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Westminster Eye: An insight into the week of politics 23 - 27 January
Monday 23 January
Gareth Thomas MP received a reply to his question to the Cabinet Office on how many charities have closed or de-registered with the Charity Commission since May 2010. Minister Nick Hurd replied saying that 13,517 charities have been removed from the Register of Charities since 1 May 2010. He explained that charities are removed from the register for a variety of reasons. For example, a charity may have ceased to exist or operate, or may have merged, incorporated or transferred its funds to another charity.
Chris Skidmore MP asked the Department of Health in what proportion of finished admission episodes the patient was over (a) 65, (b) 80 and (c) 90 years in each of the last five years for which figures are available. On the same day Jim Shannon MP asked what guidelines the Health Minister had issued to care homes on the prevention, treatment and care of fractures resulting from falls by people with osteoporosis. Replies are awaited.
Dr Julian Huppert MP asked the Secretary of State for Business, Innovation and Skills how much the (a) Medical Research Council and (b) Engineering and Physical Sciences Research Council spent on dementia research in 2010-11. In responding David Willetts said that the Medical Research Council spent £15.6 million in 2009/10. Precise figures for MRC expenditure in 2010/11 are not yet available. The Engineering and Physical Sciences Research Council estimate that they spent £3.5 million in 2010/11.
Caroline Dinenage MP asked what information the Department of Health has received from primary care trusts on plans for spending the 2011/12 NHS social care allocation; which services the money has been allocated to; and what proportion of the money is expected to be spent on older people. She also asked what estimate the Department has made of the difference between the number of people eligible for social care support in England and those receiving formal support from public or private sector agencies. A reply is awaited.
Hilary Benn MP asked the Secretary of State for Work and Pensions how many and what proportion of all adults potentially eligible for council tax benefit are pensioners in each local authority in England. Pensions Minister Steve Webb said that the number of pensioners who were entitled to council tax benefit in Great Britain, 2008/09, was between 3,950,000 and 4,490,000 which is equivalent to between 50% and 63% of the entire population entitled to council tax benefit. For context, the take-up rates of pensioners in 2008-09 were lower than non-pensioners for council tax benefit: pensioners had a take-up rate of between 56% and 64% while non-pensioners had a take-up rate of between 72% and 81%.
Tuesday 24 January
The Commons Health Committee
published its highly anticipated report regarding public expenditure
The Committee said that health and social care must be seen as two aspects of the same service and planned together in every area for there to be any chance of a high quality and efficient service being provided which meets the needs of the local population within the funding available. Best practice should be rolled out across the Health Service and underperforming commissioners held to account.
The report suggested that precious little evidence of the urgency which it believes this issue demands—on both quality and efficiency grounds. It is a question to which the Committee will return in its Report on Social Care.
The report noted that the Audit Commission argued that a key factor in progress towards joint commissioning is the quality of existing relationships on the ground. The Committee was concerned that NHS organisations are giving highest priority to achieving short-term savings which allow them to meet their financial objectives now, at the expense of planning service changes which would allow them to meet their financial and quality objectives in later years.
The report continued that the Nicholson Challenge can only be achieved through a wide process of service redesign on both a small and large scale. These changes should not be deferred until later in the Spending Review period: they must happen early in the process if they are to release the recurring savings that will be vital in meeting the challenge. In the meantime, the Committee was concerned that savings are being made through “salami-slicing” existing processes instead of rethinking and redesigning the way services are delivered.
The overall picture is of a service that is continuing to function by restricting eligibility, by making greater savings on other local authority functions and by forcing down the price it pays to contractors. The scope for further efficiencies is severely limited. The Government’s response to Dilnot’s proposals should set out how a sustainably funded system will continue into the future. The challenge is to continue to provide a meaningful service until a new system is in place.
In spite of Government assurances, local authorities are raising eligibility criteria in order to maintain social care services to those in greatest need. The Committee reported that it was It is deeply concerning that £116m of the £648m intended to be spent through the NHS on improving the interface between health and social care is being spent on sustaining existing eligibility criteria. This suggests that this money (which was intended to support greater integration of services) is in fact being used to maintain the existing system. To the extent that this is true it is a lost opportunity to promote the necessary process of service integration.
ADASS found that 82% of councils are only providing care to those whose needs are assessed as significant or higher. The Department of Health said that the settlement was intended to “hold the position steady” until a new funding system for social care was developed. The tightening of eligibility criteria shows that the settlement is not sufficient to achieve this. Early reports from the Health Service are that the transfer of money from the NHS to be spent on social care has been effective. This is important but the fact remains that it represents just 1% of annual funding for the NHS. There is scope to extend transfers of this kind. The Department of Health should urgently investigate the practicalities of greater passporting of NHS funding to social care.
The Committee’s report into its inquiry into social care is expected in the first week of February.
Paul Maynard MP asked what proportion of gross national income is spent on services for the elderly. A reply is expected shortly.
Wednesday 25 January
Andrew Jones MP asked the Secretary of State for Work and Pensions how much was paid to pensioners as a result of the increase in cold weather payments in winter 2010-11. Steve Webb replied that during the 2010/11 winter season, it is estimated that cold weather payments amounting to £264.4 million was awarded to pensioners. This has been presented in the Autumn 2011 Statement of 29 November 2011.
