Hills Fuel Poverty Review

From Age UK :

Professor John Hills is possibly the leading contemporary academic expert on poverty and inequality in Britain today.   He follows in the distinguished footsteps of Tawney, Titmus and Peter Thompson.   He accepted the challenge to lead the independent review into fuel poverty because, as he modestly says,

Julio Martinez

he was intrigued by the subject and wanted to understand it better.

The first part of his brief was “to consider fuel poverty from first principles:  to determine the nature of the issues at its core, including the extent to which fuel poverty is distinct from poverty, and the detriment it causes”.   Long term fuel poverty campaigners were fearful that by making this the question, Government ministers wanted to find an excuse to airbrush fuel poverty off the agenda and get off the hook of confronting the rapidly escalating numbers of households dropping into fuel poverty over the last five or six years.   Their fears are confounded in Hills’ Foreword to his report:  “That fuel poverty remains a serious problem is clear from the evidence we review”, he states.  

His report goes on to observe that households in or on the margins of poverty face costs stacking up to £1.1bn more than a typical households to keep warm, that those on low incomes cannot afford the investment to make their houses energy efficient – which is a key issue in the climate change and carbon reduction agenda, and crucially that living in cold homes has a series of effects on illness and mental health.   That last is the lead item on his chapter on the Impacts of Fuel Poverty.

For the rest of this typically thorough and comprehensive review (over 150 pages), the Hills team have looked at different ways of defining fuel poverty.   The current definition, which John Hills accepts, is based on the 2000 Warm Homes and Energy Conservation Act, which states that “a person is to be regarded as living in fuel poverty if he is a member of a household living on a lower income in a home which cannot be kept warm at a reasonable cost”.   But if the devil is in the detail, this leads to further issues about defining low income, adequate warmth, and reasonable cost, and most of this Interim Report is probing around this area.  

 Hills props up several different methodologies to measure fuel poverty, all of which come up with big numbers, and some are higher and some lower than the current statistical measurements indicate.

 Hills will produce his final report in January, when he will put some recommendations forward, as well as analysing the impact of various policy prescriptions for the growing number of households in fuel poverty.  

 Read the full report

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The Party Conferences and Public Service Reform

From Age UK :
The headline stories from the Party Conferences were about the economy, and the orchestration by the organisers and managers to present their parties in themost favourable light.   Party members were a bit thin on the ground, but lobbyists were there in abundance.   Yet around the fringe meetings, the theme of public service reform was vigorously discussed.

Public service reform is one area to which all the parties subscribe with varying degrees of warmth.   The common ground is that we cannot provide services in the top-down way as in the past:  they must be more user-responsive and ‘personalised’, and we have to re-configure them to get more outcomes for less money.  

How we do this is more difficult.   Localism, enshrined in the Coalition Agreement, passes more responsibility to local government and local representatives, with a diminished role for the centre to set national targets and eligibility criteria, but local councillors attending the conferences were in two minds about having this task thrust upon them.   They will need to rethink their role:  are they the voice of the Council delivering the services, or are they the voice of the neighbourhood, demanding that the Council needs to change the way it provides services (ie place-shapers, seeking new powers for community groups and other service-providers in their patch)?  

Nowhere was this more hotly debated than in the area of social care provision, a big ticket spending item for local government, and one where there is a policy vacuum as the Government tries to draw a new map which triangulates national entitlements, local flexibility in service responses, and encouraging new service providers to enter the market.

That last was also discussed on the fringe.   How do we enable more mutuals and social enterprises, and support more local volunteering, to add to our public service offering?   At all the conferences there was willingness to engage with this issue, but a raft of difficulties and barriers was identified.  

We are spreading the word about models of good practice very poorly.   There are few immediate places where would-be providers can access good information about extant working models.   There is little resource for the consumer who is encouraged to take control of their personalised budget to find ideas and inspiration.   Whilst at all the Party Conferences there was willingness to address public services reform, there was a shared frustration with how to do so.

