Each year, the Government decides how much to raise benefits and tax allowances. The basis for these upratings is rarely debated, yet has major long-term consequences for the relative living standards of different groups and for public finances. The impact of benefit and tax uprating on incomes and poverty from the Joseph Rowntree Foundation considers the implications of present uprating policies, which mean that some parts of the tax and benefit system are uprated by earnings growth, other parts by prices and some not at all.

The impact of continuance of these polices over the newxt 20 years will be a doubling of the child poverty rate alongside a substantial gain to the public finances. Some of this budgetary gain may be needed to meet other demands – of an ageing population for example – but the cost falls disproportionately onto poorer groups and could be raised more fairly.

Residents’ views of new forms of high density affordable living from the Joseph Rowntree Foundation explores residents’ views about living in new affordable higher density housing and how far residents’ expectations of living in high-density developments were met. In particular it explores:

• reasons for moving in;
• the impact of architecture and design;
• community cohesion, including integration across tenures;
• crime and antisocial behaviour;
• the impact of the surrounding neighbourhood;
• future housing aspirations, including whether residents wanted to move;
• housing management;
• affordability.

The Bercow Review of services for Children and Young People (0–19) with Speech, Language and Communication Needs - Interim Report ( Executive Summary) identifies 5 key themes:

• Communication is crucial – communication is at the core of all social interaction.  Communication is a key life skill. Communication is a fundamental human right. For some children and young people, acquiring the ability to communicate is a difficult and ongoing challenge. Just as the nature and severity of their needs will vary, so will the type and extent of the help required to address them.
• Early identification and intervention are essential in order to avoid poor outcomes for children and young people – in addressing delay and disorders, the most important facts we know are the value of early intervention and the danger of its absence. If a child receives the right help early on, he or she has a better chance of tackling problems, communicating adequately and making progress. If a child does not benefit from early intervention, there are multiple risks – of lower educational attainment, of behavioural problems, of emotional and psychological difficulties, of poorer employment prospects and, in some cases, of a descent into criminality.
• A continuum of services, designed around the family, is needed – universal, targeted and specialist services are required to meet the range of needs and, as the Government envisages in its recent Children’s Plan, children, young people and their families must be at their heart.
• Joint working is critical – in planning, commissioning and delivering universal, targeted and specialist provision, it is critical that health services and children’s services, including schools, work together in support of children and young people with SLCN. No single agency can deliver any one of the five Every Child Matters outcomes for children and young people by working in isolation. Separate silos produce misunderstandings, cause divisions and can be bewildering or infuriating to parents for whose children services are delayed or denied as a result.
• The current system is characterised by high variability and a lack of equity – the current system is routinely described by families as a “postcode lottery”, particularly in the context of their access to speech and language therapy (SLT).

In 2007 was invited by the Prime Minister and Secretary of State for Health to look at how UK experience and expertise in health could be used to best effect to help improve health in developing countries in terms of needs as identified and expressed by people from those countries and in order to add practical value to work already under way.  This resulted in the Crisp report Global health partnerships: the UK contribution to health in developing countries.  The formal response Global health partnerships - the Government response is now available.

Person or place-based policies to tackle disadvantage? Not knowing what works from the Joseph Rowntree Foundation looks at the effectiveness of policies introduced by the Labour government since 1997 to encourage employment, education and reducing income disadvantage, focusing on policies that explicitly take account of people and places.

It finds that person and place-based policies have mostly developed separately and often in isolation from each other. This separation does not reflect the relationships between places and the poverty and disadvantage of people who live in them.

Key findings

• Most policy interventions, whether person or place-targeted, had small, favourable impacts. In the rare cases where information on expenditure was available, costs were generally offset by savings to the Exchequer.
• Both forms of intervention had significant positive impacts on particular aspects of education results and employment. However, it was not possible to determine whether person or place-based policies were better, as they tended to have different objectives that prevented direct comparison.
• Some interventions had negative consequences for the average participant or detrimental effects on some groups of participants.
• It was rarely possible to explain properly how policy interventions worked or why they failed, because the way they were intended to work.
• Evaluators judged policies to have the greatest impact if they delivered individually tailored support to the most disadvantaged people with minimal complexity. The evaluators considered policies successful if they reflected local needs and priorities and were shaped by active engagement with stakeholders, including end users.

