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Westminster Eye: An insight into the week of politics 16 - 20 January

Monday 23 January
On Monday the Department of Health announced that it is providing up to £100 million in additional funding to doctors in emerging Clinical Commissioning Groups to improve local services and reduce pressures on the NHS during the colder months. Clinicians in these groups will spend the money directly on local care services that best meet their patients' clinical needs and prevent unnecessary admissions to hospital.

John McDonnell MP received an answer to his Treasury question on what the policy is on exempting from VAT the charges for home care for people with disabilities and secondly what estimate had been made of the cost to the public purse of exempting from VAT the charges paid for home care by people with disabilities. In responding , David Gauke MP said that welfare services are exempt from VAT but only if the services are supplied by a charity, a state-regulated private welfare institution or agency, or a public body. If provided by any other body then they will be taxable at the standard rate. He added that no estimate has been made of the VAT paid at the standard rate on such supplies as the data is not collected.

MP Kwasi Kwarteng received a response to his question over what the steps Government is taking to reduce the cost of social care provision. Paul Burstow MP replied by saying that local authorities are accountable for delivering efficiency savings in adult social care, but the Department has worked with the sector to consider the opportunities to reduce costs. To this end, the Department has part-funded a programme of Adult Social Care Efficiency launched by the Local Government Association in November 2011.

Furthermore, in November 2010 the Department published A Vision for Adult Social Care outlining a number of suggestions for areas where local authorities could make efficiency savings. Among others, these included:

  • maximising the potential of reablement services
  • developing an integrated crisis or rapid response services
  • rolling out telecare support; and
  • minimising back office administration.

As a result of wishing to keep local authorities free of additional burdens, the Department does not collect its own data on efficiency savings. Other sources, including the Association of Directors of Adult Social Services budget survey, suggest that efficiencies are being delivered successfully, without unduly affecting frontline services.

Douglas Carswell MP had asked the Secretary of State for Energy and Climate Change what steps the Government is taking to increase the affordability of energy for elderly people during the winter and what steps were planned to take to make energy bills more affordable for elderly people. Gregory Barker MP said that the Government is committed to helping people, especially low income vulnerable households, heat their homes more affordably.

The Warm Home Discount Scheme will assist two million households each year, including over 600,000 pensioners in receipt of pension credit guarantee credit who will receive a Core Group discount of £120 off their electricity bill this winter, automatically without having to apply for it. In addition, the Government continues to fund the Warm Front scheme. The Government is also requiring suppliers to provide energy efficiency measures to low income vulnerable households through the Carbon Emissions Reduction Target, Super Priority Group.

The Department for Work and Pensions provides pensioner households with winter fuel payments to help with additional heating costs during the winter. Cold weather payments are also made to low income and vulnerable households where there is an average temperature of 0°C or below for seven consecutive days. These payments have been increased to £25 per week and in winter 2010/11 over 17 million cold weather payments were paid in Great Britain worth an estimated £430 million. In the future, the Green Deal and new Energy Company Obligation will be one of the Government’s key policies.

In the House of Lords, Baroness Greengross asked what measures are in place to inform people of the steps they need to take to ensure their wishes regarding medical treatment at the end of life are respected if they lose capacity.

The Parliamentary Under-Secretary of State, Department of Health Earl Howe said that the Department of Health makes annual resources available to the NHS and local authorities to implement the Mental Capacity Act. These resources are for them to inform and support people who may have lost or be about to lose capacity about their wishes regarding treatment and care. The department's end-of-life care strategy provides further guidance in this area. He continued that advance care planning is not a one-time issue, it is an ongoing process. It requires regular reviews of a patient's wishes and assessments of their needs. Support, training and education for staff in understanding that, and taking forward care planning, are being made available through the end-of-life care strategy. People's wishes and needs change throughout life.

Tuesday 24 January
On Tuesday Housing Minister Grant Shapps and Communities Minister Andrew Stunell called on councils to use every opportunity under the New Deal for Older People to give elderly people more choice and control over where they live, so they are not pressured to sell their home or move into residential care. Under the scheme the council will arrange for elderly people to move into rented accommodation, and take responsibility for maintaining and letting their property at an affordable rate. Homeowners will benefit from the rental income from their home, which will be passed back into their estate at an agreed date. Under the New Deal for Older People the Government is providing funding for home adaptations so older people can live in their own homes for longer, and backing innovative schemes that offer elderly people the assistance they need to live independently.

Earlier, Sarah Newton MP had asked whether the Department of Health collects data on the number of acute care patients aged over 75 years who are delayed in being discharged from hospital. On Tuesday Paul Burstow replied saying that this information is no longer collected centrally and could be obtained only at disproportionate cost.

The Health Committee held its final oral evidence session on its Inquiry into Social Care. The witnesses were Paul Burstow MP, Minister of State for Care Services, and David Behan CBE, Director General of Social Care, Local Government and Care Partnerships, Department of Health.

Care minister Paul Burstow opened the evidence session by welcoming the committee's interest in social care and said that the committee's findings would provide a "valuable" viewpoint on the government's social care proposals. Paul Burstow confirmed that the government's proposals on social care relating to law reform and other care issues would be published as a white paper in the spring, alongside a separate progress report on funding. Social care reforms relating to funding of social care, he said, would not be contained within the white paper. Dilnot did not offer a blueprint, Burstow argued, it offered a "design guide" for social care. He declined to confirm that there would be a social care Bill in the next Parliament.

