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|23 Jul 2016|
John's Jolly Walking Group
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.
A local authority is facing a judicial review challenge over its plans for a £225,000 funding reduction to short break services. The legal action against West Berkshire Council is being brought by the families of two severely disabled children, a 14-year-old boy (B) and an 8-year-old girl (E) from Newbury.
West Berkshire’s budget for short breaks will reportedly be cut by 54% to £190,000 for 2016/17 following a decision made by the council at a meeting on 1 March.
The claimants argue that the funding reduction is unlawful, including breaching the Breaks For Carers of Disabled Children Regulations 2011. The regulations are designed to safeguard the needs of carers who would be better able to care for their disabled child more effectively if short breaks were provided.
The parents of B, who has autism and a rare neurodevelopmental disorder called William’s Syndrome, said the “life-saving” short breaks services enabled their son not only to have meaningful social experiences, but gave them a much needed break to spend quality time with his siblings and each other.
The parents of E, who is eight years old and has autism, ADHD, epilepsy and cortical dysplasia, said they relied on short breaks services to give E the opportunity to play with children her own age and so they can spend quality time with their 12-year-old son.
The claimants said the cuts meant B and E would no longer be able to access the same level of services as they did before.
Alice Cullingworth, a solicitor at Irwin Mitchell, said the council had been invited to reverse its decision and “think again” after having assessed the sufficiency of short breaks for families in West Berkshire. The authority has also been asked to apply some of its reserves to prevent cuts to short breaks.
She added: “There is no evidence West Berkshire properly analysed the level of demand for children’s short breaks services or what services will be available to meet this demand with a reduced budget of £190,000 for 2016/17.
“Nor is there proper and lawful consideration as to whether the council will be providing a sufficient range of day-time care, overnight care, educational or leisure activities, and services to assist carers in the evenings, weekends or school holidays as the law requires.”
Steve Broach of Monckton Chambers has been instructed by Irwin Mitchell as counsel for the claimants.
A spokesman for West Berkshire said: “We are aware that a judicial review application has been made by Irwin Mitchell. We do not believe it is well founded. We will not be in a position to comment further until the legal proceedings have concluded.”
The London Borough of Ealing is facing legal action over proposals to close a respite care facility for young people with complex disabilities.
The proceedings against the council are being brought by law firm Irwin Mitchell on behalf of the family of a 17-year-old, severely disabled boy (C) who has used Heller House in Southall for two nights per week since December 2010. C has also used the nine-bedroom children’s home for short breaks.
Ealing took the decision on 16 February to close the facility. The claimant argues, however, that no alternative respite care has been formalised and children who use Heller House could be forced to travel out of the borough.
Calling on the council to rescind its decision, Irwin Mitchell claimed that, because Ealing decided to close the facility without knowing whether there would be suitable alternative services available, the decision was in breach of the Equality Act 2010 as the council did not know whether and how disabled children would be detrimentally affected.
The law firm said C’s family relied on respite services to enable him to have meaningful social interactions with other youngsters in a safe and controlled environment as well as to give them a much needed break to spend time with their other children, including C’s 20-year-old brother who also has autism and complex needs and lives in a residential placement most of the time.
Alice Cullingworth, a solicitor at Irwin Mitchell, said: “We have spoken to a number of families who have told us that they would like to use the Heller House service if it were available, who either did not know about it or have not been able to access the service to date.
“It’s clear that by closing the only in-borough provider of overnight respite that there is a risk that if alternative providers lack capacity out of borough then children may not be able to access services to meet their assessed needs.”
She added: “We have spoken to a local councillor, Jon Ball, who confirmed that in his opinion it appears negotiations between Ealing Council and other local authorities are far from concrete, and that only very superficial conversations with other local authorities have been conducted to date.
“Councillor Ball confirmed to us that he believes there is no agreement presently with other local authorities, even in outline, which means a decision has been made to close this invaluable facility without a concrete alternative for the young people who so highly depend on it.”
We have had over 300 responses to the survey on the experience of people with learning disabilities with health services. Most have been from people with learning disabilities and we have people replying from all over Scotland.
Most people have been happy with their experience of health services. This has applied to all 3 services that we asked about Doctors – Hospitals – NHS 24.
They helped with my needs
I feel I got a good experience in hospital
The doctors are very good to me. I usually don't have to wait very long to see a doctor
People have reported that Doctors have been respectful and listened to them. Staff in hospital have been nice and looked after them. NHS 24 has responded quickly and helped people in need. Read the full report here
Some problems were reported.
Some Doctors didn’t listen to what people with learning disabilities had to say. Some people find it hard to express what they are feeling and what is wrong with them and in these cases, the doctors may jump to conclusions.
Doctors lack time to talk to me
Doctor surgery have tried to help me but hospital don't seem to be interested
A nurse didn't ask me but asked a stranger if I had a period. I asked for females but they still put on male staff
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.