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Find out about the people behind Royal Voluntary Service in our series of guest stories from our volunteers, staff and partners.
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It’s easy to get caught up in the commercial side of Christmas, with the shops piled high with gifts and presents and the TV constantly bombarding us with adverts for the latest perfumes and electrical gadgets. But it’s worth remembering that all some people want for Christmas is a little care and attention.
The best gift you can give this year is your own time and effort to help out a good cause in your local area. You don’t need any special skills or experience, and it won’t cost you anything, but the rewards it gives are priceless.
Volunteers are the lifeblood of many charity organisations, and without them many simply wouldn’t be able to deliver the services that are so vital in your local community. No amount of money can replace a willing pair of hands when it comes to the sharp end of charity services, and volunteers can make a real difference.
You don’t have to make a huge commitment, most organisations, such as WRVS will welcome any time that you can spare to help. Just a couple of hours per week can really change the lives of older people in your community.
A couple of hours delivering Meals on Wheels, for example, not only ensures that the elderly and infirm get a hot, healthy meal once a day, but also gives them a welcome visitor to check on their well-being and stop for a chat. Support at home is another great way to help people to live independently, while making sure that they get all the services and support that they need.
So this Christmas, give something that really counts, give a little of your time to your local community by volunteering.
The beginning of the week began with oral questions to the Communities and Local Government Ministers. Margot James MP asked what discussions they had held with the Secretary of State for Health on funding for adult social care. In responding the Communities and Local Government Minister Bob Neill said that the Secretary of State had held a number of discussions with the Secretary of State for Health. In recognition of the need to reform the system the Government has said that we will bring together proposals in a White Paper in the spring. An extra £7.2 billion was being provided over the next four years to protect access to services that support vulnerable people.
In her supplementary question Margot James said that the recent report by the Equality and Human Rights Commission exposed the poor quality of care of some home care providers. She had received complaints from constituents that reinforce the report's findings. Funding has been a problem for a long time and would the Minister discuss further with the Secretary of State for Health the diversion of more money from health to social care, on top of the £648 million already announced?
In his reply Bob Neill said that it is appropriate that Government consider the matter in the context of the White Paper that is to come out in April. The report is valuable, and the Government as a whole will want to consider its recommendations carefully. He pointed to the £648 million in this year that will be followed by another £622 million in the next. That £1 billion coming from the Department of Health is matched by £1 billion coming from the Department for Communities and Local Government.
Helen Jones MP asked why the Minister did not admit that the Secretary of State's ambition to be the biggest axe man in Whitehall has been achieved on the backs of elderly and vulnerable people. She said that 70% of councils had to cut social care, leaving old people to make difficult choices. The cost in wasted lives was high, and the cost to the NHS through more delayed discharges and more emergency admissions will run into millions of pounds. She asked why the Government did not now admit that the Government's policy is not only uncaring and out of touch but economic madness.
Robert Neill said that Ms Jones had failed to recognise the fact that the Government have assisted local councils in the greatest need by increasing the weighting given within the settlement to the needs allowance and by introducing a transition grant to assist those that are most dependent on public money. She had failed to recognise that the Government is trying to rectify the economic mess that left by the previous administration. She had also failed to recognise the observation of the head of the No10 policy unit when she was in government that the "long-term funding of social care was the largest piece of unfinished social reform under Labour."
Jim Cunningham MP received an answer to his question posed the previous week on how much the Department of Health has spent on research on the (a) causes and (b) treatment of dementia since 2010. Social Care Minister Paul Burstow reported that Dementia is a research priority for the Government. Through the National Institute for Health Research (NIHR) and the Policy Research Programme, the Department funds a wide range of research on dementia including research on causes, diagnosis, treatment, and organisation and delivery of health and social care services. The Department's expenditure on dementia research increased from £12.7 million in 2009-10 to £18.6 million in 2010-11.
The NIHR has issued a themed call on dementia. This call extends across the translational pathway, covering the fields of cause, cure and care, including prevention. In addition, four new NIHR biomedical research units in dementia will receive a total of £18 million over five years from April 2012.
Several MPs asked the Communities Minister what assessment had been made of the effect on the third sector of reductions in funding for local authorities. Ministers responded by saying that they are working closely with the third sector to assess capacity and provide support, for example through the Transition Fund and Big Society Capital and we are looking together at opportunities for the Voluntary and Community Sector from increased local authority commissioning. Andrew Stunell MP agreed that local spending decisions are a matter for local councils but there was no excuse to target the voluntary sector disproportionately.
Jim Cunningham MP received a reply to his question on what steps the Government is taking to ensure house building schemes take into account the needs of older people.
Minister Bob Neill said that Part M (access to and use of buildings) of the building regulations already includes a number of provisions including level thresholds, downstairs toilets and accessible switches and sockets that help to make all new homes more accessible and age friendly. In addition, the Housing Strategy published on 21 November sets out Government's view that new housing developments need to make further suitable provision for the ageing population by ensuring a mix of property types, including Lifetime Homes, which help to provide the diversity and choice needed to support longer term independent living. Future needs will vary considerably at a local level and the Government believe that decisions on the number of Lifetime Homes within each development should be made at a local level, in proportion to local need and aligned with other local housing support and information services. They are exploring how research undertaken by DCLG can be used to support local authorities in developing proportionate and effective policy at a local level.
The draft national planning policy framework asks local councils to plan for a mix of housing based on current and future demographic trends and the needs of different groups in the community, including older and disabled people. The draft framework makes clear that councils should have a robust understanding of housing requirements in their area, and that they should produce local plans, in consultation with people in the local area.
Helen Jones MP followed up her recent question with two more relating to communications between the Departments of Health and Communities and Local Government. She asked what recent discussions had been held with Ministers in the Department of Health and Communities on the possible extra costs for the NHS of local authorities introducing changes to the criteria governing eligibility for social care. Her other question asked what estimate had been made of the possible extra costs which will be incurred by the NHS as a result of local authorities introducing changes to the criteria for eligibility for social care.
Paul Burstow responded by saying that in the spending review, Government recognised the pressures on the adult social care system within a challenging settlement for local government, and took the decision to prioritise adult social care by allocating an additional £7.2 billion to the system over the four years to 2014-15 to support local authorities in delivering social care. When combined with a rigorous local authority focus on efficiency, this additional £7.2 billion means that there is funding available to protect people's access to care and deliver new approaches to improve quality and outcomes.
Jim Cunningham MP asked the Secretary of State for Health what steps he is taking to ensure consistent levels of provision of social care support across the country.
Paul Burstow replied that local authorities are responsible for providing or arranging care services for their populations. Their funds are derived from local taxation and funding from central Government. The great majority of this funding is provided without condition. It is for local authorities to decide how best to manage their resources, according to local priorities.
In the spending review, the Government recognised the pressures on the adult social care system within a challenging settlement for local government. It took the decision to prioritise adult social care by allocating an additional £7.2 billion to local authorities over the four years to 2014-15 to support them in meeting their social care commitments. When combined with a rigorous local focus on efficiency, this additional money will mean that there is funding available to protect people's access to care and deliver new approaches to improve quality and outcomes.
The Health Select Committee interviewed Andrew Dilnot, Lord Warner and Dame Jo Williams as part of its inquiry into social care. Dilnot himself said that not enough was currently being spent on social care, something that was of extreme importance to the nation. He added that it was absolutely vital to look at the funding for social care for those that were most in need. He said there was no doubt that not all of this funding had made its way through. He said local authorities were over spending on care, it was not the case that social care was an unpopular thing. He said the commission argued strongly that local and central government needed to come together to create a national eligibility criteria. Dame Jo said that portability of an assessed need to other local authorities "could be addressed quite urgently", along with national eligibility criteria. She said a universal assessment system would be more clear and transparent. Lord Warner said that as local authorities tightened eligibility criteria as more elderly people ended up in hospital and the NHS "takes up the slack". He said the Department of Health should examine how spare capacity in the NHS could be created and money could be released from the NHS to social care. Lord Warner suggested that spare NHS beds could appear if money was quickly put into the adult social care system, but that spare capacity was currently poorly understood. He said serious work must be done on how this transfer could take place.
