Healthwatch shortchanged: I am Jack’s complete lack of surprise

News from Healthwatch England today that:

around a quarter of the £43.5 million made available by the Department of Health to fund local Healthwatch has failed to materialise in local Healthwatch accounts.

Collectively the 148 local Healthwatch organisations have received £10 million less than was outlined in the budget by the Health Secretary

The money has either gone missing when it was allocated to DCLG to give to local authorities, or when local authorities themselves allocated it to local Healthwatch.

I’d love to say this was a one-off, but unfortunately it’s not. I previously pointed out:

although £27m was allocated for LINks, Councils only spent £24.3m of it on LINks – they effectively creamskimmed 9% off the budget

and concluded there was “no guarantee they won’t do the same for local [Healtwatch]”. Sure enough, that’s what’s happened.

There will be talk of “commissioning and procurement” costs, as well as “building” and “other overheads”, but that’s all crap, and local government* / DCLG will know it.

Two things really stick in the craw about this:

  1. Healthwatch is a statutory requirement. If this is being done for something that’s legally required, what the heck is being done to things that don’t have the same underpinning (such as advocacy?)
  2. Notwithstanding the overall very difficult financial climate, local councils often get support to meet their own statutory requirements. For example, they were given £11.3m in 2013/14 to collect new information regarding adult social care services (itself more than the amount local Healthwatch are missing).

As I tweeted:

What a load of bollocks.

(Original news via HSJ)

*I am actually a fan of local government, but sometimes it really doesn’t help itself.


Closing the Gap in mental health – four observations

Four quick observations on the publication of Closing the Gap: Priorities for essential change in mental health (pdf).

1. It’s good to see it published and it’ll be a useful document to refer to.

2. The significant changes needed will come about only through an alliance of everybody affected by the mental health system, from both the top down and the bottom up. The target audiences explicitly identified in the document miss one half of this equation by not including people with mental health problems, their (representative) organisations or families/carers.

3. As @shaunlintern over at HSJ highlighted, the focus on parity in mental health is a sham when NHS England and Monitor have cut the 2014/15 tariff price for mental health (and community) services by a fifth more than the reduction proposed for acute providers

4. The signatories to the policy are Nick Clegg and Norman Lamb. No Jeremy Hunt, in his role as Secretary of State for Health, or (perhaps more noteworthily) as a Conservative. Are the Lib Dems looking to claim mental health as their own ahead of 2015?

Examples of not #coproduction

In what is an otherwise good document, the latest version of the Adult Social Care Outcomes Framework drops a bit of a clanger:

Its content has been co-produced by the Department of Health, the Association of Directors of Adult Social Services (ADASS) and the Local Government Association

Producing something between a central government department and two representative umbrella bodies – maybe a few meetings, each organisation drafting bits, commenting on each other’s drafts, and then jointly publishing – is not an example of the coproduction I’m familiar with.

Whilst recognising its importance, I’ve never been one for getting too bogged down in language and definitions. I’ve suggested previously that, when it comes to coproduction, it’s better to say what it isn’t than what it is (see point 1 here).

To help things along, here are some other circumstances which I’d suggest are not coproduction.

  • I was driving to the tip the other day and the person behind bumped into my car. Despite what he said, we didn’t coproduce an insurance claim
  • I got home from a long day at work to discover my wife had doubled the number of cushions on the sofa. Even though she claimed we’d talked about it, I don’t think this counts as coproduction
  • I’d started off with the intention of coproducing what clothes my kids would wear last week. In the end, though, I had to tell them it wasn’t appropriate to wear only their pants and swimming goggles to school, and that I didn’t care if their socks were “itchy”
  • My energy company wrote to me the other day and said that it was basically colluding with the other energy companies to raise prices well above inflation. They can call this coproduction with each other all they like, but it’s bloody not.
  • (There are, of course, more serious cases where things masquerade, or just plain aren’t, coproduction)

I hope this is useful. Do please add your own examples of what isn’t coproduction, either in the comments or using #notcoproduction.

