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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.