Gareth Thomas MP received reply from Simon Burns on his question on the steps his Department is taking to measure progress on the implementation of policies supporting the big society initiative. Simon Burns said that the Department of Health encourages and supports the big society agenda. In health care, public health and social care, the big society vision has driven our work to help people take control over their lives, the services they use and communities they live in. He added that the Government is embedding this new approach throughout our proposed health and social care reforms. The vision set out for the national health service, social care and public health puts patients, service users and carers at the heart of services they use and in control of what they access-"no decision about me without me". This is well aligned with a big society approach. He concluded by saying that over the coming years the Department will continue to have a strategic role in the design of the new health and care system. It will be a key shaper and architect and as such will ensure that strategies and policies keep people at the forefront of all that they did, working together with partners and stakeholders to achieve better experiences for all those who interact with the health and care system and help to grow the big society.
Thursday 26 January
Tim Farron MP asked the Department of Health what assessment had been made of the effect of the social care system on the financial sustainability of the NHS and what assessment had been made of the prospects for using increased resources for social care to reduce avoidable emergency admissions and NHS costs. He also asked the Chancellor what discussions he has had with the Secretary of State for (a) Health, (b) Communities and Local Government and (c) Work and Pensions on the potential for reform of the funding of social care to result in savings to the public purse across Government. Replies are awaited.
Hazel Blears MP asked a series of questions of the Departments of Health and Work and Pensions on what discussions they had held with other Departments on planned reforms to the funding of social care the uses of funding allocated to social services.
Hilary Benn MP also asked a series of older people related questions. He asked what estimate had been made of expenditure by each local authority (a) overall and (b) per head of population on social care in each of the last ten years. He also asked about spending on Meal on Wheels by each local authority (a) overall and (b) per head of population on Meals on Wheels for pensioners in each of the last ten years and what the average charge was for meals on wheels services in each local authority area in each of the last ten years. Replies are awaited.
Friday 27 January
The Department of Health published its monthly delayed transfers of care figures for December 2011. These showed a decline in both in the number of individual delays and the overall numbers of days compared to the previous month. This was said to be down to usual seasonal variations that occur at Christmas and New Year.
Westminster Eye: An insight into the week of politics 16 - 20 January
Monday 23 January
On Monday the Department of Health announced that it is providing up to £100 million in additional funding to doctors in emerging Clinical Commissioning Groups
to improve local services and reduce pressures on the NHS during the colder months. Clinicians in these groups will spend the money directly on local care services that best meet their patients' clinical needs and prevent unnecessary admissions to hospital.
John McDonnell MP received an answer to his Treasury question on what the policy is on exempting from VAT the charges for home care for people with disabilities and secondly what estimate had been made of the cost to the public purse of exempting from VAT the charges paid for home care by people with disabilities. In responding , David Gauke MP said that welfare services are exempt from VAT but only if the services are supplied by a charity, a state-regulated private welfare institution or agency, or a public body. If provided by any other body then they will be taxable at the standard rate. He added that no estimate has been made of the VAT paid at the standard rate on such supplies as the data is not collected.
MP Kwasi Kwarteng received a response to his question over what the steps Government is taking to reduce the cost of social care provision. Paul Burstow MP replied by saying that local authorities are accountable for delivering efficiency savings in adult social care, but the Department has worked with the sector to consider the opportunities to reduce costs. To this end, the Department has part-funded a programme of Adult Social Care Efficiency launched by the Local Government Association in November 2011.
Furthermore, in November 2010 the Department published A Vision for Adult Social Care outlining a number of suggestions for areas where local authorities could make efficiency savings. Among others, these included:
- maximising the potential of reablement services
- developing an integrated crisis or rapid response services
- rolling out telecare support; and
- minimising back office administration.
As a result of wishing to keep local authorities free of additional burdens, the Department does not collect its own data on efficiency savings. Other sources, including the Association of Directors of Adult Social Services budget survey, suggest that efficiencies are being delivered successfully, without unduly affecting frontline services.
Douglas Carswell MP had asked the Secretary of State for Energy and Climate Change what steps the Government is taking to increase the affordability of energy for elderly people during the winter and what steps were planned to take to make energy bills more affordable for elderly people. Gregory Barker MP said that the Government is committed to helping people, especially low income vulnerable households, heat their homes more affordably.
The Warm Home Discount Scheme will assist two million households each year, including over 600,000 pensioners in receipt of pension credit guarantee credit who will receive a Core Group discount of £120 off their electricity bill this winter, automatically without having to apply for it. In addition, the Government continues to fund the Warm Front scheme. The Government is also requiring suppliers to provide energy efficiency measures to low income vulnerable households through the Carbon Emissions Reduction Target, Super Priority Group.
The Department for Work and Pensions provides pensioner households with winter fuel payments to help with additional heating costs during the winter. Cold weather payments are also made to low income and vulnerable households where there is an average temperature of 0°C or below for seven consecutive days. These payments have been increased to £25 per week and in winter 2010/11 over 17 million cold weather payments were paid in Great Britain worth an estimated £430 million. In the future, the Green Deal and new Energy Company Obligation will be one of the Government’s key policies.
In the House of Lords, Baroness Greengross asked what measures are in place to inform people of the steps they need to take to ensure their wishes regarding medical treatment at the end of life are respected if they lose capacity.