Community empowerment in practice: lessons from Communities First looks at community empowerment in local governance and service delivery which has become a key component of government policy in the UK. However, there are critical challenges to achieving this in practice. This research sees the Joseph Rowntree Foundation use 9 case studies to consider:

It considers:

• how far partnerships have developed and evolved to empower communities;

• the relationships communities have with other representative channels;

• the extent to which communities have influenced other agendas;

• the overall impact of regeneration partnerships.

It finds that:

• Community members responded positively to the opportunities for participation provided by Communities First and, as they began to recognise their own role in promoting positive change in their community, their confidence in their abilities increased.

• Community members brought varied skills and knowledge to the partnership process but required support to develop the skills required for effective partnership working.

• Levels of community engagement were improved by providing multiple routes to participation. Highly localised forums that fed into the partnership widened community empowerment and helped to support community members of the partnerships.

• Little evidence of community influence over statutory members of Communities First partnerships and no evidence of significant mainstream ‘programme bending’ where statutory agencies prioritised actions and expenditure in the Communities First partnership area.

• Clearer links are needed between strategic partnerships at ward level and those at the local authority level. Local Strategic Partnerships or Local Service Boards are not sufficiently local or connected to the community to facilitate effective community empowerment.

• Concludes that government will need to provide incentives and sanctions to promote a greater statutory sector response to processes of community empowerment. Consideration should be given to allocating specific functions and resources to local partnerships which they can deploy. The continued commitment of community members will be conditional on ‘purposeful’ community involvement.

Neighbourhood identity: People, time and place from the Joseph Rowntree Foundation considers the formation of neighbourhood identity and it’s potential impact on regeneration. The report focuses on:

• why regeneration policies often fail in their objectives;
• why the reputations of housing estates often display a remarkable longevity and resilience to change;
• how such reputations are established and understood by those in and outside particular areas;
• the implications these reputations have for the identities of neighbourhoods and the people who live in them.

Tackling health inequalities: 2007 Status Report on the Programme for Action provides a review of developments against the data since the publication of the Programme for Action in 2003. It considers progress against the Public Service Agreement (PSA) target, the national headline indicators and against government commitments. The report shows:

• Further slight narrowing of the infant mortality gap, little change in the gap in male
  life expectancy and a widening of the gap in female life expectancy since 2003–05.

• An encouraging picture on the cross-government indicators, with long-term progress in reducing child poverty and narrowing inequalities in housing quality, educational
  attainment and uptake of flu vaccinations. Cancer and circulatory (heart) disease
  mortality, child road accident casualties and teenage conceptions show a narrowing of
  inequalities in absolute terms (but not in relative terms); other areas, for example
  smoking, show a general reduction in prevalence but no narrowing of the gap between social groups

• Most departmental commitments set out in the Programme for Action and due for
  delivery by the end of 2006 have been wholly or substantially achieved.

Top tips for health in Local Authorities commissioned by ChaMPs (Cheshire and Merseyside Public Health Network) and from the Liverpool Public Health Observatory offers practical tips on joint working between the NHS and Local Authorities in the areas of:

• Reducing health inequalities

• Tackling obesity: Creating opportunities for healthy eating

• Tackling obesity: Creating opportunities for physical activity

• Improving mental health and well-being

• Promoting sexual health

• Encourage the sensible drinking of alcohol

• Creating a smokefree environment

Hit or Miss - women’s rights report from ActionAid shows that promises made by the world’s governments to tackle poverty are failing to deliver because the basic rights of women in the developing world are being ignored.  The report finds that women and girls formed the majority of the poor and hungry, and, in south Asia, women are getting a shrinking share of income as the economy continues to grow. Ten million more girls than boys miss out on primary school, while African women accounted for 75% of all young people living with HIV/Aids.

