Recently in politics Category

The ongoing battle over the government's cuts to (or reform of) disability living allowance is reaching crisis point.
Today, as the House of Lords prepares to debate the proposals in the Welfare Reform Bill, 16 charities have written a letter pressing the government to call a halt to the bill and subject its plans to replace DLA with a cheaper personal independence payment to review.
This follows a feverish day yesterday in which the government announced one concession - agreeing to keep the qualifying period for the benefit following the onset of disability at three months, rather than doubling it to six - while also confirming the sheer scale of the change it is proposing. Replacing DLA with PIP would mean that 500,000 fewer working-age adults would be receiving the benefit by 2015-16 than with the status quo.

Meanwhile, the mainstream media, and not just the Guardian, has taken hold of the issue, with a head-to-head on this morning's Today programme between disability minister Maria Miller (left) and reform critic and disability activist Lord Low over the way forward.
The Lords have already shown themselves ready to give the government a bloody nose over disability benefits cuts, inflicting three defeats on its sickness benefit plans last week.

There is also an amendment to the bill today that will seek to achieve what the charities are calling for by ensuring PIP is piloted before being rolled out.

I'm not nearly close enough to the politics to know whether it will succeed, though I understand that Labour and many crossbench peers - the same coalition who inflicted last week's defeats - will back it.

But what exactly are the issues?

The government's chief beef is that it believes many people are claiming DLA wrongly because they have not been reassessed on their eligibility following an initial claim. Some 70% of claimants effectively get DLA for life.

The campaigners - disabled people, charities and others - believe that the government has not proved its case, and that by pursuing its current course, many thousands of people could be robbed of the opportunity to live independently and free of abject poverty. They also claim that this will not serve to help the government reduce its deficit as cutting DLA will shunt costs onto health and social care.

Reassessing people on their eligibility for DLA or PIP seems fine, so long as the assessment itself is robust and fair.

Disabled people's past experience - based on the hated work capability assessment for employment and support allowance - is that the assessment is likely to be anything but. WCA is now subject to annual reviews to ensure that it improves.

So why not pilot the PIP assessment and see whether ministers' case stacks up?
I imagine that view has some sympathy within the DWP, but the Treasury's demand for the promised savings from setting up PIP to be delivered may make it a non-starter.

(On another note, not all disabled people are opposing the government. Former Community Care columnist Simon Stevens has given a dissenting view, in which he claims that campaigners against reform want disabled people to have "rights without responsibilities").

The troubled (to put it mildly) Care Quality Commission has had some respite from its travails as an MPs' hearing into its effectiveness, due today, has been postponed, reportedly because of David Cameron's statement on Europe.

Chief executive Cynthia Bower was due to face a grilling from the House of Commons public accounts committee, mainly about the findings of the National Audit Office's recent report into the regulator, which concluded that it was not providing value for money. However, the committee would almost certainly have quizzed Bower on recent calls for her to resign from a member of the CQC's own board, Kay Sheldon.
This is particularly pertinent today as it emerged over the weekend that the Department of Health has commissioned a review into Sheldon's claims about the way the CQC is run, made to the public inquiry into the Mid-Staffordshire Hospital scandal.

The CQC also doesn't come off well in relation to the big adult social care story of the weekend - the proposed introduction of a TripAdvisor-style website in which service users and families can post comments and ratings on adult social care services in England. This would be coupled with reports from the local HealthWatch (the latest incarnation of organisations to represent patients and service users' interests in the health and social care system) and the CQC.

Social worker ermintrude2 blogs today that the idea appears to be an attempt to "plug the holes in the CQC by resorting to 'Big Society'.

The full details are due in next spring's White Paper on adult social care. It would be extraordinary if the new ratings system for adult social care relies on scores provided by those consumers who have the time and inclination to post them and from local HealthWatches, which will lack the capacity to investigate and report on all services in their local areas. The missing ingredient is, of course, a rating derived from the judgement of the regulator, along the lines of the old-style star ratings abolished last year.

Care services minister Paul Burstow has signalled that he doesn't envisage a return to star ratings. But while I can't see this system working without it, we would need a significant revival in confidence in the Care Quality Commission for star ratings to make a comeback.
And that begs the question of whether a change in leadership is required for that to happen.

(Addition: 3.49pm: It's worth checking out this opinion piece on the future of regulation from two big beasts of the care provider world: Martin Green from the English Community Care Association and John Adams from Voluntary Organisations Disability Group, not just for the content but the comments below it. The essential narrative is that we need to return to more of a focus on improvement - something like the regulatory approach of the Commission for Social Care Inspection - as opposed to compliance with minimum standards).

(Image on Flickr courtesy of World Economic Forum)

Care services minister Paul Burstow appeared today to open the door a bit wider towards a chief social worker role that will cover both adults and children during the National children and adult services conference.

In this guest post, Laura Cook of Sense explains how the charity sought to bring home the difficulties that deafblind people face in securing social care to Conservative MPs at the party's conference last week. Pictured at the conference are Helene Ryles (left) and Liz Ball.


Getting the right social care is often down to chance. But it shouldn't be: it's about people's lives. We wanted to get this message across at the Conservative Party conference. But how? Everyone is always busy at these things; rushing to speeches, meetings and other fringe events. We needed something fun and engaging, but that hammered home the serious point that social care is far too important to gamble with. So with the lure of a free coffee and croissants, Sense invited MPs and party members to a coffee shop on 3 October for a game of "Play Your Social Care Cards Right".

