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The delivery of health and social care has undergone major change to its core structures. Many of the changes have already taken place, but most took effect on 1 April 2013. These changes will have an impact on who makes decisions about NHS services, how these services are commissioned, and the way money is spent.
Primary care trusts and strategic health authorities have been abolished, and other new organisations such as clinical commissioning groups (CCGs) have taken their place. As of this week a total of 211 CCGs are responsible for £65 billion of the £95 billion NHS commissioning budget. All 8,000-plus GP practices in England are members of a CCG, putting the majority of the NHS budget in the control of frontline clinicians for the first time. The groups will include other health professionals, such as nurses.
CCGs will commission most services, including, planned hospital care, rehabilitative care, urgent and emergency care, most community health services and mental health and learning disability services. CCGs can commission any service provider that meets NHS standards and costs. These can be NHS hospitals, social enterprises, charities, or private sector providers.
To add to the mix are health and wellbeing boards; a new forum where leaders from the health and care system work together to improve the health and wellbeing of their local population and reduce health inequalities. Each top tier and unitary authority has its own health and wellbeing board. Board members will work together to understand their local community’s needs, agree priorities and encourage commissioners to work in an integrated way. The intention is that as a result, patients and the public should experience more joined-up services from the NHS and local councils in the future. Local boards are free to expand their membership to include a wide range of perspectives and expertise, such as representatives from the charity or voluntary sectors.
In addition each local authority will have a local Healthwatch organisation in their area. The aim of local Healthwatch will be to give citizens and communities a stronger voice to influence and challenge how health and social care services are provided within their locality. Local Healthwatch will also provide or signpost people to information to help them make choices about health and care services.
Add to this other bodies such as the NHS Commissioning Board, Public Health England and Healthwatch England to name but a few, and it becomes a complex maze to work oneself through. The intention is the make health and social care more integrated and responsive to the needs of the local community. Support for older people such as that provided by organisations like WRVS has never been more necessary given the constraints on central and local Government spending. It is in everyone’s interest to work towards making sure this new system delivers. Time will tell whether the changes bring about the transformation that is urgently required.
Last week Michael Meacher MP had asked how much was spent on social care for the elderly, in each of the last 10 years. On 23rd he received his answer from Social Care Minister Paul Burstow. He said that the requested figures collected annually by the NHS Information Centre showed that social care expenditure on older people had risen from £6.17 billion in 2001/2 to £9.44 billion in 2010/11.
Caroline Lucas MP had asked the Health Minister what his timetable is for making regulations and orders under the Health and Social Care Act 2012. Simon Burns MP responded saying that many of the regulations and orders to be made under the Health and Social Care Act 2012 will come into force on 1 April 2013. This is the intended date for the NHS Commissioning Board to take on its full statutory functions; local authorities to take on new public health responsibilities; local Healthwatch organisations to come into being; and strategic health authorities and primary care trusts to be abolished. He added that other changes are planned for different dates; Healthwatch England will come into existence in October 2012, and the health special administration regime for organisations providing NHS services will come into force in April 2014.
Helen Jones MP asked Health Ministers whether they had made an estimate of potential costs to the NHS arising from ill health as a result of (a) falls by and (b) deterioration in existing conditions of adults who will not receive social care because councils have introduced restrictions on the eligibility criteria for such care. In his response Paul Burstow said that the Department had not made an estimate of the potential cost to the NHS arising from ill health as a result of falls. However, it estimated that the annual cost of health and social care for the care of all the hip fracture patients in the United Kingdom amounts to approximately £2 billion.
On the eligibility criteria question he added that the Department did not formally monitor changes to local authority social care eligibility criteria and therefore does not hold information on potential costs to the NHS arising from ill health as a result of existing conditions of adults who will not receive social care because councils have introduced restrictions on the eligibility criteria for such care. Allocations of resources at a local level was the responsibility of local authorities who are best placed to understand the needs of their community. Councils should use the framework set out in the guidance ‘Prioritising need in the context of Putting People First: A whole system approach to eligibility for social care’, to draw up local eligibility criteria. This is graded into four bands:
- moderate; and
He went on the say that on 11 May 2011, the Association of Directors of Adult Social Services published a survey that indicated that 13% (19) councils had changed their eligibility criteria between 2010-11 and 2011-12, of whom 15 councils moved from moderate to substantial. According to the survey, there are now 78% (116) councils at substantial, 15% (22) at moderate, 3% (4) at low and 4% (6) at critical.