‘Better Care: Better Lives: Improving outcomes and experiences for children, young people and their families living with life-limiting and life-threatening conditions’ aims to improve the care and support given to children in England with life-limiting or life-threatening condition and their families. The strategy calls on commissioners, service providers, voluntary sector partners – to improve the experiences of young people and their families by:

• improving data sources

• building stronger joint working arrangements

• developing better needs assessments and support regimes

• tackling inequalities

• encouraging the delivery of care in the most appropriate setting.

‘Lost: low earners and the elderly care market’, from the think tank the Resolution Foundation looks at low earners and how they fare in the elderly care system. It identifies that social care for older people rarely receives the political attention it should. The Government’s recent commitment to a Green Paper on social care provides the opportunity for elderly care to become centre stage. Theis report establishes how low earners fare in the elderly care system.

It identifies that:

• Low earners tend to be older than average, and more likely to own their own homes. They also hold disproportionately more of their wealth in housing assets (as opposed to liquid savings) than other income groups.

• Are less likely that higher earners to prepare financially for retirement through
  pensions, and worry more than other income groups as to whether they will have sufficient assets to retire comfortably.

• Inclusion of housing assets when calculating care cost contributions is of critical importance to low earners – it renders the majority of them ineligible for subsidised care, and also most at risk of having to sell their homes or downsize in order to access their wealth to pay for care. This is in contrast to lower earners,who may not own their own homes and be eligible for subsidised care, and higher earners, who may have sufficient funds to pay for care from their liquid assets, such as savings or annuities, rather than their homes.

• Low earners feel the system to be unfair – in the very low level of means testing benchmarks which excludes the majority of low earners from any state funded care; in the inclusion of housing assets which penalises those who have saved

Key messages are:

• There is acceptance that increased elderly care costs cannot be met by the government alone. Low earners still believe only the very wealthy should pay for their care costs, and that the majority of people should receive government funded care or only make a small contribution.

• The number of self funders – i.e. those who either wholly or partially pay for their elderly care – is rising, and will continue to do so, because local authorities are adjusting their eligibility criteria so that only those with greater care needs are eligible for free home or residential care, leaving those with “lesser needs” (which are now nonetheless significant) to fund themselves, regardless of income.

• For those who cannot afford to self-fund formal care – which is likely to be a more common situation amongst low earners – informal care (i.e. care provided by friends or family free of charge) is crucially important. Estimates suggest that 70 per cent of the care provided in England and Wales is currently delivered by informal carers. Demography points to the fact that the numbers of low earners reaching an age where elderly care is required will increase substantially in the next 5 to 10 years, yet the increasing number of elderly living alone, not marrying and not having children will mean there will be fewer children and relatives for older people to rely on to provide them with informal care

• Finally, low earners are also more likely to be carers of relatives than the rest of the population. The age profile of this group, combined with these factors, suggests that a significant proportion of low earners may be shouldering a dual burden – they may be caring for their elderly parents, but also still supporting (financially and otherwise) their own children. This “squeezed” generation phenomenon, which affects women in particular, will be a significant factor affecting their quality of life, but may also have a longer lasting, intergenerational impact – people who give up work to care for relatives will not be contributing to their pensions.

Looking at social exclusion in the elderly Age Concern have produced  Out of sight, out of mind: Social exclusion behind closed doors sets a number of challenges across both local and central government and for voluntary groups to ensure that older people are socially included.  These are:

• Develpment of a cross-departmental government commitment to help the most disadvantaged older people.

• Central and local government strategies for tackling social exclusion and neighbourhood renewal must include older people.

• Local authorities should revisit A Sure Start to Later Life and re-model their services to ensure they are joined-up, user-friendly, rooted in the community and flexible enough to reach out to vulnerable older people.

The report recommends:

For people who are over 80 and living alone

• Consultation and involvement that is genuinely inclusive.

• Local policies and programmes to enhance social contact.

