.
"If this is a serious attempt to create stability and certainty in a service area under real pressure due to reduced resources and increased demand, it is incompetent. Let's be clear -- this is a minister in a minority government who would have no chance of getting legislation like this through the current parliament."

You what? The key issue appears to be with a paragraph tucked away at the bottom of the Scottish government press release (which I in my haste totally missed, but which has formed the basis of all the stories in the Scottish press).

In 2008 roughly 57,000 people worked in social work services in Scotland. Were adult social care to be commissioned from the NHS by local government, approximately 38,500 adult social services staff would transfer to the NHS under lead commissioning.

I am assured by the Scottish government that it plans to be flexible about how lead commissioning will be implemented in local areas - it will not always be a case of council adult social care provision transferring to the NHS, who would then in turn be commissioned by the council to deliver it. The precise mechanics will be worked through by a lead commissioning group set up by the government.

If that is the truth, it is not a message that's getting through to Cosla. Expect the government to get a rough ride in getting this off the ground.

Afternoon update: Drugs, cuts, The Big Society and awards

By Mithran Samuel, adults' editor, on February 3, 2011 3:59 PM | No Comments

A few things you may have missed over the past few hours:-

Liverpool Council has withdrawn from the government's pilots of its Big Society initiative in response to the swingeing cuts to council funding in the city. The council's leader, Joe Anderson - a former social worker - said the very community groups who were supposed to be empowered to run services as part of the Big Society were at risk of having their funding cut.
There's an interesting article from David Brindle of The Guardian on the role of consultancy OLM in helping councils reduce the fees they pay care providers by examining the extent to which they provide value for money. Needless to say this makes OLM pretty unpopular with providers but their commercial director, Ray Hart, provides a robust defense of their approach in this piece.
The National Treatment Agency for Substance Misuse has launched a consultation on transforming the drug treatment system around the concept of recovery. Worth contributing to if that's your field.
On a happier note, The Afiya Trust has launched an awards scheme for top health and social care professionals from BME communities. Closing date for entries is 18 February.

Recovery put at heart of mental health services

By Jeremy Dunning, senior adult beat journalist on February 3, 2011 2:06 PM | No Comments

A new nationwide project that puts recovery at the heart of mental health services has been launched.

The 'Supporting Recovery' project will use research from the Centre for Mental Health, which sets out ten key indicators for organisations to develop to support the recovery of people using mental health services.

It is the result of a partnership between the Centre for Mental Health, the NHS Confederation Mental Health Network and the National Mental Health Development Unit.

The 'Supporting Recovery' project will assist services to undertake self-assessments, plan changes and report their outcomes over two years.

Supporting People row hots up in Cornwall

By Jeremy Dunning, senior adult beat journalist on February 3, 2011 12:42 PM | No Comments

The battle to save Cornwall's Supporting People services appears to be hotting up, where the council announced a 40% cut in funding.

A campaign is underway, through such mediums as Twitter, to try to push Cornish councillors to change their minds amid evidence that some senior councillors are distinctly unhappy with the reasons for the cut.

The chair of Cornwall's Housing Strategy Delivery Group, Lib Dem Cllr Derris Watson, has written to leading campaigner John Coventry and said: "The government actually put £16.116m for Supporting People into the settlement and if the 11.6% damping figure is applied the resulting funding comes out at £14.246m. This equates to the specific grant funding for 2010/11 of £14.204m.

"The government obviously recognised Cornwall's problems with an ageing population and rural nature, which makes service delivery more expensive, in what is a very generous funding measure when most councils have taken a heavy cut.

"I was invited to attend the Commissioning Body meeting for which I am grateful and can appreciate the work underway to provide cost effective services.

"If the reviews of services had been completed, and the results and new service plans were in place, there might be a case for some small cuts to funding. However as none of this work is yet completed I believe the decision is not based on any evidence just a desire to use this money elsewhere.

"There is no way that efficiency savings can make up for a 40% cut in funding - however lean and smart the delivery there must be severe cuts to services."

She added: "The leader [of Cornwall County Council] stated that of the £175m which needs to be saved by Cornwall Council, 90% would be achieved through efficiencies and only 10% from front line services. He did not answer my question as to why therefore the Supporting People funding was being cut by 40%."

Will Cornwall bow to the pressure? On current form it's unlikely, though councillors will be under no illusion as to the attitude of government ministers and many locals.

Cornwall will point out, and I feel with justification, that it is under pressure to deliver major efficiencies and therefore has to retrench as a result of the cuts it has experienced in its overall settlement. Whether Cornish providers decide to go the legal route is debatable.

