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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.
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.
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.
For the first time, today saw a proper national debate on the role that older people can play in the Government’s Big Society.
WRVS has been urging the Government to give pride of place to older peoples volunteering in its Big Society vision over the last year. We’ve felt that the volunteering agenda that really excites ministers focuses on 19 years olds gap year volunteering and not older volunteers.
Today we started to see some recognition that the Government is getting more serious about the older peoples volunteering agenda. Nick Hurd said that volunteers could play a crucial role in keeping people out of long term care. He zeroed in on the ‘Baby Boom’ generation of people due to retire in the next five years and emphasised the considerable skills that they have.
A fellow speaker, Antonia Cox author of a report on mobilising volunteers drew attention to the findings of WRVS’ report, Gold Age, which shows how much older people are already the mainstay of the Big Society.
When I spoke I highlighted the work that we are doing to reach out to people who have not volunteered before with our Carebank project in Maidenhead. I and members of the audience pressed Nick Hurd on the need for local authorities to ‘step up’ and use their considerable contacts with older people to make individuals aware of volunteering opportunities.
Geraldine Bedell spoke from the Gransnet charity and argued that one barrier to getting more older people active in their communities was a feeling that their contribution was not fully recognised and valued. Geraldine herself was a judge for WRVS’ Gold Age Power List that recognises older people’s impact across our society.
So where do we go next? WRVS will be knocking on ministers doors again asking them to follow up on some of the ideas that came, not only from us, but from Conservative activists who spoke in the meeting.
Matthew Sowemimo, WRVS Head of Public Policy spoke at the ResPublica Fringe meeting during the Conservative Party Conference.
The Strategic Spending Review for Scotland starts today with a statement from Cabinet Secretary for Finance and Sustainable Economic Growth, John Swinney. The announcement comes at the same time as the detailed 2012-13 budget process starts.
Both the Strategic Spending Review and the Budget are vital for Scotland, which has chosen a different path to that followed by the Westminster government. Where at Westminster the focus is on reducing public spending, in Scotland the government is seeking to guide the country out of recession through investment. The Strategic Spending Review will set the framework for spending up to the next Scottish election.
What we have is, effectively, a control in an experiment on whether investment or cuts are the best way out of a recession. It is, however, difficult to identify which areas of investment will be sustained in the Strategic Spending Review. While capital investment has been included in a Cabinet portfolio for the first time it is revenue spending that will be vital to determining Scotland’s future.
The watchword for the past year has been prevention. The Christie Commission, Independent Budget Review and Scottish Parliament Finance Committee have all published reports that have suggested that prevention must be at the heart of all public services.
By preventing need arising we can both increase people’s quality of life and reduce expenditure on public services. It is the win-win that can help Scotland out of the recession.
The Strategic Spending Review will allow us to see how much of a priority prevention will be for government in the coming Parliamentary term. Of course, prevention is, in itself a complex concept. There is very substantial opportunity to make huge improvements to people’s lives through intervention during the early years of childhood. But we can also make massive improvements in the lives of adults through intervening to prevent future need.
These are different things, both are of great value, but the debate about prevention is muddled by the subtle differences. We must act now to make sure that our ageing population continues to be an asset. By taking preventative approaches we will enable ourselves to grow older in a way that both maintains well being and avoids major medical interventions. That’s good for people and good for the budget.
It’s important that helping us to age well doesn’t distract from the important task of breaking cycles of intergenerational poverty. But it’s also important not to see the two outcomes in competition. Getting it right for Scotland’s people will mean more effective preventative approaches in the early years of life and for our ageing population. Indeed it will require early intervention to prevent re-offending, to encourage life-long learning and to limit welfare dependency.
The aim for the Strategic Spending Review should be to diminish acute spending wherever it occurs. The best way to achieve that is to place prevention in all its forms at the heart of public service provision.
What we hope Mr Swinney will do today is to seek new ways to shift the balance of care towards prevention. It’s the ultimate win-win, at a time when we need to create a better future for all Scotland’s people.
As MPs returned from their summer break, a debate on care and services for older people took place in the Westminster Hall on Tuesday 6 September. Tracey Crouch MP for Chatham and Aylesford began proceedings with a strongly saying that she believed that people want to live in their own home and community for as long as they can physically do so, and that the delivery of certain services can prevent people from entering residential care, which benefits both them and the state.
She expressed support for the campaign to appoint an Older People’s Minister, but understood the Government’s opposition to create another Ministerial post. She therefore suggested two options that Government might find easier to accept. The first was to establish a Cabinet Committee to look at older peoples’ issues and the second to introduce a new test within regulatory impact assessments that would examine the effect of proposals on the over-65s. Tracey Crouch supported the Dilnot Committee report and recommendations and called for a swift implementation and not a lengthy delay. She called for health checks for those in their 50s and 60s and highlighted the lack of good quality, affordable homes for those able and willing to remain independent. She talked of the problem of isolation and told the tale of how WRVS had improved an older persons quality of life by something as simple as changing a light bulb.
