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Westminster Eye: An insight into the week of politics 12 - 16 March

Monday 12 March

On Monday Helen Jones MP received an answer to her question to the Secretary of State for Communities and Local Government asking how many local authorities have increased charges (a) for the use of day centres and (b) for transport to day centres in 2011-12; and how many local authorities plan to increase such charges in 2012-13. Minister Robert Neill said that the information requested was not held centrally.

The previous week Tracey Crouch MP had asked what assessment the Health Minister had made of the conclusions and recommendations of the joint report by the NHS Confederation, Age UK and the Local Government Association on improving dignity in the care of older people. Social Care Minister Paul Burstow said that the Department welcomed the publication of the Commission's draft report, which aimed to help drive improvements in the quality of care provided to older people in hospitals and care homes. He looked forward to the publication of the Commission's final report.

He added that the Government was determined to root out poor quality care in the NHS through a range of actions. The NHS Operating Framework for 2012-13 established the issue of high quality, dignified and compassionate care as one of four key priorities for the NHS.

In addition, on 6 January, the Government had announced a series of measures to improve the quality of nursing care and free up nurses to provide the care patients and relatives expect. The measures included setting up a new independent Nursing and Care Quality Forum, tasked with ensuring that the best nursing practice is spread throughout the NHS and social care.

Meanwhile in the House of Lords, Lord Lester of Herne Hill asked the Government whether they will bring into effect the power conferred by the Equality Act 2010 to make age discrimination unlawful in providing goods, services and facilities, including health care, to the public. In her reply Baroness Verma said that following a public consultation last year, the Government was still considering the scope for and content of exceptions from any age discrimination ban and will announce how it intends to proceed in due course.

David Morris MP had asked Health Ministers what steps the Department of Health is taking to ensure that all elderly people are treated with respect and dignity in hospitals. On the same day he also asked Work and Pensions Ministers what steps their Department is taking to assess the implications of the Dilnot Report.

Tuesday 13 March

On Tuesday Paul Burstow replied saying that the Government is determined to root out poor quality care in the NHS. The Government is taking action on a number of fronts, including measures in the 2012-13 Operating framework, where quality of care, particularly for older people, is established as one of the four key priorities for the service, giving it equal billing with Operational Performance, the Quality, Innovation, Productivity and Prevention programme and Reform.

He added that the Care Quality Commission will be building on the 100 Dignity and Nutrition inspections it undertook in 2011 on behalf of the Department by undertaking a further 700 inspections this year. To improve on these inspections, the Prime Minister recently announced a new patient-led inspection regime, looking at nutrition, privacy, cleanliness and dignity.

In addition, there are also a number of National Institute of Health and Clinical Excellence quality standards that are either in place or are being developed for a range of conditions and pathways affecting older people, including incontinence, nutrition support in adults, patient experience in adult NHS services, delirium, dementia, osteoarthritis and falls in a care setting. There is also renewed funding for National Audits relevant to older people's care. There are a number of indicators in the NHS Outcomes Framework to support better care for older people around dementia care, hospital acquired infections, emergency readmission rates, improving recovery from fragility fractures and helping older people to recover their independence after illness or injury. The Government had established the National Nursing and Care Quality Forum to work with patients, carers and professionals to spread best practice to increase the quality of services to older people.

In regards of the Dilnot question directed at the pensions Minister, Paul Burstow said that following the publication of the report of the Commission on Funding of Care and Support, the Government announced they would consult with a range of people and organisations involved in care and support on their recommendations and social care reform more broadly. "Caring for our future: Shared ambitions for care and support engagement" ran between 15 September and 2 December 2011. The Government will publish their plans for social care reform in a care and support White Paper and progress report on funding in the spring.

Virendra Sharma MP had asked the Department of Health a series of questions the previous week. The first two questions focused on telecare. In summary, he asked what assessment the Department has made of the effect of telehealth and telecare services on improving patient experience and also of delivering efficiency savings in the NHS and adult social services. Virendra Sharma MP also asked what plans the Department has to support (a) primary care trusts, (b) clinical commissioning groups and (c) local authorities to commission telehealth and telecare services for people with long-term care needs. Replies are awaited.

