Banks face mental health challenge

Mental health problems affected everyday activities such as budgeting and paying bills, the Money and Mental Health Policy Institute (MMHPI) said.

Setting spending limits on cards and allowing people to set how banks contacted them would help, it said.

The trade body for High Street banks has vowed to improve inclusion.

In its mission statement covering 2016-18, the British Bankers’ Association (BBA) said that the “crucial part of the industry commitment to raising standards” should include working with mental health initiatives.

Impulses

The MMHPI said one in four people could suffer from mental health issues in any one year. It has published research suggesting that periods of poor mental health put people at risk of financial trouble.

For example it found that people with depression or post-traumatic stress disorder were likely to struggle with short-term memory, making Pin numbers harder to remember.

Those experiencing bipolar disorder or ADHD often struggled to resist impulses, potentially leading to dramatic spending sprees, it said.

People with borderline personality disorder or psychosis could find it very difficult to compare financial options and found it more difficult to plan ahead.

Extreme anxiety could also stop people opening letters or taking calls from banks.

‘I’m still playing catch-up’

Dan, aged in his 40s, says his finances are affected by his bipolar condition and anxiety. This led to a phobia of opening letters and answering the telephone, fearing his “safe space was being invaded”.

As a result, bills went unpaid and bank charges built up, leading to debts which he is still repaying after 15 years. “I’m still playing catch-up,” he says.

Although conditions are very individual, he says he would have been helped by correspondence through e-mail which would have allowed him to compartmentalise his financial matters and “take away the emotion” by dealing with it in work mode.

“Senior managers want to put measures in place, but this does not always filter down to branches and call centres,” he says.

He would like to see better training in place. Clearer literature from banks, on what assistance is available for customers with mental health problems, would also allow people to make an informed decision on revealing their condition to bank staff.

The MMHPI is challenging banks to adapt some systems already available to help those with mental health problems. For example

• The ability to delegate limited permissions to someone else to manage an aspect of your finances, as is available to wealthy individuals
• Setting spending limits on cards or blocking access to some merchant codes, as is possible on many corporate cards
• The ability to set communication preferences on an account, which is generally offered to people with visual or hearing impairments.

Polly Mackenzie, the Institute’s director, said: “For too long, it has been assumed that when people with mental health problems get behind on bills, or struggle to stick to their budget, it is because they are lazy or incompetent. Our research proves beyond doubt that’s just not true.

“Mental health problems can severely affect consumers’ ability to stay on top of their finances, shop around, or manage a budget.

“It is time for the financial services industry to adapt its services to help support people when they are unwell – just as they do to help people with physical disabilities who struggle to access a branch or engage on the phone.”

‘Balance’

A spokeswoman for the BBA said: “The industry is committed to supporting customers in vulnerable circumstances, and will consider these recommendations carefully alongside the pioneering work already done with the Royal College of Psychiatrists and others on debt and mental health issues.

“It is vital that vulnerable customers are offered the right support, although we recognise that balancing this support with respect for customers’ privacy is a difficult and sensitive issue.

“The industry is continually looking at ways to help vulnerable customers, and develop alternatives to make everyday banking arrangements easier, with useful information and suggestions on different types of payments a key part of these developments.”

LSBU Legal Advice Clinic

The Clinic is a free drop-in service 5 minutes’ walk from Elephant & Castle staffed by LSBU Student Volunteers under the supervision of practising solicitors.

• They provide basic information on any topic
• They provide generalist advice in any social welfare law matters (except immigration)
• They signpost and refer to appropriate local advice and legal services
• They provide specialist legal advice in family, housing and employment at Thursday evening sessions (accessible via our daytime drop-in)

The Clinic is located at the Clarence Centre for Enterprise and Innovation, 126 London Road, Southwark SE1 OAE.

Public drop-in sessions take place on Tues 10am to 12 noon; Wed 10am-12noon; Wed 3pm-5pm – during term-time only (30 jan-10 May 2017 [Closed for Easter 30 March to 4th April]). Their resources are limited – they aim to see around 6 people per session.

