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Westminster Eye: An insight into the week of politics 21 -25 November

22 November
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.

24 November
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."

Westminster Eye: An insight into the week of politics 14 - 18 November

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.

15 November
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
15 November
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.

Posted by Steve Smith, Public Affairs Officer at 10:00 Wednesday, 23 November 2011.

Labels: Unplanned hospital admissions, dementia research spend, early Day Motion, Sir Alan Meale, community care, adult social care, caring for our future

Westminster Eye: An insight into the week of politics 7 - 11 November

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.

8 November
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.

10 November
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.