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Westminster Eye: An insight into the week of politics 24 - 28 October
There was a flurry of activity on health related issues for older people from Wednesday onwards at Westminster.
The delayed transfers of care figures were released for September. Whilst the number of delays is constant, the delays measured in numbers of days are the highest since March. At 121,795 days for September, it is over 12,000 days higher than in April when the figure was 109,362.
In response to Rory Stewart's written question tabled the previous week on support for older people living in rural areas, the Communities Minister Andrew Stunell, said that the Government’s programme included a commitment to support older people to live independently at home. To support that commitment Government has protected funding for Disabled Facilities Grant which delivers adaptations that enable disabled people to live comfortably and independently in their homes. By the end of the spending review period the national Disabled Facilities Grant budget will increase from £169 million in 2010-11 to £185 million in 2014-15. He added that the Government was investing £1.5 million in the FirstStop Information and Advice Service which aims to help older people make informed decisions about their housing, care and support options and to help them maintain independent living in later life. The Government has also provided £51 million funding for handypersons schemes over the spending review period to deliver small home repairs and adaptations.
David Laws MP asked in a written question what the Government’s most recent estimate is of the proportion of NHS expenditure which is spent on people aged 60 years and over; and if he will make a statement. The answer is awaited and will be included in the next issue of the Westminster Eye.
On 26 October John Healey MP presented a petition from the Rotherham Pensioners Action Group. The 500 plus signatures gathered by the group over are calling for a better, fairer system of care for the future. They are worried about the crisis in care caused by big Government cuts in funding as pensioners see services cut, charges increase, and support restricted to those with the most critical care needs.
Earlier that day parliament sat through an opposition day debate that lasted several hours to discuss a motion calling on the scrapping of the Health and Social Care Bill. In exchange Labour MPs extended an offer of cross-party talks on the future of the NHS. The motion, not surprisingly, was defeated and much of the debate descended into party political point scoring. However, there were some bright spots. Deputy leader of the Liberal Democrats, Simon Hughes MP called for assurances that the recommendations of the Cavendish report on elderly care would receive full consideration.
Health Committee member Dr Daniel Poulter MP said that Health and Well-being Boards (HWBs) and the clinical commissioning groups would be "good mechanisms for delivering better integrated care". There were currently too many silos in the NHS, he argued, and said the primary and secondary sectors often did not integrate well. Local Health and Well-being Boards were "definitely a step in the right direction" towards closer integration between adult social care and the NHS, he added.
On the following day MPs debated NHS Care for Older People in the Westminster Hall. This debate was granted as a direct result of pressure from backbench MPs following the critical report from the Care Quality Commission about some of the failings in NHS hospitals in providing adequate care for older people. In contrast to the previous day, this debate was constructive and conciliatory with members from all sides of the House pretty much in agreement. Whilst there are examples of excellent care many MPs highlighted stories of poor care in hospitals brought to them by constituents. Others had experience first hand from members of their own families.
"I was heartened to see a note from
Barbara Keely MP - Worsley and Eccles South
WRVS describing ward support services
it is setting up for older people, which is
a wonderful idea. It wants to improve
the experience of older people by using
trained volunteers to support them and
their families and carers. That would
include training in dementia, which
could be important...."
WRVS is about to roll out an on ward support service and this initiative was supported and welcomed by two MPs during the debate. Barbara Keeley MP, a newly appointed to the Health Select Committee
, said that she “was heartened to see a note from WRVS describing ward support services it is setting up for older people, which is a wonderful idea. It wants to improve the experience of older people by using trained volunteers to support them and their families and carers. That would include training in dementia, which could be important.” Nick Smith MP, Principal Private Secretary to shadow Foreign Secretary recognized that the voluntary sector “could be a sensitive and sensible provider. WRVS has informed us about some of its voluntary services on wards, which include befriending patients and help with feeding. I understand that it is keen to expand those services, which is something that I support.”
"WRVS has informed us about some of its
Nick Smith MP – Blaenau Gwent
voluntary services on wards, which include
befriending patients and help with feeding.
I understand that it is keen to expand
those services, which is something
that I support...."
In responding to the debate Paul Burstow said that the finding in the CQC report and other recent reports demanded action. He agreed that follow-ups by the CQC needed to be rapid and proportionate where problems had been identified. As part of the next wave of inspections announced the previous day by the Secretary of State, the CQC will carry out inspections not only on a nine-to-five, Monday to Friday basis, but outside normal hours so that the fullest possible picture is received. The Minister said that there is nothing inevitable about illness and disability in old age. Dementia or falling over is not a normal part of ageing; illness and ageing are not synonymous, and that we must get that point across when designing our systems. That does not mean that an ageing population poses no challenges to our health care system because it does, but it is also a cause for celebration. The age shift taking place in our society is one of the biggest challenges we face, and it is right that Parliament should spend more time debating it. People over 65 account for 65% of hospital admissions and 70% of bed days. There was a need for good leadership, a change in culture and better transparency in data and complaint handling. Margot James the sponsoring MP for the debate closed by drawing the Ministers attention to the figures used during the debate in which it was put that the accepted ratio of nurses in a ward with a considerable number of older people is 1:10, whereas a paediatric ward it was staffed at a ratio of 1:4. She asked that Government should consider what can be done about concerns regarding the skill mix and the management of resources.
