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Reabling Wales - Residential care of older people

On Thursday 26 April, I will be giving evidence to the Welsh Assembly’s Health & Social Care Committee as part of its inquiry into the residential care of older people in Wales. I am doing so in my role as Chair of the Welsh Reablement Alliance, an umbrella group of bodies who provide support to people when they come out of lengthy hospital stays and help them to adapt back to life at home.

Reablement is a hugely important step-change for social care – it changes the presumption of what sort of help people need, seeking to help them re-learn daily skills so they can stay in their own homes and remain independent rather than needing to look at formalised home care or residential care. This not only affords more dignity to older people, it also make significant savings for the public purse by preventing hospital readmissions and costly long-term care packages.

Typical examples of reablement might be short-term physiotherapy interventions, or physical adaptations to the home, or it might mean short-term social support to help a person (such as a lift to the shops, or a volunteer helping to walk the dog whilst they regain physical strength) – in practice though, it is a whole range of these services. Long-term hospital stays can knock a person’s self-confidence, diminish them physically, and put all sorts of practical barriers in place which make it hard to adapt to life back at home. Reablement is simply about overcoming those barriers through short-term interventions.

Currently, there are some excellent examples of reablement in Wales – but they are all too often quite patchy and inconsistent, with huge variations between regions and huge discrepancies in the levels of funding they attract. That is partly an accident of how the service has evolved over time, but now that the Welsh Government is making bold plans to extend reablement as part of its Social Services Bill, the time has come for a more consistent level playing field for reablement, and for the Welsh Government to set out what it expects local authorities to provide.

The evidence session will be broadcast on senedd.tv at 1pm on Thursday – be sure to tune in!

Posted by Ed Bridges, Public Affairs Manager (Wales) at 00:00 Thursday, 26 April 2012.

Labels: reablement, Welsh Reablement Alliance, social care, older people, volunteering, dignity, hospital, self-confidence, Social Services Bill, senedd

Westminster Eye: An insight into the week of politics 21 -25 November

22 November
Health Oral Questions took place and there were a number that related to older peoples issues. Julie Hilling MP asked what discussions the Minister had had with the Chancellor of the Exchequer on the future costs of long-term social care. In response Minister Paul Burstow said that the Government is committed to publishing a White Paper and a progress report, responding to both the Law Commission and the Dilnot commission recommendations. As part of ongoing work, there have been numerous discussions throughout the Government, including with Her Majesty's Treasury.

As her supplementary, Julie Hilling said that at least 5,000 families a month have to make decisions about the long-term care of loved ones. Since the election, thousands have had to sell their homes and spend every penny on care. She said that many more people-and for how much longer-will be terrified about their future.

Margot James MP asked if the Minister agreed that the integration of health and social care should be leveraged by commissioners to encourage savings in the acute sector, to contribute to funding much-needed improvements in long-term social care. Paul Burstow replied that there is no doubt that more integration between health and social care is a way of improving the quality of services delivered to the public, and of releasing resources that can then be reinvested in improving services. For example, the Government knew that the use of reablement services can reduce costs and improve the quality of life outcomes for the people who receive them.

Shadow Minister Liz Kendall MP stated that social care is vital for reducing winter pressures on the NHS by helping to keep older people out of hospital, but the Government is cutting funding for older people’s social care by £1.3 billion. Delayed discharges from hospitals are already up 11% from this time last year.

The Minister responsible for care (Paul Burstow) said in Westminster Hall on 10 November: "cuts to front-line adult social care services are really beginning to bite."

She asked whether the Secretary of State agreed. In response Mr Lansley, Secretary of State, said that it was this Government who gave priority to social care. More than £7 billion was added to the social care budget as a consequence of the steps taken by the Secretary of State for Communities and Local Government and by the NHS. This year the NHS is providing an additional £648 million specifically to support adult social care. In addition, the Government had announced its Warm Homes Healthy People funding for this winter, which will provide additional support for those most urgently in need.