The Parliamentary Under-Secretary of State, Department of Health Earl Howe said that the Department of Health makes annual resources available to the NHS and local authorities to implement the Mental Capacity Act. These resources are for them to inform and support people who may have lost or be about to lose capacity about their wishes regarding treatment and care. The department's end-of-life care strategy provides further guidance in this area. He continued that advance care planning is not a one-time issue, it is an ongoing process. It requires regular reviews of a patient's wishes and assessments of their needs. Support, training and education for staff in understanding that, and taking forward care planning, are being made available through the end-of-life care strategy. People's wishes and needs change throughout life.
Tuesday 24 January
On Tuesday Housing Minister Grant Shapps and Communities Minister Andrew Stunell called on councils to use every opportunity under the New Deal for Older People to give elderly people more choice and control over where they live, so they are not pressured to sell their home or move into residential care. Under the scheme the council will arrange for elderly people to move into rented accommodation, and take responsibility for maintaining and letting their property at an affordable rate. Homeowners will benefit from the rental income from their home, which will be passed back into their estate at an agreed date. Under the New Deal for Older People the Government is providing funding for home adaptations so older people can live in their own homes for longer, and backing innovative schemes that offer elderly people the assistance they need to live independently.
Earlier, Sarah Newton MP had asked whether the Department of Health collects data on the number of acute care patients aged over 75 years who are delayed in being discharged from hospital. On Tuesday Paul Burstow replied saying that this information is no longer collected centrally and could be obtained only at disproportionate cost.
The Health Committee held its final oral evidence session on its Inquiry into Social Care. The witnesses were Paul Burstow MP, Minister of State for Care Services, and David Behan CBE, Director General of Social Care, Local Government and Care Partnerships, Department of Health.
Care minister Paul Burstow opened the evidence session by welcoming the committee's interest in social care and said that the committee's findings would provide a "valuable" viewpoint on the government's social care proposals. Paul Burstow confirmed that the government's proposals on social care relating to law reform and other care issues would be published as a white paper in the spring, alongside a separate progress report on funding. Social care reforms relating to funding of social care, he said, would not be contained within the white paper. Dilnot did not offer a blueprint, Burstow argued, it offered a "design guide" for social care. He declined to confirm that there would be a social care Bill in the next Parliament.
Barbara Keeley MP asked the minister about the pressures put on the social care system. She explained that 900,000 people were without basic social care, primary care trusts were unaware of how dementia strategy funds had been spent and funding for carers' breaks had not made it through to where it was needed. She asked the minister what gap there was in terms of funding for social care. "There is no gap", Burstow said, due to extra government funding and a "rigorous programme of efficiency".
Burstow said it was very difficult to define and identify unmet need in social care, but said that it would be included in any of the government's proposals for social care. That said, the extra funding diverted to social care by the government was in itself recognition of the existence of unmet need, he said.
Eligibility criteria and the variations between local authorities, Burstow said, were a hangover from a system that had been previously based on the poor laws. The variance in these needed to be tackled, the minister said, in order to ensure that people could continue to get the care they needed across the country.
Pressed by Grahame Morris MP to answer what was being done on the ground to ensure integration, Burstow said that the latest NHS outcomes framework contained elements relating to integration.
Sarah Wollaston MP asked if there should be a whole system approach to, for instance, care for the elderly. Burstow said there would be no single outcomes framework for elderly care and argued that it was better to have outcomes frameworks for areas that could overlap on areas like integrated care.
Chris Skidmore MP asked Burstow whether personalisation of care budgets would be embraced by the government in order to help provide individualised and integrated services. Burstow said he was not convinced that personal budgets were the only way forward, but said that they could be a "powerful" tool to ensure that services were commissioned to best suit the individual.
Jonathan Reynolds MP received an answer to his written question about progress in implementing the recommendations contained in the report of the Dilnot Commission. Paul Burstow replied saying that the coalition programme set out the Government's clear commitment to reforming the system of social care to provide much more control to individuals and their carers, and to ease the cost burden that they and their families face. This commitment to reform is why the Government acted quickly to set up the Commission on Funding of Care and Support, which published its report in July 2011.
Government welcomed the report as a valuable contribution to the debate on social care reform, but funding reform is not the only thing that needs to change in the social care system. He wanted a package of reforms that goes much wider, addresses the key failures of the current system, and ensures that people get the best possible social care.
This is why the Government has spent the last few months engaging with stakeholders from across the social care community to identify the priorities for reform, and the trade-offs between them. The results of this engagement will inform a White Paper on social care and a progress report on funding reform, which the Government will publish in the spring.
Jonathan Reynolds MP also received a reply to his question on whether the Minister would consider raising the means-tested threshold above which people are liable for their full care costs to £100,000. Paul Burstow said that the coalition programme set out the Government's clear commitment to reforming the system of social care to provide much more control to individuals and their carers, and to ease the cost burden that they and their families face. This commitment to reform is why the Government acted quickly to set up the .
In its terms of reference, the Commission was asked "to examine and provide deliverable recommendations on:
- how best to meet the costs of care and support as a partnership between individuals and the state
- how people could choose to protect their assets, especially their homes, against the cost of care
- how, both now and in the future, public funding for the care and support system can be best used to meet care and support needs; and
- how its preferred option can be delivered, including an indication of the timescale for implementation, and its impact on local government (and the local government finance system), the national health service, and-if appropriate-financial regulation."