In replying Paul Burstow said that the Department has been trialling the effect of telehealth and telecare in the Whole System Demonstrator programme, a large-scale randomised control trial. Early headline findings published by the Department on 5 December 2011 had demonstrated that when used appropriately there is potential to reduce emergency admissions and mortality. The Department estimated that there are three million people with long term conditions who could benefit from this approach, which is why the Department and leaders from industry signed a concordat demonstrating a commitment to deliver telehealth and telecare to those who will benefit. This is the Three Million Lives initiative launched on 19 January 2012.

On Wednesday Jim Cunningham MP asked what steps the Government is taking to ensure consistent levels of provision of social care support. Paul Burstow referred the MP to the reply that he gave him on 5 December 2011.

Virendra Sharma MP had asked the Health Secretary what proportion of the £648 million allocated for local authority spending on social care that also benefits health in 2011-12 was spent by each local authority in England on (a) prevention services, (b) communicating equipment and adaptations, (c) telecare, (d) crisis response services, (e) maintaining eligibility criteria, (f) re-ablement and (g) mental health. Paul Burstow said that in September 2011, the Department collected information from primary care trusts to understand how the transfer of NHS money was progressing and on which services it was being used. A demonstrative graph of all of the forms that the money is being spent on can be found in the NHS publication "The Quarter".

He added that when the information was collected, the majority of money had yet to be transferred, but agreements had been made which set out on which services the money would be spent.

The proportion of £648 million NHS transfer to local authorities was spent on different services as follows:

  1. Prevention (not including community equipment and adaptations) -10%
  2. Community equipment and adaptations - 5%
  3. Telecare - 4%
  4. Crisis response services - 8%
  5. Maintaining eligibility criteria - 18%
  6. Re-ablement - 18%
  7. Mental health - 5%

The remainder of the transfer was spent on the following services:

  • Integrated crisis and rapid response services - 8%
  • Bed-based intermediate care services - 10%
  • Early supported hospital discharge schemes - 8%
  • Other services - 14%

The MP also quizzed the Minister over his plans to introduce a national assessment framework for social care. Paul Burstow replied saying that the Government will publish their plans for social care reform in a care and support White Paper and progress report on funding in the spring. This will include responding to the recommendations made by the Law Commission and Commission on Funding of Care and Support on assessment.

Philip Davies MP received a reply to his question to the Work and Pensions Minister asking how much has been paid in each of the last three years in winter fuel payments to people in care homes. Steve Webb said that the requested information is not available as DWP datasets do not identify people who are resident in care homes receiving winter fuel payments.

Tim Farron MP had asked the Health Department how many people have received care packages following an assessment by social services in each local authority in each of the last five years. Paul Burstow replied saying that data on the provision of care packages provided by Councils with Adult Social Services Responsibilities (CASSR) is collected and published by the Health and Social Care Information Centre via the National Adult Social Care Intelligence Service.

During Prime Ministers Questions on Wednesday Gordon Marsden MP observed that study after study showed that it is crucial for older people that NHS services work closely with social care. His primary care trust in Blackpool has been doing that by working alongside the council's social services in the same set of offices. He asked why the Deputy Prime Minister was supporting a Bill that scraps trusts and such co-operation, and that puts the health of older people, including those in his constituency, at risk.

Nick Clegg MP in responding said that he backed a Bill that included, for the first time, statutory obligations to integrate social and health care. He agreed that one of the abiding failings of the health service is that social and health care are not properly integrated. There has not been much integration over the past ten years but Government was trying to change that. He added that the creation of health and wellbeing boards will bring together representatives of the NHS and social care.

Wednesday 14 March

On Wednesday, Jim Cunningham MP received an answer from Paul Burstow to his question on what recent steps he has taken to improve (a) cancer, (b) accident and emergency, (c) paediatric and (d) geriatric services in the West Midlands. In response to geriatric services, Paul Burstow said that the provision of national health services is a matter for the local NHS. The Department encourages providers to increase the quality of their services to older people, by sharing best practice, bringing people together, and putting in place the right system incentives. The Department aims to keep older people well and out of hospital; to help older people regain their independence after a period of support; to provide older people with advice and choice around their end of life care; and to give older people a greater say in their care.

On Thursday Paul Burstow responded to Tim Farron’s question on what estimate he has made of the cost of (a) continuing care assessments and (b) core assessments by social services in each local authority in each of the last five years. Paul Burstow said that no assessment of the cost to local authorities of continuing health care, and core assessments by social services had been made.

