Times continue to be tough in mental health and learning disability services thanks to continuing funding cuts, but, as Learning Disability Today and Mental Health Today editor Dan Parton reports, there remains optimism for the sector.
When former Chancellor George Osborne announced in his 2015 Autumn Statement measures that gave councils the option to raise council tax by 2% to help fund adult social care, he hoped it would plug the funding gap in services. Those in the sector were more cynical – and they were right.
The social care precept was taken up by many councils, but as figures released in July from the Association of Directors of Adult Social Services (ADASS) annual survey of all 151 directors of social services in England found, this will generate less than two thirds of the more than £600 million needed to cover the cost of the new National Living Wage this year. As a result, there is a gap of about £940 million to fill just to keep social care services operating at last year’s levels, and only for the people who accessed services last year, according to ADASS. This doesn’t take into account all those additional people who may come to need social care in the next 12 months.
While the overall budget for adult social services has risanwhile, 62 councils needed to draw on reserves last year to fund budget shortfalls, while 52 had to cut services to balance budgets. This means that the problems facing the learning disability and mental health sectors are the same as in the previous seven or eight years: services are being cut back or axed altogether due to the effects of austerity, which has seen local authority budgets slashed by about 25% since 2010, and the rise in demand for services.
Cutbacks to services is a recurring theme. For instance, the need for autism-specific respite care has become so critical that social workers have been ‘begging’ for help to find emergency placements for people with autism in crisis, according to Wirral-based charity Autism Together. Robin Bush, CEO of Autism Together, said: “The lack of respite care in our region is a crisis in the making. We know there’s a shortfall nationally of nearly £1 billion in social care funding. We’re seeing this play out locally with the closure of a well-established, council-run respite provision.”
It is a similar situation in mental health services. For instance, the number of people with mental ill health sent out-of-area to a facility outside of the NHS trust area they live in – due to a lack of hospital beds jumped by 13% in the past year to nearly 5,500, according to data from 42 of 56 trusts, obtained by the BBC and Community Care magazine through Freedom of Information (FoI) requests. Worryingly, many children and young people are finding it difficult to access services at all – even if they have been recommended for it by a GP.
GP magazine Pulse used FoI requests to get data from 15 mental health trusts and found that 60% of referrals made by GPs to child and adolescent mental health services (CAMHS) resulted in the child receiving no treatment. In addition, a third did not have their needs assessed. Pulse’s figures seem to indicate a worsening picture of access CAMHS: in 2013, 44% of referrals by GPs progressed to treatment, but by 2015 only 39% did. GPs that spoke to Pulse also reported that children and young people had to have self-harmed or attempted suicide before they were given access to treatment. When GPs have requested specialist input, many children and young people were being diverted to charities or school counsellors.
New approach – little progress
There had been improvements in some areas, such as waiting times: only 35% of respondents in 2012 were able to access treatment or support within four weeks, but nearly 55% did so in 2015. In England, the introduction of the new special educational needs and disability (SEND) system two years ago was supposed to simplify the system and make it easier for children to get the support they need. But a report by the National Autistic Society (NAS) found that, two years on, parents are having to fight just as hard and often not getting the right support from local authorities and the NHS. Surveys by the NAS of about 1,000 parents, carers and autistic children and young people found that 74% of parents said it has not been easy to get the educational support their child needs. In addition, 69% said their child waited more than a year to get support after parents or teachers first raised concerns, and 16% waited more than three years. While 50% of parents said they’re satisfied with their child’s SEND provision, just 33% were satisfied with healthcare and 30% with social care.
Causes for optimism
But despite the problems in the sector, there are positives. For example, work has begun on transforming mental health services. In July, ‘Implementing the Five Year Forward View for Mental Health’, was published, which outlined the changes people will see on the ground over the coming years in response to the Mental Health Taskforce’s recommendations to improve care.
The report details how new funding, pledged in response to the Five Year Forward View for Mental Health, rising to £1 billion a year by 2020/21 in addition to the cumulative £1.4 billion already committed for children, young people and perinatal care, will be made available for clinical commissioning groups year-on-year.
Initially, four areas will see action to improve services. Firstly, there will be £72 million investment over two years to better integrate physical and mental health services. In addition, a new £1.8 million pilot will test new approaches to delivering mental health care, including putting budgets in the hands of local providers and commissioners to drive the design of new approaches to delivering secure mental health services and children and young people’s mental health services. There will also be plans for how the £365 million allocated for specialist perinatal mental health services over the next five years will help 30,000 more women per year. Finally, there will be a £12 million roll-out over next two years of liaison and diversion services, for people with mental health needs in the court system or police services. Services will be available nationwide by 2020.
In addition, in August, local plans to transform care for people with a learning disability and/or autism were published, backed by millions of pounds of funding. The plans are the latest stage in delivering the reforms set out in ‘Building the right support: A national implementation plan to develop community services and close inpatient facilities’, published in October 2015 by NHS England, the Local Government Association and ADASS. Here, 48 local Transforming Care Partnerships (TCPs) – made up of people who use services, their families, service providers, clinical commissioning groups, local authorities and NHS England specialised commissioning hubs – are tasked with taking forward these intentions and designing new, high-quality, community-based services that reflect the wishes and circumstances of local residents. The first awards from a £30 million, three-year NHS England revenue fund to help TCPs where there is a need to speed up the delivery of new services have now been finalised. NHS England has also confirmed that £100 million of funding will be available over five years to support Transforming Care projects – up from the £15 million announced at the time of Building the right support.
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