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Westminster Eye: An insight into the week of politics 5 - 9 March

Tuesday 6 March

Tracey Crouch MP received an answer to her question asking what assessment the Minister has made of the quality of annual reviews for patients with dementia and what measures he is taking to ensure that people diagnosed with dementia who are receiving anti-psychotic medication receive regular reviews of their progress.  In responding to the two questions Paul Burstow MP, Social Care Services Minister said that the Government wanted to see a two-thirds reduction in the level of prescribing of antipsychotic drugs for people with dementia and we have commissioned an audit to measure this.

He added that the Dementia Action Alliance supported by the NHS Institute and the Department launched a 'National Call to Action' on 9 June 2011. The aim was to ensure that by 31 March 2012 all 180,000 people with dementia, who are receiving antipsychotic drugs will have undergone a clinical review, to ensure that their care is compliant with current best practice and guidelines and that alternatives to their prescription have been considered. Reducing the use of antipsychotic medication is a key element of the Dementia Commissioning Pack which is supported by a multi-disciplinary care pathway for the management of agitation in people with dementia and for the review of medication on people already receiving antipsychotics.

He finished by saying that people with dementia should have their care needs assessed regularly to ensure that they are receiving care that is appropriate as their condition progresses.

David Morris MP 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. Replies are awaited.

Virendra Sharma MP asked the Department of Health a series of questions. 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. Mr Sharma 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.

The House of Lords continued into its fifth day of the report stage of the Health and Social Care Bill. During the session Labour peer and former health minister Lord Warner moved an amendment which would insert a new clause into the Bill to give the health secretary a duty to "secure the improvement in the quality of adult social care services through local social services authorities and qualified service providers registered with the Care Quality Commission".

As part of this duty, the Secretary of State would have regard for funding, access to services, a cap on financial liability and reduction of impact onto the health services. It would also introduce national eligibility criteria and standardised charges, Lord Warner explained, a key argument heard by the Dilnot commission, of which he was a member.

He said that this one amendment would ensure that the Dilnot report's recommendations were implemented into the care system without the need for a new social care Bill in the next Parliament.

"I have low expectations of the Minister being willing to accept the amendment", Lord Warner said, as he suspected decisions would be taken by those more senior. But he urged the minister to come back to the Lords at third reading with an equivalent suggestion.

Labour peer Baroness Pitkeathley lent her support to the amendment and said it was "extremely worrying" that rumours were circulating about a delay to the government's social care white paper.

Crossbench peer Baroness Murphy said that there was "no urgent need" for the government to bring forward its white paper. Instead, she said social care was "the pressing economic and social care issue of our day" and needed to be correctly addressed through a new Bill.

Baroness Barker, a Liberal Democrat, said she agreed with Lord Warner's arguments on the importance of social care reform, "but I do not think that this is quite the way to go forward".

Health minister Earl Howe said he was in "complete agreement" on the importance of high-quality social care, but said he did not agree that the amendment was "the appropriate mechanism" to achieve Lord Warner's goals. He said that, while social care quality and funding needed to be reformed, social care law itself also needed "extensive reform". In order to avoid the very "piecemeal approach" that the Law Commission had criticised in its report on social care law, the minister said social care needed to be addressed in its own piece of legislation. "Social care is a vital public service and deserves its own focus in its own statute. Too often, debates on social care have taken place on the margins of those on another issue."

Lord Warner said he was serious about the amendment. He added that the government was "already behind time on this reform", with no assurances that a new social care Bill would be proposed to Parliament in the next session. He pushed the amendment to a vote, which was defeated by 261 votes to 203.

Wednesday 7 March

Jim Cunningham MP asked what steps the Government is taking to ensure consistent levels of provision of social care support. Alun Cairns MP asked the Chancellor of the Exchequer if he will review his policy on VAT insofar as it affects charitable organisations to serve their local communities. Replies are awaited.

