Banker, confectioner, tile maker

In [Gujerat], a banker who was having his house re-roofed had a quarrel with a confectioner. The confectioner came to an agreement with the tile makers who refused to provide the banker with tiles.

– E.A.H. Blunt, via Francis Fukuyama in Origins of Political Order.

Where DPULOs make a difference

The West of England Centre for Inclusive Living (WECIL) asked me to talk about Disabled People’s User-Led Organisations at their Annual General Meeting today, which was a pleasure and a delight.

After talking about the Strengthening DPULOs Programme (on which more here) and hearing from one of the Ambassadors for the programme (you can find out who they are here), I talked briefly about the difference that DPULOs can and do make.

In social care, for example, I noted that were DPULOs provide support services, they can make a significant difference to the choice and control disabled people (and service users more generally) can have over their support.

To take one area: in Essex there is an independent support planning service which is run by and for disabled people. As a result of the different approach, 100% of the people who use this service end up with some form of cash payment – essentially giving them more choice and control. This compares to around 20% for the local council.

Similarly, across Essex, Thurrock and Cambridgeshire, an average of 92% of people who use an independent and peer-led information, advice and guidance service to find out about the social care process end up with a Direct Payment. This compares to global figures in social care of approximately 10% of users on a Direct Payment.

Even if it’s not quite comparing apples with apples, those are pretty significant differences that indicate the underlying difference DPULOs uniquely provide in enabling people to have more choice and control.

(The Office for Disability Issues published a significant report on the role of Disabled People’s User-Led Organisations in Support, Advocacy and Brokerage here.)

As well as thinking about the role that DPULOs can play in addressing disability hate crime (covered in a separate talk to Leicester CIL earlier this week), I also looked forward to two areas I think greater involvement of DPULOs could make a difference.

The first is Access to Work.

This was recently called the government’s “best kept secret”. I think there is a significant role that DPULOs can play in bridging the gap between Job Centre Plus, employers and potential employees in letting them all know about Access to Work: how to find out about it, how to get it, what to do with it.

The benefits from this won’t just be for disabled people or businesses, either: for every £1 invested in Access to Work, the government gets nearly £1.50 in tax and National Insurance contributions.

At a time when the economy needs to grow, this seems like a pretty good thing to do.

The second area is HealthWatch.

One of the areas that is potentially strong in the current NHS reforms is HealthWatch – the bit that is going to ensure the representation of the voice of service users and patients in the new system.

There’s an argument to say that Local Involvement Networks haven’t fulfilled the overall potential they had to hold health and social care to account. I’d argue that this was partly because it was the wrong types of organisations who were trying to run LINks. As far as I know, only two DPULOs were formally LINks bodies. If we can ensure that more DPULOs take on this function as HealthWatch, I have no doubt it will make the health and social care system better.

After outlining the difference I think DPULOs can make in just one or two particular areas (their effects, of course, aren’t just limited to these) I finished my talk with WECIL with a question to its members, which I’d like to offer more widely to readers and interested parties here: as the Strengthening DPULOs Programme continues to develop and make the case for DPULOs to decision makers and stakeholders, what messages do you think they should know about regarding DPULOs?


Man walks into a column, no.30: Links

As my Mum might say at some point in the future: if you haven’t got anything in particular to blog about, don’t bother. And so it’s with that in mind I must admit, to my shame, that I don’t have a topic for this week’s post, and am thus forced to play my ‘joker’ and make do with a bunch of links to things I’ve been reading (or in one case watching). Which all just happen to be about God. The fact I’ve managed twenty nine weekly posts in 2011 without doing so should, I feel, be counted in my favour. Although actually this one is a day overdue; I don’t expect anyone’s noticed. Until now. Doh!

We begin with an article in the FT on Friday – the latest in the paper’s ‘British institutions’ series – about the Church of England. Matthew Engel reports that at the July meeting of the General Synod, in York, women and gays were temporarily off the agenda and the focus instead was on what to do about falling church attendance.

