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Westminster Eye: An insight into the week of politics 26 - 30 March

26 March

On Monday the Secretary of State for Health Andrew Lansley launched the Prime Minister’s challenge on dementia to tackle one of the most important issues the UK faces arising from an ageing population. The challenge sets out the Government's ambition to increase diagnosis rates, raise awareness and understanding and to strengthen substantially the UK’s research efforts. He added that the Government was determined to transform the quality of dementia care for patients and their families. In England today there are an estimated 670,000 people are living with dementia, a number that is increasing with one in three people set to develop dementia in the future. The three key areas where the Government wants to go further and faster and build on the progress made through the National Dementia Strategy. The three areas are:

  • driving improvements in health and care
  • creating dementia-friendly communities that understand how to help
  • better research.

Meanwhile in the House of Lords, Lord Kennedy of Southwark asked the Government what assessment they have made of the Campaign to End Loneliness (CEL) and what action they are taking to support the aims of the campaign. The Parliamentary Under-Secretary of State, Department of Health, Earl Howe, replied saying that the Government is working with the CEL to raise awareness of the problem of loneliness and tackle the factors that cause loneliness and isolation in older people. The department recently co-hosted a social isolation and loneliness summit with CEL to gain a commitment to tackle loneliness and isolation through health and well-being boards, commissioners, local communities, businesses, statutory and voluntary sector organisations. It has also commissioned CEL to produce a digital toolkit for health and care commissioners to combat loneliness and isolation.

He added that the CEL and the Ageing Well programme, funded by the Department for Work and Pensions, have produced a guide for councils on combating loneliness. Representatives from CEL play a key role in the Age Action Alliance. This is a partnership of private, voluntary and public sector organisations jointly led by the Department for Work and Pensions and Age UK.

27 March

On Tuesday The Health and Social Care Bill gained Royal Assent to become the Health and Social Care Act 2012. The core principles of the Act mean that doctors and nurses will be able to tailor services for their patients, more choice will be given to patients over how they are treated, and bureaucracy in the NHS will be reduced.

The Act will:

  • Devolve power to front-line doctors and nurses: Health professionals will be free to design and tailor local health services for their patients.
  • Drive up quality: Patients will benefit from a renewed focus on improving quality and outcomes.
  • Ensure a focus on integration: There will be strong duties on the health service to promote integration of services.
  • Strengthen public health: Giving responsibility for local public health services to local authorities will ensure that they are able to pull together the work done by the NHS, social care, housing, environmental health, leisure and transport services.
  • Give patients more information and choice: Patients will have greater information on how the NHS is performing and the range of providers they can choose for their healthcare. And they will have a stronger voice through Healthwatch England and local Healthwatch.
  • Strengthen local democratic involvement: Power will shift from Whitehall to town hall - there will be at least one locally elected councillor and a representative of Healthwatch on every Health and Wellbeing Board, to influence and challenge commissioning decisions and promote integrated health and care.
  • Reduce bureaucracy: Two layers of management - Primary Care Trusts and Strategic Health Authorities - will be removed through the Act, saving £4.5 billion over the lifetime of this Parliament, with every penny being reinvested in patient care.

Helen Jones MP asked the Communities Minister what estimate he has made of likely changes to the number of pensioners who will take up council tax benefit if localisation of the benefit is introduced. A reply is expected after recess.

Health Oral Questions took place on Tuesday.  Meg Munn MP asked what steps the Health Minister is taking to ensure that people receiving care at home funded by the NHS are involved in making the arrangements for that care. In responding the Social care Minister, Paul Burstow said that the Government’s ambition is to enable shared decision making for all NHS patients. He expected people who are eligible for NHS continuing care funding to be fully involved in discussions about their care. Subject to the results of the current personal health budget pilots, everyone eligible for NHS continuing health care, including many people receiving care at home, will have the right to ask for a personal health budget, including a direct payment, from April 2014.

In her supplementary question Meg Munn MP said that she had received a letter from one of her constituents who has had direct payments for 15 years under social services. Following a stay in hospital, she was moved on to health funding, and her life has changed dramatically for the worse. She says that she no longer has any choice in who cares for her and finds it hard to find the right people with whom she feels comfortable. She asked if the Minister will bring forward measures more quickly, so that people who have been directing their own care under social services can have the same quality of life and the same choices that they have become used to. Paul Burstow agreed and said that the Government needs to ensure that, as soon as possible, the benefits and the control that direct payments give to individuals in social care are available to people in regard to their long-term health care and particularly to continuing health care. It is realistic to say that Government can roll this out nationwide by 2014. He encouraged her to carry on those conversations with the authorities in Sheffield, and with him about the way in which people can use the current arrangements to access those facilities.

