UK: Ageing Population

Debate between Baroness Bakewell and Earl Howe

Tuesday 19th March 2013 Lords Chamber

[Earl Howe]

I am sure my noble friend is right that there is a job of work to do to inform people about the new arrangements that we are bringing in to implement the Dilnot recommendations. My right honourable friend the Chancellor’s announcement at the weekend confirms that we will introduce a cap on care costs and extend the means test upper capital threshold at the earlier date than previously announced, namely on April 2016. The reason for the change in date is to bring it into line with changes to single-tier pensions. We will need to disseminate this information sooner than we would otherwise have done.

[Baroness Bakewell]

My Lords, when I was appointed the voice of older people in 2009, these issues were already well appreciated. It is now 2013. This is an excellent report from the House committee, which everyone recognises, but I am afraid that it joins many other reports on my shelf that have been published since 2009. Will the noble Earl please tell me why he thinks change is so slow?

[Earl Howe]

My Lords, change is an increasing imperative, at least in my judgment, at local level. I talk not only to professionals in the health service but to local authorities, which will very soon be charged with looking in the round at the needs of patients and service users in their area. They know that with the financial constraints that are upon us, services need to change in order to remain sustainable and affordable. That will be a very strong driver to ensure that some of these very good recommendations are driven forward at pace.

Health: Hearing Loss

Debate between Baroness Bakewell and Earl Howe

Monday 17th December 2012 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness’s comments relating to the features that can often accompany hearing loss, such as depression and other forms of mental illness, are absolutely to the point and I recognise all that she said in that area. The national screening committee had a number of reasons for feeling that a universal screening programme would not be appropriate. First, it was not clear to it what the test should be. Secondly, it was unclear about what agreed time or schedule there should be for doing the testing. Thirdly, it felt that if there were a realistic proposal for screening, there should be randomised trials of screening beforehand. However, it is reviewing its decision of three years ago and we will have to await the results of that.

[Baroness Bakewell]

My Lords, the Minister referred to the screening authority, which recommends screening for many different ailments. Is he aware that screening notification, which goes out to all eligible citizens, stops at the age of 70 whereas it is necessary to be screened for many of these ailments after 70? Indeed, when you are over 70 you need reminding more often than when you are younger.

[Earl Howe]

My Lords, that is why we are sure that it is for general practitioners to prompt their patients, when appropriate, on having an audiology assessment. The noble Baroness is right that people need prompting but there is more than one way of doing that.

Care and Support

Debate between Baroness Bakewell and Earl Howe

Wednesday 11th July 2012 Lords Chamber

[Earl Howe]

I am grateful to the noble Lord and thank him for all his work in this area over the years. However, I am sorry that he regards the glass as only being 20% full. I would regard it as much more full than that, bearing in mind the contents of the White Paper that I outlined earlier. No, we are under no illusions about the scale of the issue, its importance or the need to get it right if the NHS is not to bear the brunt of serious strain within social care. It is an urgent matter. We are determined to fill the glass to its fullest at the earliest opportunity.

On integration, as I am sure the noble Lord knows, we have options open to us already to ensure that budgets can be pooled at a local level. This is happening in many areas. It is a very useful device to enable the NHS and social care to share responsibility for delivering care to patients and service users, who after all do not mind very much whether the service is delivered by the NHS or by social care as long as the right service is delivered. We need to work much harder on that area, too.

[Baroness Bakewell]

Can I draw the Minister’s attention to the characteristics of the very old? Time speeds up when you are old. Christmas comes round more regularly and the years pass faster. Coupled with that is increased anxiety about what those years will bring. The timescale of these matters that concern funding have a particular poignancy for people who have only a few years of life left. I urge the Minister to persuade his colleagues that the nature of defining these sums of money will give a lot of ageing people who are worried peace of mind—a phrase used in the White Paper.

[Earl Howe]

I pay tribute to the noble Baroness for all her work on behalf of the elderly. Of course she is right in her perception of the way that the elderly view time passing. We have yet to sort out the precise funding mechanism for Dilnot. However, in the mean time, as I have emphasised, we are channelling significant extra funds to local authorities to tide them over. We believe that that will be of help in the short term. Also, the deferred payment scheme should deliver considerable peace of mind to many elderly people who find that they need to move into residential care and, for whatever reason, do not wish to sell their houses. I hope that that proposal will find favour with her.

Care Homes

Debate between Baroness Bakewell and Earl Howe

Monday 28th May 2012 Lords Chamber

[Baroness Bakewell]

To ask Her Majesty’s Government what plans they have for making sure that care home ownership delivers consistent and long-term care.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the Care Quality Commission, as regulator of health and adult social care services in England, is responsible for providing assurance that all care home operators, whether in the public or independent sectors, meet regulations that set essential levels of safety and quality.