Coventry said: "The (Tory) administration is very much on the defensive, but by no means on the run."

As a government source has pointed out the government's localism bill will give people the power to trigger referendums on any local issue.

The results will not be binding - but local authorities will have to consider them when making decisions. The government said it will help people make their views known and influence decisions.

This will be too late for Cornwall and its Supporting People programme, but it may be a useful tool in future decisions.

Picture on Flickr.com courtesy of markhillary

Funding concerns pour further doubt over new mental health strategy

By Jeremy Dunning, senior adult beat journalist on February 3, 2011 10:31 AM | No Comments

Experts are increasingly questioning today whether the Coalition Government's aims in its mental heath strategy are achievable as a result of budget cuts.

The money is not ring-fenced, nor does it appear new, despite deputy prime minister Nick Clegg's claim that the government had invested £400m into rolling out talking therapies, leaving doubt as to whether locally the new talking therapy services will be invested in.

Many now argue that it will be used to plug holes in budgets given that the NHS has to save £20bn in the next four years, which even the government admits is a risk.

In its impact assessment it said: "There is currently uncertainty over how funding for talking therapies will be allocated to PCTs (and later GP Consortia).

"It is likely that this will not be ring-fenced as has been the case in the past.

"If so, there is a risk that the NHS will not allocate the expected amount on talking therapies, as the allocation is likely to be subsumed into the general PCT allocation and funds could be diverted to other priority areas.

"This will need to be managed through the new NHS Operating Framework, which instructs PCTs to deliver talking therapies services."

I also wonder why the government claims to have found £400m to invest into talking therapies.

Last summer when care services minister Paul Burstow was signaling the new strategy he made it clear there were no new resources.

Instead he said ministers from different departments would work together in the months ahead to draw up a plan.

In an article in The Guardian, Prof David Richards of Exeter University, national adviser to IAPT (Improving Access to Psychological Therapies), said any suggestion that the £400m was new money was "a lie".

He said it had been explained at a meeting of the IAPT group two weeks ago that the money would have to come from the existing NHS budget. "We were very disturbed when we found this out," said Richards.

"I personally feel very aggrieved that mental health is being used by this government to shore up its very poor opinion poll ratings and I don't want to be part of it."

One government source added: "Clegg and Burstow claimed that the money being invested in talking therapies is 'real money'. This isn't so. It's a cost pressure- which seems to be the modern way of 'funding' public services in DH [Department of Health]."

On CareSpace some commentators were warning of the dangers of focussing on short courses of Cognitive Behavioural Therapy (CBT) and point out that the evidence of IAPT is mixed.

This adds to the general doubt about the strategy's achievability, particularly with reference to talking therapies, given that yesterday I wrote about the decimation of the central team within DH that had rolled out talking therapies.

This leaves doubt as to who will be overseeing the expansion of the Improving Access to Psychological Therapies programme, which the government first pledged to roll out in the spending review.

The specifics were later given in the NHS operating framework, published in December.

So is Richards' cynicism about the government using mental health policy to shore up poor opinion polls fair?

Yes and no. Clegg, the deputy prime minister, used ITV's Daybreak programme to announce the government was repealing the law that bars mentally ill MPs from the Commons, as he launched the new mental health strategy.

The government made this promise as part of a plan to end the stigma attached to mental illness, which everyone supports.

Clearly this will also garner positive headlines and all governments need a fair share of good headlines, but dig beneath the surface of the strategy and there are issues that are yet to be resolved surrounding funding cuts.

So is this New Horizons - the Labour government's mental health vision - in a deliverable format? Burstow criticised New Horizons as "big on principles but short on details".

The new strategy - No Health without Mental Health - shares its predecessor's emphasis on promoting mental well-being through the intervention of services other than mental health services, such as Jobcentre Plus and housing, but instead of targets it has put mental health outcomes alongside physical health indicators in assessments of the quality of the NHS.

All very fine intentions, but the jury remains out on the details and the substance, which some say is lacking.

