Over the early part of this week summer returned to the south of England. It made for a sticky and uncomfortable few days.
One of the meetings I attended early in the week was jointly organised by Demos and Durham University entitled “Poor Health? The Health Service in the Age of Austerity”. Amongst the panel were MPs Dianne Abbott and Debbie Abrahams and Mike Farrar of the NHS Confederation.
The session looked at the challenges facing health policy makers through a period of economic turmoil and reduced spending resulting in fewer resources to meet increasing demand. Our society is changing around the NHS. We are living longer, and more of us are over 60 and are living with long term conditions and disabilities. The public health impact of the tough economic climate including unemployment, job insecurity, fuel poverty, homelessness etc – have an effect on the NHS. The response in cutting the national deficit – introducing cuts to disability, unemployment and housing benefits, social care budgets and funding for the third sector –reduced the capacity to cope with these social problems.
I asked the panel whether they thought the messaging around the cap and its counting against eligible care costs was helpful. Debbie Abrahams thought the proposed national threshold of substantial was too high, whilst Mike Farrar believed that people needed to be informed in clear terms what the whole package meant for them in real life.
On Tuesday I attended a session called “Living well for longer”. Amongst the panel was Lord Filkin chair of the Lords public service and demographic change committee which published “Ready for Ageing?” earlier this year. The aim of the meeting was to outline three policy ideas that Labour could adopt in terms of helping people to live healthier lives for longer. Lord Filkin said that there was a need to shift the NHS from its current hospital-centric nature, focused on the acute, to supporting those at home to manage their own conditions but that integration was not a silver bullet. For him it was unavoidable that much more would have to be spent on health and social care going forward, the question was whether this would come from the individual directly or through taxation.
Lord Filkin recognised the link between isolation and poor wellbeing and health outcomes for older people. As it would never be possible to fund through taxpayer sources all the social care needed, it was absolutely critical to look at how to grow volunteer and community support. He concluded that there had been a failure by the political class so far to engage with the issue and called for collective encouragement to address that.
Esther Rantzen from Silverline was in attendance and argued that it was crucial to look at housing for older people, which was not on anyone's agenda, with the focus centred on first time buyers. Her policy suggestion for Labour's manifesto was to include reference to this need for appropriate housing, which would free up other provision for families.
Esther herself chaired one of the last meetings I attended around the issue of suitable housing for older people. She was supported by a knowledgeable panel including Gary Day from McCarthy & Stone and Jack Dromey MP. Demos had produced a study using existing evidence coupled with their own poll. The poll showed consistently that over half of older people were interesting in moving to retirement homes or downsizing. Those interested in moving were sitting on £400 billion of housing wealth. The clear message was that whilst all eyes are on those at the bottom of the ladder, those at the top are often trapped in homes that are too big or unmanageable and some innovative thinking needs to undertaken to assist those who want move on and therefore could set off a chain reaction to release homes for others. Planning policy around building new retirement homes was often another barrier. Food for thought indeed.
Posted by Steve Smith Public Affairs Manager (England) at 00:00
Thursday, 26 September 2013.
Provisional figures out today from the Health and Social Care Information Centre show that gross current expenditure by Councils with Adult Social Services Responsibilities (CASSRs) on adult social care in England in 2012-13 was £17.1 billion. This is a 1% decrease in cash terms (2% in real terms) compared to £17.2 billion in 2011-12. Spending on older people (those over 65) was 51% (£8.8 billion) of expenditure in 2012-13, compared to 52 % (8.9 billion) in 2011-12.
Spending on meals for older people continues to decrease. The latest figures show a fall from £62million just a year ago, to £52million in 2012-13 from. This is substantially down from £96 million spent in 2003/04. This probably reflects councils reigning in spending in areas where they have some freedom, to concentrate where they have no flexibility.
One area of significant growth is in the numbers of people opting to take direct payments. This has been a result of a shift towards the personalisation of delivering care and support. These are cash payments given to service users in lieu of community care services they have been assessed as needing, and are meant to give users greater choice in deciding their care. The payment must be sufficient to enable the service user to purchase services to meet their eligible needs, and must be spent on services that meet eligible needs. Some people will use the money to buy care from an agency whilst others will directly employ their own staff, even in some cases paying members of their own family to do the care.
Spending on direct payments for adults was £1.3 billion in 2012-13 compared to £1.1 billion in 2011-12; an increase of around 15 per cent in cash terms (13% in real terms). This was an increase of 179% in cash terms compared to the £450 million spent in 2007-08. The percentage of expenditure used for direct payments for adults continued to increase and equated to 7% of gross current expenditure in 2012-13 compared to 6% in 2011-12 and just under 3% in 2007-08.
Direct payments have traditionally had a higher take-up among younger adults. But the take up from older people is increasing. Direct payments to those aged over 65 were just £21 million in 2003-04, but have risen to £395 million by 2012-13. In the last year alone direct payment jumped from £330 million.
Within the draft Care Bill there is a new duty on local authorities to provide a care and support plan. One of the core requirements of a care and support plan is a personal budget for the adult and, for the first time, a legal entitlement to a personal budget. This is complemented by a right to request a direct payment to meet some or all of those needs, to maximise the control people have over how that money is spent.
This provides an opportunity to try new and innovative ways of providing the individual with support that they believe best meets their needs. With the right help and advice it will be interesting to see how this impacts on health outcomes of older people in the years to come.
Posted by Steve Smith Public Affairs Manager (England) at 00:00
Thursday, 19 September 2013.
There’s a definite chill in the air as temperatures are far from what they were just a few weeks ago. It’s a sharp reminder that winter is looming on the horizon. Ministers have announced an additional £500milion over 2 years for NHS Trusts to spend on winter planning and to bolster A&E resources when they are in most demand. The money is being made available to 53 NHS Trusts. A proportion will go to community support and primary care.
"We welcome the additional funding that has been announced and the fact that it allows time for planning to ensure the money is delivered in an effective way. We are also pleased that there has been an acknowledgement of the importance of looking after the needs of older patients who represent such a high proportion of hospital admittances in winter. However, only a small proportion of the money allocated is signposted for community services, an area we feel should be more of a focus. Only by investing more in community services such as our Home from Hospital service which supports older patients when they are discharged from hospital can we meet the long term aim of reducing the number of older people going in to A&E in the first place."
David McCullough, chief executive of Royal Voluntary Service
Indeed the Government recognises that we need more radical change to reduce pressures on A&E Departments over the longer term. Although the extra funding is useful, it’s unhelpful to go through this annual process to stave off a “crisis”. The Government is currently consulting on plans to provide improved care for vulnerable older people to keep them out of hospital through better, more proactive care in their community. There is a practical role here for the voluntary sector to play by working in partnership with the authorities and commissioners in boosting preventing the need for hospital admission and readmission.
We know that the number of people going to A&E departments in England has risen by 32 per cent in the past decade, and by one million each year since 2010. The over-65s represent 17 per cent of the population, but 68 per cent of NHS emergency bed use. They also represent some of the NHS's most vulnerable patients, and those most at risk from failures to provide seamless care.
Integration has been talked about for years, but now we have a £3.8billion Integration Transformation Fund to make sure everyone gets a properly joined up service in order to get the care they need from whoever is best placed to deliver - the NHS or the local authority.
As the Social Care Minister Norman Lamb said, "This (integration) can no longer be just an aspiration - by joining up service, we will help keep people out of hospital and provide better care."
Often the issue is not just about what's going on in the hospital, although that is very important - the pressure would be relieved if fewer patients needed to go to hospital because they were kept well and treated at home or in their local communities.
Posted by at 00:00
Wednesday, 11 September 2013.