Blog

Going nowhere fast?

We all know how frustrating it is to be left marooned when the car is off the road for repairs, or the buses are unreliable in bad weather – but for over 18,000 older people in Wales, this isolation through lack of decent transport is a daily reality. New WRVS research released today has found that 17% of older people in Wales have been hit by a reduction in public transport services, with many being left trapped at home through poor access to public or community transport.

Whilst the narrative of cuts in transport services is not new, it is about to get a whole lot more severe. The recent Welsh Government announcement of the merging of different funding streams for transport services has signalled a massive 26% reduction in subsidies for local transport services – and across Wales, the impact is already being felt as vital local services are withdrawn or cut to the bone.

Frustratingly, this is happening at exactly the time when those services are needed the most. Figures indicate that 66% of Welsh single pensioners do not have a car, and it has also been shown that 40% of households without a car feel that local bus services fail to meet their travelling needs to the local town or shops, and 65% believe services are inadequate for travel to their local hospital. Further cutbacks will make a bad situation worse, especially for older people – reliable local transport networks become increasingly significant as people get older, with journeys for essential items and social activities sometimes becoming more of a challenge.

At the heart of this is the extent to which transport planning takes account of the voices of older people. Today’s WRVS research indicates that older people feel dis-empowered and disenfranchised; 23% of respondents did not feel able to make comments or complaints about local transport services, and this clearly has an impact when services fail to meet their needs. It should shame us as a nation that nearly 20% of older people are unable manage the walk to/from their nearest public transport, and that many of that same group feel unable to do anything to challenge the system.

This is not, however, simply another request for more money. What today’s research underlines is that we can spend existing resources more shrewdly on services which protect the most vulnerable. Community transport (such as Bwcabus or WRVS services) is a great example, with schemes being viewed much more positively than regular public transport, and rural areas in particular benefiting from such services. Community transport is also rated extremely highly by users in terms of its social impact and for its social return on investment.

We need to help promote community transport, and ensure that funding is there for schemes to become sustainable in the longer-term. We should start by increasing the proportion of transport funding which has to be spent on community transport – realigning spending priorities to ensure that we keep vulnerable older people connected and independent. We also need to ensure that older people have an outlet to express formally their concerns about transport, so that their voice is not marginalised or ignored. Without these sorts of fundamental changes, we may find ourselves waiting for a bus that simply never comes.

Families, loneliness and digital inclusion

A couple of weeks ago, there was a meeting at the Welsh Assembly of the Cross-Party Group on Older People & Ageing, where we spent a very interesting hour talking about older people’s access to technology, and the ways in which older people in Wales are increasingly using the internet to stay in touch with their families.

Some of the news is very good indeed – there are some great examples of older people being helped to learn new IT skills, and of software like Skype transforming older people’s ability to speak with – and see – their children and grandchildren on a regular basis. Meanwhile, at a Welsh Government level, support for the Communities 2.0 project has widened access exponentially.

All of this is very encouraging, but as new research launched today by WRVS reveals, the bigger picture is somewhat bleaker. For all the technological advances of the past 20 years, older people in Wales remain incredibly lonely, with nearly three-quarters of over 75s who live by themselves feeling isolated; worryingly, older people who live alone are actually LESS likely to be in contact with their children than older people who live with their husband or wife. This comes on top of previous findings which showed that older men in Wales are the loneliest group of people in the UK.

Moreover, the WRVS research found that older people in Wales are less likely to speak to their children every day than is the case for the UK as a whole, and that for 11% of Wales’ older people, their nearest child lives more than an hour’s drive away. Part of this can be explained by Wales’ rural geography, but economics and the harsh financial climate has also played a part; 82% of children who have moved away from their older parents have done so for work reasons.

The clear message from all of this is that more needs to be done to help older people to be connected with their families. With the Winter Break just round the corner, many of us will take the time to visit our families – but what about the 8,666 older people in Wales who WRVS estimate will spend Christmas Day alone this year?

