Tag Archives: local government

Disability, Health, Learning disability, Social care, Uncategorized, Young people

Why did Connor Sparrowhawk die in a specialist NHS unit?

1 Comment

Connor Sparrowhawk (photo: Sara Ryan)
Connor Sparrowhawk (photo: Sara Ryan)
The death of 18-year-old Connor Sparrowhawk at Slade House assessment and treatment unit was avoidable, according to a recently published report. What happened to Connor, who was admitted to the specialist care in Oxfordshire a year ago today, has reignited debate about the use of these units – Winterbourne View was a privately run unit where the abuse of patients with learning disabilities was exposed by BBC’s Panorama in 2011.

The full piece I wrote for today’s Guardian is here – please read it alongside the words of Connor’s mother, Sara Ryan, who describes the fight for justice for her son.

From today for 107 days (the length of time Connor was in Slade House), there is a campaign to raise awareness of what happened to Connor. Building on the palpable sense of anger and injustice, it is hoping to push for action.

You can follow the campaign on Twitter @JusticeforLB #JusticeforLB. Connor’s mother’s blog is here.

I’m posting some additional contributions from a few interviewees here as there wasn’t space in the published piece.

Sandie Keene, president of the Association of the Directors of Adult Social Services, stressed the fact that it’s not just social care commissioners who are responsible for the continued use of units like Slade House:
“Commissioning these days is a complex environment [it’s within] NHS England, clinical commissioning groups, social care commissioning.” Keene adds that the solution is partly “to find better ways of cascading the best practice”.

Mark Neary won a legal fight to get his autistic son, Steven, out of the kind of care Connor was in. He explained what these units are like for individuals and families: “After Steven’s experience in an assessment and treatment unit where he was unlawfully held for the whole of 2010, I question what the purpose of these places is. In our case, the judge remarked about the lack of assessment when Steven was first taken there and there didn’t appear to be any treatment taking place. The unit appeared to me to be a holding container. And a very expensive holding container at that. The other aspect of the unit that shocked me was how much families were excluded. On a major medical document, I wasn’t even mentioned as Steven’s next of kin – his keyworker at the unit was. To have my whole 20 years experience of Steven negated was quite terrifying. And worst of all, it must be awful for the person detained there to be cut off from the people who have cared for them all their life. Steven has autism. Does that need treatment? And even if it does, is it good for a person for whom routine is everything to be kept in one of these places?”
* You can read Mark’s blog and his stories of his son’s time in an assessment and treatment unit

Jenny Morris, an independent consultant who advised the previous government on disability, puts the lack of progress on moving people out of units and into the community down to two things: “There are negative attitudes in society in general toward people with learning disabilities plus ignorance or lack of understanding about how denying people the ability to communicate their needs, and failure to meet their needs, leads to “challenging behaviour. When things go wrong the response is to write new or updated standards and codes of practice etc instead of paying attention to how to recruit, retain and value people who can – because of their values – provide good care and empower people. If we paid more attention to the characteristics of people who provide good care, plus how to support them with training and good working conditions etc, and less to problematising the needs of people with learning disabilities we might not see the kind of institutional disablism that persists in so many services.”

A senior contact, who didn’t wish to be named but who runs a large care organisation, talked about the closure of long-stay hospitals and how what’s developed in their place is almost as bad: “We closed closed them and some pretty similar things have replaced them. The policy context for working with people with challenging behaviour has been clear for over 20 years..the best way to develop servives for people with challenging behaviour is individualised services around the person and it needs to be small scale local and in the community. It has been out there [ie known about and practised by the best care providers] for years, but seldom happens.”

I interviewed Katrina Percy, the chief executive of Southern Health, which ran the now-closed unit that Connor was in. Southern was criticised in an independent report into Connor’s death and is currently being investigated by health regulator Monitor.

Asking why units like Slade House exist, I mentioned the buck passing that families feels goes on between ‘stakeholders’ – with commissioners of services and clinicians complaining about the lack of community-based alternatives, and service providers for people with learning disabilities suggesting commissioners don’t know about, or cannot afford, existing alternatives. Percy replied: “I feel it’s got to be a joint piece of work, so often the experts [who sit on commissioning boards] come from our organisation, but the commissioners need to make the decision that they wish to commission this new [community-based] model of care”.

