Who said this about #socialcare and the #Dilnot commission?

Who said this about social care and the Dilnot Commission?

Urgent reform of the social care system is needed and the Government have made clear their commitment and determination to reach a fair and enduring settlement for the system for generations to come. We want a sustainable adult social care system that gives people the support and freedom to lead the life they choose, with dignity…

This will be [achieved] with legislation to establish a sustainable legal and financial framework for adult social care in this Parliament.

Yep (column 11WS).


HealthWatch: Good in principle, worrying in practice

This was posted as a guest blog on the always insightful Health Policy Insight, run by the always amusing (in a good way) @HPIAndyCowper, who has kindly allowed me to re-post it here.

Criticisms of the reforms of the health system have focused primarily on shifting £80bn of public expenditure to GP commissioning consortia.

Much less attention has been paid to the issue of patient/user voice and representation in the reformed system, something this post aims to address (building on two posts at the time of the White Paper, here and here and one just before the Health & Social Care Bill was published).

The White Paper contained proposals for the creation of both HealthWatch England and local HealthWatch – building on the work of existing Local Involvement Networks (LINks) – in each upper-tier local authority area.

Local HealthWatch will essentially be the local “consumer champion” for health and social care users, promoting choice and control, influencing the shape of services, and highlighting issues in service delivery, including through advocacy.

HealthWatch England will provide support to local HealthWatch and synthesise the issues they highlight at the national level, working with the NHS Commissioning Board and the Care Quality Commission.

In principle, the introduction of HealthWatch based on the work of LINks is a good idea (though there is a question over how effective LINks have been); what’s more, there is “extra” money being made available for both local HealthWatch and HealthWatch England to carry out their roles.

In practice, however, there are 3 significant areas of worry about HealthWatch arising from the Next Steps consultation response and the Health & Social Care Bill and its associated Impact Assessment.

The first is money. Though there will be “extra” money for local HealthWatch, this is being taken from existing services.

In 2009/10, £27m was allocated for LINks. For local HW, the funding that was used to fund the Independent Complaints Advocacy Service (£11.7m) and PALS (£19.3m) is being handed to local authorities to commission local HW, meaning there will be £59.1m in 2010/11.

HW England will also have £3.5m of its own funding (figures from Impact Assessment, para D42).

But the major issue – and the number one risk identified by the DH itself – is that this money won’t be ringfenced. Instead, since the money will be allocated to local authorities under normal LA funding arrangements, Councils can choose how to spend it.

In 2009/10, although £27m was allocated for LINks, Councils only spent £24.3m of it on LINks – they effectively creamskimmed 9% off the budget. There is no guarantee they won’t do the same for local HW.

The second issue is independence. Local HW will be “contracted by and accountable to Local Authorities” (Impact Assessment, para D34). This does not make them independent in principle; nor, potentially, in practice.

More worrying is that HW England will only be a statutory committee of the CQC. Despite the Next Steps consultation response suggesting this means HW England would be “independent” (para 2.59), the Impact Assessment formally recognises (para D24) that

setting up HealthWatch as a statutory committee of CQC [means] it would not be formally independent of the NHS and social care system.

Furthermore, HW England’s funding will need to “maximise synergies” with roles within CQC (para D28) to ensure its funding of £3.5m goes as far as possible. No “independent” committee should have to rely to this extent on staff within its host body.

Even more significantly, the Chair of the Committee will be appointed by the Secretary of State (Next Steps, para 2.59). The Health & Social Bill also stipulates that some members of the Committee will be appointed and others elected (Impact Assessment, para D27), but with no details about the blend of appointed and elected members or the process for elections (D26) – this is to follow in further regulations.

None of this sounds particularly independent, and there have to be worries about how this will operate in practice. Anyone who knows how the statutory disability committee within the EHRC has operated in practice – a very similar set up to that proposed for HW England within CQC – will rightly be concerned.

The final issue is advocacy, particularly complaints advocacy, in which confusion reigns. Next Steps suggests (para 2.43) that local HW should have a role in NHS complaints advocacy, but that Local Authorities will now be responsible for commissioning it and that this may or may not be through local HW.

Conversely, the policy summary signed by Andrew Lansley as part of the Impact Assessment says that HW will bring together patient voice and complaints advocacy. It won’t – especially since advocacy in social care is not mentioned a single time anywhere in documents relating to the Health & Social Care Bill.

Unlike much of the rest of the proposed health reforms, the suggestions for HealthWatch were actually quite good in principle.

In practice, significant questions about money, independence and advocacy as one of the new, key functions of HW means the end position for HealthWatch is much the same as everything else associated with Lansley’s reforms.

Reflecting on HealthWatch in the Health White Paper melee (updated)

Whilst the pandemonium about various changes proposed by the Health White Paper continue (rightly so, by the way), the issue of patient and user voice remains as high up the agenda as it usually does.

That is, not at all.

I’ve focused on this area in two previous posts – one on patient voice in the White Paper and another on the question of democratic accountability.