The NHS Outcomes Framework 2012-13 was published.This refreshes the first NHS Outcomes Framework published for England in December 2010 and includes updated definitions for some of the indicators in the framework.
The framework has three main purposes, which remain the same in this updated version:
- to provide a national level overview of how the NHS is performing against certain outcome measures
- to act as a mechanism for the Secretary of State to hold the NHS Commissioning Board to account for delivering improvements in outcomes, from April 2013
- to act as a catalyst for driving improvement and a focus on outcomes throughout the NHS.
In the Lords, Dilnot Commissioner, Lord Warner, received a reply to his question on what would be the cost to the Government of the cap on lifetime care costs proposed in the report of the Commission on Funding of Care and Support if that cap was increased from £35,000 to (1) £50,000, (2) £60,000, (3) £70,000, (4) £80,000, (5) £90,000, and (6) £100,000.
The Parliamentary Under-Secretary of State, Department of Health Earl Howe said that the Commission on the Funding of Care and Support set out detailed costings in its evidence and analysis report, and these included costs for different levels of the cap. This information is available in the Analysis and Evidence Supporting the Recommendations on the Commission on Funding of Care and Support and The Government is considering the recommendations of the Commission and will publish their response in a White Paper and progress report on funding in the spring.
Towards the end of the week during the Health and Social Care Bill reading debate, Lord Warner moved an amendment regarding the health secretary's annual report. He acknowledged the need for reform in the social care and health systems, but argued that they were not on a level playing field; and the reduction in access to state-funded care services had seen an increasing burden on informal carers. "At the heart of this problem is that social care simply does not have the standing of the NHS," he said. He called for a clear duty upon the health secretary to promote a comprehensive social care system; and the amendment would require an annual report on the health service's integration with the care sector. Earl Howe agreed on the importance of integration between the health and social care sectors. However, he argued that the amendment was unnecessary because the Bill already contained duties to promote and encourage the commissioning and provision of integrated services.
On Thursday John Hemming MP received a reply from the Health Minister to the question on when the Government would publish a response to the Dilnot Commission's report Fairer Funding for All. Paul Burstow said that the Government had set out its initial response on 4 July. The Government welcomed this report, which is an immensely valuable contribution to meeting the long-term challenge of an ageing population. Government had spent the last few months engaging with stakeholders from across the care and support community to ensure that we get funding reform-and social care reform more broadly-right. The Government plan to publish a social care White Paper and a progress report on funding reform in the spring.
Robert Buckland MP asked what steps the Minister has taken to meet each of the six shared objectives contained in his Department's mental health outcomes strategy and what meetings he has had with Ministerial colleagues on cross-Government steps to achieve each of the six shared objectives contained in his Department's mental health outcomes strategy. Andrew Gwynne MP quizzed the Minister on his assessment of the likely take-up of telehealth schemes. Richard Burden MP asked what recent meetings Ministers have had with representatives of the Care and Support Alliance and whether there were plans to bring forward proposals to reform the care system. Replies to these questions are awaited.
Posted by Steve Smith, Public Affairs Officer at 00:00
Friday, 16 December 2011.
On Monday Simon Kirby MP received an answer from the Minister to his question on what assessment the Department of Health has made on the findings of the Shaping our Age report by WRVS on loneliness. Minister Anne Milton said that the Department of Health welcomes the Shaping our Age report and has noted its findings. She added that the engagement exercise, Caring for Our Future: Shared ambitions for care and support, was launched on 15 September 2011, and will last until early December. This engagement exercise will cover among its six themes prevention, integration, quality, personalisation, shaping local services, and financial services. After the engagement exercise, the Government will set out its response to the Dilnot Commission in the spring, with full proposals for reform of adult social care in a White Paper and progress report on funding reform.
Helen Jones MP asked what discussions had taken place with Ministerial colleagues on the likely effect of the Local Government Resource Review on social care. Bob Neil MP replied that the Secretary of State for Communities had regular discussions with ministerial colleagues on a range of issues.
Tuesday saw the Chancellor George Osborne deliver the Autumn Statement. The statement contained a commitment to raise the basic state pension by £5.30 and the pension credit by £5.35. He also announced that the pension age was being raised from 66 to 67 in 2026. Finally total managed expenditure in real terms was to fall by 0.9% for the years 2015-16 and 2016-17 following the current spending round.
The previous week Jim Dobbin MP had asked how much of the extra £70 million funding announced for re-ablement has been (a) spent by and (b) allocated to each Primary Care Trust and on what services this money has been spent. Paul Burstow provided a response on Tuesday. He said that the Department of Health had announced on 5 October 2010 that £70 million of extra funding would be allocated to Primary Care Trusts (PCTs) to be spent across the health and social care system to enable the NHS to support people back into their homes after a spell in hospital through re-ablement. Allocations to PCTs were made on 4 November 2010, and details on this are available here
Following the extra £70 million re-ablement monies the Government allocated to PCTs in 2010-11, on 4 January 2011 the Department announced a further allocation of £162 million to PCTs for winter pressures funding on social care services that also, benefit the NHS.
Examples of the kinds of services PCTs could invest in included further investment in re-ablement services, to help people regain their independence and reduce the need for ongoing care.
He continued by saying that the spending review and 2011-12 NHS operating framework announced further funding to PCTs in financial years 2011-12 and 2012-13 to develop local reablement services in the context of the post-discharge support plans submitted to strategic health authorities last December. This funding totals £150 million in 2011-12 and £300 million in 2012-13, and is contained within recurrent PCT baseline allocations. Details on this are also available here and here
It is for PCTs in partnership with local agencies to commission services to meet the healthcare needs of their local populations, taking account of local and national priorities.
Chris Skidmore MP wanted to know how many people over the age of (a) 65, (b) 75 and (c) 85 years were admitted to accident and emergency centres in each of the last 10 years for which figures are available. Replies are awaited. Minister Simon Burns MP replied saying that patients are not admitted to accident and emergency (A&E) centres; though they may be admitted to other hospital departments following an attendance at an A&E department. Statistics for admissions to A&E are therefore not available. Statistics are available for attendances at A&E departments though not for the exact age ranges requested, and have only been published since 2007-08. The 2009-10 admissions for ages 60-69 were 1,186,933; for ages 70-79 114,954; for ages 80-89 991,054 and for ages 90-99 256,618.
Several MPs asked what the Communities Minister what assessment had been made of the effect on the third sector of reductions in funding for local authorities. Jim Cunningham MP asked what steps the Government is taking to ensure house building schemes take into account the needs of older people. Replies are awaited.
Helen Jones MP followed up her recent question with two more relating to communications between the Departments of Health and Communities and Local Government. She asked what recent discussions had been held with Ministers in the Department of Health and Communities on the possible extra costs for the NHS of local authorities introducing changes to the criteria governing eligibility for social care. Her other question asked what estimate had been made of the possible extra costs which will be incurred by the NHS as a result of local authorities introducing changes to the criteria for eligibility for social care, broken down by region. Replies are awaited
Dilnot Commission member Lord Warner asked the Government what would be the cost to the Government of the cap on lifetime care costs proposed in the report of the Commission on Funding of Care and Support if that cap was increased from £35,000 to (1) £50,000, (2) £60,000, (3) £70,000, (4) £80,000, (5) £90,000, and (6) £100,000. A reply is awaited.