Technology offers some hope for the future; the WRVS research showed that 85% of older people who use Skype say that it helps them feel more connected. However, this is simply not an option for some older people, with figures showing that 308,000 over-70s in Wales have never surfed the internet. Even those who do can often face confusing and conflicting messages – such as the list of websites blocked by local authorities to users of their computers in libraries (which includes a disproportionately high number of older people). Skype is a really good example, with many local authorities banning access to Skype over their computers because of a misguided ‘safety first’ attitude, which only serves to reinforce people’s concerns and prejudices about technology rather than challenging them. If we’re to help unfamiliar audiences to overcome their suspicion of technology, we need to start by getting public bodies to do the same.

We are at an interesting junction of age relations. We have a growing cohort of older people, and have a huge divide between the “digital haves” and the “digital have-nots”. For those older people who are able to exploit technology, there are huge opportunities to stay better-connected with friends and families, despite society becoming more disparate as people move further afield to find work. But we also have to cater for the large cohort who cannot (through lack of access or lack of expertise) use the technological corridors open to them. It is surely a sad state of affairs when half of our older people cite the television as their main source of company, particularly when more ‘active’ technologies could be transforming their lives by ensuring they can do the thing they value most – being able to see and hear their loved ones.

Measuring Loneliness: The start of a journey not the end

Yesterday saw the Department of Health issue it’s Adult Social Care Outcomes Framework (ASCOF) for 2013/14. Normally this would not be a newsworthy feature in itself. But yesterday was different. For the first time local authorities will measure levels of isolation and loneliness for users of care and support and carers. This is in response to the key White Paper commitment to address loneliness and social isolation.

It doesn’t sound much in itself. The ASCOF was only first published in March 2011 and has been evolving since then. The inclusion of measuring loneliness, albeit to only a section of society, is a culmination of a great deal of effort by a number of bodies including the Campaign to End Loneliness of which WRVS is a Board member. The previous social care Minister Paul Burstow should also take credit for his role in this achievement.

But it’s not just users of social care users and carers who can feel lonely and isolated. The Department of Health in its Public Health Outcomes Framework (PHOF) 2013-16 recognises that “social connectedness” is a public health issue and is working on a wider population measure of loneliness. In January the PHOF included social connectedness as an indicator to improving the wider detriments of public health. At that stage major work was required across all of the indicators (age, location, gender, socioeconomic group etc). The inference was that this work could take in excess of a year. A revised PHOF was issued earlier this week showed that social connectedness is still included as an indicator, but remains requiring major development work which suggests that this could take some time. This is where our efforts should now be directed.

But the inclusion of isolation and loneliness in the ASCOF is a good start. We should not take our eye off the ball. There is a growing impetus around tackling loneliness and isolation. We have overcome that important first step of getting it acknowledged as having a serious negative impact on an individual’s health and wellbeing. The online toolkit issued by the Campaign in May is also designed to support health and wellbeing boards to better understand, measure and commission to address loneliness and social isolation. We are now on the way to measuring it so that a strong evidence base will help ensure that the right support including that provided by organisations, like WRVS, is available to those that need it.

Read WRVS' response to the Adult Social Care Outcomes Framework announcement

Wales: a good place to grow old?

I was privileged yesterday to attend the launch of a new report by Age Alliance Wales on whether or not Wales is a good place to grow old.

Age Alliance Wales is an umbrella organisation, of which WRVS is a member, helping charities and service providers to speak to the Welsh Government with a clear voice on issues affecting older people. The new report, co-authored with the Bevan Foundation, makes for interesting reading.

As some of the media reports have already noted, it reveals glaring inconsistencies in how much Welsh local authorities are spending on older people. Furthermore, support for older people when they leave hospital was often shown to be patchy.

Yesterday’s launch was both encouraging and unsettling in equal measure. Excellent speeches from BBC Wales’ Roy Noble and the new Older People’s Commissioner, Sarah Rochira, managed inspire a sense of optimism about what we could do in Wales if the resources allowed. Yet underlying that – and key to the report – is a sense that there so much work which needs to be done if we are to make things better. In addition to the challenges mentioned above, the report is clear that older people in Wales are often in poor physical health, are often lonely, and often experience difficulty in accessing services. With Wales’ older population rising faster than any other part of the UK, this is a problem which is set to increase unless action is taken.

