Tag Archives: NHS

NHS reform – impact on social care

Andrew Lansley’s much-vaunted white paper on the future of the NHS was published yesterday afternoon, promising widespread reform, including the abolition of PCTs and SHAs and giving commissioning power to GP consortiums. But what will it mean for social care? Here are a few of my initial thoughts.

Firstly, there are concerns that the reforms focus on general services and that people with learning disabilities, mental health problems and dementia have been largely ignored – this came through strongly on Twitter yesterday, from what I saw.

To test this, I did a quick word search of the white paper to gauge how many times certain phrases were mentioned; mental health is mentioned 8 times in the 61-page document, Alzheimers or dementia receives one mention [as @seetheperson pointed out to me], and learning disability – or learning disabilities – never crops up.

To me, this is shocking. Considering that people with learning disabilities, dementia and mental health issues make up a significant chunk of those that use NHS services, the lack of attention given to them is a worrying omission.

Specialist services are often a lifeline or those who use them and an acknowledgement of this – and preferably a commitment to give them at least some degree of protection – would have been reassuring to the many service users who are already distinctly nervous about what government cuts will mean for services.

Hopefully the government is planning for learning disability and mental health services separately…

Also, do GPs, who will now have power over which services are commissioned in their area, have the specialist knowledge that is often required in MH/LD to be able to give an authoritative view on what sorts of services are needed? Mental health charity Mind’s chief executive Paul Farmer has already questioned this and called on them to talk to experts and “tap in to the personal knowledge of patients and mental health charities about what works.” 

There is also cynicism over whether GP commissioning will work from some within the profession. For example, the GP for hire blog gives a distinctly lukewarm reaction to the proposals, saying it will put more pressure on salaried and locum GPs, and could lead to divided interests for those doctors involved on a consortium.

Also, will GP consortiums not exacerbate the postcode lottery, which was supposed to be got rid of? If commissioning a service depends on the decision of the GP consortium – a group of individuals with their own opinions – surely there is the risk that one consortium would approve it, but the one next door would not.

It hardly improves patient choice if they find that their needs are rejected in one area but available in another.

But there were some good points in the white paper. For instance, it talks of promoting the joining-up of health and social care services and promoting preventative action. I can’t argue with that principle – health and social care are closely linked, so that is a no-brainer and could help to reduce duplication of information and bring about efficiencies. Also, preventative action is generally accepted to reduce the need for costlier, more complex services down the line.

The white paper also says that the government’s vision for adult social care will be outlined later this year, and indicate that it will be a continuation of the current personalisation drive towards choice and control for service users. A white paper will follow next year. Nothing new there, but it is good to have the timeline in place.

In conclusion, the government’s reforms are certainly ambitious, but they are also risky. Social policy think-tank Civitas has warned that considerable resources will be needed to enact the restructuring – I’m not sure how that sits with the aim of saving £20 billion by 2014 – and if it is got wrong it could lead to a dip in the NHS’ performance for at least a year.

That will be the acid test of these reforms – will it make services better for service users? I’m sceptical, but only time will tell, as ever with any reforms.

This white paper provides so many points for discussion so it is more than likely that I will blog on aspects of it again later in the week.

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Would increasing NHS spending cut social care services?

Interesting stuff from shadow health secretary Andy Burnham today, as reported in the Guardian, who claims that increasing NHS spending could adversely affect social care provision.

Burnham objects to the government’s commitment to increase NHS spending in real terms year on year; “If they persist with this councils will tighten their eligibility criteria even further for social care. There will be barely nothing left in some parts of the country, and individuals will be digging ever deeper into their own pockets for social care support,” the Guardian reports him as saying.

As a cynical journo, my instant reaction is this is just a way of scoring a few cheap political points before the emergency Budget next Tuesday. And it probably is – but he does make a couple of salient points nevertheless.

It has struck me as odd that the only department with a guarantee of an increase in spending – amid swingeing cuts for everyone else – is health, especially at a time when the NHS is performing relatively well – if you take meeting the majority of targets as ‘well’. It smacked of a sop to the electorate – increasing health spending is always a vote winner.

Also, while there is nothing to say that the increase in NHS spending will come from the social care budget, there is nevertheless an element of robbing Peter to pay Paul with the Conservative commitment too – its reasonable to assume that increases in one department will mean that others gets cut. There are no spending commitments for social care (that I know of), so cuts in this area would seem inevitable.

Burnham also notes that putting the NHS in a stronger financial position to social care would make joint working – the current prevailing trend – harder to achieve.

