Government abdicating responsibility for social care, say providers

The head of the organisation that represents adult care providers in England has accused the government of abdicating responsibility for social care and claimed that ageism is affecting treatment of the elderly.

Speaking to the Guardian, Martin Green, the chief executive of Care England, warned the care home sector is at a tipping point and accused the government of lacking leadership on the issue. .

Philip Hammond, the chancellor, has bowed to widespread pressure over funding and will use Wednesday’s budget to invest an extra £1.3bn over two years in social care, including care homes. However, the spending gap in social care is expected to reach at least £2.6bn by 2020, according to the Local Government Association. Record numbers of care homes are already closing and more than 400 care home businesses have been declared insolvent since 2010, official figures show.

Critics of the industry claim it is financial difficultly due to private companies racking up huge debts and failing to invest. However, Green blamed the government for the crisis facing the sector.

“The government is abdicating responsibilities for social care to local authorities,” he said. “I think it owes more to the protection of vulnerable politicians than it does to the protection of vulnerable adults. My view is that if you ask me who is to blame it is the government. The government should be delivering a very clear vision for what social care is, they should be giving clear expectations to citizens about what they should expect from the system and what they should expect to pay for and none of that is happening.”

Green warned that the small businesses in the sector – the so-called “mom and pop” operations which account for the majority of homes in the UK – are under unprecedented pressure due to a rise in costs and a fall in the price that local authorities pay towards caring for residents, which can now be as little as £2.24 per hour. Care England’s members include independent care providers ranging from single care homes, voluntary organisations providing homecare, and multinational companies such as Bupa.

Green claimed that a culture of ageism has become a serious problem for social care. He said that the care for the elderly is treated differently to other health issues.

“The amount of ageism in the system is quite outrageous,” he said. “I was giving a talk to some older people and a lady said a really killer question to me: ‘Can you explain to me why my husband’s disease, Alzheimer’s, has been classed as a social care problem while my brother-in-law who has got cancer gets everything from the NHS?’ My answer to her was ‘I will tell you why, because your husband is old and because they want you to pay for it’.”

He added: “Remember we have an equality and human rights act where age is a protected characteristic. What has the Equality and Human Rights Commission done on this issue? They have done very little on age. They are obsessed with race, gender, sexuality and disability and they completely ignore age. Actually I would say ageism is probably the most prevalent form of discrimination in our society today.”

Green said that the government needed to ensure that any financial support for the sector in the budget made its way to care providers, rather than getting stuck inside local authorities. He claimed that some of the cash raised by local authorities through a council tax precept last year has not made its way to care providers, despite the government insisting that social care should be the recipient of the tax hike. “They need to have an mechanism to absolutely be clear that it goes to the frontline,” he said.

Green, who has run Care England since 2015, said he agreed with the warning last year by the Care Quality Commission, the industry regulator, that the industry is at a tipping point. “What we will start to see is far less services at a time when we have got far more need,” he added.

Despite the pressure on the sector, Green defended the large companies in the industry, such as private equity-owned Four Seasons, which have significant debts and are paying millions of pounds in interest ever year.

“I have politicians that sneer at me about venture capital taking over the sector. My response is ‘Well, it’s a good job someone is because the government is not putting any money in’.”

Hammond is expected to say that the £1.3bn for social care should directly benefit the NHS, by reducing the number of patients who end up stuck in hospital despite being medically fit to leave, because social care in their area is unavailable.

It is likely to be directed at schemes that aim to tackle what the NHS calls delayed transfers of care, or “bedblocking”, and the risk of mainly older patients being admitted or readmitted to hospital.

However, the chancellor is set to face down demands from Labour, the British Medical Association and many NHS bodies by refusing to increase the health service’s budget beyond the sums already agreed.

The BMA has called for an extra £10bn a year for the NHS, while Labour has demanded £12bn for health and social care. Hammond will trigger claims that neither he nor Theresa May appreciate the full extent of the NHS crisis, which saw unprecedented numbers of hospitals declare themselves unable to cope over the recent winter.

But he is expected to make an extra £200m available for NHS capital projects in 2017-18, after warnings from NHS England chief executive Simon Stevens that his planned “transformation” of the health service in England would struggle unless local NHS bodies had more money to spend building and repairing premises.

Jeremy Hunt, the health secretary, controversially moved more than £1bn from the NHS’s capital budget to its revenue budget in an attempt to give hospitals more money to spend amid an unprecedented financial squeeze.

Government abdicating responsibility for social care, say providers

Private providers are part of the NHS’s problem, not the solution | Letters

I’m afraid Stephen Dalton is wrong about pretty much everything (Private money is the NHS’s saviour, not its bogeyman, 22 November). Where sustainability and transformation plans have been published (most have been shrouded in secrecy, and for good reason) it is clear that cuts and closures are on the way. For instance, 600 GPs are to be reduced to 400 in one part of London alone, and maternity units and A&E departments face the axe. We have the second lowest number of hospital beds per capita in the EU, and that is set to fall further. Dalton says we must move care away from hospitals, but that means investing in primary and community care, both of which have been undermined and cut.