I asked if concerned the trust is worried about losing its healthcare licence given the critical reports (the report into Connor’s death and inspections by the care sector regulator, as the piece today explains). Percy responded that she did not know about a potential breach of licence, but said the trust had been in discussion with Monitor and “the organisation overall has an awful lot of strengths”. She added: “One of the hardest thing in my job is about enabling focus where things go wrong, but not allowing that to pervade a very big organisation where lots of things go very right [where] in fact we’re seen as leading edge and my job as chief exec is to absolutely make sure that we get that that balance and prioritisation and focus right.”

On the calls for her resignation, Percy replied that she would like to “meet the family and talk to them directly so they actually see what I’m like as an individual and as a chief executive.” She added: “There are many things we are very proud of in this organisation and we provides services to millions of people and therefore I think my best place is to help us continue to improve services for every single person who needs to use them.” Asked to clarify, Percy replied: “I don’t see that it’s approporiate that I would resign, no.”

Responding to what she would say if she met Connor’s family, specifically his mother Sara Ryan, Percy said: “I would apologise unreservedly that her son and her family were let down by our services…I would ask her when she feels ready, if that is what she would like to do, to continue to campaign and work with us to design a set of services where this will never happen again.”

* Seven members of staff who worked at the now-closed Slade House are subject to a “human resources investigation”, with the first disciplinary hearing due to take place this month. In an email after the Guardian piece went to press, Southern Health confirmed “three members of staff have been suspended”.

Cuts, Disability, Health, Learning disability, Local government, Third sector, Uncategorized

Ordinary residence, extraordinary mess

“Disabled people in residential care who want to live more independently are being prevented from doing so by funding wrangles between local authorities” – that’s taken from a piece I wrote three years ago, but since then little has changed.

The original piece is on the Guardian website:

"Caught in a trap: disabled people can't move out of care", The Guardian October 2010
“Caught in a trap: disabled people can’t move out of care”, The Guardian October 2010

Here’s the mess: an individual’s “ordinary residence” is usually in his or her original local authority area, so if a council places someone in residential care outside the area, it remains financially responsible.

But when someone decides to move from that residential care in the new area into supported accommodation within the same (ie “new”) area, their original authority argues that it is no longer responsible for funding. However, the new authority – where the person actually lives – argues against funding someone not originally from the area. The result – limbo.

Confusing? Not really, what it boils down to is that councils are passing the buck over people’s care, effectively dictating where people should live -and all the while, individuals themselves appear to have no say. And quibbling over the care bill will only get worse as local authority cuts continue to bite.

I’ve been involved in a piece of work published today by social care organisation Voluntary Organisations Disability Group. The VODG has previously demanded action to resolve such ordinary residence dilemmas and, this time, it argues that the Care Bill offers ample opportunity to finally tackle the challenge. The new briefing, Ordinary residence, extraordinary mess, is available from the VODG website, with this post outlining how the situation has become “business as usual” in many areas.

One way forward, which the bill could accommodate, is strengthening the duty on local authorities to cooperate with providers and with each other to prevent delays in funding when people want to move from one care setting to another. The Epilepsy Society, for example, which contributed to today’s publication, estimates that in the last three years it has covered gaps in fees totalling £350,000 and “staff time involved in chasing fees over the same period has amounted to approximate 340 days across all departments including senior and service managers, finance and administrative staff”.

Here’s just one story from today’s publication, from a social care provider in central England:
“Joe moved out of residential care into supported living accommodation nearby, run by the same charity provider. Council A, where Joe is now ordinarily resident, is refusing to take over funding from Council B which had previously paid his out of county residential care fees. Some 14 months later, the social care provider (a medium sized charity) is owed nearly £50,000 from Council A for this one client. Members of the charity’s finance team chase Council A each week and include copies of previous correspondence and agreements. Council A continues to delay payments, giving the provider different reasons for not paying and passes the query around different council departments. The charity has continued to provide care and covered this gap in fees.”