Their public telephone number is 020 7815 5450 and their email is [email protected] (but please note they do not provide advice by phone or email).

3 Key reasons why carers should have a flu vaccination

Two

Flu often strikes without warning, it could leave a carer with little or no time to make alternate arrangements

Three 

A flu jab reduces the risk of the carer passing the virus on to the person they care for, who could become dangerously ill as a result

THINK FLU – THINK CARER

Court backs wheelchair user who was stopped from boarding bus

A wheelchair user who was unable to board a bus in Yorkshire has won a partial victory at the supreme court that should help secure more priority places for disabled passengers.

Doug Paulley tried to get on a FirstGroup bus from Wetherby to Leeds in 2012 but the wheelchair space was being used by a mother with a pushchair and a sleeping child.

The woman rejected the driver’s request to move or fold the pushchair and so the driver told Paulley he could not board the vehicle.

In its ruling on Wednesday, the court allowed Paulley’s appeal to the extent that the driver should have considered taking further steps to pressurise the non-wheelchair user into leaving the space.

His test case has been supported by the the Equality and Human Rights Commission (EHRC) which has called on bus operators to ensure that those confined to wheelchairs can travel more easily.

Paulley took his claim for discrimination to the supreme court after the court of appeal in 2014 decided that transport firms were not required to force one traveller to make way for another.

By a majority of four to three justices, however, the court decided not to award damages to Paulley.

Welcoming the decision, Paulley said: “I’m absolutely delighted. It represents a significant cultural change.

“It’s been a long fight of five years by a lot of people. I’m incredibly grateful that so many people gave put so much time, effort and passion into it. I know it was done for the cause.

“We have achieved something here that will make a difference not just for wheelchair users but for other disabled people.”

Chris Fry, of the law firm Unity Law who represented Paulley, told disability campaigners who had attended the hearing: “It’s a win for Doug and all of you so that you will have an expectation that you will have a right to travel.

“Three of the supreme court justices would have gone as far as saying that the policy should go as far as removing people from the bus who do not comply [with a request to make room].”

The judgment, Fry said, replaced the old “request and retreat” policy for drivers with a more forceful “request and require” policy.

“It’s the Paulley Principle. We now have priority and right of access. We know that parliament us interested in this case. There’s a lot more to do.”

Poorer families worse off by 2020 as prices outstrip welfare rises

Prices are expected to have gone up by 35% over the course of the decade but child benefit will have risen by just 2%, according to End Child Poverty coalition research.

Struggling families also find it harder to make ends meet because they are being hit by a “poverty premium” that leaves them paying more for goods and services, its report found.

“Forecasts suggest that child poverty rates will rise significantly in coming years,” the report said.

“Low income families really are feeling the pinch – trapped between support being eroded by the cost of living rising much faster than benefit rates, and facing some of the highest prices on basic essentials as a result of a poverty premium on key goods and services.”

An typical unemployed single parent with two children received benefits of around £198 a week before housing in April 2010, according to the Feeling the Pinch report.

To keep up with increased living costs, the payments, such as child benefits, tax credits and Jobseeker’s Allowance, would need to reach around £267 a week by 2020 but are expected to only reach £214, it added.

The £53 a week loss amounts to a hit of nearly £2,756 a year.

End Child Poverty, which is made up of around 100 organisations including Barnardo’s, Oxfam and the TUC, also warned housing benefit reforms mean payments to cover rent costs bear “little relationship” to accommodation bills.

If rents continue to rise at similar rates as they have over recent years, families in an average two-bedroom home face a shortfall of £155 a month, it predicted.

The poorest families are hit by a poverty premium that means they are forced to pay more for the same items as those who are wealthier, the coalition said.

Its research found higher loan rates, the cost of renting white goods instead of buying outright, steeper insurance premiums, cheque cashing costs and less favourable energy bills could leave poor families paying £1,700 more.

The coalition called on the Government to stop the four-year freeze on children’s benefits and said it must increase housing support in line with local rents.