In addition, the Audit Commission's 2008 report: ‘The Effect of Fair Access to Care Services Bands on Expenditure and Service Provision’ found there is no directly observable link between the council's eligibility criteria policy and emergency admissions to hospital.
Nick Smith MP had asked what assessment the Treasury had made of the effect on pensioners of the proposed changes to age-related income tax allowances. Treasury Minister David Gauke MP replied on 24th saying that no on wouldl pay more tax in 2013-14 than they do today as a result of the changes. There were no cash losers. He said that the Government remained absolutely committed to supporting pensioners. He added that the Government had introduced a triple guarantee for the basic state pension, ensuring that it will increase each and every year by the highest of earnings, prices or 2.5%. The Government had also protected other benefits that make a real difference to the lives of millions of pensioners.
In his follow up question Nick Smith wanted to know what the Minister had to say to those who are turning 65 in just under a year's time as they were set to be more than £25 a month worse off than they thought they would be, but they had no time to plan for that change. David Gauke said that those who turn 65 next year would benefit from the biggest increase in the personal allowance that has ever been seen.
Stephen Williams MP said that he was sure that many MPs had received letters from constituents over the years saying that they did not want their taxes spent on one thing and preferred them to be spent on something else. He believed it was right in principle, therefore, that the Government cap the ability of the super-rich to allocate taxes to charities of their choice. He asked the Chancellor to acknowledge, however, that universities and medical research charities have always depended on philanthropic support and in reviewing the cap on tax relief, will he ensure that those institutions' interests are safeguarded. David Gauke was grateful for the support and explained that Government was looking to explore with charities dependent on large donations how this can be implemented without it having a major impact on them.
Tim Farron MP had asked what recent steps the Department of Health had taken to implement the recommendations of the Dilnot Report. In his response Paul Burstow said that Government would publish a White Paper on social care and a progress report on funding reform in spring 2012. The progress report will set out the Government's response to the Commission's recommendations.
Ian Lucas MP asked Business Ministers what discussions they had held with Royal Mail on its concessionary scheme for pensioners to purchase stamps at Christmas. In his reply Norman Lamb MP said that Ministers in the Department for Business held regular meetings with Royal Mail to discuss a broad range of issues, including the scheme to offer discounted stamps to some low income households at Christmas. The pricing of stamps, including proposals for discounts, is an operational matter for the company. However, Ministers were informed of the plans and kept updated on progress.
On 25th Ian Austin MP asked the Work and Pensions Minister what the average value per year will be for a new pensioner no longer entitled to Savings Credit once it is abolished for new pensioners. A reply is awaited.
On 26th Margaret Ritchie MP asked the Chancellor of the Exchequer what estimate his Department has made of the financial effect on charities of his proposal to introduce a cap on tax relief for charitable donations. David Gauke explained that at the Budget 2012 the Government had announced it would introduce a cap on unlimited income tax reliefs to ensure that those on higher incomes cannot use them excessively. He added that the Government will explore with charities and philanthropists ways to ensure this new limit on uncapped reliefs will not impact significantly on charities that depend on large donations to carry out their charitable activities. A consultation document on the detail of the policy, including the implications for philanthropic giving, will be published in the summer.
On 30th the Department of Health published the monthly delayed transfers from hospital figures. The data showed that whilst the actual number of delays was static at just over 4,000 the number of days had increased by around 10,000 to 119,416. A similar jump was seen last year in the same month. Of the delayed days over 76,000 were due to the NHS.
