November 2011 Archives

Professionals supporting people at the end of life may want to check out this online resource from the Social Care Institute for Excellence, bringing together publications, videos and other training materials on the issue.
In the video above Scie practice development manager Pamela Holmes uses an example from her own experience to highlight the importance of the information hub. She has also posted a piece about this.
Also today, the National Institute for Health and Clinical Excellence has published a quality standard on end-of-life care, setting out what service users should expect from health and adult social care provision.

Among the standards are:-

• That people approaching the end of life are offered a comprehensive, holistic assessment and a personalised care plan.
• That they are offered timely, personalised support for their social, practical and emotional needs.
• People in their last days of life are identified in a timely way and receive co-ordinated care in accordance with their personalised care plan.

Worth a read when you have a moment.

The government has decided to reverse its decision to scrap the mobility compentent of the disability living allowance, reports have revealed.
We've an interview with Maria Miller, minister for disabled people, this afternoon, so keep an eye on the site!

This is Care Quality Commission board member Kay Sheldon, who yesterday called on the chief executive, Cynthia Bower, to go, citing leadership failings at the regulator in an explosive evidence session before the public inquiry into the Mid-Staffordshire hospital scandal.
Sheldon, for those who do not know, is a longstanding advocate for people who use mental health services, particularly detained patients. She has used services - and been detained - herself.
The CQC has responded to Sheldon in vigorous fashion, with fellow commissioners accusing her of "factual inaccuracies" and the CQC itself declaring itself "extremely disappointed" by her evidence.

It must be a difficult - and with respect to the CQC, lonely - time for Sheldon.
However, she has been given a boost from an esteemed source in the shape of Lord Kamlesh Patel, former chair of the Mental Health Act Commission, the watchdog for detained mental health patients whose role was absorbed by the CQC in 2009 and where Sheldon was a commissioner.

Speaking in the House of Lords on behalf of a private member's bill to tackle discrimination on grounds of mental health, Patel said:

"Kay was in many respects an unusual choice [to be a board member of the Mental Health Act Commission]. She was not the usual type of person to apply to be on a board, and she clearly made her views known at the interview. As someone who had experienced detention several times under the Mental Health Act, she said she would consistently stand up for the rights of service users and be a voice for those who have direct experience of mental health problems. We could not have had a more excellent advocate of service-user rights, and that, in essence, was our core function: to ensure the protection of those very rights. Kay is now a member of the Care Quality Commission, and I know that she remains firmly and completely committed to the rights of people using health services and continues to ensure that the voices of service users are at the forefront of decisions about healthcare."

We reported last week that the government is expected to announce that it will reverse plans to scrap mobility payments for state-funded disabled people.
Well, a story today from The Times (behind a pay wall) has all but confirmed this.

In it, disability minister Maria Miller (pictured) is quoted as rejecting the central case for change - that the mobility component of disability living allowance - worth £50 a week - duplicates money provided to service users in their care packages by local authorities.

This has been repeatedly found to be false - most recently and convincingly by the inquiry conducted by Lord Low. And now Miller has found that the evidence for duplication is "patchy at best", says The Times. Unsurprisingly, the charities behind the Low review - Leonard Cheshire Disability and Mencap - are cock-a-hoop about the U-turn (expected this Thursday).

"We applaud the government for listening to the thousands of disabled people who have raised this issue, and reversing the plan to scrap this vital benefit," said Leonard Cheshire Disability chief executive Claire Pelham. "This allowance is just so important for those who receive it - it can make the difference between being able to get out independently, and being trapped inside."

But before we get the champagne corks popping, it's worth spelling out the following:-

• The Treasury has budgeted for the cut in the benefit, worth £160m a year.
• This money will have to be found from somewhere and there is a significant danger that it will be found from disabled people's pockets.
• The government is already planning to replace DLA with the less generous personal independence payment and it could be that the £160m is found from making that reform even less generous (apart from for people in residential care).

However, it has to be a good thing that this policy is being dumped in the dustbin where it belongs.

One of the central conundrums of personalisation is how people with personal budgets can make judgements about the calibre of unregulated services that they might wish to purchase.
One solution is the Support with Confidence scheme, which accredits providers of support services to help users make more informed choices. It is delivered by councils who have signed up to the scheme, through partnerships of adult social care and trading standards departments.

