What will the #LBBill cost?

One of the key considerations that we have had to consider since proposing and developing the #LBBill has had to be about whether it makes financial sense! As much as quality of life experience for disabled people is our paramount concern, it would have been remiss of us to draft and co-produce a Bill without considering the question of what the Bill would cost. To that end Professor Chris Hatton, has done some number crunching and projections for us:

Obviously, human rights shouldn’t come with a price tag. Equally obviously, MPs thinking about sponsoring the #LBBill as a Private Member’s Bill are going to ask the question about the cost consequences of implementing the #LBBill. This short blogpost cannot provide a definitive answer to this question, but it will try and sketch out some of the main cost issues involved, and suggest that the #LBBill will not result in an explosion in the costs of supports for disabled people.

Two clauses in the #LBBill involve changes to the way that public services work with disabled people to make decisions:

Clause 5. Living arrangements to be subject to approval, and

Clause 10. Duty to involve disabled people and supporters in decisions made about their care

These changes should be cost neutral, as they do not directly change the actual support offered to disabled people. Increases in time spent to gain the approval of disabled people should be balanced by reductions in current levels of pointless monitoring and scrutiny of disabled people and the consequences of services making poor decisions without regard to the person’s wishes. Substantial public money is already spent on these processes (for example, almost £300 million was spent on assessment and care management just for working age adults with learning disabilities by local authorities in 2012/13 click here for more).

Two clauses in the #LBBill specify guidance and consultation arrangements, and reporting requirements:

Clause 6. Duty to report on living arrangements and community support, and

Clause 11. Guidance

These are likely to be cost neutral, as public bodies already have a range of reporting requirements concerning their treatment of disabled people, and the reporting requirements here are likely to replace or become part of existing annual reporting arrangements (for example the Autism Self-Assessment Framework and the Learning Disability Self-Assessment Framework).

A further two clauses in the #LBBill involve amendments to existing legislation:

Clause 7. Amendments to Mental Capacity Act 2005

Clause 8. Removal of people with learning disabilities and autistic spectrum conditions from scope of Mental Health Act 1983

Firstly to ensure that the Mental Capacity Act operates in line with its original intentions, and secondly to remove people with learning disabilities and autistic spectrum conditions from aspects of the Mental Health Act. These clauses will at worst be cost-neutral, as they may prevent some people being admitted to inappropriate and expensive inpatient services (at an average cost of over £171,000 per person per year) without due process or regard to people’s actual needs both in the short-term and long-term.

The remaining five clauses of the #LBBill are explicitly concerned with services and supports for disabled people:

Together, and in concert with the clauses already mentioned, they aim to ensure that all disabled should be able to live in the community with choices equal to others and the support necessary to ensure their full inclusion and participation in the community (Clause 1. Implementation of Article 19 of the Convention on the Rights of Persons with
Disabilities).

Furthermore, public bodies cannot use the cost of residential care as a benchmark from which to evaluate people’s requests for non-residential support (Clause 2. Residential care not relevant to decisions in relation to community support for disabled people), and they have a duty to secure the most appropriate living arrangement with the disabled person, with financial considerations secondary to Clause 1 (Clause 4: Duty to secure most appropriate living arrangement).

To underpin these clauses, there is a duty to secure enough community support of the types that disabled people want and need (Clause 3. Duty to secure sufficient supply of community support), including community mental health services (Clause 9. Duty to provide community mental health services to disabled people).

Because the #LBBill would result in disabled people making meaningful decisions about where they are living and how they are to be supported in ways that have not happened to date for the majority of disabled people, it is impossible to construct a cast-iron economic model of the cost implications of the #LBBill.

However, there are good reasons to assume that an explosion in costs will not happen as a result to the #LBBill:

1) There are considerable public resources locked into inappropriate inpatient services for less than 3,000 people with learning disabilities and/or autism (over £500 million every year), with the #LBBill projected to result in a drastic reduction in these services. More is also likely to be spent on residential special schools for disabled children, from which considerable savings could also be made.