Dalton says that the private sector can help the NHS. Well, up to a point, Lord Copper. The private sector has always been there, but as a peripheral presence and not competing with the NHS. The compulsory competition introduced by Andrew Lansley has been a very costly failure. The private sector is expensive, unaccountable, and will walk away when it can’t make a profit. By cherrypicking profitable services it destabilises the local NHS, which can’t drop the expensive work or turn away patients with complex problems. And its ethos is questionable, leading, for example, to profits being sent offshore with no tax paid.

The answer for the current NHS crisis is to fund the NHS to the EU average (it is currently heading down to less than 7% GDP), to deal with the costly market and PFI schemes which are wasting money hand over fist, to value and support the staff, and to stop re-disorganising it every two years in a futile effort to sort out the last political mess inflicted on it.
Dr Jacky Davis
Founder member, Keep Our NHS Public

• The article by Stephen Dalton is simplistic in the extreme. Here in Cornwall we have examples of two of the privatisations he extols. Both failures.

Twelve years ago a panel I was a member of voted to give Serco the out-of-hours service for Cornwall. It was a mistake. They were condemned by a parliamentary committee for cooking the books and they have since abandoned the contract. I voted against them.

In 2014 the Royal Cornwall hospitals trust board of which I was vice-chairman voted to allow Mitie to run their hotel services, catering, cleaning etc. I voted against. They have proved to be a disaster. If Stephen Dalton wishes to write these misleading articles he should at least give examples of the successes of privatisation. Does Hinchingbrooke ring a bell with him?
Rik Evans
Truro, Cornwall

• Stephen Dalton argues that “examples of beneficial of private sector involvement include … more rapid discharge from hospital through well-established ‘recovery at home’ services and access to private sector community diagnostic facilities”. Meanwhile you report that the private company Mitie has said it would withdraw from its healthcare business, which provides home care for the elderly (Mitie profit warning as it bales out of elderly care, 22 November); your article quotes the chief executive as saying that government spending cuts had made the healthcare business unviable: “If we are serious about social care in the UK it needs significantly more than the funding that has been suggested.” Quite.

More generally it is worrying that Dalton, as chief executive of the NHS Confederation, still does not understand that for private companies profits come before patients, and that any system that has to fork out to shareholders has less to spend on care. Supposed benefits from “greater efficiency” usually means cutting corners and paying workers less.
Dr David Griffith
London

• Despite Stephen Dalton’s assertion of an apparent “political negativity” towards privatisation of the NHS, the non-public-sector involvement within our healthcare system actually continues unabated: the Department of Health’s funding of “independent sector providers” rose from £4.1bn in 2009-10 to £8.7bn in 2015-16. And a study published in the Journal of Public Health in July this year found that: “An increased use of private sector provision by NHS boards was associated with a significant decrease in direct NHS provision and with widening inequalities by age and socio-economic deprivation.”
Steven Jouanny
Sheffield

• We completely agree with Stephen Dalton’s assertion that we need to shift the focus away from hospitals in order to help create a more sustainable NHS. However, being more open to private providers is not the only answer.

The mixed economy for end-of-life care in the UK is a case in point, and the role of charitable hospices in this should not be overlooked. Last year hospices in the UK spent more than £868m on care and supported 200,000 people with life-limiting conditions – a significant contribution to the UK’s health economy.

Hospice care is provided free and yet hospices receive only a third of their funding from the NHS, having to raise the rest themselves through community fundraising. Hospices have a strong ethos of compassionate care, coupled with a vibrant culture of innovation and enterprise reflected in the new and different ways they raise income and successful partnerships developed with other providers.

In these hugely challenging times for the NHS, improving end-of-life care by working more closely with hospices could help deliver the sustainability that is so desperately needed.
Tracey Bleakley
CEO, Hospice UK 

• On the occasion of American Thanksgiving, as a British citizen who lives in the US but finds myself in the UK with an ailing father, I feel compelled to express my gratitude for one of the things that makes the UK exceptional: the NHS and associated strongly held value that good healthcare for all is a right not a privilege. I am a management consultant and have spent a large chunk of my career working within the American healthcare system. The recent US election troubles me greatly as the incoming administration seems to offer little vision for healthcare other than the aspiration to unwind the recent gains of improved access to all. In recent weeks I have sat holding my sleeping father’s hand as he moves beyond a stroke. As I’ve watched the wonderful staff on the Dunkery stroke unit at Musgrove Park hospital in Taunton, which, somewhat ironically, started as an American army hospital during the second world war, I have felt incredibly grateful for the compassionate care he – and my family – are receiving. Absent is the additional stress of wondering how we as a family will be able to pay for his care, which would already be well into the hundreds of thousands of dollars had he been born on the other side of the pond.
Celia Kirwan
Boston, Massachusetts

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Private providers are part of the NHS’s problem, not the solution | Letters

NHS Providers chief executive: ‘We are under the greatest pressure in generations’ – video

Chris Hopson, the chief executive of the body that represents hospitals across England, appears on the Andrew Marr Show on Sunday, following a startling warning issued by the body that the NHS is close to breaking point because of its escalating cash crisis. The warning also comes days before the Commons health select committee decides whether to launch a special inquiry into the state of the NHS in England

Read: NHS chiefs warn that hospitals in England are on the brink of collapse

NHS Providers chief executive: ‘We are under the greatest pressure in generations’ – video

America"s Most significant Overall health Insurance Providers

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America"s Most significant Overall health Insurance Providers

Grownup care providers at breaking point as squeeze on funding requires its toll | David Brindle

Oxfordshire county council has for the previous 4 many years pulled out all the stops to avoid passing on a 38% minimize in its grant for providers for homeless folks. But now the authority says it has nowhere left to turn and is reluctantly planning to phase in the reduction, including stopping all funding for dedicated support for those with substance misuse difficulties.

