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Westminster Eye: An insight into the week of politics 11 -15 July
It was a bumper week in Parliament on social care issues.
Monday began with Lewisham East MP Heidi Alexander tabling an early day motion that read:
“That this House notes that cross-party commitment and co-operation is urgently needed to reform the way that adult social care is delivered; acknowledges the desire amongst all parties for this reform; recognises how important it is that the reports of the Law Commission and Commission on Funding of Care and Support are acted upon; further notes that local government is ready to work with central government on this extremely pressing agenda; and calls for immediate and detailed debate on how to take reforms forward and a subsequent care and support reform White Paper and Bill to follow promptly”. The motion presently has the support of eight MPs.
An All Party Parliamentary Group open meeting took place on Monday evening to discuss the Andrew Dilnot report. Andrew Dilnot gave a similar presentation that he gave at Independence Day. Other speakers included Barbara Keeley, Emily Thornberry, Lord Warner and Earl Howe. There was some time for questions in the last 15 minutes or so and preference was given to APPG members and other MPs in the room. They easily took up the time and so no additional questions were taken from the floor.
Paul Burstow replied to Penny Mordaunt’s question from the previous week. He acknowledged the WRVS commissioned report by Frontier Economics and said that he recognised that investment in integrated preventative services by the NHS and local authorities led to better outcomes for individuals including helping people to live independently for longer, and can also realise efficiencies for both the NHS and local authorities. The Government had invested £150 million in the NHS this year to support re-ablement, which will help people recover their independence after a spell in hospital.
Paul Burstow also responded to Claire Perry’s question on reviewing the allocation of social care funding following the increase in the number of delayed discharges from hospital in May. He said that no one should be made to 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. The Government has recently 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 spell in hospital. The spending review recognised the importance of social care and the Government had allocated an additional £2 billion by 2014-15 to support the delivery of social care. As part of this funding, this year funding of £150 million has been made available for re-ablement and £648 million for social care spend that benefits the NHS which could help to reduce the level of delayed discharges. Local authorities are responsible for decisions on how to allocate their resources.
Health Oral Questions took place on Wednesday afternoon. The questions generated a fair amount of debate around social care including the recommendations made within the Dilnot report. A number of MPs raised questions of interest to WRVS. These included Stella Creasy MP asking what estimate had been made of the change in net public expenditure on older people's social care since April 2010. She also quoted the Association of Directors of Adult Social Services, who reported that nearly £1 billion is being taken out of social care budgets following cuts and asked when the Minister would deliver interim funding relief, so that patients can be discharged from hospital, and to avoid a crisis in social care.
Paul Burstow said that expenditure on social care for older people was £7.5 billion for 2009-10. He added that £700 million of the £1 billion is to be found not through cuts in services, but through efficiency savings, for example through the use of telecare, which significantly reduces costs, and investment in re-ablement services, which save resources and help people to get back on their feet. When it comes to investment, the Government have already made clear their commitment through the spending review, and are investing, by the end of this Parliament in 2014-15, an additional £2 billion.
Bob Blackman MP claimed that the extra money being given to adult social care was good news, but in Harrow, the council was setting the £2.1 million additional funding against redundancies, rather than passing it on to the weak and the vulnerable and asked that action be taken to ensure that the new money reaches the people who need it. Paul Burstow said he was determined to make sure that the additional resources that the NHS is transferring to social care delivers real benefits for people who need social care services, protect services, and allow local authorities to make the right decisions about how they continue to support not just investment in prevention, but those most in need.
Pat Glass MP was disappointed that the Government's White Paper would not be published until the spring, and asked if the Government agree to take forward the commission's recommendations on national eligibility criteria and portable care assessments? Paul Burstow the ADASS survey showed that the majority of local authorities moved, under Labour, to "substantial" needs being the test for access to social care. The Law Commission has made recommendations portability that the Government have to consider, and would need to look to legislate on that.
In the Lords Baroness Smith of Basildon received a reply to her question on what steps the Government had taken to ensure that the additional funding allocated for social care is being spent as Ministers intend. Earl Howe in his reply said that the additional funding for social care has been allocated in two distinct ways, through formula grant to local authorities and from the NHS to local authorities. In 2011-12, an additional £530 million was allocated to local government in addition to existing departmental grants for social care. This funding was allocated to local authorities through the local government formula grant. Formula grant is not hypothecated for different services and it is therefore not possible to determine how much of the additional funding through local government has been allocated for social care. However, the Government do receive local authorities' budgeted spend on adult social care through the revenue account data returns in June of each year.
