August 2024 Edition

In this edition of Casebook, we look at health care in homelessness centres; highlight Patient Partnership week taking place the first week of September; look at challenges faced by councils in SEND, adult social care and dental provision; and extend an invitation to open days at the Campus for Future Living and a place at the online National Rural Conference – all happening in the next few weeks! Read on…

Partnership to provide defibrillators at homelessness centres

National homelessness charity Crisis has partnered with Rural Services Partnership Member, Community Heartbeat Trust (CHT), one of the UK’s leading resuscitation charities, to provide Crisis’ Skylight centres with defibrillators.

The new defibrillators will provide potentially life-saving support in case of an emergency at Crisis’ nine Skylights across Britain, which support people at risk of or experiencing homelessness with one-to-one support, training, and wellbeing services. Alongside providing the defibrillators, Community Heartbeat Trust will provide bespoke training to Crisis staff.

Community Heartbeat Trust originally recommissioned telephone kiosks for defibrillators, now with around 1,000 sites in England. CHT also focus on providing defibrillators in areas more in need or where people are more at risk of suffering 'out of hospital cardiac arrests’. To date, CHT have placed around 9,000 community defibrillators, backed by governance, sustainability and resilience programmes.

People experiencing homelessness have far worse health outcomes than the general population, in part due to the physical toll of homelessness, as well as the challenges and barriers in accessing healthcare. People experiencing homelessness are six times more likely to have heart disease and are more likely to die than people with secure housing. In fact, health inequalities are so stark that the mean age at death is just 45.4 years for men and 43.2 years for women experiencing homelessness, respectively.

People in the most deprived areas are twice as likely to suffer an ‘out of hospital cardiac arrest’ compared to those from the least deprived areas, highlighting the urgent need to tackle both the ongoing homelessness crisis and the severe health inequalities that homelessness leads to.

Crisis has seen a stark increase in demand for its services, with the number of people approaching the charity for support rising by 25% in just one year. The Westminster government has made positive announcements on housing and homelessness in recent weeks, including confirming its plan to ban Section 21 ‘no fault’ evictions, and proposals to tackle the shortage of affordable and social housing, but further action is needed, Crisis says.

The charity is calling on the government to establish a unit for ending homelessness that would be backed by the Prime Minister and sit at the heart of the government. This would ensure a coordinated, strategic approach to deliver the change needed to build a future free from homelessness, which recognises the important role that our health services have in preventing and ending homelessness.

Andrew Burnip, Director of Operations at Crisis, said: 

“We’re really pleased to be partnering with Community Heartbeat Trust to ensure all of our Skylight centres are provided with new defibrillators.

“People experiencing homelessness face shocking health inequalities and are at greater risk of cardiac arrest. By having these potentially life-saving pieces of kit in all of our Skylights, we will ensure people receive the best possible treatment in an emergency, should they ever need it.

“Far too many people’s lives are being endangered, and sadly cut short, because they do not have a safe and secure place to call home. We know housing is a fundamental building block of health, and so access to good quality, affordable housing is vital to ending homelessness and the health inequalities that arise from it.”

Martin Fagan, National Secretary at Community Heartbeat Trust, said: 

“Currently, people who are in some way socially deprived have a more than double chance of suffering a cardiac arrest. So, until this figure comes down, it’s vitally important that we’re able to provide defibrillators in areas where people might need them most.

“Community Heartbeat Trust is one of the UK’s leading resuscitation charities, and we’re delighted to be partnering with Crisis. For many years we have supported the provision of defibrillators into areas of social need and homelessness, and working with Crisis will allow more work in this important area.”

Patient Partnership Week 2024 Enhancing Access to Health and Social Care

The Patients Association's Patient Partnership Week 2024 is set to commence on Monday, 2nd September.  This event offers a series of informative webinars aimed at improving patient engagement and healthcare delivery.  

These webinars, free and accessible via Zoom, represent an invaluable opportunity for healthcare professionals and patients alike to engage in meaningful dialogue and learn about progressive strategies in healthcare.