Baroness Greengross received a reply on Thursday to her question about the Government ‘s assessment of the impact of (a) hospital admissions, and (b) emergency hospital admissions, on health outcomes for people with a diagnosis of dementia. In replying Earl Howe said that they know that people with dementia stay longer in hospital and that there is room for improvement in the quality of their care. He said that was why improving the quality of care in general hospitals is one of the Government's four key priorities for improving dementia care services. The Government want to see people with dementia only admitted to hospital when absolutely necessary and, when they are in hospital, to receive high-quality care from staff trained to care for people with dementia.
On 21 September 2011, following a year-long project funded by the department, the Royal College of Nursing launched a new commitment to the care of people with dementia in general hospitals. The commitment is a guide to promote a positive experience and support the delivery of dignified care for people living with dementia and their families, in hospital.
During the ninth day of the Committee stage of the Health and Social Care Bill in the Lords, Baroness Bakewell moved an amendment regarding how well NHS services met the needs of older people. This would require the board's annual report to be measured by how effectively it met the needs of older people; and were intended to test views on the creation of a commissioner for older people.
Baroness Jolly highlighted the forthcoming consultation on social care in the New Year, and asked if an older person's commissioner was likely to be included in the next Bill. Responding, Earl Howe, the Minister, said he was sympathetic to the amendments, and completely understood their motivation. However, he said that the government already received advice from the UK Advisory Forum on Ageing on steps to improve well-being and independence in later life. The national clinical director for older people, Professor David Oliver, also held regular meetings with organisations such as Age UK and WRVS, he added. In terms of a future health Bill, he said that the government "certainly do not have a closed mind" on the issue of an older people's commissioner.
Jim Dobbin MP followed up on his question of last week to ask the Secretary of State for Health what assessment he has made of the reasons for delayed hospital discharge. Paul Burstow MP said that based on the latest information, about 61% of delayed transfers in October are attributable to the NHS and 32% to social care, with the remaining 7% being attributable to both in October 2011.
He continued that no one should be made to stay in hospital longer than necessary. The NHS and social care must work together to ensure people have the support they need on leaving hospital. The new Clinical Commissioning Groups will bring together general practitioners, specialist doctors and nurses to shape the best joined-up local care for patients, helping to avoid unnecessary delays. The Department has allocated additional funding to help people return to their homes after a spell in hospital-by 2012-13 this will be £300 million per year. This money will help people to leave hospital more quickly and get settled back at home with the support they need.
Jim Dobbin MP quizzed the Minister over how many delayed hospital discharges there have been of (a) under and (b) over 75 years old in each region since May 2010. Paul Burstow MP produced a table providing this information. Most recent figures showed that the Department collects data only on people over 75 years for acute delayed transfer of care and that the figure for the final quarter of 2011 was 1,806, the highest for the year.
Jim Dobbin MP also asked the Minister what assessment he has made of the costs to the NHS of delayed hospital discharge. Paul Burstow MP replied saying that the Department of Health does not collect data on the cost of delayed transfers of care. Data on the number of delays are published each month by the Department.
He added that significant sums of money had been made available in this spending review period to reduce the level of delayed discharges to a minimum. In the last financial year, an extra £162 million was made available to local health and care services to spend on front-line services, and an additional £70 million of funding was available for spend on helping people to return to their homes after a spell in hospital. This money was aimed at helping people to leave hospital more quickly, get settled back at home with the support they need, and to prevent unnecessary admissions to hospital. This year, there is £150 million available for re-ablement and £648 million for social care spend that also benefits the NHS.
Also on Thursday John Hemming MP asked the Health Minister when he expects to publish the Government's response to the Dilnot Commission's report Fairer Funding for All. A reply is expected shortly.
Posted by Steve Smith, Public Affairs Officer at 17:00
Tuesday, 06 December 2011.
Shaping our Age,
Caring for Our Future: Shared ambitions for care and support,
reform of adult social care white paper,
commission on funding of care and support,
Health Oral Questions took place and there were a number that related to older peoples issues. Julie Hilling MP asked what discussions the Minister had had with the Chancellor of the Exchequer on the future costs of long-term social care. In response Minister Paul Burstow said that the Government is committed to publishing a White Paper and a progress report, responding to both the Law Commission and the Dilnot commission recommendations. As part of ongoing work, there have been numerous discussions throughout the Government, including with Her Majesty's Treasury.
As her supplementary, Julie Hilling said that at least 5,000 families a month have to make decisions about the long-term care of loved ones. Since the election, thousands have had to sell their homes and spend every penny on care. She said that many more people-and for how much longer-will be terrified about their future.
Margot James MP asked if the Minister agreed that the integration of health and social care should be leveraged by commissioners to encourage savings in the acute sector, to contribute to funding much-needed improvements in long-term social care. Paul Burstow replied that there is no doubt that more integration between health and social care is a way of improving the quality of services delivered to the public, and of releasing resources that can then be reinvested in improving services. For example, the Government knew that the use of reablement services can reduce costs and improve the quality of life outcomes for the people who receive them.
Shadow Minister Liz Kendall MP stated that social care is vital for reducing winter pressures on the NHS by helping to keep older people out of hospital, but the Government is cutting funding for older people’s social care by £1.3 billion. Delayed discharges from hospitals are already up 11% from this time last year.
The Minister responsible for care (Paul Burstow) said in Westminster Hall on 10 November: "cuts to front-line adult social care services are really beginning to bite."
She asked whether the Secretary of State agreed. In response Mr Lansley, Secretary of State, said that it was this Government who gave priority to social care. More than £7 billion was added to the social care budget as a consequence of the steps taken by the Secretary of State for Communities and Local Government and by the NHS. This year the NHS is providing an additional £648 million specifically to support adult social care. In addition, the Government had announced its Warm Homes Healthy People
funding for this winter, which will provide additional support for those most urgently in need.
Iain Stewart MP asked what leadership role the Government expects the new Health and Well-being Boards to play in determining significant NHS service changes in each local area. Mr Lansley said that the Health and Well-being Boards will have a role not only in leading improvements in public health and social care but, through the joint strategic needs assessment and the strategy derived from that, in establishing how services should respond to the needs of the local population. The clinical commissioning group should respond directly to that, and any specific service configuration changes should form part of the commissioning plan. In addition, the local authority, through its scrutiny role, will have a continuing ability to refer those plans for review.
In a written question Brandon Lewis MP asked the Secretary of State for Transport is taking to maintain public transport provision for elderly people in rural areas who are affected by planned changes to the funding of local bus services. Transport Minister Norman Baker replied that outside London, the provision of bus and community transport services in rural areas, as in urban areas, is a matter for commercial operators and for local authorities.
However, he said that the Government understood that buses are a lifeline for many people in rural areas. £10 million of extra funding was recently provided to local councils to help develop community transport in their areas. The Government is also providing £560 million over four years through the Local Sustainable Transport Fund to help local authorities to support economic growth and reduce carbon emissions. Moreover, the Government had committed to protect the statutory entitlement for concessionary bus travel, ensuring that older people can maintain greater freedom and independence.
Further written questions still awaiting a response included Simon Kirby MP who quizzed the Minister on what assessment his Department has made on the findings of the Shaping our Age report by WRVS on loneliness.
Also Helen Jones MP wanted to know what discussions had taken place with Ministerial colleagues on the likely effect of the Local Government Resource Review on social care.
Baroness Smith of Basildon received a reply to the question she put to Ministers the previous week asking in the light of statistics produced by the Department of Health showing that between January and March 2011, 75% of all acute delayed transfers were of people aged 75 or over, whether they will reverse the decision to stop collecting this data in this form, given its role in helping to understand the relationship between the National Health Service and social care provision for older people.