It also urged the Government to set up a commission to find ways to stop the poorest customers paying the highest prices for goods and services.

Sam Royston, chair of the End Child Poverty coalition, said: “Families living in poverty are trapped between frozen support, rising costs of living, and a hefty poverty premium which means that they pay the most for basic essentials.

“End Child Poverty members know all too well the impact this poverty trap has on children’s lives. Too often, families are facing impossible choices between feeding their children and heating their home.

“The Government needs to take action now, to lift the four-year freeze on children’s benefits, and to ensure that the highest prices for family essentials aren’t paid by those who can least afford them.”

A Government spokesman said: “Our welfare reforms are incentivising work and restoring fairness to the system. Tackling poverty and delivering real social reform is a priority, and we are helping people to keep more of what they earn, and supporting households with the cost of living.

“We are increasing the National Living Wage, have frozen fuel duty for seven years running and our increases to the personal allowance have reduced tax bills for some of the lowest earners by £1,000 a year.”

Listening to people with dementia and their carers

The Department of Health’s listening programme will include different ways of gathering people’s views and experiences, both in person and online.

The first part of this work is an online survey for people who have been diagnosed with dementia in the past 2 years (since November 2014), and people who provide unpaid care for them. The survey, which is open until 31 January 2017, asks about people’s experiences of dementia diagnosis, support and awareness. It has been produced in consultation with people with dementia, their carers and our partner organisations.

As well as the online survey, local dementia groups will be able to discuss the questions in groups or one to one and feed the results back to the department. To help with this, we have published guidance on holding discussions with people with dementia and carers. We want to make sure that we hear from as many people as possible, particularly those from diverse communities and those whose voices aren’t often heard. We will be organising specific discussion groups with these communities.

This survey, and our future plans for the programme, will help us to assess what difference the Dementia Challenge 2020 Implementation Plan is having and where further improvements to the delivery of services and support may be needed at a local level.

The programme’s scope will cover the 5 main themes in the Implementation Plan:

• health and care
• risk reduction
• dementia awareness and social action
• research
• continuing the UK’s global leadership role

We’ll use the feedback, data and information that we gather to inform the formal review of the Implementation Plan in 2018.

Most autism practice not supported by good evidence, finds study

The report finds that most current policy and practice is not supported by good quality evidence of benefit and cost-effectiveness. This leads to a loss of opportunities to substantially improve quality of life for autistic children and adults and their families whilst also potentially reducing costs. “A great deal more could and should be done to generate evidence to shape policy and improve practice in autism.”, the report argues.

Filling knowledge gaps

The National Autism Project, funded by The Shirley Foundation, has been bringing together “evidence on what works well for autistic people and what makes economic sense”. The report calls for urgent investment in good quality research focused on filling gaps in our knowledge of which types of support are most effective by asking questions such as:

• Does it meet needs, improve functioning or improve wellbeing?
• Does it do what autistic people or parents believe will be of help and not harmful to them?
• If the intervention is intended to be preventative, does it actually reduce the risk of illness or other unwanted outcomes?
• Does it make economic sense? Is it feasible, affordable and cost-effective (meaning the outcomes achieved are sufficiently important to justify the necessary resources)?

The project’s research, carried out by a team at the London School of Economics and Political Science, analysed existing evidence on a wide range of possible ‘interventions’ for autistic children and adults including: screening and diagnostic assessment; early interventions; social skills programmes; parent training and support: CBT for anxiety; employment support; health checks; personalised care and support (including personal budgets and circles of support); assistive and adaptive technologies; anti-stigma and anti-bullying work, and medication.