Iain Stewart MP asked what leadership role the Government expects the new Health and Well-being Boards to play in determining significant NHS service changes in each local area. Mr Lansley said that the Health and Well-being Boards will have a role not only in leading improvements in public health and social care but, through the joint strategic needs assessment and the strategy derived from that, in establishing how services should respond to the needs of the local population. The clinical commissioning group should respond directly to that, and any specific service configuration changes should form part of the commissioning plan. In addition, the local authority, through its scrutiny role, will have a continuing ability to refer those plans for review.

In a written question Brandon Lewis MP asked the Secretary of State for Transport is taking to maintain public transport provision for elderly people in rural areas who are affected by planned changes to the funding of local bus services. Transport Minister Norman Baker replied that outside London, the provision of bus and community transport services in rural areas, as in urban areas, is a matter for commercial operators and for local authorities.

However, he said that the Government understood that buses are a lifeline for many people in rural areas. £10 million of extra funding was recently provided to local councils to help develop community transport in their areas. The Government is also providing £560 million over four years through the Local Sustainable Transport Fund to help local authorities to support economic growth and reduce carbon emissions. Moreover, the Government had committed to protect the statutory entitlement for concessionary bus travel, ensuring that older people can maintain greater freedom and independence.

Further written questions still awaiting a response included Simon Kirby MP who quizzed the Minister on what assessment his Department has made on the findings of the Shaping our Age report by WRVS on loneliness.

Also Helen Jones MP wanted to know what discussions had taken place with Ministerial colleagues on the likely effect of the Local Government Resource Review on social care.

Baroness Smith of Basildon received a reply to the question she put to Ministers the previous week asking in the light of statistics produced by the Department of Health showing that between January and March 2011, 75% of all acute delayed transfers were of people aged 75 or over, whether they will reverse the decision to stop collecting this data in this form, given its role in helping to understand the relationship between the National Health Service and social care provision for older people.

In his response Earl Howe said that no one should stay in hospital longer than is necessary. The NHS and social care must work together to ensure people have the support they need on leaving hospital. Some patients need particular support after a spell in hospital to settle back into their homes, recover their strength and regain their independence. The Government has increased the level of investment made available to local health and care services to spend on front line services and helping people return to their homes after a hospital stay. While it is recognised that the delays for over-75s is a large proportion of the total, the aim should be reducing the number of delays for all ages. Latest figures showed that 76 per cent of acute delays were for over-75s and 23 per cent of admissions were for over-75s.

He continued that the spending review recognised the importance of social care in protecting the most vulnerable in society. In recognition of the pressures on the social care system in a challenging local government settlement, the Government had allocated an additional £2 billion by 2014-15 to support the delivery of social care and help protect people's access to services upon discharge.

As part of this funding, an allocation of £150 million has been made available this year for reablement and £648 million for social care spend that benefits the NHS which could help to reduce the level of delayed discharges. The reablement money will help people to leave hospital more quickly, get settled back at home with the support they need, and to prevent unnecessary admissions to hospital. Local authorities are responsible for decisions on how to allocate their resources.

The data from the NHS are collected with the aim of helping commissioners to commission the most effective and appropriate services for their local population and to help service users to make informed decisions. The data collected is frequently reviewed to ensure it meets this aim.

Lilian Greenwood MP asked the Minister what recent assessment he has made of the adequacy of resources provided for the care of older people. Paul Burstow said that the Government had committed an additional £7.2 billion to support social care over four years up to 2015. This is on top of £6.8 billion of existing departmental grant funding. Taken together these funds along with a rigorous approach to quality and productivity improvement provide local councils with sufficient resources to protect access to care for older people.

24 November
The Department of Health published the operating framework for the NHS in England 2012-13, which sets out the business and planning arrangements for the NHS.  One of the key areas that will receive particular attention during 2012 - 13 is the improvement of services for older people. There is a systemic set of things that the report sets out that will require organisations to work together. These include participation in and publication of national clinical audits that relate to services for older people and non-payment for emergency readmissions within 30 days of discharge following an elective admission.

