Care Services (Bradford)

David Ward Excerpts

Monday 8th July 2013 Commons Chamber

[Mr David Ward (Bradford East) (LD)]

The very first time that a son or daughter is asked by one of their parents, “And who exactly are you?”, is a chilling and frightening experience. It is a question of good days and bad days. In most cases there will be many good days—many fun days. It is not the end of the world, but it is very much the end of a world that the son or daughter knew. My hon. Friend the Minister is more conversant with the figures than I am, but they are startling for us as a nation. Some 800,000 people suffer from dementia. We are told that the figure will increase to 1 million in the next 10 years or so. The Alzheimer’s Society believes that the cost to us as nation of supporting those people is £23 billion, and that is with only half of those who have dementia being diagnosed with it.

However, I am here to tell a good story, about the work going on in Bradford. I would not be forgiven by Cathy Henwood, the dementia-friendly communities co-ordinator in the Alzheimer’s Society, if I did not point out that we were doing dementia-friendly work in Bradford before the Prime Minister’s challenge, which I will return to later. The dementia measures taken in Bradford have been well supported by the council. Stage one of the work included the recruitment of a small pilot group of organisations, such as the gurdwara, the Church of England, the community centre, a local branch of Lloyds TSB, a pharmacy and others. They were asked to review their organisations and write action plans. A checklist was produced by the Alzheimer’s Society to help them do that. That list was developed with people who had dementia and those who cared for people with dementia.

The second stage of the work is where my patch of Idle, where I live, came in. It is a village—yes, I was an Idle councillor for 26 years. The Alzheimer’s Society developed a community-based approach to supporting people with dementia which started in Idle and Thackley. The area happens to have three Liberal Democrat councillors, I am pleased to say, and they were determined to put together supportive structures for those with dementia in their ward development plans. Councillor Jeanette Sunderland leads the Lib Dem group. She and her colleagues Councillors Griffiths and Reid, working with the Alzheimer’s Society, held a community meeting on a bleak and snowy day in January—we do have some bleak and snowy days in Bradford in January. It was nearly cancelled but it went ahead despite the weather, and 40 participants turned up and 14 people signed up and agreed to stay involved. That meeting was partly for awareness raising, with a speaker who had dementia, and with information about the effects of dementia and how to help, and it was also partly a consultation, with discussion about what is good about living in Idle and what would be problematic for people with memory problems—what could be changed, and so forth.

A number of subsequent meetings have been held, as was a support group meeting, with both carers and those with dementia, at a volunteer event. All was going well. As of April, with some funding from the Joseph Rowntree Foundation and Bradford council, this work was looking to expand out of one ward out of the 30 in Bradford to work with 20 communities in total over a two-year period.

There was an announcement in the Telegraph and Argus about the Bradford District Dementia Action Alliance, which had brought together lots of groups and organisations, including the Yorkshire police, the Bradford royal infirmary and St Luke’s hospital, Bradford university and Bradford college. They have now been granted early adopter status for the dementia-friendly community recognition programme.

This is all really good news, added to which I believe it is important to congratulate the coalition Government on the focus they have placed on this, for example with the Prime Minister’s welcome launch of the dementia challenge. So far, so good, then.

The background to this at the national level is as follows. There is a £2.68 billion reduction in adult social care funding either so far or through to March 2014, and locally a 16% reduction over the last two years in adult and community service budgets, which amounts to £23 million in Bradford. A joint survey by Age UK and the College of Social Work found that 94% of people witnessed a squeeze on budgets for care services in the past three years, and 81% said they were seeing negative impacts on social care.

The Minister will, I am sure, refer to the Government funding that has recently been made available. That is focused on the crucial integration of health and social care, but integration can happen at any level of support, of course. Eligibility is the gateway to support; it provides the level at which a person can access support. As the Minister well knows, Bradford’s council is consulting on changing the criteria in Bradford, and that consultation will run until 4 August. I am pleased to say that on 15 July the former care Minister, my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), will be coming to Bradford to launch the Bradford Cares campaign, which is supported by Scope. It is running a national campaign, but we will run a local version of it, in which we will seek to persuade the people of Bradford to support our campaign against the council’s proposed changes. We feel it is particularly relevant to those with dementia because, as the Minister knows, people with dementia are often physically able. With a little help and support, they are quite capable of looking after themselves.

