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Experiences of ageing in the EU - How does the UK compare?

LonelinessNew WRVS research published today suggests that the experience of ageing in the UK is poor compared to other EU countries, with older people in this country the loneliest, poorest and the most concerned about age discrimination.

The research focused on a range of indicators, including health, wealth and levels of loneliness in four EU countries (the UK, Germany, Netherlands and Sweden). Of the four countries, the UK was rated third in its overall performance.

Loneliness and lacking somebody in whom to confide are particular problems in the UK, with our older people having the highest rates of loneliness and the highest prevalence of life-limiting illness. Meanwhile, our older people more frequently feel that they have been shown a lack of respect because of their age than older people in other countries.

So where are the key policy differences which account for the different experiences of ageing, and what lessons might we learn here in Wales?

I think the research highlights some sad truths and should act as a wake-up call to improve services for older people. In particular, we should be concerned about the loneliness faced by older people here in Wales; we know from other studies that overcoming loneliness and isolation is the factor that is most important to improving quality of life for older people. Doing so can keep people happier, healthier and out of hospital and in their homes for longer. But we need to do more by protecting low-level social support services such as lunch clubs and good neighbour schemes, and also improve signposting so that lonely older people are systematically directed towards help.

Today’s new study emphasises that the establishment of an Older People’s Commissioner for Wales marks Wales out as forward-thinking in its policy approach to ageing. Yet too often, that same fact can be a weakness, with the OPCW potentially being viewed as a panacea to the challenges we face. By the same token, measuring quality of life amongst the older population (for example, the Older People’s Wellbeing Monitor for Wales) is very welcome in allowing us to benchmark our progress against other EU countries – but the Monitor has not been updated since 2009. Given the centrality of wellbeing to the Social Services (Wales) Bill, we would argue that the monitor should be reinvigorated as an annual report.

Wales has made some great strides on helping to improve the lives of older people – but today’s research shows that there is still a great deal to be done for us to keep up with some of our European neighbours. The Welsh Government’s next steps will be crucial in determining whether or not they can rise to the challenge.

This blog originally appeared on the Bevan Foundation's website, www.bevanfoundation.org 

Posted by Dr Ed Bridges, Public Affairs Manager (Wales) at 00:00 Friday, 25 May 2012. 0 Comments

Labels: ageing, loneliness, health, wealth, lunch clubs, good neighbours, Older People's Commissioner for Wales, Social Services Bill, Wales

Westminster Eye: An insight into the week of politics 9-18 May

Wednesday 9 May

The Queen's Speech included a draft bill to modernise adult care and support in England, setting out what support people could expect from government and what action the government would take to help people plan, prepare and make informed choices about their care.

The main benefits of the draft Social Care Bill would be:

  • modernising care and support law to ensure local authorities fit their service around the needs, outcomes and experience of people, rather than expecting them to adapt to what is available locally
  • putting people in control of their care and giving them greater choice, building on progress with personal budgets
  • consolidating the existing law by replacing provisions in at least a dozen Acts with a single statute, supported by new regulations and statutory guidance
  • simplifying the system and processes, to provide the freedom and flexibility needed by local authorities and social workers to allow them to innovate and achieve better results for people
  • giving people a better understanding of what is on offer, to help them plan for the future and ensure they know where to go for help when they need it

The main elements of the draft Social Care Bill are:

  • modernising the legal framework for care and support, to support the vision of the forthcoming White Paper on care and support
  • responding to the recommendations of the Law Commission, which conducted a three-year review into social care law
  • establishing Health Education England as a non-departmental public body
  • establishing the Health Research Authority as a non-departmental public body
  • creating a London Health Improvement Board
  • carrying out engagement and pre-legislative scrutiny on the draft Bill, as many in the social care sector have called for, to enable government to listen to people with experience and expertise, to make the most of this unique opportunity to reform the law

Under changes announced in the Queen's Speech charities will be able to claim top-up payments on up to £5,000 of small donations without needing Gift Aid declarations,. This scheme will be particularly helpful for small charities that rely on bucket collections, which can find it impractical to get the necessary paperwork that Gift Aid requires.

Meanwhile in the Lords, Lord Touhig asked the Government what steps they are taking to provide support for people with dementia. A reply is awaited.