“It is not one thing I like to do, but we’re not uncommon in performing it,” says John Jackson, the council’s director for social and community companies. “The reality is that I have to shield providers for men and women I have a statutory responsibility for.”

According to new investigation published right now, Oxfordshire’s choice is emblematic of the state of adult social care services across England. Findings from a survey of adult social care directors reveal that half say that fewer people are getting solutions barely a single in three says they are safeguarding the size of the individual budgets older individuals and disabled adults acquire to pay for their care and support, and 6 in 10 directors are braced for much more legal difficulties.

The Association of Directors of Adult Social Companies (Adass), which conducted the survey, has hitherto been notably measured – critics may say overly so – in its response to cuts ordered by the coalition government since 2010. But now it warns that the social care program is on the brink of becoming unsustainable. Its president, David Pearson, calls on wider society to say how far it is ready to shield “a great number of vulnerable individuals who will fail to obtain, or not be ready to afford, the social care providers they require and deserve”.

Recalling that earlier this year the National Audit Office (NAO) questioned no matter whether councils had been approaching the limits of their capability to soak up pressures on social care budgets, Pearson says: “Our survey shows past doubt that we have reached the point in which we are unable to absorb the pressures they, and our survey, have recognized.”

The survey adds to the sense of financial crisis. Demands for extra cash for the NHS are mounting and this week the Neighborhood Government Association (LGA) warns that councils in England face a £5.8bn funding gap by March 2016 due to even more cuts in grant – forcing twelve.5% savings in 2014-15 alone – and escalating demand for services, especially for older folks.

The funding gap for adult social care on its very own will be £1.9bn by March 2016, the LGA estimated. Following yr, 2015, is “make or break” for social care with the introduction of the government’s Better Care Fund, expected to pool more than £5bn of current money from councils and the NHS to devote on integrated companies that are created to hold individuals out of hospital. Recent government funding for social care is £14bn.

Pearson, even so, says the scale of the challenge far outstrips any benefit that may possibly come from integration. “It is not the directors’ occupation, but that of the country as a complete and its politicians, to debate how significantly, in times of the most serious adversity, vulnerable people should be protected from the consequences of that adversity by the introduction of new cash into social care.”

Norfolk gives a flavour of the challenge. The county’s population is projected to rise 25% by 2033, but numbers of people aged 65-74 will increase 54% and numbers aged 75 or above will soar by 97%. Significantly of this growth will be in isolated rural communities in the north of the county.

Norfolk’s grownup social solutions department already reviews development of 53% in referrals above the past 5 years, collectively with a near-tripling of demand for intensive homecare assistance of ten hours a week or more, at the very same time as it has been creating £72m cost savings, which contains cutting the numbers of social perform posts and paring back preventive services. Nevertheless, it says paying on frontline care has been protected.

With more cuts of £59m in Norfolk social providers planned in excess of the following three years, nonetheless, continuing to safeguard care is no longer practical. Some £14m is coming out of people’s personalized budgets, £6m from support for people with learning or physical disabilities and £4.5m from the contract with the council’s very own residential care firm.

Asked what the future holds, Sue Whitaker, Labour chair of Norfolk’s adult social services committee, says: “I have a feeling that attempting to provide anything at all on best of what is needed statutorily is going to be exceptionally hard, if not impossible.”

This displays the national image painted by the Adass survey. Primarily based on returns from directors in 144 councils with adult social care responsibilities, 95% of the complete, Adass calculates that an additional £266m (1.9%) is becoming taken out of services in 2014-15, producing a complete 12% real-terms minimize in investing given that 2010 whilst demand for companies has risen 14%. The net effect, for that reason, is stated to signify complete cost savings given that 2010 of 26% or £3.5bn.

Questioned about the most likely affect in excess of the subsequent two many years, 47% of directors say men and women who employed solutions would get smaller sized individual budgets for their care and assistance 48% say fewer men and women would be ready to get solutions 50% forecast greater pressure on the NHS 55% expect care providers to encounter financial problems and 59% anticipate receiving more legal issues to cuts.

With most provision of care these days outsourced, 19% of directors admit not being aware of if all their contractors paid the national minimum wage and only three% are assured that all paid the larger, unofficial residing wage. As numerous as 75% say they commission some homecare visits of just 15 minutes, despite the fact that 90% of them say this kind of visits were merely to check on an individual’s wellbeing or medication.

Richard Humphries, assistant director of policy at the King’s Fund thinktank, says the survey rings painfully accurate. “This is the consequence of the 2010 paying settlement that supposedly protected the NHS but left the social care technique totally exposed,” he says. “It was all completely predictable.

“What we are seeing now is a double whammy with each the NHS and social care simultaneously facing a crunch year up coming yr. Most people cannot see how to get beyond this without extra income – not just funds for much more of the exact same, but for transformation of companies. The Better Care Fund is Ok, but it truly is a extremely modest step in direction of a lot larger measures that are needed.”