A further debate on funding of social care has been granted and will take place in Westminster Hall on 10 November.
It’s one of those annoying, jargonistic words which mean little to those outside of a small bubble – but increasingly, the idea of reablement is something which is starting to gain political traction within Wales.
The term already elicits different definitions and understandings – and too often serves as a term onto which people project their own preconceptions. For clarity, my own interpretation is similar to the definition provided by the Office for Public Management:
"At heart, reablement is about helping people to do things for themselves, rather than doing things to or for people. It’s about supporting the whole person – addressing their physical, social and emotional needs. It’s an outcome-focused, personalised approach, whereby the person using the service sets their own goals and is supported by a reablement team to achieve them over a limited period... It focuses on what people can do, rather than what they can’t, and aims to reduce or minimise the need for ongoing support after reablement"
In simple terms then, reablement is largely common sense – helping people to negotiate the difficulties of daily living (often after a prolonged spell in hospital) so that they can live active and independent lives.
When it’s looked at in those terms, reablement starts to make sense. But it doesn’t happen by accident – it needs support from government (at a national, regional and local level) to happen. And that’s why it has been so encouraging to see greater attention being paid to reablement in Wales.
Last week, the Welsh Assembly’s Health & Social Care Committee agreed to explicitly incorporate issues around reablement into the terms of reference for their inquiry into residential care of older people. In the same week, I was fortunate enough to chair another meeting of the Welsh Reablement Alliance, an umbrella group of charities and professional bodies keen to expand and improve reablement provision in Wales.
It was also a pleasure to attend an event at the Senedd held by Care & Repair Cymru looking at helping people with physical adaptations to their homes to ensure independent living amongst older people. Undoubtedly the highlight of the event for me was a message of support sent by Gwenda Thomas AM (Deputy Minister for Social Services) in which she said:
"Reablement must be at the heart of our approach. Reablement services will be a requirement across Wales so that social services and the NHS working together can help people to maximise their recovery or develop ways of living that fit their new circumstances."
Gwenda Thomas AM (Deputy Minister for Social Services)
To see such clear, explicit support for reablement services from someone at the heart of Welsh Government policy on social care represents a major step forward. There is still much to do in order to shape a holistic and consistent reablement service for Wales – there is still an imbalance in the focus on physical support and the need for social support which improves wellbeing – but the very fact that an obscure term now has currency within the halls of power can only be a good thing.
Westminster Eye: A round up of recent events
Both Houses were in recess over the conference season. The House of Lords returned on 3 October and the House of Commons returned on 10 October.
Department of Health released its monthly delays in transfers of care for the month of August. The figures showed a slight decrease in the number of delays but the number of days is the highest since April and the second highest this year. Delays in transfers in days are now 119,770 against 107,845 in April. Only March at 122,392 was higher in 2011.
The Office of Fair Trading (OFT) published a report on the UK market for mobility aids after a seven month investigation. The OFT found that people may be paying too much for mobility aids and the elderly can experience high pressure and misleading sales practices when buying this equipment at home. The OFT launched consumer protection investigations into two national mobility aids traders, in relation to suspected unfair doorstep sales practices and over terms and conditions and service delivery.
The OFT has also launched a national consumer awareness campaign providing consumers with practical tips and informing them of their rights when buying mobility aids on the doorstep. The OFT offers the following advice to consumers purchasing at home:
- Think twice before you buy and if you are made to feel under pressure to make a purchase, have the confidence to say no.
- Be wary of time-limited or exclusive offers that need to be signed on the spot - this can be a high pressure sales tactic.
- Double check the facts. Do you fully understand the costs and know whether it includes extras like installation, on-going serving charges or warranties?
- Always shop around to compare products and prices.
- Talk to someone you trust for a second opinion.
- If you spend over £35 with a trader at home, you usually have seven days in which to cancel.
The Department of Heath began its flu vaccination programme for winter 2011-12. The Department says that there is a targeted approach for those who need to be called. GP surgeries should contact those individuals in the at-risk groups so that they can be vaccinated. Anyone in the 65 and over age group and is entitled to a free flu jab.
Parliament returned and on 4 October Simon Kirby MP received a reply to his question asking what guidance the Department of Health provided to local authorities on steps to reduce isolation, loneliness and fear amongst people in later life. In replying, Social Care Minister Paul Burstow said that the Department has not issued any specific guidance to local authorities in relation to reducing isolation, loneliness and fear among older people. However, the Department is seeking to collect data around social participation through the 2011-12 Adult Social Care Outcomes Framework indicator, which focuses on enhancing the quality of life for people with care and support needs including older people. In addition, the Department's national evaluation of Partnerships for Older People Projects informed councils about the benefits that small services such as providing practical help and emotional support could positively affect the health and well-being of older people.
