Pathways Associates Policy Briefing – July 2013
This is a new, regular bulletin for learning disability commissioners and other associated professionals in the northwest.
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In this issue:
1. Draft national minimum eligibility threshold for adult social care
2. National Personalisation Surveys
3. Personal Health Budgets – support for CCGs
4. Involving the public in health and social care decision-making
5. Community Safety Partnerships
6. Winterbourne View Joint Improvement Programme
7. CCG Commissioning for Special Educational Needs
8. DWP Work Programme Official Statistics
9. Further consultation on the PIP assessment
10. Spending Round 2013 – Summary and Brief Analysis
1.1 The Government’s White Paper Caring for our future: reforming care and support set out a long-term programme to reform care and support. The introduction of the Care Bill into Parliament is a major step in taking forward these reforms, as it will modernise social care legislation and put in place a system that promotes people’s well-being.
1.2 One of the important new changes is the national eligibility criteria for adult care and support. These will set a minimum threshold for people’s care and support needs which must be met by local authorities in all areas. Local authorities will not be able to restrict eligibility beyond this threshold. Of course, if authorities wish to do so, they can meet other needs which are below the national threshold.
1.3 The Government has proposed to set the national threshold at a level which would in terms of its practical outcome be equivalent to “substantial” in the current system. This is the level currently operated by the vast majority of local authorities. However Community Care reports that older people’s and disability charities, who have campaigned for a lower ‘moderate’ threshold, have attacked the plans, warning they would shut hundreds of thousands of people in need out of the system.
1.4 The discussion document sets out a minimum threshold on what needs are eligible for care and support in local authorities across England, for people needing care and family carers respectively. They are set to come into effect from April 2015. The document can be accessed here.
1.5 In contrast to current regulations the proposed draft eligibility criteria explicitly includes:
- A link, between the provision of care and support and the prevention of risk to a person’s well-being
- Extended rights for family carers to assessments and the first ever entitlement to support from the local authority to meet eligible needs
- Support around household tasks, work, training, education and volunteering.
- Support around any caring responsibilities the adult has for a child
- Support to access necessary facilities or services in the local community
1.6 The Personal Social Services Research Unit (PSSRU) at the London School of Economics estimate for the additional cost of moving all LAs to the new eligibility criteria is around £23 million per year. However these costs do not include additional support for carers. Costs arising from these changes are estimated to be in the region of £125 to £150 million per year. The discussion documents states that all new costs to local authorities will be funded in full by Government.
1.7 Stakeholders can express their views on the regulations and provide evidence direct to the mailbox firstname.lastname@example.org up to 29 November 2013.
2.1 Two national surveys on the implementation of personal budgets have recently been published: the Community Care personalisation survey and the National Personal Budgets Survey undertaken by In Control and Lancaster University and published by Think Local Act Personal.
2.2 Over two-thirds of social care professionals in the Community Care survey said they needed more training in relation to helping people build personal and community networks and in relation to knowledge of local or non-traditional services. Similarly in the TLAP survey, accessing community resources was the area in which the fewest personal budget recipients reported good outcomes. This could indicate a tendency to still focus on ‘specialist’ intervention rather than using the support to access universal services in the community.
2.3 Social workers complained strongly in the Community Care survey about bureaucracy, with two-thirds saying that assessment paperwork was too complex for potential personal budget users to complete themselves. In addition, only 1 in 10 social workers said their Resource Allocation System was transparent and easy for people to understand. Service users in the TLAP survey reported similar frustrations with various forms of bureaucracy and restriction. So both local authority staff and disabled people are saying there is an urgent need to simplify processes and to make sure the view of disabled and older people are heard in planning. The need for clear, accessible, systems, without needless bureaucracy is particularly crucial if people with learning disabilities are to access personal budgets in a meaningful way.
3.1 A key objective for commissioners of healthcare is to become dramatically better at involving patients; empowering them to manage and make decisions about their own care and treatment.
