What we're saying
Find out about the people behind Royal Voluntary Service in our series of guest stories from our volunteers, staff and partners.
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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.
Understanding and getting to grips with the opportunities and challenges of an increasing ageing population is one of the key conundrums that the Government and wider society has to currently face.
The pre Christmas House of Lords debate on the place of older people in society highlighted the net financial contribution that older people make to the UK economy, citing the WRVS figure of £40billion benefit in 2010. But it’s not just about finances. Earlier this week in a response to a tabled question, Baroness Warsi said that the Government recognised the importance of the issues facing people in later life and the contribution they make to society, but did not have all the answers. She added that the Age Action Alliance was created in recognition of the need for a radical shift in approach and its vision was informed and driven by older people themselves.
The Lords Committee on Public Service and Demographic Change took oral evidence from Ministers Hunt, Lamb and Webb on Wednesday. In response to questions around what the Cabinet had done collectively to address issues arising from an ageing population, Hunt said that it had taken some good first steps but agreed that there was much more that it could do. He agreed that the ageing population was a nettle that had to be grasped. He saw the 2 biggest issues being the sustainability of the NHS and pension provision. The Committee Chair appeared sceptical; saying that the Committee had not seen much in the way of a coherent long term strategy to look at the scale of the challenges around ageing and that most work undertaken was fiscal and short term in nature.
Early in the week, the Coalition’s mid-term review re-confirmed the Government’s support for the principles set out in the Andrew Dilnot report. But any detail as to how the future costs of adult social care would be met was disappointingly absent. Just a couple of days later to emphasise the urgency, analysis by London Councils estimated that the funding gap for providing adult social care in London will amount to £907m within five years. Councils in London currently spend a third (£2.8 billion) of their total budgets on adult social care and this is set to rise dramatically as the number of Londoners aged over 65 increases by some 50,000 during the next five years.
So in a week when detail was thin on the ground about long term thinking on the future funding of care and for older people more generally, it is clear that there is a major role for the third sector to step up to the plate and take on an enhanced role. But this week there was criticism of the Government from the Chief Executive of AVECO that the potential for charities to transform public services remains largely untapped, with reforms in too many areas either glacially slow, as demonstrated by social care funding reform.
In his response, the Civic Society Minister said that harnessing the spirit of common purpose witnessed in 2012 so that together big social problems could be tackled was a cultural change that won’t happen overnight, especially in challenging economic times. He acknowledged that Britain is blessed to have some of the most generous people and the most innovative charities in the world.
He is right - the spirit is there, in spades. It is estimated that in the UK about 20 million people volunteer in some form. In WRVS alone over 50% of its 40,000 volunteers are over the age of 65. Not only are the volunteers helping older people in a more cost-effective way than through expensive state mechanisms like the NHS, but they are helping themselves to enjoy better mental and physical health outcomes. This is essential as the Government plans its strategies for the future. And WRVS, in celebrating in 2013 its 75th year of civic service, is keen for this message of volunteering to amplify and grow.
Introducing a requirement for councils to invest in preventative practices and early intervention is a step in the right direction. But it is merely a step. As local authorities cut back on non essential services, the White Paper has failed to address the estimated £1billion shortfall that is leading councils to cut these vital services and leave older people vulnerable in their own homes. To turn the rhetoric into reality, the Government must put measures in place to ensure local authorities act on the White Paper advice and commission services that offer a standard of care to older people in their community that will enable them to live life instead of merely exist.
Some councils are already finding cost effective ways to implement support services without damaging the long term health of their communities but others seem to be making knee jerk decisions based on the pounds they will save in the short term without thought for the huge increases in costs they are storing up for the future.
The services WRVS’ 40,000 volunteers provide – a helping hand, a warm meal, a lift to hospital or a chat over a cup of tea – help older people stay independent in their own homes for longer and ensure they remain connected to their communities. Delivered by volunteers, they are cost effective and save lives as well as money for the taxpayer.
Monday 27 February
MP received a reply from the Minister to his question on what proportion of the Department of Health expenditure was spent on services for the elderly in the latest period for which figures are available. In his reply Paul Burstow said that around 40% NHS acute, mental health, primary care and prescribing by general practitioner is estimated to be spent on people aged 65 years and above. Information by age is not held centrally for other expenditure by the NHS. In addition, adult social care is funded by local authorities, through a combination of central Government grant funding and locally-raised council tax. He added that provisional data for 2010-11 shows that local authority net expenditure on adult social care for people aged 65 and over was £7.42 billion. This represents 50.8% of total net expenditure on adult social care.