Should the #ILF close? Yes. But… (updated)

It’s not efficiencies. It’s not bloated public spending. It’s disabled people not being supported to meet the most basic elements of day-to-day life – getting out of bed, making a cup of tea, or going to the supermarket.

I’ve immodestly quoted from a post I wrote over 3 year ago on the Independent Living Fund, when it was announced it was closed to new applicants. 6 months later, I wrote another post after it was officially announced ILF was to close from 2015, noting responsibility was likely to fall to those well known cash-rich organisations, local councils.

Today, a court of appeal bid to overturn the abolition of the ILF has been approved. I haven’t seen the full judgment, but it seems to cite both the Equality Act (and great work from the EHRC for intervening to this effect) and that the decision to close the Fund didn’t take account of the flavour of consultation responses.

This is good news.

It doesn’t solve the problem, though, of what to do with the Independent Living Fund in the long term.

For me, the definitive report on what to do with the Independent Living Fund was written in 2006 by Melanie Henwood and Bob Hudson. It notes the peculiar history of the ILF: set up in 1988 as a transitional arrangement, a related new fund created in 1993, the original fund closed to new applications but replaced by an extension fund, all meaning there have actually been two funds operating in parallel since 1993. The report also highlights the huge number of considerations that have to be taken into account when doing anything with the ILF, not least of which is recognising the vital support it provides to 19,000 people.

And it also notes the ILF is anomalous in the long term, and that it continues to account for a large amount of social care expenditure whilst operating to different rules and remits that are incongruent to mainstream social care. It also notes ILF can result in inequity, unaccountability, duplication, arbitrary decisions and major confusion.

As such, the report concludes the ILF should close.

I agree.


In closing the ILF, there are a number of points and principles which must be observed, and that at a minimum are:

  • Any transition from ILF to other funded support should be slow and steady. (In the 3 years since DWP announced the closure of the ILF in 2015, I think very little activity could be detected)
  • The money people received through ILF should be protected, and most definitely shouldn’t be swallowed up by local authority budgets
  • The better parts of the ILF (such as a national, portable system) should influence the new location of the money, rather than these being lost.

The world since Henwood and Hudson wrote their report has changed, not least in the considerable cuts we are seeing in social care and the wider health and welfare reforms. But shifting the principles and support of the ILF into the main provision of social care is still the best thing to do, as long as the minimum points above are met.

The DWP’s original attempt at closing the ILF clearly didn’t do this; the motivation was instead to cut money, and the court of appeal has rightly picked them up on it.

Now, though, there is a chance to look again at this properly. Hopefully the DWP will do this, and do it:

  1. With people from the Department of Health working on the Care Bill and the Integration Transformation Fund
  2. With people driving the personalisation of health and social care
  3. Most importantly, with the people who will be affected by the change.

Update: the full court of appeal judgment is here. It indeed uses the Public Sector Equality Duty as the basis of quashing the original decision.

Integration Transformation Fund: Robbing Peter to pay Paul?

Despite what my wife says and what my schoolteachers used to say, my natural state is not one of being a pain in the arse.

I’m at risk of seeming like this, though, when it comes to the integration in health and social care.

I say this for two reasons:

  1. Last week, I blogged to note that integration in mental health hasn’t had the most positive effect on personalisation, and to ask how we can work to ensure the same doesn’t happen more generally
  2. After reading the most recent announcement on the Integration Transformation Fund (see here – pdf) I’ve noticed that part of the Fund in 2015/16 will be made up of c£220m of Disabled Facilities Grant funding and £130m Carers’ Breaks funding.

We knew that the Integration Transformation Fund wasn’t going to be new money, and we knew Paul (aka integration of health and social care) needs the money. But Peter (aka disabled people in their inaccessible homes and carers) isn’t exactly rolling in it at the moment.

Just to prove my wife and schoolteachers wrong (always a strong motivation, that), let’s end on two positives:

  1. Integration across health and social care is absolutely something to aim for, for all the reasons people highlight (including the money and the currently artificial divide between health and social care that affects people more than it affects budget lines)
  2. Without a doubt the most successful integration will be done at the level of the individual, for example (but not only) bringing together Personal Budgets and Personal Health Budgets. As much as possible should therefore be done to enable this (but without, I’d suggest, nicking money from where there already isn’t very much!)

