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Yesterday saw the Department of Health issue it’s Adult Social Care Outcomes Framework (ASCOF) for 2013/14. Normally this would not be a newsworthy feature in itself. But yesterday was different. For the first time local authorities will measure levels of isolation and loneliness for users of care and support and carers. This is in response to the key White Paper commitment to address loneliness and social isolation.
It doesn’t sound much in itself. The ASCOF was only first published in March 2011 and has been evolving since then. The inclusion of measuring loneliness, albeit to only a section of society, is a culmination of a great deal of effort by a number of bodies including the Campaign to End Loneliness of which WRVS is a Board member. The previous social care Minister Paul Burstow should also take credit for his role in this achievement.
But it’s not just users of social care users and carers who can feel lonely and isolated. The Department of Health in its Public Health Outcomes Framework (PHOF) 2013-16 recognises that “social connectedness” is a public health issue and is working on a wider population measure of loneliness. In January the PHOF included social connectedness as an indicator to improving the wider detriments of public health. At that stage major work was required across all of the indicators (age, location, gender, socioeconomic group etc). The inference was that this work could take in excess of a year. A revised PHOF was issued earlier this week showed that social connectedness is still included as an indicator, but remains requiring major development work which suggests that this could take some time. This is where our efforts should now be directed.
But the inclusion of isolation and loneliness in the ASCOF is a good start. We should not take our eye off the ball. There is a growing impetus around tackling loneliness and isolation. We have overcome that important first step of getting it acknowledged as having a serious negative impact on an individual’s health and wellbeing. The online toolkit issued by the Campaign in May is also designed to support health and wellbeing boards to better understand, measure and commission to address loneliness and social isolation. We are now on the way to measuring it so that a strong evidence base will help ensure that the right support including that provided by organisations, like WRVS, is available to those that need it.
Read WRVS' response to the Adult Social Care Outcomes Framework announcement
On Monday the Secretary of State for Health Andrew Lansley launched the Prime Minister’s challenge on dementia to tackle one of the most important issues the UK faces arising from an ageing population. The challenge sets out the Government's ambition to increase diagnosis rates, raise awareness and understanding and to strengthen substantially the UK’s research efforts. He added that the Government was determined to transform the quality of dementia care for patients and their families. In England today there are an estimated 670,000 people are living with dementia, a number that is increasing with one in three people set to develop dementia in the future. The three key areas where the Government wants to go further and faster and build on the progress made through the National Dementia Strategy
. The three areas are:
- driving improvements in health and care
- creating dementia-friendly communities that understand how to help
- better research.
Meanwhile in the House of Lords, Lord Kennedy of Southwark asked the Government what assessment they have made of the Campaign to End Loneliness (CEL) and what action they are taking to support the aims of the campaign. The Parliamentary Under-Secretary of State, Department of Health, Earl Howe, replied saying that the Government is working with the CEL to raise awareness of the problem of loneliness and tackle the factors that cause loneliness and isolation in older people. The department recently co-hosted a social isolation and loneliness summit with CEL to gain a commitment to tackle loneliness and isolation through health and well-being boards, commissioners, local communities, businesses, statutory and voluntary sector organisations. It has also commissioned CEL to produce a digital toolkit for health and care commissioners to combat loneliness and isolation.
He added that the CEL and the Ageing Well programme, funded by the Department for Work and Pensions, have produced a guide for councils on combating loneliness. Representatives from CEL play a key role in the Age Action Alliance. This is a partnership of private, voluntary and public sector organisations jointly led by the Department for Work and Pensions and Age UK.
On Tuesday The Health and Social Care Bill
gained Royal Assent to become the Health and Social Care Act 2012. The core principles of the Act mean that doctors and nurses will be able to tailor services for their patients, more choice will be given to patients over how they are treated, and bureaucracy in the NHS will be reduced.
The Act will:
- Devolve power to front-line doctors and nurses: Health professionals will be free to design and tailor local health services for their patients.
- Drive up quality: Patients will benefit from a renewed focus on improving quality and outcomes.
- Ensure a focus on integration: There will be strong duties on the health service to promote integration of services.
- Strengthen public health: Giving responsibility for local public health services to local authorities will ensure that they are able to pull together the work done by the NHS, social care, housing, environmental health, leisure and transport services.
- Give patients more information and choice: Patients will have greater information on how the NHS is performing and the range of providers they can choose for their healthcare. And they will have a stronger voice through Healthwatch England and local Healthwatch.
- Strengthen local democratic involvement: Power will shift from Whitehall to town hall - there will be at least one locally elected councillor and a representative of Healthwatch on every Health and Wellbeing Board, to influence and challenge commissioning decisions and promote integrated health and care.
- Reduce bureaucracy: Two layers of management - Primary Care Trusts and Strategic Health Authorities - will be removed through the Act, saving £4.5 billion over the lifetime of this Parliament, with every penny being reinvested in patient care.
Helen Jones MP asked the Communities Minister what estimate he has made of likely changes to the number of pensioners who will take up council tax benefit if localisation of the benefit is introduced. A reply is expected after recess.
