Yesterday’s confirmation by the Health Secretary revealed that the cap on social care will be set at £75,000 in England. This headline has received a cautious welcome from most quarters. However, the cap cannot be looked at in isolation and at the moment it is still difficult to see how many older people and those entering old age in the coming years will be affected as there are still a number of unknown factors. In addition, boarding and food costs are not included in the cap. The objective is to try and ensure that people living in their own home are not penalised unfairly as they are still responsible for paying their housing costs. These so called “hotel” costs will be capped at £12,000 a year.
The cap won’t take effect until April 2017 and the Government has stated that £75,000 in 2017 is in effect worth the equivalent of £61,000 in today’s prices. The current threshold over which support is not provided is rising from £23,250 to £123,000, a rise of nearly £100,000. This means that more people will be entitled to receive some support for their care albeit on a sliding scale.
The big element missing in all of this is at what level the national “eligibility criteria” will be established. At the moment councils are free to set the criteria at low, moderate, substantial or critical. This perpetuates something of a postcode lottery. As funding has become tighter, an increasing number of local authorities have set their criteria at substantial. At the last count well cover 82% of England’s local authorities were at a substantial level or higher. The level at which this is set will be important calculating how many people will be supported. The higher the eligibility criteria bar is set means that those with lower needs which may prevent or delay more intensive and expensive interventions may miss out.
But the response to Dilnot is not the full answer. Implementation of these changes and those proposed in the Care and Support Bill won’t take effect for over 5 year’s and there is already a shortfall in the funding of adult social care that will increase during this time as local authorities make further savings.
All of this goes to demonstrate that volunteers working within organisations such as WRVS are key in delivering the practical support that older people want, but without the huge bills attached, not just for now, but for the long term.
Both Houses returned on Tuesday 10 January following the Christmas recess.
On 10 Sarah Newton MP asked whether the Department of Health collects data on the number of acute care patients aged over 75 years who are delayed in being discharged from hospital.
During Commons Health Oral questions, the contribution of volunteers was raised. In particular Sir Bob Russell MP asked if there was a conflict between the big society, volunteers and localism if major retail stores are brought into hospitals to the detriment of friends organizations. Paul Burstow replied saying that he was aware that it is a matter of concern that over a number of years some hospitals have chosen not to use the WRVS or friends organisations' services. These decisions have to be made by local NHS trust boards, but the purpose of the strategy the Government published last year is very much to make sure that when the boards make these decisions they are focused on the benefits of volunteering for the volunteer, the organisation and the patients.
In the same session Fiona Bruce MP raised the issue of the benefits of telecare to older people in the north-west of England, where the number of over-65s will grow by 50% and the number of over-85s is set to more than double by 2025. Secretary of State Andrew Lansley responded saying that there were an increasing number of older people in the community and that he wanted to support them to be independent and to improve their quality of life. The whole system demonstrator programme was the largest trial of telehealth systems anywhere in the world. In the three pilot areas of Kent, Cornwall and Newham, it demonstrated a reduction in mortality among older people of 45%; a 21% reduction in emergency admissions; a 24% reduction in planned admissions to hospital; and a 15% reduction in emergency department visits. Those are dramatic benefits, which is why Government is so determined to ensure, over the next five years, that it reaches out to older people who are living at home with long-term conditions and improve their quality of life in this way.
During exchanges over progress on the Health and Social Care Bill Stephen Dorrell MP said that the background of the recommendation of the NHS Future Forum, that a key priority for the future is greater integration between health care and social care a priority that was explicitly endorsed last week by the Prime Minister. He asked if the Minister agreed that the key opportunity in the Bill, through the health and well-being boards, is to drive that agenda, which has been much talked about for many years and actually to start to deliver on that rhetoric. In responding Simon Burns agreed that it is the way forward and Government fully recognised that. Government is deeply committed to achieving that aim, and that is why the Secretary of State has added an extra £150 million to the existing £300 million, to facilitate progress towards it.
Greg Mulholland MP said that care of older people is one of the most pressing issues facing this country. He asked if the Prime Minister would join him in welcoming Age UK's Care in Crisis campaign, which was launched on Monday. He asked whether he will commit to ensuring that the White Paper due in the spring will present a way forward on this vital issue. The Prime Minister paid tribute to the MP and to the Age Concern campaign. There was a huge challenge to rise to and Government wants to do so through the White Paper. There are three elements: the rising costs of domiciliary care, improving the quality of the care that people receive, and addressing the issue of people having to sell their all their assets to pay for care. Government was looking hard at all those issues to work out a way forward that is right for the system, and that the country can afford.