Webinar Highlights:

• Implementing shared decision-making in practice, Monday 2nd September 11am – 12pm. Patient Jess Plant and Trustee Professor Alf Collins will explore the benefits to patients and the health system of shared decision making.
• In conversation with the Patient Safety Commissioner, Monday 2nd September 3– 4pm. Dr Henrietta Hughes, Patient Safety Commissioner will discuss her work with our Chief Executive Rachel Power. She’ll talk about Martha’s rule and patient safety principles.
• Barriers to care faced by those with cancer and blood disorders, Tuesday 3rd September 2pm – 3pm. Patient Ram Paul, John James OBE Chief Executive at the Sickle Cell Society, and Alfie Bailey-Bearfield, Head of Health Improvement & Influencing at Pancreatic Cancer UK discuss reducing health disparities and improving access to care for underserved communities living with cancer and blood disorders.
  
  
• Empowering patients as equal partners in care, Wednesday 4th September 9– 10am. Professor Havi Carel, from the University of Bristol's Department of Philosophy, will talk about the EPIC (Epistemic Injustice in Healthcare) project and its findings, and how changes can be made to ensure patients’ experiences are better valued by the health system.
• Effective communication strategies for informed patients, Thursday 5th September 8– 9am. Demos' Director of Participatory Programmes, Miriam Levin and patient Rajendra Patel will discuss how critical communications is in the provision of healthcare.
• Joining services around patients: the role of data, Friday 6th September 9- 10am. NHS England's Chief Data and Analytics Officer Ming Tang discuss with patients Amin Islam and Sandra Rennie how data can improve the provision and quality of care, and ensure patients are at the centre of their own care.

More events are being added so visit the website to keep up to date.  If you have any questions, please contact [email protected]

Patient Partnership week is sponsored by Novartis and Eli Lilly and Company. Neither company has had any input into or influence over content of the webinars or any of the related activities.

CCN report shows educational outcomes for SEND pupils have failed to improve in last decade

Educational attainment amongst children with special educational needs and disabilities (SEND) has not improved since the introduction of landmark reforms in 2014, despite councils projected to be spending £12bn on these services by 2026, up from £4bn a decade ago.

The findings come in a new independent report by Isos Partnership commissioned by the County Councils Network and the Local Government Association. Based on substantial engagement with councils, schools, health partners, young people and parents, the study concludes that the current system is not working for families, schools and councils alike.

Download the report here.

With a new government now in place, councils say the need for reform of SEND services is now ‘unavoidable’ with the report setting out a system at breaking point despite families, schools and councils all acting rationally. Councils have called on the new government to set out reform of SEND over the next 18 months, delivering its manifesto pledge to ensure mainstream schools become more inclusive.

The report outlines how councils are struggling to cope with a more than doubling of children on Education, Health and Care Plans (EHCPs) within a system that creates ‘perverse incentives’ to shift responsibility between public bodies and inadvertently creates adversarial relationships between local authorities and parents. It finds a system weighted down by legal disputes through tribunals and an over-reliance on special schools due to a loss of parental confidence that mainstream schools can meet their children’s needs.

Unless the system is fundamentally reformed, the report warns that outcomes for children and young people with SEND will not improve and the system will become even more financially unviable for councils. The report estimates that local authorities are projected to be spending £12bn a year on SEND services by 2026, but will still face a £5bn funding black hole to meet demand that year.

Those deficits are currently being kept off councils’ balance sheets, but if they were to be placed onto their accounts, one in four councils surveyed for the research said that they would cease to be solvent within a year or less: a significant financial cliff edge.

Despite this increase in spending, educational attainment for pupils has not improved, including reading, writing and maths, and at various different ages.