#Dilnot: a principle and a precedent

What today’s announcement of a £75k cap on the costs of social care does is allow the coalition government to say at the next election that it has introduced an historic change in social care funding that no government has previously been able to do.

Politically, that’s a substantial achievement.

Of course, there are significant questions and details that arise from a £75k level of the cap (or £61k in today’s prices, since the £75k figure is at 2017 prices) and associated changes. People like Claudia Wood and Marc Bush are highlighting what these questions are.

But there is a principle and a precedent that we should today celebrate.

The principle is that a cap has been placed on how much someone has to pay for social care. That is, the government has (finally) drawn a line beyond which individuals won’t have to go to meet care costs during their lifetime. (That this is being paid for by a freeze in inheritance tax allowance is an admittedly very tasty cherry on top.)

The precedent is that of top-up tuition fees. Once the principle of top-up tuition fees of up £3,000 a year was introduced in 2003, the question then became one of where the line is drawn. That line was changed to £9,000 top-up tuition fees last year, and will probably change again in the future.

In the context of the social care cap, I am hopeful the precedent will work the other way: that once government sees in practice what the effect of the costs cap is it can adjust the level accordingly.

The “win” today is therefore the principle that the £75k has been introduced; the precedent of top-up tuition fees is a reason for optimism.

#DPULO resources and policy documents

This post is one for the policy geeks: you have been warned!

There is a pretty good existing amount of resources available for Disabled People’s User-Led Organisations (DPULOs) to support them in their development. Part of the issue, though, is that people don’t know where they are, how to access them or what to do with them.

One of the aims of the Strengthening DPULOs Programme is to both establish a repository of all such information that is as comprehensive as possible and to develop new resources that significantly complement and add value to existing information.

As such, the programme aims to capture, aggregate and share any relevant information that can support the development of DPULOs.

In the meantime, below is a full overview of the resources and information available on the topic of DPULOs that I’m aware of. It covers:

  • DPULOs and policy – the documents that form the framework for the role of Disabled People’s User-Led Organisations within policy
  • Broader Civil Society resources with a disability/personalisation perspective – a selection of resources that focus on building the capacity of organisations within the fields of disability and personalisation
  • Learning resources for DPULOs – full details of the resources focused specifically on building the capacity of user-led organisations

Inevitably this won’t be fully comprehensive, and will be updated over time. Thus, if you know of any other relevant resources, please do let me know about them.

DPULOs  and policy

A number of documents form the framework for the role of Disabled People’s User-Led Organisations within policy. The following are documents specific to DPULOs, their role in this policy environment and ways in which they can develop their work in order to positively respond:

The following are documents that establish the policy environment specifically in social care and health to which DPULOs contribute:

Broader Civil Society resources with a disability / personalisation perspective

There is a significant amount of information available to support Civil Society organisations to build their capacity and/or respond to the personalisation agenda in social care. However, capacity building support dedicated to disability and Disabled People’s User-Led Organisations is not as well developed. The resources below are a selection of better quality resources with more of a focus on disability and DPULOs.

Learning resources for DPULOs

There are a number of resources focused specifically on building the capacity of disabled people’s user-led organisations. The first two capture learning drawn specifically from the Department of Health’s DPULO Development Fund work between 2008-10. The rest are resources dedicated specifically to DPULOs from other strands of work and include a number of DPULO case studies or the work commissioners are doing to support DPULOs.

Both the Department of Health and ecdp (a DPULO based in Essex) have produced short videos demonstrating the work being done to build the capacity of DPULOs, as well as the work some DPULOs are doing in their local community. These are embedded below:

Social Care TV also has a dedicated video on personalisation and User-Led Organisations, available here. There are also a considerable number of videos about DPULOs that use the “DPULO hashtag” on YouTube.

Social work practices: pilots, pioneers and DPULOs

I blogged a while ago on the Social Work Practice pilots that the Department of Health proposed last year. This was exciting for me, since the benefits of social work practices are almost exactly the same for the benefits that accrue from disabled people’s user-led organisations (DPULOs).