In his response Earl Howe said that no one should stay in hospital longer than is necessary. The NHS and social care must work together to ensure people have the support they need on leaving hospital. Some patients need particular support after a spell in hospital to settle back into their homes, recover their strength and regain their independence. The Government has increased the level of investment made available to local health and care services to spend on front line services and helping people return to their homes after a hospital stay. While it is recognised that the delays for over-75s is a large proportion of the total, the aim should be reducing the number of delays for all ages. Latest figures showed that 76 per cent of acute delays were for over-75s and 23 per cent of admissions were for over-75s.
He continued that the spending review recognised the importance of social care in protecting the most vulnerable in society. In recognition of the pressures on the social care system in a challenging local government settlement, the Government had allocated an additional £2 billion by 2014-15 to support the delivery of social care and help protect people's access to services upon discharge.
As part of this funding, an allocation of £150 million has been made available this year for reablement and £648 million for social care spend that benefits the NHS which could help to reduce the level of delayed discharges. The reablement money will help people to leave hospital more quickly, get settled back at home with the support they need, and to prevent unnecessary admissions to hospital. Local authorities are responsible for decisions on how to allocate their resources.
The data from the NHS are collected with the aim of helping commissioners to commission the most effective and appropriate services for their local population and to help service users to make informed decisions. The data collected is frequently reviewed to ensure it meets this aim.
Lilian Greenwood MP asked the Minister what recent assessment he has made of the adequacy of resources provided for the care of older people. Paul Burstow said that the Government had committed an additional £7.2 billion to support social care over four years up to 2015. This is on top of £6.8 billion of existing departmental grant funding. Taken together these funds along with a rigorous approach to quality and productivity improvement provide local councils with sufficient resources to protect access to care for older people.
The Department of Health published the operating framework for the NHS in England 2012-13, which sets out the business and planning arrangements for the NHS. One of the key areas that will receive particular attention during 2012 - 13 is the improvement of services for older people. There is a systemic set of things that the report sets out that will require organisations to work together. These include participation in and publication of national clinical audits that relate to services for older people and non-payment for emergency readmissions within 30 days of discharge following an elective admission.
Also on Thursday Jim Dobbin MP asked how much of the extra £70 million funding announced for re-ablement has been (a) spent by and (b) allocated to each Primary Care Trust and on what services this money has been spent. Chris Skidmore wanted to know how many people over the age of (a) 65, (b) 75 and (c) 85 years were admitted to accident and emergency centres in each of the last 10 years for which figures are available. Replies are awaited.
On Thursday afternoon the House of Lords led by the chairwoman of the Council for Healthcare Regulatory Excellence, Baroness Pitkeathley debated Dilnot and the Future Funding of Social Care. Paying tribute to the work of the Commission on Funding of Care and Support, she said that the current system of social care could be described as "in crisis, severely stretched or broken, depending on where you sit". She expressed her disappointment that other than the minister, no Conservative peers had put their name down to speak in the debate. The Labour peer highlighted the problems of a system that was "not fit for purpose", adding: "We are spending inadequate amounts on care and support, both publicly and privately".
She outlined the recommendations of the commission's report: A cap, between £25,000 and £50,000, on individuals' contribution to their social care; after which they should be eligible for full state support. There should also be national eligibility criteria and portable assessments. She argued that the estimated cost of the proposals, at £2bn, paled in significance compared to the £170bn that social security cost each year. She urged parliamentarians to harness the consensus of support for the Dilnot proposals. Baroness Pitkeathley called on the minister to outline when action would be taken:
Lord Lipsey expressed concerns that the Dilnot recommendations were "in danger of going down the pan". Turning to the role of the private sector he said that there were currently very few insurance policies for long-term care. He suggested that insurance companies were hesitant in this area because of the fear that people will live longer and longer and that the costs of that care will bankrupt the companies". "Without a state-funded cap which limits the liabilities of insurance companies, mass private insurance is a dead duck," he said. Lord Lipsey praised the Dilnot report, but said that the proposed cap of £35,000 that an individual would bear was too low.
Lord Rix expressed concerns about the tightening of eligibility criteria, and highlighted that 83 per cent of councils were only supporting people with 'critical' or 'substantial' needs. Lord Desai wanted to see some incentives to promote the buying of social care insurance at a very young age by people.
Lord Low of Dalston warned that time was running out, and that Dilnot was not enough. Baroness Wall of New Barnet highlighted the benefits of integrated health and social care systems, which could be achieved through joint commissioning and planning, and pooled budgets.
Lord Warner thought that implementation of Dilnot could be brought forward through using the current Health and Social Care Bill as a vehicle to draw up regulations.
In responding for Government Earl Howe said that the decision to protect social care funding would help to alleviate pressures on the system. He admitted that demand for services would rise, and that their funding and legal framework had to change. The current engagement process would provide a forum for debate, and inform the white paper and progress report, to be published next April, he said.
The government would not shy away from its responsibilities he said, and its commitment to "legislate at the earliest opportunity is undiminished", but added that the Dilnot recommendations carried "significant costs". On the level of the cap, he said that £100,000 would seem unobtainable to most people, and would not stimulate the development of financial services.
Following immediately on, the Lord Bishop of Ripon and Leeds opened a debate on voluntary sector funding which noted how effective and innovative the voluntary sector was, juxtaposed against the "massive underfunding" it also faced. He called for "specific ring-fencing of government money, public money, for areas such as mental health, where charities struggle as mental health issues grow, with increasing homelessness and fear." The Bishop also spoke of the need for a "greater fairness in the allocation of local authority funds."
In backbench contributions, Lord Rennard called for "much greater transparency in how local authorities fund the voluntary sector and how they decide on the best long-term providers of services." Above all, Lord Rennard argued, "there needs to be much greater respect between government at all levels and the voluntary sector."
Posted by Steve Smith, Public Affairs Officer at 10:00
Tuesday, 29 November 2011.
long-term social care,
integration of health and social care,
Delayed hospital discharges,
Warm homes healthy people funding,
health and well-being boards,
operating framework for the NHS in England 2012-13
This week was cut short by a brief Recess with Members of both Houses returning on 21 November. Normally this is the time for the Queens Speech detailing the legislative programme for the coming session. But there is no Queens speech this year.
Shadow Social Care Minister Liz Kendall MP received an answer to her question on how many unplanned hospital admissions for people aged 65 years and over there were, broken down by (a) local authority and (b) NHS commissioner in each month in (i) 2008-09, (ii) 2009-10, (iii) 2010-11 and (iv) 2011-12. The Minister Paul Burstow said that the Department does not have data in the format requested but does have data with a count of Finished Admission Episodes (FAEs) where the age of the patient is 65 or over; by month, primary care trust of responsibility and local authority of residence for the years 2008-09 to 2011-12. Data for 2011-12 are provisional and only for the months April to June inclusive.
He added that it should be noted that FAEs is not a count of patients as a patient may have been admitted more than once during the period stated. The footnotes contain further information which should be used when interpreting the data. The detailed information has been placed in the House of Commons Library.
Hilary Benn MP asked the Secretary of State for Health how many people were waiting to be discharged from hospital because of a shortage of community care facilities in each local authority area in the latest period for which figures are available. Paul Burstow responded by saying that in England in September 454 people were awaiting a care package in their own home and 130 people community equipment and adaptations. The figures for each local area had been placed in the Commons library.
