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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!

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.

Westminster Eye: An insight into the week of politics 13 February - 17 February

This week at Westminster was quieter than normal as the Commons was in recess, but there were still some newsworthy items.

13 February

At the beginning of the week Lord Harrison asked the Government what action it is taking to mark the 2012 European Year for Active Aging. A response is awaited.

Caroline Flint MP, Labour's Shadow Energy and Climate Change Secretary, followed up on her Commons question regarding energy tariff for older people. On responding to reports that the number of pensioners dying from hypothermia has doubled in five years, said: "The energy market has to be made to work better for pensioners and other customers. Complicated tariffs mean too many are overpaying for gas and electricity. That's why Labour has proposed a simple rule for the energy companies - that pensioners over seventy-five be given the lowest tariff on offer, and guaranteed by law if necessary. And to ensure a fair deal for all consumers, we need to open up the energy companies' books so people can see for themselves at what price they buy and sell energy."

14 February

Baroness Bakewell proposed an amendment to the Social Care bill which would lead to the creation of a commissioner for older people. 

"The Commissioner be a single, sympathetic individual, able to speak up directly for the old themselves. They would ideally have a background in caring, and be conspicuously on the side of the old, speaking "for us" to those with the power and money to do something to improve the situation for millions of older people"

Baroness Bakewell

15 February

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.

Earl Howe, the Parliamentary Under-Secretary of State, Department of Health said that the department collected information from primary care trusts in September 2011 to understand how the £648 million transfer was progressing and on which services it was being used. The information suggests that the money is being used on a wide range of services. He added that a full breakdown of this can be found in the National Health Service publication The Quarter: Quarter 2.

The House of Commons is now in recess and returns on 20 February. Health Orals is due to take place on Tuesday 21 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.

Local councils that cut social care will only push up costs in longer term

WRVS today responded to the House of Commons Health Select Committee report’s conclusions that a funding gap remains for providing social care.

The evidence is clear that if local councils do choose to move more older people out of social care support in the next year they will only push up costs in the longer term.

The committee are right to commend the stronger lead that ministers have given to expand joint working between the health service and local government and WRVS will closely monitoring how local decision makers deliver on this objective.

However, it is clear that we need real accountability at local level. We and others will also be asking ministers to report back at a national level on the picture that is emerging across the country.

Further info on the Health Select Committee here www.parliament.uk/healthcom

Social care: The crunch beckons

To be eligible or not to be eligible, that is the question

I was conducting some online research the other day about how Scottish local authorities go about offering free personal care and social care more broadly to older people. By the way, it's important to remember that those two things are not synonymous, the former is much more about the real personal stuff like hygiene, dressing and mobility whereas the latter can be about things like transport and shopping. Anyway, to cut a very long story short, basing their approach on Scottish Government (SG) guidance - newly fashioned in 2009 after lots of consultation - all local authorities use eligibility criteria to determine who gets services. Because resources are limited, those who are most at critical or substantial risk of harm are prioritised to recieve services. That might be logical and fair just now but, as WRVS has pointed out, unless we, as a society, can start to move towards preventative services which mean there are progressively less and less people at that level of risk, we're very soon going to crash mightily into the buffers of unaffordability, with casualties all round.

To be fair to both Scottish central and local government they all seem committed to the idea of 'adopting a strong preventative approach to help avoid rising levels of need' (that's a direct quite from the SG guidance) but it appears that limited resources mean, in fact, that few local authorities if any can commit to providing the extensive preventative services that they would ideally like to. Reading the local authority responses to the the 2009 consultation, some of them seem very pro-prevention indeed. Unfortunately, reviewing their eligibility criteria in 2010, these two examples illustrate the spectrum of the way they are apparently obliged to function (I will spare their blushes and let them remain anonymous):

‘The Health and Social Care Department assessment prioritises assistance to those whose needs have been assessed as being within the Critical and Substantial categories. People whose needs have been assessed in Moderate or Low categories may (my italics) receive help to maintain or develop abilities or to prevent further deterioration.’

‘LOW – you or others are at low risk of harm or loss of independence. For these needs, we will not (my italics) provide services. However, we will offer advice and information about alternative sources of support.’

Let's be clear, I'm not saying this is all local authorities' fault. What I am saying is that, sooner or later, some radical funding decisions need to be made about what money goes to which bit of the public sector and to the voluntary and private sector partners that work with it. With that in mind, here's a telling quote for you from the House of Commons Health Committee Report on NHS Continuing Care from way back in 2005:

“The question of what is health and what is social care is one to which we can find no satisfactory answer, and which our witnesses were similarly unable to explain in meaningful terms."

It only takes a little dot-joining to detect the radical solution that statement might be taken to imply but I'll let you work that one out for yourselves. Happy figuring!

Posted by Andrew Jackson