The line which hit me hardest yesterday was the testimony of an older person who met with the new Older People’s Commissioner, and told her that all she needed to make her happy were three things – something to love, something to do and something to look forward to. For all the public policy strategies, jargon and frameworks, that ambition underlines what really matters – providing older people with what they think makes for a happy and healthy life.

If we can help older people to have those three things, then we truly will have made Wales a good place to grow old.

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

New 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 

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.

Westminster Eye: An Insight into the week of politics 16 – 20 April 2012

At the beginning of the week Richard Harrington MP asked the Health Minister when he expects to publish his Department's social care White Paper. The answer was delivered on 17 April and was short and sweet. Paul Burstow said that it would be published in the Spring of 2012.

Michael Meacher MP asked how much was spent on social care for the elderly, in each of the last 10 years. A reply is expected on 23rd April.

Health Shadow Liz Kendall MP asked for a breakdown of hospital admissions and emergency readmissions since 2006/7. The figures provided by Minister Simon Burns in the answer indicate that emergency admissions for the 75+ age group had risen from around 306,000 in the first quarter of 2006 to 366,000 in the fourth quarter of 2010/11. Likewise emergency readmissions within 28 days of discharge for the same age group had risen from 154,000 in 2006/7 to 188,000 in 2009/10.

During the Finance Bill Reading on Monday, David Ruffley MP noted how many charities had estimated that the cap would lead to a 20 per cent reduction in their charitable donations, and called for an exemption for UK charities. Treasury Minister Danny Alexander was clear that the government was proposing a limit of £50,000 or a quarter of someone's income, to what were currently uncapped reliefs. "However", he said, "we will discuss this with philanthropists and charities-indeed, those discussions are ongoing. Some features of the American system, for example, may be attractive, which the Government would certainly examine and consider as part of that process."

16 April

On 16 April Simon Kirby MP received answers to his questions to Health Ministers on loneliness posed before the Easter recess. He had asked what engagement his Department had with WRVS at the recent Loneliness summit and what steps his Department is taking to reduce loneliness among the elderly. Paul Burstow said that on 15 March 2012, the Department co-hosted a loneliness summit with the Campaign to End Loneliness (CEL). The event saw charities, businesses, hon. Members and public sector organisations come together to start a conversation about loneliness and isolation in older age and how it could best be tackled. He explained that CEL had been commissioned by the Department to produce a digital toolkit for health and social care commissioners to combat loneliness and isolation.

He added that the CEL is a coalition of five partner organisations: Age UK Oxfordshire, Independent Age, Manchester city council, Sense and WRVS, all of whom played an active role at the summit. During the summit, representatives from all of the partner organisations (including WRVS) had the opportunity to engage with the Department. The chief executive of WRVS spoke at the event and answered questions as part of a panel with other speakers.

Virendra Sharma MP received a response to his question to the Secretary of State for Health on what proportion of the £648 million allocated for primary care trust (PCT) spending on social care was spent on (a) prevention services, (b) communicating equipment, (c) telecare, (d) crisis response services, (e) maintaining eligibility criteria, (f) re-ablement and (g) mental health by each PCT. Minister Paul Burstow replied by saying that the Department collected information on the use of the funding allocated to support social care services in September 2011. Data at primary care trust (PCT) level had been placed in the Library. The returns from PCTs showed that they planned to transfer £642 million of the £648 million made available in 2011-12.

He confirmed that following the survey, the Department of Health followed up with the two PCTs which, at the time of the survey, had not yet agreed the majority of their transfer and sought assurances that plans were in place to reach an agreed position. Agreements had been made for the remaining £6 million to be transferred to local authorities.