3.2 Patients are increasingly involved in their own personal care planning, becoming key to the decisions made about their care. In addition new Personal Health Budgets (PHB) will give them the opportunity to manage funds and say how they are used.
3.3 After a successful pilot programme, from April 2014 people eligible for NHS continuing healthcare (including parents of children); across England will have the right to ask for a PHB. Others with long term health, physical or mental health conditions or disabilities may also benefit.
3.4 Clinical Commissioning Groups (CCGs) will be responsible for delivering PHBs and support is available to them, via an NHS support and delivery programme. This builds on best practice and other information developed during the pilot programme and learning from early adopter sites.
3.5 All CCGs (and other NHS organisations responsible for delivery of PHBs) are invited to take part in the programme. This includes:
- support to carry out a local self-assessment using markers of progress
- the chance to take part in an accelerated development programme
- taking part in the next national personal budgets survey
- access to the personal health budgets toolkit and FAQ
- access to a learning network
3.6 For more information about personal health budgets and to join the programme please visit the personal health budgets website.
4.1 It has never been more important, or more difficult, to engage the public in decisions on service restrictions and cuts. This article from Guardian Professional offers some useful advice.
5.1 CCGs now take on health responsibilities within Community Safety Partnerships (CSPs). Commissioners will recognise the link between health inequalities and offending behaviour and that by improving health outcomes reoffending can be reduced as well as improving health and wellbeing to local communities.
5.2 Along with the police, local authorities, fire and probation services, NHS Primary Care Trusts formerly had a role to play in community safety and law and order as part of a Community Safety Partnership. This responsibility now falls to the CCGs.
5.3 Community Safety Partnerships have a number of responsibilities in relation to learning disabled people including:
- reducing health inequalities
- strengthening safeguarding services
- developing offender health services (including mental health and learning disability services)
- improving the quality of life and independence of ‘vulnerable’ people,
- improving the life chances of children.
5.4 There are around 270 CSPs in England compared to 212 CCGs. In some areas therefore, CCGs will need to be represented on more than one CSP.
5.5 The Local Government Association has also published a useful guide for CCGs about CSPs that can be found on their website.
6.1 The Local Government Association and NHS England have established, with support from the Department of Health, the Winterbourne View Joint Improvement Board. This is chaired by Chris Bull, a former local authority and PCT chief executive.
6.2 The Joint Improvement Programme has written to local authorities seeking their support in completion of a self-assessment stocktake. The purpose of the stocktake is to enable local areas to assess their progress and for that to be shared nationally. The stocktake is also intended to enable local areas to identify what help and assistance they require from the Joint Improvement Programme and to help identify where resources can best be targeted.
6.3 This document follows the recent letter from Norman Lamb, Minister of State regarding the role of Health and Wellbeing Boards (HWBs) and the stocktake will provide a local assurance tool for your HWBs.
6.4 The completion of the stocktake will help to establish what needs to be expedited and provide a firm basis for each local development plan. CCGs and area teams will want to work with local government colleagues and contribute to the stocktake to develop a comprehensive picture of local progress. A copy of the letter sent to local authorities and the stocktake is available here.
6.5 There has just been a call for evidence on ‘what does good look like’ for children and young people with learning disabilities or autism with mental health conditions or with behaviour that displays as challenging
6.6 One of the key actions of the Winterbourne View Concordat is to develop a core specification to support local authorities and CCGs to commission specialist services. Work is underway to develop the core specification which will be outcome focused and evidence based. We are keen for this evidence base to include operational evidence, especially where local commissioners, providers, and families have been working together to implement preventative and positive interventions to challenging behaviour. The team are To help us we are seeking good practice examples of specialist services for children and young people (aged 0-25) with learning disabilities and / or autism across education, health and social care
7.1 CCGs will have an important role to play, working jointly with local authorities, in assessing needs and agreeing an Education, Health and Care (EHC) plan for each child and young people with Special Educational Needs. The Children and Families Bill, currently in Parliament, will place a new statutory duty on CCGs from 2014 to deliver the health services agreed in plans. This letter from the Department of Education details how CCGs and local authorities can find out more about the proposed new arrangements, and engage with Pathfinders on local approaches to SEN.