[Baroness Bakewell]

I thank the noble Earl for that Answer, but it does not quite meet the background that has arisen since 30 April, when the private equity firm Terra Firma acquired Four Seasons Health Care, which is the largest elderly care provider in the UK. Given that equity firms often favour a short-term business plan model, and in the light of the collapse of Southern Cross, would the Government consider a “fit and proper person” test for care home ownership?

[Earl Howe]

My Lords, I am aware that this idea is circulating. Recent events have taught us that intelligence about the market and scrutiny of providers should be better. However, we are not convinced that a “fit person” test is necessarily the right approach. Having said that, we will be setting out our proposals shortly and we will consult on those, so there will be an opportunity for the sector to input its views. We should bear in mind that anyone who registers with the CQC as a provider of care must by law be of good character and have the necessary experience. The provider is also required to notify the CQC of any convictions or cautions against them and of any voluntary insolvency arrangements involving them.

Health and Social Care Bill

Debate between Baroness Bakewell and Earl Howe

Thursday 8th March 2012 Lords Chamber

[Earl Howe]

My Lords, while, for reasons which I shall explain later, I do not feel able to accept this amendment, I say immediately to the noble Baroness that she has raised a very important issue with which the Government are in complete sympathy.

It is important for older people to have a strong voice to champion their interests and to ensure that their needs are addressed in public services. Both I and my honourable friend the Minister of State for Care Services have met the noble Baroness over recent months to discuss this issue and have been struck forcefully by the powerful case that she has made. As she is aware, my honourable friend would like to continue these discussions with her, as we are particularly grateful for the expertise that she brings to this area.

I am sure noble Lords will agree that older people are affected by a wide range of issues—not only health and social care but areas of policy such as housing and pensions. The Government recognise this. The UK Advisory Forum on Ageing, co-chaired by the Minister of State for Care Services and the Minister of State for Pensions, provides advice across government on the additional steps that they and their partners need to take to improve well-being and independence in later life.

In health, a range of functions in relation to older people are already carried out in this country. That should not surprise us because we all know that a very large proportion of the NHS budget is accounted for by healthcare delivered to the elderly. The Department of Health is pursuing a number of initiatives to improve the care of older people in hospitals, care homes and other settings. These initiatives cover all stages of the care pathway—from helping individuals to stay healthy and to stay in the community all the way through to end-of-life care. For example, the department already has a National Clinical Director for Older People, Professor David Oliver, whose remit is to promote the better care of older people across the NHS and social services, and to provide clinical leadership for cross-government work on older people.

My noble friend Lady Barker rightly stressed the key role of social care in relation to older people. Looking across the spectrum of health and social care, each health and well-being board will be required to develop a joint strategic needs assessment, identifying the current and future needs of the local population, and a joint health and well-being strategy to set out how those needs will be met. I can say to the noble Baroness, Lady Bakewell, that it is intended that health and well-being boards will bring together the key local commissioners to enable them, first, to consider the total resource available to improve their population’s health and well-being, and then to come to a joint understanding about how those resources can best be invested. This will undoubtedly help to encourage a more integrated local service which is better able to meet the needs of older people by joining up NHS and social care services. I hope that that offers some reassurance to the noble Baroness that the voice and needs of older people in health is absolutely a priority for this Government.

Amendment 231A proposes that the role of commissioner for older people should fall on a member of HealthWatch England. I am afraid that I cannot agree that that would be an effective approach. The first reason is the one that I mentioned earlier: the role of an old people's champion goes wider than health and social care. Equally importantly, the job of HealthWatch England will be to carry out functions in relation to people. The word “people” is a deliberately broad term and its ordinary meaning would include older people of course, so we do not feel that it would be appropriate to give a member of HealthWatch England a remit for older people, which would give additional weight to one group of people over another. It could also lead to calls for a commissioner for other groups like those with learning disabilities and it would be difficult to see where the list would stop.

Although I completely understand the concern that older people have often lacked a voice within the system, and the need to ensure that they are not overlooked, we do not agree that the singling out of this group over others, within the context of healthwatch, would be the best way to achieve that. We want to address the concerns of the noble Baroness but not in this way. In the light of that and on the basis that she will continue to have discussions with my honourable friend on the issue in a wider sense, I hope that she will feel sufficiently reassured to withdraw her amendment.

[Baroness Bakewell]

I thank the noble Earl for that engagement with the argument which I hope to start. Having a toe in the door, I hope that I can keep it open and perhaps prise it a little bit further open.

The noble Earl cites all the amazing institutions which are responsible for older people and one wonders why there is such a catalogue of misery across the country. Why are things going wrong? Why do they not answer the needs of older people? Why are there so many people catalogued as living wretched lives and writing letters of complaint, virtually with tear-stained ink? This is a major problem that the system is not answering. Therefore, I hope to take the issue further.