"That this House is aware of the vital importance of the provision of social care for people suffering from dementia, currently estimated as affecting around 750,000 people in the UK, two-thirds of whom live in the community; recalls the findings of the Dilnot Commission in July which included within it a recommendation to create a fairer funding mechanism for social care, rather than the current system which leaves tens of thousands of families to pay all of their loved ones' care costs whilst they themselves suffer this terrible terminal health condition; praises the work of the Alzheimer's Society which has campaigned for many years to end such dementia tax; and urges the Government to hear its call for them to engage in urgent cross party talks to explore how a fairer, transparent system can be developed and then established."
Commons Early Day Motion tabled by Sir Alan Meale MP
Chris Skidmore MP asked how much his Department spent on dementia research in each financial year since 1997-98. The Minister provided a lengthy table but the figures for recent years are 2007-08 £22.2m, 2008-09 £18.4m, 2009-10 £12.7m, 2010-11 £18.6m.
Baroness Smith of Basildon received answers to the first two written questions that she had tabled the previous week. The Baroness had asked what assessment Government had made of the progress made in providing preventative services that overcome social isolation amongst older people following the Healthier Lives Green Paper and the Vision for Social Care. The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) said that the department is seeking to collect data around social participation through the 2011-12 Adult Social Care Outcomes Framework indicator, which focuses on enhancing the quality of life for people with care and support needs.
He added that on 16 November 2010, the Government published A Vision for Adult Social Care: Capable Communities and Active Citizens, which sets the context for the future direction of adult social care in England. One of the principles of the vision is preventive strategies, which set out to reduce dependency by promoting stronger and more active communities that enable people to be less isolated and vulnerable.
In addition, the Department's national evaluation of Partnerships for Older People Projects informed councils of the benefits of some services including befriending, which demonstrated health-related quality of life gains for older people.
Baroness Smith of Basildon had also asked the Government what discussions they have had with a view to introducing an impact test to examine the effects of policy proposals on those aged over 65 following the Westminster Hall debate in the House of Commons on 6 September.
Earl Howe replied that the department has not recently had any discussions on a separate impact assessment process for older people. However, age is a protected characteristic under the Equality Act 2010 which confers a duty on public authorities, including the Department of Health, to pay due regard to the need to eliminate discrimination, harassment and victimisation, advance equality of opportunity and promote good community relations in everything they do. Such work may not always take the form of a discrete impact assessment but understanding the potential impact of departmental policies on older people is inherent in the public sector equality duty in Section 149(1) of the aforementioned Act.
Government is committed to addressing the issues that affect older people. The Department for Work and Pensions leads on strategy for our ageing society and helps to co-ordinate this agenda across government. The Minister of State for Pensions and the Minister of State for Care Services jointly co-chair the UK Advisory Forum on Ageing. The forum provides an opportunity to bring together the representative views of older people and provides advice to Ministers across government on the steps that it and its partners need to take to improve well being and independence in later life.
The department is currently running an engagement exercise on the reform of social care, "Caring for Our Future" until 2 December. Through this process, the Government is inviting views from a wide range of interested people and groups, including people who use care and support services, carers, local councils, care providers, and the voluntary sector.
Baroness Greengross tabled a series of questions relating to the incidence of dementia. Replies are expected shortly.
Brandon Lewis MP received a long and comprehensive answer from the Minister about the steps being taken to ensure elderly patients in NHS facilities receive adequate hydration and nourishment.
The Department had commissioned the Care Quality Commission (CQC) to undertake the Dignity and Nutrition Inspection (DANI) programme and its final national report was published last month. There are a number of steps the Department is taking to improve care for elderly patients in the NHS.
There are a number of National Institute for Health and Clinical Excellence quality standards commissioned by the Department that are either in place or are being developed for a range of conditions and pathways affecting older people including incontinence, nutrition support in adults, patient experience in adult NHS services, delirium, dementia, osteoarthritis and falls in a care setting.
One of the eight high impact actions developed for nursing relates to keeping people nourished and getting better, and aims to stop unintentional weight loss and dehydration in patients. Since April 2010, it has been a requirement of a hospital’s continuing registration with the CQC that service users are protected from the risks of dehydration and inadequate nutrition.
Within the NHS Operating Framework and the NHS Outcomes Framework, there are a number of indicators to support better care for older people. These include dementia care, hospital acquired infections, emergency readmission rates, improving recovery from fragility fractures and helping older people to recover their independence after illness or injury. The Department is also funding national audits of falls and bone health, dementia, continence and hip fracture.
Local Involvement Networks in each local authority area are able to enter and view services to obtain the views and experiences of patients, service users and their families about their experiences of care and treatment at the time they are receiving it. This information can be shared with the CQC. The Department of Health supports the Partnership on dignity in care, which has been established by the NHS Confederation, Age UK and the Local Government Group.
Caroline Lucas asked whether the Minister is considering mechanisms to ensure that hospitals are provided with financial incentives to participate in arrangements for integrated care for people aged over 75 years to facilitate better patient care and prevent avoidable hospital admissions. A reply is awaited.
Andrea Leadsom MP received an answer to her question on how much funding has the Department of Health allocated to social care for the elderly. Paul Burstow explained that allocating funding for adult social care is the responsibility of local authorities, who receive funding from central Government through the local government formula grant and raise money locally through council tax.
He added that the latest local authority budget data for 2011-12 show that local authorities have budgeted £7.0 billion towards social care for those over 65. The Department of Health also estimate that around £300 million has been transferred to local authorities for older people's services from primary care trusts this year, as part of the additional support for social care provided through the health system. Budgeted expenditure for older people will therefore be around £7.3 billion this year.
Liz Kendall MP quizzed the Minister over how many unplanned hospital admissions for people aged 65 years and over there were, broken down by (a) local authority and (b) NHS commissioner in each month in (i) 2008-09, (ii) 2009-10, (iii) 2010-11 and (iv) 2011-12. A reply is due next week.
The highlight of the week was a three hour backbench committee debate on funding of social care that took place in Westminster Hall. Sarah Newton MP opened the debate. There had been a failure in political will, resulting in only limited action being taken. However, demographic change and its impact is now an issue moving rapidly up the political agenda. All parties have signalled a desire for a long-term, all-party solution to the care crisis. It is clear that now is the time for us to take action.
Polling evidence last year showed that 62% of the public saw care reform as one of the most important issues for the Government, and more than 50% of people felt that political parties were not doing enough to improve care for older people.
The Dilnot Commission’s report had support from a wide range of stakeholders and was warmly welcomed by all political parties. She said that real spending on the NHS has risen by £25 billion since 2004, spending on social care for older people and adults with disabilities had simply not kept pace. She said that whilst Cornwall had not cut services this was not the case across the country where cuts to social care were at an estimated 7%. This was creating stress in the NHS. Delays in the discharge of people from hospitals are significantly higher than they were in the same months last year. Over 75% of delayed transfers for acute care are for people aged 75 and over. She looked forward to a WRVS report which would provide evidence of the impact of councils not using effectively the additional funds that they received from the NHS.
Penny Mordaunt MP mentioned the massive unmet need in dementia care in particular bathing facilities and all the other things that constituents should have but that too many of them do not have access to. She added that some poor commissioning practices have gone on, discriminating against independent providers which could a better job at a lower cost, and have large amounts of volunteer support and a whole raft of other stuff.
Barbara Keeley said that the current system is unfair and unsustainable. The provision of information and advice is poor quality and very limited. Requests for support are increasing. In 2009-10, there were 2.1 million contacts from new clients to social services, an increase of 4% from 2008-09 and of 8% from 2004-05. Many hundreds of thousands of people never have their needs assessed. 82% of local authorities now provide care only to those with “substantial” or “critical” needs. Of those aged over 65 who needed help with bathing, 66% were not receiving any help at all. The number of delayed discharges from hospital was 11% higher in September and October this year than in the same two months in 2010. Delaying discharges from hospital is an expensive solution to the problem of inadequate social care.