What do you think? Have your say on CareSpace

Picture of Nick Clegg on Flickr.com courtesy of World Economic Forum

Mental health strategy's drive to boost therapies at risk

By Mithran Samuel, adults' editor, on February 2, 2011 8:08 PM | No Comments

The ink is barely dry on the mental health strategy but already questions are being raised on its goal to roll out talking therapies to all who need it by 2015. And those questions are being posed by government itself in its own impact assessment, as we report today.
At issue is deep cuts to the Department of Health team responsible for supporting the Improving Access to Psychological Therapies programme that the DH wants to expand.
Eleven of the team's 14 members are leaving next month, we understand, raising significant questions about whether there will be sufficient support from the centre to help deliver on the talking therapies pledge.
In the era of localism, it is up to local NHS bodies and councils to interpret government priorities in line with local needs, without central prescription, but that does not mean that support from experts is not required to make policy a reality.
This is particularly so when the extra £400m set aside for the expansion of talking therapies from 2011-15 is not ring-fenced and is expected to be used at a time when the NHS is under massive financial pressures and is being reorganised. And, of course, mental health remains that journalist's cliche - a Cinderella service. But we shall see...

Mental health strategy out today - what will it say?

By Mithran Samuel, adults' editor, on February 2, 2011 12:00 AM | No Comments

The government is publishing its mental health strategy today.
Care services minister Paul Burstow has given an interview to The Guardian, outlining the main points:

As I blogged the other day there will be a £400m funding injection over the next four years, to extend access to talking therapies.
This will apparently be new money, it is reported today (rather than a recycling of other health service cash).
It will ensure universal access to talking therapies by extending support to children, older people and those with severe mental health conditions (as well as people of working-age with common mental health problems who currently receive support).
The government also intends to provide some funding for the Time to Change campaign to tackle discrimination against people with mental health problems, when its current lottery and Comic Relief funding ends.
There will be a strong focus on early intervention, promoting mental well-being and supporting people with mental health problems into work, as set out by Burstow in an article for us last year.
Progress on delivering the strategy will be monitored by a cabinet sub-committee. Burstow says the problem with the last government's 2009 mental health strategy, New Horizons, was that the Labour administration didn't provide a route map for implementation.

While many people in mental health will agree with the themes of the strategy, there will be (at least) two major concerns:

How will it deal with the fact that mental health services are under severe pressure due to rising demand and falling resources (as we report this week)?
And what will be the impact of the government's NHS reforms, which will put GPs in charge of commissioning health services, including mental health, an area where family doctors appear to lack confidence in their own knowledge and commissioning skills.

We will be covering the strategy on our website this morning and will hopefully have some more news very shortly. The strategy should appear here on the Department of Health site.

Social workers 'alienated', adult care directors warned

By Mithran Samuel, adults' editor, on February 1, 2011 8:20 PM | No Comments

If you have a moment have a read of this. Three leading social work professors, Andrew Kerslake (Oxford Brookes), Jon Glasby (Birmingham) and Peter Beresford (Brunel) have provided some advice for the Association of Directors of Adult Social Services on how they should respond to the challenges facing adult social care over the coming years: personalisation, mounting demand, the public sector funding crunch etc.

It's well-worth a read and thoughtful, as you might expect. But I was struck by this comment from Glasby, a former social worker:

"Many of the social workers I meet seem to feel very isolated and alienated - as if personalisation is giving them empowering language but that they are being set up to fail by a financial context that makes it impossible to deliver. Some also feel that their directors may not necessarily be on their side and that they might be using the language of personalisation to justify cuts in the number of social workers that they would have wanted to make anyway."

This certainly backs up what social workers are saying about the way in which personalisation is being implemented at the moment, but it is a strikingly strong remark about the plight of social workers in adults' services.

He then calls on Adass to stand up for social work and take a clear and confident position about what it has to offer.

Given that most adult directors are former social workers, I am sure the association is clear about the value of social work.

But standing up for social work is another thing. My sense is that most directors feel responsibilities to service users, local and national taxpayers, their councils and their staff but would not see it as their role to single out any group of staff above any other.

The association is also clear about the need to be inside the tent in discussions with government, which means not being seen to stand up for particular public service professional interests (never popular with right-of-centre governments).

Hopefully Glasby's clarion call will provoke some thought, in Adass and elsewhere, about what is happening to adult social workers.

Personalisation at risk as cuts start to bite

By Mithran Samuel, adults' editor, on February 1, 2011 7:37 PM | 1 Comment

As you may have seen we've done a fair bit on the risks to personalisation posed by cuts and the increasing tendency of councils to restrict how service users can spend personal budgets.

Here's my take on what this means for social care.

The basis of this story is what social workers are telling us and is drawn from our CareSpace forum.

Protest against frontline cuts in pictures

By Vern Pitt, journalist, on February 1, 2011 4:43 PM | No Comments

As I mentioned this morning the Learning Disability Coalition today kicked off a campaign protesting against the cute to frontline service for people with learning disabilities.

Here are some photos of the protest outside the Department for communities and Local Government and Local Government Association's headquarters in Westminster.

