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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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Westminster Eye: An Insight into the week of politics 16 – 20 April 2012

At the beginning of the week Richard Harrington MP asked the Health Minister when he expects to publish his Department's social care White Paper. The answer was delivered on 17 April and was short and sweet. Paul Burstow said that it would be published in the Spring of 2012.

Michael Meacher MP asked how much was spent on social care for the elderly, in each of the last 10 years. A reply is expected on 23 April.

Health Shadow Liz Kendall MP asked for a breakdown of hospital admissions and emergency readmissions since 2006/7. The figures provided by Minister Simon Burns in the answer indicate that emergency admissions for the 75+ age group had risen from around 306,000 in the first quarter of 2006 to 366,000 in the fourth quarter of 2010/11. Likewise emergency readmissions within 28 days of discharge for the same age group had risen from 154,000 in 2006/7 to 188,000 in 2009/10.

During the Finance Bill Reading on Monday, David Ruffley MP noted how many charities had estimated that the cap would lead to a 20 per cent reduction in their charitable donations, and called for an exemption for UK charities. Treasury Minister Danny Alexander was clear that the government was proposing a limit of £50,000 or a quarter of someone's income, to what were currently uncapped reliefs. "However", he said, "we will discuss this with philanthropists and charities-indeed, those discussions are ongoing. Some features of the American system, for example, may be attractive, which the Government would certainly examine and consider as part of that process."

16 April

On 16 April Simon Kirby MP received answers to his questions to Health Ministers on loneliness posed before the Easter recess. He had asked what engagement his Department had with WRVS at the recent Loneliness summit and what steps his Department is taking to reduce loneliness among the elderly. Paul Burstow said that on 15 March 2012, the Department co-hosted a loneliness summit with the Campaign to End Loneliness (CEL). The event saw charities, businesses, hon. Members and public sector organisations come together to start a conversation about loneliness and isolation in older age and how it could best be tackled. He explained that CEL had been commissioned by the Department to produce a digital toolkit for health and social care commissioners to combat loneliness and isolation.

He added that the CEL is a coalition of five partner organisations: Age UK Oxfordshire, Independent Age, Manchester city council, Sense and WRVS, all of whom played an active role at the summit. During the summit, representatives from all of the partner organisations (including WRVS) had the opportunity to engage with the Department. The chief executive of WRVS spoke at the event and answered questions as part of a panel with other speakers.

Virendra Sharma MP received a response to his question to the Secretary of State for Health on what proportion of the £648 million allocated for primary care trust (PCT) spending on social care was spent on (a) prevention services, (b) communicating equipment, (c) telecare, (d) crisis response services, (e) maintaining eligibility criteria, (f) re-ablement and (g) mental health by each PCT. Minister Paul Burstow replied by saying that the Department collected information on the use of the funding allocated to support social care services in September 2011. Data at primary care trust (PCT) level had been placed in the Library. The returns from PCTs showed that they planned to transfer £642 million of the £648 million made available in 2011-12.

He confirmed that following the survey, the Department of Health followed up with the two PCTs which, at the time of the survey, had not yet agreed the majority of their transfer and sought assurances that plans were in place to reach an agreed position. Agreements had been made for the remaining £6 million to be transferred to local authorities.

Bob Blackman MP had asked the Secretary of State for Health if he will respond to the findings of the Whole Systems Demonstrator Project report on the costs per quality-adjusted life year of the Government's telemedicine programme. Paul Burstow said that the Whole System Demonstrator (WSD) was a very complex study comprising of over 6,000 people across three sites and independently evaluated by six leading academic institutions. Telehealth headline findings were published by the Department on 5 December and show reductions in hospital admissions and mortality can be achieved. There will be more detailed findings published following the completion of the ongoing peer review process in the coming weeks and months.

He continued that at the recent Kings Fund International Congress on Telehealth and Telecare, the research team shared some of their findings on cost per quality adjusted life year (QALY). The high cost of telehealth at the start of the WSD study does have an affect on the cost of QALY results, but what is clear is that if the price point for the equipment is reduced then the cost per QALY will be significantly lower.

Matthew Hancock MP had asked the Minister for the Cabinet Office how many people in each (a) region, (b) local authority and (c) parliamentary constituency are over state pension age. Minister Nick Hurd in his response said that the information requested fell within the responsibility of the UK Statistics Authority. The Director General for the Office for National Statistics replied to the question, placing copies of the detailed tables in the House of Commons Library. The headline was that at August 2011 12,645,850 older people were in receipt of a state pension.

Gareth Thomas MP asked the Chancellor if he will publish his forecasts for the impact on charitable giving of the 2012 Budget's introduction of a cap on tax relief on donations to charities. A reply is awaited.

17 April

Susan Elan Jones MP asked what assessment had been made of the potential effect of the freezing of the personal tax allowance for over-65 year olds on levels of pensioner poverty. A reply is awaited.

Helen Jones MP asked Health Ministers whether they had made an estimate of potential costs to the NHS arising from ill health as a result of (a) falls by and (b) deterioration in existing conditions of adults who will not receive social care because councils have introduced restrictions on the eligibility criteria for such care. A reply is expected on 23rd April.