Indeed, I hoped that some DPULOs would be involved in the delivery of the Social Work Practice pilots.

And, indeed, they are. The document embedded at the bottom of this post is a summary I’ve created of all of the Social Work Practice pilots, and includes two in particular – Birmingham and North East Lincolnshire – that are explicitly working with DPULOs.

The good news doesn’t end there. SCIE has recently announced a further 10 Social Work “Pioneer” projects – essentially the same thing as Social Work Practices, but just starting a bit later.

The full press release is here. What’s particularly exciting about this is that a further two sites – another in Birmingham and one in York – are directly involving DPULOs.

This is fantastic, and I’ll share relevant learning and information as the Social Work Practices and Pioneers move forwards.

History of DPULOs and the policy context

Over the last few months, I’ve been lucky enough to contribute to a few publications about Disabled People’s User-Led Organisations. This post is therefore an extract drawn together from a few of these publications – including ripfa’s Key Issues on ULOs – about the history of DPULOs and the policy context, up until the general election in May 2010. The Strengthening DPULOs Programme continues the story from then, building upon the platform below.

Disabled People’s User-Led Organisations (DPULO) are part of a long history of Disabled People’s Organisations and Centres for Independent Living (CIL).CILs themselves began with war veterans returning to the United States in the 1960s and wanting to live independently rather than in institutions. In the UK, similar attempts by disabled people in the 1980s to live independently in the community rather than in residential care led to the creation of the first CIL.

In 2005, a key report – Improving the Life Chances of Disabled People – highlighted the difference to disabled people’s lives that CILs made in the places where they existed. As a result, it made Recommendation 4.3:

By 2010, each locality (i.e. each area with social care responsibilities) should have a user-led organisation modelled on existing Centres for Independent Living (CILs).

The Department of Health took responsibility for the development of DPULO policy nationally and established a variety of characteristics that DPULOs should demonstrate. These corresponded to two distinct areas:

  1. A set of values to which an organisation should adhere, including: working from a social model of disability perspective, promoting independent living, promoting human and legal rights, and engaging with all local disabled people, carers and other people who use support services
  2. A set of characteristics an organisation should demonstrate, including: being legally constituted, having a minimum of 75% of voting members on the management board drawn from the organisation’s constituency, demonstrating sustainability, and working with commissioners.

In addition, there was a set of typical activities and services a DPULO could deliver in order to support independent living, as follows:

  • Information and advice
  • Advocacy and peer support
  • Support in using personal budgets and direct payments
  • Support to recruit and employ personal assistants
  • Assistance with self assessment and support planning
  • (Disability) equality training
  • Support the implementation of the Disability Equality Duty by public sector organisations in the locality.

The three areas above are highly inter-related and lead to two distinct features of DPULOs: they operate on both the demand side (i.e. providing the individual and collective ‘voice’ of and for the direct experiences of disabled people, carers and people who use support services) and the supply side (i.e. providing services).

In practice, the need to establish both demand- and supply-side activities and existing arrangements gives rise to a number of potential operating and delivery models for DPULO­s. These models often build on the long histories of existing organisations and the types of activities they undertake and include:

  • An ‘all under one roof’ approach, where one DPULO ­covers all or the majority of suggested services and constituency groups
  • Umbrella partnerships between existing organisations, with attendant governance arrangements (be they formal, such as a written governing document, or informal, such as a partnership agreement or network)
  • Several DPULOs in one area, each providing a specific service(s).

Local history, circumstances and resources often determine the most appropriate approach from a number of options to take in further building the capacity of DPULOs.

A 2006/07 DH study initially identified 647 potential DPULOs across England. However, a follow-up DPULO baseline study carried out for the DH in 2009 noted there are only 66 established DPULOs and 64 local authorities that have no DPULOs at all. A further DH study is being carried out at the time of writing to determine the current national picture as accurately as possible.