Tony Baldry MP pressed the Minister on a date for the White Paper and said that the scale and nature of the growing demand must be recognised. He agreed that the cost to the NHS of delayed discharges could be significant without action. He highlighted the rising rate of dementia as the numbers of older people grew and the knock on impact on the required level of carers.
Heidi Alexander MP warned of the £80 million worth of cuts in the next three years in her constituency of Lewisham and the very difficult decisions about how to make all that work. She pressed the Minister commit to a Bill in the next Queen’s Speech.
Margot James MP said that spending on adult and social care rose by only 0.1% between 2004 and 2010. During that period the numbers of older people needing care expanded significantly. The number of older people aged over 65 increased by 7.7%, while the number of very elderly—the over-80s—increased by 11.6%. Spending on the NHS had increased by 27%, on the police by 20% and on schools by 12%. The proportion of local authorities providing care to people in moderate need fell from 36% in 2004 to 21% in 2010.She believed that to be a false economy. The Government had diverted £1 billion from the NHS to social care, and that has been well received, but did not go far enough.
Opposition spokesperson, Liz Kendall MP, mentioned the substantial levels of unmet need estimated by the Kings Fund to be around £1.2 billion. Eight out of ten councils now provide services only for people with substantial or critical needs. The Association of Directors of Adult Social Services said that social care spending has been cut by £1 billion this year, with even bigger cuts likely next year. There will be a real-terms cut of £1.34 billion to adult social care in the Government’s first two years once inflation is taken into account; £1.3 billion is being cut from social care spending for those over 65. Local council budgets are being cut by 27% during the spending review period and that that will have an effect on adult social care, because social care budgets are the biggest discretionary spend for local councils. She called for full and proper debate including politicians and the public
In responding for Government Paul Burstow, Social Care Minister, said that the Government was committed to a White Paper that they will publish next April. He admitted that things are tough, and that councils had had to make difficult decisions. It has not been an easy time and difficult decisions have had to be made across Government.
In the previous spending review, which was announced last October, the Government provided an extra £7.2 billion over four years up to 2015 to protect social care, partly through councils and partly through the NHS. The aim was to alleviate the potential pressures on the adult social care system in what would be a challenging overall funding settlement for local government.
Government had front-end loaded the funding for the first two years to insulate social care from cuts to local authority budgets. Combined with a focus on efficiency, he believed that the additional funding will protect people’s access to care services. He said that budget data collected by the Department for Communities and Local Government from local authorities suggests that social care budgets are around £200 million lower than last year, which is a reduction of just over 1.5%. However, it is not inevitable that reductions in spending lead to cuts in front-line services. For every £1 that has been saved or taken out of spending in social care by local authorities, 70p can be attributed to efficiency savings. He did not believe that Ministers should micro-manage the decisions of every local authority or dictate to local authorities about how to manage their resources.
Of the £648 million reallocated from the NHS for this year, nearly half has already been transferred and agreements are in place to transfer the remainder. The feedback that he had showed that the money is being spent on where intended —prevention and rehabilitation, re-ablement, early hospital discharge schemes and integrated crisis response services. The money was making a difference in the communities in which they are being used. He admitted that times are tough and there are areas where cuts to front-line adult social care services are really beginning to bite. He claimed that there was a mixed picture across the country and it was not true that “less money equals more cuts.” He acknowledged that WRVS are publishing a report which he will read with interest when it is published.
He concluded by saying that when the decisions are made Government will have looked at this process and the White Paper outcomes, and will be in a position to legislate at the earliest opportunity. Social care, he said has languished and rested in the “too-difficult-to-do” box for far too.
Last week David Laws MP asked in a written question what the Government’s most recent estimate is of the proportion of NHS expenditure which is spent on people aged 60 years and over. In response Simon Burns, Minister of State for Health, said that the most recent and partial analysis of national health service expenditure by age was supplied in departmental report 2006 based on analysis of financial year 2003-04 which showed that 43% of total Hospital and Community Health Sector expenditure was on people aged 65 and over.
On Monday Brandon Lewis MP quizzed the Department of Health on the steps it was taking to ensure elderly patients in NHS facilities receive adequate hydration and nourishment. A reply is awaited but it is likely to be similar to the one given by Lord Howe in response to Lord Morris of Manchester covered later in this piece.
Teresa Pearce MP asked how much the Department of Health spent on dementia research in (a) 2009-10 and (b) 2010-11 and what estimate the Government had made of spending on such research in each of the next three financial years. Paul Burstow, Minister for Social Care, said that dementia is a research priority for the Government. The Department's expenditure on dementia research increased from £12.7 million in 2009-10 to £18.6 million in 2010-11. Four new Institute for Health Research (NIHR) biomedical research units in dementia will receive a total of £18 million over five years from April 2012.
On Wednesday the Health Committee published its Public Health report. Although it made no recommendation relating directly to older people, it said that it had found that frontline public health services are not being protected. Furthermore, it said that the Department has failed to give a convincing account of its distinction between frontline and non-frontline spending in public health services. Unless it can do so, the suspicion will remain that it is an arbitrary distinction and that public health services are suffering, and will suffer, in consequence of the cuts that are being made. In setting the public health budget, it sought reassurance that the Department will take account of objective measures of need. This must apply in respect of both the national budget and allocations to local authorities.
The Committee also made comments on ring-fencing. In its view ring-fencing risks encouraging local authorities to see only spending from the ring-fenced budget as relevant to public health and runs counter to a "place-based" approach, which would allow the wider determinants of health to be more effectively addressed. Furthermore, even with ring-fencing, there is a risk of local authorities "gaming" the system and effectively raiding their public health allocations by "redesignating" as public health spending services that they are already providing from other budgets.
There was a considerable amount of activity of interest in the House of Lords this week. Lord Morris of Manchester asked the Government what response they will make to the Care Quality Commission findings of instances of elderly people being deprived of food, water or dignity in NHS hospitals; and what action they have taken or will be taking.
Earl Howe, The Parliamentary Under-Secretary of State, Department of Health, responded by saying that there is a range of initiatives the department has taken or is taking.
A number of National Institute for Health and Clinical Excellence quality standards commissioned by the department are either in place or are being developed for a range of conditions and pathways affecting older people including incontinence, nutrition support in adults, patient experience in adult NHS, delirium, dementia, osteoarthritis and falls in a care setting. One of the eight high-impact actions developed for nursing, relates to keeping people nourished and getting better and aims to stop weight loss and dehydration. This action is taken locally with initiatives such as red trays to identify patients who need help with eating and drinking. Since April 2010, it has been a requirement of a hospital's continuing registration with the Care Quality Commission (CQC), that service users are protected from the risks of dehydration and inadequate nutrition; within the NHS Operating Framework and the NHS Outcomes Framework, there are a number of indicators to support better care for older people. These include dementia care, hospital-acquired infections, emergency readmission rates, improving recovery from fragility fractures and helping older people to recover their independence after illness or injury; and the department is also funding national audits of falls and bone health, dementia, continence and hip fractures.
He continued by saying that local involvement networks in each local authority area are able to enter and view services to obtain the views and experiences of patients, service users and their families about their experiences of care and treatment at the time they are receiving it. Subject to the Health and Social Care Bill, local HealthWatch organisations will continue this enter and view activity. This information can be shared with the CQC's compliance inspectors, which will help to focus the inspection on specific concerns and thereby help the CQC to hold local services to account. Local Healthwatch will also be the champion for public and patients, service users and carers in health and social care services. Healthwatch England will be able to use information from local Healthwatch, and elsewhere, to form a national picture of services. Locally and nationally, Healthwatch will have a remit to make recommendations about how services could or should be improved.