New analysis contained in the report Towards an effective and financially sustainable approach to SEND in England, demonstrates the challenge within the system and the case for change:

• Half a million more children and young people are now identified as having special educational needs. Since the 2014 reforms of the SEND system, the number of children and young people with EHCPs – which set out the level of statutory support individuals are eligible to receive – has risen from 240,183 in 2015 to 575,973 in 2023/24, an increase of 140 per cent over 10 years. A further 1.2 million children in schools are identified as requiring SEN support below the level of a statutory EHCP, up from 990,000 in 2015.
• In seven of the last 10 years, more children with ECHPs have been placed in special schools compared to mainstream settings. Since 2014/15, there has been an increase of 60 per cent in the numbers of children and young people in state-funded special schools and a rise of 132 per cent in the number placed in independent and non-maintained special schools. In total 185,000 pupils with an ECHP were in special schools in 2024, up from 109,000 in 2015. For local authorities, the costs to the high needs block of a maintained specialist school placement are £25,000 per year, with an independent placement costing £58,500. This is compared to £8,200 for placing a child with an EHCP in a mainstream school.
• Higher rates of identification of SEND are not leading to better educational attainment. The report reveals that children with EHCPs have seen performance flatline, or decline, across key educational milestones over the past decade. At the end of primary school in 2022/23, only 8 per cent of children and young people with EHCPs achieved the expected level in reading, writing and mathematics – exactly the same percentage who achieved that level in 2016/17. At the other end of the age spectrum, only 30 per cent of young people with EHCPs achieved Level 2 by age 19 compared with nearly 37 per cent who achieved this level in 2014/15.
• This is despite expenditure by councils tripling over the course of a decade. In 2015, councils SEND related expenditure was £4bn, with this forecast to reach £12bn by 2026.
• These rising costs on SEND have outpaced reform and funding from the previous government. Despite bespoke ‘Safety Valve’ financial support for some councils, transfers from mainstream school budgets and use of councils reserves all projected to total around £1bn between 2019 and 2026, new analysis shows cumulative deficits currently stand £3.2bn this year and are projected to rise to £5bn by 2026.
• With these deficits currently held off councils’ budgets due to a temporary ‘statutory override’ councils face a financial cliff edge when this ends in March 2026. If the statutory override came to an end tomorrow, 1 in 4 councils surveyed for the report said that they would cease to be solvent within a year or less, with half stating they would cease to be solvent in three years or less.

The report recommends the new government invests in building capacity in mainstream schools to meet children’s needs, such as therapists, educational psychologists, and wider inclusion support, helping to reduce the reliance on specialist school places. It also recommends resetting the vision and guiding principles of the SEND system towards inclusion, prevention and earlier support which would cater for young people who do not have a statutory plan, with such plans reserved for the most complex cases.

Reforms would also include a new ‘national framework’ for SEND and establishment of ‘Local Inclusion Partnerships’ to enable more effective assessments, commissioning and collaboration between councils, schools and health. This would be supported by the creation of a National Institute for Inclusive Education as an independent arbiter around inclusive education and support for children and young people with additional needs.

Cllr Tim Oliver, County Councils Network Chairman, said:

“The SEND system is broken. Wide-ranging reform in 2014 was well intentioned but a decade on, it has created a system that does not work for councils, schools and parents alike. Parents often feel they struggle to access schools’ services, lack the capacity to support pupils, and councils have seen a doubling in needs over the last ten years, and have amassed deficits that threaten their financial solvency. Most importantly, education outcomes and employment opportunities have not improved for children with SEND.

“As this landmark report shows, the case for reform is unquestionable. With a new government in place and elected on a ‘change’ platform, it is vital that reform happens over the next 18 months. The government should build on this report’s clear recommendations and work with local government to create a system that is sustainable for councils and schools and works better for parents and pupils.”

Cllr Louise Gittins, Local Government Association Chair, said:

“What parents and children need and deserve is a properly reformed and funded SEND system that meets the care and support requirements of every child and young person with special needs.

“For too long, the current system has failed children with SEND and left parents struggling to ensure their child gets the support they desperately need. As set out in our Local Government White Paper, we are calling for action which builds new capacity and creates inclusion in mainstream settings, supported by adequate and sustainable long-term funding, and the writing off of councils’ high needs deficits.”

Councils call for delay to unfunded cap on care, warning of £30bn funding shortfall

England’s largest councils are urging the government to delay the introduction of the cap on adult social care costs, warning that the reforms are impossible to implement by October 2025 due to a staggering £30 billion funding shortfall. The County Councils Network (CCN) has released a report, in collaboration with Newton, detailing the severe financial and operational challenges that local authorities face.

