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Westminster Eye: An insight into the week of politics 6 February - 10 February

Monday 6 February

David Morris MP received a reply to his question to the Health Minister on what steps he is taking to improve the services offered to patients following discharge from an NHS hospital. Social Care Minister, Paul Burstow, said that no one should be made to stay in hospital longer than necessary. The NHS and social care must work together to ensure people have the support they need on leaving hospital. He added that the new Clinical Commissioning Groups will bring together general practitioners, specialist doctors and nurses to shape the best local care for patients, helping to avoid unnecessary delays. The Government would continue to take significant steps to improve the services offered to patients following discharge from hospital. For example, it had been announced on 3 January 2012, a one-off additional allocation of £150 million to primary care trusts in England, for immediate transfer to local authorities for investment in social care services which also benefit the health system. The aim was to reduce the pressure on health services, and particularly hospitals during the winter period. This new investment will enable local services to discharge patients from hospital more quickly and provide support for people in their own homes. The Department is investing extra cash to help people return to their homes after a spell in hospital—by 2012-13 this will be £300 million per year and will help people to leave hospital more quickly and get settled back at home with the support they need.

Tracey Crouch MP received a reply from Paul Burstow on the representations he had received on the reform of social care. Paul Burstow said that the care and support White Paper and progress report on funding reform, planned for spring 2012, will set out the Government's plans for reforming the care and support system. The Government had launched "Caring for our future" in Autumn 2011. He had worked with leaders from the care and support community, and with expert reference groups, to seek a broad range of views from people who use care and support services, carers, local councils, care providers and the voluntary sector. During the engagement and since it formally ended, Ministers have met with a range of organisations about reform of care and support. The Department is currently reflecting on the findings and will continue to work with stakeholders to develop policy and to help the Government decide the approach to the care and support White Paper and progress report on funding reform.

Tracey Crouch MP had asked a second question relating to the assessment made of the effect of changes in funding for social care on (a) avoidable emergency admissions and (b) NHS costs. Paul Burstow responded by saying that effective partnership working and integration are key enablers in delivering against the Quality, Innovation, Productivity and Prevention challenge within the NHS, and supporting improved efficiency within social care. This includes ensuring the people do not stay, in hospital longer than they need to.

He continued that the Department has put in place practical measures to support social care services, in the context of a challenging local government settlement, and to encourage improved joint working between primary care trusts and local authorities. In 2011-12, £648 million has been allocated to PCTs to transfer to councils for spending on social care services that also benefit health. The Department has been clear that PCTs and local authorities will need to work together closely in order to agree appropriate areas of social care investment, taking account of joint priorities identified by the Joint Strategic Needs Assessment for their local populations. Evidence from a survey of PCTs suggests that this funding is being used both to prevent unnecessary admissions to hospital (through crisis response services for example), and to ensure people are able to leave hospital quickly (through intermediate care and re-ablement services for example). A further £150 million (rising to £300 million in 2012-13) has been allocated to PCTs for the development of post-discharge support and re-ablement services. There is local discretion over how this money is to be spent, but in a letter to the service the Department has been clear that:

"This funding is intended specifically to develop current reablement capacity in councils, community health services, the independent and voluntary sectors, with the objective of ensuring rapid recovery from an acute episode and reducing people's dependency on social care services following discharge."

In addition to these funding streams, the Department announced on 3 January 2012 that it was making a further £150 million available to PCTs, to transfer to local authorities for spending on social care. The Department has set out that this funding should be used to target delayed transfers of care which are attributable to social care services. He finished by saying that recently published data shows that the number of patients experiencing delayed discharge from hospital has fallen to its lowest level since this data has been collected. In December 2011, 3,659 patients experienced a delayed transfer of care, a 5.6% fall on the same month last year. This he claimed suggested that additional funding provided by the Government to promote joint working between health, and social care services is having a positive impact in reducing costs to the NHS.

In response to a question from Karen Buck MP on what the change has been in the proportion of gross current social services expenditure on meals and personal social care for people aged over 65 by each local authority in the period from 2001-02 to 2010-11, Paul Burstow said that the information requested is currently being collated and will be placed in the Library as soon as it is available.