Barbara Keeley MP asked the minister about the pressures put on the social care system. She explained that 900,000 people were without basic social care, primary care trusts were unaware of how dementia strategy funds had been spent and funding for carers' breaks had not made it through to where it was needed. She asked the minister what gap there was in terms of funding for social care. "There is no gap", Burstow said, due to extra government funding and a "rigorous programme of efficiency".

Burstow said it was very difficult to define and identify unmet need in social care, but said that it would be included in any of the government's proposals for social care. That said, the extra funding diverted to social care by the government was in itself recognition of the existence of unmet need, he said.

Eligibility criteria and the variations between local authorities, Burstow said, were a hangover from a system that had been previously based on the poor laws. The variance in these needed to be tackled, the minister said, in order to ensure that people could continue to get the care they needed across the country.

Pressed by Grahame Morris MP to answer what was being done on the ground to ensure integration, Burstow said that the latest NHS outcomes framework contained elements relating to integration.

Sarah Wollaston MP asked if there should be a whole system approach to, for instance, care for the elderly. Burstow said there would be no single outcomes framework for elderly care and argued that it was better to have outcomes frameworks for areas that could overlap on areas like integrated care.

Chris Skidmore MP asked Burstow whether personalisation of care budgets would be embraced by the government in order to help provide individualised and integrated services. Burstow said he was not convinced that personal budgets were the only way forward, but said that they could be a "powerful" tool to ensure that services were commissioned to best suit the individual.

Jonathan Reynolds MP received an answer to his written question about progress in implementing the recommendations contained in the report of the Dilnot Commission. Paul Burstow replied saying that the coalition programme set out the Government's clear commitment to reforming the system of social care to provide much more control to individuals and their carers, and to ease the cost burden that they and their families face. This commitment to reform is why the Government acted quickly to set up the Commission on Funding of Care and Support, which published its report in July 2011.

Government welcomed the report as a valuable contribution to the debate on social care reform, but funding reform is not the only thing that needs to change in the social care system. He wanted a package of reforms that goes much wider, addresses the key failures of the current system, and ensures that people get the best possible social care.

This is why the Government has spent the last few months engaging with stakeholders from across the social care community to identify the priorities for reform, and the trade-offs between them. The results of this engagement will inform a White Paper on social care and a progress report on funding reform, which the Government will publish in the spring.

Jonathan Reynolds MP also received a reply to his question on whether the Minister would consider raising the means-tested threshold above which people are liable for their full care costs to £100,000. Paul Burstow said that the coalition programme set out the Government's clear commitment to reforming the system of social care to provide much more control to individuals and their carers, and to ease the cost burden that they and their families face. This commitment to reform is why the Government acted quickly to set up the .

In its terms of reference, the Commission was asked "to examine and provide deliverable recommendations on:

  • how best to meet the costs of care and support as a partnership between individuals and the state
  • how people could choose to protect their assets, especially their homes, against the cost of care
  • how, both now and in the future, public funding for the care and support system can be best used to meet care and support needs; and
  • how its preferred option can be delivered, including an indication of the timescale for implementation, and its impact on local government (and the local government finance system), the national health service, and-if appropriate-financial regulation."

He added that in response to this challenge, the Commission recommended a cap on people's lifetime care costs, set at between £25,000 and £50,000. The Commission also recommended that the upper asset threshold of the current means-tested system (which would remain in place with a cap) be raised to £100,000-and this is the recommendation to which the question refers. The Commission said that the extended means test would work with the cap to ensure that, if the cap were set at £35,000, no one has to use more than 30% of their assets paying for care.

The Commission's report has formed the basis of Government's recent engagement with stakeholders. This engagement exercise brought together the priorities for reform from across the social care system, and examined the trade-offs between them. The results of the engagement are now published, and Government are using them to inform a White Paper on social care, and a progress report on funding reform, which will be published in the spring.

Jonathan Reynolds MP final related question on introducing national eligibility criteria and portable assessments for the provision of adult social care this topic was also answered. Paul Burstow replied saying that the coalition programme set out the Government's clear commitment to reforming the system of social care to provide much more control to individuals and their carers, and to ease the cost burden that they and their families face. In response to this challenge, the Commission made recommendations on a number of aspects of the social care system, including eligibility.

Local authorities are currently required to use the same assessment scale, but are free to set their eligibility threshold at any point on this scale. The Commission recommended that a a national threshold was set at "substantial" need.

Care users who move from one local authority to another currently lose their eligibility to care until they are reassessed. The Commission recommended that the rules be changed so that they retain eligibility until they are reassessed.

The Commission's report has formed the basis of Government's recent engagement with stakeholders. This engagement exercise brought together these recommendations with other priorities for reform from across the social care system, and examined the trade-offs between them. The results of the engagement are now published, and Government are using them to inform a White Paper on social care, and a progress report on funding reform, which will be published in the spring.

Last week Ben Bradshaw MP asked a series of questions around the rates of admission to hospital for patients over 74 years with a secondary diagnosis of dementia in each primary care trust in England in each of the last 12 months. Replies were placed in the House of Commons Library on Thursday. The figures showed that there had been 321,159 finished consultant episodes and that there had been 2,603,887 bed days recorded during that time.

Lord Lester of Herne Hill asked the Government when they intend to implement Section 29 of the Equality Act 2010 on the prohibition of age discrimination in the provision to the public of goods, facilities and services. Baroness Verma said that the Government will announce how it intends to proceed in the Government's published response to the age discrimination consultation in due course.

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