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Care for the geriatric baby boom legion

In Forbes, Carolyn Rosenblatt, a lawyer with the law most explains the importance of access to diagnosis, which can help explain behavior such as dementia and ensure that the interactions of medications, infections, stroke, or dehydration, even if they were not responsible for problems in memory or behavior. My father by a friend as an example, it offers four recommendations when a parent shows disturbing behavior. These include on-access scanning of the MD reliable, and preferably a neurologist who works with elderly patients, and to locate and complete documentation estate planning (while people are still competent to sign the documents), and advance planning for the needs of care possible, and to discuss the situation in the original with all of the family members during a meeting of the family.

Associated Press article by post / Washington highlights the trend for older children re-design their homes to create spaces for their parents move in with them. National Association of Home Builders reports that 62% of builders surveyed said they were working to amend the home related to aging in 2010. Suggested based on interviews with the story involving the parents in a conversation with the builder will make the transition smoother. The company can in Indianapolis, called the next door garage apartments, and convert a garage for two cars in an apartment in full within ten days for $ 35,000. I got family, women and mother in law came to live with them and explained that this arrangement works well because her mother in law does not require a medical complex, along well by living together, and the mother in law drives a part of her accompanying each month, and thus to retain some independence.

Sacramento Bee article on the importance of communication between adults and children and parents on issues of long-term care, including end of life care preferences and financial health.Barbara Gillogly, Professor of Gerontology, explains that the talks, while critical, “If people do not talk about it, they need to understand that at some point, someone else will make those decisions for them … Do you want the state to make those decisions? Do you want your children to adults to make the best guess of what they have? or do you want them to know? “

Still Hungry to be Heard – CQC Dignity and Nutrition Report

From Age UK :

Today, the Care Quality Commission (CQC) published the Dignity and nutrition for older people report, summarising spot check inspections of 100 acute hospitals in England. The inspectors looked at the essential standards of dignity and nutrition on wards caring for older people. They found, that for nutrition, action needed to be taken in 49 of the 100 hospitals.

Age UK has worked with the CQC to support this inspection process – and we are shocked by the outcome. Perhaps the most disturbing thing about the CQC report is that it shows that this situation is not inevitable. Some hospitals are clearly getting things right. But what about the others?

We have previously identified ‘seven steps’ of good practice which hospital staff need to follow, and we know that in some places these are making a real difference.

The CQC report identifies a further three factors – leadership, staff attitudes and resources. In line with this, we think the time has come to bring external pressure to bear on hospital managers to drive improvements. So we want the government to compel all hospitals to publish data showing malnutrition rates on their wards in a form the public can understand.

The CQC inspections have shown that there is something systemically wrong in some hospitals and hospital managers must take action to change this. A requirement to publish the numbers on malnutrition would act as a powerful driver of change for hospital managers, who can currently hide behind the fact that malnutrition is a complex issue and treat each problem as an isolated case.

Age UK hears regularly from the relatives and carers of older people who have not been supported to eat properly in hospital. This is why we are running the Hungry to be Heard campaign to challenge the scandal of people in later life becoming malnourished in hospitals. This is Irene’s story:

Irene, 89, was admitted to hospital in November 2010. She was in hospital for three months and during that time lost an immense amount of weight, so much that she was unrecognisable by the time she left. Irene’s grand-daughter Morgan said: ‘When my sister or I were with her during mealtimes we often witnessed the food trolley coming round and staff asking her if she was hungry, to which she replied “no”. The staff would not question this refusal and just move on to the next patient. So she often missed her dinner. When we weren’t there, nobody seemed to encourage her to eat or asked why she did not want the food.’

But Irene’s is not an isolated case. This week Age UK campaigners, including Irene’s grand-daughter Morgan, took more than two thousand postcards to the Department of Health, calling for the government to require hospitals to publish the numbers.

– Find out more about Age UK’s Hungry to be Heard campaign

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State Pension Age Announcement – Not far enough?

From Age UK :

After many months of campaigning, today’s announcement that women affected by the state pension age changes will wait a maximum of 18 months to claim their pension was welcome news for those women who would have had to wait up to 2 years. 

For many women though we understand that this change does not go near enough and appreciate entirely your disappointment and anger that the Government has not reversed its policy. We understand that you feel let down and angry. 

Age UK has worked with many of you to try and get the Government to  reverse its policy of speeding up the equalisation of SPA and increasing the SPA to 66 sooner than originally planned.   Today was an important step in the right direction, we like you wanted the Government to go further.

