The Care Quality Commission’s Annual Report ‘The State of Care’ has been published today, offering us the CQC’s latest assessment of health care and social care in England.

Access details of the report, view the Press Release launching it , and download the Summary and Full Report from this page on the CQC website.

A key finding of the report is that “a better system of care is needed for people with a learning disability or autism who are, or are at risk of, being hospitalised, segregated and placed in overly restrictive environments”.

The CQC calls the current situation unacceptable.

Its report describes that situation as follows:

Some people are struggling to get access to the mental health services they need, when they need them.

This can mean that people reach a level of ‘crisis’ that requires immediate and costly intervention before getting the care they need, or that they end up in inappropriate parts of the system.

Too many people with a learning disability or autism are in hospital because of a lack of local, intensive community services.

We have concerns about the quality of inpatient wards that should be providing longer-term and highly specialised care for people.

We have shone a spotlight this year on the prolonged use of segregation for people with severe and complex problems – who should instead be receiving specialist care from staff with highly specialised skills, and in a setting that is fully tailored to their needs.

Since October 2018, we have rated as inadequate 14 independent mental health hospitals that admit people with a learning disability and/or autism, and put them into special measures.

This is an unacceptable situation. A better system of care is needed for people with a learning disability or autism who are, or are at risk of, being hospitalised, segregated and placed in overly restrictive environments. We must all work together to make this happen.

We also know that people with the most severe and enduring mental ill-health do not always have access to local, comprehensive rehabilitation services and are often in inappropriate placements far from home. This weakens support networks and the ability of family and commissioners to stay in close contact, sometimes with devastating consequences.

We are seeing issues with the availability of care. There has been a 14% fall in the number of mental health beds between 2014/15 and 2018/19. While this is in line with the national policy commitment to support people in the community, it is vital that people in crisis can access support when needed.

All of this is underpinned by significant issues around staffing and workforce.

Our inspectors are seeing too many mental health and learning disability services with people who lack the skills, training, experience or clinical support to care for patients with complex needs. In the majority of mental health inpatient services rated as inadequate or requires improvement since October 2018, the inspection reports identified a lack of appropriately skilled staff as an issue.

Just received: a press release from the LGO, who is so concerned at the percentage rise in complaints about EHCPs, and in the proportion of complaints he upholds, that he has issued a special Focus Report on the failings of the SEND system.

“Children with special educational needs and disabilities are increasingly being failed by the system designed to support them, the Local Government and Social Care Ombudsman has found.

In its latest report about the Education, Health and Care (EHC) plan process, the Ombudsman has revealed it is now upholding nearly nine out of every 10 (87%) cases it investigates – a startling figure compared with its uphold rate of 57% across all cases it looks at, discounting SEND cases.

The new report, ‘Not going to plan?’ looks at the common problems the Ombudsman is finding when investigating parents’ concerns. Serious issues include severe delays of up to 90 weeks – and regularly of more than a year – when issuing a plan, not anticipating local needs, communication and preparation for meetings, and a lack of oversight by senior staff.”

Full details here: www.lgo.org.uk/information-centre/news/2019/oct/a-system-in-crisis-ombudsman-complaints-about-special-educational-needs-at-alarming-level   and in the report itself,  downloadable as a PDF via a link on this web page.

The report is only 29 pages long  Read especially the Ombudsman’s Foreward from which this is an extract:

“… a system beset with serious problems, including:

> Severe delays – of up to 90 weeks but regularly more than a year
> Poor planning and anticipation of needs– such as council areas simply without any specialist provision available to them
> Poor communication and preparation for meetings – including regular stories of nonattendance and no, or insufficient, paperwork submitted
> Inadequate partnership working – with EHC plans regularly issued without advice from health or social care services
> Lack of oversight from senior managers – cases ‘drifting’ needlessly and attempts to farm out responsibilities to parents”

One particularly concerning development over the last two years has been examples we’ve seen of councils putting up additional barriers to services in efforts to ration scarce resources.
While sympathetic to the severe financial constraints which councils tell us they are working under, we can never accept this as an excuse for failing to meet the statutory rights of children.”

Also worth noting is the concluding section entitled “Scrutiny and the role of councillors”  where the ombudsman, Michael King, lists the questions that councillors should be asking  about their local authority (and, by implication, have not been asking).

Published today, the Local Government and Social Care Ombudsman’s Annual Review provides an overview of the state of adult social care, confirming what many people with learning disabilities, and their families and carers, will  know through personal experience.

As the Ombudsman Michael King puts it ” The challenging picture we see played out in the media on an almost weekly basis is very much reflected in the types and seriousness of the complaints we receive and the faults our investigations put right. Many of the issues we see appear to be driven by attempts to ration scarce resources, and we received and upheld more complaints about fees and charging this year than in previous years. While I recognise the challenging environment both commissioners and providers are operating within, any attempts to reduce costs must also properly consider the impact on the rights and dignity of people who use services, and must comply with both the letter and the spirit of the Care Act 2014″.

The Review is always worth a look. If nothing else, read the Ombudsman’s 2-page forward. Or follow the links and dig down to the league table spreadsheets – to see how any  particular local authority has performed with regard to complaint-handling.

Following the publication of the Care Quality Commission’s “Thematic Review of Restrictive Practices, Seclusion and Segregation”, Minister Caroline Dinenage has now issued a written statement on behalf of Department of Health and Social Care.

She begins with the following statements:

“The Government has made improving the care and treatment of autistic people and people with a learning disability a priority. Society is rightly judged on the way it treats its most vulnerable citizens.

In November 2018, the Secretary of State for Health and Social Care made a statement to the House of Commons following the reporting of the case of Bethany, a young autistic woman who was held in seclusion in hospital for too long.