Simon Hart MP asked the Minister for the Cabinet Office what estimate he has made of the number of people who are full-time volunteers; and how many such people volunteer for 35 or more hours per
Nick Hurd replied saying that data from the 2009-10 Citizenship Survey suggests that approximately 163,000 people in England and Wales volunteered for 140 hours or more in the four weeks prior to interview-equivalent to 35 hours a week or more. Data are not available to determine if such individuals were full-time volunteers.
Andrew Lansley laid before Parliament the Government response to the House of Commons Health Committee's report Public Expenditure.The Committee's report was published on 24 January 2012.
In its statement the Government said that the modernisation and efficiency challenges it is seeking across health and social care are exceptional; ones that are vitally necessary to secure sustainable and improving services. They are also inextricably linked and mutually supportive. These changes are critical to bringing about a modern care system that is fit to deliver the high quality, responsive, personalised services wanted by people today. As a part of these reforms, the Government is protecting funding for the NHS and allocating additional funding for social care.
Tuesday 28 February
On Tuesday Baroness Gibson of Market Rasen received a reply to her question which asked the Government what steps it is taking to reduce the burden of administration associated with volunteering. Lord Wallace of Saltaire replied saying that the Government is determined to make it easier to volunteer and run civil society organisations by cutting bureaucracy. The Government had set up the Civil Society Red Tape Taskforce, chaired by Lord Hodgson of Astley Abbotts, to identify what stops people giving more time and money to civil society organisations. Their report Unshackling Good Neighbours, makes 17 major recommendations that we are taking forward and Lord Hodgson will review progress in implementing them in May.
Baroness Gibson of Market Rasen had asked a further question over making it easier for employers to release their employees to assist in the voluntary organisations in which they have an interest.
The Baroness Wilcox said that the Giving White Paper made clear that the Government fully supports and encourages organisations making time available for employees to volunteer. The Government has also made its ambitions clear with their commitment to turn the Civil Service into a civic service, supporting civil society organisations. This will encourage civil servants to give time by providing them with opportunities to use their skills and using volunteering as a means of learning and professional development both in terms of gaining new skills and experiences and also better understanding of the impact of government policies on the civil society sector. She added that under Every Business Commits, the Government is challenging businesses to take action on priorities including promoting employee well-being and engaging with communities, with Government committing in return to encourage enterprise and reduce red tape to create the best conditions for businesses to succeed.
Wednesday 29 February
On Wednesday Hilary Benn MP asked the Communities Minister what the average charge was for Meals on Wheels in each English local authority in each year since 2000. A reply is awaited.
Tracey Crouch MP asked the Health Minister what assessment he 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. A reply is awaited.
Thursday 1 March
On Thursday during the House of Lords debate entitled “International Women’s Day - Motion to take note
” on 1 March Baroness Royall of Blaisdon included WRVS in her closing address for the opposition.
"Earlier this week I was privileged to attend a reception for the WRVS which now has 40,000 volunteers but needs more. When one thinks of the WRVS, meals on wheels and hospital cafes and trolleys come to mind. These are important tasks but the WRVS does so much more to help older people stay independent at home and active in their community"
Baroness Royall of Blaisdon
Posted by Steve Smith, Public Affairs Officer at 09:00
Saturday, 03 March 2012.
Services for the elderly,
Adult social care,
Public Expenditure report,
Unshackling Good Neighbours report,
Giving White Paper,
Every Business Commits policy,
International Women’s Day
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,
Taking off my Scots bunnet just for now and putting on my English... er... Bowler hat? Top hat? What do folk wear on their heads down south these days? Well, anyway, whatever you wear to declare your Englishness imagine that I’m wearing that because I’m blogging today to talk about social care in England and what the UK’s coalition government are going to do about it, once they have got over the trauma of David Laws departure. If ever there was a story that could use the word ‘rocked’ without sounding wildly inappropriate, this was it. But I don’t have time to go there today. If his replacement, Danny Alexander, MP for Inverness, Nairn, Badenoch & Strathspey (that’s basically the Highlands for you guys) the here-today-gone-today ex- Scottish Secretary, now Chief Secretary to the Treasury, does anything exciting maybe I’ll use his Scottishness as an excuse to blog about him. But moving swiftly on...