Thursday 10 May

During Commons Oral Questions to the Leader of the House Glyn Davies MP said that the Queen's Speech included a commitment to a draft Bill on adult social care, which is a hugely complex and important subject. He asked if the Leader of the House agreed that there should be debates on it during the new Session to ensure that the momentum of this important policy is not lost. In his reply Sir George Young said that he agreed. He referred to his response to the shadow Leader of the House. This was one of the issues that the last Government did not address. He continued that the current Government had commissioned the Dilnot report, and a White Paper will be published this spring containing proposals on adult care. There will then be a draft Bill to take the agenda forward. In the meantime, resources have been put into the NHS and adult services to give more support to social services departments, which he recognised are under pressure.

Monday 14 May

Baroness Wheeler tabled a Lords Oral Question to ask the Government what is the timetable for the draft bill to modernise adult care and support in England announced in the Queen's Speech and to what extent the proposals in the bill follow the recommendations of the Dilnot Commission. An answer is expected on 11 June.

Tuesday 15 May

Harriet Harman MP received a reply to her question to the Chancellor of the Exchequer what estimate he has made of the likely revenue to the Exchequer from the cap on tax relief for philanthropic activity as a result of his proposal. David Gauke responded by saying that the Government announced at Budget 2012 a proposal to introduce a limit on all previously uncapped income tax reliefs from April 2013. This included the charitable reliefs for Gift Aid, Payroll Giving and gifts of land and shares. Costings approved by the Office for Budget Responsibility were published in the budget. He added that the Government estimated the philanthropic element of this to be £50 million to £100 million. The Government had clearly stated its intention that those charities which rely on large donations are not significantly affected. To this end discussions with stakeholders from the charity sector are currently taking place to better understand any impacts. This will inform a formal consultation on the delivery of the measure over the summer.

Hilary Benn MP asked the Communities and Local Government Minister what guidance he has provided to local authorities on the application of business rate relief in respect of properties that are used wholly or mainly for charitable purposes. David Evennet MP asked Health Ministers how many people aged over 60 received a free prescription in each of the last three years. Answers to these questions are expected on 21 May.

In the Lords on the 15 May , Opposition whip Baroness Wheeler accused the government of breaking their promises on social care. By not committing themselves to a comprehensive Bill and a timetable for the implementation of reform the government was shying away from the needed reform she said. She added that the lack of legal framework in the Bill and explanation of how the £1bn shortfall in funding was to met, whilst trying at the same time to extending personal budgets was going to raise expectations that could not be met. She said, "Reform of social care must deal with the interrelated issues of long-term funding which allows for people to plan for the costs of retirement, improved quality of care through integrated health and social care commissioning".

Lord Adebowale, chief executive of Turning Point, said that the failure of the draft Social Care Bill to address funding must be addressed urgently. "I was one of 78 signatories to an open letter sent to the Prime Minister earlier this month organised by the Care and Support Alliance" he added. "It warns that the system is chronically underfunded and that, without reform, too many old and disabled people will be left in desperate circumstances, struggling on alone and living in misery and fear."

Lord Warner argued that the draft Bill on adult social care would not deal with funding. "Funding social care has become a ticking time bomb, not least because a financially challenged NHS picks up the tab for the social care casualties who end up occupying inappropriate and expensive hospital beds," he said.

Speaking about social care, Baroness Tyler of Enfield said the forthcoming White Paper, the funding progress report and the draft Bill should be seen and judged as "an overall package." She felt Dilnot provided a framework for a long-term settlement for funding social care though noted concerns about affordability.

Lord Smith of Leigh talked about social care as it impacted upon the NHS. "Unless we get social care right, the NHS will not be able to achieve those savings", he said and called for radical change and integration of health budgets.

Lord Collins of Highbury touched on the Dilnot review into social care, saying the care system had reached breaking point, but the government seemed further away from addressing the "fair and sustainable solutions" arising from the review.

Baroness Barker asked what progress had been made on delivering greater integration of health and social care.