Stephen Dorrell MP intervened and asked whether the constituency case raised by Meg Munn did not highlight the increasingly urgent need to achieve much more integration between health and social services, and indeed between different parts of the NHS, in order to provide joined-up care that focuses on patients' needs and delivers better value for money to the taxpayer. Paul Burstow said that Mr Dorrell was right. He added that it is not just a question of delivering more integration within health care-which is often still too fragmented, or between health and social care; it is also a question of recognising that issues such as housing and leisure are critical to the delivery of greater well-being, and to an improvement in the health of the nation. The Health and Social Care Bill gives people in every part of the system a clear duty to collaborate, integrate, and deliver better care for all.

Ian Swales MP intervened saying that his constituent Joyce Benbow was discharged from Redcar Hospital last November, but is still there, owing to a failure to agree on her care package. He asked when would those managing health and social care budgets be more joined up so that people receive the right provision at the right time. In his reply Paul Burstow said that this demonstrated the importance of joining up hospital care, community care and social care, which has often been overlooked. He added that the Government had invested more than £300 million this year in developing more re-ablement services, and in January the Government invested an extra £150 million in support for them. The Government was also extending its plans for more tariff reform to ensure that local hospitals have the means to drive the development of such services in their communities.

Nick Smith MP asked what recent assessment the Minister had made of the performance of services for older people. Paul Burstow saying that a number of inspections, reports, independent audits, and investigations have revealed long-standing and unacceptable variations in the standard of care that older people receive in the NHS, and in social care. The Government is determined to root out poor-quality care wherever it is found. The national Nursing and Care Quality Forum had been established to work with patients, carers and professionals to spread best practice.

Nick Smith’s supplementary focused on the British Geriatrics Society's Quest for Quality report which identified that too many people in care homes were without access to NHS services, including psychiatric, physiotherapy and continence services. He asked what action the Government is taking to ensure that care home residents get the high-quality NHS care that they deserve. Paul Burstow responded by saying that in England, one of the things that the Government is doing is making sure that a programme of special inspections of care homes, conducted by the Care Quality Commission, looks at those issues to ensure that Government provides the right range of support services for people in care homes. In addition, the National Institute for Health and Clinical Excellence has produced quality standards; in particular, it has been working on quality standards relating to issues affecting older people-incontinence, nutrition support for adults, patient experience, delirium, dementia, and many others.

In her question Margot James MP said that Russells Hall hospital, which serves her constituency, has reviewed recent reports, and done its own research, on dignity and care for older patients. It has elevated the qualities of care and compassion to the top of its criteria for recruiting health care assistants. Paul Burstow said that it is important that that is applied to all who have direct responsibility for delivering care, and hands-on care in particular. The work that Russells Hall Hospital is doing on care and respect, and in its responsibility programme, is a good example of that. On issues such as dementia, the Government is clear that it needs to ensure good advice, training and support for all nursing staff. He was working with the Royal College of Nursing on this so that they treat people who have dementia with dignity.

In her intervention Liz Kendall MP stated that the Government is rightly building on Labour's national dementia strategy, and the Minister should know that the dementia crisis cannot be addressed without tackling the crisis in care. She added that the Government had cut more than £1 billion from local council budgets for older people's care, services are being withdrawn and care charges for dementia sufferers are soaring. The Alzheimer's Society and Age UK say that these cuts have pushed the system to breaking point. She asked if the Minister agreed with them. Paul Burstow responded by saying that the Government identified £7.2 billion of additional investment to go into social care over the life of this Parliament, and those resources are being used creatively by some local authorities to protect front-line services. He urged her to applaud the authorities that are doing that and join in condemning those that are cutting services despite being given the resources.

Further on dementia care, Mark Menzies MP welcomed the announcement on support for dementia care. He asked what assurances the Secretary of State could give that this will be an aggressive strategy, looking at matters such as new access to drugs, early diagnosis and support for carers of those with dementia. Andrew Lansley replied saying that not only were there the recent announcements, but as part of that there was the establishment of three sets of champions, including Angela Rippon and Jeremy Hughes from the Alzheimer's Society, working together as champions to raise awareness and understanding, Ian Carruthers and Sarah Pickup as champions on improving treatment and care, and Dame Sally Davies, the chief medical officer, and Mark Walport from the Wellcome Trust, as champions for research. Their objective is specifically, to hold the Government to account, not only for the ambitions set out, but for going further and faster.