18 April

Jim Shannon MP tabled a Commons Early Day Motion, “That this House notes the benefits that tax relief for charities brings with special reference to gift aid; recognises the great work that charities carry out in helping people across the UK; understands that any reduction of the amount that can be given to a charity with tax relief would be detrimental to charities across the UK; and calls for there to be no adverse change to the arrangements as they currently stand allowing people to make donations as they see fit and are able.”

During Prime Ministers Questions on the same day Kelvin Hopkins MP noted that two years ago, in his pensioner pledge, the Prime Minister said: "it is fundamental to me that people who have worked hard all their lives, and are now drawing their pension, deserve to be treated with respect." He asked if the Prime Minister really thought that trying to sell his granny tax as a "simplification" was treating pensioners with respect. The Prime Minister explained that the basic state pension was being increased by £5.30 a week this April. At the same time, the Government was saving the winter fuel payments, the cold weather payments, the free television licence, the free bus pass, and the other pensioner benefits. The Government was also examining the case for a single-tier pension of around £140 each. He expected Members in all parts of the House to welcome that, because it would be a well-paid basic state pension that encouraged people to save before they became pensioners.

Alex Cunningham MP noted that the Prime Minister's official spokesman argued last week that rich individuals were avoiding tax by giving to charities which "don't, in all cases, do a great deal of charitable work". He asked if the Prime Minister could name any of these charities. The Prime Minister responded by saying that the figures show that last year 300 people earning over £1 million in our country got their rate of tax down to 10%. He agreed that Government must protect charities and encourage philanthropic giving, but that there was a need to make sure that rich people are paying their fair share of taxes.

Michael Meacher MP asked the Secretary of State for Health if he will undertake an inquiry into the local authority funded system of domiciliary care and the costs and benefits at the present level of overall funding. Paul Burstow replied saying that the Government had no plans for an inquiry into the local authority funded system of domiciliary care.

19 April

During Oral Answers on Women and Equalities issues Nia Griffith MP asked what recent discussions Minister had held on tackling age discrimination. The Minister for Equalities Lynne Featherstone MP said that she discussed age discrimination, as appropriate, with Minister and officials and held discussions with industry bodies and others. Earlier this month, the Government endorsed an insurance industry agreement to make motor and travel insurance more accessible to older customers through "signposting" arrangements.

In her follow up Nia Griffith said that she recalled serving on the Committee that considered the Equality Bill with the Minister, and that she was keen to push forward the age discrimination provisions. She asked what had happened in the two years since the Bill received Royal Assent as the age discrimination legislation had not been implemented. Lynne Featherstone said that she had not changed her mind. The Government’s consultation proposed a ban on age discrimination in health and social care, and that there should be no exceptions to that, unlike other issues. It was an important lever, and the delay has come about because the Government wants to make sure it gets it right. She concluded that the Government will come forward as soon as it has made a decision and that was expected to be soon.

Reabling Wales - Residential care of older people

On Thursday 26 April, I will be giving evidence to the Welsh Assembly’s Health & Social Care Committee as part of its inquiry into the residential care of older people in Wales. I am doing so in my role as Chair of the Welsh Reablement Alliance, an umbrella group of bodies who provide support to people when they come out of lengthy hospital stays and help them to adapt back to life at home.

Reablement is a hugely important step-change for social care – it changes the presumption of what sort of help people need, seeking to help them re-learn daily skills so they can stay in their own homes and remain independent rather than needing to look at formalised home care or residential care. This not only affords more dignity to older people, it also make significant savings for the public purse by preventing hospital readmissions and costly long-term care packages.

Typical examples of reablement might be short-term physiotherapy interventions, or physical adaptations to the home, or it might mean short-term social support to help a person (such as a lift to the shops, or a volunteer helping to walk the dog whilst they regain physical strength) – in practice though, it is a whole range of these services. Long-term hospital stays can knock a person’s self-confidence, diminish them physically, and put all sorts of practical barriers in place which make it hard to adapt to life back at home. Reablement is simply about overcoming those barriers through short-term interventions.

Currently, there are some excellent examples of reablement in Wales – but they are all too often quite patchy and inconsistent, with huge variations between regions and huge discrepancies in the levels of funding they attract. That is partly an accident of how the service has evolved over time, but now that the Welsh Government is making bold plans to extend reablement as part of its Social Services Bill, the time has come for a more consistent level playing field for reablement, and for the Welsh Government to set out what it expects local authorities to provide.

The evidence session will be broadcast on senedd.tv at 1pm on Thursday – be sure to tune in!

Posted by Ed Bridges, Public Affairs Manager (Wales) at 00:00 Thursday, 26 April 2012.

Labels: reablement, Welsh Reablement Alliance, social care, older people, volunteering, dignity, hospital, self-confidence, Social Services Bill, senedd

Topical issues in the news this week...

Parliament is in recess this week and so I’ve taken a wider look at three topical issues which have been in the spotlight this week and have a link to older people and the voluntary sector.