I very much agree with the noble Baroness, Lady Barker, that we should not medicalise the issue of being old. We have to keep old people fit so that they can enjoy old age. If this matter is to be referred to other government departments, I would include the DCMS so that access for older people to theatres and cinemas, help with hearing and so on can improve their quality of life. There is much to be improved, as we all know. I welcome the noble Earl’s commitment to making that so and I hope to follow it up in future. I beg leave to withdraw my amendment.

Health: End-of-life Care

Debate between Baroness Bakewell and Earl Howe

Monday 16th January 2012 Lords Chamber

[Earl Howe]

Unfortunately, my Lords, we do not hold information about how many advance decisions have been made out or pursued; those statistics are not collected centrally. However, I am aware that lasting powers of attorney, which the noble Lord will know came in under the Mental Capacity Act, are growing in popularity and number. The numbers are rising, although I do not have those statistics in my brief. We are encouraged by the fact that people are now aware that they can delegate to a loved one—a family friend or whoever—to take decisions in their best interests should they lose capacity later on.

[Baroness Bakewell]

Given that people on the whole now know that they have a right to decide when treatment can be withdrawn, and to ask for that to happen, what advice is in place for medical staff who, faced with such a decision, still hesitate to carry out the wishes for fear of prosecution?

[Earl Howe]

My Lords, the end-of-life care strategy that we are pursuing, published by the previous Government, highlighted the need for a cultural shift in attitude and behaviour related to end-of-life care within the health and social care workforce. The noble Baroness is quite right that this is an issue. In partnership with the national end-of-life care programme, we have taken forward a number of initiatives to develop the workforce’s understanding. We have commissioned the development of an e-learning package, which is turning out to be popular, that includes advance care planning and communication skills. Core competences and principles for end-of-life care have been developed, and a number of pilots have been taken forward in that area. A document called Talking About End of Life Care: Right Conversations, Right People, Right Time has been published and was completed early last year. There are a number of initiatives in this area.

Health and Social Care Bill

Debate between Baroness Bakewell and Earl Howe

Monday 7th November 2011 Lords Chamber

[Baroness Bakewell]

My Lords, I thank the noble Earl for his thoughtful consideration of my amendment. Because this is so impending a situation, it has to be taken on board for the future. The noble Earl spoke about having data that were robust in terms of verifiability and about evidence for the over-75s being harder to come by. However, life expectancy in this country is 84 for women and 79 for men, so there are data somewhere. I reiterate that there is a growing groundswell of concern, evident in newspapers when the story goes wrong, about the National Health Service failing older people, and I am sure that the Minister is as keen as I am to see that end. I beg to move.

[Earl Howe]

My Lords, I completely understand the points that the noble Baroness has made and I am sure that there is general sympathy in this Committee for the issues that have been aired through successive reports. I refer not just to the Care Quality Commission’s findings but to those of the ombudsman relating to care for the elderly in both the NHS and care home settings. The noble Baroness should be in no doubt that this is very high on the Government’s list of priorities but, as she recognised herself, there are particular obstacles that we have to overcome before we can move forward in the way that she has indicated and that we all want.

[Baroness Bakewell]

I beg leave to withdraw the amendment.

Care Homes

Debate between Baroness Bakewell and Earl Howe

Tuesday 7th June 2011 Lords Chamber

[Baroness Bakewell]

To ask Her Majesty’s Government what steps they are taking to protect the interests of residents of care homes, such as those operated by Southern Cross.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the Government will take whatever action is necessary to protect the welfare of care home residents. Southern Cross has plans in place to restructure its business and is keeping the Government updated on progress. We will continue to keep in close touch with the situation and will work with local authorities, the Care Quality Commission and others to ensure that there is an effective response, which delivers protection to everyone affected.

--- Later in debate ---

[Baroness Bakewell]

I thank the noble Earl for that information. Given the latest revelations that Southern Cross traded the care of older people for short-term profit and that the Care Quality Commission so woefully failed to come to the help of suffering people in a home in Bristol, can I urge him to take the most urgent steps as soon as possible to relieve the suffering of people who are old, frail and dependent, and who are suffering much neglect?

[Earl Howe]

My Lords, I am sure the noble Baroness’s concerns will be echoed throughout the House. We have seen distressing reports in recent days of the treatment of certain patients in private hospitals, but the worry over Southern Cross relates much more to its financial situation and the future of its residents. I can assure the noble Baroness that we are taking this situation very seriously. We are in touch, as I have said, with all the relevant parties—and have been for the last several months. We are making sure that everybody is aware of their responsibilities in this area, not least towards the residents concerned. As regards Southern Cross, we are now in a critical period when restructuring is being explored, and we wish those efforts well.