Back in Oxfordshire, Jackson thinks the county council has a sustainable – if unpalatable – 4-yr strategy for social care. His political boss, Conservative cabinet member Judith Heathcoat, has advised the Oxford Mail she is “as relaxed as I can be” with the planned 38% cuts in housing-associated support, which are component of a £64m financial savings package across the authority in excess of 4 years.

Other cost savings will come by means of less expensive help for men and women with finding out disabilities, moving them both out of residential care or perhaps from two-man or woman flats to shared accommodation for five. Older people will also be hit: individuals attending overall health and wellbeing centres might up coming year be charged £20 a day.

Jackson’s dread is that growing numbers of legal issues will be incurred over people’s statutory rights to care. “In the end we cannot not meet people’s care requirements” he says. “We would want to do that morally anyway, but the law is really clear about it. We will not require the courts to tell us that.”

Grownup care providers at breaking point as squeeze on funding requires its toll | David Brindle

Kid psychological health providers "failing 3-quarters of kids"

Assessments for circumstances such as autism are below risk. Photograph: Stephen Voss/Alamy

Only a quarter of youngsters with psychological well being problems are receiving the treatment method they want, according to a study produced by the body charged with bettering the well being services in England.

An inner presentation, made by NHS England and shared with the Observer, paints a picture of a services in crisis, in accordance to one particular charity, due to the fact of spending budget cuts and growing demand. It notes that “multiple critiques have recognized the identical troubles”.

The report also provides proof that, as a outcome of a rise in younger people needing treatment method for complex mental wellness problems, assessments for problems this kind of as focus deficit hyperactivity disorder (ADHD) and autism are being delayed, even though other individuals are not currently being recognized or handled. The presentation says that 35% of grownups with anxiety or diagnosable depression are not in get in touch with with mental health companies, but this rises to 76% of those aged five to 15. It notes that only six% of paying on mental wellness goes on solutions aimed at children and young individuals, even however 50% of lifetime mental illness commences by the age of 14.

The analysis – carried out more than in the past 3 months – will raise concerns that a service that is currently failing to meet the demands of many customers is getting reduce additional, and will help claims that youthful people are currently being hit by a double whammy: psychological overall health is a “Cinderella support” compared with physical circumstances and inside of that support younger men and women do not get the same degree of attention as adults.

The presentation reveals that cuts are increasingly getting reported in spots such as south-west London. It says the Maudsley Youngster and Adolescent Psychological Well being Services reviews cuts across its London boroughs ranging from 17% to 38%, and quotes the considerations of mental wellness teams across the nation.

1 crew said that its £1m spending budget was to be slashed by £300,000 from up coming yr. As a result, it was obtaining to draw up ideas to turn out to be an urgent assessment and urgent remedy support only.

Professionals would be unable to deliver the treatment for which they had been educated. One more acknowledged that its specialist and early intervention providers were getting dismantled.

A third mentioned that an increase in both schedule and emergency presentations had left it with no selection but to give priority to clinical danger instances more than routine adhere to-up exercise, such as assessments for ADHD and autism.

The document quotes statistics, which reveal that in England there is only one psychological wellness professional per thirty,000 young folks below twenty, compared with one per five,300 in Switzerland, 6,000 in Finland and seven,500 in France.

A recent survey by YoungMinds, a mental overall health charity, located that two-thirds of nearby authorities had minimize their budgets for younger people’s mental wellness.

“For all the welcome policy announcements from government about youngsters and youthful people’s psychological health, the picture on the ground for a lot of kids, younger men and women and their families is of solutions in crisis,” stated Sarah Brennan, chief executive of YoungMinds.

“The cuts to early intervention companies are now triggering serious pressures on inpatient beds. It is verging on inhumane for kids and younger men and women to finish up, as they do now, being shipped hundred of miles across the nation for the nearest bed, held in police cells or placed on unsuitable adult wards. We ought to be ashamed of the paltry help and care we assign to the psychological overall health of kids and younger men and women in this nation.”

The presentation explains that a database mapping psychological well being provision for young people was “discontinued post April 2010″.

“The final national review was completed ten years ago and so we have no up-to-date nationwide data on the numbers of kids and young individuals with mental wellness troubles,” Brennan said. “Organizing service provision without having recent information is very tough, fraught with hazards and not price-effective.”

The acute strain on the program will have repercussions later on, the presentation warns. It claims that social emotional programmes – used to deal with “perform disorder” (a lot more frequently acknowledged as antisocial disorder) in young young children – conserve the NHS £84 for each pound spent.

Dr Jacqueline Cornish, NHS England’s nationwide clinical director for kids, younger people and transition to adulthood, said: “We should make positive kids and young people get the correct care from the proper person as quickly as achievable.

“We are especially investing £17.4m to boost earlier intervention, diagnosis and remedy of mental well being issues in underneath-18s, as we know that this is the most productive and effective way to tackle psychological overall health problems.”

But Enver Solomon, director of proof and influence at the Nationwide Children’s Bureau, stated that young children and younger people’s mental well being had not obtained the “financial and political priority” it deserved for far too lengthy.