Bob Blackman MP had asked the Secretary of State for Health if he will respond to the findings of the Whole Systems Demonstrator Project report on the costs per quality-adjusted life year of the Government's telemedicine programme. Paul Burstow said that the Whole System Demonstrator (WSD) was a very complex study comprising of over 6,000 people across three sites and independently evaluated by six leading academic institutions. Telehealth headline findings were published by the Department on 5 December and show reductions in hospital admissions and mortality can be achieved. There will be more detailed findings published following the completion of the ongoing peer review process in the coming weeks and months.

He continued that at the recent Kings Fund International Congress on Telehealth and Telecare, the research team shared some of their findings on cost per quality adjusted life year (QALY). The high cost of telehealth at the start of the WSD study does have an affect on the cost of QALY results, but what is clear is that if the price point for the equipment is reduced then the cost per QALY will be significantly lower.

Matthew Hancock MP had asked the Minister for the Cabinet Office how many people in each (a) region, (b) local authority and (c) parliamentary constituency are over state pension age. Minister Nick Hurd in his response said that the information requested fell within the responsibility of the UK Statistics Authority. The Director General for the Office for National Statistics replied to the question, placing copies of the detailed tables in the House of Commons Library. The headline was that at August 2011 12,645,850 older people were in receipt of a state pension.

Gareth Thomas MP asked the Chancellor if he will publish his forecasts for the impact on charitable giving of the 2012 Budget's introduction of a cap on tax relief on donations to charities. A reply is awaited.

17 April

Susan Elan Jones MP asked what assessment had been made of the potential effect of the freezing of the personal tax allowance for over-65 year olds on levels of pensioner poverty. A reply is awaited.

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. A reply is expected on 23rd April.

18 April

Jim Shannon MP tabled a Commons Early Day Motion, “That this House notes the benefits that tax relief for charities brings with special reference to gift aid; recognises the great work that charities carry out in helping people across the UK; understands that any reduction of the amount that can be given to a charity with tax relief would be detrimental to charities across the UK; and calls for there to be no adverse change to the arrangements as they currently stand allowing people to make donations as they see fit and are able.”

During Prime Ministers Questions on the same day Kelvin Hopkins MP noted that two years ago, in his pensioner pledge, the Prime Minister said: "it is fundamental to me that people who have worked hard all their lives, and are now drawing their pension, deserve to be treated with respect." He asked if the Prime Minister really thought that trying to sell his granny tax as a "simplification" was treating pensioners with respect. The Prime Minister explained that the basic state pension was being increased by £5.30 a week this April. At the same time, the Government was saving the winter fuel payments, the cold weather payments, the free television licence, the free bus pass, and the other pensioner benefits. The Government was also examining the case for a single-tier pension of around £140 each. He expected Members in all parts of the House to welcome that, because it would be a well-paid basic state pension that encouraged people to save before they became pensioners.

Alex Cunningham MP noted that the Prime Minister's official spokesman argued last week that rich individuals were avoiding tax by giving to charities which "don't, in all cases, do a great deal of charitable work". He asked if the Prime Minister could name any of these charities. The Prime Minister responded by saying that the figures show that last year 300 people earning over £1 million in our country got their rate of tax down to 10%. He agreed that Government must protect charities and encourage philanthropic giving, but that there was a need to make sure that rich people are paying their fair share of taxes.

Michael Meacher MP asked the Secretary of State for Health if he will undertake an inquiry into the local authority funded system of domiciliary care and the costs and benefits at the present level of overall funding. Paul Burstow replied saying that the Government had no plans for an inquiry into the local authority funded system of domiciliary care.

19 April

During Oral Answers on Women and Equalities issues Nia Griffith MP asked what recent discussions Minister had held on tackling age discrimination. The Minister for Equalities Lynne Featherstone MP said that she discussed age discrimination, as appropriate, with Minister and officials and held discussions with industry bodies and others. Earlier this month, the Government endorsed an insurance industry agreement to make motor and travel insurance more accessible to older customers through "signposting" arrangements.