Adrian Sanders MP tabled an Early Day Motion. The EDM currently has 11 signatories
"That this House congratulates the Hairy Bikers' television campaign to reform the Meals on Wheels service and to recruit more volunteers for the Meals on Wheels service; applauds the valuable work undertaken by the Meals on Wheels service for the most vulnerable in society; notes that councils are cutting subsidies to the Meals on Wheels service; further notes that many of the users of the service cannot afford to pay the resulting increased prices; calls on the Secretary of State for Communities and Local Government to protect the subsidies for the Meals on Wheels service and to encourage more volunteers across the country to take part in the scheme."
Adrian Sander's EDM
Paul Burstow responded to a question from Ian Austin MP who asked what assessment he has made of the effect of reductions in funding to local authorities on the number of day centres operational in
(b) the West Midlands
(c) Dudley borough.
Paul Burstow said that the responsibility for addressing and commissioning social care needs of local communities rests with local authorities. The Government recognised the importance of social care services and have taken steps to ensure that local authorities have sufficient funds to provide them. In recognition of the pressures on the social care system in a challenging fiscal climate, we have allocated an additional £2 billion by 2014-15 to support the delivery of social care. With an ambitious programme of efficiency, there will be enough funding available both to protect people's access to services and deliver new approaches to improve quality and outcomes. Numbers of day centres is collected centrally.
The House of Commons Health Committee held an oral evidence session on public expenditure. This involved members of the Committee firing questions at the Secretary of State Andrew Lansley and his team of senior officials. The Minister faced robust questioning from the Committee. In particular Dr Dan Poulter MP pressed on the need for more integration and joined commissioning of care services for older people but was concerned over the lack of incentive for it to take place.
David Tredinnick MP asked how local authorities were supposed to maintain eligibility criteria when funding was being cut and demand was increasing. The Department of Health admitted than even after the transfer of £800m this year from the NHS to PCTs, that they would still face a reduction of between 1 and 1.5%. The Minister went on to explain where the additional money as being spent.
The Care Quality Commission published a report State of Care on its targeted inspection programme of NHS hospitals. It looked at whether older people are treated with respect and whether they get food and drink that meets their needs. The report notes alarming findings at over half of the hospitals visited, with 20 hospitals failing to meet one or both standards.
This was quickly followed up by two MPs seeking a debate about the care of older people in hospital. Margot James MP asked that following the worrying report from the Care Quality Commission on the lamentable standards in the care of older people in the NHS-it found that 20% of the 100 hospitals it inspected were almost criminally negligent-could there be a debate on this subject? A question from Nick Smith MP followed in similar fashion, pressing the Leader of the House for a statement on NHS care for the elderly and time in the House to discuss the matter as soon as possible.
In responding Sir George Young said that he too was concerned over the findings and that he would welcome such a debate. He suggested that the Backbench Business Committee was approached to see whether it might find time for one. The call for a debate accepted by the Committee and time has been set aside on 27 October to discuss NHS Care of Older People.
Minister Begins To Sing WRVS Song On Volunteering
For the first time, today saw a proper national debate on the role that older people can play in the Government’s Big Society.
WRVS has been urging the Government to give pride of place to older peoples volunteering in its Big Society vision over the last year. We’ve felt that the volunteering agenda that really excites ministers focuses on 19 years olds gap year volunteering and not older volunteers.
Today we started to see some recognition that the Government is getting more serious about the older peoples volunteering agenda. Nick Hurd said that volunteers could play a crucial role in keeping people out of long term care. He zeroed in on the ‘Baby Boom’ generation of people due to retire in the next five years and emphasised the considerable skills that they have.
A fellow speaker, Antonia Cox author of a report on mobilising volunteers drew attention to the findings of WRVS’ report, Gold Age, which shows how much older people are already the mainstay of the Big Society.
When I spoke I highlighted the work that we are doing to reach out to people who have not volunteered before with our Carebank project in Maidenhead. I and members of the audience pressed Nick Hurd on the need for local authorities to ‘step up’ and use their considerable contacts with older people to make individuals aware of volunteering opportunities.
Geraldine Bedell spoke from the Gransnet charity and argued that one barrier to getting more older people active in their communities was a feeling that their contribution was not fully recognised and valued. Geraldine herself was a judge for WRVS’ Gold Age Power List that recognises older people’s impact across our society.
So where do we go next? WRVS will be knocking on ministers doors again asking them to follow up on some of the ideas that came, not only from us, but from Conservative activists who spoke in the meeting.
Matthew Sowemimo, WRVS Head of Public Policy spoke at the ResPublica Fringe meeting during the Conservative Party Conference.