Jack Dromey the Labour MP for Birmingham, Erdington said that successive Governments had failed to address the growing crisis in social care. He said that the Government’s cuts were going to deep, too quickly, and were having a damaging impact on local authorities’ ability to deliver services and gave examples of what was happening in his constituency. He too offered his support for Dilnot. He added that WRVS has done excellent work in the field, and had said rightly that the Government must both address the adequacy of the funding that they have made available and ensure that it is wisely spent and properly monitored.
Anne Marie Morris whose constituency was in a region of the country with the highest population of older people, raised the issue of quality in residential homes and in domiciliary care.
Margot James said that the increase in local authority budgets for adult and social care had been minimal compared with the increase in many other local authority budgets, particularly that for children and younger people’s services. With adult and social care, the starting base is already very low, which is one of the problems and is why local authorities are struggling so much.
Tony Baldry was not confident about who had a grip on domiciliary care and trying to ensure that there are sufficient providers of day care for those who need it. If the thorny issue of delayed discharge was to be addressed, more thought was needed on how to ensure that there are sufficient places in the nursing home and residential care sector. Enhancing the professionalism of care staff and also their reputation and status was key for success.
Gareth Johnson said that Care and services for older people are of increasing importance, and agreed with the sentiments expressed about how to deal with the issue sooner rather than later. He was surprised how easy it was in England to close care homes and the lack of security of tenure for residents.
In summing up for the opposition, Emily Thornberry spoke of the terrible consequences of the massive spending cuts are becoming clearer, in particular on underfunding in the social care system, which was getting to breaking point. She had already shared with the Minister her research on the effect of the cuts on local authorities and on adult social care and she was undertaking further research which she would send to him in due course.
Her preliminary findings showed £1.3 billion in real-terms cuts in local authority spending on social care in both 2010-11 and 2011-12. For the oldest and most vulnerable, the picture showed real-terms spending on social care for the over-65s lower than in 2009-10 by £60 million in 2010-11 and £1.3 billion in 2011-12. The Opposition made it clear that it will work with the Government to find a solution to long-term funding of care based on the Dilnot recommendations. Funding was not the only matter dealt with in the recommendations of Dilnot and the Law Commission. They included recommendations to improve available information, to support carers, and to enable portability of care. She wanted to ensure that that happens, and quickly and pressed the Minister to commit to legislation during the next session of Parliament to deal with the Dilnot recommendations.
Paul Burstow responded on behalf of the Government. He stated the coalition’s commitment to see health and social care provided in ways that achieve better outcomes and deliver more personalised services. A sea change was required in the nature of the working relationships at local level, so that closer relationships between local authorities and the NHS become the norm.
He stressed that NHS funding that goes directly to local authorities for measures that support social care and benefit health will rise to £1 billion per year by 2014-2015. This year, £650 million had been allocated to PCTs and transferred to local authorities to invest in social care services. He appreciated the support from all parties about the Dilnot inquiry and the appetite to get on with action. He said that he would ensure that that appetite was well understood across Government. The Dilnot report submitted in July made an excellent contribution to providing a framework around a wider reform of social care for the future. The Government would soon set out a further process of consultation not only about the details of implementing the Dilnot inquiry
In closing he commended the contribution made by the voluntary sector and charities, in particular the role that such organisations can and do play in tackling social isolation including practical, low-level help—for example, helping to change a light bulb, which sometimes seemed to take forever.
On the same day the Health and Social Care Bill was being debated and tabled amendments being voted on. By the end of the week the Bill had been dispatched to the House of Lords for further scrutiny.
Penny Mordaunt MP for Portsmouth North tabled two interesting written Parliamentary Questions during the week. The first was to ask what role the Minister proposes for clinical audits in assisting commissioning bodies to (a) identify the reasons for emergency readmissions of patients aged over 65 years of age and (b) evaluate the effectiveness of post-discharge planning. This is something that WRVS called for in its open letter to Paul Burstow in July. The second question asked what role the Minister proposes for befriending services in the NHS.
In answering the first question Simon Burns stated that NHS service organisations should use appropriate indicators to monitor and seek to improve the quality of the care which they are commissioning or providing.
Available indicators include various measures of the rates of emergency readmission following specific procedures, and an indicator of the proportion of older people who were still at home 91 days after discharge from hospital into rehabilitation, services. Where these high-level indicators show cause for concern, more detailed local clinical audit may be helpful in identifying the possible underlying causes. In line with the Government's commitment to greater transparency in the information available on the outcomes of patient care, providers are encouraged to share appropriate data from clinical audit with their commissioners.
In responding to the second question, Paul Burstow said that people supported by community care services can often feel socially isolated and lonely. Befriending services provide people in this situation with opportunities for social interaction and a sense of being part of a community. These services can be particularly helpful for people recovering from a mental illness, older people, people on the autistic spectrum, and those accessing palliative care.
He continued that the Government’s goal is to give local communities a much greater say in determining local arrangements for assisting and supporting NHS patients. The new local Healthwatch will make its own decisions about what is needed locally-whether and how to make the best use of local people to respond to the needs of patients both in hospitals and in community settings. This builds on the existing powers of local authorities and local health bodies to commission both advocacy and befriending services.