“It is very clear that there is a damaging lack of clarity on responsibility and accountability for the powerful commissioning of children’s psychological wellness services as well as an alarming reduction in the provision of expert and early intervention providers,”

Kid psychological health providers "failing 3-quarters of kids"

Good public providers "poisoned" by poor dealing with of complaints, say MPs

Tory MP Bernard Jenkin, chair of the Commons public administration decide on committee. Photograph: Michael Stephens/PA

Good public solutions ranging from the NHS to regional government are also often currently being “poisoned” by inadequate managing of complaints, a cross-party group of MPs has found.

In a report commissioned right after the Mid-Staffordshire NHS scandal, the Commons public administration committee said many elements of the government have to get better at listening to complaints. It said the government total fails to conform to ideal practice on handling the public’s issues.

The report suggests that a Cabinet Office minister get charge of how complaints are dealt with across the government and there should be a single level of get in touch with for citizens to raise considerations about public services.

It said ministers should personally deal with complaints brought to their attention by MPs rather than delegate them.

Bernard Jenkin, the chairman of the committee, said: “As factors are, most folks feel there is no stage in complaining.

“Unless of course and till we have a culture of leadership in public providers that listens to, values and responds to complaints, from support consumers and staff, there will always be the prospective for tragedies like Mid-Staffs, and opportunities to enhance providers and public self-confidence will be missed yet again and once more.”

Good public providers "poisoned" by poor dealing with of complaints, say MPs

Psychological well being providers want targeted investment, not even much more cuts

Providing mental wellness support consumers targeted advice on stopping smoking could enhance their physical wellness and save income. Photograph: Jonathan Brady/PA

By 2030, there will be an estimated two million more adults with a psychological well being problem. So, what should the new NHS England chief executive Simon Stevens’s priorities be when it comes to improving psychological overall health in the NHS?

First, target on individuals locations exactly where the NHS can both increase people’s lives and conserve income. At least £1 in every single £8 invested on prolonged-phrase conditions is linked to poor psychological well being. If we could support individuals folks far better, we could make huge enhancements. For illustration, cognitive behavioural techniques have been proven to help patients decrease their anxiousness, cope greater with their illness, and be admitted to hospital much less. A recent pilot located that targeting psychological health support at some patients with persistent obstructive pulmonary ailment could conserve £5 for each and every £1 invested.

Second, improve the physical health of people with psychological health issues. Thoughts and Rethink Psychological Sickness have campaigned consistently on this concern. By giving psychological wellness support end users tailored suggestions on stopping smoking, we could start to make real headway in improving good quality of care.

As a third priority, exploit the options presented by digital technological innovation. The Clintouch project, led by Manchester University, is acquiring support end users to monitor their signs and set medication reminders via their smartphones – permitting clinicians to intervene much much more swiftly if they display signs of deteriorating among sessions. Organisations like Big White Wall are leading the way in delivering treatment on the web, commissioned by the NHS.

Psychological wellness service consumers must also have the exact same rights to pick who supplies their healthcare, inside of guaranteed waiting occasions, as individuals using bodily health providers. And a coherent vision demands to be produced about what our long term workforce must appear like. Some commentators talk about the potential to boost options for folks who have experienced mental sickness to perform a function, each formally and informally. Other individuals talk passionately about the want to retain clinical input and knowledge.

But what about funding? Budgets have been cut for 3 years in a row. And NHS England and the regulator, Monitor, lately advisable cutting funding for psychological well being services by twenty% far more than for acute hospitals, when referrals to local community teams are up 13%, and have increased by sixteen% for crisis providers. NHS England have to make sure psychological wellness providers are not topic to a fourth 12 months of cuts. To do so would be a lower too far for the 1.6 million men and women who look for aid from NHS mental overall health providers every single 12 months.

Psychological well being providers want targeted investment, not even much more cuts

Which way now for public providers in Scotland?

Would an independent Scotland be able to reverse the Uk government’s austerity measures? Photograph: Jeff J Mitchell/Getty Photographs

Housing policy has been devolved for many years. The Scottish government controls budgets for investment and capital subsidy. The austerity axe has fallen heavily on social housing. We would welcome reinvestment to supply a lot necessary cost-effective housing, at a lower value to the public purse. The most powerful way to remedy the bedroom tax is full repeal. We welcome cross-party assistance in the Scottish parliament to mitigate the impact of the tax with additional investing. The tax underlines the tensions between social security and housing policy just above half of all social rents payable in Scotland are sourced from housing benefit, but housing benefit expenditure is a lot reduce per capita simply because rents are decrease here. Policymakers have no management in excess of the means by which individuals are supported to shell out rental expenses. In the event of a no vote, we would seem for even more devolution of powers to allow Scotland to workout management above how to assistance housing charges. But if there’s a yes vote, we would expect a social security system to meet Scottish needs and policy objectives. 

Enhanced homelessness rights, the abolition of appropriate to buy and fuller rights for tenants are a sample of the measures that signify the divergence among housing policy in Scotland and the rest of the Uk. What ever the vote, housing policy will proceed to evolve. That’s not to diminish the significance of a yes vote. Taking complete handle of welfare and taxation are the two biggest policy levers on supply. With rewards and taxation powers firmly held at Westminster, landlords nevertheless dance to those tunes far more than those of Holyrood. Whatever the end result of the vote, there are two certainties – Scotland’s immediate want for a new lengthy-term prepare on homelessness and to build at least 10,000 new inexpensive residences every single year for the foreseeable potential.