The new analysis by Newton reveals that the cost of the care cap and a more generous means-test has increased by a third, now totalling £30 billion over the next decade. Councils argue that this financial burden is unfunded, making the planned reforms unfeasible without significant additional resources from the government.

Summary of Key Findings:

• Due to a combination of inflation and demand the updated analysis by Newton shows that the minimum total cost of the reforms over the nine-year period analysed now stands at £30bn. The costs of the flagship element – the cap on care and extended means test - has risen 34%, from £13.9bn to £18.6bn.
  
  
• Councils in county and rural areas are most exposed to these costs, with 63% of the entire costs of the means-test and cap within these areas. Regionally, councils in the South East, South West and East of England combined account for 61% of the total minimum cumulative cost of these elements.
• With no money currently allocated to the reforms, funding was councils’ biggest concern about implementing the reforms. All bar one (97%) of councils said they were ‘very concerned’ about a shortfall in funding. In addition, eight in ten said they were very concerned about implementing the changes in the current timescales, whilst six in ten said they were very concerned about recruiting the numbers of staff to carry out extra assessments.
• Because of these funding, staffing, and timescale concerns, nine in ten (86%) of councils said they were not well prepared for the reforms with nine in ten (92%) supporting a delay of at least a year or more. Since the delay in 2022, and with uncertainty on the future of reforms after the election, preparations have been totally paused nationally and locally, while the analysis shows over 5,000 additional staff would need to be recruited.
• Every council said adequate funding was necessary to make the reforms workable. Nine in ten also said the current system must be sustainable before introducing reform.
• The £1.7bn in funding re-prioritised from the reforms in late 2022 has kept the show on the road for day-to-day adult social care services. Nine in ten (86%) councils spent the money offsetting inflationary costs, whilst half (54%) used it to commission more care packages and recruit more social workers.
• If the government was to instead use this funding for reform, there could be significant consequences. Without this funding, eight in ten (80%) of councils said it was likely they would not fulfil their statutory duties in adult social care, and six in ten (57%) said they would have to consider issuing a S114 Notice.
• Keeping services at a level as they are now and investing in workforce capacity is the top priority for councils over the next Parliament. All bar one council (97%) said ensuring there is enough funding to deliver the same amount of care services at present was their top priority, followed by workforce recruitment and retention (94%). Just a quarter (24%) said introducing the charging reforms were a high priority, with less than one in ten (9%) believing the introduction of a ‘national care service’ should be a priority.

Cllr Martin Tett, Adult Social Care Spokesperson for the County Councils Network, stated:

"We are just over 15 months away from the introduction of seismic reforms in adult social care, and the new government must make an urgent decision on their future. Councils have serious concerns over their deliverability: these new estimates show the costs have increased significantly to £30bn over the next decade, while currently the reforms are totally unfunded. The political hiatus before the election also meant preparations have been suspended nationally, while locally councils have been focused on day-to-day services, and still face major shortages in social workers.

As a result, nine in ten local authorities are not well prepared to implement the reforms in October 2025. To put it bluntly, it will be impossible to implement these reforms next Autumn in the current timescales and with no funding committed to the reforms. Equally, the government cannot take money currently being spent on day-to-day adult social care services for these reforms, with our survey showing it will have devastating consequences for councils and the thousands of people who rely on local authority care.

We have always supported the principles of the reforms, as they will make the system fairer. But if the government is to proceed with the reforms, then it must delay them by at least a year – but likely more – to reassess the real costs and set out a way to fully-fund them. We understand yet another delay will be frustrating for campaigners, but under the current circumstances introducing them next year could have some serious consequences."

Download the full report HERE.

Kerry Booth, Chief Executive, Rural Services Network:

"Given these significant challenges, it is crucial that the government considers the CCN's recommendation to delay implementing the care cost cap. This delay will allow a thorough reassessment of costs and ensure necessary funding, preventing disruptions to social care services. Specific funds must be allocated to avoid diverting critical resources.

Investment in recruiting and training social care workers is essential to address severe workforce shortages and maintain care quality. Rural councils require special attention to manage their unique challenges, including higher elderly populations and self-funders, necessitating targeted interventions.