Westminster Eye: An insight into the week of politics 7 - 11 November

Brandon Lewis MP received a long and comprehensive answer from the Minister about the steps being taken to ensure elderly patients in NHS facilities receive adequate hydration and nourishment.

The Department had commissioned the Care Quality Commission (CQC) to undertake the Dignity and Nutrition Inspection (DANI) programme and its final national report was published last month. There are a number of steps the Department is taking to improve care for elderly patients in the NHS.

There are a number of National Institute for Health and Clinical Excellence quality standards commissioned by the Department that are either in place or are being developed for a range of conditions and pathways affecting older people including incontinence, nutrition support in adults, patient experience in adult NHS services, delirium, dementia, osteoarthritis and falls in a care setting.

One of the eight high impact actions developed for nursing relates to keeping people nourished and getting better, and aims to stop unintentional weight loss and dehydration in patients. Since April 2010, it has been a requirement of a hospital’s continuing registration with the CQC that service users are protected from the risks of dehydration and inadequate nutrition.

Within the NHS Operating Framework and the NHS Outcomes Framework, there are a number of indicators to support better care for older people. These include dementia care, hospital acquired infections, emergency readmission rates, improving recovery from fragility fractures and helping older people to recover their independence after illness or injury. The Department is also funding national audits of falls and bone health, dementia, continence and hip fracture.

Local Involvement Networks in each local authority area are able to enter and view services to obtain the views and experiences of patients, service users and their families about their experiences of care and treatment at the time they are receiving it. This information can be shared with the CQC. The Department of Health supports the Partnership on dignity in care, which has been established by the NHS Confederation, Age UK and the Local Government Group.

Caroline Lucas asked whether the Minister is considering mechanisms to ensure that hospitals are provided with financial incentives to participate in arrangements for integrated care for people aged over 75 years to facilitate better patient care and prevent avoidable hospital admissions. A reply is awaited.

8 November
Andrea Leadsom MP received an answer to her question on how much funding has the Department of Health allocated to social care for the elderly. Paul Burstow explained that allocating funding for adult social care is the responsibility of local authorities, who receive funding from central Government through the local government formula grant and raise money locally through council tax.

He added that the latest local authority budget data for 2011-12 show that local authorities have budgeted £7.0 billion towards social care for those over 65. The Department of Health also estimate that around £300 million has been transferred to local authorities for older people's services from primary care trusts this year, as part of the additional support for social care provided through the health system. Budgeted expenditure for older people will therefore be around £7.3 billion this year.

Liz Kendall MP quizzed the Minister over how many unplanned hospital admissions for people aged 65 years and over there were, broken down by (a) local authority and (b) NHS commissioner in each month in (i) 2008-09, (ii) 2009-10, (iii) 2010-11 and (iv) 2011-12. A reply is due next week.

10 November
The highlight of the week was a three hour backbench committee debate on funding of social care that took place in Westminster Hall. Sarah Newton MP opened the debate. There had been a failure in political will, resulting in only limited action being taken. However, demographic change and its impact is now an issue moving rapidly up the political agenda. All parties have signalled a desire for a long-term, all-party solution to the care crisis. It is clear that now is the time for us to take action.

Polling evidence last year showed that 62% of the public saw care reform as one of the most important issues for the Government, and more than 50% of people felt that political parties were not doing enough to improve care for older people.

The Dilnot Commission’s report had support from a wide range of stakeholders and was warmly welcomed by all political parties. She said that real spending on the NHS has risen by £25 billion since 2004, spending on social care for older people and adults with disabilities had simply not kept pace. She said that whilst Cornwall had not cut services this was not the case across the country where cuts to social care were at an estimated 7%. This was creating stress in the NHS. Delays in the discharge of people from hospitals are significantly higher than they were in the same months last year. Over 75% of delayed transfers for acute care are for people aged 75 and over. She looked forward to a WRVS report which would provide evidence of the impact of councils not using effectively the additional funds that they received from the NHS.

Penny Mordaunt MP mentioned the massive unmet need in dementia care in particular bathing facilities and all the other things that constituents should have but that too many of them do not have access to. She added that some poor commissioning practices have gone on, discriminating against independent providers which could a better job at a lower cost, and have large amounts of volunteer support and a whole raft of other stuff.