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Still Hungry to be Heard – CQC Dignity and Nutrition Report

From Age UK :

Today, the Care Quality Commission (CQC) published the Dignity and nutrition for older people report, summarising spot check inspections of 100 acute hospitals in England. The inspectors looked at the essential standards of dignity and nutrition on wards caring for older people. They found, that for nutrition, action needed to be taken in 49 of the 100 hospitals.

Age UK has worked with the CQC to support this inspection process – and we are shocked by the outcome. Perhaps the most disturbing thing about the CQC report is that it shows that this situation is not inevitable. Some hospitals are clearly getting things right. But what about the others?

We have previously identified ‘seven steps’ of good practice which hospital staff need to follow, and we know that in some places these are making a real difference.

The CQC report identifies a further three factors – leadership, staff attitudes and resources. In line with this, we think the time has come to bring external pressure to bear on hospital managers to drive improvements. So we want the government to compel all hospitals to publish data showing malnutrition rates on their wards in a form the public can understand.

The CQC inspections have shown that there is something systemically wrong in some hospitals and hospital managers must take action to change this. A requirement to publish the numbers on malnutrition would act as a powerful driver of change for hospital managers, who can currently hide behind the fact that malnutrition is a complex issue and treat each problem as an isolated case.

Age UK hears regularly from the relatives and carers of older people who have not been supported to eat properly in hospital. This is why we are running the Hungry to be Heard campaign to challenge the scandal of people in later life becoming malnourished in hospitals. This is Irene’s story:

Irene, 89, was admitted to hospital in November 2010. She was in hospital for three months and during that time lost an immense amount of weight, so much that she was unrecognisable by the time she left. Irene’s grand-daughter Morgan said: ‘When my sister or I were with her during mealtimes we often witnessed the food trolley coming round and staff asking her if she was hungry, to which she replied “no”. The staff would not question this refusal and just move on to the next patient. So she often missed her dinner. When we weren’t there, nobody seemed to encourage her to eat or asked why she did not want the food.’

But Irene’s is not an isolated case. This week Age UK campaigners, including Irene’s grand-daughter Morgan, took more than two thousand postcards to the Department of Health, calling for the government to require hospitals to publish the numbers.

– Find out more about Age UK’s Hungry to be Heard campaign

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Growing pains – health and social care bill debate in the House of Lords

From Age UK :

The Health and Social Care Bill has its second reading – a debate on the general principles of the Bill – in the House of Lords on Tuesday 11th and Wednesday 12thOctober. More than 90 Members of the Lords have put their names down to take part in the two-day debate. Two Peers have tabled amendments to try and force extra scrutiny of the Bill because of concerns that the Bill was rushed through the House of Commons. Labour peer Lord Rea, a former lecturer at St.Thomas’ Hospital Medical School and GP, has tabled a motion that, if passed, would mean the Bill would go no further in the House of Lords and could not pass into law in this session of Parliament. Lord Owen, a Crossbench peer, physician and former Parliamentary Under-Secretary for Health, has tabled a motion that would have the effect of sending certain clauses of the Bill to a select committee. In particular Lord Owen wants to see extra examination of changes the Bill makes to control of the NHS, the role of the secretary of state and the plans for Monitor, the new NHS regulator.

 The Bill, which has completed its progress in the House of Commons, aims to change how NHS care is commissioned through the greater involvement of clinicians and a new NHS Commissioning Board; to improve accountability and the involvement of patients in their care and to give NHS providers new freedoms to improve quality of care.

 Age UK wants to see the Bill act as a catalyst to improve health services for older people. Throughout our work with parliamentarians during the course of this bill we have been pointing out the problems older people face in accessing health and social care services. Too many older people in the UK experience poor practice and ageist attitudes when it comes to care which can put their health at risk.  Older people often struggle to access the basic care they need as the NHS continues to under-commission essential preventative services such as falls prevention, continence care and audiology. These types of services make a huge contribution to keeping older people well, independent in their own homes and helping to maintain a decent quality of life.