When I was a councillor chairing the area committee we looked at the issues affecting elderly people and we assumed that they would relate to benefits, housing, adaptations and so on. It became evident that the crucial issue facing many elderly people was isolation, the impact of which, as we know, can lead to a deterioration in a person’s condition, particularly if they have dementia. Early intervention, not integrated intervention, is the key. This is about providing moderate care not only because it is relatively inexpensive, but because we know that investing in this form of support can save up to 130%.

If Bradford council’s decision goes through, it could well affect 2,000 people. We believe that if the council is doing this on the basis of concern about cost, it is very much a false economy, as it will cost the council more in the long term. I fear that despite the great strides that will be made by finally having integrated care systems, a change in eligibility thresholds will mean that hundreds of thousands of people will still not get the key early and preventive care about which I know the Minister cares passionately. They will not receive the care that they so desperately need and that is why it is so important to consider the eligibility criteria. As the Alzheimer’s Society has highlighted,

“setting the eligibility threshold at substantial will fail to make the shift to a system of prevention whereby people get the support they need to cope at home and avoid unplanned admissions to hospital and residential care.”

My Liberal Democrat colleagues on Bradford council have put down a motion for debate tomorrow, applauding the work that is going on in Bradford, particularly the Bradford District Dementia Action Alliance. We have had some cross-party coalition work on dealing with dementia, and I urge all Bradford councillors to support that motion, with the goal of making Bradford a dementia-friendly district by 2015. The dictionary definition of “to care” is to

“take thought for, provide for, look after, take care of”.

We must take care, and we must not care less.

I look forward in particular to the Minister’s response on integration. I know he sees it as a great opportunity, but my concern is that unless it operates at an appropriate level we will not only lose the savings that are possible through preventive work but see a deterioration in many people’s conditions and a growing cost. We are still at an early stage in the development of the health and wellbeing boards, and change is also happening in the national health service as a whole. These are risky days for many people, and although the additional funding to support integration must be welcomed, we must ensure that it is at the appropriate level.

[The Minister of State, Department of Health (Norman Lamb)]

I congratulate my hon. Friend the Member for Bradford East (Mr Ward) on securing the debate and on all the work he has done both in Bradford and to bring the stories from Bradford to a national forum. He has done more than anyone to highlight the importance of care services and working with the community to improve services for people. Indeed, the extraordinary consultation exercise he undertook following the White Paper last year was an exemplar of how to engage with the local community. The extent to which people felt able to comment and give their views and ideas was commendable.

I also congratulate the Bradford District Dementia Action Alliance on its work. My hon. Friend made the point that Cathy Henwood from the Alzheimer’s Society had identified Bradford as developing the concept of dementia-friendly communities before the Prime Minister’s dementia challenge, but I am pleased that he acknowledged that the Government have done a lot to highlight the importance of improving dementia care. The Prime Minister’s dementia challenge highlighted three strands: improving health and care services; creating dementia-friendly communities, which is exactly what is happening in Bradford; and a much greater focus on research so that we can find cures, understand better how to prevent some types of dementia, such as vascular dementia, and understand through research how best to care for people with dementia. The Government are more than doubling the amount spent on research, which is a good thing in itself.

The work about which my hon. Friend spoke started in the ward of Thackley—

[Mr Ward]

Idle and Thackley.

[Norman Lamb]

Idle and Thackley—those wonderful names. Local councillors got the community involved and that is exactly what needs to happen. When we talk about how to meet the extraordinary challenges of the future, with an ageing community, there must ultimately be collaboration between statutory services and the community. Bradford appears to be showing the way in which that can be done and I stress that it requires the integration of services and care shaped around the needs of the individual with preventive care to stop the deterioration in their condition.