Barbara Keeley said that the current system is unfair and unsustainable. The provision of information and advice is poor quality and very limited. Requests for support are increasing. In 2009-10, there were 2.1 million contacts from new clients to social services, an increase of 4% from 2008-09 and of 8% from 2004-05. Many hundreds of thousands of people never have their needs assessed. 82% of local authorities now provide care only to those with “substantial” or “critical” needs. Of those aged over 65 who needed help with bathing, 66% were not receiving any help at all. The number of delayed discharges from hospital was 11% higher in September and October this year than in the same two months in 2010. Delaying discharges from hospital is an expensive solution to the problem of inadequate social care.

Tony Baldry MP pressed the Minister on a date for the White Paper and said that the scale and nature of the growing demand must be recognised. He agreed that the cost to the NHS of delayed discharges could be significant without action. He highlighted the rising rate of dementia as the numbers of older people grew and the knock on impact on the required level of carers.

Heidi Alexander MP warned of the £80 million worth of cuts in the next three years in her constituency of Lewisham and the very difficult decisions about how to make all that work. She pressed the Minister commit to a Bill in the next Queen’s Speech.

Margot James MP said that spending on adult and social care rose by only 0.1% between 2004 and 2010. During that period the numbers of older people needing care expanded significantly. The number of older people aged over 65 increased by 7.7%, while the number of very elderly—the over-80s—increased by 11.6%. Spending on the NHS had increased by 27%, on the police by 20% and on schools by 12%. The proportion of local authorities providing care to people in moderate need fell from 36% in 2004 to 21% in 2010.She believed that to be a false economy. The Government had diverted £1 billion from the NHS to social care, and that has been well received, but did not go far enough.

Opposition spokesperson, Liz Kendall MP, mentioned the substantial levels of unmet need estimated by the Kings Fund to be around £1.2 billion. Eight out of ten councils now provide services only for people with substantial or critical needs. The Association of Directors of Adult Social Services said that social care spending has been cut by £1 billion this year, with even bigger cuts likely next year. There will be a real-terms cut of £1.34 billion to adult social care in the Government’s first two years once inflation is taken into account; £1.3 billion is being cut from social care spending for those over 65. Local council budgets are being cut by 27% during the spending review period and that that will have an effect on adult social care, because social care budgets are the biggest discretionary spend for local councils. She called for full and proper debate including politicians and the public

In responding for Government Paul Burstow, Social Care Minister, said that the Government was committed to a White Paper that they will publish next April. He admitted that things are tough, and that councils had had to make difficult decisions. It has not been an easy time and difficult decisions have had to be made across Government.

In the previous spending review, which was announced last October, the Government provided an extra £7.2 billion over four years up to 2015 to protect social care, partly through councils and partly through the NHS. The aim was to alleviate the potential pressures on the adult social care system in what would be a challenging overall funding settlement for local government.

Government had front-end loaded the funding for the first two years to insulate social care from cuts to local authority budgets. Combined with a focus on efficiency, he believed that the additional funding will protect people’s access to care services. He said that budget data collected by the Department for Communities and Local Government from local authorities suggests that social care budgets are around £200 million lower than last year, which is a reduction of just over 1.5%. However, it is not inevitable that reductions in spending lead to cuts in front-line services. For every £1 that has been saved or taken out of spending in social care by local authorities, 70p can be attributed to efficiency savings. He did not believe that Ministers should micro-manage the decisions of every local authority or dictate to local authorities about how to manage their resources.

Of the £648 million reallocated from the NHS for this year, nearly half has already been transferred and agreements are in place to transfer the remainder. The feedback that he had showed that the money is being spent on where intended —prevention and rehabilitation, re-ablement, early hospital discharge schemes and integrated crisis response services. The money was making a difference in the communities in which they are being used. He admitted that times are tough and there are areas where cuts to front-line adult social care services are really beginning to bite. He claimed that there was a mixed picture across the country and it was not true that “less money equals more cuts.” He acknowledged that WRVS are publishing a report which he will read with interest when it is published.

He concluded by saying that when the decisions are made Government will have looked at this process and the White Paper outcomes, and will be in a position to legislate at the earliest opportunity. Social care, he said has languished and rested in the “too-difficult-to-do” box for far too.