Health and Social Care update from our work as Strategic Partner (SP) to the Department of Health, NHS England and Public Health England.
Disability Rights UK leads a user-led consortium as one of 22 strategic partners in the voluntary sector. This month’s update includes reflections on the events and workplan of our ‘Win-Win Alliance – disabled people leading change’ (lead on commissioning ), and on how this will support local user-led organisations and finally news, plans and insights on addressing health inequalities and patients and service users driving integration and commissioning.
http://disabilityrightsuk.org/policy-campaigns/health-and-social-care-reforms
We have had our workplan for 2014-15 approved together with our consortium partners Shaping Our Lives and Change. Contact Bernd.Sass@disabilityrightsuk.org if you are interested in pursuing shared project ideas on peer support, pooling personal budgets or on how to get service users involved in commissioning and procurement across the cycle from start to finish.
Moving beyond notions of increasing ‘voice’ and attending to ‘experience’, we have made disabled people the real drivers of health and social care support. There are now a number of inroads for patients and service users to direct both commissioning and provision of services across our six project clusters. A non-exhaustive list includes the following:
1. Commissioning and procurement co-produced: We are currently co-facilitating 10 sessions over half a year for a CCG during which children and young people with mental health problems are driving a procurement exercise with a 20% stake in the bidder evaluation process and subsequent annual contract variations – we are as yet unaware of a similarly far reaching attempt.
2. Charity providers kick-starting ULOs to quality-check services and provide peer support: The ULO ‘Peer Support North East’ was kick-started by a consortium of regional charity providers (supported by Disability Rights UK). Peer Support North East now not only sees 350 of their peers a month to support them across traditional service boundaries but also checks the services of its founders for quality and involvement as driver for health outcomes and produces health audits:
There are of course numerous benefits for disabled peers getting support from a one-stop shop of people who have been through a similar experience in the past and know the issues. However, we really want to spread this model and therefore also need to point out what’s in it for provides and commissioners: this long-term investment in peer support means building a feedback mechanism into one’s own services. Providers will be better prepared for the demands for more personalised, flexible solutions from service users and stand better chances in tender and review meetings with commissioners. Finally, providers can improve on efficiency as bottlenecks in the system are more easily spotted and rectified.
3. Peer support integrated in care pathways: our flagship programme on 'user-driven commissioning' has attracted further consultancy work on establishing peer support not only as a separate service but also as integrated element of new cross-sector care pathways (next to but independent of other commissioned ‘services’) with peer support acting as a very effective bridge to self-care.
4. From independence to integration in managing personal (health) budgets: We are keen to build on our former programme of supporting personal (health) budget holders to pool these budgets and establish their own peer-led commissioning organisations.
5. Linking provider payment to minimum scores on co-produced experience and outcome measures: Further projects we are initiating are about supporting patients and service users to shape outcomes to determine provider payment.
At the last Strategic Partners days on 9 and 10 September we met the new NHS chief Executive Simon Stevens and were able to raise a number of important issues directly with him. There were also some of the usual challenges and some fresh responses,from invited guests and other voluntary and community sector partners:
- Simon Stevens provided an interesting take on the NHS five tear forward view. He committed to making greater efforts to improve the uptake of cancer screening programmes by learning disabled people in particular. When queried by us, he seemed very open to more community-based funding models which do not hinge on services but recognise and reward people directly for their contributions to health and social care and quality of life outcomes for example. He found it worth exploring further the potential of supporting people to pool their personal (health) budgets and whether there could be a ‘right to peer support’ to gain traction for a whole support infrastructure provided by peers which could become an integral part of commissioned care pathways and (as 30th right) also a tangible core part of the NHS Constitution.
- An update on the NHS Mandate informed us that the Better Care Fund of £3.4bn has been ring-fenced. Parity of mental and physical health will be particularly highlighted and there will be clearer expectations on access and waiting times for services such as Improving Access to Psychological Therapies (IAPT), Early Intervention and A&E. There was no reassurance on our question how services can generally be made more accountable towards people using those services, eg by linking payment to providers achieving minimum scores on patient-reported outcome and experience measures (PROMs/PREMs) or supporting the person to build greater social networks and social capital. No response was given as to how people with mental health problems could become more autonomous in making self-referrals in stepping up and down.
- There was lot of consensus on NHS England’s plans for shared decision-making, access to care records, accessible information standards and the information Standard – which all seek to empower patients and the public. However noble these goals and approaches are, local delivery in our experience is still very often prevented by GPs and other clinicians being immersed in agendas that have more money attached to them such as the ‘£5 per head’ (previous Vulnerable Older People’s Plan).
- A discussion with the Compassion in Practice team (at NHS England’s Nursing Directorate) revealed a considerable budget for the corresponding strategy but no clear signs to bring about greater compassion by co-production with people. Despite a recognition of ‘compassion fatigue’ being a grave concern (related to staff in practice for a number of years rather than newly qualified entrants), there do not seem to be any efforts to actually strengthen those aspects of care, support and treatments which are non-clinical and relate to engagement in order to prevent scandals such as Winterbourne View. Clearly, a lot could be gained by investing in co-production teams to deliver improvements over longer term projects (as opposed to one-off patient consultations). After a year, we have to conclude that we are not getting anywhere in making ‘compassion’ a joint venture with clinicians recognising patients as strong and visible partners on a daily basis. The same lessons apply to the more localised improvement programmes of ‘Productive Wards’ and ‘Releasing Time to Care’ – just as in the early days of personalisation, there are plenty of job descriptions for project managers which do not make any reference to acknowledging lived experience of any kind.
