Westminster Eye: An insight into the week of politics 5 - 9 March

Tuesday 6 March

Tracey Crouch MP received an answer to her question asking what assessment the Minister 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.  In responding to the two questions Paul Burstow MP, Social Care Services Minister said that the Government wanted to see a two-thirds reduction in the level of prescribing of antipsychotic drugs for people with dementia and we have commissioned an audit to measure this.

He added that the Dementia Action Alliance supported by the NHS Institute and the Department launched a 'National Call to Action' on 9 June 2011. The aim was to ensure that by 31 March 2012 all 180,000 people with dementia, who are receiving antipsychotic drugs will have undergone a clinical review, to ensure that their care is compliant with current best practice and guidelines and that alternatives to their prescription have been considered. Reducing the use of antipsychotic medication is a key element of the Dementia Commissioning Pack which is supported by a multi-disciplinary care pathway for the management of agitation in people with dementia and for the review of medication on people already receiving antipsychotics.

He finished by saying that people with dementia should have their care needs assessed regularly to ensure that they are receiving care that is appropriate as their condition progresses.

David Morris MP 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. Replies are awaited.

Virendra Sharma MP asked the Department of Health a series of questions. 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. Mr Sharma 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.

The House of Lords continued into its fifth day of the report stage of the Health and Social Care Bill. During the session Labour peer and former health minister Lord Warner moved an amendment which would insert a new clause into the Bill to give the health secretary a duty to "secure the improvement in the quality of adult social care services through local social services authorities and qualified service providers registered with the Care Quality Commission".

As part of this duty, the Secretary of State would have regard for funding, access to services, a cap on financial liability and reduction of impact onto the health services. It would also introduce national eligibility criteria and standardised charges, Lord Warner explained, a key argument heard by the Dilnot commission, of which he was a member.

He said that this one amendment would ensure that the Dilnot report's recommendations were implemented into the care system without the need for a new social care Bill in the next Parliament.

"I have low expectations of the Minister being willing to accept the amendment", Lord Warner said, as he suspected decisions would be taken by those more senior. But he urged the minister to come back to the Lords at third reading with an equivalent suggestion.

Labour peer Baroness Pitkeathley lent her support to the amendment and said it was "extremely worrying" that rumours were circulating about a delay to the government's social care white paper.

Crossbench peer Baroness Murphy said that there was "no urgent need" for the government to bring forward its white paper. Instead, she said social care was "the pressing economic and social care issue of our day" and needed to be correctly addressed through a new Bill.

Baroness Barker, a Liberal Democrat, said she agreed with Lord Warner's arguments on the importance of social care reform, "but I do not think that this is quite the way to go forward".

Health minister Earl Howe said he was in "complete agreement" on the importance of high-quality social care, but said he did not agree that the amendment was "the appropriate mechanism" to achieve Lord Warner's goals. He said that, while social care quality and funding needed to be reformed, social care law itself also needed "extensive reform". In order to avoid the very "piecemeal approach" that the Law Commission had criticised in its report on social care law, the minister said social care needed to be addressed in its own piece of legislation. "Social care is a vital public service and deserves its own focus in its own statute. Too often, debates on social care have taken place on the margins of those on another issue."

Lord Warner said he was serious about the amendment. He added that the government was "already behind time on this reform", with no assurances that a new social care Bill would be proposed to Parliament in the next session. He pushed the amendment to a vote, which was defeated by 261 votes to 203.

Wednesday 7 March

Jim Cunningham MP asked what steps the Government is taking to ensure consistent levels of provision of social care support. Alun Cairns MP asked the Chancellor of the Exchequer if he will review his policy on VAT insofar as it affects charitable organisations to serve their local communities. Replies are awaited.

Thursday 8 March

"That this House believes there is an
urgent need to reform the current
system of providing and paying for the
care of adults in England and Wales;
recognises that social care, unlike the
NHS, has never been free at the point
of need irrespective of income; notes
the central role of informal carers in
the provision of care; welcomes the
Coalition Agreement pledge of reform
and legislation; further welcomes the
plans for better integration between
adult social care services and the NHS;
welcomes the extension of personal
budgets; urges the Government to
ensure that fairness is central to reform,
including access to advice, advocacy,
assessment of need, care services as well
as funding options; recognises the need
to break down the barriers to portability;
and further urges the Government to
publish its White Paper as soon as possible,
and to bring forward legislation."

Sarah Newton MP moved a motion for a debate
in the main Commons Chamber
On Thursday Helen Jones MP asked the Secretary of State for Health how many local authorities have (a) increased charges and (b) changed eligibility criteria for social care since May 2010. Minister Paul Burstow replied saying that setting levels of eligibility and levels of charging for social care are local decisions. Councils are answerable to their local populations on both counts, in line with guidance and regulation set by the Department.

Virendra Sharma MP 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.

He also asked the Minister what plans his Department has to introduce a national assessment framework for social care; and if he will make a statement. Replies are awaited.

Philip Davies MP asked the Work and Pensions Minister how much has been paid in each of the last three years in winter fuel payments to people in care homes. Tim Farron MP 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. Replies are awaited,

The Health and Social Care Bill reached the sixth of its seven scheduled days of its report stage in the House of Lords. Baroness Bakewell called for a commissioner for older people. She had suggested the amendment in committee but now sought to have the role subsumed into the agenda of HealthWatch England, rather than a freestanding role. Health Minister Earl Howe said he did not feel he could accept the amendment, though this was "a very important issue with which the government is in complete sympathy." He said that the Department of Health was already pursuing a number of initiatives to improve the care of older people in hospitals, care homes and other settings.

Sarah Newton argued that the £145billion spent annually on social care, NHS and welfare payments needed to be spent differently and more efficiently as people lived longer and longer lives. She said that she hoped to see better integrated health care between charities and doctors, nurses and social workers. However, before such a revolution could be introduced, she argued there was "an urgent need to design a fairer system based on shared responsibility to pay."

Health committee member, Barbara Keeley MP expressed her concerns over funding for dementia care and accused the government of masquerading cuts as increased personalisation of care. She went on to explain the case for the government to set aside £5bn over the next three years to meet the growing demand for social care.

Minister Paul Burstow said the solution to good social care lay in "reducing pressure on the NHS, but above all it means helping people to live the lives that they want." He said that the current care and support system is not fit for purpose and that patching and mending it would no longer suffice.

He added that the Government was considering not just funding reform, but the legal structure that governs social care, which must be updated, referring to the content of the white paper, now expected in the Spring.

Shadow Health Minister Andy Burnham described the issue as the "biggest unresolved public policy challenge facing the country" and that the Government needed to work out how to provide an integrated and people centered approach to care.

He pointed out the real life gaps between the minister's statement and the reality of health care on the ground, and added that "we must address the question of the local government baseline alongside that of Dilnot."

Laura Sandys MP welcomed the Dilnot report but suggested that it was perhaps a little pre-emptive. She said that until we can be explicit about what this care looks like and feels like, and what people's experiences of it will be, it is difficult to talk to people about how we expect them to pay for it. Any new social care system should be refocused around the principle of early intervention and she questioned whether enough attention was being paid to the three biggest reasons for going into care: dementia, incontinence, and accidents, such as falls.

Health committee member, Dr Sarah Wollaston MP spoke about the funding gap in social care, and the need to increase funding for the sector at least slightly, "so that we can achieve what we want to achieve for our older people: dignity and independence".

The motion was agreed.

Posted by Steve Smith, Public Affairs Officer at 09:00 Wednesday, 14 March 2012.

Labels: Dementia care

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