8.1 New figures show that a small proportion of disabled people have gained a job since the Government’s Work Programme launched two years ago.
8.2 The Department for Work and Pensions (DWP) said its report showed a sharp increase in the overall number of jobseekers finding work through the programme, compared with the previous figures released in November 2012. But the DWP figures also show that less than 3% of claimants of employment and support allowance (ESA) – the new out-of-work disability benefit – have secured at least three months’ paid work since the scheme started in June 2011.
8.3 The number of former incapacity benefit claimants who have found jobs through the Work Programme after being reassessed for their “fitness for work” and found eligible for ESA was even lower – 0.8% by the end of March 2013.
8.4 The figures reveal that just 210 former Incapacity Benefit claimants have so far had a “job outcome” of at least three months since the Work Programme began.
8.5 For more information see the Work Programme Official Statistics.
9.1 From April 2013 Disability Living Allowance (DLA) began to be replaced for new claimants with a new benefit, Personal Independence Payment (PIP). Like DLA, PIP is intended to provide a contribution to the extra costs faced by people with disabilities and long-term health conditions. Whether individuals receive the benefit, and how much they receive, will be determined by an assessment of their needs.
9.2 The Government has received feedback from some disabled people and their organisations saying that they are unhappy with the changes that have been made to the assessment criteria for the ‘moving around activity’ as a result of a previous consultation and want a further opportunity to have their views considered. The government has therefore decided to carry out an additional consultation, seeking further views on the Moving around activity.
9.3 The consultation can be accessed here and closes on 5 August 2013.
10.1 The Chancellor of the Exchequer announced the outcomes of the spending round on 26th June 2013. His statement and supporting documents set out spending priorities over the rest of the Parliament in line with the government’s economic plan.
10.2 In summary the government will continue to reduce public sector budgets in an attempt to balance the national budget deficit. The LGA points out that the 10% cut in local government funding planned for 2015-2016 comes on top of the 33% cuts implemented since 2010. The Association is concerned that this will result in some councils struggling to meet their statutory responsibilities.
10.3 Budget reductions are not applied evenly across local councils, some will face greater cuts in cash terms (and as a proportion of their total budget) than others. Councils will also take different approaches to reducing budgets across their departments. The impact upon social care and other council activities will vary, depending upon the approach that local councils take to balancing their total budgets.
10.4 The spending round prioritizes investment in long-term infrastructure projects and other programmes that will promote economic growth. Investment is also targeted to support public sector reform, including integration of health and social care and initiatives intended to reduce demand upon costly specialist or long term support.
10.5 The spending round targets investment at the NHS, Adult Social Care and Education, and provides additional flexibility in the use of some funding. However the overall picture for local government in particular, and the public sector as a whole, is one of continuing austerity and severe financial challenges. A brief financial analysis of the spending round undertaken by the Institute for Public Policy Research (IPPR 26th June) is provided as Appendix 1.
Key Elements of the Spending Round
10.6 Health and Social Care
10.6.1 The government’s spending round documents are available via the HM Treasury website at: https://www.gov.uk/government/publications/spending-round-2013-documents
Elements of the spending round that are directly relevant to health and social care are summarized below.
- The government will put £3.8 billion into a pooled budget for health and social care services to work more closely together in local areas, in order to deliver better services to older and disabled people, keeping them out of hospital and avoiding long hospital stays. This shared pot includes an additional £2 billion from the NHS and builds on the existing contribution of around £1 billion in 2014-15, with the aim of delivering better, more joined-up services to older and disabled people, to keep them out of hospital and to avoid long hospital stays.
- To ensure that closer integration between health and social care can start immediately, the NHS will make an extra £200 million available in 2014-15 as an upfront investment in new systems and ways of working that will benefit both services.