Key recommendations for social care

Many of the report’s policy recommendations, which were refined during workshops held in each of the four nations, are relevant to social care. They include:

• The need for public bodies and service providers to participate in good quality effectiveness research into services and programmes currently commissioned for autistic adults and/or children and their families.
• The need for commissioners to consider to what extent the claims of service providers are borne out by objective research evidence which considers the benefits or otherwise that services actually have on the lives of autistic people.
• Endorsement of the importance of person-centred models of support in work with autistic people.
• Recognising the additional barriers faced by autistic people in accessing appropriate care and support compared to the general population. The report points out “autistic people generally have more health problems than other people, and a higher risk of premature death”.
• The cost-effectiveness of early and preventive support.
• The need to overcome ‘silo budgeting’ which fails to invest in effective interventions in one sector (eg social care) which reduce costs in another sector (eg health). The report does not propose systemic changes or service integration, but rather “proportionate coordination – creating the means by which different organisations and the professionals within them can work together to find pragmatic solutions for individual autistic people”.
• The need to recognise the impact of environmental stressors, uncertainty and anxiety on behaviour which causes concern and to invest in community support if any long-term progress is to result from the Transforming Care agenda to reduce the number of people in institutional settings.
• The importance of good transitions, including the need to prevent foreseeable crises (such as the eventual death of a parent primary carer) “by ensuring that a full assessment of needs is in place”. The report points out that, despite the Care Act, “there is a widespread lack of implementation” of social care assessments which actually recognise and set out the full needs of an adult, whilst most of those needs are still being met by an informal carer.

Overall, the National Autism Project report argues that “better informed decision making and wiser allocation of resources” could reduce the negative personal, social and economic consequences of “the cumulative disadvantages experienced by many autistic people over their lives” and lead to an “autism dividend”.

More than 7,000 nurses could face axe under secret NHS plans

Every area has been ordered to draw up meaures to save £22bn and reorganise health services in order to meet rising demand from an ageing population.

But new documents suggest that the proposals could result in the loss of more than 17,000 staff by 2020 – including 7,300 nurses and midwives.

Last night senior nurses said the implications for safety were “truly frightening” with widespread shortages of staff already in overstretched hospitals.

The forecasts, seen by Health Service Journal, also reveal that the plans rely on a dramatic reversal in trends which have seen casualty units under unprecedented pressure.

While A&E attendances across England have risen by 4.5 per cent and emergency admissions by 3.5 per cent in the past 12 months, the plans rely on a 4.2 per cent fall in attendances, and a 0.8 per cent drop in admissions.

Health authorities across England have been ordered to draw up 44 “sustainability and transformation plans” (STPs) to tackle rising pressures on the health service.

The controversial measures will see swingeing bed cuts in many parts of the country, and widespread closures of Accident & Emergency departments.

Officials insist that the changes will improve patient care, by shifting investment into GP and community services.

The analysis by HSJ examined finance, workforce and efficiency forecasts supplied alongside the STPs.

The data – from a sample of one in four STPs – suggests that savings rely heavily on job cuts, with a 2.3 per cent fall in registered nurses, and a 1.6 per cent reduction in all jobs.

Applied across England, it would mean reducations of around 17,300 staff in total, including 7,300 nurses, midwives and health visitors.

While the forecasts set out plans to boost GP numbers, the time taken to train such staff mean a time lag between cuts to hospital staff, and any significant increase in family doctors.

The documents also set out plans to increase the number of GP “support staff.” Health officials said this might include some nurses.

Senior doctors have warned that the NHS is currently battling the worst winter crisis in its history.

Latest figures show that in the first week of January, almost half of NHS trusts declared major alerts, with fears that the situation may worsen, amid rising levels of flu.

Tom Sandford, Royal College of Nursing drector of England, said reductions in nursing posts would have “truly frightening” implications for patient safety.

“Nursing staff make up the biggest proportion of the NHS workforce. There are already 24,000 vacant nursing posts across the UK,” he said.

“We have been hearing from members how the current situation is the worst that many have ever experienced. The situation cannot be allowed to worsen.”

Nigel Edwards, chief executive of think tank the Nuffield trust, suggested the plans were an unrealistic attempt to balance the books.

“Demand has been going up by around four per cent a year for around two decades and the demography of the next three to five years is characterised by the population ageing rapidly and growing – with a bulge in the group that uses healthcare most,” he said.