Health Oral Questions took place on Tuesday. Meg Munn MP asked what steps the Health Minister is taking to ensure that people receiving care at home funded by the NHS are involved in making the arrangements for that care. In responding the Social care Minister, Paul Burstow said that the Government’s ambition is to enable shared decision making for all NHS patients. He expected people who are eligible for NHS continuing care funding to be fully involved in discussions about their care. Subject to the results of the current personal health budget pilots, everyone eligible for NHS continuing health care, including many people receiving care at home, will have the right to ask for a personal health budget, including a direct payment, from April 2014.
In her supplementary question Meg Munn MP said that she had received a letter from one of her constituents who has had direct payments for 15 years under social services. Following a stay in hospital, she was moved on to health funding, and her life has changed dramatically for the worse. She says that she no longer has any choice in who cares for her and finds it hard to find the right people with whom she feels comfortable. She asked if the Minister will bring forward measures more quickly, so that people who have been directing their own care under social services can have the same quality of life and the same choices that they have become used to. Paul Burstow agreed and said that the Government needs to ensure that, as soon as possible, the benefits and the control that direct payments give to individuals in social care are available to people in regard to their long-term health care and particularly to continuing health care. It is realistic to say that Government can roll this out nationwide by 2014. He encouraged her to carry on those conversations with the authorities in Sheffield, and with him about the way in which people can use the current arrangements to access those facilities.
Stephen Dorrell MP intervened and asked whether the constituency case raised by Meg Munn did not highlight the increasingly urgent need to achieve much more integration between health and social services, and indeed between different parts of the NHS, in order to provide joined-up care that focuses on patients' needs and delivers better value for money to the taxpayer. Paul Burstow said that Mr Dorrell was right. He added that it is not just a question of delivering more integration within health care-which is often still too fragmented, or between health and social care; it is also a question of recognising that issues such as housing and leisure are critical to the delivery of greater well-being, and to an improvement in the health of the nation. The Health and Social Care Bill gives people in every part of the system a clear duty to collaborate, integrate, and deliver better care for all.
Ian Swales MP intervened saying that his constituent Joyce Benbow was discharged from Redcar Hospital last November, but is still there, owing to a failure to agree on her care package. He asked when would those managing health and social care budgets be more joined up so that people receive the right provision at the right time. In his reply Paul Burstow said that this demonstrated the importance of joining up hospital care, community care and social care, which has often been overlooked. He added that the Government had invested more than £300 million this year in developing more re-ablement services, and in January the Government invested an extra £150 million in support for them. The Government was also extending its plans for more tariff reform to ensure that local hospitals have the means to drive the development of such services in their communities.
Nick Smith MP asked what recent assessment the Minister had made of the performance of services for older people. Paul Burstow saying that a number of inspections, reports, independent audits, and investigations have revealed long-standing and unacceptable variations in the standard of care that older people receive in the NHS, and in social care. The Government is determined to root out poor-quality care wherever it is found. The national Nursing and Care Quality Forum had been established to work with patients, carers and professionals to spread best practice.
Nick Smith’s supplementary focused on the British Geriatrics Society's Quest for Quality report which identified that too many people in care homes were without access to NHS services, including psychiatric, physiotherapy and continence services. He asked what action the Government is taking to ensure that care home residents get the high-quality NHS care that they deserve. Paul Burstow responded by saying that in England, one of the things that the Government is doing is making sure that a programme of special inspections of care homes, conducted by the Care Quality Commission, looks at those issues to ensure that Government provides the right range of support services for people in care homes. In addition, the National Institute for Health and Clinical Excellence has produced quality standards; in particular, it has been working on quality standards relating to issues affecting older people-incontinence, nutrition support for adults, patient experience, delirium, dementia, and many others.
In her question Margot James MP said that Russells Hall hospital, which serves her constituency, has reviewed recent reports, and done its own research, on dignity and care for older patients. It has elevated the qualities of care and compassion to the top of its criteria for recruiting health care assistants. Paul Burstow said that it is important that that is applied to all who have direct responsibility for delivering care, and hands-on care in particular. The work that Russells Hall Hospital is doing on care and respect, and in its responsibility programme, is a good example of that. On issues such as dementia, the Government is clear that it needs to ensure good advice, training and support for all nursing staff. He was working with the Royal College of Nursing on this so that they treat people who have dementia with dignity.
In her intervention Liz Kendall MP stated that the Government is rightly building on Labour's national dementia strategy, and the Minister should know that the dementia crisis cannot be addressed without tackling the crisis in care. She added that the Government had cut more than £1 billion from local council budgets for older people's care, services are being withdrawn and care charges for dementia sufferers are soaring. The Alzheimer's Society and Age UK say that these cuts have pushed the system to breaking point. She asked if the Minister agreed with them. Paul Burstow responded by saying that the Government identified £7.2 billion of additional investment to go into social care over the life of this Parliament, and those resources are being used creatively by some local authorities to protect front-line services. He urged her to applaud the authorities that are doing that and join in condemning those that are cutting services despite being given the resources.