Debbie Abrahams MP received a reply to her written question to the Secretary of State for Communities and Local Government on what steps his Department plans to take to evaluate the implementation of the measures contained in its document Creating the Conditions for Integration. Andrew Stunell MP replied saying that the written ministerial statement Creating the Conditions for Integration of 21 February 2012, sets out the Government's approach to enabling and encouraging integration, including the role of exemplar projects. This policy document complements the Government's Social Mobility Strategy and Equality Strategy. Specific projects in 'Creating the Conditions' will be monitored and evaluated against each project's objectives. Integration is predominately a local issue which requires a local response, and therefore evaluation is a matter for local areas.

Diane Abbot MP asked what estimate the Health Minister has made of the number of NHS patients in England who are housebound. Paul Bustow said that the information is not held centrally.

Diane Abbott MP also asked the Secretary of State for Health how many older people were subject to delayed discharge from hospital as a result of malnutrition in (a) 2010, (b) 2011 and (c) the latest period for which figures are available in 2012. Paul Burstow said that the information requested was not collected centrally. He added that delayed discharges occur when a patient is medically fit to be transferred from hospital, but is still occupying an acute bed because of a lack of capacity in the wider system. If a patient is suffering from malnutrition and is not medically fit, they would not be ready for discharge from hospital and therefore could not be counted as delayed.

28 March

On Wednesday Simon Kirby MP tabled two written questions around the subject of loneliness. The first asked what engagement the Department of Health had had with WRVS at the recent Loneliness Summit. The second question asked what steps the Department is taking to reduce loneliness amongst the elderly. On the same day Virendra Sharma MP asked what proportion of the £648 million allocated for primary care trust (PCT) spending on social care was spent on (a) prevention services, (b) communicating equipment, (c) telecare, (d) crisis response services, (e) maintaining eligibility criteria, (f) re-ablement and (g) mental health by each PCT. Answers are expected for all these questions on or around the 16 April.

In the Lords on Wednesday Lord Warner asked the Government how many commissioning support services for clinical commissioning groups are expected to be identified by 1 April 2012; and how many of those are expected to be led by former primary care trust managers. Earl Howe in responding said that work is in hand within primary care trusts (PCTs), strategic health authorities and the NHS Commissioning Board Authority to develop the necessary arrangements to support the new commissioning system. The detailed strategy describing this is set out in the publication Developing Commissioning Support: Towards Service Excellence. Information on the number of emerging National Health Service commissioning support services is not yet available. The leadership of these organisations as at 1 April 2012 is a matter for the PCT clusters. The department does not hold information on PCT cluster staffing arrangements.

Both Houses are now in Easter recess. Both Houses return on 26 April.

Westminster Eye: An insight into the week of politics 19 - 23 March

Tuesday 20 March

On Tuesday Ian Paisley MP received an answer from the Minister on whether his Department has considered a cap on lifetime social care payments. Minister Paul Burstow said that the coalition agreement set out the Government's clear commitment to reforming the system of social care to provide much more control to individuals and their carers, and to ease the cost burden that they and their families face. This commitment to reform is why Government acted quickly to set up the Commission on Funding of Care and Support, which published its report in July 2011.

He added that the Commission recommended a "capped cost model", where people's lifetime care costs are limited at between £25,000 and £50,000. Once someone has accrued eligible care costs up to this level, the state would cover their remaining care costs. The Commission's report has formed the basis of Government's recent engagement with stakeholders. This engagement exercise examined the impact of these recommendations, and brought them together with other priorities for reform from across the social care system to look at the trade-offs between them. When the Commission published its report in July 2011, Government set out their commitment to publish a White Paper on social care and a progress report on funding reform in the spring-a timetable to which we remain committed.

Helen Jones MP asked the Communities Minister what estimate he has made of likely changes to the number of pensioners who will take up council tax benefit if localisation of the benefit is introduced. A reply is expected next week

Wednesday 21 March

On Wednesday during the Cabinet Office Commons oral answers session, Lilian Greenwood MP asked what recent discussions the Minister had had on the types of Government funding models available to the voluntary and community sector. The Cabinet Office Minister Nick Hurd said that the Government wanted to help the voluntary and community sector to become more resilient by developing three pillars of funding: traditional giving, income from the state including more opportunities to deliver public service and a new pillar, and the emerging market of social investment.

In her supplementary question Lilian Greenwood said that many local voluntary organisations were set up to complement statutory services. She believed that if the predominant funding source for the voluntary sector is now to be public sector contracts, thousands of valuable voluntary groups throughout the country be left high and dry, showing once again the Government's contempt for the big society that they championed. Nick Hurd said that the Government is developing three pillars of funding, with the encouragement of high levels of giving, including a very generous tax incentive introduced by the Chancellor in the previous Budget; a new source of funding, social investment; and the launch of the world's first social investment bank within a few weeks. The Government wants to do more with the sector to help deliver public services. The Government will be opening up new opportunities for charities and social enterprises to help with that aim.

