What we're saying
Find out what we're saying - where we share our thoughts and opinions and make comments on issues facing older people, volunteering and preventative care.
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Are we prepared to reduce emergency readmissions rates for older people?
The focus of the older people debate centred this week was on the Government’s plans to radically reform pension provision and provide a flat rate pension of £144 a week by 2017. This announcement by the Pensions Minister Steve Webb MP completely overshadowed figures published on the same day by the Department of Health showing that over a ten year period emergency readmissions for the total population had increased from 370,940 in 2000/1 to 648,147 in 2010/11. When taking a closer look at the 75 and over age group, the figures are even more worrying. The raw data shows that in 2000/01 the numbers of emergency readmissions for the older age group were just under 100,000, but by 2010/11 had doubled to just over 200,000 a year. This equates to a rise in emergency readmissions for the older people from 11.04% to 15.69%. One can ponder why this is the case, an increase in the numbers of older people, changes in counting methodology, definitions and various other possible changes in circumstances, but nevertheless the rise is still significant.
There is a crucial role for the emerging Clinical Commissioning Groups to play in ensuring that the support and the services that keep people safe at home are made available. Over recent years money has been transferred from the mainstream NHS to local authorities for the purposes of reablement and post discharge support in addition to more general social care.
There is a growing consensus that low level social care that provides vital practical support is preferable to them returning to hospital shortly after discharge when it is not necessary. During Health oral questions on Tuesday, Stephen Dorrell MP, Chair of the Health Select Committee, quizzed the Minister saying that one of the most effective things to do to improve the patient experience of health and care is to improve the co-ordination, not just between the hospital service and community-based health services, but between the NHS and social care.
However, WRVS research into the relationships that are being formed at a local level are not as advanced as one would like to see at this stage. Of the 98 PCTs that responded to a WRVS FOI enquiry into relationships with the local authority, 20 had pooled budgets, and 3 had informal regular meetings. Just a single PCT had established a joint working group with representatives from local authorities specifically for commissioning services related to admissions/discharges.
On Monday the Guardian published data from its survey in which professionals working in local government said they did not have the knowledge and expertise to commission services. The vast majority (77%) said they needed more training to do the job of commissioning well, while 14% said they were already being expected to perform jobs without the necessary skills. Just 8% said they felt fully equipped to take on the job of commissioning. Almost half of those surveyed admitted they had not heard of the Social Value Act, which requires public bodies including councils to consider the social value of a contract when procuring services and goods.
Penalties on readmission rates were introduced to improve clinical practice and it is estimated that the cost to the NHS of patients being readmitted to hospital within a month following discharge is £2.2bn. It is clear that the increase in unnecessary emergency readmissions of older people is unsustainable and takes up valuable resource which could be more effectively used elsewhere in the healthcare system. It is still early days, and it may take some further steps and time but there are cost effective solutions that exist for example, Home from Hospital services, that can deliver better outcomes on the ground. It is time that more use is made of these types of service.
So where's the strategy for the long term?
Understanding and getting to grips with the opportunities and challenges of an increasing ageing population is one of the key conundrums that the Government and wider society has to currently face.
The pre Christmas House of Lords debate on the place of older people in society highlighted the net financial contribution that older people make to the UK economy, citing the WRVS figure of £40billion benefit in 2010. But it’s not just about finances. Earlier this week in a response to a tabled question, Baroness Warsi said that the Government recognised the importance of the issues facing people in later life and the contribution they make to society, but did not have all the answers. She added that the Age Action Alliance was created in recognition of the need for a radical shift in approach and its vision was informed and driven by older people themselves.
The Lords Committee on Public Service and Demographic Change took oral evidence from Ministers Hunt, Lamb and Webb on Wednesday. In response to questions around what the Cabinet had done collectively to address issues arising from an ageing population, Hunt said that it had taken some good first steps but agreed that there was much more that it could do. He agreed that the ageing population was a nettle that had to be grasped. He saw the 2 biggest issues being the sustainability of the NHS and pension provision. The Committee Chair appeared sceptical; saying that the Committee had not seen much in the way of a coherent long term strategy to look at the scale of the challenges around ageing and that most work undertaken was fiscal and short term in nature.
Early in the week, the Coalition’s mid-term review re-confirmed the Government’s support for the principles set out in the Andrew Dilnot report. But any detail as to how the future costs of adult social care would be met was disappointingly absent. Just a couple of days later to emphasise the urgency, analysis by London Councils estimated that the funding gap for providing adult social care in London will amount to £907m within five years. Councils in London currently spend a third (£2.8 billion) of their total budgets on adult social care and this is set to rise dramatically as the number of Londoners aged over 65 increases by some 50,000 during the next five years.