In the House of Lords Lord German asked the Government what proportion of the £648 million allocated for local authority spending on social care that also benefits health in 2011-12 was spent on (1) prevention services, (2) communicating equipment and adaptations, (3) telecare, (4) crisis response services, (5) maintaining eligibility criteria, (6) re-ablement, and (7) mental health. A reply is awaited.

Tuesday 7 February

Ann Clwyd MP received a reply from the Minister on when the Department's planned White Paper on adult social care is expected to be published. Paul Burstow acknowledged that urgent reform of the care and support system is needed to provide people with more choice and control and to reduce the insecurity that they and their families face. He added that the Government are taking decisive steps so people can plan and prepare for their care needs, access high quality care when they need it, and exercise choice and control over the care they receive. The care and support White Paper and progress report on funding reform, planned for spring 2012, will set out the Government's plans for transforming the care and support system. It remained the Government’s intention to legislate as soon as possible afterwards.

The previous week Tracey Crouch MP had asked the Communities and Local Government Minister what recent representations he had received on the role of local authorities in the reform of social care. Robert Neill said that the Secretary of State for Communities and Local Government has received no formal representations on the role of local authorities in social care reform. However, the Department for Health carried out an engagement exercise with stakeholders on priorities for reform last autumn and will publish a White Paper on the reform of adult social care in the spring. The Department for Communities and Local Government has been working closely with the Department for Health to understand the impact of social care reform on local authorities and to clarify their role in this area.

Hazel Blears MP had asked the Work and Pensions Minister what recent discussions he has had with his ministerial colleagues on planned reforms to the funding of social care. In her reply Maria Miller said that Ministers have had a number of discussions with ministerial colleagues in the Department for Health over the last year to discuss the findings of the Dilnot Commission on the funding of social care, and the forthcoming care and support White Paper.

Wednesday 8 February

Caroline Flint MP received a reply to her call to ensure that all people over 75 years old are automatically placed on the cheapest tariff by their gas and electricity supplier. Energy Minister Gregory Barker said that the Warm Home Discount scheme has been introduced to provide targeted support for low income and vulnerable households.The type of support offered and eligibility criteria for the scheme were consulted on and the final scheme has been designed to provide targeted support to those who need it most. This includes specific support for the poorest pensioners. This year alone, over 600,000 pensioners in receipt of pension credit guarantee credit only will receive the £120 core group discount. In total the scheme will assist around two million low income and vulnerable households each year. In addition, all pensioner households already receive the winter fuel payment and are among those eligible for the cold weather payment.

Dr Thérèse Coffey asked the Cabinet Office how many pensioners were employed in 2009-10 and in 2010-11. In his reply Mr Hurd said that the numbers were approximately 1.4 million for each year.

The House of Commons Health Committee published its report in social care and called for the government to press ahead with the £1bn long-term care funding reforms proposed by the Dilnot Commission. The committee also claimed cuts in support are driving increased demands on the NHS as they called for an overhaul of the way the system is run. In its report the cross-party group of MP recommended that elderly care, health and housing services are joined up to stop patients being "passed like a parcel" from one service to another. The MPs suggested that failure to link up commissioning and provision across the services leads to more hospital admissions, later discharge and poorer outcomes.

Pensions Minister Steve Webb said that over one million pensioners who may be entitled to Pension Credit should check if they are missing out on extra cash. Up to £2.93 billion of Pension Credit goes unclaimed every year and as many as 1.6 million people could be entitled to this money. He added that if average temperatures are recorded as or forecast to be zero degrees Celsius or below over seven consecutive days, then people who get Pension Credit are automatically entitled to a Cold Weather Payment. The Government had made over three million Cold Weather Payments so far this winter.