My hon. Friend will be aware of the need for the care and support system to change as local authorities face challenges resulting from an ageing population. That is why the coalition Government have decided to reform the system of care and support. He talked about the situation in Bradford and I understand that more than 71,000 people there are aged 65 and over, about 14% of its total population. Bradford’s joint strategic needs assessment for 2012 predicts that by 2033—not that far off—the number of local people over 90 will increase from 2,800 to 8,700, an increase of more than 200%. We all face an extraordinary challenge.

As we debate access to care and support services, I am aware that City of Bradford metropolitan district council sets its eligibility criteria at moderate. The report that my hon. Friend published earlier in the year indicated that 97% of people who replied to his survey welcomed setting the eligibility criteria at that level. Bradford council now proposes to change its band to substantial, because of pressures on its budget, and that would affect about 25% of people who currently receive care and support. I completely understand that the Bradford Cares campaign wishes to ensure that services are maintained at the existing level.

The care and support White Paper, which was published in July 2012, is an important and fundamental step towards addressing the challenges of an ageing society. Our reforms will focus more attention on people’s well-being—that is at the centre of everything that the Care Bill tries to achieve—and independence throughout their lives, rather than waiting for people to reach crisis point. They will also put people in control by giving them a far greater say about their care and support, as well as by ensuring that services are designed around what people actually want and by putting their priorities and preferences above and beyond the needs of the institution. My hon. Friend will be aware that the Care Bill, which has been widely welcomed, will be a single, modern statute for care and support. It will make legislation clearer and fairer, and it will be built around people not processes, and individuals not institutions.

As the Government’s White Paper made clear, our vision is a modern care and support system that promotes people’s well-being by enabling them to prevent and postpone the need for care and support, and puts them in control of their lives so that they may pursue opportunities, including education and employment, and realise their potential. Assessments will remain an integral part of the system, but rather than acting primarily as a gateway to the adult receiving care and support—or not, if they fail the assessment—the future system will place much more emphasis on the role of the assessment process in supporting people to identify their needs, to understand the options available, to plan for meeting care needs and caring responsibilities, and to reduce or delay needs, when possible.

Any adult who appears to the local authority to have care and support needs, whatever the level of need, has the right to an assessment. That right will cover carers, so this is an extension of their existing rights. The low threshold for entitlement to an assessment will mean that authorities will have earlier contact with far more people with low-level needs.

[Mr Ward]

May I say how much I welcome the policy on the assessment of carers? Many carers who visit my constituency office are on the verge of needing care themselves because of the stress that they are under. It is the failure to identify their personal needs and the support that they require that puts them in such a stressful position.

[Norman Lamb]

My hon. Friend is absolutely right. The Care Bill’s provisions on carers represent an enormously welcome advance. In a sense, they will give carers the same entitlements to assessment and then support, if that is deemed necessary, as the people for whom they care.

The “Fair access to care services” framework was introduced in 2003. It aimed to provide a fairer and more transparent system for the allocation of social care services. The assessment and eligibility framework was reproduced in the “Putting People First” guidance that was published in 2010. The current assessment and eligibility framework is graded into four bands: critical; substantial, which is the case for most local authorities; moderate, which applies to Bradford and some 15 other authorities; and low, which covers only two or three councils. Local authorities can choose which band they wish to set for their local criteria, and Bradford has the legal power to change its eligibility criteria, as long as it consults its local community.

People continue to tell us, however, that the process for determining who is eligible for care and support is confusing and unfair. Decisions are not transparent and there is variation across the country, and the end result is that people can be left without the support that they need. The existing assessment and eligibility framework is therefore not working effectively, and that is widely recognised. That is why we are introducing a national minimum threshold for eligibility through the Care Bill. The Bill will set out the eligibility criteria—the point at which local authorities must meet an adult’s care and support needs, or a carer’s support needs. Local authorities will remain able to meet lower needs locally, if they choose to do so.