2) The #LBBill is likely to result in a considerable reduction in the number of people in more expensive and restrictive residential care homes or nursing homes (for example, over 35,000 adults with learning disabilities are in these services at an annual cost of over £2 billion, at a unit cost of almost £70,000 per year per person).

3) Less restrictive and more desirable alternatives such as tenancies with decent support, or shared lives arrangements, are on average less expensive than residential or nursing care, as are community supports such as home care and support from professionals. The savings made from reduced use of highly restrictive services would allow increased use of effective non-residential supports funded at decent levels to allow people to lead meaningful lives.

4) Sizeable amounts of public money are also spent on community-based services and direct payments (at least £1.7 billion per year for working age adults with learning disabilities, for example), which would also be part of the resources covered by the #LBBill. Under the #LBBill, as disabled people have more of a role in commissioning decisions, it is likely that more creative commissioning decisions will be made, linking services to broader supports available to all such as community leisure facilities and libraries.

Finally, it is worth mentioning that the #LBBill is consistent with and would add considerable force to the general direction of NHS England and local authority policy. In particular, the joint NHS England and ADASS ‘Transforming Care’ plans include plans to drastically reduce inpatient services for people with learning disabilities and/or autism, to correspondingly increase and improve community-based supports, and to develop effective supports for considerable numbers of children and families to reduce crises and support people to lead meaningful lives.

Overall, my view is that the #LBBill will not result in an explosion of costs in supports for disabled people. Well over £6 billion pounds per year is currently being spent on services for adults with learning disabilities, for example, yet existing services are often seen by disabled people as obstructive and unfair.

Getting the #LBBill into law is the most effective way of driving really significant changes in the lives of disabled people that are otherwise at risk, despite the best intentions of the Care Act, NHS England and local authorities.

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News on the #LBBill second draft

It is now four long months since the 12 Days of the #LBBill Christmas; we know we’ve been silent in that time here (there has been some discussion on twitter and facebook), but we thought blog readers were long overdue an update. Perhaps the most significant development has been the publication of the government consultation Green Paper: No voice unheard, no right ignored. Norman Lamb paid tribute to the #JusticeforLB team when he launched it (that includes you if you’re reading this and supporting the LBBill) and you can see our response here. So, what has happened for the LBBill in 2015 so far?

1) Feedback

We have spent time pouring over the feedback that you’ve all provided so far. You can see most of the feedback here, and there has been some sent by email. This has been absolutely critical to the process, we are insistent that the LBBill will represent what you tell us you would like, as far as we can bring all of that together. This is a crowdsourced bill, so your input really does matter.

LBBill Feedback Meeting

2) Meeting with interested people

Last month we held a meeting in London (with some joining by phone remotely) to bring together a group of interested people who had given us feedback. This group was made up of representatives from Disabled People’s Organisations, User-Led Organisations, Charities, Providers, Parents and Carers. We included as many people as the room would fit and we tried to make the group as diverse as possible. The meeting included people who had organised events to gather feedback on the first draft of the Bill, and we discussed that feedback to inform a second draft.

3) Discussion on- and offline

One of the joys of being involved with the LBBill is the enthusiasm for it, on and offline. So far this year people have spoken about the Bill at a number of events, conferences, discussions and workshops. These occasions have ranged from a self-advocate conference in Blackpool with karaoke, to online discussions in the early hours of the morning, to an All Party Parliamentary Group meeting in the House of Commons; every opportunity to discuss the Bill is important, we need more people to consider what a good, messy life for disabled people looks like.

LBBill Blackpool Conference

4) Draft 2

Following these meetings and events, the discussion and feedback was considered further and a Draft 2 was written. This draft should be available to share at the end of this month (April). We were ambitious and had initially hoped we could turn it around by the end of March but we are determined not to share a draft unless it is fully accessible, so we are taking a little longer to get the easy-read version right. Keep your eyes peeled but we should share something later this month.