He added that in response to this challenge, the Commission recommended a cap on people's lifetime care costs, set at between £25,000 and £50,000. The Commission also recommended that the upper asset threshold of the current means-tested system (which would remain in place with a cap) be raised to £100,000-and this is the recommendation to which the question refers. The Commission said that the extended means test would work with the cap to ensure that, if the cap were set at £35,000, no one has to use more than 30% of their assets paying for care.
The Commission's report has formed the basis of Government's recent engagement with stakeholders. This engagement exercise brought together the priorities for reform from across the social care system, and examined the trade-offs between them. The results of the engagement are now published, and Government are using them to inform a White Paper on social care, and a progress report on funding reform, which will be published in the spring.
Jonathan Reynolds MP final related question on introducing national eligibility criteria and portable assessments for the provision of adult social care this topic was also answered. Paul Burstow replied saying that the coalition programme set out the Government's clear commitment to reforming the system of social care to provide much more control to individuals and their carers, and to ease the cost burden that they and their families face. In response to this challenge, the Commission made recommendations on a number of aspects of the social care system, including eligibility.
Local authorities are currently required to use the same assessment scale, but are free to set their eligibility threshold at any point on this scale. The Commission recommended that a a national threshold was set at "substantial" need.
Care users who move from one local authority to another currently lose their eligibility to care until they are reassessed. The Commission recommended that the rules be changed so that they retain eligibility until they are reassessed.
The Commission's report has formed the basis of Government's recent engagement with stakeholders. This engagement exercise brought together these recommendations with other priorities for reform from across the social care system, and examined the trade-offs between them. The results of the engagement are now published, and Government are using them to inform a White Paper on social care, and a progress report on funding reform, which will be published in the spring.
Last week Ben Bradshaw MP asked a series of questions around the rates of admission to hospital for patients over 74 years with a secondary diagnosis of dementia in each primary care trust in England in each of the last 12 months. Replies were placed in the House of Commons Library on Thursday. The figures showed that there had been 321,159 finished consultant episodes and that there had been 2,603,887 bed days recorded during that time.
Lord Lester of Herne Hill asked the Government when they intend to implement Section 29 of the Equality Act 2010 on the prohibition of age discrimination in the provision to the public of goods, facilities and services. Baroness Verma said that the Government will announce how it intends to proceed in the Government's published response to the age discrimination consultation in due course.
Westminster Eye: An insight into the week of politics 10 - 13 January
Both Houses returned on Tuesday 10 January following the Christmas recess.
On 10 Sarah Newton MP asked whether the Department of Health collects data on the number of acute care patients aged over 75 years who are delayed in being discharged from hospital.
During Commons Health Oral questions, the contribution of volunteers was raised. In particular Sir Bob Russell MP asked if there was a conflict between the big society, volunteers and localism if major retail stores are brought into hospitals to the detriment of friends organizations. Paul Burstow replied saying that he was aware that it is a matter of concern that over a number of years some hospitals have chosen not to use the WRVS or friends organisations' services. These decisions have to be made by local NHS trust boards, but the purpose of the strategy the Government published last year is very much to make sure that when the boards make these decisions they are focused on the benefits of volunteering for the volunteer, the organisation and the patients.
In the same session Fiona Bruce MP raised the issue of the benefits of telecare to older people in the north-west of England, where the number of over-65s will grow by 50% and the number of over-85s is set to more than double by 2025. Secretary of State Andrew Lansley responded saying that there were an increasing number of older people in the community and that he wanted to support them to be independent and to improve their quality of life. The whole system demonstrator programme was the largest trial of telehealth systems anywhere in the world. In the three pilot areas of Kent, Cornwall and Newham, it demonstrated a reduction in mortality among older people of 45%; a 21% reduction in emergency admissions; a 24% reduction in planned admissions to hospital; and a 15% reduction in emergency department visits. Those are dramatic benefits, which is why Government is so determined to ensure, over the next five years, that it reaches out to older people who are living at home with long-term conditions and improve their quality of life in this way.
During exchanges over progress on the Health and Social Care Bill Stephen Dorrell MP said that the background of the recommendation of the NHS Future Forum, that a key priority for the future is greater integration between health care and social care a priority that was explicitly endorsed last week by the Prime Minister. He asked if the Minister agreed that the key opportunity in the Bill, through the health and well-being boards, is to drive that agenda, which has been much talked about for many years and actually to start to deliver on that rhetoric. In responding Simon Burns agreed that it is the way forward and Government fully recognised that. Government is deeply committed to achieving that aim, and that is why the Secretary of State has added an extra £150 million to the existing £300 million, to facilitate progress towards it.
Greg Mulholland MP said that care of older people is one of the most pressing issues facing this country. He asked if the Prime Minister would join him in welcoming Age UK's Care in Crisis campaign, which was launched on Monday. He asked whether he will commit to ensuring that the White Paper due in the spring will present a way forward on this vital issue. The Prime Minister paid tribute to the MP and to the Age Concern campaign. There was a huge challenge to rise to and Government wants to do so through the White Paper. There are three elements: the rising costs of domiciliary care, improving the quality of the care that people receive, and addressing the issue of people having to sell their all their assets to pay for care. Government was looking hard at all those issues to work out a way forward that is right for the system, and that the country can afford.
