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30 Jul 2016
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A High Court judge has given a disabled man permission to bring a legal challenge against a county council after it decided to reduce his care package.   The case is thought to be the first of its kind since the Care Act 2014 came into force.

The claimant, Luke Davey, 39, is quadriplegic and has cerebral palsy. His disabilities were caused due to a virus he contracted as a child.  Oxfordshire County Council is responsible for providing him with care and support to Mr Davey, who lives in his own adapted home and is supported by a team of carers to live independently.

According to his lawyers, Irwin Mitchell, “despite an assessment in April 2015 stating he needs 24-hours care a day and a stable care package for over 20 years the council took steps to reduce Luke’s funding over the past 12 months down to 17.5 hours which his family, and an independent report said would have a negative effect on his wellbeing”.

The law firm launched legal proceedings in the High Court on his behalf, arguing that Oxfordshire was in breach of the Care Act in not making sufficient payments to meet his care needs.     An interim court order was made at the recent permission hearing, requiring the council to continue paying for the full cost of Mr Davey’s current care package until the final hearing (expected to take place later this year).

Rebecca Chapman, the claimant’s solicitor, said: “Luke is an intelligent but vulnerable man who is dependent on a wheelchair, registered blind and relies on support from the council to fund carers so that he can live his life to his full potential. Luke can make his own decisions but requires assistance with all of his personal care needs and activities of daily living and in April 2015 the council assessed him as needing 24 hours care a day. Luke has decided he does not want to be forced to spend time alone.

“An Independent report has stated that the reduced care plan will have a detrimental impact on his wellbeing and independence and Luke, through the support of his family has asked us to challenge the decision to reduce his care.”

Chapman added: “We will argue that the council has duties under the Care Act 2014 and has not taken into account the reasons why the reduced payments will have such a significant detrimental impact on Luke’s health and wellbeing.”   Irwin Mitchell will also seek to argue in the case that a reduction in the rates of pay for skilled carers and assistants would be unreasonable and unlawful. 

A spokesman for Oxfordshire said: “It would be inappropriate to comment at this stage pending consideration of this case by the Court. In the meantime we continue to work with Mr Davey and his family.”

An early study by the Policy Innovation Research Unit into the development of Health And Social Care Integration in England has found it struggling.   Just as in Scotland, H&SCI started with ambitious visions to transform care for people with multiple long-term conditions and frail older people by shifting services out of hospitals, reducing costs and improving people’s experiences of care

There had been plans to use a wide range of initiatives to meet these objectives including multi-disciplinary teams, improved access to services, rapid response teams to reduce avoidable admissions, telecare and telehealth, increasing the use of community resilience and personal health budgets.

However such ambitions became more limited and focused on “short term, financially driven goals”, mainly around containing hospital admission and discharge costs.   The range of initiatives used had narrowed to setting up multi-disciplinary teams, improving care planning, creating a single point of access for services and using care navigators to provide people with information and advice on accessing care.

Health And Social Care Integration is struggling in England.   Increasing financial constraints on councils and NHS bodies are making it harder to achieve integrated health and social care, government-funded research has warned.   The study also found that engaging frontline staff in initiatives to integrate care was proving challenging in a climate where they were “firefighting” to keep existing services running. 

Health and social care were beset by an “integration paradox” in which the financial environment made it ever more important to integrate care but, at the same time, made it more difficult to make progress in doing so. 

The findings came from an early evaluation of the integrated care and support pioneers programme, a Department of Health initiative set up in late 2013 to test new ways of integrating care for people who needed the support of multiple care services.   The study, by the Policy Innovation Research Unit, assessed the initial 14 pilots from January 2014 to July 2015 and was largely based on interviews with 140 council, clinical commissioning group (CCG), NHS trust and voluntary sector staff involved in pioneers.

 

The pioneers started with ambitious visions to transform care in their areas for people with multiple long-conditions and frail older people by shifting services out of hospitals, reduce costs and improve people’s experiences of care.  They had plans to use a wide range of initiatives to meet these objectives including multi-disciplinary teams, improved access to services, rapid response teams to reduce avoidable admissions, telecare and telehealth, increasing the use of community resilience and personal health budgets.

But the researchers found that over time their ambitions appeared to have become more limited and focused on “short-term, financially driven goals”, mainly around containing hospital admission and discharge costs.   Also, the range of initiatives used had narrowed to setting up multi-disciplinary teams, improving care planning, creating a single point of access for services and using care navigators to provide people with information and advice on accessing care.

Interviewees identified a number of barriers to and enablers of integration. Most of the enablers were local factors. These included the relative simplicity of organisational structures, with the best arrangement perceived to be when a pioneer involved just one council, CCG and NHS trust with similar boundaries. The most important of the enablers was perceived to be staff involvement in integration initiatives and the extent to which they felt ownership over them.

Glasgow City introduced personalisation in 2010 as part of a programme designed to save up to £6.4 million per year.  The first phase of this for people with learning disabilities was rapidly extended to other groups.  As individual budgets became the preferred method of managing support packages the council moved to close a number of day centres arguing that with individual budgets, less people would use these  services.

Actually it seems that less people now use any services in Glasgow.   Official figures from ESAY reports that the number of people with learning disabilities receiving any service from the council fell again in the last year, this time by 104 people  to just 2,306 in 2015.  

Figures produced by the NHS suggest that others have been seeking out NHS help when they cannot get it from the council.    At around the time of the introduction of personalisation in Glasgow the number of “inpatient weeks” rose rapidly as can be seen in the chart.   By 2013, it was costing NHS Greater Glasgow & Clyde an additional £4.5 million per year.  

It seems strange that a policy of that was presented as being about Choice And Control should be connected to less people getting any service and more people using  specialist hospital services.

 

 

In a surprise announcement Glasgow City Council is to close Cordia, the Arms-Length External Organisation (ALEO) which until now has been the preferred provider of social care in the city. Cordia employees will transfer  to the Council, bringing its social care function back in-house.  

As part of the new approach, the Council will overhaul the way that it purchases community-based care services from other providers, including the third sector, in line with their Transformation Strategy, a far reaching reform programme that aims to modernise working practices and deliver required savings of £133m over the next two years.  See this article for more details

Proposals include testing a new purchasing model, which will see a move away from purchasing care services by the hour.  It is unclear at this stage what the new model will look like, however, a further report will be submitted to committee in March 2016 outlining plans, which will include working with a small number of organisations in the coming year to test out new approaches.