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.

Advertisements

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?

Day 1: Twelve Days of Christmas #LBBill

It’s the first day of Christmas and even though we know most of you will likely have dinner to cook, or be in a sprout coma for the next couple of days, or working and caring around the clock… we wanted to take this opportunity to wish you a Happy Christmas, and also to direct your thinking towards the #LBBill.

Over the Twelve Days of Christmas we’ll send you an email each day asking for your thoughts, comments or feedback. We will focus on one element of the proposed #LBBill, or our journey together so far, each day.

To kick us off, in case any of you missed it during the #JusticeforLB Advent Calendar (it was Day 7) we have Santa Claus discussing the #LBBill

Secondly, we have an audio introduction with easy-read images requesting feedback on the #LBBill. Please share this far and wide with your networks:

We’ll be back in touch tomorrow, but for now, please accept our wishes for a Happy Christmas.

What is LB Bill? Easy Read overview

Screenshot 2014-09-28 18.10.13

Screenshot 2014-09-28 18.10.02Screenshot 2014-09-28 18.09.51

Screenshot 2014-09-28 18.09.42

Screenshot 2014-09-28 18.09.33

Screenshot 2014-09-28 18.09.21

Screenshot 2014-09-28 18.09.10

Screenshot 2014-09-28 18.08.59

 

You can download this overview to share with people here.

We would like to thank the many people who have helped us to produce accessible documents about the LB Bill.

This overview was put together by Kaliya of People First England with Philipa, Jez, Dan and the Words to Pictures Team at Change, with financial support from Alicia and the Housing and Support Alliance.

LB Bill Timeline and Process

We wanted to share a post that outlines the steps we need to undertake to try and get the LB Bill into law.

September and October 2014

icon_14215

Steve will have a go at writing some words for the LB Bill, including what people have shared with him so far.

14 October 2014 This meeting has been postponed and will not now happen on 14 October but later this year, we will update this post when we have confirmation of the new date.

icon_28970 icon_61476icon_18205

A small group of people involved with LB Bill and JusticeforLB have been invited to a meeting called the All Party Parliamentary Group on Disability.

This is where politicians and people involved in making policy about disability come together.

We will launch our first draft of the LB Bill there. 6 Oct – We will be launching the first draft as soon as we have an easy read version available. It will be available here first.

Some people have asked us how they can give us money to help with the LB Bill campaign. You will be able to do that after 14 October.

We also hope that some newspapers and websites will want to talk to us about the LB Bill.

November and December 2014

icon_3373  icon_13585icon_11579icon_37153

This is when we need people to meet up and discuss what they think of the LB Bill that we have written.

We will provide questions to help your thinking.

You may wish to think alone, or you may wish to meet in a group.

You can talk about the LB Bill anywhere you like, the more people who talk about it the better.

icon_8678icon_27464

Once you have decided on what you think then you need to let us know what you agree with and what you disagree with.

We will let you know how to tell us, closer to the time.

January 2015

icon_27480

Steve and some helpers will look at everyone’s comments and have another go at writing the LB Bill.

February, March and April 2015

icon_12349 icon_10015icon_4203

At this point we need you to contact your local Member of Parliament (MP).

They represent your views and we need to make sure they know about the LB Bill.

7 May 2015

icon_11440

We all have a vote to choose who should run the country. The votes are collected at the General Election on 7 May 2015.

If someone asks you to vote for them, ask them what they think about LB’s Bill and make sure they know about it.

June 2015

icon_3190

We need as many MPs as we can get to support LB’s Bill. Every MPs name is put into a hat.

Twenty names are pulled out the hat.

If one of those is an MP who supports LB Bill, they can ask to change the law.

Help us

icon_23949 LB_dude square

If we work together we will hopefully be able to change the law, in memory of LB.

You can download the LB Bill Timeline and Process document with this information in, if you wish to share it with other people who are not online.

All icons freely available for public use from The Noun Project website.