Thursday 8 March

"That this House believes there is an
urgent need to reform the current
system of providing and paying for the
care of adults in England and Wales;
recognises that social care, unlike the
NHS, has never been free at the point
of need irrespective of income; notes
the central role of informal carers in
the provision of care; welcomes the
Coalition Agreement pledge of reform
and legislation; further welcomes the
plans for better integration between
adult social care services and the NHS;
welcomes the extension of personal
budgets; urges the Government to
ensure that fairness is central to reform,
including access to advice, advocacy,
assessment of need, care services as well
as funding options; recognises the need
to break down the barriers to portability;
and further urges the Government to
publish its White Paper as soon as possible,
and to bring forward legislation."

Sarah Newton MP moved a motion for a debate
in the main Commons Chamber
On Thursday Helen Jones MP asked the Secretary of State for Health how many local authorities have (a) increased charges and (b) changed eligibility criteria for social care since May 2010. Minister Paul Burstow replied saying that setting levels of eligibility and levels of charging for social care are local decisions. Councils are answerable to their local populations on both counts, in line with guidance and regulation set by the Department.

Virendra Sharma MP 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.

He also asked the Minister what plans his Department has to introduce a national assessment framework for social care; and if he will make a statement. Replies are awaited.

Philip Davies MP asked the Work and Pensions Minister how much has been paid in each of the last three years in winter fuel payments to people in care homes. Tim Farron MP 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. Replies are awaited,

The Health and Social Care Bill reached the sixth of its seven scheduled days of its report stage in the House of Lords. Baroness Bakewell called for a commissioner for older people. She had suggested the amendment in committee but now sought to have the role subsumed into the agenda of HealthWatch England, rather than a freestanding role. Health Minister Earl Howe said he did not feel he could accept the amendment, though this was "a very important issue with which the government is in complete sympathy." He said that the Department of Health was already pursuing a number of initiatives to improve the care of older people in hospitals, care homes and other settings.

Sarah Newton argued that the £145billion spent annually on social care, NHS and welfare payments needed to be spent differently and more efficiently as people lived longer and longer lives. She said that she hoped to see better integrated health care between charities and doctors, nurses and social workers. However, before such a revolution could be introduced, she argued there was "an urgent need to design a fairer system based on shared responsibility to pay."

Health committee member, Barbara Keeley MP expressed her concerns over funding for dementia care and accused the government of masquerading cuts as increased personalisation of care. She went on to explain the case for the government to set aside £5bn over the next three years to meet the growing demand for social care.

Minister Paul Burstow said the solution to good social care lay in "reducing pressure on the NHS, but above all it means helping people to live the lives that they want." He said that the current care and support system is not fit for purpose and that patching and mending it would no longer suffice.

He added that the Government was considering not just funding reform, but the legal structure that governs social care, which must be updated, referring to the content of the white paper, now expected in the Spring.

Shadow Health Minister Andy Burnham described the issue as the "biggest unresolved public policy challenge facing the country" and that the Government needed to work out how to provide an integrated and people centered approach to care.

He pointed out the real life gaps between the minister's statement and the reality of health care on the ground, and added that "we must address the question of the local government baseline alongside that of Dilnot."

Laura Sandys MP welcomed the Dilnot report but suggested that it was perhaps a little pre-emptive. She said that until we can be explicit about what this care looks like and feels like, and what people's experiences of it will be, it is difficult to talk to people about how we expect them to pay for it. Any new social care system should be refocused around the principle of early intervention and she questioned whether enough attention was being paid to the three biggest reasons for going into care: dementia, incontinence, and accidents, such as falls.

Health committee member, Dr Sarah Wollaston MP spoke about the funding gap in social care, and the need to increase funding for the sector at least slightly, "so that we can achieve what we want to achieve for our older people: dignity and independence".

The motion was agreed.

Posted by Steve Smith, Public Affairs Officer at 09:00 Wednesday, 14 March 2012.

Labels: Dementia care

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.