- An additional £200 million will be invested to extend the Troubled Families programme and change the way that local authorities, health, education and criminal justice services work with a further 400,000 vulnerable families. These families have multiple problems which create issues for their community and have a high cost to the public sector.
- £335 million will be made available to local authorities in 2015-16 to prepare for delivery of the capped costs system from April 2016 and a universal offer of deferred payment agreements from April 2015. This investment begins a programme of reforms to social care funding which will mean that no-one will face unlimited care costs or be forced to sell their home in their lifetime to pay for residential care.
- NHS England will lead further work in local areas on efficiency savings from 2015-16 to meet rising demand from an ageing population. As a first step, the Department of Health will publish plans in the summer for an overhaul of NHS procurement that could save up to £1 billion.
10.6.2 In the Spending Round 2013 document (HM Treasury 2013) presented to Parliament the government states that it has:
‘made choices at a time of spending restraint, which target resources on the needs of people with disabilities. The decisions on funding for health services and social care will benefit many people with disabilities. A commitment to ensure that more adults and young people have access to clinically proven psychological therapies, and that every accident and emergency department will have constant access to mental health professionals will ensure that people with mental health problems, including those with disabilities, get the best possible care.’
10.6.3 The Association of Directors of Adult Social Care welcomes additional investment in social care to support integration with Health but points out that the benefits of integration and the flow of funds from Health to local councils will not be as effective if the potential benefits are offset or outweighed by the wider financial pressures upon local councils.
10.7 Child Care and Education
10.7.1 Elements of the spending round that are directly relevant to Education are summarised below. Government will:
- Consult in July on the details of the new scheme of Tax-Free Childcare announced at Budget 2013 that will support working families with childcare costs from autumn 2015. The existing entitlement to 15 hours a week of free early education for all three-and four-year olds will continue, and will be extended to around 40 per cent of two-year olds by 2014-15, benefiting the less advantaged
- Consult on how best to introduce a fair national funding formula for schools in 2015-16 – supporting schools reform and taking a vital step towards fixing the historic and unfair differences in funding between schools in different local authorities. In future, the amount of funding a school receives will be based on a fair and rational assessment of the needs of its pupils – including how many are deprived
- Protect funding for schools in real terms, including the Pupil Premium that provides additional funding for disadvantaged pupils
- Support the next stage of schools reform to free up the system and increase choice – including continued roll out of academies and funding for up to 180 new Free Schools, 20 new Studio Schools and 20 University Technical Colleges a year.
- Consult this summer on options for major reform of apprenticeships funding to place purchasing power directly in the hands of employers.
10.7.2 The government states that:
‘In the schools system, the continuation of the Pupil Premium in real terms will disproportionately benefit children and young people with disabilities, and the Government will continue to reform services for those with special educational needs.’
10.7.3 President of the Association of Directors of Children’s Services, Andrew Webb expressed concern that the 2013 spending round will place Children’s Services budgets under further pressure.
“If any more pressures push the numbers of children in care up higher, it immediately takes money out of the other children’s social care activities – safeguarding and preventative areas,”
“Even though core assessments, care planning and so on have been protected a bit up to now, all those services that contribute to managing children safely in the community, such as children’s centres, are almost certainly going to have to be revisited and cut again,”
(Andrew Webb, Community Care Magazine June 2013)
10.8.1 Elements of the spending round that are directly relevant to the welfare system are summarized below. Government will:
- Introduce upfront work search, requiring all claimants to prepare for work and search for jobs right from the start of their claim;
- Introduce weekly rather than fortnightly visits to Jobcentres for half of all jobseekers;
- Require all unemployed claimants, and those earning less than the Government expects them to, to wait seven days before becoming eligible for financial support;
- Require all claimants who are subject to conditionality to verify their claim every year;
- Require all claimants whose poor spoken English is a barrier to work to improve their English language skills; and
- Require lone parents who are not working to prepare for work once the youngest child turns three.