I have to confess I’ve not had chance to read the government’s response to the White Paper consultation (“Next Steps“) and what it says or updates about HealthWatch (HW). As far as I can tell, it’s strengthened issues around advocacy (particularly by saying advocacy services can still be contracted for directly by LAs, rather than sitting within HWs), strengthened HW representation on Public Health and Wellbeing Boards, and generally reduced the need for overview and scrutiny.

Of course, I’ll blog on what Next Steps actually says about HW when I’ve read it.

But in the meantime, today saw an event in the area I work on the establishment of a local HW. Here are some quick and dirty observations of the day:

  • The level of understanding of what the Health White Paper is seeking to achieve is low
  • The level of understanding of what HW England and the local HW will do is low
  • The level of understanding of the relationship between HW England and the local HW is low
  • There is a significant divorce between health and social care in the views of service user “representatives”
  • “Entrenched interests” doesn’t come anywhere near explaining the problems facing commissioners of local HW over the next few months
  • If today was anything to go by, the profile of people directly engaged as “representatives” and volunteers in LINks at the moment can be summed up in two words: (1) old; and (2) white
  • Partnership working between organisations who are or will be relevant to the local HW feels a long way off
  • For areas where there are unitary and county councils close together, the question of whether there is a joint Health and Wellbeing Board across all of them or a separate one for each is a very, very thorny one
  • This said, the question of whether there is one local HW per council or a local HW operating across several is a bit easier – it’s only a very thorny question and not a very, very thorny one
  • No one knows what money will be available to commission the local HW, or whether it will be ring-fenced. I’m guessing not, since it will sit in LA budgets. (As a comparison, in 2009/10, the DH awarded £24.3m across all 150 LINks.)

This may all sound like doom and gloom, and at least in that regard it’s similar to most other proposals in the Health White Paper.

But it’s not.

All the government needs to do is create some clarity soon on the topic of HW England and local HW in order to allow commissioners to demonstrate the local leadership they are hugely capable of.

Next week’s Health and Social Care Bill may give us this, so amid the tumult of discussion about the big ticket items, remember to keep an eye out for what the Bill says on HealthWatch.

Update: Of course, I forgot to mention whether social media was mentioned as a means of engagement for HW. Apart from the most cursory of mentions – a gesture towards Facebook – it wasn’t. A few of the kool kids at the back of the room whispered about it away from the more vocal participants in the day, but it was a useful reminder of how little wider awareness social media there is amongst parts of the population and as part of the debate/solution to engagement.

It would be great to have the opportunity to change that.

More positively, there seems to be some excellent LINks work at the moment on Twitter – see this list from LINk East Sussex and this nicely chirpy stream from Somerset LINk.

Andrew Lansley’s losing gamble

I’ve just caught up with this excellent editorial from the Observer on the government’s NHS gamble:

David Cameron learned in opposition that voters are not easily persuaded to trust the Conservative party with the NHS. So he came into government with two pledges aimed at allaying suspicion: spending on healthcare would be protected and there would be no scary meddling with the service. He is in danger of failing on both counts.

The interesting part is the personal nature of the editorial concerning Andrew Lansley:

[T]he personal ambitions of the health secretary are also key. Mr Lansley is a senior figure in the party and was once Mr Cameron’s boss at Tory HQ. He held his current portfolio for six years in opposition, time to develop a grand project that would be his political legacy. Noting that cabinet colleagues are implementing ambitious plans for education, welfare and justice, Mr Lansley is determined to do the same at the Department of Health. But his vision evolved under different economic circumstances, when no one envisaged the austerity now being inflicted on public services. The NHS, more than any institution, needs cautious navigation through the new fiscal landscape. Mr Lansley’s refusal to moderate his plans accordingly suggests stubbornness and pride are trumping political judgment.

Back in July we noted that Lansley had the “winning combination” of

arrogance, ignorance and power.

Of course, we were being flippant. What we joked was Lansley’s winning combination has turned out to be Lansley’s losing gamble.

It’s just a shame that the NHS and its patients will pay for his bet.

Andrew Lansley on the value of disability benefits

People use the attendance allowance and disability living allowance to help them, under their own control, to create a quality of life for themselves that helps them to remain independent. That is precisely in line with the policy we are all trying to pursue. It is clear that if one narrowly focuses only on care needs, we will miss out much that goes to constitute well-being, and there is no health without well-being, and there is no independence, without sustaining people’s quality of life.

That was Andrew Lansley, speaking in parliament during an opposition day debate on the topic of disability benefits for older people.

He was right then. I wonder if he disagrees with what his colleagues – now in government – are thinking of doing now?

Previous Tory views on disability benefits

The government yesterday launched its consultation on reforms to Disability Living Allowance. I blogged extensively on it yesterday.

One of the huge – and, as far as I can see, new – announcements was that the government is considering rolling out the cuts to DLA not just to the 1.8m of working age in receipt of DLA, but also those under 16 and those over 65.

Given this, I thought it was timely to recall some recent history.

As part of their Green and White Papers on adult social care, Labour suggested using £100m of the Attendance Allowance budget to help pay for the National Care Service. (To put that figure in context, the Attendance Allowance budget for 2009/10 was £7.505bn.)