In her follow up Nia Griffith said that she recalled serving on the Committee that considered the Equality Bill with the Minister, and that she was keen to push forward the age discrimination provisions. She asked what had happened in the two years since the Bill received Royal Assent as the age discrimination legislation had not been implemented. Lynne Featherstone said that she had not changed her mind. The Government’s consultation proposed a ban on age discrimination in health and social care, and that there should be no exceptions to that, unlike other issues. It was an important lever, and the delay has come about because the Government wants to make sure it gets it right. She concluded that the Government will come forward as soon as it has made a decision and that was expected to be soon.

Westminster Eye: An insight into the week of politics 26 - 30 March

26 March

On Monday the Secretary of State for Health Andrew Lansley launched the Prime Minister’s challenge on dementia to tackle one of the most important issues the UK faces arising from an ageing population. The challenge sets out the Government's ambition to increase diagnosis rates, raise awareness and understanding and to strengthen substantially the UK’s research efforts. He added that the Government was determined to transform the quality of dementia care for patients and their families. In England today there are an estimated 670,000 people are living with dementia, a number that is increasing with one in three people set to develop dementia in the future. The three key areas where the Government wants to go further and faster and build on the progress made through the National Dementia Strategy. The three areas are:

• driving improvements in health and care
• creating dementia-friendly communities that understand how to help
• better research.

Meanwhile in the House of Lords, Lord Kennedy of Southwark asked the Government what assessment they have made of the Campaign to End Loneliness (CEL) and what action they are taking to support the aims of the campaign. The Parliamentary Under-Secretary of State, Department of Health, Earl Howe, replied saying that the Government is working with the CEL to raise awareness of the problem of loneliness and tackle the factors that cause loneliness and isolation in older people. The department recently co-hosted a social isolation and loneliness summit with CEL to gain a commitment to tackle loneliness and isolation through health and well-being boards, commissioners, local communities, businesses, statutory and voluntary sector organisations. It has also commissioned CEL to produce a digital toolkit for health and care commissioners to combat loneliness and isolation.

He added that the CEL and the Ageing Well programme, funded by the Department for Work and Pensions, have produced a guide for councils on combating loneliness. Representatives from CEL play a key role in the Age Action Alliance. This is a partnership of private, voluntary and public sector organisations jointly led by the Department for Work and Pensions and Age UK.

27 March

On Tuesday The Health and Social Care Bill gained Royal Assent to become the Health and Social Care Act 2012. The core principles of the Act mean that doctors and nurses will be able to tailor services for their patients, more choice will be given to patients over how they are treated, and bureaucracy in the NHS will be reduced.

The Act will:

• Devolve power to front-line doctors and nurses: Health professionals will be free to design and tailor local health services for their patients.
• Drive up quality: Patients will benefit from a renewed focus on improving quality and outcomes.
• Ensure a focus on integration: There will be strong duties on the health service to promote integration of services.
• Strengthen public health: Giving responsibility for local public health services to local authorities will ensure that they are able to pull together the work done by the NHS, social care, housing, environmental health, leisure and transport services.
• Give patients more information and choice: Patients will have greater information on how the NHS is performing and the range of providers they can choose for their healthcare. And they will have a stronger voice through Healthwatch England and local Healthwatch.
• Strengthen local democratic involvement: Power will shift from Whitehall to town hall - there will be at least one locally elected councillor and a representative of Healthwatch on every Health and Wellbeing Board, to influence and challenge commissioning decisions and promote integrated health and care.
• Reduce bureaucracy: Two layers of management - Primary Care Trusts and Strategic Health Authorities - will be removed through the Act, saving £4.5 billion over the lifetime of this Parliament, with every penny being reinvested in patient care.

Helen Jones MP asked the Communities Minister what estimate he has made of likely changes to the number of pensioners who will take up council tax benefit if localisation of the benefit is introduced. A reply is expected after recess.

Health Oral Questions took place on Tuesday.  Meg Munn MP asked what steps the Health Minister is taking to ensure that people receiving care at home funded by the NHS are involved in making the arrangements for that care. In responding the Social care Minister, Paul Burstow said that the Government’s ambition is to enable shared decision making for all NHS patients. He expected people who are eligible for NHS continuing care funding to be fully involved in discussions about their care. Subject to the results of the current personal health budget pilots, everyone eligible for NHS continuing health care, including many people receiving care at home, will have the right to ask for a personal health budget, including a direct payment, from April 2014.

