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Integration of health and social care to promote WRVS approaches to loneliness

Prevention is at the heart of how Scotland’s political parties and policy community want to address the current social and economic situation. Instead of cutting frontline services to save money, the Scottish Government has dedicated itself to preventing need arising. This means higher quality of life and lower frontline costs. It is always better to stop someone getting ill than to cure an avoidable illness. While much of the debate about prevention has focused on early years, there is an important case to be made for prevention amongst older people.

Because loneliness is a major cause of ill health for older people the services WRVS provide can help to prevent the early stages of acute illnesses. Stopping older people getting lonely by providing community transport or good quality hot meals delivered daily is one way of preventing dementia. Social clubs and good neighbours schemes keep older people involved in a community and help those people to maintain a higher quality of life.

But one of the roadblocks to prevention is the arrangement of public services. While this is quite technical and not terribly interesting, the impact could be huge. This is because at the moment local authorities pay for prevention. They have responsibility for keeping older people well, independent and in their own homes. But if they spend money doing this, they see none of the savings, which accrue to the NHS as fewer people need to be admitted for costly treatment.

The long awaited consultation on health and social care integration aims to square this circle. It will ensure that the savings made through prevention can be put into further preventative services. This will allow a profound shift in the balance of care.

The basis of the consultation is that:

1. Nationally agreed outcomes will be introduced that apply across adult health and social care;
2. Statutory partners (including the NHS) will be jointly accountable to Ministers, Local Authority Leaders and the public for delivery of those outcomes;
3. Integrated budgets will apply across adult health and social care; and
4. The role of clinicians and care professionals will be strengthened, along with engagement of the third and independent sectors, in the commissioning and planning of services.

WRVS hopes that the release of funds to prevention will allow a substantial increase in the scope and reach of preventative services. We’re pleased that there will be strengthened engagement from the third sector. This, however, must ensure that there is a full engagement both in the preparation of plans and sign-off of plans and spending.

The proposal suggests that Community Health Partnerships be replaced with Community Health and Social Care Partnerships, which have budget holding powers and are the joint responsibility of Local Authorities and Health Boards. But the really important outcome of the proposals is the opportunity to unlock resources for prevention. Resources that are currently wasted treating preventable conditions.

WRVS will be working with Scottish Government to improve the proposals over the summer, and we hope that the proposals, when implemented, will prompt a new approach to providing services for older people. That new approach must be one that focuses on quality of life and independence for older people.

Westminster Eye: An Insight into the week of politics 23 April – 2 May 2012

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:

• critical;
• substantial;
• moderate; and
• low.

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.

Westminster Eye: An Insight into the week of politics 16 – 20 April 2012

At the beginning of the week Richard Harrington MP asked the Health Minister when he expects to publish his Department's social care White Paper. The answer was delivered on 17 April and was short and sweet. Paul Burstow said that it would be published in the Spring of 2012.

Michael Meacher MP asked how much was spent on social care for the elderly, in each of the last 10 years. A reply is expected on 23rd April.

Health Shadow Liz Kendall MP asked for a breakdown of hospital admissions and emergency readmissions since 2006/7. The figures provided by Minister Simon Burns in the answer indicate that emergency admissions for the 75+ age group had risen from around 306,000 in the first quarter of 2006 to 366,000 in the fourth quarter of 2010/11. Likewise emergency readmissions within 28 days of discharge for the same age group had risen from 154,000 in 2006/7 to 188,000 in 2009/10.

During the Finance Bill Reading on Monday, David Ruffley MP noted how many charities had estimated that the cap would lead to a 20 per cent reduction in their charitable donations, and called for an exemption for UK charities. Treasury Minister Danny Alexander was clear that the government was proposing a limit of £50,000 or a quarter of someone's income, to what were currently uncapped reliefs. "However", he said, "we will discuss this with philanthropists and charities-indeed, those discussions are ongoing. Some features of the American system, for example, may be attractive, which the Government would certainly examine and consider as part of that process."

16 April

On 16 April Simon Kirby MP received answers to his questions to Health Ministers on loneliness posed before the Easter recess. He had asked what engagement his Department had with WRVS at the recent Loneliness summit and what steps his Department is taking to reduce loneliness among the elderly. Paul Burstow said that on 15 March 2012, the Department co-hosted a loneliness summit with the Campaign to End Loneliness (CEL). The event saw charities, businesses, hon. Members and public sector organisations come together to start a conversation about loneliness and isolation in older age and how it could best be tackled. He explained that CEL had been commissioned by the Department to produce a digital toolkit for health and social care commissioners to combat loneliness and isolation.