Accredited organisations must:-
• ensure that they and their staff are properly trained for their work.
• undertake any appropriate training.
• submit criminal records checks and clearance.
• provide references as part of their application.
• respond promptly and appropriately to customer complaints.

Organisations are then monitored by the council in question.

It also, importantly, applies to personal assistants - perhaps the fastest growing part of the social care provider market but one that is entirely unregulated. Providers regulated by the Care Quality Commission can also apply.

There are obvious issues, of course, notably that first your local council has to sign up to Support With Confidence and then convince local providers of support that it is worth their while going through the accreditation process.
But it seems potentially a useful solution to the issue of judging quality in a personalised world.

Five organisations have been awarded funding today to develop services, under the government's programme for disabled people's user-led organisations (DPULOs).

They are:-

• Disability Equality North West - to develop new services that support disabled people to live independently.
• Organisation of Blind Africans & Caribbeans - to develop the skills of their staff in order to run a more sustainable business.
• Oxfordshire My Life, My Choice - to set up Oxfordshire's first radio programme by and for people with learning disabilities.
• Personalisation Plus - Support Buddies - to set up a volunteering project where people with mental health issues support each other.
• Voice for All - to purchase equipment which will enable members with learning disabilities to run their organisation more effectively.

They all sounds like worthwhile projects, but there is a bigger picture around the future of DPULOs, with opportunities and threats:

• The biggest such organisation in the country is being created through the merger of the National Centre for Independent Living, Disability Alliance and Radar.
• National decision-makers are increasingly stressing the vital role of user-led organisations in delivering the personalisation agenda - not just in providing support services to people who use direct payments but in brokerage and support planning.
• The magnitude of council cuts begs the question of how ULOs are faring in terms of their funding and in tenders for council contracts. I'm not sure what the latest picture is on this but would be keen to find out.

(Addition, 13 December: It's been brought to my attention that the disabled people's user-led organisations programme has provided funding to many more organisations than the ones listed above and is providing non-financial support, including through a number of ambassadors who are working to support DPULOs and share learning between them. I believe more news about the programme will be forthcoming shortly.)

I've never seen Macmillan Cancer Care as a particularly militant charity but it is shaping up for a fight with government over reform of the work capability assessment, which governs access to employment and support allowance.

Here's the background in brief:-

• Previously people who received intravenous chemotherapy were not forced to undergo the work capability assessment and were placed in the "support group" of employment and support allowance, which means their benefits are unconditional. This did not apply to people receiving oral chemotherapy or radiotherapy.
  
• Macmillan said that this failed to acknowledge that people receiving oral chemotherapy or radiotherapy often were as adversely affected by their treatment as people receiving intravenous chemo.
  
• The government asked Macmillan to collect evidence on this, which it did, and accepted the charity's case that the current discrimination didn't wash.
  

This is where it gets difficult.

Macmillan wanted people receiving intravenous and oral chemotherapy (with some caveats) and the most debilitating forms of radio placed in the support group without having to undergo the assessment.

However, the charity has said that the government came back with a proposal which could see cancer patients receiving all types of treatment forced to undergo the work capability assessment.

"This shows a clear disregard and misunderstanding of what it's like to undergo punishing treatment," said chief executive Ciaran Devane.

I can't find a reference to the government plans anyway; however, it claims they would have reduced the number of face-to-face assessments faced by cancer patients and increased numbers going into the support group. 

Macmillan has won a victory of sorts; the government has pledged to go back to the drawing board and hold an informal consultation next month on the best way forward.

We'll keep an eye on this one as it progresses.

2011 isn't becoming any less tumultuous for the Care Quality Commission.
The Guardian reports today that board member Kay Sheldon and inspector Amanda Pollard are going to give critical evidence on the CQC to the inquiry into the Mid-Staffordshire hospital scandal.
The paper reports: "Sheldon and Pollard have given signed witness statements to the inquiry that are critical of the performance of the watchdog's leadership. Both contradict evidence given to the inquiry by the regulator."
The evidence is likely to focus on the role of CQC chief executive Cynthia Bower, who was formerly chief of the West Midlands Strategic Health Authority, which was and is responsible for performance managing Mid-Staffordshire Hospital.

