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Westminster Eye: An insight into the week of politics 10 - 13 January

10 January
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.

11 January
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.

12 January

"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.

Westminster Eye: An insight into the week of politics 21 December - 6 January

21 December

Baroness Jolly asked the Government what support and guidance is being offered to pathfinder clinical commissioning groups in commissioning integrated health and social care services. A reply is expected after 12 January.

23 December
The Department of Health published a package of data. This included November’s figures for the delayed transfers of care. In comparison with October, November’s figures showed a drop in delays in total days from 118,664 to 116,572 made up of improvements in both acute and non acute delays. However, numbers of cases were up slightly from 4,196 to 4,215.

30 December
A new survey of care provided by local councils, published by Labour, reveals increases and disparities in charges for services for vulnerable elderly and disabled people.

Councils are increasing charges for:

  • home care: the average hourly charge is now £13.49, a rise of 6% since 2009-10
  • Meals on Wheels: the average charge is now £3.44 per meal, a rise of 13%
  • transport: for example to day centres: the average charge for a journey is now £2.32, a rise of 33%

These increases mean the average yearly cost for an older person who pays for ten hours of home care a week is now £7,015 a year. Older people who also get Meals on Wheels every day now pay an average of £8,271 a year. With transport charges to go to a day centre three times a week an older person now pays £8,633 per year. There are differences in the price people pay for care, depending on where they live. This ranges from free home care in Tower Hamlets to care costing £20.34 per hour in Cheshire East.

1 January
The Department of Health announced that additional sums of money are being made available for social care and housing support. The Department made an additional £150 million revenue available via primary care trusts in order to address delayed discharges, and a further £20 million capital expenditure to add to the Disabled Facilities Grant, making it easier for disabled people to live in their own homes.

"Older people often need particular
support after a spell in hospital to settle
back into their homes, recover their
strength and regain their independence.
This money will enable the NHS and
social care to work better together
for the benefit of patients."

Secretary of State for Health, Andrew Lansley 

3 January
In a letter published in the Daily Telegraph today, a group of more than 60 government advisers, charity directors and independent experts called on the government and the Labour Party to overhaul England's "failing" social care system. The letter follows new evidence last week of rising care bills for families, and costs to the NHS of 'delayed discharges'. It argues that, alongside celebrating the fact that the UK population is living longer, action must be taken to meet the 'unavoidable challenge' of how to support increasing numbers of older and disabled people who need care.

The letter argues that the current social care system is failing this challenge, with serious consequences for society, family life and the economy - leaving older and disabled people at risk, families facing huge care bills, businesses losing staff who are forced to give up work to care for loved ones and the NHS coping with avoidable hospital admissions and 'bed blocking'.

The signatories say that meeting this challenge this will require 'political leadership'. They urge the Prime Minister to 'seize the opportunity' of cross-party talks on the future of social care to 'deliver a social care system which can provide the well-funded and high-quality care and support we would all expect for ourselves and our families.'

In the early part of the week political commentators speculated that the Queens Speech, outlining the legislative programme for the coming year, will take place on 9 May, with a fall back to 16 May if this does not work.

It was reported that three million lives could be improved across England thanks to new high-tech healthcare. After seeing the technology in practice in Cornwall, Care Services Minister Paul Burstow pledged to make it available to more people with long term conditions.

In order to make this a reality, over the next five years the Department of Health will work with industry, the NHS, social care and professional organisations to bring the benefits of assistive technology such as telehealth and telecare to millions of people with long term conditions. Telehealth and Telecare use electronic equipment to read vital health signs such as pulse, weight, respiration and blood oxygen levels, which can be read remotely by health professionals in a different location. It means that people can stay in the comfort of their own homes with the peace of mind that a doctor or nurse will be alerted should there be a problem.

Housing Minister Grant Shapps launched a new deal to help older people to continue living comfortably in their own homes - with particular support for those leaving hospital. With nearly one in five of the whole population expected to be aged 65 or over by 2020, Ministers are determined to ensure elderly, vulnerable people get the help they need to live independent lives, and can be safe in the knowledge that they won't get ripped off by dodgy dealers and fraudsters. Mr Shapps has given £51 million towards Home Improvement Agencies, who will provide help and advice including:

  • housing advice, including help to move to more suitable accommodation if needed
  • handyperson services, including small home repairs, home safety and security adaptations
  • energy efficiency advice
  • arranging for adaptations and home repairs to be made, including grab rails, stair-lifts and major work such as ground floor extensions.

These agencies also offer hospital discharge services - ensuring older people leaving hospital care are given the support they need to be able to recuperate in the comfort of their own homes. He has also announced £1.5 million funding for FirstStop, which provides independent advice to older people looking to plan their future housing needs - whether in their own homes, or in care homes.

A number of bodies including WRVS called on the Government to affirm its commitment to volunteering by making portable Criminal Records Bureau (CRB) checks free to volunteers.

Whilst the Government has confirmed that CRB checks themselves will remain free for volunteers, a decision has yet to be made about the cost of the online system that will ensure volunteers will not have to be checked every time they begin a new role. In the current system CRB checks are free but not portable, but Government risks solving one problem only to create another if in the proposed new system they are portable but not free.

5 January
The King's Fund and the Nuffield Trust jointly called for an ambitious new goal to be set to ensure that delivering integrated care assumes the same priority over the next decade as reducing waiting times was given over the last. The new goal to improve the experience of patients with complex health needs is the central recommendation in a new report published by the two think tanks. The report argues that integrated care - which aims to co-ordinate care more effectively around the needs of patients - is essential to meet the needs of the ageing population and transform the way care is provided to people with long term conditions. The report follows the Prime Minister's pledge earlier this year to make integrated care one of his five key priorities for the NHS.

On the same day it was reported in Thursday’s Guardian that David Cameron has ordered health and social care services to be brought together in order to benefit patients in a move which government advisers are calling the NHS's most urgent overhaul. Reports suggest that the prime minister has been persuaded by senior doctors and Downing Street health advisers that, without integration, the NHS could become unsustainable due to rises in the number of patients with long-term health conditions such as obesity, diabetes and breathing problems.

6 January
Prime Minster David Cameron, made a speech in which he outlined plans to require nurses to make hourly ward rounds and for members of the public to make inspections of wards. Mr Cameron wants nurses to focus on "patients not paperwork" while all hospitals will be expected to implement regular ward rounds "to systematically and routinely check that patients are comfortable, are properly fed and hydrated". This follows a spate of critical reports last year over the levels of care of the elderly in hospitals including by the Care Quality Commission where it found a fifth of NHS hospitals were breaking the law on care of the elderly. Its study also found half of hospitals were failing to provide all-round good nutrition to elderly patients while 40% do not offer dignified care.

So not the usual cut and thrust you would find in the Chamber, but some interesting developments which set the scene for 2012. Both the Lords and Commons return on 10 January.