The CCN report highlights the urgent need for a strategic reassessment of adult social care reforms. The Rural Services Network urges the government to secure proper funding and provide targeted support, ensuring a sustainable and equitable implementation that protects vulnerable populations in rural and county areas."

Councils taking action to address dental provision in North Devon

North Devon and Torridge district councils are committing to helping dental provision in the region following a special meeting.

A joint meeting of North Devon Council's policy development committee and Torridge District Council's external overview and scrutiny committee was held last month, in which a panel of dental professionals explained the challenges facing the dental sector across the region and nationwide, as well as answering questions from the committee and the public.

The two committees have separately reconvened since the meeting and have identified a range of steps to action improvements locally, from working with education providers to establish links to dentistry qualifications, to promoting oral health.

The councils will also be reflecting the need for improvements to dental provision within their joint local plan and economic strategy.

Vice-chair of North Devon Council's Policy Development Committee, Councillor John Patrinos, said:

"As councillors we have been inundated with complaints from residents about access to dentists and orthodontists in the area and have heard concerning stories of people of all ages foregoing treatment or travelling across the country to see dentists in areas they previously lived.

"Following a productive joint meeting in which we were able to improve our understanding of the situation, our councils are committed to doing what we can to help mitigate and improve on these issues, working with the relevant health and education bodies wherever possible to achieve it."

Chair of Torridge District Council's External Overview and Scrutiny Committee, Councillor Cheryl Cottle-Hunkin, said:

“It is well documented that the sustained lack of dental provision across Torridge and North Devon has led to a critical reduction in health outcomes.  As councillors, we are extremely concerned about the lack of NHS dentists and the massive impact it has on the community – especially when we hear horror stories of people resorting to DIY dentistry and the potential problems it is storing up for the future. 

"I hope that following this meeting, we can all work together to develop a strategy to improve the situation.  As a council we are fully supportive and committed to doing what we can to make this happen and bring more dental provision into our area.”

Join us to make a difference to wellness in coastal Lincolnshire

You might have already heard a little about the Campus for Future Living, a new development in Mablethorpe which promises to bring together support, innovation and research with services for the community. Here is your chance to come along and find out more at one of our Engagement Days. We believe there is a huge opportunity for everyone to get involved to help tackle challenges to wellness for Lincolnshire and beyond, join us to find out more.

Campus for Future Living Engagement Days

Thursday 29 August 12pm – 6pm
Tuesday 10 September 12pm – 6pm

To find out more view and click below:

National Rural Conference – Rural Health and Care Session

The Rural Services Network (RSN) is thrilled to announce the National Rural Conference 2024, happening from 16-19 September. This virtual event, accessible via Zoom, is the premier gathering for policymakers and rural service professionals.

On Thursday 19 September there will be a session dedicated to Rural Health and Care with speakers from Lincoln Institute for Rural and Coastal Health, RABI (Royal Agricultural Benevolent Institution), NHS Cornwall & Isles of Scilly and Imperial College London.

Members of the Rural Health Alliance can attend the Conference for free.  To check your organisation’s membership or for any queries, contact [email protected]. Joining instructions will be sent out a few days before the event.

Don't miss this transformative event shaping the future of rural services. Secure your spot now and be part of the conversation driving rural innovation.

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RURAL SERVICES NETWORK

Up to date news on Health and Care
The Rural Services Network provides a useful source of themed news content and data. Check out the latest news on Health & Wellbeing and Vulnerability, where you’ll find articles on a diverse range of rural issues affecting rural communities. You might also find this research on Over 65 Population Projections useful too.

Latest from RSN Member Insights
RSN Member Insights is the place to discover the statistics that define communities within our membership.  It is regularly updated with new analyses, and these will be highlighted in the 'What's New' section of the RSN's Weekly Rural Bulletin. The Rural Bulletin also provides a selection of the most rurally topical news items, so do subscribe and encourage your colleagues to subscribe to what is an invaluable weekly periodical.

To make a suggestion of data that would benefit you by being included in the Member Insights section, please email Dan Worth, our Research and Performance Analyst, at [email protected].

The Rural Health & Care Alliance is a membership organisation administered by the Rural Services Network on behalf of the National Centre for Rural Health & Care.  Explore the RHCA service below: