Report on the joint CSCI & Healthcare Commission Improvement Board for Learning Disabilities Meeting held on 20 November 2008

The main two items on the agenda for this meeting were as follows:

REPORT BACK ON "CUTTING THE CAKE FAIRLY"

his is a new report from CSCI and the full report and six background papers are available on www.csci.org.uk.

CSCI were asked to look at how councils could allocate services more fairly, i.e. they were asked to look at current eligibility criteria Their main findings were:

Fair Access To Care, which is the current process for allocating resources, is being interpreted differently across the country. Both the general public and staff within councils themselves find it difficult to understand Fair Access To Care at times.
Some councils still focus on "services" rather than on what people need.
Assessments are sometimes "service" led and this means that people's needs are not necessarily explored properly
There are inadequate assessments for people with long-term or fluctuating conditions and people with autism or people in transition.
Sometimes councils ARE trying to support people who don't meet their eligibility threshold because of their interest in people's welfare.

The overall conclusion is that the criteria for the allocation of resources is a secondary issue to the size of the cake which is inadequate in terms of meeting people's needs.

The report makes the observation that rationing should be set in the broader context of putting people first and that everyone should have proper one-to-one advice about their support needs.

It asks the Department of Health to think urgently about making one particular set way that all councils must use for determining resources to ensure that people with the same needs get treated the same in all parts of the country.

The report also recommends that councils should look at how they answer and make decisions when people first come to them to ask for help and that councils should make sure that people with special support needs, such as people with mental health needs, can access ordinary services.

The findings of the report will be fed into the Department of Health's work on the future of social care.

HEALTHCARE FOR ALL – SIR JONATHAN'S MICHAEL'S ENQUIRY

Fiona Ritchie from the Healthcare Commission fed back on this enquiry, which was ordered into general health services for people with learning disabilities. The review was an independent one.

The report found "appalling examples of discrimination, abuse and neglect across a range of health services". More specifically, the report found that people with learning disabilities often faced poor treatment, prejudice, discrimination and avoidable health risks due to a range of issues. A lack of awareness of health needs of people with learning disabilities across the NHS, including primary care, was found and, in addition, it was also found that health staff are not making enough "reasonable adjustments" under the Disability Discrimination Act.

There was evidence that access to treatment was being delayed because NHS staff did not recognise the symptoms early enough and a risk of harm was possible because information is presented to people with learning disabilities in a way that they cannot understand. The report also found that there is poor data on the needs of people with learning disabilities and a lack of appropriate training for staff.

In terms of the response from the Healthcare Commission (to be replaced by the Care Quality Commission in April 2009), the following proposals were flagged up:

To work with the Department of Health to add into core standards that providers must make reasonable adjustments to the provision and delivery of health services

To look at having specific performance indicators for acute care

To look at have Patients' Surveys that people with learning disabilities can participate in

To consider review on the health needs of people with learning disabilities