Dr Huppert asked the Secretary of State for Health how much funding was provided for medical research into dementia in (a) 2008-09, (b) 2009-10 and (c) 2010-11; and what proportion of the health research budget this represented in each year. Simon Burns responded by stressing that dementia is a research priority for the Government. Through the National Institute for Health Research and the Policy Research Programme, the Department funds a wide range of research on dementia including research on causes, diagnosis, treatment, and organisation and delivery of health and social care services. The proportion of the Department's central research and development revenue budgets spent on dementia research in 2008-09 was £18.4m (2.2%), in 2009-10 £12.7m (1.4%) and in 2010-11 £18.6m (1.9%).

Questions tabled for answer at Health Orals on 22 February included one from Lorely Burt MP who asked what steps the Department of Health is taking to improve the standard of dementia care in hospitals. In addition David Crausby MP asked what recent assessment has been made of the quality of services for older people.

The House of Commons is now in recess and returns on 20 February.

Westminster Eye: An insight into the week of politics 23 - 27 January

Monday 23 January

Gareth Thomas MP received a reply to his question to the Cabinet Office on how many charities have closed or de-registered with the Charity Commission since May 2010. Minister Nick Hurd replied saying that 13,517 charities have been removed from the Register of Charities since 1 May 2010. He explained that charities are removed from the register for a variety of reasons. For example, a charity may have ceased to exist or operate, or may have merged, incorporated or transferred its funds to another charity.

Chris Skidmore MP asked the Department of Health in what proportion of finished admission episodes the patient was over (a) 65, (b) 80 and (c) 90 years in each of the last five years for which figures are available. On the same day Jim Shannon MP asked what guidelines the Health Minister had issued to care homes on the prevention, treatment and care of fractures resulting from falls by people with osteoporosis. Replies are awaited.

Dr Julian Huppert MP asked the Secretary of State for Business, Innovation and Skills how much the (a) Medical Research Council and (b) Engineering and Physical Sciences Research Council spent on dementia research in 2010-11. In responding David Willetts said that the Medical Research Council spent £15.6 million in 2009/10. Precise figures for MRC expenditure in 2010/11 are not yet available. The Engineering and Physical Sciences Research Council estimate that they spent £3.5 million in 2010/11.

Caroline Dinenage MP asked what information the Department of Health has received from primary care trusts on plans for spending the 2011/12 NHS social care allocation; which services the money has been allocated to; and what proportion of the money is expected to be spent on older people. She also asked what estimate the Department has made of the difference between the number of people eligible for social care support in England and those receiving formal support from public or private sector agencies. A reply is awaited.

Hilary Benn MP asked the Secretary of State for Work and Pensions how many and what proportion of all adults potentially eligible for council tax benefit are pensioners in each local authority in England. Pensions Minister Steve Webb said that the number of pensioners who were entitled to council tax benefit in Great Britain, 2008/09, was between 3,950,000 and 4,490,000 which is equivalent to between 50% and 63% of the entire population entitled to council tax benefit. For context, the take-up rates of pensioners in 2008-09 were lower than non-pensioners for council tax benefit: pensioners had a take-up rate of between 56% and 64% while non-pensioners had a take-up rate of between 72% and 81%.

Tuesday 24 January

The Commons Health Committee published its highly anticipated report regarding public expenditure.

The Committee said that health and social care must be seen as two aspects of the same service and planned together in every area for there to be any chance of a high quality and efficient service being provided which meets the needs of the local population within the funding available. Best practice should be rolled out across the Health Service and underperforming commissioners held to account.

The report suggested that precious little evidence of the urgency which it believes this issue demands—on both quality and efficiency grounds. It is a question to which the Committee will return in its Report on Social Care.

The report noted that the Audit Commission argued that a key factor in progress towards joint commissioning is the quality of existing relationships on the ground. The Committee was concerned that NHS organisations are giving highest priority to achieving short-term savings which allow them to meet their financial objectives now, at the expense of planning service changes which would allow them to meet their financial and quality objectives in later years.

The report continued that the Nicholson Challenge can only be achieved through a wide process of service redesign on both a small and large scale. These changes should not be deferred until later in the Spending Review period: they must happen early in the process if they are to release the recurring savings that will be vital in meeting the challenge. In the meantime, the Committee was concerned that savings are being made through “salami-slicing” existing processes instead of rethinking and redesigning the way services are delivered.