Sheldon has long been prominent in the field of mental health, as a commissioner on the Mental Health Act Commission - the watchdog for detained patients whose role as taken over by CQC in 2009 - and as a voice for service users.
It will be interesting to hear what she says.

This response to today's Equality and Human Rights Commission report on human rights breaches in home care services comes from former social worker Di Galpin, senior lecturer in practice development at Bournemouth University's school of health and care and co-author of the National Competence Framework for Safeguarding Adults.

The Equality and Human Rights Commission report on the abuse of older people makes for more dismal reading on the care of older people in Britain today. Sadly this is not new to many of us who have worked in the care sector.  Yet our voices have gone unheard, leading to many, such as myself, leaving the profession in disgust. 

It is estimated up to 340,000 older people in the UK are abused each year in their own homes.  The abuse of older people now parallels that of children  with many experiencing emotional, psychological, physical, sexual and financial abuse perpetrated against them by those charged with providing care and support,  for example, partners, wider family and professional carers. Although abuse appears to pervade the lives of a substantial number of older people cries of indignation from wider society and government are strangely silent, unlike in cases of child abuse, such as Baby P and Victoria Climbie, which resulted in mass media coverage, government inquiries and the reform of childcare systems, most recently through the Munro review. 

I believe the Human Rights Act 1998 provides a framework from which we should develop care provision for those most vulnerable, a guide to practice that can help provide an ethical  and moral foundation and reframe care as compassion rather than care as a commodity to be bought ad sold in a free market. Yet the Human Rights Act 1998 is under attack with some sections of the media (Daily Mail) condemning it as a 'whingers' charter' and the Conservative Party actively seeking its removal from public life.

However, the extension of human rights is fundamental to ensuring older people are treated with dignity and respect by those charged with caring for them.

The Human Rights Act (HRA) 1998 makes it unlawful for public authorities, such as NHS hospitals and carers employed by local authorities to act in breach of the fundamental rights and freedoms set out in the European Convention on Human Rights. Problems have arisen as original definitions of  what constituted a 'public authority' were too narrow and excluded private and voluntary sector providers leaving many individuals outside of the protection offered by the Act. This loophole was partially addressed in the Health and Social Care Act 2008. Section 145 of the act provides that individuals placed in an independent care/nursing home by a local authority are covered by the Human Rights Act 1998. However, section 145 does not confer human rights obligations on other independent care providers contracted by the local authority, therefore, independent domiciliary care agencies fall outside of the Human Rights Act 1998.

This is disastrous for those most vulnerable in society, as it leaves working in a manner consistent with human rights in an individual's home to the discretion of the provider. That's why I'm delighted that the EHRC has called for human rights protections to be extended to people receiving home care arranged by councils from independent sector agencies. I think the government should also extend such protection to the increasing numbers of people purchasing care services through direct payments.

While the government suggests that the Care Quality Commission's thematic review of home care services - announced yesterday - will help, do we really have any confidence anything will change given the CQC's failures in the Winterbourne View case?

This report appears after many others this year, highlighting the disgraceful treatment older people experience from those supposed to be proving their care, whether at home, in hospital or residential care.  A report by the Health Service Ombudsman on the abuse of older people in hospital settings suggests there is a culture of indifference from both government and staff to the abuse of older people. The Independent commented:

"For a while we may pause to express outrage.  But we then move on to the urgent business of our daily lives.  Spot checks and hit squads may arrest the worst practice.....But they will not do much about a society that has hardened its heart against the elderly."

Doing nothing is not an option.  We as individuals who make up society all have a role to play, however, so does government. The review of adult social care law undertaken by the Law Commission this year made clear to government the law pertaining to the protection of vulnerable adults requires strengthening, the current framework is clearly not working.  I would suggest it is time to stop treating older people as drain on resources and start showing older people we value them, and to those who abuse older people that this will not be tolerated any longer.  This will require legislation that truly regulates, and punishes abusers, when required, and a society that refuses to allow this to continue.

