March 21, 2017 21:19
Declaration of interest – I am chair of Citizens Advice Sheffield
The Health and Care system is so complex, the responsibilities so great, the budgets so big that it is often all too easy to think that it is the most important part of peoples lives – the glue that holds everything together. Of course it isn’t – it is really a set of services that are there as a last resort when we can no longer manage on our own.
So, the risk is that while we focus on the challenges faced by health services to meet the needs of people with mental health problems it is possible to lose focus on changes that are happening elsewhere that have the potential to make a grievous impact on the wellbeing of those same people.
Social Welfare Support and Mental Health
Just like the NHS, the social welfare system is meant to provide support to help people engage with society and take control of their own lives. One of these supportive elements is the mobility component of Personal Independence Payments (PIP) which is meant to provide funding to enable people who are unable to leave their home to do so – to go shopping, see their GP, socialise, go to training etc. Subject to assessment, people with mental health problems can either get nothing, the lower rate (£22 pw) or the higher rate (£58 pw). The Government says that people with mental health problems should only be considered for the lower rate.
In November 2016 the Government lost an Upper Tribunal ruling brought in part by Citizens Advice Sheffield which declared that in some cases people with mental health problems SHOULD be eligible for the higher rate because “overwhelming psychological distress” should be considered when assessing the descriptor. This success led to the Government trying to rush a change to the regulations to block this judgement – claiming that this was an emergency! The Government claims that if it did not do this there would be an additional cost to the treasury of £3.7bn over the next five years.
Although the Government denies that changing the regulations in this way will adversely affect people with mental health problems the House of Commons Library Research Paper – Changes to Personal Independence Payment Eligibility Criteria notes that the Governments own Equality Impact Assessment says that this change to the regulations will:
“Affect 336,500 claimants of whom 282.5000 will no longer be entitled to any mobility changes.
These changes could affect people with a wide range of conditions including learning disability, autism schizophrenia, anxiety conditions, social phobias and early dementia.”
This table – also from the Equality Impact Assessment sets out the estimated impact:
Back to the NHS
These changes will affect not only the health and wellbeing of many people with mental health problems who will find it harder to get out of their homes, will become more isolated and less able to improve their wellbeing; it will also affect NHS mental health and primary care who will have more demands placed on already stretched services.
I am concerned at how quiet key players in the health system are with regard to this issue. Despite all the rhetoric associated with the Mental Health Five Year Forward View there appears to be little coherent thinking about the need for acton to address the parlous financial circumstances of many people with mental health programmes and instead a rather superficial take on parity of esteem that gives insufficient attention to health inequalities. Regrettably this (lack of) thinking is replicated in guidance on Sustainability and Transformation Plans and on Accountable Care Systems.
I think that:
What do you think?
Posted by markgamsu
Categories: Five Year Forward View for Mental Health, Mental Health
Tags: 5 Year Forward View, Citizens Advice, Inequality, mental health, NHSE, Personal Independence Payments, PHE, PIP
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Thanks Mark, as ever. Will also share with Chris Naylor and Helen Gilburt here.
We’re going to be launching a report on HIV across the pathway on April 25th . It will include social support, which NAT have raised through their report and press release yesterday (huge LA cuts in the last year). Interested in coming along? Very unusually for us it’s also free!
Here’s the background https://www.kingsfund.org.uk/projects/future-hiv-services-england. If you do want to come let me know and I’ll get you on the pre-public registration list.
Dave
David Buck (@davidjbuck)
Senior Fellow, Public health and health inequalities
The King’s Fund
11-13 Cavendish Square
London W1G 0AN
0207 3072642
http://www.kingsfund.org.uk/about-us/whos-who/david-buck
By David Buck on March 22, 2017 at 09:21
Reblogged this on A Better NHS and commented:
This is so important. I’m helping patients with mental health problems appeal their PIP assessments almost every week
By abetternhs on March 22, 2017 at 20:39
Reblogged this on Derby People's Assembly.
By 1968xavier on March 22, 2017 at 21:18
[…] a long track record of translating issues faced by their clients into evidence to challenge policy (I gave a Sheffield example here) local Public Health Teams need to consider how they can strengthen […]
By The welfare benefit system is a public health system | Local Democracy and Health on June 25, 2017 at 16:23
Agree 100%. So much, that I wrote this 2 weeks ago, hoping to get more HCPs pushing pts to claim their PIP. https://drannemurphynhs.wordpress.com/2017/10/13/pip-and-your-patients/
By Dr Anne Murphy on October 25, 2017 at 07:53
Cheers Anne – good piece on your blog too! Mark
By markgamsu on October 25, 2017 at 07:55