Live webchat with Paul Burstow, Minister of State for Care Services, with Townswomen's Guilds on 1 March 12.30-1.30pm

junkkmale

Chemical coshes... views?

If necessary, what checks and balances needed to apply?

The view of a possibly less than objective care home alone, or more?

GP? DMHoP expert? Next of kin. 2cnd opinions? What?

And if applied, what responsibilities for monitoring should be expected of those complicit in signing off on it? None? Just leave it to the care home?

Thanks for all of your questions. I just mentioned, in answer to Johanna10 my visit to Kings College and their dementia team. I was really impressed with the work they are doing to remove any inappropriate prescribing of anti-psychotic drugs as this will greatly help to reduce the levels of ongoing prescribing of these drugs in the community.

I have been campaigning to raise awareness about the terrible effect of inappropriate prescribing of anti-psychotics for over a decade. I have warned, based on the mounting research evidence of how they cut lives short, and having, as an opposition MP, felt as if I was banging my head against a brick wall, I now find myself on the other side of that wall. Prescribing levels are coming down, they need to come down quicker and we are taking a wide range of actions to support staff in the community and in care homes to support people with dementia without recourse to a prescription pad.

Johanna10

Findings by the Royal College of Nursing highlight that the skilled staff-to-patient ratio on hospital wards is actually much lower for the elderly than it is for general adults and children. You have to admit that the skilled staffing numbers simply don’t add up, especially given the complex care needs of many elderly people. In fact, it's shocking. My question to Paul, is that based on these proven and reported figures, why does the government clearly seem to place more value on the care of children and general adults over that of the elderly? (Townswomen's Guilds member and supporter of the Hear My Voice campaign)

scribblegranny

Why do wards for older people have fewer registered nurses on them (1:9 against 1:6) than adult surgical and general wards? Is this right?

The Royal College of Nursing is currently undertaking a national project on safe levels of nursing for older people in hospital. Their preliminary findings suggest that ratios of trained staff per patient are slightly lower on specialist wards for older people. But we have to remember that the average age of people in hospital is 68, and older people are to be found on all adult wards. It's important that hospitals ensure safe overall numbers of staff, but also appropriately trained staff, and this is one of the issues that the CQC have responsibility for inspecting and taking action where appropriate.

We think this piece of work is really helpful and it complements the recommendation from yesterday's Commission on Dignity's recommendation that hospitals and care homes should review their staffing levels.

I've just this morning paid a visit to Kings College hospital where I popped in to meet with staff on the Marjory Warren ward, which is a specialist ward for people with dementia or delirium.

What was great about that was that they paid a lot of attention to the small details that can make the difference between excellent care and average care.

Carol

The only feedback I ever gave was to fill in the feedback form on the back of the menu. It was left with each meal so we could comment on the food. I watched the auxilliary nurses pick them up and shove them in their pockets, then one teatime I went to the end of the ward at the same time as the auxilliaries were leaving and saw the one who had picked my form up dump it in the bin. I asked her why she had done that and she said 'sorry love - there's nowhere to take them to now.'

JessM

mmm - I wonder if any of us ever remember being asked to give "customer feedback" by any NHS professional or institution? Not part of the culture is it.

I think Carol and JessM, you're right to highlight the importance of asking patients and carers for their views. This year, we have made it a must-do for NHS organisations to publish all their data on patient satisfaction and complaints and results of national clinical audits. And at a national level, the NHS Outcomes framework (which is all about driving quality in the NHS) has a whole section about patient experience.

You may be interested to know that the CQC published the results of a survey of more that 72000 NHS outpatients this week, which shows that more people are now seen on time or early for their appointment. The survey also found, and this is really good news, that more people were being treated with respect. It also highlights improvements that are needed, not least in the way in which treatments are explained to patients.

Clot

Your own party chairman has said that the Health Bill should be dropped. Is this the most precarious moment yet for the coalition?

I haven't seen what Tim Farron has said about the Bill. I know he is passionate about the NHS and protecting it. But I think, like me, he also knows that the NHS can't stand still, that as this webchat clearly demonstrates, we need an NHS that is better-equipped to support a growing older population and that means delivering care closer to home and it means joining up health and social care to deliver the right care at the right time.

The idea that dropping the Bill solves any problem, political or otherwise, in my view, is wrong, and would mean so many of the improvements that I've described earlier, would not happen.

flibbertygibbet

Do you expect that in 10 years' time most people will be taking out some form of health insurance?

No. But I do think that there is a need for more people to wake up to the truth, even the nasty little secret, about social care: it's not free, and never has been.

I know this comes as a shock to an awful lot of people, who think it's just like the NHS and think it will be free when you need it. And the sad thing is that too many of us fail to plan for the time when we might be frailer, and as a result of that, put ourselves at greater risk.

That's why we asked Andrew Dilnot to take a long hard look at how we currently share the burden for paying for care and make proposals for changing the system.

What we propose to do will be spelt out this spring in a white paper, but everyone who is following this will understand that sorting out who pays for social care is only part of the problem. We also have to make sure that people have access to much better information at an earlier stage. As all of us get older, and I celebrate my 50th this year, we have to have conversations earlier that are about how we plan for our long-term care needs, just like we have to have those conversations about pensions and other aspects of financial planning.

greatgablegran

To your knowledge, are there any members of the Cabinet who are dependent on the care system for their relatives?