On 28 June, we published a set of draft regulations that set out the national eligibility criteria. These are intended to describe an equivalent level to the “substantial” level used by the vast majority of councils. We have committed to providing funding that will maintain the same level of services when authorities move to the new system in April 2015. This is the beginning of engagement with stakeholders before we formally consult on the regulations next spring. I assure my hon. Friend that the setting of the threshold is about establishing a minimum standard, not taking away councils’ discretion to go further. Of course, the more preventive care that can be given, the better, because that improves well-being and ultimately reduces the cost to the system, which is exactly the point that he made.

Under the current spending review, local authorities should be able to protect access to care, but we know that not all the money that was earmarked for care services has been spent in that way. Ultimately, spending on social care is a matter for local people in local authorities, and councils such as Bradford have to make tough decisions. However, we cannot improve care and support simply by throwing ever more money into the system; on the contrary, we need to work in more innovative and effective ways, exactly as is happening in Bradford, where there is really impressive work on dementia-friendly communities. That is exactly the sort of collaboration that we need to encourage.

Local authorities across the country have already been redesigning services to find more efficient ways of working. For example, many local authorities are concentrating on better integration between health and care services, improving co-operation and reducing duplication. That means better use of money, and improved care.

My hon. Friend referred to this year’s spending review settlement. It includes a £3.8 billion pooled health and social care budget to make sure that everyone gets a proper, joined-up service, and the care that they need from whoever is best placed to deliver, whether that is the NHS or the local authority. The £3.8 billion fund, shared between the NHS and local authorities, will deliver integrated services more efficiently for older people and, crucially, disabled people. It covers ensuring that health and social care work together to improve outcomes for local people, through better sharing of information, so that people need explain their problems only once; intervening early, so that older and disabled people can stay healthy and independent at home, avoiding unnecessary hospital admissions and reducing visits to accident and emergency departments; and delivering care that is centred on the individual, rather than on what the system wants to provide. Examples include NHS and social care staff working together to provide seven-day working, and better data-sharing to ensure that people can leave hospital as soon as they are ready.

The Care Bill includes a duty to provide preventive services; that is exactly the sort of thing that my hon. Friend is advocating for Bradford. That new duty on local authorities is seen by many people as potentially transformative. The White Paper sets out our ambition for health care and support to be organised around the needs of the service user, rather than focusing on organisations and services. We want a reformed system, in which organisations work together to give individuals real control and choice over the care that they receive. Good practice already exists, and we need to learn from and build on that.

I understand that Bradford’s clinical commissioning groups are working with Bradford council to deliver a three-year integration programme, which will cover all the services that help to support people so that they can remain at home, stay in their community, and regain and retain their health, well-being and independence. We want to encourage and support local experimentation, to allow areas to provide integrated care at scale and pace. We are working to support local initiatives and to identify what needs to happen to drive change at the national level. We want to learn what works well and how to overcome barriers, and to pass those lessons on to others.

On 14 May, the national partners in health care and support, including the Department, published a document entitled “Integrated Care and Support: Our Shared Commitment”, which sets out 10 commitments that the national partners have made to enable and encourage change to scale and pace, as well as expectations on local areas in return. The national partners have invited the most ambitious areas to apply to become pioneers and act as exemplars to address local barriers and support the rapid dissemination, promotion and uptake of lessons across the country. The national partners will provide the pioneer sites with dedicated central support to help them to break down barriers to delivering integrated care and support.

It is really exciting that the coalition is acting to end that long, historical divide between health and care services and, indeed, between mental and physical health services. The potential for integrated care, with a focus on prevention, and collaboration between the statutory services provided by the national health service and the local authority and the community, exactly as is happening in Bradford, can provide the early intervention that my hon. Friend discussed, and it can address isolation. He mentioned that pernicious problem. Many people live on their own, and often lead lonely lives and, as he said, both their mental and physical health deteriorates. If we can get the community to support the statutory services, providing companionship and friendship, and giving people a better life, the combination with a much more joined-up service from the statutory services can achieve the breakthrough that he described in his community.

I conclude by applauding the impressive community work in Bradford, which began in one local community, but which has the potential to spread to 20 other local communities. That is exactly what should be done, and with the support of the Care Bill, we can make that a reality, not only in Bradford but across the country.

Question put and agreed to.