In response to the potential idea (contained in the Green Paper), Andrew Lansley and Theresa May said this, launching a “campaign to protect Britain’s pensioners”:

Shadow Work and Pensions Secretary Theresa May and Shadow Health Secretary Andrew Lansley today pledged that the Conservatives would campaign to Protect Britain’s Pensioners against Gordon Brown’s plan to scrap the Disability Living Allowance and the Attendance Allowance…

Andrew Lansley said: “As ever with Gordon Brown you have to look at the small print. In order to set up a new National Care Service he is planning to take away vital benefits from the elderly and disabled… We don’t yet know what the Government’s plan for a National Care Service would really involve, but let me make it clear – it must not be funded by snatching benefits back from 2.4 million vulnerable pensioners.

“My pledge to you today is that we will Protect Britain’s Pensioners and fight against Gordon Brown’s plan to scrap benefits for the disabled.”

Theresa May added: “Labour has chosen to penalise one of the most vulnerable groups in our society for the sake of another eye catching announcement. As with every Labour initiative, someone has to pay and, as with many of them, it is the least able who are to be forced to do so.

“These benefits are a vital support for disabled pensioners and give them the chance to have an independent life with the freedom to tailor their care to their needs.

In his own Invitation to disabled people, David Cameron promised the Tories would be:

Protecting key benefits: the Winter Fuel Allowance, free bus passes, free TV licences and the pension credit. And unlike Labour, we will not scrap Attendance Allowance or Disability Living Allowance for the over 65s.

Speaking in an opposition day debate in parliament on the topic of DLA and AA, the then Shadow Disability Minister Mark Harper MP:

criticised the proposals for taking away the “control and independence” that these benefits gives older disabled people. “This is a step backwards and I hope the 39 Labour MPs who’ve already signed the motion will vote to protect the benefits so valued by older disabled people”, he said.

Finally, Andrew Lansley cited approvingly the following early day motion at the start of an opposition day debate on disability benefits for older people:

That this House recognises the vital support that attendance allowance and disability living allowance provide for people with disabilities; notes that these benefits are intended to meet the additional costs of living with an impairment or long-term health condition; further notes with concern that approximately 2.87 million people in the UK who receive disability living allowance or attendance allowance are not eligible for social care services; acknowledges that some 20,000 individuals have petitioned the Prime Minister and many more have petitioned individual hon. and right hon. Members to ensure that these benefits are secured; welcomes the Government’s announcement that disability living allowance for people under 65 years will not be scrapped; and urges the Government to ensure that attendance allowance and disability living allowance for people aged 65 years and over are secured and not abolished as part of any future reform of the social care system.

I just thought you’d like to know.

Lansley “acting quickly” on social care

Andrew Lansley announced the formation of the Commission on the Funding of Care and Support on 20 July.

At the time, he said he wanted the Commission to “act quickly” and report back to government within two months on the criteria it intends to use to judge competing proposals for reform.

That means we can expect the criteria on Monday.

Since the launch – some 57 days ago – the Commission’s website has had, erm, 0 updates. The only news item (as of today) is the launch press release, and the blogs page still says:

Content will be updated shortly.

It’s not as if there isn’t already a significant body of literature the Commission could make passing reference to in the most cursory of press releases or sharing of information on their website. There were 3 significant reports on social care in March, those already building on a Green Paper, a discussion paper and several independent reviews of social care.

Is this what Lansley had in mind when he wanted the Commission to “act quickly”?

Andrew Lansley: taking us for mugs

DH statement, 29 August 2010:

NHS 111 telephone number will eventually replace NHS Direct when it is rolled out nationally

Andrew Lansley letter, 9 September 2010 (copy of letter available here):

I have not announced plans to scrap NHS Direct

This is sophistry born of arrogance, ignorance and power. Lansley is taking us all for mugs, and we should be absolutely plain that we won’t stand for it.

The non-top down, top down approach

Ah, yes. The “Non-top down, top down approach”, also known as the “Free from political interference” initiative (Copyright – Andrew Lansley).

Andrew Lansley, 2 June 2010 (and many other places besides):

What we need to achieve [is] a change from a command-and-control, top-down system of running our schools, hospitals, health care and social care services.

Health news announcement, 27 July 2010:

Cancer patients denied new treatments because they are too expensive will now be able to appeal to a £50m government fund to pay for their drugs[.] Although the fund will pay for treatments that have been rejected as not cost-effective by Nice, ministers claimed they were not “undermining” the watchdog.

Lansley’s crusade

We noted at the end of last week that Andrew Lansley is going to ask companies to pay for advertising campaigns encouraging people not to buy their products. In return, he’ll put in place a “non-regulatory approach” to food standards.

Taking things to their logical conclusion, there are reports that Lansley is now going to scrap the Food Standards Agency, and with it

its responsibilities for nutrition and diet advice.

Others have accused Lansley of being the spokesman for the British Medical Association (see here for a round up).

I think this is unfair.

It doesn’t give enough weight to his role as unofficial spokesman and main cheerleader for the food industry lobby.