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Health, Welfare & Adult Social Care

Whilst London’s Jewish Community is regarded as the healthiest of monitored faiths in the capital, it is disproportionately older than that of the general population. 41% of the Community are over 50, compared to the London average of 27%, whilst 13% of Jewish Londoners are over 75, compared to London’s average of 6%[1] and we expect that this will only increase over time. The effects of an ageing population disproportionately impact upon our community. This has led to the development of a robust and market-leading voluntary sector care industry which embraces some of the best practice in Adult social care. We are already facing many of the big challenges in care that the UK will encounter in the near future and meeting many of these head on.

 

Commissioning of Services from Culturally Appropriate Providers

Whilst personal budgets have provided Jewish Londoners with greater choice and flexibility in choosing the right package of care, difficult decisions with long term impacts are often incredibly hard to make, particularly for those with mental health illnesses. The need for high quality universal advice services is very important, as is the depth of institutional knowledge of advice providers in the Jewish community.

Culturally appropriate providers of care provide a vital function in the delivery of Adult social care for Jewish and other minority communities in London. The majority of Jewish Londoners entering long-term care prefer to access services from Jewish providers[2]. A Jewish ‘ethos’, in addition to specific requirements around kashrut, geography and perceptions of social environment, is a key motivating factor when accessing care[3]. The Jewish Voluntary care sector is well established, from the largest residential care home, Nightingale House, to the £40m newly developed Maurice and Vivienne Wohl Campus in Golders Green, providing an integrated facility of care home, independent supported living and community centre. Individuals choosing to remain in their own homes also access independent living support from Jewish adult social care providers.

Where services are directly commissioned by local authorities, there is some concern that large third sector providers who can deliver only culturally ‘competent’ services are able to utilise the new Community “Right to Challenge” power under the Localism Act to force procurement exercises, squeezing the ability of specialist providers to compete.

It is also vitally important to recognise the added value that Jewish social care providers deliver outside of the commissioning framework. Through their integration into the wider community, Jewish care organisations generate incredible levels of social capital, not least through extensive volunteer programmes and initiatives which demonstrate the Big Society in action. This is particularly important because the focus in adult social care is shifting to re-ablement.

 When commissioning services directly or in assessing suitability of placements for care services, local authorities must empower the Jewish adult social care sector to enable them to perform their duties of culturally specific service provision under the Equalities Act. This can only be done when authorities recognise the importance of niche sector providers and support a diverse care economy with diverse commissioning lots.

 The sector continues in its desire to maintain a strong partnership with Commissioners within Local Authorities. In addition, we welcome the opportunity to  help ensure social workers, care professionals and advocates retain a strong working knowledge of the importance of the Jewish ethos of Care providers when supporting people in making decisions over how best to use their personal budgets. We would also encourage councils to allow self-funded individuals access to advocacy and advice services they commission.

 Where a direct payment arrangement would not be in the best interests of an individual, particularly in an area of low Jewish population where expertise may not exist, the Authority should look to the Jewish adult social care sector to provide an independent service fund facility.

 

Immediate & Long Term Funding for Adult Social Care

Local Authorities across the board are seeking efficiencies in their Adult social care budgets to meet increasing pressures on council finances. It is generally understood that across the adult social care sector services are being delivered at costs greater than those being met by local authorities[4]. This disparity is growing. The Jewish adult social care sector is equally pursuing efficiencies and exploring new ways to deliver services, but has nevertheless become excessively reliant on private funding, predominantly through legacies and direct giving. This is now particularly acute in residential care homes where providers continue to supply the third party top-up for residents who have exhausted independent capital. Jewish Care estimates that, of residents in its care homes, 75% receive some funding from local authorities with an average individual shortfall per annum of £15,000. Whilst such shortfalls are in part due to the extra costs of provision within London and costs that would be unreasonable to expect authorities to meet, the availability of private financial support nevertheless may well be masking a growing crisis in care funding. If the financial crisis has demonstrated anything, it is that private giving may well be unsustainable.