Shadow Health Spokesperson Liz Kendall MP asked what information the Department of Health held on the number of people in (a) England and (b) each local authority who sold their homes to pay for residential care in each of the last five years. On 30th Paul Bustow responded saying that there was no such information. Information about the sale of property to pay for residential care by service users supported by councils is not collected centrally. Local councils may also not know if properties are sold by those who arrange their own care, for example, where a person sells a property and contracts with a care provider privately without the involvement of social services.
During Commons Oral Answers to the Communities and Local Government Ministers on 30th, Grahame Morris MP said that in the national press there had been reports of dramatic increases in bed-blocking. Bed-blocking occurs when patients cannot be discharged from hospital because social care packages have not been put in place by hard-pressed local authorities. He believed that this was now costing the taxpayer about £600,000 every day. He asked if this was not this more evidence of the Government's failed policies on social care in local government. In responding Eric Pickles said that the Government had invested an extra £7.2 million. But he acknowledged that the MP had made a reasoned point. He felt that the reforms in the NHS and giving local authorities more responsibility for health should bring about a much better and much more closely co-ordinated and integrated process. The movement from hospital into care or into a person's home needs to be better organised. The Government would certainly produce a White Paper soon to deal with this. He hoped that it will meet some of the problems that Mr Morris had mentioned.
Adam Afriyie MP had asked the Secretary of State for Health if he will take steps to ensure that primary care trusts consult independent nursing homes when making changes to their payment terms for funded nursing care payments and whether he has recently had discussions with Buckinghamshire Primary Care Trust (PCT) about changes to its payment terms for funded nursing care payments; and whether he has made an assessment of the subsequent effects on cash-flow for independent nursing homes receiving payments from Buckinghamshire PCT. Paul Burstow replied saying that the annual level of the national health service contribution towards the cost of a place in a care home with nursing for those people assessed as requiring the help of a registered nurse is set at a national level. Once the need for NHS Funded Nursing Care is determined, primary care trusts (PCTs) have a responsibility to pay a flat rate contribution towards registered nursing care costs. He added that the Department would not hold discussions with individual primary care trusts about the level of the NHS Funded Nursing Care contribution or local arrangements for administering such payments. Eligibility for NHS Funded Nursing care may be considered when an individual is not eligible for NHS continuing health care and where it is considered that a place in a nursing home is the best option for meeting their needs.NHS continuing health care is a package of health and social care funded by the NHS where the individual is assessed as having a primary health need. NHS continuing health care can be provided in a range of settings including care homes.
Meanwhile in the House of Lords Baroness Greengross quizzed the Government on what action they would take to tackle the risk of malnutrition for disabled and older people who live in the community. In his reply of 2 May, the Parliamentary Under-Secretary of State, Department of Health, Earl Howe, said that there were a number of initiatives in place to help local healthcare organisations develop their nutritional policies. These included the National Institute for Health and Clinical Excellence clinical guideline to help the N HS identify patients who are malnourished or at risk of malnutrition and the "essence of care" benchmarking system, which includes food and drink, and covers health and social care settings.
He added that Government buying standards for food and catering services (GBSF), launched in June 2011, covered nutrition and sustainability aspects of food provision. GBSF is mandatory for central government departments and their agencies. However, local authorities were encouraged to adopt GBSF and, as such, if local authorities are responsible for provision of food in residential/community care settings, they could require them to implement GBSF.
He concluded by saying that the department has published practical guidance to help caterers provide food that meets the nutritional needs of adults working in or in the care of the public sector and is currently developing plans to update previous guidance on food served to older people. While the department can produce best practice initiatives for care, it is ultimately up to local nursing leadership to both ensure and assure the patients, organisational board and commissioners that good care is delivered.
Both Houses are not sitting at present. Prorogation took place on Tuesday. It is the formal name given to the period between the end of a session of Parliament and the State Opening of Parliament. The House will return to hear the Queens Speech on 9th May when the Government’s legislative programme for the next session will be set out.
Posted by Steve Smith Public Affairs Manager (England) at 00:00
Wednesday, 02 May 2012.
primary care trust (PCT),