The problem, it turns out, is that we’re simply not as scared of Hell as we once were, or of the wrath of a vengeful God. As one lay member of the Archbishop’s Council remarks: ‘There are very few Anglicans who believe that God zaps planet Earth when there are a few too many gay orgies.’ A particular relief for the 20 or 25 per cent of the clergy who are themselves gay (that is at least if you believe the guesstimate of Stephen Bates, author of A Church At War).

On a related note, I’m still ploughing through Diarmaid MacCulloch’s marvellous but massive A History Of Christianity and offer you this nugget: there is, believe it or not, one nation state in the world with an exclusively male population. It is Mount Athos, a World Heritage Site and self-governed state in Macedonia, Greece, comprising twenty Eastern Orthodox monasteries where the brothers feel so strongly that the presence of women would be a threat to their celibacy that they simply keep them out. They also still keep to the Julian calendar. Those crazy guys (gays?).

For those of you who suspect I am actually in the closet myself, and harbour (whisper it) Christian leanings, the fact that I spent Sunday afternoon at the National Theatre watching an Ibsen play about Fourth Century theology will be grist to your mill. It was Emperor and Galilean – picked almost at random from the London listings when my wife and I realised we hadn’t been to the theatre in a disgracefully lengthy period of time (as a friend remarked: ‘what, and had Blood Brothers sold out?’).

We entered the cool, dark space of the Olivier Theatre having um-ed and ah-ed about whether to waste the money already spent on tickets and give it a miss, so glorious was the weekend weather, but instead girded our loins and made the trip along a baking South Bank crammed full of sunburnt tourists and men playing Mariachi music.

The play was splendid to watch, with the theatre’s massive revolving drum alternately rotating, rising and falling to reveal dank cellars in Ephesus, poky churches in Antioch and battlefields in Persia. The focus is on a young man called Julian, nephew to the Emperor Constantius, and his burgeoning desire to throw off the restrictive shackles of Christianity in favour of ‘truth’ and ‘beauty’. When Constantius dies and Julian takes the throne, however, we see how dogmatic adherence to a singular vision of the ‘truth’ quickly leads to persecution and carnage.

The principal cast were excellent, although I’m sure I wasn’t the only person in the audience who found it hard to listen to Ian McDiarmid as the mystical Maximus, who cajoles Julian away from Christ towards paganism, without expecting the next line to be ‘As you can see, my young apprentice, your friends have failed. Now witness the firepower of this fully ARMED and OPERATIONAL battle station!’ – with a voice like that, what happens when this man asks for a pint at the bar, I wonder?

The problem, if there is one, is with the play itself, which seems rather self-contradictory. As Michael Billington writes in the Guardian: as much as Ibsen is trying to articulate the need for a new way of living, one free from the ‘doctrines of guilt and misery and denial’ (i.e. Christianity), the heroes of the piece are very clearly Julian’s close friends who, despite the newly crowned Emperor violently (in one case very violently) turning against them, maintain their goodness and their faith in Christ the Galilean. But maybe the message is simply that power corrupts: after all it’s not Julian’s rejection of Christianity that causes him to do bad things, it’s the supreme power he acquires that facilitates them.

So, that’s it blog-fans. Until next week. By which I mean probably tomorrow – I need to get back on track, after all. Do feel free to nominate a topic for me to write about.

HealthWatch: Good in principle, worrying in practice

This was posted as a guest blog on the always insightful Health Policy Insight, run by the always amusing (in a good way) @HPIAndyCowper, who has kindly allowed me to re-post it here.

Criticisms of the reforms of the health system have focused primarily on shifting £80bn of public expenditure to GP commissioning consortia.

Much less attention has been paid to the issue of patient/user voice and representation in the reformed system, something this post aims to address (building on two posts at the time of the White Paper, here and here and one just before the Health & Social Care Bill was published).

The White Paper contained proposals for the creation of both HealthWatch England and local HealthWatch – building on the work of existing Local Involvement Networks (LINks) – in each upper-tier local authority area.

Local HealthWatch will essentially be the local “consumer champion” for health and social care users, promoting choice and control, influencing the shape of services, and highlighting issues in service delivery, including through advocacy.

HealthWatch England will provide support to local HealthWatch and synthesise the issues they highlight at the national level, working with the NHS Commissioning Board and the Care Quality Commission.