In a written question Andrew Stephenson MP asked what assessment the Department of Health has made of likely savings from using telemedicine technologies in care homes. Paul Burstow replied that the Department has not made any formal assessment of likely savings that might result from using telemedicine technologies in care homes. He added that initial headline findings from the Whole System Demonstrator programme demonstrate that, in the NHS, appropriate use of telehealth can lead to significant reductions in mortality and hospital admissions, leading to efficiency gains. The Whole System Demonstrator programme was set up by the Department to provide an evaluated evidence base on the benefits of telehealth and telecare. He considered that telemedicine also has the potential to offer benefits in care home settings.
Tom Brake MP asked the Home Department when it plans to publish its response to her Department's consultation on ending age discrimination in services, public functions and associations. Minister Lynne Featherstone said that the Government response to the consultation on exceptions to the proposed ban on age discrimination will be published in due course.
The NHS Future Forum published its second set of reports to the Government in which it sets out a series of recommendations to improve the quality of patient care and achieve better outcomes. The Department of Health was able to accept all the Forum's recommendations for Government
The Forum looked at four areas of health policy: the NHS' role in the public's health, information, education and training and integration. Over four months the Forum listened to more than 12,000 people and attended more than 300 events. In this phase, the Forum set out to listen to more patients and carers and sought more input from local authorities, housing and social care providers. Of particular interest were the recommendations on integration.
- Integration should be defined around the patient, not the system - outcomes, incentives and system rules (ie competition and choice) need to be aligned accordingly
- Health and well-being boards should drive local integration - through a whole-population, strategic approach that addresses their local priorities
- Local commissioners and providers should be given freedom and flexibility to "get on and do" - through flexing payment flows and enabling planning over a longer term.
Greg Knight MP asked the Secretary of State for Health what spending his Department has recently incurred on radio advertisements relating to dementia; and for what reason it has commissioned such advertisements. Simon Burns responded by saying that in the 2011-12 financial year, the Department has spent £276,573 on radio advertising relating to dementia. The advertising formed part of the national dementia: early signs and symptoms campaign, which was commissioned to help more people receive an early diagnosis.
Ben Bradshaw MP asked a series of questions around the rates of admission to hospital for patients over 74 years with a secondary diagnosis of dementia in each primary care trust in England in each of the last 12 months. A reply is awaited.
Jonathan Reynolds MP asked what progress the Minister is making in implementing the recommendations contained in the report of the Dilnot Commission. He also asked if the Minister will consider raising the means-tested threshold above which people are liable for their full care costs to £100,000 and introduce national eligibility criteria and portable assessments for the provision of adult social care. A reply is awaited.
"That this House notes the recent Quest
for Quality report by the British Geriatrics
Society that suggests many of the estimated
400,000 older people resident in UK care
homes have variable access to NHS services
because of the type of accommodation in
which they live; acknowledges that many
people in care homes are highly vulnerable
with over 40 per cent suffering from
dementia and over 75 per cent living with a
disability; accepts that while NHS provision
to care homes can be excellent there is
considerable unwarranted variation in the
quality of provision, especially around
medications management, dementia and end
of life care; and calls on commissioners and
health service planners to remember their
obligations to ensure that the healthcare needs
of this vulnerable group are adequately met."
On 21 December Baroness Jolly had asked the Government what support and guidance is being offered to pathfinder clinical commissioning groups in commissioning integrated health and social care services. She received her reply on 12 January. In his reply Lord Howe said that pathfinders are receiving national and local development support. With their SHA and PCT cluster, pathfinders are exploring approaches to clinical commissioning, including integration of health and social care. Key to this will be engagement with local authorities and secondary care. The Government’s national learning network allows pathfinders to share learning and best practice. Pathfinders will be authorised to take on their full commissioning functions only when the NHS Commissioning Board is certain that they are ready.
Kwasi Kwarteng MP asked Health Ministers what steps they are taking to reduce the cost of social care provision. Replies are awaited.
It was announced that on 17 January the Health Committee will hold its final oral evidence session on Social Care. The witnesses would be Paul Burstow MP, Minister of State for Care Services, and David Behan CBE, Director General of Social Care, Local Government and Care Partnerships, Department of Health.
Posted by Steve Smith, Public Affairs Officer at 00:00
Monday, 16 January 2012.
pathfinder clinical commissioning groups,
NHS Commissioning Board,
whole system demonstrator programme,
Health and Social Care Bill,
care of older people,
NHS Future Forum,
Westminster Eye: An insight into the week of politics 21 December - 6 January
Baroness Jolly asked the Government what support and guidance is being offered to pathfinder clinical commissioning groups in commissioning integrated health and social care services. A reply is expected after 12 January.
The Department of Health published a package of data. This included November’s figures for the delayed transfers of care. In comparison with October, November’s figures showed a drop in delays in total days from 118,664 to 116,572 made up of improvements in both acute and non acute delays. However, numbers of cases were up slightly from 4,196 to 4,215.
A new survey of care provided by local councils, published by Labour, reveals increases and disparities in charges for services for vulnerable elderly and disabled people.