He added that the CEL is a coalition of five partner organisations: Age UK Oxfordshire, Independent Age, Manchester city council, Sense and WRVS, all of whom played an active role at the summit. During the summit, representatives from all of the partner organisations (including WRVS) had the opportunity to engage with the Department. The chief executive of WRVS spoke at the event and answered questions as part of a panel with other speakers.

Virendra Sharma MP received a response to his question to the Secretary of State for Health on 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. Minister Paul Burstow replied by saying that the Department collected information on the use of the funding allocated to support social care services in September 2011. Data at primary care trust (PCT) level had been placed in the Library. The returns from PCTs showed that they planned to transfer £642 million of the £648 million made available in 2011-12.

He confirmed that following the survey, the Department of Health followed up with the two PCTs which, at the time of the survey, had not yet agreed the majority of their transfer and sought assurances that plans were in place to reach an agreed position. Agreements had been made for the remaining £6 million to be transferred to local authorities.

Bob Blackman MP had asked the Secretary of State for Health if he will respond to the findings of the Whole Systems Demonstrator Project report on the costs per quality-adjusted life year of the Government's telemedicine programme. Paul Burstow said that the Whole System Demonstrator (WSD) was a very complex study comprising of over 6,000 people across three sites and independently evaluated by six leading academic institutions. Telehealth headline findings were published by the Department on 5 December and show reductions in hospital admissions and mortality can be achieved. There will be more detailed findings published following the completion of the ongoing peer review process in the coming weeks and months.

He continued that at the recent Kings Fund International Congress on Telehealth and Telecare, the research team shared some of their findings on cost per quality adjusted life year (QALY). The high cost of telehealth at the start of the WSD study does have an affect on the cost of QALY results, but what is clear is that if the price point for the equipment is reduced then the cost per QALY will be significantly lower.

Matthew Hancock MP had asked the Minister for the Cabinet Office how many people in each (a) region, (b) local authority and (c) parliamentary constituency are over state pension age. Minister Nick Hurd in his response said that the information requested fell within the responsibility of the UK Statistics Authority. The Director General for the Office for National Statistics replied to the question, placing copies of the detailed tables in the House of Commons Library. The headline was that at August 2011 12,645,850 older people were in receipt of a state pension.

Gareth Thomas MP asked the Chancellor if he will publish his forecasts for the impact on charitable giving of the 2012 Budget's introduction of a cap on tax relief on donations to charities. A reply is awaited.

17 April

Susan Elan Jones MP asked what assessment had been made of the potential effect of the freezing of the personal tax allowance for over-65 year olds on levels of pensioner poverty. A reply is awaited.

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. A reply is expected on 23rd April.

18 April

Jim Shannon MP tabled a Commons Early Day Motion, “That this House notes the benefits that tax relief for charities brings with special reference to gift aid; recognises the great work that charities carry out in helping people across the UK; understands that any reduction of the amount that can be given to a charity with tax relief would be detrimental to charities across the UK; and calls for there to be no adverse change to the arrangements as they currently stand allowing people to make donations as they see fit and are able.”

During Prime Ministers Questions on the same day Kelvin Hopkins MP noted that two years ago, in his pensioner pledge, the Prime Minister said: "it is fundamental to me that people who have worked hard all their lives, and are now drawing their pension, deserve to be treated with respect." He asked if the Prime Minister really thought that trying to sell his granny tax as a "simplification" was treating pensioners with respect. The Prime Minister explained that the basic state pension was being increased by £5.30 a week this April. At the same time, the Government was saving the winter fuel payments, the cold weather payments, the free television licence, the free bus pass, and the other pensioner benefits. The Government was also examining the case for a single-tier pension of around £140 each. He expected Members in all parts of the House to welcome that, because it would be a well-paid basic state pension that encouraged people to save before they became pensioners.

Alex Cunningham MP noted that the Prime Minister's official spokesman argued last week that rich individuals were avoiding tax by giving to charities which "don't, in all cases, do a great deal of charitable work". He asked if the Prime Minister could name any of these charities. The Prime Minister responded by saying that the figures show that last year 300 people earning over £1 million in our country got their rate of tax down to 10%. He agreed that Government must protect charities and encourage philanthropic giving, but that there was a need to make sure that rich people are paying their fair share of taxes.

Michael Meacher MP asked the Secretary of State for Health if he will undertake an inquiry into the local authority funded system of domiciliary care and the costs and benefits at the present level of overall funding. Paul Burstow replied saying that the Government had no plans for an inquiry into the local authority funded system of domiciliary care.