Wednesday 16 May

During Prime Minister’s Questions Dan Jarvis MP claimed that it was clear that the Government did not have a comprehensive long-term strategy for care. He asked the Prime Minister if he agreed that the sharp increase in home care charges revealed by figures released is the result of the Government’s cut of £1 billion from local council budgets for older people. The Prime Minister replied by saying that the figures were incorrect. He continued that in the spending review the Government had put £2 billion extra into adult social care, but had inherited a situation where there is not a clear strategy or pathway for social care. There was a need to deliver one. That is why there will be a White Paper this year. Ian Lucas MP asked when the White Paper would be published. The Prime Minister reminded the House that the Opposition had 13 years to do something, but that they ducked decision after decision. Royal commissions were held, but nothing was done. He concluded that within two years the Government had done far more than the opposition did in 13 years.

Michael Meacher MP asked the Secretary of State for Health how many persons in England were receiving care packages for the years 2001-02 to 2010-11; and what the average expenditure per person in each of these categories for each of these years was. In his reply Paul Burstow provided the information in a series of tables. The tables showed that gross current expenditure on older people for the year 2010-11 was £9.44m compared with £6.17m in 2001-2. The number of clients who were older people in 2010-11 was 1,064,475. The average expenditure per service user who fell into the older people category had increased from £5.2k in 2001-2 to £8.9k in 2010-11.

Thursday 17 May

Hazel Blears MP received a reply to her questions on how many people were in receipt of free residential care on the most recent date for which figures are available; the level of the means test capital limit for those requiring residential care if it had been increased in line with inflation since 2010; whether an impact assessment had been undertaken in respect of the decision not to increase the means test capital limit for those requiring residential care since 2010; and how many people were paying for all of their residential care on the most recent date for which figures are available.

Social Care Minister Paul Burstow responded saying that unless clients are in receipt of NHS Continuing Healthcare, which is fully funded by the NHS, all care home residents contribute towards the cost of their care. People with more than £23,250 in capital pay the full cost of personal care. People with less than £23,250 in capital can ask their local authority for assistance with the cost of personal care. In both cases, if individuals are assessed as eligible for NHS funded nursing care, primary care trusts have a responsibility to pay a flat rate contribution towards registered nursing care costs.

In reply to the second part of the question Mr Burstow said that at the end of the third quarter of 2011-12, the number of people eligible for NHS Continuing Healthcare was 54,833. Continuing Healthcare can be provided in a variety of settings, including care or nursing homes and in the community. Information on the care setting of individuals in receipt of NHS Continuing Healthcare is not collected.

He added that had the capital limits been uprated in line with general inflation, he estimated that, assuming the normal rounding process: the lower limit would be £15,000 now, rather than £14,250, as set in 2010; and the upper limit would be £24,500 now, rather than £23,250, as set in 2010.

The decision in the Spending Review 2010 not to increase capital limits was taken in order to help local authorities, at a time of financial stringency, to maintain the level of services they provide. The Spending Review 2010 covers government spending up to April 2015. However, the capital limits are being kept under review in order to monitor the impact of not increasing them.

The Department undertook an equality impact assessment in respect of the decision not to increase the capital limits for those requiring residential care in 2011. Information on the numbers of people funding their own residential care costs is not collected centrally.

Chris Skidmore MP asked how many patients received treatment from the NHS for dementia in each year since 1997. A reply is expected on 24 May.

Friday 18 May

Kelvin Hopkins MP tabled an Early day motion “That this House notes that hospital care for older people is currently an area of public concern and that all patients' experience of care should be one of safety, dignity and comfort, delivered by staff that have the right skills to care; welcomes the Royal College of Nursing's report on Safe staffing for older people's wards and its recommendations; and calls on the Government to adopt the report's recommendations to ensure the provision of good quality, compassionate and safe nursing care for all older people in hospital and thus to meet the expectations of patients, nurses and the public, both now and in the future.”

During the course of the week the Conservative Party held elections for the influential 1922 Committee. Of interest was that while Tracy Crouch stood down, Penny Mordaunt and Simon Kirby, who have both shown interest in older people issues of late, were elected.

For Labour there was a reshuffle of the Front Bench in the Lords. Baroness Angela Smith joins Lord Denis Tunnicliffe as a deputy chief whip, and Baroness Smith will also work alongside Lord Richard Rosser in the Home Office team. Baroness Glenys Thornton will move across from Health to lead on Equalities. Lord Phil Hunt takes on Health as well as being Deputy Leader.