I went to The National Development Team for Inclusion's conference about the Winterbourne View scandal yesterday and was interested in what a frontline carer in the audience had to say in one of the Q&A sessions.

The carer said what she saw in the Panorama programme was a group of carers who were undervalued and that was why they had lost their way in the services they provided.

My initial reaction was one of surprise at sympathising with people who had been portrayed as such monsters on the BBC show, but as the carer continued, I saw her point.

"They didn't feel valued, they didn't understand what was expected of them," she said. "The situation for the carers at Winterbourne needs to be looked at. How were they treated by management? Did they have PDPs? All of the investigations and reviews about this case are starting too high up: you need to start with the frontline."

The carer said that desperate situations could make both professional carers and families alike commit unspeakable acts.

"When your back is against the wall, when you're desperate, you go with whatever's there. Parents are saying their child can't cope at home. Packages of care are being removed and families don't know what to do.

"There was a mother who made her learning disabled son drink bleach because she was in such a desperate place. People don't know what to do."

A depressing point, but one that's interesting to consider. Should the carers at Winterbourne View be shown the compassion that a woman driven to killing her learning disabled son is shown? Was the woman who forced her son to drink bleach shown enough compassion?

In children's services, there is a recent emphasis on the fact that serious case reviews should focus on the past of the abusing parents to help determine the root cause of a tragedy. Should investigators do the same for staff at Winterbourne View?

Anyone wondering what good quality and cost-effective support for the disabled looks like should look no further than this latest report from Voluntary Organisations Disability Group.

Some early pointers on how next spring's adult social care White Paper may shape up have been published by the Department of Health, in an attack of transparency.
Last week, the group of wise women and men who are leading the DH's engagement process to develop the White Paper gathered to discuss their early findings, based on submissions they have received and their own thoughts, and the department has usefully summarised the discussions on its website.
So what can we learn from this? Here are a few points:-

• Some scepticism about the proposals put forward by the Dilnot commission to reform care funding that are supposed to form the basis for future reform. (For those very few of you who need a refresher on Dilnot here it is). Here's a choice quote on this:- "Major concern that the Dilnot commission was asking the wrong question at the wrong time. Many asked whether the systems (both health and social care) should be doing far more to improve independence, prevention and early intervention rather than arguing for more money for escalating needs and demographics." That is to say, Dilnot's focus on how you insure all people against the need for social care was wrongheaded; instead it should have been focusing on how you prevent and minimise social care needs across the board. The engagement process has also identified support for Dilnot, but with government deeply reluctant to cough up the £1.7bn cost of his proposals it may be that the scepticism is enough to knock them out of the game.
• Significant concerns about the quality of council commissioning, with too great a focus on costs and insufficient emphasis on the quality of services. Not a great surprise but it begs the question about how the White Paper can address this issue at a time of significant resource constraints.
• Significant problems in putting the social care transformation agenda into practice - by this I mean the project to shift services from crisis-end, long-term interventions to preventive, short-term support, integrate social care with health and universal services and empower service users to shape their own support through personal budgets and improved information and advice.  

Have a read and see what you think. The engagement process closes on 2 December so have your say if you haven't already done so.

(Image by dantaylr on Flickr)

The Care Quality Commission's review of home care services, announced today, comes five years after the report of a similar review by its predecessor organisation, the Commission for Social Care Inspection.

CSCI's report found that home care services in England were often delivered in 15-minute slots that militated against undignified care, were task-based rather than responsive to what people really needed and suffered from high turnover and shortages in staff. Much of the blame it laid at commissioners' doors.

Fast forward five years and a very similar picture was painted by a survey of members by the United Kingdom Homcare Association, which found users' safety and dignity were being put at risk by cuts and shortened visits, and the interim report of the Equality and Human Rights Commission's inquiry into home care. The EHRC's final report, due out tomorrow, is not expected to depart from this line. Moreover, the CQC itself says it shares the EHRC's concerns that people in home care are seeing their human rights being breached.

All of which begs the question of what the CSCI review achieved and what, realistically, can the CQC achieve, particularly as the CQC lacks one of the weapons that its predecessor had in its armoury, namely an overview of how well councils were commissioning services.