• Low-intensity home services.

• Thoughtful planning of local services and transport options to help promote independence.

For people who are recently bereaved

• Improved support for counselling and support services.

• Multi-agency initiatives to identify and follow-up on bereaved people at risk of exclusion.

For people who are living in unfit housing

• ‘Handyperson’ schemes available nationwide.

• Multi-agency promotion of home repair schemes and free home audits.

• Improvements to the Warm Front scheme.

• Improve access to suitable housing, by reforming planning rules, funding home adaptations, and matching’ people to accessible homes.

For people who have limited capacity to make their own decisions

• Improved support for independent advocacy.

• Services that sustain social contact and independence for as long as possible.

Thanks to Sue over at Lancashire Care for pointing out this one.

Mental Health Act Commission Eleventh Biennial Report (In Place Of Fear) questions whether all inpatient mental health services provide their patients with acceptable levels of security, care, or a sense of being treated as  someone who matters. It welcome the Government’s announced refocus on inpatient services and call for it to concentrate on building up these aspects, in place of the fear that many patients have of services and that many people have of mentally disordered people.  The importance of breaking such ‘circles of fear’ for Black and minority ethnic patients are particularly welcomed.

There is evidence that inpatient services are losing staff and resources to community
services, but that pressures on inpatient beds remain high. Over half of all wards are full or have more patients than beds, with staffing shortages and unpleasant ward environments undermining the therapeutic purpose of inpatient admission.

The report highlights the dangers inherent in devolved service commissioning for ensuring adequate levels of specialist provision, and note the vulnerability of mental health services as Trusts face financial crises.

The extension of patient ‘choice’ across health service provision should not be allowed further to disadvantage or ostracise patients who are unable to exercise choice because of their mental incapacity or because of legal powers of compulsion held over
their treatment.

Boundaries of current mental health law under stress, with discussion of about forty cases
in court, and a more general observation of legal powers being used in ways that may not have been intended by Parliament, often for pragmatic reasons where professionals are keen to intervene in what they perceive to be a person’s best interest or as measures of social order.

It also discusses aspects of the use of present mental health powers in relation to civil detention and police powers, including an extended discussion on the detention of mentally disordered offenders.We provide analysis of deaths of detained patients; seclusion incidents notified to the Commission; and Second Opinion activity during this period.

The report has a strong focus on measures to encourage and support the empowerment of all patients, including those without mental capacity to make certain decisions about their care.

It finally reviews the proposed future arrangements for monitoring detention of mentally disordered persons and suggest ways in which the forthcoming Mental Health Bill might be improved to ensure acceptability to mentally disordered persons and the effective protection of their rights.

Mental Health Act Commission Eleventh Biennial Report - Errata and Addendum

The drivers of Black and Asian people’s perceptions of racial discrimination by public services: a qualitative study presents findings from research commissioned in order to understand the drivers of Black and Asian people’s perceptions of racial discrimination in eight key public services. The report sets out the factors that contribute to perceptions of discrimination or fairness.

Local doctors’ surgeries were perceived to be fair.  GP services are perceived to be benevolent,  doctors are highly-trained professionals who only focused on each person’s biomedical needs and who developed personal relationships ith many of their patients. Most believed that the diverse ethnic profile of doctors guaranteed fair services. Only a small minority of respondents had directly experienced racial discrimination: they were almost all Asian patients who had been seen by Asian doctors. These experiences did not lead them to think that GP services in general were racist. Respondents noted no improvements in GP service because they had always considered them to be fair.

Lesbian, gay, bisexual and trans (LGBT) people experience a number of health inequalities which are often unrecognised in health and social care settings. These briefings are intended to show that LGBT people can be younger, older, bisexual, lesbians, gay men, trans, from black and minority ethnic (BME) communities and disabled, and to dispel assumptions that they form a homogeneous group.

The briefings provide easy-to-read guidance for health and social care commissioners, service planners and frontline staff. They aim to inform the delivery of appropriate services and to support health and social care professionals in their everyday work with LGBT people by providing fundamental awareness and evidence of LGBT needs in relation to health.