While the powers-that-be seem unwilling to either acknowledge the scale of the problem or indeed have the confidence to untangle the mess, vulnerable people across the country remain in limbo, unable to move to the place of their choice because of bureaucratic wrangles.

As Anna McNaughton’s mother told me three years ago: “All Anna wants is to live in a suitable home – it’s a basic human need, not a luxury.” It’s a desperate situation that three years on, her words still have the same resonance.

Journalism, Local government, Race, Uncategorized

Comment is free

Hello all, briefly highlighting my words posted in the comments thread under my Guardian interview last week with the Muslim mayor of Tower Hamlets council, Lutfur Rahman.

I’m re-posting my comment here for clarity given there were around 140 responses last time I looked.

“Thanks if you’ve read and commented on this piece. As many of you know, it’s written for the SocietyGuardian interview slot, which has a particular format and tone and if it was an investigation or piece of long-form journalism, it would have been tagged as such. 
The aim, mentioned early on, is to push aside the mutual mudslinging, hype and hate, and look specifically at whether or not aspects of the latest budget stack up long term – essentially, can the council balance its books? The piece doesn’t set out to repeat or re–explore the well–documented allegations and criticisms which are available to read in other places:
‘Is it time that Tower Hamlets, a political morass and England’s third most deprived authority where half the 250,000 residents are from black and minority ethnic (BME) backgrounds, mostly Bangladeshi, be looked at afresh?’
While it’s not possible to include or analyse every element of spending or cuts in 1200 words, the piece ultimately disputes Rahman’s claim of fireproofing the frontline and his divisive nature, outlined at the start, is reflected by many of the responses here.”

Here’s a comment from my editor in the same thread:
“As the editor of the Society section I commissioned Saba to interview Lutfur Rahman, about the plans he had in place to try to protect public services in Tower Hamlets from huge spending cuts. He seemed to be taking a very different approach to councils such as Newcastle, whose leader we profiled a couple of weeks earlier. The interview was intended to explore Rahman’s approach by giving him a chance to put his case and to assess whether or not his plans were viable.
I appreciated that he is a divisive figure for various reasons outlined in the interview – such as alleged links to Islamic fundamentalist groups which he has has repeatedly and categorically denied – but the purpose of the interview was not to focus on this aspect of his leadership which has been the subject of TV documentaries and countless column inches, but to focus on his policy initiatives. I feel that it achieved this, as some of you have acknowledged in your comments.”

If you’re interested in reading more, try this, on the Telegraph website, which leads on from the comments thread and outlines issues not included in the Guardian piece. These issues weren’t included for the reasons stated in the piece itself and in the two responses above.

More background, history, facts, detail as well as conjecture from all parties involved – journalists, commentators, residents, Rahman’s supporters, his opponents and politicians of all hues – is easily found via a quick Google search.

Finally, there are a couple of links here and here (specifically the section marked footnote on the second link) by other writers who have felt compelled to clarify their reporting of and interviews with Rahman.

Happy reading!

Health, Local government

Prevention, partnership, proofing against the future

With less than six months to go before councils adopt responsibility for public health from the NHS in April 2013, much depends on successful collaboration between cross-sector agencies.

As the date approaches, the latest Guardian public health seminar gathered together an expert panel and audience of 50 stakeholders to discuss the changeover. The debate focused on partnership between the public and private sectors and barriers to integration. Read the rest of my piece on the Guardian website.

Employment, Local government, Women

Unemployed to enterprising

Maria Ellingham had not worked full-time for a decade after having children. She then became a single parent who had the will to work but lacked the way. She was a qualified reflexologist and wanted to set up her own business, but she needed to find the confidence and to learn the skills of self-employment.

Yet in July, two months after taking part in a council-commissioned scheme, Ellingham launched her own reflexology business. A former account manager at a cosmetics company, she is among 54 people helped into employment or self-employment through Central Bedfordshire and Bedford borough councils’ building enterprising communities scheme.

Read more about the scheme to help people off benefits and into self-employment offers lessons for all service contracts on the Guardian local government network.

Maria with her children in her treatment room

Cuts, Disability, Health, Housing, Learning disability, Local government, Older people, Social care, Uncategorized

Sticking plasters, surgery and spending reviews

A damp squib of a sticking plaster, or what health secretary Andrew Lansley has said is the “most comprehensive overhaul [of social care] since 1948” and an end to the care lottery?

