What we're saying
Find out what we're saying - where we share our thoughts and opinions and make comments on issues facing older people, volunteering and preventative care.
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BBC - Operation Meet the Street
For most of us, Christmas is a magical time. Shop shelves are groaning with presents and delicious food just waiting to be shared. Every time we open a magazine or turn on the TV we’re faced with advice on how to host the perfect Christmas gathering. It’s a time of happiness and togetherness. But if there’s no-one to share it with, the festive season loses its sparkle. And that’s especially true for the nearly half a million older people who are set to spend this Christmas day on their own.
The Royal Voluntary Service has been working for many years to combat loneliness throughout the year, not just at Christmas. So we welcome the BBC’s series of programmes aired this week, Operation Meet the Street, which shines a spotlight on the UK’s epidemic of loneliness. Celebrity chef James Martin takes famous people back to their childhood homes to see who lives in the street now. The aim is to set up a local social network designed to tackle loneliness at a grass-roots level.
More people than ever say they’re lonely, and the problem grows as we get older. Many children fly the nest and set up home hundreds of miles away from their parents. Social networks contract because of illness and bereavement leaving many older people isolated in their own home, with their mental and physical health suffering as a result.
Operation Meet the Street is the kind of campaign which fits in well with our Good Neighbours schemes. We match lonely older people with one of our army of volunteers who can offer companionship and practical help. This could mean getting some shopping in, walking the dog, changing a light bulb or just sitting down for a friendly chat over a cup of tea. Social contact like this can make a huge difference to people who might otherwise not see anyone for days on end. We are also working in partnership with Community Christmas, which is a portal where you can search for events and activities taking place on Christmas Day, so that no-one is forced to spend Christmas on their own.
Operation Meet the Street is on BBC1 all this week at 9:15am and then available on iPlayer
National Audit Office reports on planning stage of Better Care Fund
Tuesday’s report from the National Audit Office on Planning for the Better Care Fund painted a disappointing picture of plans containing misplaced assumptions not backed up with evidence through a lack of engagement with important stakeholders.
As a result, during the summer the process was placed on hold and targets and incentives were redesigned. Plans were not put to Ministers in April as intended because the financial risk to the NHS was regarded as far too great.
Plans have been reworked and last month we learned that 146 of the plans, the vast majority, have been approved, including those requiring further support (91) and some with certain conditions attached (49).
The Better Care Fund now contains some £5.3 billion in funding and exceeds the minimum contribution by £1.5 billion. The amount of credible savings has been adjusted down from £1billion to £532 million made up of reduced emergency admissions (£283 million), reduced delayed transfers of care (£31 million) and increased effectiveness of reablement (£30 million). The vast majority of savings appear to accrue to the NHS.
The main change was to the framework for the £1 billion payment-for-performance part of the Fund. The proportion of the £1 billion linked to performance now depends on the level of the local target for reducing total emergency admissions to hospitals.
We know all too well that there are far too many people being admitted and readmitted into hospital unnecessarily. Over 200,000 older people are readmitted into hospital within a month of discharge. Together the plans aim to deliver over one year an overall reduction in non-elective activity (general and acute) of 163,162 stays. In addition over 2 years the Fund aims to deliver 100,962 fewer unnecessary days spent in hospital, 11,860 older people remaining at home 3 months after discharge and 1,948 more people supported to live independently.
This process has been tough on local authorities. In the past few months local areas would have been preparing to implement the Fund. Instead they were reviewing and resubmitting their plans. This may impact on their performance and therefore ability to hit targets in the early stages of the Better Care Fund which may have a knock on effect on resources.
Joined up health and social care is a laudable and necessary ambition given tight funding and an increasingly ageing population. With the emphasis so strong on reducing hospital admissions, local government believes that the resources to support wider local initiatives to promote integration and prevention will be reduced. Reducing admissions by over 3% when they have risen by 47% over the past 15 years is a very ambitious target.
Providing a degree of focus and direction is a good thing and is an improvement on a vague call to pool budgets. But we must not lose the good initiatives that already exist. The dust is now settling and it is hoped that lessons have been learned and that that the Fund can deliver on its core undertaking “to give elderly and vulnerable an improved health and social system and to join up health and care services around the needs of patients, so that people can stay at home more and be in hospital less”.
New NHS model to make more use of volunteers
In its Five Year Forward View published last week, NHS England has set out it how it wants to change the health service in the coming years.
The challenges are vast but not insurmountable. In particular the report says that the challenges of an ageing population can be met by a combination of increased real-terms funding, efficiencies and changing the models of care delivered.