In her supplementary question Meg Munn MP said that she had received a letter from one of her constituents who has had direct payments for 15 years under social services. Following a stay in hospital, she was moved on to health funding, and her life has changed dramatically for the worse. She says that she no longer has any choice in who cares for her and finds it hard to find the right people with whom she feels comfortable. She asked if the Minister will bring forward measures more quickly, so that people who have been directing their own care under social services can have the same quality of life and the same choices that they have become used to. Paul Burstow agreed and said that the Government needs to ensure that, as soon as possible, the benefits and the control that direct payments give to individuals in social care are available to people in regard to their long-term health care and particularly to continuing health care. It is realistic to say that Government can roll this out nationwide by 2014. He encouraged her to carry on those conversations with the authorities in Sheffield, and with him about the way in which people can use the current arrangements to access those facilities.

Stephen Dorrell MP intervened and asked whether the constituency case raised by Meg Munn did not highlight the increasingly urgent need to achieve much more integration between health and social services, and indeed between different parts of the NHS, in order to provide joined-up care that focuses on patients' needs and delivers better value for money to the taxpayer. Paul Burstow said that Mr Dorrell was right. He added that it is not just a question of delivering more integration within health care-which is often still too fragmented, or between health and social care; it is also a question of recognising that issues such as housing and leisure are critical to the delivery of greater well-being, and to an improvement in the health of the nation. The Health and Social Care Bill gives people in every part of the system a clear duty to collaborate, integrate, and deliver better care for all.

Ian Swales MP intervened saying that his constituent Joyce Benbow was discharged from Redcar Hospital last November, but is still there, owing to a failure to agree on her care package. He asked when would those managing health and social care budgets be more joined up so that people receive the right provision at the right time. In his reply Paul Burstow said that this demonstrated the importance of joining up hospital care, community care and social care, which has often been overlooked. He added that the Government had invested more than £300 million this year in developing more re-ablement services, and in January the Government invested an extra £150 million in support for them. The Government was also extending its plans for more tariff reform to ensure that local hospitals have the means to drive the development of such services in their communities.

Nick Smith MP asked what recent assessment the Minister had made of the performance of services for older people. Paul Burstow saying that a number of inspections, reports, independent audits, and investigations have revealed long-standing and unacceptable variations in the standard of care that older people receive in the NHS, and in social care. The Government is determined to root out poor-quality care wherever it is found. The national Nursing and Care Quality Forum had been established to work with patients, carers and professionals to spread best practice.

Nick Smith’s supplementary focused on the British Geriatrics Society's Quest for Quality report which identified that too many people in care homes were without access to NHS services, including psychiatric, physiotherapy and continence services. He asked what action the Government is taking to ensure that care home residents get the high-quality NHS care that they deserve. Paul Burstow responded by saying that in England, one of the things that the Government is doing is making sure that a programme of special inspections of care homes, conducted by the Care Quality Commission, looks at those issues to ensure that Government provides the right range of support services for people in care homes. In addition, the National Institute for Health and Clinical Excellence has produced quality standards; in particular, it has been working on quality standards relating to issues affecting older people-incontinence, nutrition support for adults, patient experience, delirium, dementia, and many others.

In her question Margot James MP said that Russells Hall hospital, which serves her constituency, has reviewed recent reports, and done its own research, on dignity and care for older patients. It has elevated the qualities of care and compassion to the top of its criteria for recruiting health care assistants. Paul Burstow said that it is important that that is applied to all who have direct responsibility for delivering care, and hands-on care in particular. The work that Russells Hall Hospital is doing on care and respect, and in its responsibility programme, is a good example of that. On issues such as dementia, the Government is clear that it needs to ensure good advice, training and support for all nursing staff. He was working with the Royal College of Nursing on this so that they treat people who have dementia with dignity.