Most early reaction to today’s long awaited care and support white paper and its associated draft bill is firmly on the side of the former view.

I’ve yet to read all the detail, but while there’s a much-needed focus on elderly care, there’s not enough of a recognition for other sections of society needing care and support, and nothing to plug the funding gap.

As Merrick Cockell, chairman of the Local Government Association, told Radio 4’s Today programme this morning: “We haven’t got time to tinker around…We’ve got to look at radical change.” The LGA has said there is a £1.4bn gap this year between the money available and the cost of maintaining social care services. There’s a good run down of the council perspective on the LGC website and while this post from Ermintrude2 was written before the publication of the white paper, it’s a really good explanation of the issues.

While today’s announcement picks up some from the Dilnot report (Dilnot suggested a system for the elderly where the total cost of care would be capped to £35,000 and support to old people should be extended to those with assets of £100,000), any “victory” for common sense and civil society is bittersweet because it fails to lacks the cash to make real far-sighted change a reality. The proposals might well show good will, but there’s no financial way (this communitycare.co.uk piece relates to the vision for social work, which could be undermined by the lack of cash).

It is, as shadow health secretary is quoted in the Guardian’s politics live blog as saying, “a pick and mix approach to the Dilnot package”. So the government hasn’t taken up the “once in a lifetime opportunity” that Dilnot mentioned when he launched his vision of how to fix the social care system.

Among today’s main points are plans for an optional social insurance scheme under which people pay the government premiums to ensure that their costs for care and accommodation are capped, and a “universal deferred payments” system where councils lend money to those needing care, then recover the cash when the house is sold after death. Sound sensible – perhaps even familiar? That’s because it’s already in use – around 9,000 people already used deferred payments.

Today’s government press statement suggests we watch this space: “The government will continue to work with stakeholders to consider in more detail variants under the principles of the Dilnot commission’s model, before coming to a final view in the next spending review.”

Having already waited with bated breath for today’s long overdue white paper and draft bill, it’s unlikely that many will hold it much longer.

Here’s a flavour (by no means a comprehensive round up) of reaction on Twitter and the web to today’s social care white paper:

Richard Humphries, senior fellow at the King’s Fund: “There is a financial vacuum at the heart of these proposals which undermines the bold and ambitious vision for a reformed system set out in the White Paper.”

Julia Unwin, chief executive of the Joseph Rowntree Foundation: “Successive governments have failed to act. Without a sense of urgency more of us face insecurity and uncertainty as we age. The failure to address social care properly will only mean more pressure on the NHS thereby destroying all hopes of a sustainable and functioning health system in the future.”

Clare Pelham, chief executive of disability charity Leonard Cheshire Disability: “It is a question of fundamental decency that disabled and older people should be able to live their lives with dignity in Britain in the 21st century. We hear a great deal about the need to support older people through dignified social care, but it is important that the needs of younger disabled people are not overlooked.”

Mark Goldring, chief executive of Mencap:”The social care system is in crisis. Years of underinvestment and cuts to services have left one in four adults with a learning disability literally stuck in the home, isolated and at risk, with family carers at breaking point and scared about the future…We are reassured to see that the Government has committed to fund immediate reforms, but this promising blue print will never get off the ground if it fails to address the chronic underfunding in social care. The Government cannot delay any longer, and must now outline an urgent plan of how it intends to fund social care reform in the long term.”

Carers UK chief executive Heléna Herklots: “The measures set out in the draft Care and Support Bill would move from piecemeal carers’ rights legislation to the establishment of carers’ rights in government legislation and, for the first time, equalise carers’ rights with disabled people rights…But to make these rights a reality, what carers also need is a social care system with the resources to overcome years of chronic underfunding and rapidly growing demand. Those who face soaring care bills, service cuts and a daily struggle to access even basic support from the social care system, may see new rights in legislation as empty promises without the funding to back them up.”

