Monday, 28 November 2016

Housing benefit?

A week ago (and many thanks to Donna Glover for pointing me to this) the Government began an open consultation (responses in by 13thFebruary folks) on the future of funding for supported housing across England,Wales and Scotland.

This is a massive issue, particularly in terms of how much housing benefit goes into supported housing landlords’ coffers when there is a serious shortage of affordable housing for rent.
As part of the consultation, the government has published an evidence review conducted by Ipsos Mori, Imogen Blood & Associates, and the Housing and Support Partnership, using a mixture of official statistics, datasets, surveys, and extrapolation 

Although it’s somewhat ticklish territory given the scale of the cuts being scythed from public funding to support for people with learning disabilities, it’s long been my contention that there is still a lot of public money being spent to institutionalise people with learning disabilities rather than to really support people to live the lives they want. And a big chunk of money I haven’t known about is housing benefit – a chunk of money that has recently probably been getting bigger as local authorities try and shunt some of their social care accommodation costs on to housing benefit by re-registering residential care as supported living.

Although there is in this blog my usual dose of finger in the air calculation, so extreme caution is needed about this stuff, the evidence review gives us some basic figures to work on. So – here we go…

The evidence review says that there are 38,500 working age adults with learning disabilities in England (i.e. aged 18-64 years) in some form of supported housing. This is almost a quarter (24%) of all working age adults in England in supported housing. Of these 38,500 people, most of the supported housing is provided by housing associations (24,500 people), followed by charities (5,500 people) and local authorities (2,000) – ‘other’ (either private landlords or housing where the commissioners don’t know who the landlord is because the housing and support is so enmeshed) accounts for 6,500 people. This doesn’t quite add up to the amounts reported by local authorities in national statistics but anyway, let’s press on…

Information from private rented providers in England suggest that, on average, people with learning disabilities in supported housing are paying £104 per week in rent and £59 per week in service charges. If there are 38,500 people in supported housing, this adds up to a grand total of £208.2 million per year in rent and £118.1 million per year in service charges for people with learning disabilities. If housing benefit is paying for this, then this would add up to £326.3 million in housing benefit for supported housing for people with learning disabilities.

The evidence review also asked as part of their survey how much local authorities in England were funding for the support elements of supported housing over and above rent and service charges, and they came up with a total figure of £640 million per year for people with learning disabilities (equivalent to £320 per person per week for support).

This is a very quick blogpost just really to alert people to the report and the consultation so I haven’t had time to digest it, but some very quick thoughts:

  1. For working age people with learning disabilities, this suggests that almost a billion pounds a year (£966.3 million) is spent on supported housing, with around a third of this coming from housing benefit.
  2. Even adding up the rent, service charge and support costs, supported living is still considerably cheaper to the public purse at £483 per person per week than residential care for working age adults with learning disabilities at £1,336 per person per week.
  3. Following on from point 2), Rochdale and other local authorities planning re-institutionalising routes take note.
  4. Also following on from point 2), and perhaps heretically, it’s quite possible that supported housing support is too cheap, meaning that for many people living connected lives that they want to live becomes effectively impossible and people become prisoners in their own homes housing units.
  5. Last thing – separating the funding sources of housing benefit from local authority funding of support has not resulted in the meaningful separation of housing and support for many people. It has also not stopped a commercially driven drift away from people living in their houses in the middle of their streets, to ‘specialist’ complexes promoted by organisations grabbing a bigger share of the ‘market’. The money needs to be meaningfully controlled by people who can put it to good use, rather than leaving people at the mercy of landlords’ interests while being blamed for their rents being expensive.

Thoughts on this would be very welcome – I may well have made more mistakes than usual!

Tuesday, 1 November 2016

Where have all the nurses gone?

This post updates and extends a blogpost I did last year about trends over time in the learning disability nursing workforce in England. There has been a lot of noise made about the importance of learning disability nurses in helping people with learning disabilities get decent access to decent healthcare. On the principle that an organisation’s priorities are often shown in where it puts its money, what are the priorities of those training and employing nurses in the NHS?

So, what’s happening to the workforce of nurses working specifically with people with learning disabilities in England? NHS Digital, as part of their suite of NHS workforce statistics, provide monthly information on the number of Whole-Time Equivalent (WTE) nurses in the categories of Community Learning Disabilities nurses and Other Learning Disabilities nurses. The graph below shows this information for the month of May from 2010 through to 2016.

For community learning disabilities nurses, there were 2,571 WTE nurses in May 2010, dropping steadily to 1,973 WTE nurses in May 2016 (a drop of 23% in 6 years), with numbers stabilising from 2014 to 2016. The decrease for ‘other’ learning disabilities nurses (presumably in large part working in general hospitals, although they may also be in NHS specialist inpatient units or other services) is even bigger and more sustained, dropping from 2,916 WTE nurses in May 2010 to 1,529 WTE nurses in May 2016 (a drop of 48% in 6 years). Overall, this is a drop of 36% in the number of WTE learning disability nurses over 6 years.

Similar figures are also available for specialist learning disability nursing support staff working in the NHS. The graph below shows that the number of WTE community learning disability nursing support staff dropped from 1,805 in May 2010 to 551 in May 2016 (a drop of 56% in 6 years). The number of ‘other’ learning disability nursing support staff also dropped, from 8,962 in May 2010 to 4,255 in May 2016 (a drop of 53% in 6 years). Overall, this is a drop of 55% in 6 years.

The equivalent figures for WTE learning disability psychiatrists working in the NHS are in the last graph below. The numbers here have hardly changed, from 450 in May 2010 to 432 in May 2016 (a drop of 4% in 6 years).

When looking at this, it’s worth bearing in mind that this workforce information is for NHS services only – we don’t know how many nurses and nursing support staff are working with people with learning disabilities in third sector/private services (particularly specialist inpatient services, which have increased their, um, market share, shall we say, over this time period).

In some ways it’s unclear what is going on here. Among other things, it could be a combination of deprofessionalisation of staffing within NHS services, a shift towards generic rather than specialist nursing roles, shifting service patterns (away from NHS inpatient services towards independent sector inpatient services, for example), and of course straightforward cuts to nursing roles.

At the start of this post I said that one way to track an organisation’s priorities is to see where it invests its money. This was too simplistic – whatever the NHS is now, it’s certainly not one organisation. Whatever the Department of Health and NHS England may say about the importance of learning disability nursing, the number of nurses who are trained and employed isn’t under their control. It’s ultimately down to Health Education England, over 200 Clinical Commissioning Groups, approaching 250 NHS Trusts, and almost 8,000 GP practices. Not to mention the almost 900 independent sector organisations providing healthcare (figures from the NHS Confederation). In a reversal of Aneurin Bevan’s dictum Whitehall can drop all the bedpans it wants, but there’s no reverberation in hospital corridors.