In her intervention Liz Kendall MP stated that the Government is rightly building on Labour's national dementia strategy, and the Minister should know that the dementia crisis cannot be addressed without tackling the crisis in care. She added that the Government had cut more than £1 billion from local council budgets for older people's care, services are being withdrawn and care charges for dementia sufferers are soaring. The Alzheimer's Society and Age UK say that these cuts have pushed the system to breaking point. She asked if the Minister agreed with them. Paul Burstow responded by saying that the Government identified £7.2 billion of additional investment to go into social care over the life of this Parliament, and those resources are being used creatively by some local authorities to protect front-line services. He urged her to applaud the authorities that are doing that and join in condemning those that are cutting services despite being given the resources.

Further on dementia care, Mark Menzies MP welcomed the announcement on support for dementia care. He asked what assurances the Secretary of State could give that this will be an aggressive strategy, looking at matters such as new access to drugs, early diagnosis and support for carers of those with dementia. Andrew Lansley replied saying that not only were there the recent announcements, but as part of that there was the establishment of three sets of champions, including Angela Rippon and Jeremy Hughes from the Alzheimer's Society, working together as champions to raise awareness and understanding, Ian Carruthers and Sarah Pickup as champions on improving treatment and care, and Dame Sally Davies, the chief medical officer, and Mark Walport from the Wellcome Trust, as champions for research. Their objective is specifically, to hold the Government to account, not only for the ambitions set out, but for going further and faster.

Debbie Abrahams MP received a reply to her written question to the Secretary of State for Communities and Local Government on what steps his Department plans to take to evaluate the implementation of the measures contained in its document Creating the Conditions for Integration. Andrew Stunell MP replied saying that the written ministerial statement Creating the Conditions for Integration of 21 February 2012, sets out the Government's approach to enabling and encouraging integration, including the role of exemplar projects. This policy document complements the Government's Social Mobility Strategy and Equality Strategy. Specific projects in 'Creating the Conditions' will be monitored and evaluated against each project's objectives. Integration is predominately a local issue which requires a local response, and therefore evaluation is a matter for local areas.

Diane Abbot MP asked what estimate the Health Minister has made of the number of NHS patients in England who are housebound. Paul Bustow said that the information is not held centrally.

Diane Abbott MP also asked the Secretary of State for Health how many older people were subject to delayed discharge from hospital as a result of malnutrition in (a) 2010, (b) 2011 and (c) the latest period for which figures are available in 2012. Paul Burstow said that the information requested was not collected centrally. He added that delayed discharges occur when a patient is medically fit to be transferred from hospital, but is still occupying an acute bed because of a lack of capacity in the wider system. If a patient is suffering from malnutrition and is not medically fit, they would not be ready for discharge from hospital and therefore could not be counted as delayed.

28 March

On Wednesday Simon Kirby MP tabled two written questions around the subject of loneliness. The first asked what engagement the Department of Health had had with WRVS at the recent Loneliness Summit. The second question asked what steps the Department is taking to reduce loneliness amongst the elderly. On the same day Virendra Sharma MP asked what proportion of the £648 million allocated for primary care trust (PCT) spending on social care was spent on (a) prevention services, (b) communicating equipment, (c) telecare, (d) crisis response services, (e) maintaining eligibility criteria, (f) re-ablement and (g) mental health by each PCT. Answers are expected for all these questions on or around the 16 April.

In the Lords on Wednesday Lord Warner asked the Government how many commissioning support services for clinical commissioning groups are expected to be identified by 1 April 2012; and how many of those are expected to be led by former primary care trust managers. Earl Howe in responding said that work is in hand within primary care trusts (PCTs), strategic health authorities and the NHS Commissioning Board Authority to develop the necessary arrangements to support the new commissioning system. The detailed strategy describing this is set out in the publication Developing Commissioning Support: Towards Service Excellence. Information on the number of emerging National Health Service commissioning support services is not yet available. The leadership of these organisations as at 1 April 2012 is a matter for the PCT clusters. The department does not hold information on PCT cluster staffing arrangements.

Both Houses are now in Easter recess. Both Houses return on 26 April.