Councils are increasing charges for:
- home care: the average hourly charge is now £13.49, a rise of 6% since 2009-10
- Meals on Wheels: the average charge is now £3.44 per meal, a rise of 13%
- transport: for example to day centres: the average charge for a journey is now £2.32, a rise of 33%
These increases mean the average yearly cost for an older person who pays for ten hours of home care a week is now £7,015 a year. Older people who also get Meals on Wheels every day now pay an average of £8,271 a year. With transport charges to go to a day centre three times a week an older person now pays £8,633 per year. There are differences in the price people pay for care, depending on where they live. This ranges from free home care in Tower Hamlets to care costing £20.34 per hour in Cheshire East.
The Department of Health announced that additional sums of money are
being made available for social care and housing support. The Department
made an additional £150 million revenue available via primary care
trusts in order to address delayed discharges, and a further £20 million
capital expenditure to add to the Disabled Facilities Grant, making it easier for disabled people to live in their own homes.
"Older people often need particular
Secretary of State for Health, Andrew Lansley
support after a spell in hospital to settle
back into their homes, recover their
strength and regain their independence.
This money will enable the NHS and
social care to work better together
for the benefit of patients."
In a letter published in the Daily Telegraph today, a group of more than 60 government advisers, charity directors and independent experts called on the government and the Labour Party to overhaul England's "failing" social care system. The letter follows new evidence last week of rising care bills for families, and costs to the NHS of 'delayed discharges'. It argues that, alongside celebrating the fact that the UK population is living longer, action must be taken to meet the 'unavoidable challenge' of how to support increasing numbers of older and disabled people who need care.
The letter argues that the current social care system is failing this challenge, with serious consequences for society, family life and the economy - leaving older and disabled people at risk, families facing huge care bills, businesses losing staff who are forced to give up work to care for loved ones and the NHS coping with avoidable hospital admissions and 'bed blocking'.
The signatories say that meeting this challenge this will require 'political leadership'. They urge the Prime Minister to 'seize the opportunity' of cross-party talks on the future of social care to 'deliver a social care system which can provide the well-funded and high-quality care and support we would all expect for ourselves and our families.'
In the early part of the week political commentators speculated that the Queens Speech, outlining the legislative programme for the coming year, will take place on 9 May, with a fall back to 16 May if this does not work.
It was reported that three million lives could be improved across England thanks to new high-tech healthcare. After seeing the technology in practice in Cornwall, Care Services Minister Paul Burstow pledged to make it available to more people with long term conditions.
In order to make this a reality, over the next five years the Department of Health will work with industry, the NHS, social care and professional organisations to bring the benefits of assistive technology such as telehealth and telecare to millions of people with long term conditions. Telehealth and Telecare use electronic equipment to read vital health signs such as pulse, weight, respiration and blood oxygen levels, which can be read remotely by health professionals in a different location. It means that people can stay in the comfort of their own homes with the peace of mind that a doctor or nurse will be alerted should there be a problem.
Housing Minister Grant Shapps launched a new deal to help older people to continue living comfortably in their own homes - with particular support for those leaving hospital. With nearly one in five of the whole population expected to be aged 65 or over by 2020, Ministers are determined to ensure elderly, vulnerable people get the help they need to live independent lives, and can be safe in the knowledge that they won't get ripped off by dodgy dealers and fraudsters. Mr Shapps has given £51 million towards Home Improvement Agencies, who will provide help and advice including:
- housing advice, including help to move to more suitable accommodation if needed
- handyperson services, including small home repairs, home safety and security adaptations
- energy efficiency advice
- arranging for adaptations and home repairs to be made, including grab rails, stair-lifts and major work such as ground floor extensions.
These agencies also offer hospital discharge services - ensuring older people leaving hospital care are given the support they need to be able to recuperate in the comfort of their own homes. He has also announced £1.5 million funding for FirstStop, which provides independent advice to older people looking to plan their future housing needs - whether in their own homes, or in care homes.
A number of bodies including WRVS called on the Government to affirm its commitment to volunteering by making portable Criminal Records Bureau (CRB) checks free to volunteers.
Whilst the Government has confirmed that CRB checks themselves will remain free for volunteers, a decision has yet to be made about the cost of the online system that will ensure volunteers will not have to be checked every time they begin a new role. In the current system CRB checks are free but not portable, but Government risks solving one problem only to create another if in the proposed new system they are portable but not free.
The King's Fund and the Nuffield Trust jointly called for an ambitious new goal to be set to ensure that delivering integrated care assumes the same priority over the next decade as reducing waiting times was given over the last. The new goal to improve the experience of patients with complex health needs is the central recommendation in a new report published by the two think tanks. The report argues that integrated care - which aims to co-ordinate care more effectively around the needs of patients - is essential to meet the needs of the ageing population and transform the way care is provided to people with long term conditions. The report follows the Prime Minister's pledge earlier this year to make integrated care one of his five key priorities for the NHS.
On the same day it was reported in Thursday’s Guardian that David Cameron has ordered health and social care services to be brought together in order to benefit patients in a move which government advisers are calling the NHS's most urgent overhaul. Reports suggest that the prime minister has been persuaded by senior doctors and Downing Street health advisers that, without integration, the NHS could become unsustainable due to rises in the number of patients with long-term health conditions such as obesity, diabetes and breathing problems.