Also, cutting social care could increase the burden on the NHS if more people end up in hospital due to falls etc due to struggling without care services they need because they cannot afford them. They could stay there longer if there is not the social care provision – meals on wheels, housing, care services etc – to support them in the community on release.

But whatever happens in next week’s Budget, it would seem the future for social care is an austere one; at a local level, there are already news stories of cutbacks in services, or charges for them increasing. To pick one example at random, here is a story from the online version of the Northampton Chronicle & Echo about county council proposals – currently out to public consultation – to raise £600,000 by increasing the cost of social care services.

Northampton County Council justifies this plan by saying that without the increase in charges, services would have to be cut.

This is a situation repeated across the country. It would seem that social care providers and service users are going to have to do more with less. How the government – and local authorities – will deal with this will be interesting to see. All should become clear in the coming weeks.

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General election: let battle commence on social care

Finally, one of the worst-kept secrets in the country is officially announced; the general election will be on May 6.

It has been said by many that adult social care will be one of the crucial points on which the election is fought. If so, this can only be a good thing, but only if the public know exactly what they will be voting for and currently, they don’t.

We know Labour’s plans for the future of adult social care; they were in last week’s White Paper. They have outlined plans for a National Care Service, along the lines of the NHS. How it would be paid for is still unclear – but don’t let practical details get in the way of a good policy.

But as for the other main 2 parties – and, in the interests of balance, all the minority parties as well – we know that they don’t think much of Labour’s ideas, but other than that, we know very little about their plans.

The Conservatives have been plugging away with its £8,000 voluntary insurance scheme for paying for elderly care. However, those in the know in the sector don’t believe that this will come up with enough to cover the costs. The Tories disagree. Other than that, we know they favour telecare and a national system of assessment and eligibility for care, and that’s about it.

Meanwhile, the Liberal Democrats want to find cross-party consensus on the way forward in social care, as was being discussed in secret by health ministers earlier this year before Andrew Landsley blew the lid on the meetings. They also want yet another commission to investigate possible ways forward, and have said they would spend £420 million to give carer’s an extra week’s respite – as long as they care for more than 50 hours per week.

I haven’t heard much from any of the minority parties on social care – if anybody knows more, please leave a comment below.

But all this shows that we do not have a full debate on social care – that can only be achieved when others announce their policies and can be analysed objectively against the others.

That is the challenge now for the Conservatives and Liberals – show us your plans and let us decide which way forward is the best for social care.

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Improving dementia services will take time

When the National Dementia Strategy was launched amid much fanfare last February, the government said that dementia would become a priority and services would be improved. But nearly a year on, the rhetoric hasn’t been backed up by enough action, according to the National Audit Office.

In its interim report on improving dementia services in England the NAO was heavily critical of the implementation of the strategy – or lack of it.

Amyas Morse, head of the NAO, said; “At the moment this strategy lacks the mechanisms needed to bring about large scale improvements and without these mechanisms it is unlikely that the intended and much needed transformation of services will be delivered within the strategy’s 5-year timeframe.”

However, some feel that the NAO has jumped the gun with its criticism. For instance, Martin Green, chief executive of the English Community Care Association, called the report “somewhat premature”. He believes that while there is a lot more to be done to improve services, “the development of the strategy and the achievements so far represent a significant improvement in raising the profile of dementia services and giving some clear direction for the future of care and support.”

Green does have a point; it needs to be recognised that it takes time – especially in local authorities and the NHS – for change to happen. For instance, one of the main aims of the strategy is to give basic training in dementia to every health professional that comes into contact with someone with the condition. It takes time to set a project like that up and then complete it.

It is a 5-year strategy and shouldn’t be judged too harshly yet. But nevertheless the NAO’s report should serve as a kick up the behind for government, local authorities and the NHS to ensure that they do implement measures to improve dementia services or at least start putting the mechanisms in place to do so.

This agenda is evidently not going to be forgotten about, and organisations such as the NAO won’t be afraid to criticise if they see things aren’t going as well as they should be. This should ensure that the Dementia Strategy isn’t quietly swept under the carpet by the bodies involved – possibly tempting given the swingeing public sector funding cuts coming – and do, in time, deliver the standards of services required.

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More work needed to raise social care standards

While the Care Quality Commission has tried its best to get a positive spin on the findings in its review of adult social care services  published today, as ever, most people and the media have focused on the negative aspects of it. And they’re right to.

Despite the overall quality of services improving in the past year in all areas, there is still a significant minority of ‘poor’ and ‘adequate’ services being provided to adults and especially older people.