The overall picture is of a service that is continuing to function by restricting eligibility, by making greater savings on other local authority functions and by forcing down the price it pays to contractors. The scope for further efficiencies is severely limited. The Government’s response to Dilnot’s proposals should set out how a sustainably funded system will continue into the future. The challenge is to continue to provide a meaningful service until a new system is in place.

In spite of Government assurances, local authorities are raising eligibility criteria in order to maintain social care services to those in greatest need. The Committee reported that it was It is deeply concerning that £116m of the £648m intended to be spent through the NHS on improving the interface between health and social care is being spent on sustaining existing eligibility criteria. This suggests that this money (which was intended to support greater integration of services) is in fact being used to maintain the existing system. To the extent that this is true it is a lost opportunity to promote the necessary process of service integration.

ADASS found that 82% of councils are only providing care to those whose needs are assessed as significant or higher. The Department of Health said that the settlement was intended to “hold the position steady” until a new funding system for social care was developed. The tightening of eligibility criteria shows that the settlement is not sufficient to achieve this. Early reports from the Health Service are that the transfer of money from the NHS to be spent on social care has been effective. This is important but the fact remains that it represents just 1% of annual funding for the NHS. There is scope to extend transfers of this kind. The Department of Health should urgently investigate the practicalities of greater passporting of NHS funding to social care.

The Committee’s report into its inquiry into social care is expected in the first week of February.

Paul Maynard MP asked what proportion of gross national income is spent on services for the elderly. A reply is expected shortly.

Wednesday 25 January

Andrew Jones MP asked the Secretary of State for Work and Pensions how much was paid to pensioners as a result of the increase in cold weather payments in winter 2010-11. Steve Webb replied that during the 2010/11 winter season, it is estimated that cold weather payments amounting to £264.4 million was awarded to pensioners. This has been presented in the Autumn 2011 Statement of 29 November 2011.

Gareth Thomas MP received reply from Simon Burns on his question on the steps his Department is taking to measure progress on the implementation of policies supporting the big society initiative. Simon Burns said that the Department of Health encourages and supports the big society agenda. In health care, public health and social care, the big society vision has driven our work to help people take control over their lives, the services they use and communities they live in. He added that the Government is embedding this new approach throughout our proposed health and social care reforms. The vision set out for the national health service, social care and public health puts patients, service users and carers at the heart of services they use and in control of what they access-"no decision about me without me". This is well aligned with a big society approach. He concluded by saying that over the coming years the Department will continue to have a strategic role in the design of the new health and care system. It will be a key shaper and architect and as such will ensure that strategies and policies keep people at the forefront of all that they did, working together with partners and stakeholders to achieve better experiences for all those who interact with the health and care system and help to grow the big society.

Thursday 26 January

Tim Farron MP asked the Department of Health what assessment had been made of the effect of the social care system on the financial sustainability of the NHS and what assessment had been made of the prospects for using increased resources for social care to reduce avoidable emergency admissions and NHS costs. He also asked the Chancellor what discussions he has had with the Secretary of State for (a) Health, (b) Communities and Local Government and (c) Work and Pensions on the potential for reform of the funding of social care to result in savings to the public purse across Government. Replies are awaited.

Hazel Blears MP asked a series of questions of the Departments of Health and Work and Pensions on what discussions they had held with other Departments on planned reforms to the funding of social care the uses of funding allocated to social services.

Hilary Benn MP also asked a series of older people related questions. He asked what estimate had been made of expenditure by each local authority (a) overall and (b) per head of population on social care in each of the last ten years. He also asked about spending on Meal on Wheels by each local authority (a) overall and (b) per head of population on Meals on Wheels for pensioners in each of the last ten years and what the average charge was for meals on wheels services in each local authority area in each of the last ten years. Replies are awaited.

Friday 27 January

The Department of Health published its monthly delayed transfers of care figures for December 2011. These showed a decline in both in the number of individual delays and the overall numbers of days compared to the previous month. This was said to be down to usual seasonal variations that occur at Christmas and New Year.