And what solutions have they found?

Thanks

I don't have chapter and verse about the personal experience of Cabinet members and their family members, but what I can say is that some of the most powerful speeches made in parliament by MPs are ones where they draw on their personal experience and that of their family of health and care, and for me as an MP, the value of holding regular face-to-face surgeries with constituents is an invaluable source of firsthand experience and certainly fires me up for the job I do.

MervynK

Paul,

The Government has essayed the idea of enrolling members of the local public as additional lay inpectors to keep an eye on dignity, cleanliness, and the things you describe as basic commonsense. Has this thought been progressed?

Thankyou MervynK. The Prime Minister talked about this when he launched the Government's initiative to free up nurses from paperwork to spend more time with patients. The idea builds on our plans to establish a local HealthWatch in every community in England that will act as the champion for patients and those who use social care services. ONe of the ways in which they will be able to do that will be through volunteers taking part in inspections of hospitals, care homes etc. This will build on work such as the PEAT inspection programme, and we will be piloting this approach to inspection this coming year.

Just want to stress, this is not a substitute for the work of the Care Quality Commission, who themselves have started to involve patients directly in their inspection work which has provided invaluable insight and challenge to inspections.

JessM

Many years ago I was struck by the fact that most surgery is performed on older people? Do you know what percentage of beds is occupied by those over 70? (And if you don't know this - why not?)

Thanks for these questions. Fact is, older people are the main users of health services in this country. They account for about 60% of admissions into hospital and 70% of days in hospital beds. One quarter of those days in hospital beds are occupied by people over the age of 80.

Many of these people are vulnerable and have multiple health problems, such as dementia, diabetes, arthritis and many other possible conditions. Whilst this makes the care challenging and complex, it should never be an excuse for healthcare professionals to focus on the health problem at the expense of treating the person. That's why we have to see the care and treatment of older people as being the business of everyone who works in the NHS and care support services.

That is why training and ongoing professional development are so important. It's why the Royal Colleges and the professional regulators have such a crucial role to play in making sure that the curricula really do reflect how healthcare professionals should meet those challenges of providing the right care for older people.

juliaJ

Hello Paul, thank you for coming onto Gransnet. My question is: Is it your aim to bring in a national care system, as recommended by the Law Commission, to end the postcode lottery in care?

granIT

Do you think social care should be integrated with health services? When money is taken from care (by hard-pressed local authorities - it's not ring-fenced, of course) the NHS has to pick up the pieces anyway.

Wouldn't it be better to have a more integrated, strategic approach?

Thank you JuliaJ and GranIT for your questions about social care. Julia asked about the Law Commission report on social care. What I can tell you is that I think social care law in this country is a complete dog's breakfast, and is the product of piecemeal change over the last 60 years. Our social care law looks back to the poor law and is not fit for purpose.

The Law Commission's recommendations provide an excellent basis for a comprehensive overhaul of the law and the Government will be setting out its plans in a white paper shortly.

One of the things I heard last autumn, while we were consulting as part of our Caring for Our Future work, was just how hard people find it to navigate their way around the care system, which is where I can pick up on gratIT's question. We are making sure that health and social care are working much more closely together going forward. THat's not about more organisational change, it's about changing practice and making sure health and care professionals are working together as a team and that's the sort of integration we really need.

rosiemus

Do you think the Lib Dems have genuinely managed to improve the NHS bill? Sometimes I worry you're making concerned noises but not improving what seems like a pretty unpopular piece of government work. Thank you

Thank you for the question Rosiemus. Again, there are a lot of postings in this thread about different aspects of the bill itself, and a lot about the politics of the bill. Perhaps I could pull a few of those questions together and try to answer them now.

The Bill is about improving quality of care and the results for patients and carers. The reform is all about using the expertise of health professionals and the experience of patients and carers to inform the way services are designed and delivered in the future.

The Bill safeguards a comprehensive health service, free at point of use.

Much of the reporting of the Bill is a cocktail of scaremongering and flawed analysis and completely misleading conclusions.

The Bill will not lead to a market-led NHS, it will lead to a patient-led NHS.

Rosiemus, as I'm sure you know, the Bill is currently in the House of Lords, where peers of all parties have been scrutinising it for months. They are now debating and voting on changes to improve theBill. Many of those changes are the result of hard work by Liberal Democrat peers, such as Shirley Williams.

If I thought the Bill did half of the lies and half-truths that have been spread against it, I would not support it.

In fact the Bill will strengthen the Secretary of State's accountability to parliament. For the first time, he will have to consult on and seek parliamentary approval for the priorities he sets on the NHS.

The Bill will for the first time ever will require the NHS to tackle health inequalities. It will also make joined-up care within the NHS and within social care the driving force for quality care.

Not only does the Bill strengthen local accountability to make sure that services actually fit the needs of the local population, it also returns responsibility for public health to councils, where many of the actions to prevent ill-health in the first place can be taken.

Can I urge those asking about mandates to take a look at both the 2010 Lib Dem and 2010 Conservative manifestos, they might be surprised at what they find there.