Prime Minster David Cameron, made a speech in which he outlined plans to require nurses to make hourly ward rounds and for members of the public to make inspections of wards. Mr Cameron wants nurses to focus on "patients not paperwork" while all hospitals will be expected to implement regular ward rounds "to systematically and routinely check that patients are comfortable, are properly fed and hydrated". This follows a spate of critical reports last year over the levels of care of the elderly in hospitals including by the Care Quality Commission where it found a fifth of NHS hospitals were breaking the law on care of the elderly. Its study also found half of hospitals were failing to provide all-round good nutrition to elderly patients while 40% do not offer dignified care.
So not the usual cut and thrust you would find in the Chamber, but some interesting developments which set the scene for 2012. Both the Lords and Commons return on 10 January.
Posted by Steve Smith, Public Affairs Officer at 11:45
Friday, 06 January 2012.
delayed transfers of care,
social care and housing support,
Disabled Facilities Grant,
Home Improvement Agencies,
Criminal Records Bureau (CRB checks)
Westminster Eye: An insight into the week of politics 12 - 20 December
At the beginning of the week The Archbishop of York, Dr John Sentamu called for urgent and lasting reform of the way care is funded for older people in England, stating that the system is no longer fit for purpose. Writing an open letter to the Prime Minister, the Archbishop asked the Government to consider a new social covenant to protect the most vulnerable in society.
Tuesday 13 December
Richard Burden MP received an answer to his question to the Secretary of State for Energy and Climate Change on what steps his Department is taking to ensure elderly and vulnerable people do not suffer ill health or die as a result of severe weather in the winter of 2011-12. In replying Gregory Barker MP said that the coalition Government is committed to tackling fuel poverty and supporting vulnerable consumers to heat their homes at an affordable cost.
This year is the first year of the mandatory Warm Home Discount scheme, which will provide over 600,000 of the poorest pensioners with a Core Group discount of £120 off their electricity bills. Other low income vulnerable households may also be assisted through the scheme. Overall the Government expected 2 million low income vulnerable households a year to be assisted through the scheme.
Funding of the Warm Front scheme was to be continued, providing low income vulnerable households, living in energy inefficient properties, with energy efficient heating and insulation measures. In addition, the Department for Work and Pensions provide pensioner households with winter fuel payments to help with additional heating costs during the winter. Cold weather payments are also made to low income and vulnerable households where there is an average temperature of 0°C or below for seven consecutive days. These payments have been increased to £25 per week and in winter 2010-11 over 17 million cold weather payments were paid in Great Britain worth an estimated £430 million.
He was working closely with the Department of Health on their cold weather plan, which aims to avoid the adverse health effects of winter by raising public awareness and triggering actions by those in contact with people most at risk. The plan sets out what needs to happen before and during periods of severe winter weather in England, and builds on established national and local campaigns for winter health with a more co-ordinated approach. The plan will work through a system of cold weather alerts in operation from 1 November to 31 March.
Chris Skidmore MP asked the Health Minister what proportion of users of adult social care services are not self-funding in each local authority area. The reply given by Social Care Minister, Paul Burstow on 15 December was that the information requested is not collected centrally.
During Commons Oral Questions to the Cabinet Office Julie Hilling MP asked what steps they are taking to support the voluntary sector. Cabinet Office Minister Nick Hurd MP said the Government was supporting the sector by cutting red tape, investing in transition funds for infrastructure and front-line organisations, creating significant new opportunities for the sector to deliver public services, and supporting new initiatives to encourage giving and social investment. He continued that the Government had put in place a £107 million transition fund to help the most vulnerable organizations.
Richard Burden MP asked Health Ministers what recent meetings the Department have had with representatives of the Care and Support Alliance and whether he plans to bring forward proposals to reform the care system. Paul Burstow responded by saying that the Care and Support Alliance have been involved throughout the engagement exercise, having met with officials and engagement leads to discuss their priorities for the reform of adult social care. Numerous events and meetings had also taken place with the constituent groups of the Care and Support Alliance, and a number of their members were chosen specifically to participate in Caring for our future engagement exercise. He added that Ministers have attended a number of these events and have met with many representatives of the Care and Support Alliance since Caring for our future was launched on 15 September 2011.
The feedback received from the engagement will be considered alongside the recommendations from the Commission on Funding of Care and Support and the Law Commission. The Government is committed to publishing a White Paper, and a progress report on funding, in spring 2012, and to legislating at the earliest possible opportunity.
Thursday 15 December
Mark Menzies MP asked what assessment the Government has made of the likely effect of the proposed reforms of the NHS on dementia care for the elderly. Paul Burstow responded saying that improving the quality of care for people with dementia and their carers was a priority for the Government. Last year it launched a new outcomes focused implementation plan for the National Dementia Strategy. This makes a clear commitment to accelerate the pace of improvement through a greater focus on local delivery and local accountability and empowering citizens to hold local organisations to account.
Julian Sturdy MP asked the Chancellor of the Exchequer whether he has any plans to provide further incentives for use of the Gift Aid scheme. Treasury Minister Chloe Smith said that the Budget 2011 announced a significant package of reforms to encourage charitable giving, including new measures on Gift Aid. These included raising the Gift Aid benefit limit from £500 to £2,500 and a Gift Aid Small Donations Scheme, so that charities can claim a Gift Aid style payment when collecting small donations and where circumstances for collecting the necessary donor details are difficult. The Government are also committed to reducing the administrative burdens on charities through the introduction of an online filing system for making Gift Aid claims and supporting the charity sector in developing a Gift Aid database. The Government keeps taxes and reliefs under review. Any changes are announced at Budget.