Integration of health and social care to promote WRVS approaches to loneliness

Prevention is at the heart of how Scotland’s political parties and policy community want to address the current social and economic situation. Instead of cutting frontline services to save money, the Scottish Government has dedicated itself to preventing need arising. This means higher quality of life and lower frontline costs. It is always better to stop someone getting ill than to cure an avoidable illness. While much of the debate about prevention has focused on early years, there is an important case to be made for prevention amongst older people.

Because loneliness is a major cause of ill health for older people the services WRVS provide can help to prevent the early stages of acute illnesses. Stopping older people getting lonely by providing community transport or good quality hot meals delivered daily is one way of preventing dementia. Social clubs and good neighbours schemes keep older people involved in a community and help those people to maintain a higher quality of life.

But one of the roadblocks to prevention is the arrangement of public services. While this is quite technical and not terribly interesting, the impact could be huge. This is because at the moment local authorities pay for prevention. They have responsibility for keeping older people well, independent and in their own homes. But if they spend money doing this, they see none of the savings, which accrue to the NHS as fewer people need to be admitted for costly treatment.

The long awaited consultation on health and social care integration aims to square this circle. It will ensure that the savings made through prevention can be put into further preventative services. This will allow a profound shift in the balance of care.

The basis of the consultation is that:

  1. Nationally agreed outcomes will be introduced that apply across adult health and social care;
  2. Statutory partners (including the NHS) will be jointly accountable to Ministers, Local Authority Leaders and the public for delivery of those outcomes;
  3. Integrated budgets will apply across adult health and social care; and
  4. The role of clinicians and care professionals will be strengthened, along with engagement of the third and independent sectors, in the commissioning and planning of services.

WRVS hopes that the release of funds to prevention will allow a substantial increase in the scope and reach of preventative services. We’re pleased that there will be strengthened engagement from the third sector. This, however, must ensure that there is a full engagement both in the preparation of plans and sign-off of plans and spending.

The proposal suggests that Community Health Partnerships be replaced with Community Health and Social Care Partnerships, which have budget holding powers and are the joint responsibility of Local Authorities and Health Boards. But the really important outcome of the proposals is the opportunity to unlock resources for prevention. Resources that are currently wasted treating preventable conditions.

WRVS will be working with Scottish Government to improve the proposals over the summer, and we hope that the proposals, when implemented, will prompt a new approach to providing services for older people. That new approach must be one that focuses on quality of life and independence for older people.

Posted by Pete McColl, Public Affairs Manager Scotland at 00:00 Wednesday, 09 May 2012. 0 Comments

Labels: prevention, Scotland, quality of life, loneliness, illness, older people, old age, elderly, social care, health, independence

Westminster Eye: An Insight into the week of politics 23 April – 2 May 2012

Last week Michael Meacher MP had asked how much was spent on social care for the elderly, in each of the last 10 years. On 23rd he received his answer from Social Care Minister Paul Burstow. He said that the requested figures collected annually by the NHS Information Centre showed that social care expenditure on older people had risen from £6.17 billion in 2001/2 to £9.44 billion in 2010/11.

Caroline Lucas MP had asked the Health Minister what his timetable is for making regulations and orders under the Health and Social Care Act 2012. Simon Burns MP responded saying that many of the regulations and orders to be made under the Health and Social Care Act 2012 will come into force on 1 April 2013. This is the intended date for the NHS Commissioning Board to take on its full statutory functions; local authorities to take on new public health responsibilities; local Healthwatch organisations to come into being; and strategic health authorities and primary care trusts to be abolished. He added that other changes are planned for different dates; Healthwatch England will come into existence in October 2012, and the health special administration regime for organisations providing NHS services will come into force in April 2014.

Helen Jones MP asked Health Ministers whether they had made an estimate of potential costs to the NHS arising from ill health as a result of (a) falls by and (b) deterioration in existing conditions of adults who will not receive social care because councils have introduced restrictions on the eligibility criteria for such care. In his response Paul Burstow said that the Department had not made an estimate of the potential cost to the NHS arising from ill health as a result of falls. However, it estimated that the annual cost of health and social care for the care of all the hip fracture patients in the United Kingdom amounts to approximately £2 billion.