In the same debate Phil Wilson MP said that a survey commissioned by Charity Bank had revealed that more than 20% of charities have suffered from the cancellation of contracts with businesses and Government bodies in the past year. He asked if the Minister agreed that the Government's refusal to recognise the needs and benefits of charities and voluntary organisations in policy formulation is preventing such organisations from getting vital funding to which they are entitled. Nick Hurd said that this was an important point and that any commissioner in the public sector needs to engage with stakeholders in communities before commissioning services, not least in the voluntary and community sector, whose stakeholders tend to have a much better understanding of the needs of the people the Government was trying to help.

Seema Malhotra MP asked what assessment the Minister had made of the change in the level of funding to the voluntary sector in 2011-12. Nick Hurd MP responded by saying that most voluntary sector organisations receive no public funding at all, but those that do cannot be immune from the need to reduce public spending. That is why the Government is taking active steps to help the most vulnerable organisations, to encourage more giving and social investment, and to create new opportunities to deliver more public services.

In the following question Seema Malhotra MP said that the most recent report by the National Council for Voluntary Organisations shows that, according to the Government's own figures, charities are facing cuts of £1.2 billion in public money per year. She asked if the Minister agreed that the Government need to do more to support the voluntary sector to address what the NCVO had described as a "toxic mix of circumstances" affecting charities. Mr Hurd replied by saying that almost 80% of charities receive no money from the state, but the Government has made it clear that those that do cannot be immune from cuts. This Government is taking action to protect the most vulnerable organisations, create new sources of funding and open up new opportunities for charities and social enterprises to deliver public services.

Yvonne Fovargue MP asked what steps the Minister is taking to ensure that the community and voluntary sector is considered in policy formulation in all Departments. In replying for the Cabinet Office, Oliver Letwin MP said that the Government’s agenda is to give community groups and other voluntary sector organisations a much wider role in fulfilling the demands and needs of the public than they have had in the past. That is why, in considering each of our public service reforms, the Government had paid particular attention to the question of how the voluntary and community sector can work through them and help them.

In her supplementary question Yvonne Fovargue MP said that research by the NCVO has shown that Government Departments plan to cut a further £444 million of funding from the voluntary and community sector. She asked if the Minister agreed that that is evidence of the complete disregard of his own Government for that sector. Oliver Letwin replied by saying that this was not the case. In 2010-11, the funding stood at rather less than £200 million, but in 2011-12 it went up and it has almost maintained the 2011-12 levels, still above those of 2010-11-for 2012-13. The Government is investing in the voluntary and community sector, not disinvesting in it.

On Wednesday several questions of interest were tabled and selected for Health oral questions scheduled for Tuesday 27 March. Nick Smith MP is to ask what recent assessment has been made of the performance of services for older people. Meg Munn MP is to ask what steps the Minister is taking to ensure that people receiving care at home funded by the NHS are involved in making the arrangements for that care. Finally Margot James MP will ask what assessment has been 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.

Alun Cairns MP received an answer to his question to the Treasury asking if they will review the policy on VAT insofar as it affects charitable organisations who serve their local communities. Treasury Minister David Gauke replied saying that the Government valued the contribution of charities across a wide spectrum of national life and interests.

He added that the UK has one of the most generous tax systems for charities in the world. Existing reliefs for charities are worth over £3 billion a year. Within this, are existing VAT reliefs worth over £200 million per year. These include zero rates for charities on sales of donated goods, medical equipment and the construction of charitable buildings. In addition Gift Aid, the largest single relief, is now worth nearly £1 billion to charities each year. In terms of whether the Government could extend the VAT reliefs further; in many cases, EU VAT rules mean that it would not be necessary or possible to provide a refund scheme to any contracted provider of public services. The provision of any services under a contract, by a charity or a business, will normally be regarded as a business activity and thus within the scope of VAT. Therefore, if the services provided are taxable the provider will be able to recover their VAT costs through the normal VAT system. However, if the services provided are VAT exempt, any form of VAT refund is prohibited under EU VAT law. Where a provider does incur irrecoverable VAT in the provision of public services, these costs should be taken into account by the contracting public sector organisation when agreeing funding.

Diane Abbot MP asked what estimate the Health Minister has made of the number of NHS patients in England who are housebound. A reply is awaited.

Thursday 22 March

On Thursday Andrew Rosindell MP asked what steps the Health Minister is taking to increase the number of doctors specialising in geriatrics. A reply is awaited.