In principle, the introduction of HealthWatch based on the work of LINks is a good idea (though there is a question over how effective LINks have been); what’s more, there is “extra” money being made available for both local HealthWatch and HealthWatch England to carry out their roles.

In practice, however, there are 3 significant areas of worry about HealthWatch arising from the Next Steps consultation response and the Health & Social Care Bill and its associated Impact Assessment.

The first is money. Though there will be “extra” money for local HealthWatch, this is being taken from existing services.

In 2009/10, £27m was allocated for LINks. For local HW, the funding that was used to fund the Independent Complaints Advocacy Service (£11.7m) and PALS (£19.3m) is being handed to local authorities to commission local HW, meaning there will be £59.1m in 2010/11.

HW England will also have £3.5m of its own funding (figures from Impact Assessment, para D42).

But the major issue – and the number one risk identified by the DH itself – is that this money won’t be ringfenced. Instead, since the money will be allocated to local authorities under normal LA funding arrangements, Councils can choose how to spend it.

In 2009/10, although £27m was allocated for LINks, Councils only spent £24.3m of it on LINks – they effectively creamskimmed 9% off the budget. There is no guarantee they won’t do the same for local HW.

The second issue is independence. Local HW will be “contracted by and accountable to Local Authorities” (Impact Assessment, para D34). This does not make them independent in principle; nor, potentially, in practice.

More worrying is that HW England will only be a statutory committee of the CQC. Despite the Next Steps consultation response suggesting this means HW England would be “independent” (para 2.59), the Impact Assessment formally recognises (para D24) that

setting up HealthWatch as a statutory committee of CQC [means] it would not be formally independent of the NHS and social care system.

Furthermore, HW England’s funding will need to “maximise synergies” with roles within CQC (para D28) to ensure its funding of £3.5m goes as far as possible. No “independent” committee should have to rely to this extent on staff within its host body.

Even more significantly, the Chair of the Committee will be appointed by the Secretary of State (Next Steps, para 2.59). The Health & Social Bill also stipulates that some members of the Committee will be appointed and others elected (Impact Assessment, para D27), but with no details about the blend of appointed and elected members or the process for elections (D26) – this is to follow in further regulations.

None of this sounds particularly independent, and there have to be worries about how this will operate in practice. Anyone who knows how the statutory disability committee within the EHRC has operated in practice – a very similar set up to that proposed for HW England within CQC – will rightly be concerned.

The final issue is advocacy, particularly complaints advocacy, in which confusion reigns. Next Steps suggests (para 2.43) that local HW should have a role in NHS complaints advocacy, but that Local Authorities will now be responsible for commissioning it and that this may or may not be through local HW.

Conversely, the policy summary signed by Andrew Lansley as part of the Impact Assessment says that HW will bring together patient voice and complaints advocacy. It won’t – especially since advocacy in social care is not mentioned a single time anywhere in documents relating to the Health & Social Care Bill.

Unlike much of the rest of the proposed health reforms, the suggestions for HealthWatch were actually quite good in principle.

In practice, significant questions about money, independence and advocacy as one of the new, key functions of HW means the end position for HealthWatch is much the same as everything else associated with Lansley’s reforms.

Friday puzzle, no.14 (one week later edition)

It may very well be that you get 2 Friday Puzzles today. Think of it as a BOGOF special from your very own arbitrary constant.

Anyway, here’s last week’s puzzle:

At the recent race meet, the 100 metres heats were closely monitored. Each contestant had to run in two races so that the average place could be determined. Only one runner finished in the same place in both races. Alan was never last. Charlie always beat Darren. Brian had at least one first place. Alan finished third in at least one of the races. Both Darren and Charlie had a second place. What were the two results?

The answer was: Race 1: Brian, Charlie, Alan, Darren. Race 2: Charlie, Darren, Alan, Brian.

Here’s this week’s puzzle, courtesy of Brainbashers:

A cricketer’s average in his first 18 innings was 16.5 runs. After a further 8 innings, his average had increased to 32.5 runs. What was his average for the last 8 innings? Note: you don’t need any cricket skills to solve this puzzle, nor do you need to know what an innings consists of.

Other links: