HCEveryone knows mental health is the ‘Cinderella’ service - The Healthcare Commission has claimed that sweeping & sustained changes are needed to services for people with learning difficulties if they are to meet the standards expected in the 21st century.  Its first audit of specialist inpatient healthcare services for people with learning difficulties paints a bleak picture.

The Commission found that:
* most services for people with learning difficulties provide poor standards of care
* there are unacceptable variations in the quality of services throughout the country
* even the best services were not up to the standard expected of modern services
* while services are driven by committed staff working in difficult environments, significant institutional failings are depriving people with learning difficulties of human rights & dignity in many instances

The Commission did not find evidence of physical abuse in any service, but it did refer six services to local authorities under Protection of Vulnerable Adults protocols following concerns raised about the care of individuals or overall standards of care and made 2,548 recommendations to improve aspects of care. 

It said services operated off the radar of the healthcare system, with poor leadership, poor training and no framework to measure the performance of services. As a result of this, people with learning difficulties:
* live in poor physical environments
* are offered few choices in how they live their lives and
* are isolated from their communities
Press release ~ The audit, the report and easy read summary ~ Protection of Vulnerable Adults protocols ~ Making referrals to the Protection of Vulnerable Adults (POVA) list

DHFunding is the priority, not another consultation - Care Services Minister Ivan Lewis has launched a consultation (closes 11 March 2008) to seek views on the priorities for learning disability for the next 3 years.  'Valuing People Now - From Progress to Transformation' sets the agenda across a range of issues, including health & well-being, housing, employment, education and community inclusion.

It builds on the vision set out in Valuing People (2001), based on the four main principles of: Rights, Independence, Choice and Inclusion and the key areas it will focus on are:
* the personalisation what people do - helping people to be socially included in their local communities, with a particular focus on paid work
* better health - ensuring that the mainstream NHS provides full & equal access to good quality healthcare and that specialist healthcare services are modernised
* access to housing - ensuring that people have access to housing that they want & need with a focus on home ownership and real tenancies
* making sure that change happens - making learning disability partnership boards more effective and checking that the things the government say should happen do actually happen

Proposals based on the consultation’s responses will be published by summer 2008.
Press release ~ 'Valuing People Now - From Progress to Transformation' ~ Valuing People (2001) ~ Mencap ~ DH - Learning disabilities ~ 'Progression through Partnership' ~ 'Through Inclusion to Excellence' ~ Mencap - Good Practice guides and related documents ~ Connects: the Mental Health and Learning Disabilities Portal ~ Scottish Consortium for Learning Disability ~ CSIP: Our initiatives: Learning disabilities ~ Valuing People Support team ~ Foundation for People with Learning Disabilities ~ Survey of adults with learning difficulties in England: Final and summary reports ~ British Institute of Learning Disabilities ~ NLH - Learning Disabilities ~ LDUK~ Realising potential ~ Employers' Forum on Disability ~  Office for Disability Issues ~ Mansell Report

DHTimely care combined with full rehabilitation & support – The Government has promised that anyone in a higher-risk group who suffers a minor stroke will receive an MRI scan within 24 hours under new plans to revolutionise stroke services.  The strategy aims to accelerate the emergency response to stroke, by setting out a framework for care for those affected by stroke and raising awareness about symptoms & risk factors.

By following the actions set out in the strategy, up to 6,800 deaths and cases of disability could be avoided every year.  A further 1,600 strokes could be averted through preventative work.

Key measures include:
* MRI scans for higher-risk individuals with Transient Ischaemic Attack (TIA) - also known as 'minor strokes' - within 24hrs of experiencing symptoms, which could lead to an 80% reduction in the number of people who go on to have a full stroke

* Immediate transfer of those with suspected stroke to a specialist centre offering immediate clinical assessment, scans and clot-busting drugs. All local areas will have 24/7 coverage by at least one specialist centre

* People affected by stroke and their carers should have immediate access to high quality rehabilitation & support from stroke-skilled services in hospital, allowing people to get home faster

The strategy sets clear goals which NHS commissioners are expected to meet over the next ten years.  However, the DH would expect to see noticeable progress over the next three years. 
Press release ~ New National Stroke Strategy ~ DH - Stroke ~ Stroke Association ~ National Stroke Sentinel Audit ~ The Royal College of Speech and Language Therapists (RCSLT)  ~ A new ambition for stroke - a consultation on a national strategy ~ Commons Committee: Reducing brain damage: faster access to better stroke care ~ NAO: Reducing Brain Damage: Faster access to better stroke care ~ Stroke Research Network ~ Quality of care for stroke and TIA in General Practice ~ 'Coronary Heart Disease Ten Years On: Improving Heart Health'

Home OfficeA working solution or just more fingers in the Dyke - Home Secretary Jacqui Smith has announced changes to the UK's immigration regime to ‘ensure the system is firm but fair and supports Britain's shared values’, which include plans to ensure:
* that migrants can integrate into communities through strengthened requirements for English language
* all migrants play by the rules with strengthened restrictions on citizenship for those who break the law, and
* protection for vulnerable people through measures to combat forced marriage

The statement of intent for Tier 1 shows how the new tier will replace 8 existing immigration routes for people who are highly skilled, entrepreneurs, investors or have undertaken studies to a high level and want to stay in the UK to work.

Tier 2, targeting skilled workers with a job offer and Tier 5, for temporary workers such as musicians, actors & sportsmen will both come on line in the third quarter of 2008, while Tier 4, for students, will follow at the beginning of 2009Tier 3, which covers low skilled routes, will only be used if specific shortages are identified that cannot be filled from the UK on domestic or European labour force.

New measures to help to protect the vulnerable from being pressurised into forced marriage are being proposed by the Home Office in a new consultation.  A separate consultation seeks views on the introduction of an English language test before entry for people applying for a spouse visa to help to encourage successful integration. Both consultations close on 27 February 2008.

In addition, from 1 January 2007, no one who has a conviction which is not spent under the Rehabilitation of Offenders Act will normally be able to be granted citizenship.
Press release ~ Statement of intent for tier 1 of PBS ~ 'Marriage to partners from overseas a consultation paper’ ~ 'Marriage visas: Pre-entry English language requirement for spouses - a consultation paper' ~ BIA: A points based system ~ Migration Advisory Committee ~ Forced Marriage Unit ~ Good Character requirement

HM TreasuryA little help can make a big difference - Ensuring that everyone in the UK can access the financial system and manage their finances is the objective of the Action plan for financial inclusion for 2008-11, launched last week by Economic Secretary to the Treasury Kitty Ussher.

Financial exclusion causes extra costs and real disadvantage as:
* it makes day-to-day money management more difficult & expensive and can make it harder to find a job
* it makes it harder for families to plan for the future and manage spending peaks & troughs, and
* if things go wrong, financial exclusion makes people more vulnerable to financial distress and a spiral of debt, poverty & hardship

The plan details a number of initiatives to advance the Government's 3 priority goals for financial inclusion:
* Enabling people to manage their day-to-day money
* Planning for the future and coping with financial pressure, and
* Dealing with financial distress
Press release ~ Action plan for Financial Inclusion ~ Financial Inclusion - the way forward ~ Financial Inclusion Taskforce ~ ATM Working Group Report 'Cash Machines - Meeting Consumer Needs ~ Face to Face Debt Advice Project - BERR ~ OFT – Save Xmas ~ FSA - Money made clear ~ Advice Services Alliance ~ Advice UK: network of advice-providing organisations ~ Citizens Advice ~ Legal Services Commission ~ Money Advice Trust ~ Growth Fund for Third Sector Lenders

DIUSA very necessary investment - The National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs) will see their funding from £2m just over £5m in 2010/11.

Replacement is the ultimate aim for the Centre, but as long as the use of animals continues to be necessary, every effort must be made to minimise the numbers used and improve their welfare.  Optimal laboratory animal welfare is critical for scientific, ethical and legal reasons.

Currently UK, EU and US legislation requires the data on the safety, quality & efficacy of new medicines and their potential to harm human health and the environment to be assessed.  All medicines made available for use in the UK need to be tested in animal studies.
Press release ~ NC3Rs - National Centre for the Replacement, Refinement and Reduction of Animals in Research ~ Medical Research Council (MRC) ~ Biotechnology and Biological Sciences Research Council (BBSRC) ~ Animals (Scientific Procedures) Act 1986 (ASPA) ~ BBC - Science & Nature: Animal Experiments ~ Home Office: Research and testing using animals

NAOIf they work and are cost effective why aren't they resourced adequately? - Crisis Resolution Home Treatment teams (CRHT) are having a positive impact on local acute mental health services, providing an alternative to hospital admission for people experiencing a short-term mental health crisis.

CRHT teams help people though short-term mental health crises by providing intensive treatment & support outside hospital, ideally in their own homes.  Used appropriately & safely, CRHT brings clinical benefits and increased patient satisfaction.

But a report by the National Audit Office found that services are being limited by a lack of input from specialist health & social care professionals, variations in staffing levels across the country and too few admissions to hospital being assessed by CRHT teams.

The report also found wide variations between areas in the extent to which teams are staffed & resourced. Only three regions achieved the Department’s estimate for a full functioning service of 14 or more whole-time-equivalent CRHT staff per 150,000 population.  Almost a third of teams received no dedicated consultant psychiatrist input at all and fewer than half reported having dedicated input from approved social workers.
 Press release ~ Helping people through mental health crisis: The role of Crisis Resolution and Home Treatment services ~ Executive Summary ~ Crisis Resolution Home Treatment Services: Report from a Survey of Referring Clinicians ~ 1999 National Service Framework for mental health ~ NHS Plan (2000) ~ Department of Health’s 2002 Public Service Agreement ~ Crisis Resolution Home Treatment Psychologists Network ~ CSIP report

Industry NewsA rewarding impact on the environment & community that also generates savings – Councils and Housing Associations are using Comet Business Services to help set up Tenant Reward and Incentives Schemes, which encourage tenants to be more responsible for their property, thus generating significant savings and also having a substantial positive impact on the environment & community, through improving the appearance of neighbourhoods and their surrounding areas.

The schemes can be as simple or complex as required to meet all budgets.  A small level scheme example could be ‘receive a £20 Comet Gift Card if your home is left in good condition when you move’.  Larger schemes could include regular prize-draws and competitions to win TVs, Computers & Game Consoles keeping tenants active and constantly encouraging them to look after their properties. 

The schemes not only tend to result in reduced rent arrears, a drop in anti-social behaviour and more sustainable tenancies, evidence also suggests that average re-let times for properties are significantly lower, as are repair costs.

A 2005/06 analysis on 90 void properties, to look at where the money was being spent, highlighted potential savings £53,000 on total expenditure of £159,487.  Further savings could be made by reducing the need to raise & chase recharges and through reduced re-let times, which would also save on void rent loss.
Full details ~ Housing Quality Network ~ Housing Quality Network Reward Exchange ~ Audit Commission: Developing a reward incentive scheme ~ NFDC: The Introduction of a Tenant’s recognition and rewards scheme ~ Text-Connect: SMS Text competitions boost tenant incentive scheme ~ Comet Public Sector Discount Card

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