• Introduction
• Briefing 1: Working with lesbian, gay, bisexual and trans (LGBT) people
• Briefing 2: Improving access to health and social care for lesbian, gay, bisexual and trans (LGBT) people
• Briefing 3: Young lesbian, gay and bisexual (LGB) people
• Briefing 4: Older lesbian, gay and bisexual (LGB) people
• Briefing 5: Lesbian health
• Briefing 6: Gay men’s health
• Briefing 7: Bisexual people’s health
• Briefing 8: Healthy lifestyles for lesbian, gay, bisexual and trans (LGBT) people
• Briefing 9: Mental health issues within lesbian, gay and bisexual (LGB) communities
• Briefing 10: Sexual health
• Briefing 11: Trans people’s health
• Briefing 12: Lesbian, gay and bisexual (LGB) people from Black and minority ethnic communities
• Briefing 13: Disabled lesbian, gay and bisexual (LGB) people

A brief shout out to Sue over at Lancashire Care who noticed this.

Disability Poverty in the UK shows that disabled people are twice as likely to live in poverty as non-disabled people.  Disabled people are more likely to live in poverty than they were 10 years ago, with an estimated three million disabled people living in relative poverty in the UK .

The report shows

• Low levels of employment for disabled people mean that many are trapped in inescapable poverty. For people not expected to work, benefit levels frequently fail to cover basic costs of living, leaving them with no real route out of poverty.
• Half (49 per cent) of disabled people surveyed had no savings. The majority revealed this was because their incomes were way below the national average.
• Disabled people face discrimination in the education system. Disabled people are more than twice as likely to have no qualifications as non-disabled people.

The Leonard Cheshire Disability report makes a significant number of recommendations to help end disability poverty. This includes extending Winter Fuel Allowance to many disabled people who would also benefit from support with heating costs and reviewing how disability benefits support those disabled people who are not expected to work.

The Future of Care Funding: Time for a change is the outcome of the nationwide Caring Choices: Who will pay for long-term care? initiative which aims to help shape future policy on long-term care for older people. It draws on the views of 700 people, carers and others in consultation, as well as a survey of those who attended the events and input from web visitors.

It shows high levels of dissatisfaction with means testing and the “postcode lottery” over social care entitlements. Nine in ten respondents to the “Caring Choices” consultation thought everyone should be entitled to some funding from the government and most people thought the current system of means testing unfairly penalised people who had made provision for their old age.

However only one in five believed that personal care should be funded totally by the state and a key option favoured by respondents was for people to receive a baseline entitlement, regardless of their income and wealth, with the individual also paying a contribution.

The Health of the Nation report from CACI and TNS

The HealthACORN classification groups the GB population into 4 groups, 25 types and 60 sub-types. By analysing diet, health and exercise characteristics as well as demographic attributes, HealthACORN provides an in-depth understanding of different communities in every part of the country. The classification names and descriptions have been chosen to be simple and non-judgemental. The Health ACORN Methodology is described in this ducument.

HealthACORN looks at the mix of people within a neighbourhood and identifies four broad kinds of area:

• Group 1 - Existing Problems: High levels of serious illness and poor diet and consumption patterns
• Group 2 - Future Problems: High levels of severely unhealthy lifestyles likely to lead to serious illness
• Group 3 - Possible Future Concerns: Generally good health but with some potentially unhealthy lifestyle traits
• Group 4 - Healthy: Good health with few lifestyle issues

The following documents rank Local Authorities using HealthACORN.

Local Authority Rank - Existing Problems

Local Authority Rank - Future Problems

Local Authority Rank - Possible Future Concerns

Local Authority Rank - Healthy

Health ACORN Types by Local Authority

Caring for Vulnerable Babies: The reorganisation of neonatal services in England (Executive Summary) considers if the reorganisation of neonatal services in England has helped improve care for premature and low birth weight babies with fewer babies travelling long distances for suitable treatment. The National Audit Office in it find that further improvements to the service are being limited by shortages in nursing staff, a lack of cots in the right place at the right level of care and a lack of widespread specialist 24 hour transport. They also provide a comparison with international neonatal services via RAND Europe: The provision of neonatal services and the Survey of Neonatal Units in England by the National Audit Office upon which the report is based.