One of these new models of care includes engagement with communities and citizens in new ways to build on the energy and compassion that exists across England. NHS England estimates that three million volunteers already make a critical contribution to the provision of health and social care in England. We have services in more than 300 hospitals across the country, with 14,000 volunteers working in shops, cafes, on trolley services, offering befriending services on wards, and support on a return home through our Home from Hospital service. Royal Voluntary Service knows from the variety of support it offers to patients and their families while they’re in hospital, and to older people on their return home the real positive difference this can make to lives. Indeed, an analysis of the Hospital 2 Home service we run in Leicestershire identified that readmissions of older people supported by the scheme are half the national rates.
Our own survey carried out earlier this year indicated the support offered by volunteers is worth £487million to Britain’s healthcare service. Our survey also showed that nearly two thirds of Britons believe that volunteers play a vital role in the NHS, and 63 per cent agree that they provide essential emotional support to patients when doctors and nurses are stretched for time. Furthermore, 54 per cent said they feel the work of volunteers should be better utilised to help relieve the pressure on the health service.
The help provided by volunteers to the health service mustn’t be underestimated and volunteers need to be taken seriously. A report by the Kings Fund last year suggests that for the average trust, every pound invested in volunteering could yield around £11 in added value. It recognised that trusts need a more sophisticated approach for measuring the value of volunteering, to include patient experience and quality of care.
The report also identified that just over 50 per cent of acute trusts have a formal strategy for the future of volunteering which indicates that much more could be done to better match volunteers to the roles where they can add most value. Although their work may be simple, it is a source of vital support and we know that the emotional benefits volunteers offer to patients can make a real difference to wellbeing. However, to continue to help more people during a hospital stay or on a return home, we require a radical shift in culture. Volunteers can work side by side with professionals to support older people have an impact well beyond what statutory services alone can achieve.
Funding in both NHS and social care is tight and will continue to be so for the foreseeable future. A NHS funding gap of £30billion by 2020/21 is often quoted as a worst case scenario by sector experts. NHS England says that action will be needed on three fronts – demand, efficiency and funding - to bring this figure down. The role of the voluntary sector is crucial in meeting this aim and we are ready to play our part.
Lib Dems to reopen NHS settlement, but big funding gap remains.
On the day of a historic first parliamentary seat for UKIP in Clacton, I look back at this week’s health and social care announcements from the Liberal Democrats and compare them to the messages from Labour and Conservative over the past few weeks.
There were some big announcements from Norman Lamb on mental health aimed at narrowing the gap in how physical and mental health is treated. There were also new pledges that will benefit carers by offering a £250 ‘Carers Bonus’ paid annually by 2020 and increasing the carers allowance earnings disregard from £100-£150, allowing carers to keep more of what they earn.
Lamb also made commitments to shift the system from repair towards prevention, further integration and more personalisation and control to individuals, continuing the emphasis that the Lib Dems have placed on these themes in the coalition. Lamb also made special reference to the important role that volunteers in the community can play in reducing loneliness and hospital admissions.
On funding the Lib Dems committed to put an additional £1billion into the NHS above the ring fenced amount in 16/17 and 17/18 and free social care for people at the end of life. In addition the Lib Dems pledged to reform pensions so that the current ‘triple lock’ indexation is made permanent through law.
During the conference a motion on Age Ready Britain was debated. The motion highlighted that there is no single action or policy that will prepare the UK for an ageing society - it requires a co-ordinated approach across many areas of public policy to create an age-friendly nation. In particular the conference called for a Cabinet Committee on wellbeing and ageing to be established, the appointment of a Minister for Ageing and a statutory independent Older People's Commissioner. It was also recommended that Health and Wellbeing Boards should be strengthened and other important recommendations were made around housing and the planning system.
The dust has now settled and it’s clear that health and social care will be a key battleground in next May’s general election.
All the main parties made new pledges to increase NHS funding to some extent, from ring fencing by the Conservatives to Labour’s new £2.5 billion “Time to Care Fund”. However, it seems that the Lib Dems have made the clearest commitment on funding and have accepted the immediate urgency by pledging to re-open next year’s funding settlement. There is a good deal of agreement on the need for more integration but a lot more is hidden behind party politics on competition and other structural issues.
But will a billion here and there make the difference? Experts indicate that by 2020 the NHS funding gap will be in the region of £30 billion. Therefore, the sums being pledged significantly underplay the massive scale of the challenges that the health and social care services face in the next few years, especially with an increasing demand from an ageing population with a growing number of complex conditions.