Further on dementia care, Mark Menzies MP welcomed the announcement on support for dementia care. He asked what assurances the Secretary of State could give that this will be an aggressive strategy, looking at matters such as new access to drugs, early diagnosis and support for carers of those with dementia. Andrew Lansley replied saying that not only were there the recent announcements, but as part of that there was the establishment of three sets of champions, including Angela Rippon and Jeremy Hughes from the Alzheimer's Society, working together as champions to raise awareness and understanding, Ian Carruthers and Sarah Pickup as champions on improving treatment and care, and Dame Sally Davies, the chief medical officer, and Mark Walport from the Wellcome Trust, as champions for research. Their objective is specifically, to hold the Government to account, not only for the ambitions set out, but for going further and faster.
Debbie Abrahams MP received a reply to her written question to the Secretary of State for Communities and Local Government on what steps his Department plans to take to evaluate the implementation of the measures contained in its document Creating the Conditions for Integration. Andrew Stunell MP replied saying that the written ministerial statement Creating the Conditions for Integration of 21 February 2012, sets out the Government's approach to enabling and encouraging integration, including the role of exemplar projects. This policy document complements the Government's Social Mobility Strategy and Equality Strategy. Specific projects in 'Creating the Conditions' will be monitored and evaluated against each project's objectives. Integration is predominately a local issue which requires a local response, and therefore evaluation is a matter for local areas.
Diane Abbot MP asked what estimate the Health Minister has made of the number of NHS patients in England who are housebound. Paul Bustow said that the information is not held centrally.
Diane Abbott MP also asked the Secretary of State for Health how many older people were subject to delayed discharge from hospital as a result of malnutrition in (a) 2010, (b) 2011 and (c) the latest period for which figures are available in 2012. Paul Burstow said that the information requested was not collected centrally. He added that delayed discharges occur when a patient is medically fit to be transferred from hospital, but is still occupying an acute bed because of a lack of capacity in the wider system. If a patient is suffering from malnutrition and is not medically fit, they would not be ready for discharge from hospital and therefore could not be counted as delayed.
On Wednesday Simon Kirby
MP tabled two written questions around the subject of loneliness. The first asked what engagement the Department of Health had had with WRVS at the recent Loneliness Summit. The second question asked what steps the Department is taking to reduce loneliness amongst the elderly. On the same day Virendra Sharma
MP asked 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. Answers are expected for all these questions on or around the 16 April.
In the Lords on Wednesday Lord Warner asked the Government how many commissioning support services for clinical commissioning groups are expected to be identified by 1 April 2012; and how many of those are expected to be led by former primary care trust managers. Earl Howe in responding said that work is in hand within primary care trusts (PCTs), strategic health authorities and the NHS Commissioning Board Authority to develop the necessary arrangements to support the new commissioning system. The detailed strategy describing this is set out in the publication Developing Commissioning Support: Towards Service Excellence. Information on the number of emerging National Health Service commissioning support services is not yet available. The leadership of these organisations as at 1 April 2012 is a matter for the PCT clusters. The department does not hold information on PCT cluster staffing arrangements.
Both Houses are now in Easter recess. Both Houses return on 26 April.
Last week Audit Scotland released its report into Transport for Health and Social Care. One of the most significant ways transport for health and social care is provided is through the community transport initiatives run by organisations like WRVS. As community transport is a major part of WRVS’ work in Scotland this report is really important for our work.
It was really good to see that the report recognises how vital transport is to older people’s quality of life. While often overlooked community transport means it’s possible for people to get to the shops, visit their friends and attend hospital appointments. This means that transport is a vital way in which we can stop loneliness.
The report has amongst its conclusions that there are funding pressures on voluntary sector provision, better scope to join up services and potential for better joint working with the voluntary sector. While we knew this, it’s good to have it confirmed in an official report.
Loneliness is surprisingly common. Shockingly half of older people say that the television is their main source of company. Across the UK, 200,000 older people don’t get help to get out of their homes, and organisations like WRVS have a really important role to play in improving quality of life for those people.
Community transport is a vital part of combating loneliness and helping older people live happier, more fulfilled lives, getting them out to the shops, to social events and to vital appointments at the hospital or GP. By helping older people get out of their houses WRVS and other voluntary sector organisations make it easier for older people to stay part of the community. This reduces loneliness and isolation which are often triggers for ill health.
So it’s clear that the community transport services WRVS provides make a huge difference to the lives of older people. But these services are under pressure and need to be properly funded. Too often the value that community transport gives to people’s lives to the community is overlooked when funding decisions are made. Similarly, organisations like WRVS could make an even greater difference if services were better joined up across council boundaries and between Councils and Health Boards.
Better support for community transport will lead to reduced loneliness, and all the health and social benefits that come with reduced loneliness. It is vital to ensuring we have an active older population that local authorities and health boards take community transport seriously. That must mean proper funding that recognises the role that transport plays in preventing loneliness and more support for better joint working between organisations like WRVS, the NHS and local government.