On the eligibility criteria question he added that the Department did not formally monitor changes to local authority social care eligibility criteria and therefore does not hold information on potential costs to the NHS arising from ill health as a result of existing conditions of adults who will not receive social care because councils have introduced restrictions on the eligibility criteria for such care. Allocations of resources at a local level was the responsibility of local authorities who are best placed to understand the needs of their community. Councils should use the framework set out in the guidance ‘Prioritising need in the context of Putting People First: A whole system approach to eligibility for social care’, to draw up local eligibility criteria. This is graded into four bands:

  • critical;
  • substantial;
  • moderate; and
  • low.

He went on the say that on 11 May 2011, the Association of Directors of Adult Social Services published a survey that indicated that 13% (19) councils had changed their eligibility criteria between 2010-11 and 2011-12, of whom 15 councils moved from moderate to substantial. According to the survey, there are now 78% (116) councils at substantial, 15% (22) at moderate, 3% (4) at low and 4% (6) at critical.

In addition, the Audit Commission's 2008 report: ‘The Effect of Fair Access to Care Services Bands on Expenditure and Service Provision’ found there is no directly observable link between the council's eligibility criteria policy and emergency admissions to hospital.

Nick Smith MP had asked what assessment the Treasury had made of the effect on pensioners of the proposed changes to age-related income tax allowances. Treasury Minister David Gauke MP replied on 24th saying that no on wouldl pay more tax in 2013-14 than they do today as a result of the changes. There were no cash losers. He said that the Government remained absolutely committed to supporting pensioners. He added that the Government had introduced a triple guarantee for the basic state pension, ensuring that it will increase each and every year by the highest of earnings, prices or 2.5%. The Government had also protected other benefits that make a real difference to the lives of millions of pensioners.

In his follow up question Nick Smith wanted to know what the Minister had to say to those who are turning 65 in just under a year's time as they were set to be more than £25 a month worse off than they thought they would be, but they had no time to plan for that change. David Gauke said that those who turn 65 next year would benefit from the biggest increase in the personal allowance that has ever been seen.

Stephen Williams MP said that he was sure that many MPs had received letters from constituents over the years saying that they did not want their taxes spent on one thing and preferred them to be spent on something else. He believed it was right in principle, therefore, that the Government cap the ability of the super-rich to allocate taxes to charities of their choice. He asked the Chancellor to acknowledge, however, that universities and medical research charities have always depended on philanthropic support and in reviewing the cap on tax relief, will he ensure that those institutions' interests are safeguarded. David Gauke was grateful for the support and explained that Government was looking to explore with charities dependent on large donations how this can be implemented without it having a major impact on them.

Tim Farron MP had asked what recent steps the Department of Health had taken to implement the recommendations of the Dilnot Report. In his response Paul Burstow said that Government would publish a White Paper on social care and a progress report on funding reform in spring 2012. The progress report will set out the Government's response to the Commission's recommendations.

Ian Lucas MP asked Business Ministers what discussions they had held with Royal Mail on its concessionary scheme for pensioners to purchase stamps at Christmas. In his reply Norman Lamb MP said that Ministers in the Department for Business held regular meetings with Royal Mail to discuss a broad range of issues, including the scheme to offer discounted stamps to some low income households at Christmas. The pricing of stamps, including proposals for discounts, is an operational matter for the company. However, Ministers were informed of the plans and kept updated on progress.

On 25th Ian Austin MP asked the Work and Pensions Minister what the average value per year will be for a new pensioner no longer entitled to Savings Credit once it is abolished for new pensioners. A reply is awaited.

On 26th Margaret Ritchie MP asked the Chancellor of the Exchequer what estimate his Department has made of the financial effect on charities of his proposal to introduce a cap on tax relief for charitable donations. David Gauke explained that at the Budget 2012 the Government had announced it would introduce a cap on unlimited income tax reliefs to ensure that those on higher incomes cannot use them excessively. He added that the Government will explore with charities and philanthropists ways to ensure this new limit on uncapped reliefs will not impact significantly on charities that depend on large donations to carry out their charitable activities. A consultation document on the detail of the policy, including the implications for philanthropic giving, will be published in the summer.

On 30th the Department of Health published the monthly delayed transfers from hospital figures. The data showed that whilst the actual number of delays was static at just over 4,000 the number of days had increased by around 10,000 to 119,416. A similar jump was seen last year in the same month. Of the delayed days over 76,000 were due to the NHS.