The present Uk strategy to dealing with asylum and refugees is not match for purpose. It’s getting dealt with in the broader immigration technique, which is yet another area of public policy that is a toxic debate. Asylum is swept up in that when it is a separate situation that demands to be accomplished in a different way to border manage and determining who gets to operate right here. We’re pleased that a variety of the suggestions we place forward [for how the asylum and refugee system would perform in an independent Scotland] have been included in the white paper on independence. Principally, the idea of establishing a separate agency just to deal with asylum and refugee troubles – free of charge from day-to-day political interference. A specific agency separate from immigration, signifies we will have decisions that will be more primarily based on proof. It’s about restating the truth that claiming asylum is not a crime – it truly is component of the global human rights framework.

At a individual degree, I am quite fearful that if the vote is yes, all the other problems such as currency, debt and political welfare methods will take precedence, and there will be absolutely nothing happening [in migrant rights] for a handful of years. I know the Scottish government feels that the immigration and asylum situation is all about integration. I think that integration is a two-way process. In the United kingdom, it really is also one particular sided – “how can migrants fit in?”. Integration smacks of “tolerance” and I would a lot choose “acceptance”.

When you speak to folks in nearby communities, the actual story is not about the internal workings of Holyrood or Westminster. It is about the local providers that communities need to have, and giving people a say about what matters locally to them. Efficient regional democracy is fundamental to the variety of nation we want to dwell in. The options and difficulties that we face in different parts of the country demand regional selections and neighborhood accountability. More solutions are run by distant bureaucracies, and frequently people providers are becoming accomplished to individuals rather than delivered with them.  Generating Scotland a fairer, healthier and wealthier spot will not be attained from the top down. The actuality is that strengthening lives means empowering nearby democracy and letting regional people determine on their priorities, their solutions, and their spending. 

Social operate legislation has been separate from England for many years. Though the 32 councils make a decision on certain social work funding, considerably latest policy is perceived as more and more centralised, for instance, grownup assistance and protection. It truly is yet to be witnessed how social care partnerships could be influenced by the vote. Some really specialist assets are accessed in England this kind of as detox, therapeutic residential care, and secure care – despite the fact that councils consider to steer clear of this, at times there are no amenities right here. Also, some charities offering care, this kind of as Barnardo’s and Action for Children that are Uk-wide with Scottish offices, may review their position in an independent Scotland. Social function delivery in Scotland has been significantly impacted by the impact of welfare reform imposed by Westminster. Our members have to deal with people’s confusion about universal positive aspects and the resulting penalties that can depart young children and households in enhanced poverty. There is a view that a yes vote could help repeal some of this legislation. Several of our members want social workers to be freed up to return to their direct position as modify agents within communities. A smaller country, both independent or with elevated devolved powers, may possibly permit for that debate.

Our roles as campaigners, service providers and neighborhood builders will not disappear. There will often be a require to mobilise citizens, regardless of whether to help in hospices or put an end to poverty and inequality.  Independence will neither support nor hinder the improvement of the correct approaches to keep older folks out of hospital, youngsters off the dole or offenders out of prison. What will adjust for us is the leverage to challenge a lot more and to construct the type of inclusive value-primarily based society and sustainable economic system that some of us dream of. With the criminal welfare cuts and the austerity policies of the United kingdom government, the big query is: would large levels of poverty and inequality stand a better likelihood of becoming addressed in an independent country? Would it pave the way to create an financial technique that works for the bulk? With independence, we would count on an immediate turnaround in approaches to welfare – from belligerent harassment to support and empowerment. Voluntary organisations would play a huge portion in the immediate task of nation building, but whether it’s a yes or no vote, there will usually be a lot more to do to develop a much better, fairer society.

Amongst disabled individuals in Scotland there is a huge volume of dread about the new personal independent payment (PiP), universal credit score and the impact of bedroom tax. Even though massive [policy] regions are devolved in Scotland, there is a mismatch at policy level. For instance, Inclusion Scotland favours houses for life [designed to accommodate people"s altering care wants] but the bedroom tax undermines that [as it forces individuals to move to smaller sized properties]. We can now meet with crucial policy and selection makers and give them our account of what is necessary – they do not often act but we can speak and get a hearing. There is a challenge in going down to Westminster and getting access to ministers. It is physically attainable to lobby [members of the Scottish parliament], which can make achieving political modify simpler.

Public well being is a severe matter for Scotland. Given that devolution, the Scottish government has brought in daring initiatives, including the abolition of prescription fees and the provision of cost-free eye tests for all. And let’s not overlook that we had been the 1st United kingdom nation to introduce the smoking ban. Now the Scottish government is pushing ahead with strategies for plain packaging on cigarettes and minimum unit pricing on alcohol. These stage to a distinct set of government priorities than individuals of Westminster. The Scottish government factors to cuts in welfare investing brought in by Westminster exacerbating bad well being. Independence would give Scotland the power to target on strengthening wellness by seeing wellness, social care and wider social problems as all portion of the exact same picture.

Devolution has led Scotland down a different path from the rest of the Uk with commitments to universal public providers, no privatisation and free of charge schooling. But “mitigating Britain” cannot be our long term. We are caught with the unbalanced United kingdom economic system and each and every time Westminster cuts funding from public companies, our budgets fall. You saw this just lately in which Scotland diverted funds from other budgets to lessen the affect of the bedroom tax. Scotland is presently halfway in the direction of being a different variety of nation. Independence is an opportunity to try out and complete the occupation.