In addition to funding through formula grant, the Government provided a specific allocation of £648 million to Primary Care Trusts (PCTs) for 2011-12. As part of the Government's planning and assurance processes for 2011-12, they are holding strategic health authorities (SHAs) to account for ensuring that arrangements are in place between local authorities and PCTs for the funding to be transferred and objectives for the investment agreed. Local authorities and the NHS have been working together to agree how this funding should be best used to support social care services. NHS planning assurance showed that all SHAs had confirmed there were local plans in place to agree the transfer. Government will continue to get information on the progress of the money as the NHS financial reporting year progresses.
In addition to this funding, the Government allocated £150 million to PCTs in 2011-12 to develop local re-ablement services in the context of the post-discharge support plans submitted to SHAs this December. It is for PCTs and local authorities locally to agree the plans for this funding. In 2010-11 an extra £162 million to local health and care services to spend on front-line services. In addition, £70 million was made available for re-ablement services in 2010-11.
Emily Thornberry MP asked what the timetable is and what are the reasons are for the time taken to publish the findings of the Whole System Demonstrator programme on telemedicine.
Stuart Andrew MP asked the Secretary of State for Health whether there will be a person appointed to the NHS Commissioning Board who’s main duty is to promote integration across health and social care and. how he plans to promote the integration of health and social care budgets. In response to the first part of the question Simon Burns said that the Board itself will determine its own appointments but will include people with a range of skills and experience covering both health and social care.
Paul Burstow, in replying to the second part of the question, said that flexibilities in the NHS 2006 Act already support opportunities for integrated working by facilitating lead commissioning, integrated provision and pooled budgets. Greater integration had been identified between health and social care as a key priority and has demonstrated its importance by the development of new and integrated health, social care and public health outcomes frameworks. Furthermore, there will be a stronger duty on the NHS Commissioning Board, clinical commissioning groups, the health and well-being boards and monitor to encourage integrated working at all levels. Improving integration between health and social care will also be one of themes of the engagement exercise following on from the Government's response to the report of the Commission on the funding of care and support.
Thursday saw the publication of Healthy Lives, Healthy People: Update and Way Forward which sets out the Government's vision for a public health system that places local communities at its heart. It will have a clear focus on prevention and reducing inequalities and will work across Government to address the wider social determinants of health.
On Thursday Tom Blenkinsop MP asked what recent estimate Government had made of the annual cost to local authorities (a) in Teesside and (b) nationally of the provision of social care.
The week ended with Andrew Dilnot, head of the Commission on the Funding of Care and Support, saying that he will be disappointed if the Government have not released a white paper responding to his recommendations by April 2012.
Westminster Eye: An insight into the week of politics 4 - 8 July
The week began with Penny Mordaunt MP asking the Government what thought had been given to Frontier Economic's findings on the Social Return on Investment that WRVS services in preventative care for older people saves money for the NHS and local authorities. Claire Perry MP asked the Government whether there were plans to review the allocation of social care funding following the increase in the number of delayed discharges from hospital in May. Answers are awaited.
Barbara Keeley MP received answers to her questions, particularly those on changes to the eligibility criteria for social care and what steps were being taken to monitor changes to local authority social care eligibility criteria. Social Care Minister, Paul Burstow, said that there was no change in the Department's policy that it does not formally monitor changes to local authority social care eligibility criteria. Allocation of resources at local level is the responsibility of local authorities. Councils should use the framework set out in its guidance to draw up local eligibility criteria. The Association of Directors of Adult Social Services (ADASS) published a survey that showed that 13% (19) councils had changed their eligibility criteria between 2010-11 and 2011-12. According to the survey, there are now 78% (116) councils at substantial, 15% (22) at moderate, 3% (4) at low and 4% (6) at critical.
Barbara Keeley MP also received answers to other questions about monitoring the expenditure of funding allocated to local authorities for social care and how much of the funding for social care announced has been allocated to each local authority. Paul Burstow said that the additional funding for social care was allocated in two distinct ways, through formula grant to local authorities and from the NHS to local authorities. In 2011-12, an additional £530 million was allocated to local government in addition to existing departmental grants for social care. In addition to funding through formula grant, the Government provided a specific allocation of £648 million to primary care trusts for 2011-12 for measures that support social care.
The Government is holding strategic health authorities to account for ensuring that arrangements are in place between local authorities and PCTs for the funding to be transferred and objectives for the investment agreed. NHS planning assurance showed that there were local plans in place to agree the transfer. The Government allocated £150 million to PCTs in 2011-12 to develop local re-ablement services. It is for PCTs and LAs locally to agree the plans for this funding. In 2010-11 an extra £162 million was made available to local health and care services for front-line services. In addition, £70 million was made available for re-ablement services in 2010-11.