Shadow Health Spokesperson Liz Kendall MP asked what information the Department of Health held on the number of people in (a) England and (b) each local authority who sold their homes to pay for residential care in each of the last five years. On 30th Paul Bustow responded saying that there was no such information. Information about the sale of property to pay for residential care by service users supported by councils is not collected centrally. Local councils may also not know if properties are sold by those who arrange their own care, for example, where a person sells a property and contracts with a care provider privately without the involvement of social services.

During Commons Oral Answers to the Communities and Local Government Ministers on 30th, Grahame Morris MP said that in the national press there had been reports of dramatic increases in bed-blocking. Bed-blocking occurs when patients cannot be discharged from hospital because social care packages have not been put in place by hard-pressed local authorities. He believed that this was now costing the taxpayer about £600,000 every day. He asked if this was not this more evidence of the Government's failed policies on social care in local government. In responding Eric Pickles said that the Government had invested an extra £7.2 million. But he acknowledged that the MP had made a reasoned point. He felt that the reforms in the NHS and giving local authorities more responsibility for health should bring about a much better and much more closely co-ordinated and integrated process. The movement from hospital into care or into a person's home needs to be better organised. The Government would certainly produce a White Paper soon to deal with this. He hoped that it will meet some of the problems that Mr Morris had mentioned.

Adam Afriyie MP had asked the Secretary of State for Health if he will take steps to ensure that primary care trusts consult independent nursing homes when making changes to their payment terms for funded nursing care payments and whether he has recently had discussions with Buckinghamshire Primary Care Trust (PCT) about changes to its payment terms for funded nursing care payments; and whether he has made an assessment of the subsequent effects on cash-flow for independent nursing homes receiving payments from Buckinghamshire PCT. Paul Burstow replied saying that the annual level of the national health service contribution towards the cost of a place in a care home with nursing for those people assessed as requiring the help of a registered nurse is set at a national level. Once the need for NHS Funded Nursing Care is determined, primary care trusts (PCTs) have a responsibility to pay a flat rate contribution towards registered nursing care costs. He added that the Department would not hold discussions with individual primary care trusts about the level of the NHS Funded Nursing Care contribution or local arrangements for administering such payments. Eligibility for NHS Funded Nursing care may be considered when an individual is not eligible for NHS continuing health care and where it is considered that a place in a nursing home is the best option for meeting their needs.NHS continuing health care is a package of health and social care funded by the NHS where the individual is assessed as having a primary health need. NHS continuing health care can be provided in a range of settings including care homes.

Meanwhile in the House of Lords Baroness Greengross quizzed the Government on what action they would take to tackle the risk of malnutrition for disabled and older people who live in the community. In his reply of 2 May, the Parliamentary Under-Secretary of State, Department of Health, Earl Howe, said that there were a number of initiatives in place to help local healthcare organisations develop their nutritional policies. These included the National Institute for Health and Clinical Excellence clinical guideline to help the N HS identify patients who are malnourished or at risk of malnutrition and the "essence of care" benchmarking system, which includes food and drink, and covers health and social care settings.

He added that Government buying standards for food and catering services (GBSF), launched in June 2011, covered nutrition and sustainability aspects of food provision. GBSF is mandatory for central government departments and their agencies. However, local authorities were encouraged to adopt GBSF and, as such, if local authorities are responsible for provision of food in residential/community care settings, they could require them to implement GBSF.

He concluded by saying that the department has published practical guidance to help caterers provide food that meets the nutritional needs of adults working in or in the care of the public sector and is currently developing plans to update previous guidance on food served to older people. While the department can produce best practice initiatives for care, it is ultimately up to local nursing leadership to both ensure and assure the patients, organisational board and commissioners that good care is delivered.

Both Houses are not sitting at present. Prorogation took place on Tuesday. It is the formal name given to the period between the end of a session of Parliament and the State Opening of Parliament. The House will return to hear the Queens Speech on 9th May when the Government’s legislative programme for the next session will be set out.

Posted by Steve Smith Public Affairs Manager (England) at 00:00 Wednesday, 02 May 2012. 0 Comments

Labels: Social care, NHS, healthwatch, nutrition, charity, charitable donations, primary care trust (PCT), philanthropy, older people, health

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