The Lord Filkin led House of Lords Committee on Public Service and Demographic Change in 2013 said that Governments had been woefully underprepared for ageing and that there had been a collective failure to address the implications. Without urgent action ageing could turn into a series of miserable crises. He called for all political parties to consider the ageing society in their manifestos for the 2015 election. It appears from the events of the past 3 weeks that the main parties are still not prepared to tackle this head on.
We call on all parties, whoever comes to power next May, to engage with the voluntary sector to help them get their policies right and to build a stronger agreement about the changes needed to create better health and care.
Posted by Steve Smith at 15:17
Friday, 10 October 2014.
Conservatives: NHS budget continues to be ring fenced. But is it enough?
On Older People’s Day when there are a record level of more than 1 million people aged 65 or over in work, the Prime Minister announced that a future Conservative Government will raise the tax-free personal allowance from £10,500 to £12,500. Furthermore the threshold at which people pay the 40p rate, currently £41,900 will rise to £50,000.
In yesterday’s closing speech the Prime Minister announced his commitment to balance the books by 2018. To achieve this the Conservatives will need to find £25 billion worth of savings in the first two years of the next Parliament. £25 billion is actually just three per cent of what government spends each year.
On Tuesday Health Secretary Jeremy Hunt announced that the NHS budget would not be cut like those health services in Greece, Portugal or Italy but would continue to be protected and rise in real terms in the coming years.
Political commentators have yet to analyse the content of the speech in detail. However ,it’s become clear that a commitment to £25 billion more in Government savings, whilst maintaining NHS expenditure and giving billions of pounds back in tax cuts is not going to be easy. It will mean some savage cuts to other Government budgets. Local authority budgets have come under a lot of pressure in recent years and this looks set to continue for some time. Many council based services that frail and older people rely on could be put at risk. This will make the work of the voluntary sector all the more important.
The Government argues that the only way to continue to increase spending in the NHS was to have a strong economy. Hunt was keen to stress that the two building blocks to improving the NHS were personal care and personal choice.
The first step towards this is integration of the health and social care system. Hunt pointed to the 150 local authorities working with local NHS partners on Better Care Fund to pool commissioning to reduce emergency admissions.
He added that personal care means more than integration, it needs a response from GPs too and he announced the training and retaining of an extra 5,000 GPs. Key to this personal care was providing better access to GPs. Improved out of ours access to GPs is to be rolled out to 25% of the population and then to all by the end of the next parliament. In time the whole population would have access to GPs between 8am and 8pm and during weekends.
Last year the Government announced that over 75s should have a GP named on their medical record responsible for their care. In the new GP contract for 2015 this is to be expanded so that every single person in England will have a family doctor named on their record and responsible for their care. In addition everyone will have access to their own medical records by April 2015.
There was some good news for older people with pension pots. On Monday Chancellor George Osborne unveiled a new tax cut for pensioners. In a bid for the grey vote, he announced that the Government would abolish the "punitive" 55% tax that is levied when people pass on a pension pot. The change will apply to all payments made from April 2015, and means that people will be able to pass on their pension pot effectively tax-free.
Next up the Liberal Democrats.
Labour: A shot in the arm for the NHS?
Although Labour leader Ed Miliband said little or nothing around tackling the UK budget deficit he stuck to safe Labour territory at the Party Conference. The highlight of his seventy minute speech was the announcement that an incoming Labour government will create a £2.5 billion a year NHS “Time to Care Fund” as part of his plan to save and transform the NHS. This pledge, one of six in a ten year plan, gained the longest round of applause of the day. He said that the first priority for the fund will be to support 20,000 more nurses, 8,000 more GPs, 5,000 more careworkers and 3,000 more midwives. It is claimed that his will help address a growing problem which has meant one in four people not getting a GP appointment within a week, more than half of nurses saying their wards are dangerously understaffed, and community care services which can often prevent people from needing expensive hospital treatment in crisis.
The aim of the fund is to give doctors and nurses the time to care properly for patients, as well as beginning to transform services in communities and at home so the NHS can meet the challenges of the 21st Century at a time of financial pressures. A key element will be the impact on community services which should keep us healthy and ease the pressure on NHS frontline services.
