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 3: Twelve Days of Christmas #LBBill

Day 3 of the #LBBill Twelve Days of Christmas and we’d like to start with a huge thank you to those of you who have joined the discussion. We’ve seen some edits on the feedback pages here (go ahead, all welcome, add your own comment at the bottom of the document rather than editing other people’s if you prefer). There has also been ongoing discussion on facebook, twitter, the blogposts here and by email. So thank you all.

Please note if you send us other people’s details or contact information we won’t make the blog comments public (but they are all read… thanks Don). Please take the time to explain why your thoughts relate to the Bill or the relevant Clause clearly, what is obvious to you may not be to any other reader. Please also reply on specific clause pages where possible.

Today we move onto Clause 2. We have an audio introduction to the clause with easy-read images:

Clause 2 deals with a very specific problem. We know of cases where a Local Authority or NHS body is refusing to provide a disabled person with the care they need at home on the basis that they could provide the same care more cheaply in a residential setting. We think this is wrong, and we also think the Department for Health would agree with us.

However, not every Local Authority or NHS body seems to accept this, so we think we need the law to spell it out. Clause 2 would prevent the cost of residential care being taken into account at all when deciding what level of care to provide for someone at home. It seems to us this is obviously a good idea. Do you agree? Have we missed something?

#LBBill: turning social care policymaking on its head

We were contacted a couple of weeks ago by a few journalists interested in what we are doing.

Today Community Care published an article we wrote about LB Bill, why we’re doing it and how it works. You can read it here.

Screenshot 2014-10-27 11.56.36

If you’ve just found us today after reading the article, welcome.

You can follow the blog (blue FOLLOW button in top right) and then you’ll get an email each time we publish an update.

We hope to have the first draft of the Bill very soon and look forward to your feedback.