Tax and charitable donations

During the week, tax and charitable donations hit the headlines. Under current rules higher rate taxpayers can donate unlimited amounts of money to charity, and offset it against their tax bill to effectively bring the amount of tax they pay down to zero. In last month's Budget, Chancellor George Osborne said that from 2013, there would be a cap on previously uncapped tax reliefs - including those on charitable donations - set at £50,000 or 25% of a person's income, whichever was higher.

That means an individual with an income of £4m could still give £1m to charity and get full tax relief for that £1m. However, if they want to donate more, this will have to come from their taxed income.

Charities have been upset by suggestions that charitable giving is a loophole being exploited by tax avoiders - and point out that wealthy benefactors give away far more than they ever get back in tax relief.  A number of charities in all sectors have predicted that they will lose out financially at a time when they are being asked to do more as public funding for services is reduced. Many politicians across the spectrum have been critical the policy, including the Business Secretary Vince Cable who is reported as supporting a crackdown on "abusive tax avoidance" but it should be "separated from genuine charitable giving".

Conservatives such as Conor Burns MP tweeted “Loophole is donations to non-UK based charities. Well that’s surely easy? Exempt UK regulated charities from the cap. Don't hit everyone.” Zac Goldsmith MP tweeted “If people use bogus charities to avoid tax, close them. But it’s wrong to clobber them all to prevent minority abuse.”

Lord Hodgson, the Conservative peer reviewing the Charities Act for the government, said "We don't want the law of unintended consequences to impact on charities. If there's a big restriction then it will make things difficult."

Prime Minister, David Cameron has said he will listen "very sympathetically" to concerns from charities about the impact of a planned cap on tax relief on donations. This is an issue that is likely to run into the next few weeks as the debate continues over support for this Budget proposal.

Patients discharged from hospital

On Thursday the Times published some findings based on a freedom of information survey of NHS Trusts over the times of the day that patients are discharged from hospital. The Times contacted 170 NHS Trusts and received replies from 100 of them. The returns showed that almost 240,000 patients were discharged between the hours of 11pm and 6am in the morning.

The data obtained by the Times suggests this may be happening in 3.5% of cases across the board with very wide variations. But that needs putting into context. It seems some hospitals are including patients who have died in their figures, while some patients, such as women who have had a baby, may choose to leave at night. Nonetheless, it is clear there are also many cases of inappropriate discharges. In particular this could impact on older people who need planned discharge and a support package in place.

Nic Dakin MP tweeted” I was troubled to read that almost 300 000 patients were discharged from hospital during the night between 11pm and 6am.”

The Patients Association reported that it had received regular calls from people who had been sent home from hospital without any warning late at night.

"I am concerned to hear that some patients may be being discharged unnecessarily late. Patients should only be discharged when it's clinically appropriate, safe and convenient for them and their families. It is simply not fair to be sending people home late at night. We will look at this."

Prof Sir Bruce Keogh, NHS Medical Director
On Thursday the Kings Fund published a report on the creation of health and well-being boards “System Leaders or Talking Shops”, that suggests that they could be the catalyst for delivering integrated care.

Health and well-being boards will bring together the NHS, public health and local authorities to co-ordinate health and other local services. Based on interviews with 50 local authorities and detailed case studies in two areas, the report looks at the experience of the shadow boards so far, boards which had to be in place from the beginning of April.

The report identifies optimism about the prospects for success, with most of those surveyed expecting boards to deliver on their identified priorities and promote closer integration between the NHS and local authorities, a key aim. The report found:

  • strong senior level buy-in on a local level, with more than a third of shadow boards chaired by council leaders or deputy leaders and the majority chaired by the lead for health, adult social care or children's services
  • engagement in the work of shadow boards has been especially strong among public health and adult social care, with clinical commissioning groups (CCGs) less engaged but still closely involved
  • the involvement of providers has been low (less than a quarter of shadow boards include representatives of acute providers)
  • while nearly three-quarters of those surveyed think that boards will influence the work of CCGs, less than 1 in 5 think they will influence the NHS Commissioning Board.

Building on the work undertaken so far to ensure health and well-being boards deliver on their potential, the report recommends that:

  • sufficient time and resources must be devoted to the boards to ensure they deliver strong, credible and shared leadership between local organisations
  • responsibilities and roles of all new bodies in the new health system must be clearly defined to balance national and local priorities
  • a national framework for integrated care be developed to provide clearer joint accountabilities across health and social care, and to ensure joined-up care
  • to provide a catalyst for driving integrated care, local authorities must look afresh at local partnership arrangements and ensure that providers are involved in their work.

There was a clear message that boards are more likely to succeed by using skills in influencing and relationship-building rather than through formal managerial control or accountabilities (health and wellbeing boards have no powers to sign off the commissioning plans of clinical commissioning groups, for example). There were concerns – eg about budget constraints and about whether national imperatives will over-ride locally agreed priorities and about the extent to which boards can influence decisions of the NHS Commissioning Board.

Parliament returns on 16 April.

Posted by Steve Smith, Public Affairs Officer at 00:00 Friday, 13 April 2012.

Labels: Hospital discharges, tax and charitable donations, Health and well-being boards