Judge halts multi-million pound cut to capital's voluntary sector grants programme

By Jeremy Dunning, senior adult beat journalist on February 1, 2011 4:31 PM | No Comments

London Councils has been ordered by a High Court judge to re-run its entire consultation on its planned cuts to its voluntary sector grants programme.

It was ruled late on Friday and confirmed today that the original exercise failed to meet statutory equality duties.

London Councils' decision, had it gone ahead, would have taken a £10m slice from a budget which funds around 400 London-based charities and community groups.

The organisation, which represents the capital's 33 local authorities, decided in December to repatriate funds from its £26m grants programme to individual councils, meaning they would be free to spend the money as they chose.

Homeless charities were particularly concerned at this repatriation with some boroughs already proposing cuts of 25-40% to the homelessness services they already fund.

The question is whether this will lead to a raft of copycat cases taken by voluntary groups who are otherwise faced with losing substantial sums of money?

Providers of Supporting People services are mulling this option over but as Patrick Butler points out in his excellent Cuts Blog this decision does not mean axing the funding was wrong. It was only that the process leading to the decision was wrong in law.

And as he also points out councils, under huge financial pressures, are determined to make savings. I myself wonder whether as a result of having to carry out the consultation again the cuts will be even harsher?

There is some doubt over how well other councils in other authority areas have carried out their own consultations and in Nottingham Framework Housing Association is considering applying for a judicial review against the city council's decision to cut its Supporting People funding programme by around 45%.

However once councils have set their budgets, it is unlikely that the courts will want to intervene.

Louise Whitfield, a solicitor at Pierce Glynn who brought the case on behalf of a user of one of the threatened charities, Roma Support Group, said: "This case establishes that even in the current economic climate, it remains of paramount importance that public sector funding cut decisions are properly assessed for their gender, disability and race equality impacts.

"If they are not, public sector funding cut decisions will be unlawful. London Councils simply did not consider the full effect of their £10 million cuts on the hundreds of voluntary sector groups and tens of thousands of members of the public who would be affected. They will now be required to do so."

Have your say on the Health and Social Care Bill

By Vern Pitt, journalist, on February 1, 2011 11:46 AM | No Comments

If you've been following the debate on the Health and Social Care Bill which has been raging in the press and social care circles of late, then you now have a chance to have your opinion heard.

The commons Public Bills Committee is now taking submissions from those in the health and social care sector on what they think of the government's proposals.

The committee will be taking evidence until 31 March but urges people who want to submit something to do it soon so it can be considered by the committee at length. The committee's first meeting is 8 February.

Guidance on submitting evidence to the committee after the jump...

Continue reading Have your say on the Health and Social Care Bill.

Five questions to ask of local government spending data

By Vern Pitt, journalist, on February 1, 2011 10:56 AM | No Comments

By today all local authorities should have published records of all of their spending over £500 (a tracker on the Department For Communities and Local Government website shows 150 have done so, so far).

The only problem is extracting any meaningful national data from all this.

As was the case with central government spending data the data sets are not standardised or, often, even published in the same format. For instance, Gateshead Council has published the data in CSV, a format which can be manipulated in most spreadsheets allowing you to analyse it; by comparison Rochford have only published a PDF file which cannot be edited at all.

Even if this hurdle had been overcome the multiple ways in which the data is recorded (different management structures, different codes, even the structure of the spreadsheet itself) make it near impossible to use it to build any meaningful national picture without oodles of time and a good chunk of expertise.

It's unlikely I'll have any answers to my questions soon, but that doesn't mean we shouldn't ask them.

Who are social care departments paying most?

It's the obvious question. We know the companies such as Southern Cross and Four Seasons will be high up on the list but I suspect there will be a few other interesting firms mixing it with the big boys.

How much have councils spent on 'fees reduction consultants'?

Companies such as OLM have been quite popular lately in reassessing council contracts with providers with a view to getting councils better value for money. This has, understandably, proved unpopular with many providers but may in the long term have been better for the public purse. Knowing how much it cost would be a step closer to that.

More after the jump...

Continue reading Five questions to ask of local government spending data.

'Don't cut the frontline,' say learning disability campaigners

By Vern Pitt, journalist, on February 1, 2011 9:39 AM | No Comments

Today the Learning Disability Coalition will be sending delegations of people with learning disabilities to councils across the UK to implore councilors not to cut frontline services.

In a letter to the Guardian the coalition heads write: "Promises made by central government must result in ongoing commitments by local authorities which are felt on the frontline. Some of the most at-risk people in our society will be betrayed if frontline adult social care services are cut."

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