Gamblers were taken on the social care journeys of two fictional characters - Bob, a 70-year-old acquired deafblind man, and Katie, an 18-year-old young woman who was born deafblind.  By picking cards along the route, players gambled on what happened to Bob and Katie. In some cases lady luck was on their side and Bob and Katie got the right support and went on to have fulfilling and happy lives. 

But in a lot of cases players were dealt a bad hand - Bob and Katie didn't get specialist assessments or a suitable social care package and they ended up needing more health and social care support, which cost the state more in the long term.

Sadly, stories like this are all too common in the real world.  Many of the game players quickly realised that if Bob and Katie had just had support with communication and to get out to meet friends or go shopping, the cost to the health and social care system would have been a lot less. 

Via interpreters using tactile communication methods, conference delegates also had the chance to talk to Helene Ryles, who is deafblind, and Liz Ball, Sense's Campaigns Involvement Officer, who is also deafblind, about just how important social care is for deafblind people like them.

Helene said: "Before my support was increased, communicating with others was difficult and I often felt afraid in my own home. I ended up in hospital for a few months, but am doing much better now because I have more social care support. All I needed was a support worker to help me communicate, as well as training on computer software so that I can access emails and can keep in contact with people."

One party member said Liz gave her a new perspective on the importance of social care: she said she now realises the system often just makes disabled people stressed when really it should be giving people support so they can lead a decent life. She was shocked to hear that when Liz had a generic assessment social services recommended she learnt to lip-read! 

After all the players' chips were cashed and everyone had their fill of caffeine and carbs, party delegates went back to listening to speeches and rushing to meetings. But some did leave this small fringe event with more than free coffee. One delegated told us "I was never interested in social care before talking to you." Perhaps our gamble paid off.

Labour's priorities for health have been crystalized with the appointment of Liz Kendal as shadow care and older people's minister and Andy Burnham as shadow health secretary as part of leader Ed Miliband's re-shuffle.

This question is posed in a blog post by Alex Fox, chief executive of small providers body Naaps and the man chosen to help shape the government's thinking on preventive services as part of its engagement process ahead of next year's White Paper.
He makes the compelling point that people can individually claim an entitlement to crisis services (so long as they meet FACS criteria and aren't too rich to be elbowed out of the system), but not preventive ones which, he says, is "one reason why keeping up investment in prevention is hard when finances get tight".
It also removes incentives from service users to seek sources of support that improve their health and well-being as this will lead to their personal budgets being cut.
He moots people being given access to preventive services in their personal budgets if an assessment identifies that they will have significant needs in six to 12 months time.
This, interestingly, is akin to something proposed by the Commission for Social Care Inspection in a proposed reform of the Fair Access to Care Services framework in 2008 that was rejected by the Labour government on cost grounds.
Fox makes clear that he is flying some kites as they say and not even remotely reflecting government thinking but it will be interesting to see if such ideas gain greater traction this time round.

Hot on the heels of rumours that the government is about to start its "engagement" process on its social care white paper and how it will pay for adult social care in the future, comes an announcement from the Health Select Committee that it is planning its own inquiry.

It said it will consider:

• The practical and policy implications of the government's plans for funding social care, and the recommendations made by the Dilnot Commission and the Law Commission;
• The scale and implications of existing variation in access to and charges for social care in England;
• The practical and policy implications of the government's commitment to promote personalisation of social care, including personal budgets and direct payments;
• The barriers faced by recipients of social care when they wish to relocate to another area;
• Economic regulation of the social care system; and
• The practical and policy implications of the government's stated commitment to promote integration between health and social care services.

I can't help thinking that inquiries are all very well, but we know the issues. It's still down to the government to start moving and committing to the funding aspect.

It's fair to say that committee chairman Stephen Dorrell is committed to social care and has often felt it's been the poor cousin. His words should carry some weight in the government's final thinking.  

Today, Community Care reports that 10% of councils may have broken equality laws when setting their budget this year.

One in ten councils left zero days or less between consulting on their adult social care budget and setting it, raising serious question marks about whether they fulfilled their duty to have due regard to disability discrimination.

How did your council do? Find out on our map below.

View Adult social care budget consultations 2011-12 in a full screen map

Martin Green, chief executive of the English Community Care Association and government dementia champion, could face the sack if pro life campaigners get their way.

Over the weekend Green told the Telegraph he backed the legalisation of assisted suicide for adults with capacity, with appropriate safeguards. He argued it was a logical extension of the choice and control mantra of the health and social care sectors.

Now the Society for the Protection of Unborn Children has lashed out by calling for him to be fired from his government dementia advisor position.

Paul Tully, general secretary of SPUC, said: "Mr Green is clearly not interested in caring for some dementia sufferers. He seems to want them dead.

"Not only would legalising assisted suicide for the elderly create insecurity and a sense of worthlessness among older people, it would also provoke discrimination and prejudice among carers and care home staff. Imagine a government advisor on race relations saying that immigrants found it difficult to commit suicide and so should be helped to do so," he added.

I don't think it's likely he'll get the sack and here's why: Green was expressing a personal view. A view, which doesn't necessarily conflict with his role and ECCA or the DH and, in 2011, is fairly mainstream.

What the Telegraph article doesn't mention mention is that Green has previously suffered with cancer. So it's understandable that he should have a strong view (Green rarely has anything but strong views) on what should be allowed at the end of life as I imagine most people faced with such a diagnosis would find themselves giving it some thought.

Therefore, I suspect that he has given it a more detailed appraisal than most. Adding that to the debate, which is a heated one on both sides, can hardly be seen as irresponsible and whether you agree or disagree with him surely forthright reasoned voices are just those that you want advising the government on assisted suicide, dementia or any aspect of policy.