OK: there’s a quartet of big headlines under the social care policy heading. There’ll be a Commission on long term care to report within a year, barriers between health and social care will be broken down, theree'll be more use of personal budgets and more use of direct payments. This is set in the context of the rest of the coalition agreement which includes a bigger role for the third sector in public service delivery, help for older people to live at home longer through adaptations and community support programmes (though it doesn’t specify what this will look like in practice), more spending on the NHS, more opportunities for public sector staff (presumably including NHS staff?) to run services themselves using the cooperative model, pensions re-linked to earnings, retirement age up to 66 by 2016 for men and 2020 for women and so on.
So what? Well, anyone with an interest in social care should, while keeping an eye out for the development of all these policies, get off the blocks as soon as there’s an announcement of the Commission chair and get on the blower to him/her to have their say (and if they’re really influential they should be calling the Health Secretary, Andrew Lansley and Paul Burstow MP, Minister of State for Care Services and making some suggestions about who the chair should be). It seems that, while, according to the coalition agreement, the Commission will have to consider both a voluntary insurance scheme and the Wanless recommendations, all other bets are off. The Commission was a Lib Dem policy, the Tories already had theirs worked up, so I guess we can take it that they couldn’t jointly agree on a social care policy or on any of the numerous proposals that have come out in recent years. We know this because if they had, well, they would have said so wouldn’t they?
Commissions are traditionally a way of ‘kicking something into the long grass’, as they say in political circles (i.e. if we talk about it for long enough everyone will forget about it and we won’t have to do anything) but this time the issue is too immediate and important for that, as well as there being a huge question mark over how its paid for. With an ageing population there has to be some sort of change to the English system to make it work for people, which may or may not contribute to solving the country’s economic woes, meaning it will cost the state less, although it really will have to will have to be economically viable if it stands any chance of going ahead. It seems certain that, whatever proposals emerge or are accepted, it will involve greater cost to individuals who need care. Why? Well, Liam Byrne’s (Labour ex-Chief Secretary to the Treasury) note to David Laws (you know who he is) saying "Dear chief secretary, I'm afraid there is no money. Kind regards – and good luck!" might have been flippant but it was basically true. Just how this ends up being squared with the social care budget remains to be seen but squared it will have to be.
But here’s a thought for you: WRVS runs on volunteers and the impact they can have in the social care arena has been made clear in a recent report. We may not run what you’d think of as ‘social care services’ but our services occupy a space very close to them and it’s obvious that if people can stay independent, healthy and happy in their own homes for longer and therefore don’t require NHS or social care services as soon as they otherwise would, pressure on health and social care budgets is eased.
WRVS – and thousands of other voluntary organisations – arose from an initial spark, an upsurge of energy and effort, a passion and a readiness in people to tackle social problems for themselves, to look after each other as opposed to waiting for the government to do it. And in many, if not all cases, such organisations started out without a brass bean in the bank. But they still got on and did things, thanks to voluntary effort.
Now, neither I nor WRVS are suggesting that the state should be let off the hook, to be allowed to do less and less while making us do everything for nothing yet still ratcheting our taxes up (Prime Minister Dave will tell you that’s a fundamental misunderstanding of his ‘Big Society’). No. What I’m suggesting is that if we can recognise that there is a tremendous energy out there for mutual support it needs to be developed in tandem with good state services – whoever delivers those, either the state directly or someone on behalf of the state – to make sure people get what they need and so we can make the best use of our money. If we face massive service cuts because the state hasn’t got the money - and, regardless of the rights and wrongs of how we ended up in this mess and who is really to blame and who will suffer as a result, let’s be clear: the state hasn’t got the money - shouldn’t we be thinking creatively about how the shoulder of voluntary action can best be turned to the wheel rather than ending up being exploited or mistaken for a substitute for paid jobs or, possibly even worse, just being discounted because of a lack of understanding about the potential role volunteers and the voluntary (third, charitable, social enterprise, whatever) sector could, can (must?) play.
I’m not suggesting we can run things like specialist cancer care on wide eyed enthusiasm and people who can manage to be around on alternate Tuesdays and Fridays and, God knows, sometimes even the most straightforward tasks involve hacking through reels of red tape and someone might have to be paid to do that, but there are many services and activities, social care being a good example, which could benefit from much more extensive volunteer involvement. And that energy and willingness is out there.
Look at it this way; if the alternative is saying goodbye to these activities forever or ending up with second rate services, hobbling along with only pennies in their pockets, what have we got to lose?