Civil and criminal courts are already inside of the competence of the Scottish parliament, and Scotland’s prison services is separate from England’s, so there is no purpose for significantly to modify immediately in the realm of criminal justice. However, if we obtain wider powers in relation to social protection this may well have an impact on criminal justice problems. The explanation a lot of men and women end up in Scottish prisons is tied to poverty. Selections about how people on benefits are dealt with – advantages being suspended or stopped, for example – have an effect on offending costs. Independence delivers higher scope for joined-up government, for welfare policy choices to be taken in a certain Scottish context rather than being determined by Westminster.

Which way now for public providers in Scotland?

Charlotte Walker: if you reduce psychological wellness money, you have to reduce providers

It really is been an eventful couple of weeks for mental well being campaigners like Charlotte Walker, aka award-winning Bipolar Blogger, whose website is referred to as Purplepersuasion. With Nick Clegg advertising the government’s newest mental wellness technique, inquiries about cuts and the top quality of companies have been attracting consideration.

For Walker, 35, whose erudite and controversial blog shines a spotlight on the problems that proceed to face folks living with a mental illness, it is not the very first time she has heard the government’s excellent intentions. “It is not quite a lot of many years because we had the No Wellness Without Mental Wellness approach and variety of received nowhere,” Walker says of previous attempts to prioritise psychological well being. “We all go by way of these convulsions of guilt that our services is not good sufficient and pledge to make it various, but the resourcing is never ever there.”

Launching the government’s most current action plan, Closing the Gap, Clegg laid out new efforts to carry mental wellness out of the “dark ages”, which includes providing service-end users the proper to pick the place they obtained their care, the introduction of minimum waiting occasions and an extension of “speaking therapies”. He was pushing for “parity of esteem” or, in less impenetrable language, equality of care with physical wellness.

Walker welcomed Clegg’s robust assault on psychological well being nevertheless being regarded as “the bad cousin” of the NHS and for highlighting the stubborn persistence of discrimination and stigma. Even so, for all Clegg’s overtures, Walker has reservations.

“It truly is this entire annoying phrase ‘parity of esteem’,” she says. “Why are we talking about parity – no person knows what that implies. We want equality of funding, we want equality of esteem in terms of currently being taken significantly, and we want equality of treatment method as in not getting to wait for months [for treatment].”

“People are up in arms when there is a beds crisis in a normal hospital trust but they are not up in arms [about acute psychological wellness wards]. If you reduce the income then they have to cut providers.”

When it comes to selection about the place to be handled, Walker says, “just like colleges – most folks never truly want to have to travel a lengthy distance to locate a services which is respectable. They just want the one down the road to be Ok. The principal issue is the postcode lottery. What occurs to you, even with the identical diagnosis, depends purely on the place you live … which is just going to make you feel helpless and hopeless.”

Between bloggers on psychological wellness, Walker’s blunt and well-informed commentary has been broadly lauded. She helps make the level that she doesn’t create or talk about every mental well being-connected issue but rather individuals of which she has individual expertise or is especially passionate about, and it has proved a winning formula. She not too long ago won a prestigious digital media award from the charity Mind, and MPs, charities and academics now regularly contact her in for consultations.

Via the website and Twitter, Walker blends astute analysis of troubles with a raw candour about her personal knowledge of bipolar disorder, usually posting brief and occasionally harrowing descriptions of how the sickness is affecting her on any provided day, such as suicidal thoughts. What began as a personal blog in Might 2011 morphed into a fully formed platform that drew readers in their droves.

“There was no plan. It was like, ‘this is how it feels to me’,” she says. Being place on anti-psychotic drugs and going by way of the “horrendous” side effects spurred her to create about how difficult it all was. “I just considered, ‘I’ll publish this, I do not know where else to say it’. [By way of] all of this I was [contemplating]: ‘I’m going to be back at operate any minute now’,” she says.

It was a number of months following beginning to publish when she posted a site, “10 factors not to say to a depressed particular person”, which garnered 38,000 views in a single day, that Walker thought she might be on to one thing. “It was a bit in-your-face,” she says of the submit. “It got to the level exactly where so numerous individuals left me so many remarks. Actually, actually, private stuff. Individuals who didn’t know me at all just felt compelled to open up.”

It is clear Walker will take the suggestions as constructive reinforcement, but it truly is not without having its problems. “Each and every week, I will have a person e-mail me, direct message me [or] text me – who I don’t know that effectively or in some circumstances don’t know at all – asking for advice and telling me their actually very distressing situations. When it really is much more raw I actually find it quite challenging. I feel at times people overlook that I am not a mental overall health skilled,” she says.

One particular of the ongoing concerns Walker has studiously targeted on is “back-to-operate” reforms affecting jobseekers with well being troubles or disabilities. As someone with initial-hand encounter of the contentious work-capability assessment approach she is vocal about the misery it has inflicted on men and women with “hidden or fluctuating” situations, in specific.

She has taken component in “listening exercises” with MPs, where she has tried to explain the actuality for individuals impacted. “My level is: ‘look at me, I’ve got two [first-class] degrees … I’ve received all this sound operate historical past however I can’t function.’ And, if I can’t, what about all the people with extreme fluctuating psychological illnesses and no experience of interviews? My problem is so complex and so changeable it truly is all really nicely to say I could have a phased return … [but] at times I can function and occasionally I can not operate.