In a written question Andrew Stephenson MP asked what assessment the Department of Health has made of likely savings from using telemedicine technologies in care homes. Paul Burstow replied that the Department has not made any formal assessment of likely savings that might result from using telemedicine technologies in care homes. He added that initial headline findings from the Whole System Demonstrator programme demonstrate that, in the NHS, appropriate use of telehealth can lead to significant reductions in mortality and hospital admissions, leading to efficiency gains. The Whole System Demonstrator programme was set up by the Department to provide an evaluated evidence base on the benefits of telehealth and telecare. He considered that telemedicine also has the potential to offer benefits in care home settings.
Tom Brake MP asked the Home Department when it plans to publish its response to her Department's consultation on ending age discrimination in services, public functions and associations. Minister Lynne Featherstone said that the Government response to the consultation on exceptions to the proposed ban on age discrimination will be published in due course.
The NHS Future Forum published its second set of reports to the Government in which it sets out a series of recommendations to improve the quality of patient care and achieve better outcomes. The Department of Health was able to accept all the Forum's recommendations for Government
The Forum looked at four areas of health policy: the NHS' role in the public's health, information, education and training and integration. Over four months the Forum listened to more than 12,000 people and attended more than 300 events. In this phase, the Forum set out to listen to more patients and carers and sought more input from local authorities, housing and social care providers. Of particular interest were the recommendations on integration.
- Integration should be defined around the patient, not the system - outcomes, incentives and system rules (ie competition and choice) need to be aligned accordingly
- Health and well-being boards should drive local integration - through a whole-population, strategic approach that addresses their local priorities
- Local commissioners and providers should be given freedom and flexibility to "get on and do" - through flexing payment flows and enabling planning over a longer term.
Greg Knight MP asked the Secretary of State for Health what spending his Department has recently incurred on radio advertisements relating to dementia; and for what reason it has commissioned such advertisements. Simon Burns responded by saying that in the 2011-12 financial year, the Department has spent £276,573 on radio advertising relating to dementia. The advertising formed part of the national dementia: early signs and symptoms campaign, which was commissioned to help more people receive an early diagnosis.
Ben Bradshaw MP asked a series of questions around the rates of admission to hospital for patients over 74 years with a secondary diagnosis of dementia in each primary care trust in England in each of the last 12 months. A reply is awaited.
Jonathan Reynolds MP asked what progress the Minister is making in implementing the recommendations contained in the report of the Dilnot Commission. He also asked if the Minister will consider raising the means-tested threshold above which people are liable for their full care costs to £100,000 and introduce national eligibility criteria and portable assessments for the provision of adult social care. A reply is awaited.
"That this House notes the recent Quest
for Quality report by the British Geriatrics
Society that suggests many of the estimated
400,000 older people resident in UK care
homes have variable access to NHS services
because of the type of accommodation in
which they live; acknowledges that many
people in care homes are highly vulnerable
with over 40 per cent suffering from
dementia and over 75 per cent living with a
disability; accepts that while NHS provision
to care homes can be excellent there is
considerable unwarranted variation in the
quality of provision, especially around
medications management, dementia and end
of life care; and calls on commissioners and
health service planners to remember their
obligations to ensure that the healthcare needs
of this vulnerable group are adequately met."
On 21 December Baroness Jolly had asked the Government what support and guidance is being offered to pathfinder clinical commissioning groups in commissioning integrated health and social care services. She received her reply on 12 January. In his reply Lord Howe said that pathfinders are receiving national and local development support. With their SHA and PCT cluster, pathfinders are exploring approaches to clinical commissioning, including integration of health and social care. Key to this will be engagement with local authorities and secondary care. The Government’s national learning network allows pathfinders to share learning and best practice. Pathfinders will be authorised to take on their full commissioning functions only when the NHS Commissioning Board is certain that they are ready.
Kwasi Kwarteng MP asked Health Ministers what steps they are taking to reduce the cost of social care provision. Replies are awaited.
It was announced that on 17 January the Health Committee will hold its final oral evidence session on Social Care. The witnesses would be Paul Burstow MP, Minister of State for Care Services, and David Behan CBE, Director General of Social Care, Local Government and Care Partnerships, Department of Health.
Posted by Steve Smith, Public Affairs Officer at 00:00
Monday, 16 January 2012.
pathfinder clinical commissioning groups,
NHS Commissioning Board,
whole system demonstrator programme,
Health and Social Care Bill,
care of older people,
NHS Future Forum,