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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.