As of November 2010, the CQC no longer assesses councils on their commissioning, and the United Kingdom Homecare Association has already warned that this means it is "largely commenting on symptoms, without identifying the underlying cause of hurried and sometimes undignified home care".

We shall see.

We've had a few inklings to suggest community social work may be on its way back, but today I received my first email hooked on this very subject, celebrating the work of Walsall Council's community social work team.
It includes this case study from social worker Emma Harper, about two older men who attended a day centre so they could meet up with each other:

"I started to do some digging and it turned out that the pair of them only lived five minutes apart from each other. The daughter of one of them offered to drive her father to the other's home and the pair of them attend a different centre now where they can take part in activities that are more in tune with their interests. They're having a great time playing bridge and all sorts of things and it's like they've got a new lease of life. They weren't in any kind of crisis or at serious risk but things weren't quite right for them and being able to help them access what was already in their community is really satisfying."

I was encouraged to see this, both because it's good to see social workers' work celebrated and because it helps add to the momentum behind a revival in community social work.

The basic elements of the role appear to be for social workers to get to know a local community inside out, particularly what is available in terms of support from community groups, both formal and informal; to get to know people who may be in need of support, particularly those who are isolated, and to bring the two together, emphasising both what the individual can do for the community, through their abilities, skills and knowledge, as what the community can do for the individual. It is also about identifying any gaps in support that may need filling and helping to fill them through community development work. Underlying it is a philosophy that individuals and communities can solve their own problems, given the right tools and confidence, without statutory intervention.

It seems to provide at least a partial to answer several questions surrounding the current state of adult social care:-

• How to make do with less resource.
• Whether there are better ways of deploying social workers than gatekeeping statutory resources.
• How to help people who do not meet ever stricter eligibility criteria.
• How to make personalisation more than the allocation of personal budgets.
  

Here's a bit more on the topic:

• Columnist Alex Fox on why and how community social work is making a comeback.
• How Sutton and Derbyshire are rooting social workers in their communities.
• Why social workers need to engage more with their communities.
  

We'll be keeping an eye on it as things develop.

The Royal College of Psychiatrists has updated its guidelines on the assessment and treatment of people with substance misuse problems who are detained in police custody.

The guidelines recognise that the assessment and treatment of substance misusers present forensic physicians with challenges. The guidelines stress the importance of good communication, of working closely with custody officers, and of shared responsibility for the safety and care of detainees with substance misuse problems. In particular, they stress the importance of:

· the full participation of forensic physicians in all aspects and at all stages of the healthcare of detainees with substance misuse/dependence

· providing advice to custody officers and others involved with detainees with substance misuse/dependence

· comprehensive contemporaneous records

· appropriate sharing of information in accordance with the law and the General Medical Council's advice on professional confidentiality

· being aware when making all interventions that the interests of the detainee as a patient is paramount.

Professor Hamid Ghodse, chair of the working group that revised the guidance, said: "Addicted individuals should always be cared for and treated without being stigmatised - whatever their personal circumstances. Over the last couple of decades there has been a major increase in substance misuse, and a corresponding increase in the numbers of people detained in police custody who misuse substances. Most of these detainees are vulnerable people.

"It can be difficult to undertake a proper assessment of someone in police custody. However, a detained substance-dependent person who is at risk of complications is entitled to exactly the same quality of healthcare as they would receive in other locations. The overriding principle of care must be their safety, and the treatment of suffering that occurs as a result of substance intoxication or withdrawal."

photo credit: poweron

There's been a lot of reaction to the recent deprivation of liberty safeguards in which the Court of Appeal ruled that a severely disabled individual, P, was not deprived of their liberty.
We've already run a response from Mental Health Alliance Dols lead Roger Hargreaves.

Below is a reaction from John Leighton, who has been employed by the Social Care Institute for Excellence to help care homes implement the Dols and the Mental Capacity Act (here's a really useful guide he did for us on Dols for care homes).

But before looking at that, the case, under which Cheshire West and Chester Council won an appeal against an earlier Court of Protection ruling that P was in fact deprived of his liberty, has prompted much reaction, some of it adverse, on the web.