So in a week when detail was thin on the ground about long term thinking on the future funding of care and for older people more generally, it is clear that there is a major role for the third sector to step up to the plate and take on an enhanced role. But this week there was criticism of the Government from the Chief Executive of AVECO that the potential for charities to transform public services remains largely untapped, with reforms in too many areas either glacially slow, as demonstrated by social care funding reform.
In his response, the Civic Society Minister said that harnessing the spirit of common purpose witnessed in 2012 so that together big social problems could be tackled was a cultural change that won’t happen overnight, especially in challenging economic times. He acknowledged that Britain is blessed to have some of the most generous people and the most innovative charities in the world.
He is right - the spirit is there, in spades. It is estimated that in the UK about 20 million people volunteer in some form. In WRVS alone over 50% of its 40,000 volunteers are over the age of 65. Not only are the volunteers helping older people in a more cost-effective way than through expensive state mechanisms like the NHS, but they are helping themselves to enjoy better mental and physical health outcomes. This is essential as the Government plans its strategies for the future. And WRVS, in celebrating in 2013 its 75th year of civic service, is keen for this message of volunteering to amplify and grow.
Setting the scene for 2013
As we enter 2013, the many issues that come with an ageing population have never been more centre stage. Keeping with the theatrical theme, even the film industry is getting in on the act with Dustin Hoffman making his directorial debut at the age of 75 with “Quartet”, a film about four friends who reside at home for retired opera singers.
The draft Care and Support Bill published in July 2012 proposes a single, modern law for adult care and support that replaces existing outdated and complex legislation. Comments were requested by the Government by 19 October and a summary of responses was published just before Christmas. The Joint Committee on the Draft Care and Support Bill has already begun to take evidence from experts and has invited written submissions by 11 January as part of this work.
In yesterday’s report by think-tank Centre Forum, Paul Burstow sets out some ideas of how the funding of future care could be achieved by linking winter fuel payments with Pension Credit, reducing the number of recipients from over 12 million to around 3 million, saving £1.5 billion annually. The idea is welcomed by some, but criticised by others and is likely to be controversial. But it does set down an early marker for the ensuing comprehensive spending review that will begin shortly.
In December local clinicians were given the green light to take control of the NHS budget in 34 areas of England shaping the way in which care is delivered for millions of older people in the coming months and years.
The House of Lords Select Committee on Public Service and Demographic Change hold their final evidence session on 9 January, where they will put the questions that have emerged over the course of their inquiry to Ministers Jeremy Hunt MP, Norman Lamb MP and Steve Webb MP. WRVS has been one of a number of organisations that have given oral evidence at hearings over the past few months. The inquiry is the first by Parliament to assess if our society, policies and public services are really ready for the ageing population. The evidence that the Committee has received so far suggests that we are worryingly underprepared.
The outgoing Archbishop of Canterbury Rowan Williams in his final New Year Message centred on the crucial role of volunteers. He said that anyone who had seen the London Games “will have been made aware of the army of volunteers who cheerfully gave up their free time and worked away, without complaint, all hours of the day and night to make these great events happen. They were the key people who translated the Olympic vision into reality for the rest of us.” He recognised that similar acts are happening in many other communities around the country in far less glamorous circumstances. But he also asked the tougher question: what can we all do to join this silent conspiracy of generous dedication?
It is clear that urgent action is required by Government to put in place the adult social care framework that older people deserve and that will be necessary to meet the demands of the 21st century. It has also become clear that Government cannot do this alone.
Earlier this week building on the comments made by Williams, social care minister Norman Lamb said that friends, family and neighbours should all do more to prevent older people going into care unnecessarily. Just before Christmas it was announced that volunteers will soon benefit from a free service which will allow them to re-use criminal records checks time and time again. The move to cut red-tape and reduce the burden on those who give up their time to work with older people is a welcome step. The many tens of thousands that give up their time on a regular basis with WRVS and other organisations to help in their local communities are an essential part of the solution. So not only do we need a new legal framework, but also to devise new and innovative ways to encourage more people, especially those reaching retirement, to continue to contribute. At the same time movement to ensure cooperation and coordination between organisations and authorities is necessary, if we are to be in better shape at the end of 2013.