David Orr, chief executive of the National Housing Federation: “We’re pleased the White Paper recognises that housing is crucial to the integration of health and social care, and welcome the investment to build more supported housing for older people and younger disabled adults…We need a health service that invests in services that keep people out of hospital, not one that simply treats them when they get there….the Department of Health needs to encourage local government and the NHS to pool budgets, focus on housing-based preventative services and set out its full proposals for the funding of social care – for today and for tomorrow.”

Nick Young, chief executive of the British Red Cross: “That the Government is accused of failing to address the social care crisis is no surprise. The scale of the funding problem is enormous and growing. It will take courage, creativity and tremendous degree of political will to solve. That isn’t going to happen overnight.”

Reaction on Twitter using hashtags #carewhitepaper, #ukcare and #carecantwait (also check out ‏@sim89 Storify‬ compilation of early responses):
‏

@ageuklondon Though it contains some good ideas, the #carewhitepaper doesn’t go far enough. The problem of care will not go away and is getting worse!
‏@Sensetweets Deafblind people continue to be abandoned, as funding fails to materialise – our response to the #carewhitepaper
‏@TonyButcher #carewhitepaper – like excitedly looking forward to your birthday but then only getting a cheap pair of Primark socks – disappointing
‏@gary_rae If this is a “watershed moment” for #ukcare then we’re clearly drowning. #carecantwait #dilnot
‏@Marc_Bush Care crisis demanded decisive action. Today we got a holding statement…’ @scope rspnd 2 @DHgovuk ‪#carewhitepaper‬ http://tiny.cc/scopetocare
‏@WoodClaudia focus on deferred payments in ‪#carewhitepaper‬ due to absence of other funding ideas. It is option for some, not THE solution being proposed
@Ermintrude2 Disappointed that headlines about #carewhitepaper all seem to concentrate on selling houses to pay for care. System about so much more.

Disability, Health, Local government, Social care, Third sector, Uncategorized

“People aren’t cases, they’re individuals”

Debbie Walker is “a guardian angel”, according to Julie Mason, whose 86-year-old mother, Elizabeth, has Alzheimer’s.

Two years ago, when Walker, a Sheffield Council care manager, met them, Elizabeth’s care involved daily agency staff plus Julie and her sister as unpaid carers. The family felt Elizabeth lacked choice and control, spent a lot of time with nothing to do and had little social interaction. Read the rest of my piece on how one council is letting external organisations lead on support planning on the Community Care website.

A support planning session at Sheffield city council (pic: Sheffield city council)
Cuts, Local government

Local government finance: sailing into the perfect storm

Government is passing down an unprecedented austerity drive to local government. In the perfect storm of cuts, rising unemployment and ageing population, the budget failed to throw much of a lifeline to local government.

But as the Treasury resigns councils to choppy financial waters for longer than predicted, how far have authorities grasped the notion of prolonged austerity? Can they handle what needs to be done long term and to put it bluntly, how bad can it get?

Read the rest of my piece on the Guardian’s Local Government Network.

Cuts, Housing, Local government

Housing ambitions: 30-year plan for London’s biggest council landlord

It is the biggest council housing landlord in London and the fourth largest in the country. With 39,000 rented and 16,700 leasehold homes, a 19,000-strong waiting list and almost 15,000 properties needing repair ( “non-decent”, 2010 figures) the scale of Southwark council’s housing challenge demands a radical response. Housing barrister Jan Luba is to chair a pioneering study into housing need and policy – but will the council listen to it? Read my the rest of my piece on the Guardian website here.

Cuts, Education, Employment, Housing, Local government, Refugees & asylum, Social care, Social exclusion

Stephen Greenhalgh: localism hero or demolition man?

Stephen Greenhalgh is hated and feted. To Labour, he is a tyrant for keeping council tax low at the expense of frontline services in the west London borough he has led since 2006. To the Conservatives, he is a town hall trailblazer, praised by the communities and local government secretary, Eric Pickles, who describes Hammersmith & Fulham council as “the apple of my eye”.

Greenhalgh has perhaps baffled both parties by announcing he is to quit the leadership for the council backbenches in order to help steer a pilot community budget in White City, a deprived area of the borough. Rumour had him in line for a peerage. Read the rest of my interview with Stephen Greenhalgh in the Guardian’s Society pages.