It is planned to raise the £2.5 billion for the Fund by asking those living in houses worth over £2m to pay more tax, a co-ordinated crackdown against tax avoidance, and asking the tobacco companies to contribute towards the costs they impose on the NHS through a windfall levy. This means that new charges or general increases in taxation are not planned to fund increased resources for the NHS. The principle of a mansion tax already has the support of the Liberal Democrats, but much more detail needs to be worked though to tackle, for example, potential new avoidance loop holes or taxing asset rich cash poor residents with little ability to pay. Watch this space.
This morning shadow health secretary, Andy Burnham, provided more detail on Milband’s earlier announcement. He spoke of bringing social care in to the NHS so that it is built around an individual’s and family needs, dealing with a single service and a single team. He said that bringing the services together was the key to unlocking wasted expenditure. He called for hospital trusts and other NHS bodies to evolve into NHS integrated care organisations, working from home to hospital coordinating all care - physical, mental and social. New teams would be recruited that could go out into the community to ensure that people are able to stay independent in their own homes. Providing social care would no longer be regarded a second class profession but given the respect that it is long overdue.
In addition as the party had previously announced, both Miliband and Burnham re-enforced Labour’s intention to repeal the Health and Social Care Act and Section 75 in particular.
Labour’s plans for a joined up, fully integrated health and social care system was disclosed at the Party Conference in Brighton last year. Much more detail on how this will all play out will be revealed in the coming months as we draw closer to the May election.
The future of the NHS and social care, including its funding in the wake of increased demand and an ageing population, is likely to be a crucial battleground for next May’s General Election. Next up, the Conservative Conference in Birmingham next week.
A need to accept that health and social care will cost more?
This week saw the publication of a report from The Commission on Residential Care which is chaired by former Care Minister Paul Burstow MP and has over the past year explored the future of residential care– from care homes to extra care villages and supported living, for older and disabled people. You can read a copy of the report by following this link to demos.co.uk
The Commission had two main objectives. First, to create a vision of ‘housing with care’, not bound by existing definitions, but based on the outcomes that people want and value. And second, to set out how the existing offer could change to deliver this vision, across financial, operational, governance and cultural aspects of care.
The Commission found that despite there being many examples of good care, it is surrounded by negative perceptions fuelled by the headline cases that make the headlines.
The Commission made a number of recommendations to embed good practice and challenge public perceptions. These included enshrining a broader, more accurate definition of ‘housing with care’ throughout government policy; greater co-location of care settings with other community services; expanding CQC’s role in inspecting commissioning practices; and promoting excellence in the profession through the introduction of a license to practice and a living wage. The Commission concluded that these measures, among others, could help build a housing with care sector fit for the twenty-first century.
September 4 saw the long anticipated final report of the independent Commission on the Future of Health and Social Care in England (Barker Commission) by the Kings Fund. You can read a copy of the report by following this link to kingsfund.org.uk
This report examines the current health and social care system and proposes a new approach that redesigns care around individual needs. The Commission concludes that this vision for a health and care system fit for the 21st century is affordable and sustainable if a phased approach is taken and hard choices are made about taxation. We still under spend a number of other European nations when it comes to healthcare and the Commission believes it is feasible to be able to spend between 11-12% of GDP by 2025 to meet the inevitable rising demands on an ageing population.
It has recommended that health and social care should have a single ring fenced budget with central commissioning. Not many will argue with ring fenced budgets for social care and bringing both together might speed up efforts towards integrated care. But this does require yet another reorganisation which won’t be welcome. Clinical Commissioning Groups have not been in existence for long and some will say that they have not had the opportunity to develop and deliver well coordinated care.
The Commission wants those with critical needs to receive free care at the point of use and believes this should also be extended to substantial need when then economic situation allows. By 2025 those whose needs are moderate should also receive free care. Pathways should be simplified to respond to changes in need. It wants to see a new “care and support allowance” and personal budgets to give individuals more control over the support they receive.
The Commission has made some radical and controversial proposals on how to raise £5 billion to pay for this expansion. Proposals include removing exemptions on free prescriptions and means testing TV licences and the winter fuel allowance. Also suggested is requiring those over 40, in retirement and high earners to pay more in national insurance. These proposals may prove unpopular especially those which involve means testing of the vulnerable.
But firstly, politicians of all parties need to agree that more money needs to be spent. Whether it is paying decent wages and providing better training for care staff or to providing free care for those with most critical needs more funding is essential. It is not possible to meet rising demands purely by efficiencies. More funding needs to come from somewhere and this primarily equates to increased charges or taxes. It could of course come from making other choices around scaling down other big ticket projects. But with elections just 9 months away and older voters more likely to take part in a general election than other age groups, are any parties brave enough to bite the bullet?