The Department supports the partnership on Dignity in Care, which has been established by the NHS Confederation, Age UK and the Local Government Group. The partnership aims to help drive improvements in the levels of care provided to older people in hospitals and care homes and has an independent commission which is currently taking evidence.
The department has commissioned a further round of CQC dignity and nutrition inspections for older people in hospital and care home settings.
During oral questions several MPs asked what recent steps the Government has taken to support the voluntary sector. Although the Minister steered MPs to the open letter sent to all MPs and published on the Cabinet Office website setting out the strategy for encouraging more social action and supporting civil society, MPs took the opportunity to provide real examples of the pressure that charities were under. Nick Hurd MP, the Minister, said that a sector that receives £13 billion of taxpayers' money cannot be immune to the requirement to contribute to a reduction in Government borrowing. The challenge now was for Government to find a way of working together to mitigate the damage done to the voluntary sector in the short term, while preparing it for the real opportunities down the track to deliver more public services.
Caroline Lucas asked whether the Minister is considering mechanisms to ensure that hospitals are provided with financial incentives to participate in arrangements for integrated care for people aged over 75 years to facilitate better patient care and prevent avoidable hospital admissions. A reply is awaited.
Tim Farron MP tabled an Early Day Motion highlighting the issue of loneliness at Christmas.
"That this House commends the remarkable work of the Companionship at Christmas campaign, run by the charity Abbeyfield, which aims to improve the quality of life for older people by combating the acute loneliness felt by many over the Christmas period; recognises the importance of such an initiative given the growing number of older people; congratulates Abbeyfield for responding to this need in practical and creative ways by offering free lunches and overnight stays to older people in the area; acknowledges the value of inviting individuals from local communities to support, befriend and care for older people who may be far from their loved ones and suffering from loneliness; and urges all hon. Members to support and promote the campaign in their own constituencies."
Early Day Motion, Tim Fallon
Over the course of Wednesday and Thursday Baroness Smith of Basildon tabled five written questions of great interest to WRVS. These ranged from asking what progress was being made in promoting preventative care in line with the Government’s Vision for Social Care; how local PCTs had responded to the Department of Health’s request to show how the £648m transferred from the NHS was being spent; what the cost was to the NHS and local authorities of delayed transfers of care; if the Government would reintroduce the collection of data for delayed transfers for the over 75 age group; and to set out the totals in each category for the delay in transfers each month. Replies to these questions should be made by 16 and 17 November.
On Thursday Andrea Leadsom MP asked how much funding has the Department of Health allocated to social care for the elderly in the latest period for which figures are available. A reply should be made next week.
A further debate on funding of social care has been granted and will take place next week in Westminster Hall on 10 November.
There was a flurry of activity on health related issues for older people from Wednesday onwards at Westminster.
The delayed transfers of care figures were released for September. Whilst the number of delays is constant, the delays measured in numbers of days are the highest since March. At 121,795 days for September, it is over 12,000 days higher than in April when the figure was 109,362.
In response to Rory Stewart's written question tabled the previous week on support for older people living in rural areas, the Communities Minister Andrew Stunell, said that the Government’s programme included a commitment to support older people to live independently at home. To support that commitment Government has protected funding for Disabled Facilities Grant which delivers adaptations that enable disabled people to live comfortably and independently in their homes. By the end of the spending review period the national Disabled Facilities Grant budget will increase from £169 million in 2010-11 to £185 million in 2014-15. He added that the Government was investing £1.5 million in the FirstStop Information and Advice Service which aims to help older people make informed decisions about their housing, care and support options and to help them maintain independent living in later life. The Government has also provided £51 million funding for handypersons schemes over the spending review period to deliver small home repairs and adaptations.
David Laws MP asked in a written question what the Government’s most recent estimate is of the proportion of NHS expenditure which is spent on people aged 60 years and over; and if he will make a statement. The answer is awaited and will be included in the next issue of the Westminster Eye.
On 26 October John Healey MP presented a petition from the Rotherham Pensioners Action Group. The 500 plus signatures gathered by the group over are calling for a better, fairer system of care for the future. They are worried about the crisis in care caused by big Government cuts in funding as pensioners see services cut, charges increase, and support restricted to those with the most critical care needs.
Earlier that day parliament sat through an opposition day debate that lasted several hours to discuss a motion calling on the scrapping of the Health and Social Care Bill. In exchange Labour MPs extended an offer of cross-party talks on the future of the NHS. The motion, not surprisingly, was defeated and much of the debate descended into party political point scoring. However, there were some bright spots. Deputy leader of the Liberal Democrats, Simon Hughes MP called for assurances that the recommendations of the Cavendish report on elderly care would receive full consideration.
Health Committee member Dr Daniel Poulter MP said that Health and Well-being Boards (HWBs) and the clinical commissioning groups would be "good mechanisms for delivering better integrated care". There were currently too many silos in the NHS, he argued, and said the primary and secondary sectors often did not integrate well. Local Health and Well-being Boards were "definitely a step in the right direction" towards closer integration between adult social care and the NHS, he added.
On the following day MPs debated NHS Care for Older People in the Westminster Hall. This debate was granted as a direct result of pressure from backbench MPs following the critical report from the Care Quality Commission about some of the failings in NHS hospitals in providing adequate care for older people. In contrast to the previous day, this debate was constructive and conciliatory with members from all sides of the House pretty much in agreement. Whilst there are examples of excellent care many MPs highlighted stories of poor care in hospitals brought to them by constituents. Others had experience first hand from members of their own families.
"I was heartened to see a note from
Barbara Keely MP - Worsley and Eccles South
WRVS describing ward support services
it is setting up for older people, which is
a wonderful idea. It wants to improve
the experience of older people by using
trained volunteers to support them and
their families and carers. That would
include training in dementia, which
could be important...."
WRVS is about to roll out an on ward support service and this initiative was supported and welcomed by two MPs during the debate. Barbara Keeley MP, a newly appointed to the Health Select Committee
, said that she “was heartened to see a note from WRVS describing ward support services it is setting up for older people, which is a wonderful idea. It wants to improve the experience of older people by using trained volunteers to support them and their families and carers. That would include training in dementia, which could be important.” Nick Smith MP, Principal Private Secretary to shadow Foreign Secretary recognized that the voluntary sector “could be a sensitive and sensible provider. WRVS has informed us about some of its voluntary services on wards, which include befriending patients and help with feeding. I understand that it is keen to expand those services, which is something that I support.”
"WRVS has informed us about some of its
Nick Smith MP – Blaenau Gwent
voluntary services on wards, which include
befriending patients and help with feeding.
I understand that it is keen to expand
those services, which is something
that I support...."
In responding to the debate Paul Burstow said that the finding in the CQC report and other recent reports demanded action. He agreed that follow-ups by the CQC needed to be rapid and proportionate where problems had been identified. As part of the next wave of inspections announced the previous day by the Secretary of State, the CQC will carry out inspections not only on a nine-to-five, Monday to Friday basis, but outside normal hours so that the fullest possible picture is received. The Minister said that there is nothing inevitable about illness and disability in old age. Dementia or falling over is not a normal part of ageing; illness and ageing are not synonymous, and that we must get that point across when designing our systems. That does not mean that an ageing population poses no challenges to our health care system because it does, but it is also a cause for celebration. The age shift taking place in our society is one of the biggest challenges we face, and it is right that Parliament should spend more time debating it. People over 65 account for 65% of hospital admissions and 70% of bed days. There was a need for good leadership, a change in culture and better transparency in data and complaint handling. Margot James the sponsoring MP for the debate closed by drawing the Ministers attention to the figures used during the debate in which it was put that the accepted ratio of nurses in a ward with a considerable number of older people is 1:10, whereas a paediatric ward it was staffed at a ratio of 1:4. She asked that Government should consider what can be done about concerns regarding the skill mix and the management of resources.