 The sector eagerly awaits the Government’s response to the Dilnot Report and the expected Command paper on future funding arrangements for Adult care services in addition to a final settlement on the Palliative Care Funding review. Whilst this issue in the long term is not in the hands of the GLA and Local Authorities, strong leadership from the Mayor’s Office and the London Health Improvement Board and partner agencies is required to ensure that users are able to  access culturally specific services are achieved for London and its Jewish and other minority communities wherever they are.

 

Health & Wellbeing Boards & Clinical Commissioning Groups

The introduction under the NHS and Social Care Act of both Health & Wellbeing Boards within local authorities and the creation of Clinical Commissioning Groups provides opportunities and challenges for serving Jewish Londoners. It is vital that the Joint Strategic Needs Analysis  process being undertaken within individual LAs identifies the full rage of  health and social care needs that Jewish Londoners require. This applies whether or not in areas of concentration or sparse populations.

A key issue for the Jewish Community is to ensure successful support for people living in their own homes as they get older and more frail.

It is right that a pan-London Health Improvement Board should be created to bring local authorities together to remedy health inequalities that affect all Londoners. This would provide a platform upon which specific health concerns of Jewish and other minority communities can be identified, prioritised and addressed where those communities exist in geographical areas crossing Borough boundaries. The pooling of 3% of Public Health funding for pan-London strategic priorities is therefore a sensible

 We would urge the Mayor to ensure the Third Sector is represented within the Shadow LHIB. If Boards and Consortia are to attain their objectives of delivering great local care for local need, Jewish and other minority communities need to be fully engaged through the creation of Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies. Whilst we understand that Healthwatch and Monitor will both enable service users and the public to engage in public scrutiny of healthcare provision, specific Jewish and other minority services and their scrutiny can be well delivered through engaging with their respective Third Sectors. The Jewish community welcomes the opportunity to contribute and eagerly awaits more detail on how these vital functions will operate in practice locally.

 

Services Delivered Across LA Boundaries

 Delivering culturally specific services can often be achieved in a cost effective way when local authorities cooperate on services across boundaries, and there is a new imperative to cooperate more broadly in the context of budgetary constraints. The very specific cultural and religious needs of the Charedi community with its comparatively small but growing size and geography, have led to advances in cross Borough partnerships. In the case of children placed into care due to the shortage of more appropriate placements, the London Boroughs of Hackney, Haringey and Barnet actively cooperate to ensure placements are appropriate to the cultural needs of the child. These partnerships may well expand to include areas of significant Charedi population outside of London.

 Whilst sub-regional partnerships are clearly in the best interests of delivering efficient culturally specific services, long term guarantees over the financial responsibilities of authorities placing individuals into facilities outside of their purview need to be secured to ensure the stability and confidence of the service and the service user in any arrangement. Equally, more work needs to be done to identify pan-London tariffs for certain services to ensure fairness and confidence in the care sector, especially when greater economies of scale can produce efficiencies for local authorities.

 

Death Certification and the introduction of Medical Examiners

The Coroners and Justice Act (2009) makes provisions for the reform of Death Certification through new Medical Examiners, whilst Clause 53 of the Health and Social Care Bill will place the this duty with Local Authorities through their Health and Wellbeing Boards. Like many faith communities, the Jewish community has very specific customs and practices relating to death, burial and grieving. Upon death it is common for a chevra kadisha or burial society to provide immediate support for the deceased’s family and the ritual guarding and preparation of the body for burial. Burial takes place as soon as possible and in most cases will take place within 24 hours of death. We are pleased that the development of the Royal College of Pathologist’s Medical Examiners training curriculum contains specific references to culturally specific needs, and hope that this will also contain guidance on quicker alternatives post-mortem examinations

 The Jewish community therefore urges the Health and Wellbeing Boards to ensure that there is adequate 24 hour cover by Medical Examiners from their introduction in 2013 to ensure that no undue delay should arise in the issuing of death certificates.

 

 

 

 


[1] P.16 “2001 Census Profile: The Jewish population of London” 2007 (GLA Data Management & Analysis Group)

[2] P.130 “Facing the Future: The provision of long-term care facilities for older Jewish people in the UK” 2002 (Institute for Jewish Policy Research)

[3] ibid

[4] P.199 “Facing the Future: The provision of long-term care facilities for older Jewish people in the UK” 2002 (Institute for Jewish Policy Research)