Social worker ermintrude2, who works as a best interests assessor, blogged on the ruling earlier this month. She picks up on the point - also made by Hargreaves - that the judgement makes clear that a judgement on whether a deprivation of liberty has taken place must be made relative to what is "normal" for someone with similar levels of disability.

As ermintrude2 puts it: "Someone who to all intents and purposes is under 'complete and effective' control by members of staff in a residential home is not deprived of his liberty because it is 'normal' for him to treated and regarded as such."

She is very concerned about this and draws the conclusion that the judgement "sets the barrier for a deprivation of liberty so excessively high and so narrowly in scope, is remove that safeguard from a lot of people who may need it".

Community care law researcher Lucy Series (who blogs as The Small Places) has also written a summary and critical commentary on the judgement and its implications. The summary also draws together some other responses, so is well worth a look.

Also, a detailed summary and commentary on the judgement has been published by Mental Health Law Online.

Anyway, here's Leighton's response to add to the mix:

Lord Justice Munby's judgment reminds us of some perplexing questions.

It seems intuitively correct to say that a person should not be ascribed a detained status because of her condition. It seems equally sensible to say that a care regime that promotes the most 'normal life' for a person should not be regarded as a deprivation of liberty: after all, what exactly is depriving about it?

And yet we become uncomfortable when we consider the judgment alongside the level of abuses uncovered in care establishments run by Castlebeck and other similar scandals. Can it be that the most vulnerable in need of protection are to be denied that very protection simply because they are the most vulnerable?

The abuses uncovered in Rose Villa and Winterbourne View fit the type of arbitrary deprivations the Dols were intended to prevent. The abuses were clearly carried out in 'bad faith' and were beyond any reasonable purpose.

And so we are left in the middle of competing concerns. The Dols are not intended to apply to the majority of residents in care. It is difficult to see that their origin in HL v United Kingdom  was envisaged to deem a mental disorder as depriving in its very nature. On the other hand, such inherent vulnerability requires protection, doubly so when the care situation necessarily calls for such a level of control.

The solution has not yet been found. The Dols are not quite right for the use of restraint in care regimes such as for P or, for that, matter the victims of Castlebeck's abusive failures (remember, the Dols procedure was not invoked). Nor does it seem that section 6 of the Mental Capacity Act 2005 regarding restraint is sufficiently framed to prevent abusive practice.

The Dols offer the best protection we have for the time being, so it will be unfortunate to narrow their scope. In the meantime we might ponder how statute  and its attendant guidelines  protect children and children with learning disabilities from the use of physical force. Government has put in place guidance that covers adults  though the cases of abuse suggest that there is something amiss in it or its application . We need to find a way to further accountability within the institution and require personnel to be formally authorised in the use of physical restraint.

A social networking programme for GP commissioners has been created to help them commission mental health services more effectively.

The service, which will be free to join for the next 12 months, is a joint venture between the NHS Confederation Mental Health Network and Janssen.

The site will give GP commissioners access to policy information, help them share best practice, provide evidence-based approaches and offer opportunities to learn from current commissioners of mental health services.

Those joining up will also be offered the chance to meet face to face at regional meetings and explore how to go about service change.

Steve Shrubb, NHS Confederation Mental Health Network director, said: "About one in six people has some form of mental illness and GPs already recognise that mental illness is one of the most common illnesses people come to them with.

"By putting GPs in charge of commissioning budgets there are huge opportunities to get better at intervening early and making sure people get access to the most appropriate care.  There is, however, a great deal of unease about how ready GPs are to take over the commissioning of mental health services."

We've seen a lot written about the benefits of extra-care housing and we keep on seeing the same message that we need to see more.

Learning disability charity Mencap has said a court ruling on NHS care will continue to allow discrimination against people with a learning disability to go unchecked and lead to further unnecessary deaths.

Mencap sought a judicial review against the health ombudsman to challenge her approach to investigations into the deaths of six people with learning disabilities who died in NHS care. Mencap said this was part of a larger body of evidence that people with learning disabilities were "dying unnecessarily due to institutional discrimination in the NHS".

The health ombudsman carried out an inquiry into the deaths. The report was largely welcomed by Mencap, but the chairty was concerned by the approach taken to the statutory obligation on health professionals to make reasonable adjustments to accommodate the particular needs of disabled patients. Mencap said medical professionals had not complied with their legal obligation under the Disability Discrimination Act.