“I came away [from consultations with the DWP] with the impression that they believed the issue is ‘change the jobseeker to match the system’, and as a disabled individual I feel ‘no, the dilemma is, we need to have to adjust workplaces to suit us’.”

For all of her passion, campaigning came late to Walker, who carved out a effective job in the probation service prior to her psychological health seriously deteriorated. She was in her 30s by the time she sat down and wrote about her experiences, and already had more than two decades of encounters with psychological wellness services – like varying diagnoses, alterations of medications and even an try to consider her very own lifestyle. (She first designed symptoms at the age of 12 but initially medical professionals put her mood fluctuations down to “getting a teenager”.)

She says that more than the past year, her weblog has became far more campaign-focused. “Just far more and much more issues have been coming up that pissed me off, fundamentally,” she says.

When we meet, Walker describes herself as “currently being at a bit of a crisis stage at the second”, healthwise, but she plans to hold creating, campaigning and carving out a “portfolio profession”. She has written a bipolar memoir as well, The Incoming Tide, which she hopes will be a lasting legacy. For now, although, the likelihood of positive change is out there, she says. “There are some items for which we don’t need to have extra funds [and] we could do issues greater.”

Age 35.

Standing Spouse, two teenage young children.

Lives Ealing, west London.

Education Samuel Whitbread Upper College, Bedfordshire University of Luton, degree in present day English scientific studies antenatal schooling HE diploma University of Hertfordshire, degree in criminal justice studies level four NVQ in local community justice probation research diploma.

Occupation 2012-current: mental health blogger/trainer/advisor/writer 2007-12: acting senior probation officer/probation officer, London Probation 2005-07 trainee, London Probation 2003-05: probation officer, Bedforshire Probation 2002-03: clinical audit and effectiveness officer, Bedford hospital NHS trust 2000-01: student midwife, Bedford hospital and antenatal teacher, NCT.

Awards Mark Hanson digital award, Thoughts Awards 2013 mood disorder award, Mentalists Awards 2012.

Interests Choral singing, innovative writing, cooking, travel.

Charlotte Walker: if you reduce psychological wellness money, you have to reduce providers

It really is not just grownup psychological wellness providers that are hurting from cuts | @guardianletters

Mental ill wellness seems to be anything most folks do not want to speak about, and it was a relief to read not only Nathan Filer’s phrases but also those of his buddy (Exactly where did mental wellness care go so incorrect? 25 January). Nonetheless it is not only in adult mental health services that the cuts are hurting. I perform in a neighborhood NHS psychological wellness staff for youngsters, young people and their families. The young children and youthful men and women we operate with starve themselves, minimize themselves, hear voices, become so anxious they can not get to school, so troubled they are not able to find out or make pals, are so unhappy they want – and attempt – to kill themselves.

Some of them have dad and mom who will assistance them. But some will not want their households involved in their care. And occasionally households just don’t have the assets to offer a secure base for their children. Back in the day, social companies had been able to stage into the breach, but structural alter and cuts have led to an increase of the threshold by which households can get a services. Non-statutory companies plugged the gap for a while, but cuts are biting and providers this kind of as counselling centres for young folks are closing all above the nation. If psychological well being solutions are the Cinderella of NHS overall health care, those for kids and young individuals are even further behind in the queue.
Tanya Smart
Lewes, East Sussex

• Nathan Filer has highlighted the difficulties facing psychological overall health care. Bed and staff shortages suggest folks can not get the assist they need. The schedule use of antipsychotics as a chemical restraint and discrimination against people who experience psychological wellness troubles is a genuine fear. But psychological well being nurses have a obligation to be holders of hope. We need to recognise optimistic alterations and, as we say to people we care for, factors will get greater.

Who would have believed, even 10 many years ago, that as a pupil psychological well being nurse I would have the chance to be inspired by people like Rachel Waddingham of the Hearing Voices Network and Ron Coleman of Functioning to Recovery, view plays carried out by end users of mental well being services, or engage in enlightened debates about the use of medication and observations. This is an fascinating time for psychological well being care, and I actually think things can get better. If one in 4 of us knowledge psychological overall health troubles, then we all have a obligation to push for modify. Too several people nevertheless do not get the care they deserve. Nevertheless, as an alternative of complaining and despairing about the long term, let us recognise excellent practice, like Hearing Voices, and use it to inspire us all to battle for much better for everybody.
Matilde Rahtz
Oxford

• The clue as to why successive governments have closed 50% of mental wellness in-patient beds in the past ten years lies in Filer’s very own description of the care packages supplied – primarily: food, lodging, respite from a chaotic way of life and some medication and treatment. Patients received a temporary “lift” but sustained health improvement frequently eluded them. A lot more focused neighborhood-based mostly healthcare packages, this kind of as early intervention in psychosis, are much more efficient and less pricey than an in-patient stay. The NHS, in spite of resource pressure, stays a planet-class entity in the advancement of new varieties of residence-based remedies, and resistance to change – typically between NHS clinicians – is one particular of its major problems.
Ken Harper
Former vice chair, Manchester mental well being and social care NHS trust

It really is not just grownup psychological wellness providers that are hurting from cuts | @guardianletters