Our response to the Kings Fund report 'A new settlement for health and social care'
In response to the release of the Kings Fund report A new settlement for health and Social Care, published today 4 September 2014. The report recommends that some benefits should only be given to those older people most in need, and that those savings and increased taxation should be used to fund the inevitable increased cost in social care. Follow this link to read the full report A new settlement for health and Social Care
Britain is facing an ageing population, which along with many positives, also brings challenges. To allow a truly preventative and personalised approach to care for older people, which should be our focus when looking to reduce costs, it is essential that health and social care budgets are unified and integrated. The voluntary sector has an important role to play in bringing down the costs of care and ensuring the individual needs of older people are met.
David McCullough, Chief Executive
Better Care Fund: Reducing hospital admissions now a priority
The Public Accounts Committee chaired by Margaret Hodge MP recently reported that there had been an 8% real terms cut in spending on adult social care between 2010/11 and 2012/13. This was despite the growing numbers of elderly and disabled people, who are most likely to be reliant on care. As a result care and support is focused on those with the most severe needs.
In addition the Care Act will introduce new duties on local authorities, including a duty to assess carers’ needs and provide support and obligations in respect of those that fund their own care. These new duties are being introduced as local authority budgets become increasingly constrained.
And it’s not just social care that is under strain. Hospitals are under growing pressure too. NHS hospitals ended the last financial year in the red for the first time in eight years, according to official figures, with 26 loss-making trusts reporting a combined deficit of £456.8m.
The number of NHS trusts referred to the health secretary over financial concerns increased almost fourfold in a year, a report reveals. Nineteen were flagged in the financial year 2013-14, compared with five in 2012-13, according to the Audit Commission. Twenty-four clinical commissioning groups (CCGs) were also referred.
Clearly this situation is not sustainable in the long term. Recently the Government announced changes to the allocation of funds through the Better Care Fund. The key change is that £1billion will be paid locally and be linked to reducing hospital admissions. In 2012-13, there were 5.3 million emergency admissions to hospitals, representing around 67 per cent of hospital bed days in England, and costing approximately £12.5 billion.
This change places more pressure on local authorities to draw up plans that do more to tackle the level of hospital admissions. For that reason it is essential that local authorities engage more fully with the voluntary sector in coming up with practical, low cost support that could help achieve this aim. For example, figures published by the HSCIC last month show that older people are the largest group who attend A&E or are admitted into hospital as an emergency following a missed outpatients appointment. A missed appointment can increase the likelihood of a hospital visit or stay by 2-3 times.
Similarly older people who are discharged from hospital after a stay have a 15 per cent chance of being readmitted within a month. This amounts to over 200,000 readmissions a year for the over 75 age group and far exceeds readmissions for the rest of the adult population.
However, we know that Royal Voluntary Service volunteers through our Community Transport services can provide support for older people who are housebound, isolated and have difficulties getting out. Royal Voluntary Service volunteers undertake some 90,000 journeys on behalf of older people. These may be trips to and from hospital or to a GP appointment. Equally, these may be trips to the shops or into town, journeys that enrich lives and really add to the pleasure of day-to-day living.
Likewise we know that that having a volunteer on hand to provide practical support for an older person on returning home from a hospital stay can significantly reduce the numbers of older people being readmitted within a short period of time.
The voluntary sector doesn’t have all of the answers but it can help take some of the strain and relieve some of the pressures that both the NHS and local authorities face.
Our response to Nuffied Trust report on reducing emergency hospital readmissions
In response to the Nuffield Trust’s report which asserts that initiatives in place to reduce emergency readmissions aren’t effective in the short and medium term, and that emergency readmissions are rising rather than falling, David McCullough, Chief Executive of Royal Voluntary Service, said:
It is essential at a time of increased pressure on local authority funding and scarce NHS resources that the money available is used in the best possible way, to achieve the guideline reduction in unplanned admissions of at least 3.5 per cent in line with the Better Care Fund. There is a cost-effective solution available in the support that can be offered by the voluntary sector that is very successful in reducing emergency readmissions. Volunteers can provide personalised, practical support which addresses the needs of individuals. We know from our own research that this kind of help has a hugely positive impact on older people’s wellbeing and results in fewer emergency readmissions; readmission rates among people aged 55 and over who use our Home from Hospital scheme in Leicestershire is 50% lower than the national average for older people.
Posted by David McCullough, Royal Voluntary Service chief executive at 11:14
Thursday, 10 July 2014.