Following the ruling, David Congdon, Mencap head of campaigns and policy, said: "We believe that this ruling will deter individuals from making further complaints in cases where they have been seriously let down by medical professionals on the basis of their disability."

Personalisation consultancy in Control has produced an interesting paper on personalising the use of money by a community in order to achieve an agreed set of outcomes.

An important deprivation of liberty safeguards judgement was published today, under which the Court of Appeal overturned an earlier Court of Protection ruling that a man with severe learning and physical disabilities, P, was deprived of his liberty in a residential setting. The appeal was brought by the local authority involved, Cheshire West and Chester Council. In this guest blog, Mental Health Alliance Dols lead Roger Hargreaves appeal explains the significance of the judgement.

The original judgement found that P was deprived of his liberty because, in addition to being under the total control of the staff in his supported living placement, he required, from time to time, restraint to prevent him from harming himself or sometimes others. 

However the appeal judges, led by Lord Justice Munby who is generally regarded as the leading authority on this issue, concluded that these interventions were not sufficient to tip the balance from restriction to deprivation of liberty, given that P's life was as normal as was possible for someone with his type and degree of disability (and in particular that he had regular access to the outside world); that the placement was supported by his family who had regular contact with him; and that he was not attempting to leave. They stressed that the periods of restraint were only brief and not "pervasive"; were for the purpose of preventing harm; were the minimum necessary to ensure his health and safety; and would be required wherever he was living including his family home.

Although the outcome of this appeal effectively returns the law to where it was before the original decision, Munby's explanation of the reasons is very valuable, as it sets out the case law more clearly and explicitly than before.  In particular, it stresses that a judgement as to whether or not there is a deprivation of liberty has to be made by comparing the life the person is leading with what would be normal for someone with similar disabilities, as opposed to normal for the population as a whole. 

It will no doubt come as a relief in particular to supported-living providers, who if the original judgement had been allowed to stand would have been faced with the possibility that the care arrangements of perhaps thousands of service users with challenging behaviours would have needed authorisation by the Court of Protection.

It should, however, be stressed that "pervasive" i.e frequent and severe restraint might still tip the balance into deprivation, as might objection from family or resistance by the person themselves. Munby also made it clear that whilst the objective purpose of the restraint, for example, whether it is for the purpose of health and safety or as a punishment, is relevant to the question of whether it is, or is not deprivation, the subjective motivation, for example that it is being done in the person's best interests, is not, and this will hopefully help to correct a very common misunderstanding.

A project for deaf women experiencing domestic abuse called DeafHope can now go ahead due to grant funding of £320,000.

SignHealth, the national Deaf healthcare charity, has been awarded the payments from the Home Office's Independent Domestic Violence Adviser grant stream, The Henry Smith Charity and The Tudor Trust.

Steve Powell, chief executive of SignHealth, said: "Deaf women are less able to report the violence because most people don't use British Sign Language and they may also be dependent on their abuser to help them communicate with others. They are more likely to be isolated and are often unable to 'speak out'.

"The project will provide deaf women with the information and access to services in BSL that they need to build a safe life for themselves and their children, free from the threat of abuse."

SignHealth will be working in partnership with Women's Aid to develop and deliver DeafHope, which is a three year pilot project aimed at deaf women in London and the South East.

The charity then hopes to expand DeafHope to cover the whole of the UK and will be seeking further funding to be able to do this.

The service will have several strands including advocacy, counselling and a survivors' network, as well as giving training to domestic abuse service providers.

Today's Metro has a sad story about a couple who committed suicide after becoming destitute.

Watching the health select committee's social care hearing I was struck by how out of kilter MPs are with what providers want to see.

The government has decided to bring sentencing for disability-motivated murders in line with those aggravated by race, religion or sexual-orientation.

David Congdon, Mencap head of campaigns and policy, has welcomed the decison but warns there is still more to be done.

"By recognising this anomaly in sentencing, and taking steps to address it, we will move one step closer towards ending disability hate crime," he said.