- The Integrated Personal Commissioning Programme is about the best you can get in terms of making space for people to direct health and social care services themselves. A call to CCGs has been made to CCGs and local authorities by NHS England to send expressions of interest by 7 November (see previous ‘further news’ in this section), and the particular element of this call is that a voluntary sector delivery partner is required – there are also different patient groups with complex needs which the proposed projects can focus on. Simon Stevens declared that this the IPC is an attempt for the first time to blend comprehensive health and social care funding for individuals, and allow them to direct how it is used. Disability Rights UK has informed and contributed to the Prospectus, the delivery plan for the IPC. http://www.england.nhs.uk/2014/09/04/ipc-prospectus/
Further news:
Progress on premature deaths of people with learning disabilities
The Department of Health has published a report that shows progress against the 18 recommendations in the Confidential Inquiry into premature deaths of people with learning disabilities both locally and nationally.
It also recognises that more needs to be done including all local areas:
- participating fully in the Self-Assessment Framework and act on its results
- securing the provision of named care co-ordinators
- ensuring reasonable adjustments are made and audited
We are involved in a number of related initiatives, including through our user-led consortium partner Change. To read the DH report, go to: https://www.gov.uk/government/publications/progress-on-premature-deaths-of-people-with-learning-disabilities
For more on the Confidential Inquiry, go to: http://www.bris.ac.uk/cipold/
National Conversation on Health Inequalities: event report
Public Health England’s (PHE) role is to protect and improve the public’s health and reduce inequalities. With the move of responsibility for public health from the NHS into local authorities there is a new opportunity for the public health system to work more effectively with local colleagues and leaders to act on those health inequalities.
The National Conversation on Health Inequalities is a Public Health England programme about reducing differences in health. The aim is for local authorities to start talking about health inequalities in their communities.
PHE has published a range of documents and a summary of discussions from sessions at the National Conversation on Health Inequalities event on 25 June 2014. The Win –Win Alliance has been part of these discussions. There is useful information on the challenges in reducing inequalities and the factors to be addressed. We have requested a particularly insightful presentation on the ‘wisdom of experience’ from a Sociology Professor from Lancaster University to be added to the following website:
https://www.gov.uk/government/collections/national-conversation-on-health-inequalities
NHS England moves towards integrated health and social care
NHS England and partners are inviting health and social care leaders to join a programme to build a new integrated and personalised commissioning approach for people with complex needs – see previous section on Strategic Partners days. The Integrated Personal Commissioning programme will, for the first time, blend comprehensive health and social care funding for individuals, and allow them to direct how it is used. Expressions of interest are being sought from the voluntary sector who will be a will be a key partner in designing effective approaches, supporting individuals and driving cultural change.
To read more, go to: http://www.england.nhs.uk/2014/09/04/ipc-prospectus/
People have a say on future of NHS
Lord Victor Adebowale, NHS England Non-Executive Director and Chief Executive of the social enterprise Turning Point, has talked about how the future of the NHS lies in it belonging to the people and designing services people understand requires them to be fully involved in decisions NHS England makes.
To read more, go to: http://www.england.nhs.uk/2014/08/29/victor-adebowale/
NHS England works to improve safety in hospital discharge
NHS England is developing a range of resources to help healthcare providers improve safety when patients are discharged from hospital. NHS England is welcoming views, including from the voluntary sector, on how the current process can be improved and looking for examples of successful local initiatives for improving discharge handover processes.
We have fed back a case study illustrating clear improvements from the point of view of a patient, with particular use of an extra time-limited personal budget paid out at discharge.
To read more and provide your own feedback, go to: http://www.england.nhs.uk/2014/08/29/psa-communication/
Consultation - Transparency in care: visible ratings for health and care providers
The Care Act 2014 will give the Care Quality Commission (CQC) the power to assess health and social care providers’ performance and give each a rating. These ratings are designed to improve transparency by providing service users and the public with a clear statement about the quality and safety of care provided. The ratings will also incentivise providers to improve services.
This consultation seeks views on draft regulations to make it a legal requirement for health and care providers rated by CQC to display their performance ratings.
The consultation closes on 13 October 2014.
For more information and details on how to respond to the consultation, go to: https://www.gov.uk/government/consultations/transparency-in-care-visible-ratings-for-health-and-care-providers
Response to Health Select Committee’s report on long term conditions
The Government has published its response to the Health Select Committee’s report into the care, treatment and support of those with long term conditions.
The response explains the measures in place to improve the care, support and treatment of those with long term conditions, including:
- improving personalised care and support, mainly through the house of care (HOC) approach
- guidance and tools for commissioners to implement and monitor HOC approach
- system changes to improve efficiency and patient outcomes
It makes interesting reading, capturing both some (mild) challenges and the Government’s direction of travel for the time being.For more information and to read the response in full, go to: https://www.gov.uk/government/publications/response-to-health-select-committees-report-on-long-term-conditions
European Antibiotic Awareness Day: key messages on antibiotic use
Held every 18 November, European Antibiotic Awareness Day (EAAD) is a day to encourage responsible use of antibiotics. PHE have published guidance on how to use antibiotics responsibly for patients, animal keepers and pet owners, and prescribers.
EAAD is part of the UK 5 Year Antimicrobial Resistance Strategy 2013 to 2018, which focuses on antibiotics and sets out actions to slow the development and spread of antimicrobial resistance.
Please see links below to access the guidance and respective press release.
https://www.gov.uk/government/collections/european-antibiotic-awareness-day-resources
Cabinet Office launches new £1 million fund to support family carers
Inspiring social action projects that support unpaid, family carers will be helped to grow through a new fund, worth up to £1 million, launched by the Cabinet Office’s Centre for Social Action. The Carers Social Action Support Fund is accepting applications up to 22 October from organisations with plans to create or develop ambitious social action projects that will help to improve the lives of carers. These are individuals who look after, unpaid, a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support.
For more information see https://www.gov.uk/government/publications/carers-social-action-support-fund