In another linked question Simon Kirby MP asked what guidance the Department of Health provides to local authorities on steps to reduce isolation, loneliness and fear amongst people in later life. The Ministers response is awaited and will be covered here in a future Westminster Eye.
On 14 September the Health Select Committee issued a call for written evidence for its inquiry into social care. The deadline for submitting written evidence is noon on Wednesday 26 October 2011. The purpose of this inquiry is to consider the issues facing the government as it prepares its Social Care White Paper, and make recommendations for consideration by the Government before the White Paper is published. The inquiry will focus on adult social care, particularly of those people of 65 years of age and older. The Committee will consider, amongst other issues:
- The practical and policy implications of the Government's plans for funding social care, and the recommendations made by the Dilnot Commission and the Law Commission
- The scale and implications of existing variation in access to and charges for social care
- The practical and policy implications of the Government's commitment to promote personalisation of social care, including personal budgets and direct payments
- The barriers faced by recipients of social care when they wish to relocate to another area, particularly with regard to the portability of assessments
- Economic regulation of the social care system including a proportionate failure regime that can mitigate against the failure of social care providers
- The practical and policy implications of the Government's stated commitment to promote integration between health and social care services.
On 15 September the Government announced the creation of a Panel of Experts to help the Government’s discussions on how to improve the care system in England. The Caring for Our Future engagement exercise aims to pinpoint the priorities that this Government needs to focus on to inform its formal plans to improve the care system. This follows on from the report on Commission on Funding of Care and Support. It aims to use the report as the basis for engagement as a key part of a wider care and support reform agenda. To assist with this, the Department of Health has asked key leaders from the care and support community to help it to lead discussions on six broad themes:
- Quality - Imelda Redmond (Carers UK)
- Personalisation of Care - Jeremy Hughes (Alzheimer’s Society)
- Shaping local care services - Peter Hay (ADASS)
- Prevention - Alex Fox (NAAPS)
- Integration (in partnership with the NHS Future Forum) - Geoff Alltimes (Hammersmith and Fulham Council) and Dr Robert Varnam (Practising GP, Manchester)
- Role of financial services – Nick Kirwan (ABI)
Parliament is now in recess and returns in early October.
Posted by Steve Smith, Public Affairs Officer at 09:00
Tuesday, 20 September 2011.
Lessons from Sweden and Canada
Efficiency savings. Austerity measures. Cuts. Call them what you will, the economic changes being made by the Westminster Government are bound to have an impact on people who rely on services provided by (or through) the state.
Over recent months, the Bevan Foundation has considered the potential impacts on (amongst other things) children, on housing waiting lists and legal aid. But what will the impact be on older people, in Wales and beyond?
Today, the older people’s charity WRVS (in conjunction with the research consultancy SQW) have released a report, Public spending cutbacks and impacts on older people, looking at impact on older people of fiscal consolidation measures made in Sweden and Canada – two countries that have been cited as success stories by advocates of tough public spending cuts in Britain.
The headline finding is that older people suffer disproportionately from cuts, and that ultimately the burden on health services is increased. This is unambiguously supported by the Swedish and Canadian experiences:
- Older people in Sweden experienced a sharp decline in their state of health, including in pain and psychological distress. There was a 69% reduction in geriatric hospital beds, and the most adverse health impacts were amongst older people from the lowest income backgrounds
- There was also big increase in the caring burden faced by women and family members as care services in Sweden were scaled back dramatically (one in seven older people in Sweden who needed home help could not afford it)
- In Canada, a 5% cut in health spending led to increased infection rates. There was an increase in the mortality rate of Canadians over the age of 85 with a particularly dramatic increase in the rate for people in their nineties.
Disturbing though these figures are, they also have the potential to be instructive about how best to approach the planning of services for Wales to ensure that savings can be made without having a detrimental impact on service users. Others will have their own suggestions for what the Welsh Government could do to mitigate the impact of funding cuts – but here are a few suggestions.
If preventative services are embraced, not only do people benefit, but the state can also achieve real savings through reduced hospital admissions and a reduced burden on formal social services. This was recognised by the Pearson Review of social services in Wales, which characterised any retreat into core services by local authorities as “short sighted” and “unsustainable”. Support for preventative care has also come from the Social Services Improvement Agency, from BMA Cymru and from The King’s Fund. Making prevention the central component of the proposed Social Services Bill could therefore improve wellbeing and also keep hospital admission rates to a minimum.
Furthermore any moves to Common Eligibility Criteria for Welsh social services could set the threshold for care at Low, so that local authorities necessarily have to embrace the prevention agenda.
The clear message to government – at Westminster, at Cardiff Bay and elsewhere – is that cuts to preventative services could be one of the biggest false economies ever made if we truly want to make Britain a great place to grow old.
This article originally appeared at the Bevan Foundation’s ‘blog: http://thisismytruth.org
Posted by Ed Bridges, WRVS Public Affairs Manager for Wales at 10:30
Tuesday, 06 September 2011.