During Questions to the Leader of the House on Thursday, Tony Baldry MP asked for a debate early next year on social care and paying for the costs of care homes. He said that a White Paper had been promised for the Spring, but it appeared that this was going to be no more than a progress report and will not contain substantive policy decisions. He recognised that it is difficult to establish cross-party agreement on this issue, but a debate would indicate whether there was cross-party agreement on the funding of social care and the cost of care homes. As co-chair of the all-party group on carers, he wanted the matter resolved before he left Parliament. In replying Sir George Young said that one of the first actions the Government took was to establish the Dilnot report, which reported in July. There is a commitment to publish a White Paper in the Spring, which will outline the Government's response to the important issues. There have been a number of debates on this important subject, but he would welcome a further one. The Government had inherited a situation in which there were lots of White Papers but no action was taken during 13 years.
Andrew Gwynne MP asked the Secretary of State for Health what assessment he has made of the likely take-up of telehealth schemes and what discussions he has had with private companies on funding of telehealth schemes. Paul Burstow responded by saying that the Department's modelling suggests that at least 3 million people with long-term conditions could benefit from telehealth leading to a potential efficiency gain of around £1.2 billion over the next five years.The Department has been discussing with industry about new models of delivery but it will be for the NHS to commission services locally.
Monday 19 December
Anne McIntosh MP asked the Cabinet Office what plans it has to facilitate volunteering for older people. Nick Hurd replied that promoting social action among all age groups, including volunteering, is a key part of the Government's vision for the big society. The Giving White Paper, published in May 2011, outlined a number of measures that will support the creation of a culture of giving both time and money. These included the following measures which relate to volunteering and all of which are open to older people:
Over £40 million of funding over the next two years to support volunteering, giving and volunteering infrastructure by way of the Social Action Fund, Challenge Prizes and Local Infrastructure Fund. These funds have no upper age restrictions.
£1 million to support Youthnet which runs the volunteering website do-it.org.uk. Volunteering opportunities here do not have an upper age limit.
£400,000 support from Government and NESTA to trial 'Spice' in England which gives volunteers vouchers or discounts with local businesses when they do good things for the community. There is no upper age restriction on this trial.
Through the Social Action Fund, which launched in October 2010, The Government is seeking to fund programmes that encourage professionals who have retired, or are on the point of retirement, to use their experience and skills for community/public benefit.
Finally as part of the national work programme for the European Year of Volunteering 2011 the Office for Civil Society provided Age UK with a grant to promote the role of volunteering in enabling active ageing. This has been designed to lead into the European Year of Active Aging and Solidarity Between Generations in 2012.
Greg Knight MP asked what spending the Department of Health had recently spent on radio advertisements relating to dementia and for what reason it has commissioned such advertisements. The answer is expected on 11 January when the House returns.
Tuesday 20 December
Today was allocated as a Backbench Christmas Adjournment debate day. Over 30 debates were scheduled, including one tabled by Tracy Crouch MP on older people and the Campaign to End Loneliness. Speeches were kept to a maximum of six minutes so that all business could be covered during the session. During her speech, Tracy Crouch said that more than 1 million people aged over 65 say that they feel socially or emotionally lonely all or most of the time. It is heartbreaking that while many will be spending the festive season with family and friends, 500,000 older people will spend this Christmas Day alone. She added that many did not fully understand the severe social, health and financial consequences of loneliness. Researchers rate it as a higher health risk than lifelong smoking or obesity. Associated physical and mental health conditions include sleep deprivation, a weakened immune system, higher blood pressure, an increased risk of dementia and intense levels of depression. She praised the work of the Campaign to End Loneliness and of the work done in local communities. Special mention was given to the events that Medway council ran through its older people’s partnership and its work with WRVS. She finished by saying that loneliness is not just for Christmas, but this seems to be a perfectly good time to highlight loneliness amongst older people.
The Lord Commissioner of Her Majesty's Treasury Angela Watkinson responded on behalf of Government. She welcomed the good work done by Independent Age, Age UK Oxfordshire, Counsel and Care, and WRVS on the Campaign to End Loneliness. She said that the Government recognised the terrible impact that isolation and loneliness can have on people’s health and well-being. Government knows that multi-professional collaboration from a health and social care perspective on the needs of older people - including recognising isolation and those at risk from it - will make a huge contribution to keeping older people well and independent in their own homes, and to helping to maintain a decent quality of life for them. During the recently concluded the caring for our future engagement exercise the issue of loneliness and isolation among older people was raised. She concluded by adding that the Government is doing everything it can, and will also support the efforts of others, to ensure that older people have access to all the help they need to reduce social isolation.
Parliament resumes on 10 January.
Posted by Steve Smith, Public Affairs Officer at 00:00
Tuesday, 03 January 2012.
severe winter weather,
Warm Home Discount Scheme,
Warm Front scheme,
winter fuel payments,
Cold weather payments,
cold weather plan,
adult social care services,
Care and Support Alliance,
Caring for our future