Like everyone across the House, I have been moved by these individual cases and personal stories. I do not believe this is just about a few individual cases where things went wrong; this is about a system. A system across health, education, social care and criminal justice that needs to change.“

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“First of its kind autism centre aims to dramatically cut diagnosis waiting time”

This is the headline today on Sky News introducing an article on the opening of an autism diagnosis centre in Keele, Staffordshire.

The headline above an article in the ‘i’ newspaper (sorry, I can’t find it online) reads “Children’s Centre will end autism postcode lottery”.

The NAS has long highlighted  the twin problems affecting the diagnosis of autism in children;  the postcode lottery and long-waiting times. (As a parent, I have had personal experience of both). The ending of  a postcode lottery and dramatic cuts waiting times are admirable intentions, and we wish the Caudwell International Children’s Centre (CICC) all the best in these ambitions, although we note that the project is not without controversy

In the absence of  public funding, a private individual, John Caudwell, billionaire founder of Phones4U, has  paid for most of the development as an act of philanthropy. In 2017, when he initially pledged £9 towards the cost of the centre, he and his charitable foundation were criticised by some for espousing and supporting too many ‘alternative  and  non-scientific therapies’, notably in article by The Times’ Science Correspondent.

We hope and assume that the fact that the CICC is located within Keeele University means that academic and scientific rigour will be applied to its operation. We will await developments…

This is how the CICC announced the opening on its website:

The Caudwell International Children’s Centre (CICC)

The Parliamentary Joint Committee on Human Rights (JCHR), having initially launched a wider inquiry into the detention of young people, is now conducting two separate, more focused, and inter-related inquiries into the detention of people with learning disabilities and or autism in mental health and NHS inpatient facilities.

To quote  the JCHR website:

• “As a result of evidence arising from its inquiry into youth detention: solitary confinement and restrain, the Committee has taken evidence on the inappropriate detention of children and young people with learning disabilities and/or autism in mental health hospitals and the threat that such placements pose to their human rights.”

• “As part of its inquiry into detention, the Joint Committee on Human Rights will hold two evidence sessions about the treatment of people with learning disabilities and autism in Assessment and Treatment Units (ATUs) and other inpatient units.”

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The Care Quality Commission (CQC) has just published ‘The State of Care 2017/18‘, its annual assessment of health and social care in England. The report ‘looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve’.

You can find links to the report, plus a summary and an easy read version on the CQC’s introductory webpage.

Obviously, the report covers an awful  lot of ground and topics. Almost every reference to learning disability is accompanied with an observation on ‘room for improvement’.

The most relevant sections relating to learning disability are on page 48 and page 111 of the report (See extracts below). Having read these, and seen some of the statistics cited, you may think that the report understates the deficiencies in health and social  care for people with learning disabilities.

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Further to our feature article on Learning Disability, Health and Obesity , and specifically our  reporting on Public Health England events in August and October.  Speakers from Public Health England (PHE) were keen to emphasise that people with learning disabilities and/or autism should be able to access those services from the NHS to which they are entitled (e.g. annual heath checks, flu vaccinations, eye tests etc.); and that they and their carers should expect NHS staff to make reasonable adjustments in order to provide those services.

PHE has now (Oct 11th 2018) published a ‘Collection of Guides to Reasonable Adjustments’ on GOV.UK. The webpage is entitled ‘Reasonable adjustments for people with a learning disability‘. This centralisation of available information seems an eminently sensible thing to have done, at last!

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Received in today, an email from the Petitions team at Parliament:

Dear xxxxxx,

Parliament debated the petition you signed – “Prevent avoidable deaths by making autism/learning disability training mandatory”

Watch the debate: https://parliamentlive.tv/Event/Index/b10b5496-54a6-4262-bb54-5c74ec58eedf

Read the transcript: https://hansard.parliament.uk/commons/2018-10-22/debates/F8EBB4E2-C858-4B5B-B2E0-39D0C25EAA4C/AutismAndLearningDisabilityTrainingHealthcareProfessionals

Read the research: https://www.parliament.uk/business/committees/committees-a-z/commons-select/petitions-committee/news-parliament-2017/autism-training-22-10/

The petition: https://petition.parliament.uk/petitions/221033

Thanks,
The Petitions team
UK Government and Parliament

It is actually worth looking particularly at the transcript of this Westminster Hall debate. The debate may not have been well attended (to judge from the TV images), but those attending were knowledgable of  and/or interested in the issues raised.

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The Mental Capacity (Amendment) Bill is proceeding through Parliament. Following upon the DoLS crisis, about which we  posted and wrote extensively in recent years, the Bill’s primary purpose is to replace the Deprivation of Liberty Safeguards (DoLS) with the Liberty Protection Safeguards (LPS) proposed by the Law Commission’s Review.

Last week Rescare received email alerts on a Committee Stage debate in the House of Lords, in which speakers with expert knowledge of the issues and an interest in learning disability, such as Baroness Hollins, voiced their concerns over assessments of capacity by care providers and ‘registered managers’, and over the introduction of  inadequately defined terminology, especially ‘unsoundness of mind’.

The Hansard transcripts of the Lords debate, and  background information on the contents  and intention of the the Bill are available here on the Parliament website.

If you require a thorough anaylsis of  the Mental Capacity (Amendment) Bill, comprising ‘a series of perspectives’ written by barristers expert in mental capcity law, we can recommend the Special Report available on the 39 Essex Chambers website …

But also. to coincide with the Lords Committee Stage debates, a consortium of organisations with shared concerns about the Bill published  a more concise press briefing, which we think is worth reproducing here in full – since it outlines clearly the most controversial elements of the Bill.

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