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Westminster Eye: An insight into the week of politics 12 - 16 March

Monday 12 March

On Monday Helen Jones MP received an answer to her question to the Secretary of State for Communities and Local Government asking how many local authorities have increased charges (a) for the use of day centres and (b) for transport to day centres in 2011-12; and how many local authorities plan to increase such charges in 2012-13. Minister Robert Neill said that the information requested was not held centrally.

The previous week Tracey Crouch MP had asked what assessment the Health Minister had made of the conclusions and recommendations of the joint report by the NHS Confederation, Age UK and the Local Government Association on improving dignity in the care of older people. Social Care Minister Paul Burstow said that the Department welcomed the publication of the Commission's draft report, which aimed to help drive improvements in the quality of care provided to older people in hospitals and care homes. He looked forward to the publication of the Commission's final report.

He added that the Government was determined to root out poor quality care in the NHS through a range of actions. The NHS Operating Framework for 2012-13 established the issue of high quality, dignified and compassionate care as one of four key priorities for the NHS.

In addition, on 6 January, the Government had announced a series of measures to improve the quality of nursing care and free up nurses to provide the care patients and relatives expect. The measures included setting up a new independent Nursing and Care Quality Forum, tasked with ensuring that the best nursing practice is spread throughout the NHS and social care.

Meanwhile in the House of Lords, Lord Lester of Herne Hill asked the Government whether they will bring into effect the power conferred by the Equality Act 2010 to make age discrimination unlawful in providing goods, services and facilities, including health care, to the public. In her reply Baroness Verma said that following a public consultation last year, the Government was still considering the scope for and content of exceptions from any age discrimination ban and will announce how it intends to proceed in due course.

David Morris MP had 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.

Tuesday 13 March

On Tuesday Paul Burstow replied saying that the Government is determined to root out poor quality care in the NHS. The Government is taking action on a number of fronts, including measures in the 2012-13 Operating framework, where quality of care, particularly for older people, is established as one of the four key priorities for the service, giving it equal billing with Operational Performance, the Quality, Innovation, Productivity and Prevention programme and Reform.

He added that the Care Quality Commission will be building on the 100 Dignity and Nutrition inspections it undertook in 2011 on behalf of the Department by undertaking a further 700 inspections this year. To improve on these inspections, the Prime Minister recently announced a new patient-led inspection regime, looking at nutrition, privacy, cleanliness and dignity.

In addition, there are also a number of National Institute of Health and Clinical Excellence quality standards 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. There is also renewed funding for National Audits relevant to older people's care. There are a number of indicators in the NHS Outcomes Framework to support better care for older people around 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 Government had established the National Nursing and Care Quality Forum to work with patients, carers and professionals to spread best practice to increase the quality of services to older people.

In regards of the Dilnot question directed at the pensions Minister, Paul Burstow said that following the publication of the report of the Commission on Funding of Care and Support, the Government announced they would consult with a range of people and organisations involved in care and support on their recommendations and social care reform more broadly. "Caring for our future: Shared ambitions for care and support engagement" ran between 15 September and 2 December 2011. The Government will publish their plans for social care reform in a care and support White Paper and progress report on funding in the spring.

Virendra Sharma MP had asked the Department of Health a series of questions the previous week. 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. Virendra Sharma MP 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.

In replying Paul Burstow said that the Department has been trialling the effect of telehealth and telecare in the Whole System Demonstrator programme, a large-scale randomised control trial. Early headline findings published by the Department on 5 December 2011 had demonstrated that when used appropriately there is potential to reduce emergency admissions and mortality. The Department estimated that there are three million people with long term conditions who could benefit from this approach, which is why the Department and leaders from industry signed a concordat demonstrating a commitment to deliver telehealth and telecare to those who will benefit. This is the Three Million Lives initiative launched on 19 January 2012.

On Wednesday Jim Cunningham MP asked what steps the Government is taking to ensure consistent levels of provision of social care support. Paul Burstow referred the MP to the reply that he gave him on 5 December 2011.

Virendra Sharma MP had 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. Paul Burstow said that in September 2011, the Department collected information from primary care trusts to understand how the transfer of NHS money was progressing and on which services it was being used. A demonstrative graph of all of the forms that the money is being spent on can be found in the NHS publication "The Quarter".

He added that when the information was collected, the majority of money had yet to be transferred, but agreements had been made which set out on which services the money would be spent.

The proportion of £648 million NHS transfer to local authorities was spent on different services as follows:

  1. Prevention (not including community equipment and adaptations) -10%
  2. Community equipment and adaptations - 5%
  3. Telecare - 4%
  4. Crisis response services - 8%
  5. Maintaining eligibility criteria - 18%
  6. Re-ablement - 18%
  7. Mental health - 5%

The remainder of the transfer was spent on the following services:

  • Integrated crisis and rapid response services - 8%
  • Bed-based intermediate care services - 10%
  • Early supported hospital discharge schemes - 8%
  • Other services - 14%

The MP also quizzed the Minister over his plans to introduce a national assessment framework for social care. Paul Burstow replied saying that the Government will publish their plans for social care reform in a care and support White Paper and progress report on funding in the spring. This will include responding to the recommendations made by the Law Commission and Commission on Funding of Care and Support on assessment.

Philip Davies MP received a reply to his question to the Work and Pensions Minister asking how much has been paid in each of the last three years in winter fuel payments to people in care homes. Steve Webb said that the requested information is not available as DWP datasets do not identify people who are resident in care homes receiving winter fuel payments.

Tim Farron MP had 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. Paul Burstow replied saying that data on the provision of care packages provided by Councils with Adult Social Services Responsibilities (CASSR) is collected and published by the Health and Social Care Information Centre via the National Adult Social Care Intelligence Service.

During Prime Ministers Questions on Wednesday Gordon Marsden MP observed that study after study showed that it is crucial for older people that NHS services work closely with social care. His primary care trust in Blackpool has been doing that by working alongside the council's social services in the same set of offices. He asked why the Deputy Prime Minister was supporting a Bill that scraps trusts and such co-operation, and that puts the health of older people, including those in his constituency, at risk.

Nick Clegg MP in responding said that he backed a Bill that included, for the first time, statutory obligations to integrate social and health care. He agreed that one of the abiding failings of the health service is that social and health care are not properly integrated. There has not been much integration over the past ten years but Government was trying to change that. He added that the creation of health and wellbeing boards will bring together representatives of the NHS and social care.

Wednesday 14 March

On Wednesday, Jim Cunningham MP received an answer from Paul Burstow to his question on what recent steps he has taken to improve (a) cancer, (b) accident and emergency, (c) paediatric and (d) geriatric services in the West Midlands. In response to geriatric services, Paul Burstow said that the provision of national health services is a matter for the local NHS. The Department encourages providers to increase the quality of their services to older people, by sharing best practice, bringing people together, and putting in place the right system incentives. The Department aims to keep older people well and out of hospital; to help older people regain their independence after a period of support; to provide older people with advice and choice around their end of life care; and to give older people a greater say in their care.

On Thursday Paul Burstow responded to Tim Farron’s question on what estimate he has made of the cost of (a) continuing care assessments and (b) core assessments by social services in each local authority in each of the last five years. Paul Burstow said that no assessment of the cost to local authorities of continuing health care, and core assessments by social services had been made.

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.