At the end of 2007, Putting People First highlighted the importance of independent support services for people navigating the care and support system, irrespective of their eligibility for public funding. As a result it included the requirement for at least one local DPULO per area, alongside support for mainstream mechanisms to develop networks that ensure people using services and their families have a collective voice, influencing policy and provision. This policy support remains in place through both the government’s Capable Communities, Active Citizens adult social care vision and the joint agreement across a number of social care organisations, Think Local, Act Personal.

However, DPULOs support a wide range of policy areas and not just those relating to adult social care. One key area is in supporting public sector organisations in meeting their obligations under the Disability Equality Duty. Similarly, DPULOs embody an efficient, embedded and representative way of delivering what is colloquially known as the “duty to involve” and are a ready-made vehicle for delivering transformation through coproduction.

Another role is in supporting joined up support across social care and health. Local Involvement Networks (LINks) were created through the “Our Care, Our Health, Our Say” Health White Paper in 2006. They provide flexible ways for communities to engage with health and social care organisations, as well as ensure user involvement is at the heart of provision in holding bodies engaged in both the commissioning and delivery of services to account. At present, only two DPULOs in England are the host organisations for LINks. The most recent Health White Paper (2010) proposes retaining the role and function of LINks under the new name of HealthWatch, thus providing plentiful opportunity for DPULOs to engage and drive the continuing work to join up social care and health.

Finally, DPULOs – as civil society organisations run by and for their members and clients – can contribute to the overarching agenda created by the Big Society. Through enabling peer-to-peer support for disabled and older people in their local communities, and through encouraging their members and clients to use their social capital, DPULOs are extremely well-placed to facilitate citizen contributions to the Big Society agenda.

What work has been done so far to build the capacity of DPULOs?

There has been some previous national activity looking to build the capacity of DPULOs, particularly in order to enable them to support the transformation of adult social care. The DH’s DPULO Development Fund began in March 2008 to build the capacity of 25 DPULOs in total: 12 DPULOs in Wave 1 (March 08–June 09) and 13 DPULOs in Wave 2 (March 09–March 2010). This work was driven by the DPULOs involved themselves and created many learning products. Overall, the DH concluded there were mixed results concerning progress of the DPULOs involved, especially in areas like working with local authorities and sustainability.

Alongside the ULO Development Fund, the DH and ODI also undertook some DPULO capacity building work through the regions, channeling support through the Deputy Regional Directors. In 2009/10 each region was allocated some resource to look to ensure there was a DPULO in each local authority in each region, as well as support coproduction more widely.

As well as work done by central and regional government, the disability sector itself has looked to build the capacity of DPULOs. Disability LIB (“Listen. Include. Build.”) was a partnership of several disability organisations funded from 2008 by the Big Lottery Fund. The partnership provided DPULOs with capacity building information, advice and support to enable them to be more effective in their activities, and finished in June 2011.

Welcoming a DACO

What’s a DACO? It’s a Deregulation and Contracting Order and it looks like this (pdf).

This particular Order relates to two key policy pilots going on at the moment: one from the Department of Health on Social Work Practices and another from the Office for Disability Issues (sponsored by Department for Work and Pensions) on the Right to Control.

For Social Work Practices, the Order is relatively straightforward: it provides for the ability for SWPs to “discharge the statutory duties of the local authority” for their social care clients. (I wrote positively about SWPs back in November.)

The Order is interesting, though, because it also allows third parties to undertake social care reviews as part of the Right to Control process (which I’ve written about here).

This is potentially very exciting: within a controlled (i.e. pilot) environment, it provides for disabled people’s user-led organisations to be involved in the review of social care packages. It could also extend to other areas the Right to Control covers.

Where DPULOs have been as integrally involved in the social care process it has led to better outcomes for disabled and older people (as per this research on Support, Advocacy and Brokerage by the Office for Disability Issues.)

On the back of the Open Public Services White Paper yesterday, this is one example of how a tweak of a regulation here or there can have a positive and leveling impact on the commissioning landscape. I welcome it.

(Note / disclosure: My organisation ecdp is involved in the Right to Control and has contributed to work with colleagues in local and central government to realise this Order.)