 NHS reforms will impact on everyone to a greater or lesser extent but they are likely to be most keenly felt by older people; patients over 65 account for around 60% of admissions and 70% of bed days in NHS hospitals. Our ageing population means it is more and more important for the NHS to meet the needs of older people. We want the new NHS commissioning board to instigate a fundamental review of how the NHS and local authorities assess, prioritise and commission services to meet the needs of an ageing population to make sure NHS structures, particularly the new commissioning bodies understand and know how to meet the needs of older people across the UK.

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Time to find a cure for this old age-old problem

From Age UK :

When the Care Quality Commission reported this week that a lack of “kindness and compassion” is leading to the inadequate treatment of the elderly in half of all hospitals, it was shocking – but not surprising. For years, older people have been forced to endure undignified and complacent care in the NHS.

Last year, we at Age UK produced a report called Still Hungry to be Heard, which highlighted the continuing problems with malnutrition, and prompted the CQC to carry out these latest inspections. Earlier this year, the Parliamentary and Health Service Ombudsman found – while describing more appalling cases of neglect – that more than twice as many complaints about the treatment of the elderly warranted closer investigation when compared with other age groups. In our social care system, it is acceptable for an older person to be put to bed while children’s TV is still on the air, because it is the only time when a carer is available for the necessary 15 minutes. This does not reflect a society in which older people are treated with respect or dignity, but one in which they are kept at the fringes of the community.

When it comes to the health service, how is it that an organisation with a £100 billion budget is failing to provide basic standards of care? Part of the answer lies with how the NHS is organised. Over the past decade, a huge amount of extra money has been poured into the health service, much of it tied to the drive to get waiting lists down to a maximum of 18 weeks. Reaching that target was a significant achievement – but in the process, hospitals were encouraged to move people through the system as quickly as possible. The result is that patients came to be seen as conditions or procedures to be processed, rather than people.

While this approach may be acceptable when dealing with someone who has a single, simple disease or injury, it is hardly appropriate for a frail, elderly person with multiple long-term conditions. The knock-on effect is that an older person using a hospital bed can be seen as a “wasted admission”, surplus to the hospital’s “real” work.

The fact that such older people are all too often ignored or patronised not only points to a failure in attitude, but also calls into question the ability of health professionals to assess their needs appropriately. It may also explain why so-called geriatric wards often receive less resources than others – even though the term is now a misnomer, since most wards are likely to contain a large proportion, if not a majority, of older people. After all, the elderly are now the largest users of NHS services, making up two thirds of the total. And that proportion is increasing: the number of stays in hospital by people over 75 has grown by 66 per cent since 1999/2000, more than twice as fast as for those aged between 15 and 59.

Despite this, the prejudice within the health service can be deep-rooted. You don’t have to look far to find examples of doctors and nurses, just emerged from training, who seem surprised to find themselves having to look after older people. Surveys of trainee doctors have shown that they hold geriatric care in poor regard: many actively avoid it, with the best and brightest preferring to move into more “glamorous” areas, such as A&E.

The cloud that hangs over this whole issue is the continuing negative attitude towards older people in society as a whole. If they are not valued outside hospital, how can we realistically expect them to be valued inside it? How many headlines have we read recently that complain about the “tsunami” of an ageing society, rather than celebrating the fact that people are living longer?

When it comes to the NHS, the health service is going through a period of massive change. Will these reforms improve the care of older people? In reaching an answer, the Government must undertake a full and comprehensive review of how the NHS can meet their needs.

Certainly, much more needs to be done to focus the minds of hospital managers. For example, we have been calling for mandatory publication of malnutrition rates, so that people can discover where the problems are occurring, rather than waiting for the Care Quality Commission to make an inspection. This isn’t a silver bullet, but it will certainly move the issue up the agenda at hospital board meetings.

The NHS must also work with patients and the public when deciding where to deliver services, and to find out where problems are occurring. Well before charities or quangos got involved, older people knew precisely which hospitals were delivering poor care to their friends and neighbours – but they didn’t know what to do with the information. The NHS must do more to seek out such feedback and make changes. And where care continues to be poor, there must beconsequences: it shouldn’t take a Mid-Staffordshire-type inquiry to drag incompetence out of the shadows.

Finally, the NHS must do more to support its staff. If doctors and nurses are under too much pressure, it is the patients who suffer.