19 April

During Oral Answers on Women and Equalities issues Nia Griffith MP asked what recent discussions Minister had held on tackling age discrimination. The Minister for Equalities Lynne Featherstone MP said that she discussed age discrimination, as appropriate, with Minister and officials and held discussions with industry bodies and others. Earlier this month, the Government endorsed an insurance industry agreement to make motor and travel insurance more accessible to older customers through "signposting" arrangements.

In her follow up Nia Griffith said that she recalled serving on the Committee that considered the Equality Bill with the Minister, and that she was keen to push forward the age discrimination provisions. She asked what had happened in the two years since the Bill received Royal Assent as the age discrimination legislation had not been implemented. Lynne Featherstone said that she had not changed her mind. The Government’s consultation proposed a ban on age discrimination in health and social care, and that there should be no exceptions to that, unlike other issues. It was an important lever, and the delay has come about because the Government wants to make sure it gets it right. She concluded that the Government will come forward as soon as it has made a decision and that was expected to be soon.

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!

Topical issues in the news this week...

Parliament is in recess this week and so I’ve taken a wider look at three topical issues which have been in the spotlight this week and have a link to older people and the voluntary sector.

Tax and charitable donations

During the week, tax and charitable donations hit the headlines. Under current rules higher rate taxpayers can donate unlimited amounts of money to charity, and offset it against their tax bill to effectively bring the amount of tax they pay down to zero. In last month's Budget, Chancellor George Osborne said that from 2013, there would be a cap on previously uncapped tax reliefs - including those on charitable donations - set at £50,000 or 25% of a person's income, whichever was higher.

That means an individual with an income of £4m could still give £1m to charity and get full tax relief for that £1m. However, if they want to donate more, this will have to come from their taxed income.

Charities have been upset by suggestions that charitable giving is a loophole being exploited by tax avoiders - and point out that wealthy benefactors give away far more than they ever get back in tax relief.  A number of charities in all sectors have predicted that they will lose out financially at a time when they are being asked to do more as public funding for services is reduced. Many politicians across the spectrum have been critical the policy, including the Business Secretary Vince Cable who is reported as supporting a crackdown on "abusive tax avoidance" but it should be "separated from genuine charitable giving".

Conservatives such as Conor Burns MP tweeted “Loophole is donations to non-UK based charities. Well that’s surely easy? Exempt UK regulated charities from the cap. Don't hit everyone.” Zac Goldsmith MP tweeted “If people use bogus charities to avoid tax, close them. But it’s wrong to clobber them all to prevent minority abuse.”

Lord Hodgson, the Conservative peer reviewing the Charities Act for the government, said "We don't want the law of unintended consequences to impact on charities. If there's a big restriction then it will make things difficult."

Prime Minister, David Cameron has said he will listen "very sympathetically" to concerns from charities about the impact of a planned cap on tax relief on donations. This is an issue that is likely to run into the next few weeks as the debate continues over support for this Budget proposal.

Patients discharged from hospital

On Thursday the Times published some findings based on a freedom of information survey of NHS Trusts over the times of the day that patients are discharged from hospital. The Times contacted 170 NHS Trusts and received replies from 100 of them. The returns showed that almost 240,000 patients were discharged between the hours of 11pm and 6am in the morning.

The data obtained by the Times suggests this may be happening in 3.5% of cases across the board with very wide variations. But that needs putting into context. It seems some hospitals are including patients who have died in their figures, while some patients, such as women who have had a baby, may choose to leave at night. Nonetheless, it is clear there are also many cases of inappropriate discharges. In particular this could impact on older people who need planned discharge and a support package in place.

Nic Dakin MP tweeted” I was troubled to read that almost 300 000 patients were discharged from hospital during the night between 11pm and 6am.”

The Patients Association reported that it had received regular calls from people who had been sent home from hospital without any warning late at night.

"I am concerned to hear that some patients may be being discharged unnecessarily late. Patients should only be discharged when it's clinically appropriate, safe and convenient for them and their families. It is simply not fair to be sending people home late at night. We will look at this."

Prof Sir Bruce Keogh, NHS Medical Director

On Thursday the Kings Fund published a report on the creation of health and well-being boards “System Leaders or Talking Shops”, that suggests that they could be the catalyst for delivering integrated care.

Health and well-being boards will bring together the NHS, public health and local authorities to co-ordinate health and other local services. Based on interviews with 50 local authorities and detailed case studies in two areas, the report looks at the experience of the shadow boards so far, boards which had to be in place from the beginning of April.