5) LBBill Film

We are truly delighted to share with you this film which has been produced since Christmas. Filmed, edited and produced voluntarily by the awesome Luke Tchalenko, using footage from the November meeting, we hope that you find it useful and we’d like to see it shared far and wide:

So, even though we have been quiet on the blog, we hope you agree we’ve been busy and that we are making progress. The next stage in the process is for us to share Draft 2 (by the end of this month) and then to gather more feedback from you all.

There are also a number of occasions coming up where you can join a discussion about the LBBill. These include the Inclusion North event on National Politics and the LBBill which is taking place in Leeds on 28 April (please email Marie if you wish to attend) and the NWTDT | Pathways Associates CIC Green Paper consultation event in Preston on 12 May (please email Danielle if you wish to attend).

A new parliament will be formed in early May and we will then look to see what we can arrange around lobbying MPs, in the meantime if parliamentary candidates come knocking at your door, be sure to ask them what their policy is on supporting disabled people, and please do tell them about the LBBill.

Day 11: Twelve Days of Christmas #LBBill

Day 11 of the #LBBill Twelve Days of Christmas and we’re up to the final clause, Clause 8, a simple clause which would have a profound impact.

If the #LBBill becomes law, Clause 8 would remove people with learning disabilities and autism spectrum conditions from the scope of the Mental Health Act 1983.

This means that these people could only be ‘sectioned’ or otherwise treated under the Act if they also had a diagnosis of a recognised mental illness.

If a person with a learning disability or autism needed to be detained, then this would have to be done under the Mental Capacity Act. Otherwise, like the rest of the population, the only basis for detention would be the criminal law if someone committed a crime.

We know that the Mental Health Act creates some rights for people who fall under its scope and their families, but these rights are not enough to justify detention and compulsory treatment. We think it is wrong that disabled people should be treated under mental health legislation if they don’t have a mental illness.

This is explained further in today’s audio introduction film with easy-read images:

What do you think?

Do you have experience of the Mental Health Act being used in relation to people with learning disabilities or autism spectrum conditions who do not have a mental illness? Would this clause have helped?

Let us know what you think, on the feedback pages of the blog, on facebook, twitter, or by email. Thank you.

Day 5: Twelve Days of Christmas #LBBill

Day 5 of the #LBBill Twelve Days of Christmas and we’ve taken a step back from the detail to ask what it all means. Mark Neary has written a blog post offering his perspective and the astute amongst you will have noticed that LB’s pic has been replaced by Steven. It’s really important to those of us involved with the #LBBill that we situate this development in the experiences of those who it should help.

We’d like to feature more people, like Steven, whose lives could be improved if the #LBBill and the suggestions within it became law. If you are someone, or care for someone, who you think the #LBBill could help, and you would like their face to join the campaign, please email us a photo with a sentence or two of why it would make a difference and we’ll feature them later on in the 12 Days and throughout the #LBBill campaign. (Please note we will use your pics in publicity so please only use real names if you are happy to do so). Now over to Mark:

Steven

For me, there is a really simple idea at the heart of the #LBBill. If we were discussing this in relation to anyone else in the population besides physically or learning disabled people, we would be dismissed as ludicrous. The core idea is that every physically and learning disabled person has the right to choose where they live. They may choose to live on their own; on their own with support, with their families, or in a residential setting with other people. And once that choice has been exercised, other, just as important choices open up. Once someone has made a choice about the four walls they live in, then they can begin to choose how they live within those four walls.

The simplicity of the #LBBill was on my mind a lot on Christmas day afternoon. People who know mine and Steven’s story will know that he was illegally kept away from his home in an assessment and treatment unit for the most of 2010. The local authority planned to move him to Wales but on Christmas Eve 2010, through the intervention of the Court of Protection, we were able to spring him from his detainment and he came home at the very last minute to enjoy Christmas in his family home.