Also on Thursday Jim Dobbin MP asked how much of the extra £70 million funding announced for re-ablement has been (a) spent by and (b) allocated to each Primary Care Trust and on what services this money has been spent. Chris Skidmore wanted to know how many people over the age of (a) 65, (b) 75 and (c) 85 years were admitted to accident and emergency centres in each of the last 10 years for which figures are available. Replies are awaited.

On Thursday afternoon the House of Lords led by the chairwoman of the Council for Healthcare Regulatory Excellence, Baroness Pitkeathley debated Dilnot and the Future Funding of Social Care. Paying tribute to the work of the Commission on Funding of Care and Support, she said that the current system of social care could be described as "in crisis, severely stretched or broken, depending on where you sit". She expressed her disappointment that other than the minister, no Conservative peers had put their name down to speak in the debate. The Labour peer highlighted the problems of a system that was "not fit for purpose", adding: "We are spending inadequate amounts on care and support, both publicly and privately".

She outlined the recommendations of the commission's report: A cap, between £25,000 and £50,000, on individuals' contribution to their social care; after which they should be eligible for full state support. There should also be national eligibility criteria and portable assessments. She argued that the estimated cost of the proposals, at £2bn, paled in significance compared to the £170bn that social security cost each year. She urged parliamentarians to harness the consensus of support for the Dilnot proposals. Baroness Pitkeathley called on the minister to outline when action would be taken:

Lord Lipsey expressed concerns that the Dilnot recommendations were "in danger of going down the pan". Turning to the role of the private sector he said that there were currently very few insurance policies for long-term care. He suggested that insurance companies were hesitant in this area because of the fear that people will live longer and longer and that the costs of that care will bankrupt the companies". "Without a state-funded cap which limits the liabilities of insurance companies, mass private insurance is a dead duck," he said. Lord Lipsey praised the Dilnot report, but said that the proposed cap of £35,000 that an individual would bear was too low.

Lord Rix expressed concerns about the tightening of eligibility criteria, and highlighted that 83 per cent of councils were only supporting people with 'critical' or 'substantial' needs. Lord Desai wanted to see some incentives to promote the buying of social care insurance at a very young age by people.

Lord Low of Dalston warned that time was running out, and that Dilnot was not enough. Baroness Wall of New Barnet highlighted the benefits of integrated health and social care systems, which could be achieved through joint commissioning and planning, and pooled budgets.

Lord Warner thought that implementation of Dilnot could be brought forward through using the current Health and Social Care Bill as a vehicle to draw up regulations.

In responding for Government Earl Howe said that the decision to protect social care funding would help to alleviate pressures on the system. He admitted that demand for services would rise, and that their funding and legal framework had to change. The current engagement process would provide a forum for debate, and inform the white paper and progress report, to be published next April, he said.

The government would not shy away from its responsibilities he said, and its commitment to "legislate at the earliest opportunity is undiminished", but added that the Dilnot recommendations carried "significant costs". On the level of the cap, he said that £100,000 would seem unobtainable to most people, and would not stimulate the development of financial services.

Following immediately on, the Lord Bishop of Ripon and Leeds opened a debate on voluntary sector funding which noted how effective and innovative the voluntary sector was, juxtaposed against the "massive underfunding" it also faced. He called for "specific ring-fencing of government money, public money, for areas such as mental health, where charities struggle as mental health issues grow, with increasing homelessness and fear." The Bishop also spoke of the need for a "greater fairness in the allocation of local authority funds."

In backbench contributions, Lord Rennard called for "much greater transparency in how local authorities fund the voluntary sector and how they decide on the best long-term providers of services." Above all, Lord Rennard argued, "there needs to be much greater respect between government at all levels and the voluntary sector."