“These are very bold, if not heroic assumptions,” he said. “The question is whether this is achievable – and if it was, would it really be palatable?”

An NHS England spokesman said the planning process was still ongoing.

He said health officials expected to see a rise in the total number of nurses employed, with an expansion in the numbers employed in community and primary services.

“We are confident that a growing NHS will see more qualified nurses employed across England,” the spokesman said.

Around 16,000 people still receiving ‘flying visits’ by carers, despite Government’s minimum standard

Around 16,000 people are still receiving “flying visits” by carers for needs such as washing, dressing and eating, an investigation by ITV News and the charity Leonard Cheshire Disability found.

Ninety-five of the 152 councils in England responded to a Freedom of Information request, of whom 34 admitted they were still commissioning 15-minute visits for personal care, ITV News said.

Ten councils which admitted using 15-minute visits for personal care said they commission more than 20% of visits in 15 minutes or less, while one council said over 40% of its visits fall into that category, despite concerns over their use.

In April 2015 the Government signed up to new statutory guidance from National Institute for Health and Care Excellence (Nice) after it concluded compassionate and appropriate home care could not adequately be provided in less than 30 minutes.

ITV News said three health think-tanks suggested that five years of cuts to local authority budgets had left a £1.9 billion funding gap in social care.

But Mr Hunt told the programme more money had been found and councils needed to do better, saying: “It makes me very angry because how can you possibly look after someone’s care needs in just 15 minutes?

“If you look at the pressure at our hospitals caused by some of these people ending up in A&E, it’s the worst place for them to be, especially if you who are old, confused, or have dementia.

“That is why we introduced a package in December to ease the pressure. I don’t want to pretend it’s easy but we must not compromise on giving decent basic care for people who need it.”

Neil Heslop, chief executive of Leonard Cheshire Disability, said: “Councils should be observing official guidance and putting an end to 15-minute personal care visits for good.

“The practical consequences of these flying visits is that people are having to make choices – do you go to the loo or do you eat or drink. That’s a choice that nobody in the UK in 2107 should have to face.”

And in November Health Secretary Jeremy Hunt said great strides had been made in trying to lift the standards of care, saying he “totally disapproves” of 15-minute visits.

He admitted the health and social care system was facing its “most challenging period financially since the founding of the NHS”, but said the Government would try to protect those “very high standards of care”.

Care home closures set to rise as funding crisis bites

Last week, May got her sternest warning yet – the chairs of three influential Commons committees urged the prime minister to deal with the “immense challenge” of paying for health and social care in the future.

“We are calling for a new political consensus to take this forward,” Conservative MP Sarah Wollaston of the health committee, Labour’s Meg Hillier of the public accounts committee and Clive Betts, another Labour MP, of the communities and local government committee wrote.

Since the collapse in 2011 of Southern Cross, then Britain’s biggest care home operator, no other major nationwide company has failed. However, smaller firms are failing across the country.

The Guardian revealed late last year that 100 more care home businesses have collapsed since 2010 than previously thought. A staggering 380 have been declared insolvent since 2010, according to the Insolvency Service. The number of failures each year has risen sharply since 2010, when 32 businesses failed. In 2015, 74 were declared insolvent, while another 34 failed in the first six months of 2016, the most recent figures available. The squeeze is being particularly felt by so-called “mom and pop” operators, who may run one or two care homes but account for about 55% of the industry.

Care homes are struggling because of a fall in the amount that councils pay towards fees for residents at the same time as costs are rising, driven by the government’s “national living wage”, which meant that workers aged 25 or over must be paid at least £7.20 an hour from April 2016. This led to an increase in payroll costs of about 5% for most businesses last year. This rise would have been problematic anyway, but local authorities are also reducing how much they pay towards social care after seeing their budgets cut by up to 50% as a result of government austerity measures.

“Some local authorities are paying less than £2 an hour towards the cost of caring for a resident,” says one senior executive at a leading care home operator.