Poor services are always unacceptable and need to be rooted out or given help to improve. Reports like these highlight them, but it means nothing if it doesn’t help to bring about change.

To this end, the CQC’s chief executive, Dame Cynthia Bower, said the CQC is determined to raise standards, hence why 8 councils have been designated as ‘priority for improvement’ councils and another 16 are to have an in-depth inspection of their services.

Elsewhere, the new registration system for adult social care providers, NHS providers and independent healthcare will have a single set of safety and quality standards. Also, the CQC is to get tougher powers and will be able to respond to concerns more quickly.

But local councils also have a role to play in improving services, especially commissioners; they need to look at the services they are purchasing and, if they are failing, move elsewhere. Obvious perhaps, but still needs to be said because it seems some commissioners don’t do this.

Unfortunately, this may be easier said than done. While eligibility criteria for receiving social care remained largely constant in the past year, after the previous 2 years when the number of councils providing care for ‘moderate’ or ‘low’ needs fell markedly, the spectre of eligibility levels being raised again in the coming years because of dwindling budgets looms large.

With budgets being squeezed, commissioners may feel under pressure to look at the cost of services rather than the quality. By the same token, service providers may also be under financial pressure and be looking to make cutbacks, which could affect the quality of their services.

So, in essence, the CQC’s reports are positive – let’s not forget standards are improving – but they show how much work still needs to be done. But by acknowledging this, and laying out strategies to help, the next report should be more positive still. As long as budget considerations don’t impact too much, that is.

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Critics condemn planned cuts to fund free social care plan

Another day, another political row about the government’s free social care at home for the elderly plan. Today, it’s how the plan is being funded.

While the government has been criticised for thus far being oblique about where the money will come from to fund the plan – they estimate it will cost £670 million per year, but others think it will be much higher – now they are starting to say where money will come from, they are garnering more criticism.

Health minister Andy Burnham, as reported in today’s Times on the eve of the publication of the Social Care Bill, says that “£60 million would be diverted from the health service’s research and development budget and £50 million from public health promotions.”

Inevitably, scientists have warned against cutting research budgets. The current research budget is more than £1 billion per year, so that cut is hardly a drop in the ocean.

Research is key for the future of healthcare and should be considered an investment – having drugs that cure is cheaper than the cost of lengthy treatment – and cuts should be avoided if possible.

However, the money will have to come from somewhere – if the Bill actually gets passed before the election, which is not guaranteed – and tough decisions will have to be made about which budgets get cut. It’s what we have government for; they make the hard decisions so we don’t have to.

It could be that funds are found from elsewhere. For example, a productivity drive in the NHS is expected to make up to £20 billion in efficiency savings in the next 4 years, which would more than pay for the Bill.

But wherever cuts come from to fund the free personal care plan, someone is going to be left unhappy. Well, almost; nobody has criticised the plan to save £60 million by cutting down on management consultants. Strange, that.

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Queen’s Speech not enough for social care bodies

While the announcement of free personal domiciliary care for those with the greatest need was a central point of today’s Queen’s Speech, finding anyone with a positive outlook on it is difficult.

The combined weight of anti-government feeling and deep-rooted cynicism in the care sector means that the policy has been given a lukewarm response at best.

Critics cite a number of problems that haven’t been properly answered. For example, many question the costs involved; it is said to cost £670 million a year, but nobody seems to believe that. Also everyone wonders where the money for that is coming from – woolly references to ‘costs savings elsewhere in the NHS’ don’t cut it. Some also suspect councils will start to get tougher on what exactly constitutes ‘substantial and critical’ needs in a bid to save money.

It also doesn’t address the media’s perennial favourite topic of people having to sell their homes to pay for residential care. Health minister Andy Burnham admitted on Radio 5Live this morning that when someone needs to move into residential care, they will have to pay for that as they would within the current system.

It is, as Labour admits, an interim measure before the full adult social care white paper is published – but no-one quite knows when that will be, or indeed if it will get published.

The cynic in me wonders if this is just an early bit of electioneering, attempting to embarrass the Conservatives if they decided to ditch the policy, and painting Labour as a ‘caring’ party.

Indeed, whatever the pluses and minuses of this policy, it is still unlikely to make it onto the statute book before the election comes – there are only 70 working days left before the election and Tory peers have vowed to hold up legislation in the House of Lords, if it gets there.

While the idea is good – it could help 400,000 people – it does not solve the social care problem, and this seems to be one of the big criticisms. Social care needs a radical overhaul, and this only goes a relatively small part of the way. The next government – whichever party it is – needs to go much further.

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