A further debate on funding of social care has been granted and will take place in Westminster Hall on 10 November.
It’s one of those annoying, jargonistic words which mean little to those outside of a small bubble – but increasingly, the idea of reablement is something which is starting to gain political traction within Wales.
The term already elicits different definitions and understandings – and too often serves as a term onto which people project their own preconceptions. For clarity, my own interpretation is similar to the definition provided by the Office for Public Management:
"At heart, reablement is about helping people to do things for themselves, rather than doing things to or for people. It’s about supporting the whole person – addressing their physical, social and emotional needs. It’s an outcome-focused, personalised approach, whereby the person using the service sets their own goals and is supported by a reablement team to achieve them over a limited period... It focuses on what people can do, rather than what they can’t, and aims to reduce or minimise the need for ongoing support after reablement"
In simple terms then, reablement is largely common sense – helping people to negotiate the difficulties of daily living (often after a prolonged spell in hospital) so that they can live active and independent lives.
When it’s looked at in those terms, reablement starts to make sense. But it doesn’t happen by accident – it needs support from government (at a national, regional and local level) to happen. And that’s why it has been so encouraging to see greater attention being paid to reablement in Wales.
Last week, the Welsh Assembly’s Health & Social Care Committee agreed to explicitly incorporate issues around reablement into the terms of reference for their inquiry into residential care of older people. In the same week, I was fortunate enough to chair another meeting of the Welsh Reablement Alliance, an umbrella group of charities and professional bodies keen to expand and improve reablement provision in Wales.
It was also a pleasure to attend an event at the Senedd held by Care & Repair Cymru looking at helping people with physical adaptations to their homes to ensure independent living amongst older people. Undoubtedly the highlight of the event for me was a message of support sent by Gwenda Thomas AM (Deputy Minister for Social Services) in which she said:
"Reablement must be at the heart of our approach. Reablement services will be a requirement across Wales so that social services and the NHS working together can help people to maximise their recovery or develop ways of living that fit their new circumstances."
Gwenda Thomas AM (Deputy Minister for Social Services)
To see such clear, explicit support for reablement services from someone at the heart of Welsh Government policy on social care represents a major step forward. There is still much to do in order to shape a holistic and consistent reablement service for Wales – there is still an imbalance in the focus on physical support and the need for social support which improves wellbeing – but the very fact that an obscure term now has currency within the halls of power can only be a good thing.
Both Houses were in recess over the conference season. The House of Lords returned on 3 October and the House of Commons returned on 10 October.
Department of Health released its monthly delays in transfers of care for the month of August. The figures showed a slight decrease in the number of delays but the number of days is the highest since April and the second highest this year. Delays in transfers in days are now 119,770 against 107,845 in April. Only March at 122,392 was higher in 2011.
The Office of Fair Trading (OFT) published a report on the UK market for mobility aids after a seven month investigation. The OFT found that people may be paying too much for mobility aids and the elderly can experience high pressure and misleading sales practices when buying this equipment at home. The OFT launched consumer protection investigations into two national mobility aids traders, in relation to suspected unfair doorstep sales practices and over terms and conditions and service delivery.
The OFT has also launched a national consumer awareness campaign providing consumers with practical tips and informing them of their rights when buying mobility aids on the doorstep. The OFT offers the following advice to consumers purchasing at home:
- Think twice before you buy and if you are made to feel under pressure to make a purchase, have the confidence to say no.
- Be wary of time-limited or exclusive offers that need to be signed on the spot - this can be a high pressure sales tactic.
- Double check the facts. Do you fully understand the costs and know whether it includes extras like installation, on-going serving charges or warranties?
- Always shop around to compare products and prices.
- Talk to someone you trust for a second opinion.
- If you spend over £35 with a trader at home, you usually have seven days in which to cancel.
The Department of Heath began its flu vaccination programme for winter 2011-12. The Department says that there is a targeted approach for those who need to be called. GP surgeries should contact those individuals in the at-risk groups so that they can be vaccinated. Anyone in the 65 and over age group and is entitled to a free flu jab.
Parliament returned and on 4 October Simon Kirby MP received a reply to his question asking what guidance the Department of Health provided to local authorities on steps to reduce isolation, loneliness and fear amongst people in later life. In replying, Social Care Minister Paul Burstow said that the Department has not issued any specific guidance to local authorities in relation to reducing isolation, loneliness and fear among older people. However, the Department is seeking to collect data around social participation through the 2011-12 Adult Social Care Outcomes Framework indicator, which focuses on enhancing the quality of life for people with care and support needs including older people. In addition, the Department's national evaluation of Partnerships for Older People Projects informed councils about the benefits that small services such as providing practical help and emotional support could positively affect the health and well-being of older people.
Adrian Sanders MP tabled an Early Day Motion. The EDM currently has 11 signatories
"That this House congratulates the Hairy Bikers' television campaign to reform the Meals on Wheels service and to recruit more volunteers for the Meals on Wheels service; applauds the valuable work undertaken by the Meals on Wheels service for the most vulnerable in society; notes that councils are cutting subsidies to the Meals on Wheels service; further notes that many of the users of the service cannot afford to pay the resulting increased prices; calls on the Secretary of State for Communities and Local Government to protect the subsidies for the Meals on Wheels service and to encourage more volunteers across the country to take part in the scheme."
Adrian Sander's EDM
Paul Burstow responded to a question from Ian Austin MP who asked what assessment he has made of the effect of reductions in funding to local authorities on the number of day centres operational in
(b) the West Midlands
(c) Dudley borough.
Paul Burstow said that the responsibility for addressing and commissioning social care needs of local communities rests with local authorities. The Government recognised the importance of social care services and have taken steps to ensure that local authorities have sufficient funds to provide them. In recognition of the pressures on the social care system in a challenging fiscal climate, we have allocated an additional £2 billion by 2014-15 to support the delivery of social care. With an ambitious programme of efficiency, there will be enough funding available both to protect people's access to services and deliver new approaches to improve quality and outcomes. Numbers of day centres is collected centrally.
The House of Commons Health Committee held an oral evidence session on public expenditure. This involved members of the Committee firing questions at the Secretary of State Andrew Lansley and his team of senior officials. The Minister faced robust questioning from the Committee. In particular Dr Dan Poulter MP pressed on the need for more integration and joined commissioning of care services for older people but was concerned over the lack of incentive for it to take place.
David Tredinnick MP asked how local authorities were supposed to maintain eligibility criteria when funding was being cut and demand was increasing. The Department of Health admitted than even after the transfer of £800m this year from the NHS to PCTs, that they would still face a reduction of between 1 and 1.5%. The Minister went on to explain where the additional money as being spent.
The Care Quality Commission published a report State of Care on its targeted inspection programme of NHS hospitals. It looked at whether older people are treated with respect and whether they get food and drink that meets their needs. The report notes alarming findings at over half of the hospitals visited, with 20 hospitals failing to meet one or both standards.
This was quickly followed up by two MPs seeking a debate about the care of older people in hospital. Margot James MP asked that following the worrying report from the Care Quality Commission on the lamentable standards in the care of older people in the NHS-it found that 20% of the 100 hospitals it inspected were almost criminally negligent-could there be a debate on this subject? A question from Nick Smith MP followed in similar fashion, pressing the Leader of the House for a statement on NHS care for the elderly and time in the House to discuss the matter as soon as possible.
In responding Sir George Young said that he too was concerned over the findings and that he would welcome such a debate. He suggested that the Backbench Business Committee was approached to see whether it might find time for one. The call for a debate accepted by the Committee and time has been set aside on 27 October to discuss NHS Care of Older People.