Every year around 10 per cent, or 60,000, newborn babies require some form of specialized neonatal care. And these numbers are increasing, up 5 per cent between 2005 and 2006, due to an increase in the proportion of women with high risk factors such as high or low maternal age, obesity, ethnic origin, deprivation and assisted conception such as IVF. In 2006-07, some £420 million was spent on running the 180 neonatal units in England, which are organized into 23 managed clinical networks.

A number of improvements since the Department announced the reorganization of neonatal services into networks in 2003 are identified. There has been a reduction in long distance transfers of mothers and babies, with only 3.4 per cent of babies across England admitted to units outside of their network. Overall, 17 networks are meeting the target to treat babies within their network and the consistency, communication and co-ordination of care within and between the networks has improved. The number of cots has also increased from 3,243 to 3,521. Neonatal units have made strides in considering the needs of parents and involving them in their babies care. Parents are mostly very happy with the specialist care and expertise their babies receive.

In 2005, England’s neonatal mortality rate was 3.5 deaths per 1,000 live births, similar to other developed countries. But the report found that this figure masks wide variations across the country. The South West Midlands had the highest mortality rate of 4.8 deaths per 1,000 live births, compared to Surrey and Sussex with 1.8 deaths per live 1,000 births. More work is required to determine the contribution that different socio-economic, ethnic, demographic, cultural and service factors are making to these variations in mortality rates.

The report also highlighted shortages in the numbers of neonatal nurses. On average, each unit had nearly three nursing vacancies for nurses qualified in neonatal care. Only half of units met the British Association of Perinatal Medicine (BAPM) professionally developed standard for high dependency care of one nurse to two babies, and only 24 per cent met the standard for intensive care of one nurse to one baby. The vast majority of level three (intensive care) units, which require a 1:1 ratio of nurses to babies for the whole unit, did not meet the standards for intensive care.

Cots for the right level of care are not always available, resulting in units having to close and babies being cared for in the wrong places on occasions. On average, each unit had to close to new admissions once a week, the most common reasons being a lack of cots or skilled nursing staff. Nearly a third of units had to care for a baby who should have been transferred to a higher level of care and just over half looked after an improving baby who was ready to be transferred but could not because a receiving cot was not available. In 2006-07, nearly a third of neonatal units operated above the BAPM recommended occupancy rate of 70 per cent and three units operated above 100 per cent. High occupancy rates could have consequences for patient safety, for example due to increased risk of infection or inadequate levels of care.

Neonatal transport is an essential element of networked neonatal care, with all bar one providing some form of specialist transport during day time working hours, but only half of networks providing specialist transport services 24 hours a day seven days a week. Few transport services have separate staffing arrangements from the clinical inpatient services meaning that staff have to leave the unit to accompany a baby on a transfer. Three quarters of units experienced delays in moving babies and 44 per cent believed that care was compromised as a result.

The report concludes that the cost of neonatal services as a whole are not fully understood and there is a mismatch between costs and charges. Also charges per day for an intensive care cot varied from £173 to £2,384. The reorganization of care into neonatal networks has improved the co-ordination and consistency of services pointing to increased effectiveness, however there is still capacity and staffing problems and a lack of clear data on outcomes. In addition, the variable financial management information makes it difficult to judge the economy and efficiency of the service.

The NAO recommends that NHS and Foundation Trusts need to improve their financial management information. Commissioners, in conjunction with networks and Strategic Health Authorities, should commission all neonatal care services together and in particular examine the relative cost-effectiveness of the different transport options currently in place. In addition, NHS and Foundation Trusts should develop a targeted action plan to address neonatal staffing shortages.