The report identifies optimism about the prospects for success, with most of those surveyed expecting boards to deliver on their identified priorities and promote closer integration between the NHS and local authorities, a key aim. The report found:

• strong senior level buy-in on a local level, with more than a third of shadow boards chaired by council leaders or deputy leaders and the majority chaired by the lead for health, adult social care or children's services
• engagement in the work of shadow boards has been especially strong among public health and adult social care, with clinical commissioning groups (CCGs) less engaged but still closely involved
• the involvement of providers has been low (less than a quarter of shadow boards include representatives of acute providers)
• while nearly three-quarters of those surveyed think that boards will influence the work of CCGs, less than 1 in 5 think they will influence the NHS Commissioning Board.

Building on the work undertaken so far to ensure health and well-being boards deliver on their potential, the report recommends that:

• sufficient time and resources must be devoted to the boards to ensure they deliver strong, credible and shared leadership between local organisations
• responsibilities and roles of all new bodies in the new health system must be clearly defined to balance national and local priorities
• a national framework for integrated care be developed to provide clearer joint accountabilities across health and social care, and to ensure joined-up care
• to provide a catalyst for driving integrated care, local authorities must look afresh at local partnership arrangements and ensure that providers are involved in their work.

There was a clear message that boards are more likely to succeed by using skills in influencing and relationship-building rather than through formal managerial control or accountabilities (health and wellbeing boards have no powers to sign off the commissioning plans of clinical commissioning groups, for example). There were concerns – eg about budget constraints and about whether national imperatives will over-ride locally agreed priorities and about the extent to which boards can influence decisions of the NHS Commissioning Board.

Parliament returns on 16 April.

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.

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 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.

Shaping social care - What will the Social Services Bill need to do?

At an as-yet-unspecified point later this month, the Welsh Government will unveil the biggest shakeup of social care in Welsh history when they announce their Social Services Bill.

If the tension is killing you, fear not. The number of trailers for the Bill will mean there are very few surprises – last year’s White Paper made the Welsh Government’s ‘direction of travel’ very clear, and more recent statements by the Deputy Minister for Social Services have also added flesh to the bones of the Bill.

Nevertheless, there are still some big questions over what is likely to be a radical set of changes. Today, the older people’s charity WRVS is setting out what we think are the biggest challenges which the Bill will need to address. If resources and political will are focused correctly, we believe the Bill can genuinely make life better for older people across Wales through the following three mechanisms:

1. Setting the bar at the right level. Currently, there is a very clear discrepancy between the Welsh Government’s enthusiasm for preventative care services, and local government raising the threshold for care so that only those with the most critical needs receive help. When the Bill sets a national threshold for social services eligibility, the only way to enshrine prevention in the system is to set that threshold at ‘Low’; not doing so will inevitably result in relatively independent older people’s needs escalating. There is a strong consensus for this position, including from ADSS, the Welsh Government’s Pearson Review, and the Dilnot Commission in England.
2. Helping local authorities to develop and signpost services which tackle loneliness. There is a very clear link between social isolation and physical ill-health – but loneliness can also be an easy and low-cost problem to address, through things like befriending schemes or good neighbour services. The challenge is ensuring that these services are properly signposted, and that more is done to help older people at risk of isolation. The simplest answer is to ensure that the proposed annual health checks for over-50s incorporate signposting towards social support where this is appropriate.
3. Promoting wide-ranging ‘reablement’ services. Reablement services help older people to make the transition back to life at home after a stay in hospital. In Wales, the SSIA have identified that 60% of older people who enter a reablement service do not require further services after a six week intensive period of help and assistance. This not only makes a massive difference in improving an older person’s wellbeing, it also reduces costly hospital readmissions for the NHS. The Social Services Bill is likely to see a very welcome expansion of reablement services in Wales, and we would simply suggest that this includes social reablement services which are proven to bring significant benefits in terms of physical health. A lot can be learned by looking at the recommendations of those organisations already engaged in delivering reablement in Wales.

Although they may sound modest, these three suggestions would fundamentally alter social care in Wales by focusing on an older person’s quality of life rather than on ‘absence of illness’ healthcare. Getting preventative care right is the greatest challenge facing us – if we don’t change our approach, projections suggest that care services in Wales will need to increase by 24% to maintain the current level of service by 2020; this equates to around 5,000 care home places and 15,000 places for people seeking support in the home.

Properly-funded and effective preventative care services are in the best interests of older people and the public purse. Providing them will result in a care system which will make Wales a great place to grow old.

This article was first published at WalesHome