"However, there is still some way to go before all disability hate crime cases are treated equally in law and more must be done to ensure that criminal justice professionals do all they can to make disability hate crime a priority. There are 10 million disabled people in the UK, yet only 1,200 cases of hate crime have been prosecuted over a four year period, compared to almost 50,000 racist and religiously motivated crimes. We know that this does not reflect the many reports of disabled people experiencing hostility, aggression and violence in their day to day lives.

"We hope to work with judges, the police, the Criminal Prosecution Service and other authorities to ensure that the way disability hate crime is recorded, investigated, charged and sentenced, inspires confidence in the system."

The NHS South West review into the way health authorities commissioned private hospital services at care home Winterbourne View is "expected" to raise concerns about the lack of detail in any contracts between primary care trusts and Castlebeck, according to the BBC.

The report by the NHS will feed into the ongoing serious case review, which is being conducted by South Gloucestershire Council.

A spokesperson from NHS South West told Community Care the BBC report was "speculation" and the NHS report would not be published until next year, when the serious case review is due to come out.

An NHS South West statement said: "It is premature to speculate on the findings of the NHS review which has not been finalised. However, we have a responsibility to correct serious inaccuracies and it is misleading to suggest that the review will conclude that the NHS was more interested in costs than the quality of care when making these placements.

"The findings will be published in due course but in the meantime it would be wrong to comment further while investigations, including those by police, are continuing."

Government welfare reforms would force 600,000 people to disappear from the benefits system altogether, causing many to rely on family for financial support, according to researchers from Sheffield Hallam University said Scotland.

Co-author of the report, professor Steve Forthergill, said: "The large numbers that will be pushed off incapacity benefits over the next two to three years are entirely the result of changes in benefit rules - the introduction of a new tougher medical test and, in particular, the more widespread application of means-testing from next April onwards. The reduction does not mean that there is currently widespread fraud, or that the health problems and disabilities are anything less than real."

The study said Scotland, Wales and the north of England would suffer most from the changes, which are to be introduced by 2014.

Bed-blocking - or delayed discharges of care - is on the rise again with the inevitable blame game between health and social care likely to kick off before long.

Carers today will debate with care services minister Paul Burstow and minister for disability and carers benefits Maria Miller to look at the challenges carers are up against in the face of welfare reform.

At the National Carers Summit in London today, 250 carers will be present and others will join the debate online.

In 2010, spending on care fell by £1.3bn, according to carers organisation Carers UK. Carers UK is seeking assurances from the ministers that carers will not be left worse off as a result of the welfare reforms, including the £55.55 per week carers allowance.

Carers UK chief executive Imelda Redmond said: "Government must understand that cutting support to carers is not only a false economy, it is also not morally just when so many have given up work, health and contact with friends and family to care for relatives and friends who have become ill and disabled."

Under the Legal Aid and Sentencing Bill, currently being discussed by government, only domestic violence victims who can prove "a high risk of violence" will qualify for support.

In practice, this is likely to require them to have reported the abuse to police as reports from women's refuges and GPs will not be accepted as sufficent evidence. Some MPs and women's groups do not find this acceptable.

Helen Goodman, MP for Bishop Auckland, told MPs yesterday: "The reality is that most women experience 20 episodes of domestic violence before they report it to the police.

"By insisting that only a report to the police, followed by various court actions, are required for legal aid, I am afraid the [government] is condemning more women to suffer domestic violence in silence."

But Justice Minister Jonathan Djanogly said: "What I am saying is that we need to have objective evidence of domestic violence to target taxpayers' money on genuine cases where the victim needs assistance because of being intimidated or otherwise disadvantaged by the fact of facing the abuser in proceedings.

"I am not questioning the integrity of genuine victims. However, many people during the legal aid consultation were concerned about providing an incentive for unfounded allegations and the government shares this concern."

Is it me, or does this seem incredibly controversial? Djanogly says he isn't questioning genuine victims, but he's certainly questioning everyone who comes forward to report abuse, as how can anyone tell, at that point, who is "genuine" or not? Looks like shakey, shakey ground to me.

BBC Women's Hour has picked up on the issue, with a brilliant run-down of the impact of these proposals on DV victims, which you can listen to here.

photo credit: Eric The Fish (2011)