Watching Steven go about his business on Christmas morning, made me reflect on how different it would have been if he had been detained in the unit over Christmas. Here are a few examples from Christmas morning:

  • Steven awoke to have fresh fruit salad for breakfast, which he chooses to have every weekday morning. This was not possible at the Unit where the choice was either toast or cereal.
  • After opening his presents, he chose to watch the most eagerly anticipated of them – the new Mr Bean DVD. This would have been impossible in the Unit as the DVD player had broken a few months earlier and nobody had repaired or replaced it.
  • Next Steven listened to his new Abba triple set CD. He might have been allowed to do this in the Unit but he would have been sent to his room with his ghetto blaster, so as not to disturb the other residents and staff.
  • I brought Steven a Basil Fawlty mouse mat and naturally, he wanted to try it out, so up to the bedroom to do some YouTube surfing. This would have been impossible in the Unit because there was no PC or Internet for the residents to use – the only PCs were in the office and only the staff were allowed to use them.
  • Before lunch, Steven wanted his annual treat – Christmas Top of The Pops. We have every episode recorded since 1993! Whether he got to watch it in the Unit was a lottery – every bit of TV viewing had to be negotiated with all the other residents.
  • And finally, Christmas lunch. That probably would have ended up on the floor as the Unit weren’t particularly tolerant of Steven’s need to have all the food not touching on the plate. It’s quite a design feat with a full Christmas lunch but with a bit of patience it can be done.

That is just one day of the compromises and loses someone living in an assessment and treatment unit has to manage. Now multiply that by 364. Year after year. What a bleak existence.

Please get behind the #LBBill. It’s for life – not just for Christmas.

Day 4: Twelve Days of Christmas #LBBill

Day 4 of the #LBBill Twelve Days of Christmas and today we focus on Clause 3. We have an audio introduction to the clause with easy-read images here:

Clause 3 is about making sure that disabled people can access the care and support they need to live in their own homes, on their own, or with friends or family as they choose. The clause would impose a ‘sufficiency duty’ on Local Authorities and NHS bodies to make sure that there is the right amount of community support services so no-one is forced into residential care to have their needs met.

The purpose of the duty is to prevent isolation and segregation from the community. This is why we will need to define ‘residential’ care very carefully in the second draft of the Bill, because a disabled person may be more isolated and segregated in a ‘supported living’ setting than in a small community based residential home. What we think matters is not the label given to the place a person lives but what their life is actually like there. Do you agree?

Let us know what you think, on the feedback pages of the blog, on facebook, twitter, or by email. Thank you.

#LBBill Support and feedback so far

We’re delighted to share that we have broken the 1,000 barrier of support pledges. You can see who has pledged here.

We have also created an area of the website where you can view the feedback we’ve received on the first draft so far, and add comments to it yourselves. Swing by here to have a look.

Please keep your thoughts coming.

Over 800 pledges of support for #LBBill

In the last week there has been a lot of discussion about the principles of the #LBBill. Some related to Stephanie Bincliffe’s inquest, some to the Bubb report, and yet more to the brilliant article that Saba Salman wrote for the Guardian, published online and in print last Wednesday.

Screenshot 2014-12-01 11.36.56

The conversations continue as we speak with an open discussion in Manchester, organised by Eve Holt and PSG Speak Up

As well as the discussions, which are crucial to developing the next draft of the Bill, we are also getting more pledges.

We now have over 800 pledges of support for the #LBBill, 780 are from individuals, 31 from organisations and 1 from a Parliamentary Candidate.

We will be following up with others that we have spoken to recently, including the Minister Norman Lamb, to try and get them to publicly pledge their support. The Minister has done this on a number of occasions, including on BBC Radio Oxford, and when we met, so we’re hoping he’ll pledge.

We have also had some interest from the Labour Party via Andy Sawford, MP which we are actively pursuing.

Please keep pledging and keep sharing the campaign. You can see all those who have pledged their support on the page here.

Thanks again for the support, let’s make #LBBill happen. To pledge takes 60 seconds, click here, complete the form and then confirm when they email you. Thanks.