Worryingly, the health service has the highest level of work-related sickness in the country, with many nurses being put in a position in which they cannot deliver the care they want to.

The NHS is there for everyone – but this week’s report shows yet again that it continues to perform poorly for older people. It is time to move beyond diagnosing the problem, and start looking at how to solve it.

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Geriatric retirement age arguments

With the end of the Default Retirement Age gaining much attention over the weekend, 1 October 2011 also marked another, perhaps less newsworthy, milestone – it was the fifth anniversary of the implementation of the Employment Equality (Age) Regulations. The regulations made age discrimination in employment illegal, and gave workers aged 65+ rights regarding unfair dismissal and redundancy. It was an attempt to make a clear statement against age discrimination, but one which failed because of a huge anomaly contained within it. As well as the regulations’ good points, they also included a new policy – the Default Retirement Age – which allowed employers to forcibly retire people aged 65 and above for no reason other than their age. What impact have the Regulations had? To mark this anniversary, Age UK has looked at the practical impact of the regulations on employer policies and practice towards older workers. The short answer is that there has been only a small improvement in organisational policies, which is disappointing considering the fanfare raised at the regulations’ time of introduction, and the attention received since then. While this is particularly difficult for the people affected, it’s doubly a shame because there’s a strong business case against discriminating and by failing to adapt, employers are ultimately harming themselves too. We believe the lack of progress has been exacerbated by the existence of the Default Retirement Age, which has effectively given employers a ‘get out of jail free’ card – they can always rely on forcing someone out at 65, so don’t need to make a substantial effort in the meantime. Some areas of improvement But it’s not all doom and gloom – on the surface at least. There are some parts of the employment process where employer practice does seem to have improved. Chart 1 below shows that some parts of the recruitment process have become more age neutral. Recruitment and pay comparison chart Source: DWP, SEPPP2 Positives include a significant drop in employers asking for age during the recruitment process; while fewer employers now use length of service when setting organisational pay levels, shown by Chart 1. There has also been an improvement in employer behaviour when making redundancy selections. As shown by Chart 2 (below), fewer now use age or length or service as a criteria than pre-regulations, which is good for both older and younger workers. Redundancy comparison chart Source: DWP, SEPPP2 Worryingly, however, there has been no change in the proportion of employers who still have a maximum recruitment age. Furthermore, on a macro-economic level the Regulations have had no impact on 65+ employment rates, while there is no evidence businesses have suffered any negative consequences as a result, in spite of initial fears prior to 2006. Official figures and the whole truth However, we still believe there is a lot of ageist behaviour and discrimination that is not being picked up in the official figures. It’s possible an element of ‘researcher bias’ exists, where the people being surveyed are economical with the truth, and anecdotally we still hear of a great many people who are being discriminated against on grounds of age. Sadly it’s all too easy, for example, to reject someone for a job on grounds of their age without anyone being able to prove it. Hopefully the end of the DRA will precipitate a cultural change towards a more positive view of older workers, but there remains a very long way to go.

Geriatric Healthcare

Health becomes more and more an issue as a person becomes elderly. Caring for someone who health is deteriorating can be a full time task, so how do you go about living your live and helping?

This weekend, Peter Carter, chief executive of the Royal College of Nursing (RCN), said patients’ relatives need to do more to look after their loved ones in hospital. Clare Gerada at the Royal College of GPs agreed. This is what Carter said: “If you have a 24-bed ward and have got five nurses and everybody is having lunch at the same time and half the patients need feeding, it becomes difficult to get it all done,” Carter said. “You get this business of wards, very, very busy people, [patients] dying to go to the loo, elderly people wetting themselves, then they lie there feeling embarrassed — and it is about helping gran get out of bed and go to the loo”.

The NHS Confederation, Age UK and the Local Government Group have set up a new Commission to improve dignity in care provided to older patients in hospitals and care homes. The Commission is collecting evidence and intends to publish a draft report and recommendations for consultation at the end of 2011. The British Geriatrics Society has made the following submission to the Commission:

http://www.bgs.org.uk/index.php?option=com_content&view=article&id=1629:commission-on-improving-dignity-in-care-for-older-people&catid=14:consultations&Itemid=110