Large companies are also ailing. Four Seasons, the biggest care home operator in the country with more than 400 properties, is the most at risk. It recorded a pre-tax loss of £28m in the three months to the end of September 2016, the most recent financial accounts available.

The company, which is owned by Guy Hands’ private equity firm Terra Firma, is also sitting on more than £500m of debt, a legacy left by the previous owners. This debt means it pays about £30m in interest to its lenders every three months.

Four Seasons insists it can easily manage its debt burden, but Robbie Barr, the chairman of Four Seasons, warns the industry is “struggling at tipping point”. As well as care home operators collapsing, other companies could simply pull out of the industry. Bupa, one of the largest operators behind Four Seasons, was reported to be looking to sell 200 homes, although it has said it remains committed to the industry.

Stung by accusations that the autumn statement ignored social care, last month, Sajid Javid, the communities and local government secretary, announced that councils could increase council tax by an extra 3% to fund social care. He also said there would be a £240m “adult social care support grant” to help councils with care of older residents.

But Barr is cautious. He says: “It is essential that councils use the powers they have been given to raise the social care precept and pass it on to frontline elderly social care services to help offset the additional costs of the national living wage increase and avoid further pressures on a sector that is struggling at tipping point.”

Secret figures collected by Four Seasons show that although more than 90% of councils increased council tax last year – thanks to a similar 2% precept announced by David Cameron’s government – less than half of these passed it on to care homes through an increase in their fees.

Even if councils pass on the new precept, Javid’s package of measures, worth £900m, will not even cover further increases in wage costs this year. The national living wage is scheduled to rise by 4.2% in April to £7.50, which is larger than the proposed 3% increase in council tax.

The Local Government Association estimates there will be a £2.6bn funding gapin providing adult social care in England by 2020. A report by the Health Foundation, the King’s Fund and the Nuffield Trust calculates the gap would be £1.9bn in 2017 alone.

Izzi Seccombe, chair of the community wellbeing board for the LGA, says: “The care provider market cannot carry on as it is and there is a real danger of more widespread market failure.”

This squeeze is not just leading to the closure of care homes but compromises to the quality of care and an increase in costs for private residents. In a report last October the Care Quality Commission, the industry watchdog, warned that adult social care is “approaching a tipping point”. This conclusion was based on its inspections, tipoffs and external data. Its damaging findings included that half of the 1,850 social care services rated as needing improvement had not changed when reinspected and that 153 were downgraded to inadequate. Furthermore, it said the total number of nursing homes has dropped for the first time in five years and 81% of local authorities have reduced their real-terms spending on social care.

Another consequence of the crisis is that residents paying privately are suffering increases in their fees or top-up payments to make up for the shortfall in state funding. Well over half of care home residents are still either entirely or partly paid for by the state, with council funding available when a person’s savings and assets are worth less than £23,500. However, Age UK found that the number of residents paying their own costs has risen by 28.5% in the last decade and that the gap between private payers and council-funded residents is stark. While self-funders pay between £603 and £827 a week on average depending on the area, councils pay between £421 and £624 a week.

This is one of the reasons why the Competition and Markets Authority announced an investigation into the care home industry last month, a move that could have serious ramifications for the government and the major operators. The CMA said it will probe the “effectiveness of competition between care homes in driving quality and value for money for residents and taxpayers” and also “consider how local authorities and other public bodies purchase and assign care home places”. The government regulator has the legal power to force companies to make changes, as well as make recommendations to the prime minister.

Given the structural issues in the industry, the investigation has been welcomed by the biggest care home groups. Joan Elliott, managing director of UK care services at Bupa, says: “A strong, functioning care home sector is vital if the UK is to meet the growing needs of our ageing population. The new CMA market study is a real opportunity to address the barriers and blockages in the system, in particular how some local authorities set up their contracts, price quality care and pass through government funding.”

With 430,000 people in care homes and more than 11 million people aged 65 or over in the UK, the problems need to be addressed urgently. The country cannot afford to lose another 70-odd care home businesses in 2017, but that looks likely unless the government steps in.