Tuesday was Independence Day, a conference to promote debate and innovative thinking on policy on meeting the needs of an older population. There were a number of high quality speakers including David Behan of the Department of Health and Andrew Dilnot whose Commission had reported on the future funding of care a week earlier. WRVS was in attendance with an exhibition stand, but also posing questions to the panellists and later in the afternoon leading a Shaping Our Age Master Class.
Eligibility of social Care was back making the headlines on Wednesday following the Supreme Court’s ruling to back Kensington and Chelsea’s decision not provide night care to an older person. In response to this and news from ADASS that there were further cuts in the pipeline, WRVS sent an open letter to Paul Burstow, warning that Government inaction over local authority care cuts is untenable. In the letter, WRVS asked for action to be taken over Birmingham City Council's attempt to restrict care to those with critical needs only. The letter also calls for clinical audits of emergency admissions to hospital amongst the over 65s given that increased numbers of older people may be hospitalised following the cuts. The audit findings would equip commissioners with the data they need to evaluate the impact of post-discharge planning and assist in the planning of jointly commissioned services.
By the end of the week Baroness Smith of Basildon had received replies from Parliamentary Under-Secretary of State, Department of Health, Earl Howe, on some WRVS specific questions. Her first question asked the Government what steps they were taking in response to the finding in the Frontier Economics report that investment in WRVS services in preventative care for older people provides significant savings for the National Health Service and local authorities. Earl Howe agreed that investment, by the NHS and local authorities, in integrated preventative services can lead to better outcomes for individuals including helping people to live independently for longer, and realise efficiencies for both the NHS and local authorities. £150 million was invested in the NHS this year to support re-ablement, which helped people recover their independence after time in hospital.
Baroness Smith also asked what equality impact assessment the Government had undertaken of the effect of the Comprehensive Spending Review settlement on social care; and what risks to physical health and well-being outcomes for older people arising from the settlement were identified. Earl Howe responded that the spending review recognised the importance of social care in protecting the most vulnerable in society. The coalition Government had allocated an additional £2 billion by 2014-15 to support the delivery of social care. This meant that there is enough funding available both to protect people's access to services and deliver new approaches to improve quality and outcomes. Local authorities are responsible for decisions on how to allocate their resources and therefore responsible for assessing the impact of their spending decisions, which may include an equality analysis if appropriate. The department will monitor outcomes for social care users, as set out in the publication Transparency in Outcomes: A Framework for Adult Social Care.
Westminster Eye: An Insight into the week of politics 27 June - 1 July
On Monday Barbara Keeley MP tabled a host of social care related written questions for both the Health and Communities and Local Government Ministers to answer. This comes in addition to a batch of related questions tabled the previous week for which answers are still awaited.
On Wednesday Minister for Care Services, Paul Burstow gave the Keynote speech on Social Care Reform at a Kings Fund/Age UK event. Mr Burstow warned that care for the elderly would “never” be free, describing the idea of a fully state-funded system as “a fantasy” and that “the boat has sailed on a wholly tax-funded social care system”. Mr Burstow said he expected a rough ride when the reform plans are announced especially from those who did not understand the system. He stressed that many people already face care costs of more than £50,000, while one in ten will have to pay more than £100,000.
WRVS was in attendance and asked what action the minister was taking to ensure that local authorities invested in preventative social care as directed in last November’s Vision document as it made both economic and social sense. Mr Burstow said that he was a supporter of localism and wasn’t going to micro manage councils spending. But before he answered the Minister praised WRVS for the its work in producing the Gold Age Power List and the positive message it sent about older people making a significant contribution to society in all walks of life.
Also on Wednesday Desmond Swayne MP asked the Secretary of State for Health whether he plans to respond to the Equality and Human Rights Commission report on care for people aged over 65 in England and if he will make a statement. Paul Burstow replied that there can be no place for poor quality care in care services. He welcomed the interim findings of the Equality and Human rights Commission report on home care. The Government would respond to the final report when it is published in November this year. This report and others will help drive up standards in care and expose bad practice. He finished by saying that the Government would publish a White Paper setting out the Government's plans for reforming social care-this will include measures designed to improve the quality of care and support services.
The big social care event of next week will be the publication on Monday of the report of the Commission on Funding of Care and Support, chaired by Andrew Dilnot. Many groups have pre-empted the announcement and publicly set out their own wish lists. But more on that next week...
Public service provision in Scotland is at a crucial juncture
The character of public service provision in Scotland is at a crucial juncture. There is a fundamental reconsideration of the architecture of the state for the first time in a generation. Where previous governments have sought to focus on economic growth or distributing the benefits of economic growth to create a fairer society, Scotland is now trying to create a fairer society with lower levels of government spending.