- The Government will introduce a cap on welfare spending to improve spending control and ensure that welfare remains affordable. The cap will apply to over £100 billion of welfare spending. The basic and additional state pension will be excluded.
10.8.2 The government states that:
‘The Department for Work and Pensions settlement includes funding for supporting disabled people to find work through specialist programmes and wider support.’
10.8.3 Managing welfare spend is a central aim of the 2013 spending round. Government continues its efforts to move people (including those with disabilities) off state benefits and into work. It must be noted that so far the Work Programme has had little success at moving disabled people into sustainable, paid employment (see paragraphs 8.2 – 8.4).
10.8.4 Campaigners have expressed concern that the disability section of the spending round equality impact analysis mentions increases in spending on mental health treatment, the government’s special educational needs reforms, money spent on improving access to the railway system, NHS spending, disability employment programmes and even funding for Paralympians; but there is no mention of the welfare cap or cuts of 10 per cent to local government spending.
Key Points to Consider
10.9 Whilst public sector agencies have welcomed various elements of the investment and additional flexibilities announced as part of the 2013 spending round the overall position is extremely challenging and local government is particularly hard hit.
10.10 The Society of Local Authority Chief Executives stated the ‘local councils are running out of ways to save money alone and that puts the future of local services on the line.’ (SOLACE 26.6.2013).
10.11 The spending round focuses upon delivering greater efficiency across the public sector and targeting investment to drive economic growth. For example the government will provide a fund of £2bn per annum to local councils to drive economic development. In response the LGA stated that:
‘The £2 billion a year does not come close to the £70 billion recommended by Lord Heseltine, nor is it all money taken from Whitehall departments, as he suggested it should be. The majority of the fund is simply a reallocation of existing council funding with less freedom over how it’s spent.’
10.12 The LGA is also very concerned that:
‘Diverting £400 million from the New Homes Bonus means councils will now be forced to pool money which they were previously able to use directly to fund local services which matter most to their local areas.’
(Spending Round Announcement, LGA Response 27.6.2013)
10.13 Perhaps the most important point to note about the 2013 spending round is that whilst additional money will be directed to support adult social care (some of which will only be available when local targets are achieved) and other aspects of the public sector there will be an overall reduction in local government budgets on top of the severe cuts already implemented or planned.
10.14 The scale of the financial pressures faced by local government and other public sector agencies presents a risk that local councils will be forced to cut services that would otherwise help to reduce demand for specialist treatment and support. This may include further cuts to universal services such libraries and leisure and tightening up controls on social care and other support to vulnerable groups.
10.15 Whilst local councils (and their partner agencies) will take different approaches to coping with on-going financial pressure the strong focus upon reducing demand and reliance on costly services and support will certainly continue.
10.16 Success is likely to depend upon developing more effective preventative approaches across the health and social care systems which divert people away from traditional support, or enable them to move on more quickly to live as independently as possible in the community. A spokesman for the LGA pointed out that ‘getting adult social care right is important for securing the sustainability of local government as a whole’. The work to integrate health and social care processes is seen as fundamental to reducing longer term financial pressure.
10.17 The 2013 spending round sets out how the government will prioritise spending in the areas that yield the highest economic returns, including investing savings realised by reducing public sector budgets into transport, science and innovation, education and skills, the support that businesses need to export and grow, and further reforms to drive competition and cut red tape.
10.18 Public sector agencies will be analysing the detail of the spending round to understand what it means for them and to decide how to respond. All agencies will aim to mitigate the risks presented by on-going cuts in public sector funding and to maximise the benefit of new flexibilities and investment. Greater integration of health and social care is a good example of how working across sectors and organisational boundaries will help agencies to manage their costs and improve outcomes for the people they serve.
10.19 However, despite government’s assurance that it has made provision to meet the needs of disabled people and other potentially vulnerable groups the stark reality is that the scale of the cuts implemented and planned since the 2010 spending round will make it very difficult for the public sector, and local government in particular, to maintain vital services.