Last week the Commission on the Future Delivery of Public Services in Scotland (or Christie Commission as the report is popularly known) reported. The Commission, chaired by former STUC General Secretary Campbell Christie, was set up by the last Scottish Government with the aim of providing some radical thinking on how high quality public services can be provided in a time of budget constraint. Scotland was always going to elect a government that was committed to substantial continued provision of public services. The fundamental question was how to do this when the block grant the Government receives from Westminster was diminishing.
The Christie Commission must be read in the context of the Scottish Government commissioned Independent Budget Review, and the Scottish Parliament Finance Committee’s Report on Prevention. Together these provide a crucial insight into the new direction Scottish politics is taking.
The touchstone for this new direction is prevention. Where previously public spending was allocated to a number of what we might judge to be public goods, there is now a commitment to investigating how services can be tailored to prevent future need. So where in the past spending commitments were made to blanket provision of primary or secondary education or a national health service future expansion of the state must deliver lower demand on acute services.
This will improve quality of life for everyone. By preventing ill health or crime the lives of everyone in the community is enhanced. The thinking is that by targeting resources at activities which are known to reduce future demands on public services Scotland can continue to provide high quality public services.
So far, so obvious – the real challenge for Scotland’s politicians, and the area where the Christie Commission paves the way for change is in implementing effective prevention. The umbrella body for local authorities, CoSLA was quick to welcome the report, and its focus on prevention. But it’s hard to see how more provision by Local Authorities on their own will be enough to deliver the outcomes that the Christie Commission is seeking.
Real progress will only come when we have a genuine commitment to building more resilient communities. That means bringing together not only the apparatus of government, but all of the resources available to our communities. And the most obvious resource those communities have is the community itself. Where local authorities are effective at providing a safety net, it is volunteers and voluntary organisations that most often provide the services that are most effective at preventing need as this report into WRVS services in Leicester and Staffordshire proves.
When WRVS Meals on Wheels services deliver a meal to someone they also make sure that that person is safe, warm and well. In doing so they help to ensure not only that that person won’t be using acute hospital services, but also that they feel part of a community. And not only does the person receiving the meal benefit, but the volunteers delivering the meal get to do something worthwhile, meet new friends and keep themselves active for longer.
These things, though they provide real and concrete benefits, are difficult to measure. I sincerely hope that one outcome of the Christie Commission will be an acknowledgement by government at local and national level that because something is difficult to measure, doesn’t mean that it delivers no benefit. In fact, often the elements of service that are most difficult to measure are those that create most benefit.
I’d be really interested to hear what it is that keeps you or yours well and happy – if you’ve got experiences or any comments, do please share them below...
Dilnot's Commission Report on Funding of Care and Support published
Today is one of the most important days in the history of social care provision since the war. Whilst health services were provided free at the point of use from 1948 onwards, social care has been increasingly subject to charging. Social care has never attracted anything approaching the priority level that has been accorded to the health service. For people with degenerative conditions and older people, whilst medical interventions can treat them, it is social care that enables people to have a full life. The 2010 Health Select Committee report found that the system was variable, unfair to carers and failed to prevent or delay disability.
The variability of the system will in part be addressed by today’s report by Andrew Dilnot and his colleagues. Moving towards a system where individuals know how much they will need to contribute towards paying for long term care could relieve pressure on many families. However long-term care is only part of the wider picture of provision that enables people with disabilities, older people and their carers are enabled to have fulfilment and dignity. Unless ministers pursue this level of ambition, then more people are likely to be pushed into residential care regardless of the balance of contributions made by the individuals and the state.
The system has to reduce the vulnerability of older people and this makes it essential that the retrenchment of home care provision is reversed. Prior to the cuts programme, 300,000 fewer people were receiving state funded domiciliary care support. There is now a well-established trend of local authorities restricting care services for those people with the most severe needs and this has intensified since 2010. The 2008 Commission for Social Care Inspection argued that this policy was self-defeating as it only pushed up costs in the longer term. The Dilnot report concludes that there are unacceptable variations in eligibility for services across the country. In Wales, WRVS has already called for harmonised eligibility criteria.
It is also good to see that Andrew Dilnot and his colleagues have recommended that preventative care is beneficial. As the Commission report says, these activities have the potential to stop an individual’s needs escalating. WRVS has long argued that preventative care should focus on overcoming the loneliness faced by many older people and helping them manage life challenges, like bereavement and returning home after a spell of hospitalisation. Department of Health funded research showed that it is often older people with lower care needs where the taxpayer could derive the greatest benefits from preventative services. However this is exactly the group who are having services withdrawn from them at the moment. Frontier Economics also found that WRVS services in Staffordshire could reduce demand for long-term care.
Dilnot has had his say. Many of his proposals have risen to the challenge of reforming a broken social care system.
The ball is now in the court of health ministers.