TPR 2015 Care

 

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TPR 2015 Care

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2014 / 2015 CARE EDITION A YEAR IN PERSPECTIVE F O R E W O R D S The Rt Hon George Osborne MP The Rt Hon Alistair Burt MP R E P R E S E N TAT I V E S Advinia Healthcare Age UK Lincoln St Cuthberts Care Hoar Cross Nursing Home Auden House 247 Professional Health Morar Lodge F E AT U R E S Review of the Year Review of Parliament ©2015 WE STM I N STE R P U B LI CATI O NS www.theparliamentaryreview.co.uk

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Foreword The Rt Hon George Osborne MP Chancellor of the Exchequer The UK grew faster than any other major advanced economy in the world last year, and is set to do the same again this year. Over the past 5 years we created two million new jobs. And the deficit – now 3.7% of GDP – is a third of what we inherited in 2010. But all that progress could be put at risk if we don’t continue with the plan that is delivering for the working people of this country. Economic security is at the heart of that plan. It’s not enough to simply eradicate the deficit – we have to reduce our unsustainably high level of national debt. At the Budget I published a revised Fiscal Charter that commits us to running a surplus in normal times to bear down on debt. In the autumn the House will vote on that charter and I hope it will mark the start of a new settlement for Britain’s public finances. Improving productivity – the amount that British workers produce for every hour they work – is the key route to making the UK stronger and families richer, and it’s the greatest economic challenge of our time. We’ve set out concrete steps that we’re going to take to improve the infrastructure, education and skills of the UK – and to make sure that this time it’s a truly national recovery. Some of the biggest reforms include setting up a new roads fund to pay for the sustained investment our roads so badly need and introducing a radical new apprenticeship levy on large firms. We’re also devolving even more powers to local areas over things like planning, skills and Sunday trading rules. And to back British businesses and encourage them to invest we’re setting the annual investment allowance at £200,000 and cutting corporation tax to 18% by 2020 – making it the lowest in the G20. The final part of the plan is to make sure work always pays, so at the Budget I announced a new national living wage, reforms to our welfare system and lower taxes for working people so we move Britain to being the higher wage, lower tax, lower welfare economy we want it to be. “ “ Improving productivity is the key route to making the UK stronger and families richer, and it’s the greatest economic challenge of our time FOREWORD | 1

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Foreword The Rt Hon Alistair Burt MP Minister for Community and Social Care Advances in diagnosis and treatment mean we are living much longer. This is an excellent achievement that we should be proud of, but an ageing population means pressure on the NHS is growing. Within 5 years we will need to look after a million more over 70s. This pressure is intensified with the rise in chronic long-term conditions and a rapid growth in ‘lifestyle’ diseases such as obesity, as well as the welcome recognition that we need to do more to tackle mental ill health. To deal with this challenge we have to work in better, smarter ways to keep our growing elderly population healthy and living independently, or our hospitals will be overwhelmed. That’s why this government is embarking on the biggest ever programme to integrate health and social care so that people will be able to get the care they need outside of hospital and at a time that suits them. It is our ambition that by 2020 England will be the first country in the world to provide a truly 7-day NHS. The increasing demand for longer-term elderly care has made it clear that NHS and social care providers need to work together to coordinate care around each patient. So we are taking action though our £5.3 billion Better Care Fund, which is getting local NHS and councils working better together, and our ambition for a 7-day service will result in fewer days spent in hospital and social care. more than a billion pounds will also be spent over the next 5 years to improve mental health services. I want local areas to have the power to decide what is best for their communities, and strongly support the move towards more devolution of health and social care. Greater Manchester is the first English region to be given full control of its health spending, with the city’s £6 billion health and social care budget being taken over by the region’s councils and health groups. Longer term we want to see other areas coming forward with the same ambitions for their health and care services. I support an increased focus on preventive care, which costs less and helps people to live healthier, more active lives. This is surely what joined up health and social care should be all about. “ I am proud to be part of a government that is supporting the NHS’s own plan for its future – the Five Year Forward View – by committing an additional £10 billion by 2020 into health services that are being joined up with social care. As part of our commitment to the NHS, I want local areas to have the power to decide what is best for their communities, and strongly support the move towards more devolution of health and social care 2 | FOREWORD “

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Review of the Year CQC tackles failing care homes through special measures care services has been knocked by shocking examples of poor care,’ said Ms Sutcliffe. ‘I want to restore confidence by celebrating the good work we do see while also tackling persistent poor performance.’ Care home operators, however, are concerned about how the new regime will operate. Des Kelly, executive director of the National Care Forum, which represents not-for-profit care providers, questioned whether 6 months was a realistic time-frame in which to turn around a failing care home. ‘I know from experience that the journey from failing to meeting all the necessary standards is a difficult and challenging one, and one that often takes a lot longer than is initially expected,’ said Mr Kelly. ‘Being classified as in special measures would attract serious difficulties for local authorities in placing and funding people. Embargoes on placements would inevitably follow swiftly. Smaller providers would be most at risk from such action and the role of local commissioners is crucial.’ He went on to say: ‘Major changes to the approach to regulation and inspection are currently being developed and introduced, and CQC has significant additional duties and responsibilities of market oversight. Given the new responsibilities and significant demands on CQC, the timing of this new regime could risk seriously undermining the progress that the regulator has made over the last couple of years.’ review of the year CARE EDITION Andrea Sutcliffe, chief inspector of adult social care at the CQC Special measures that were first applied to hospital trusts are now being applied to care homes. In August 2014, the Care Quality Commission (CQC) announced a new regime to tackle failing care through special measures from April 2015. The process was introduced by the CQC in 2013 to 11 failing health trusts. Based on a system first used in schools, health and care services are rated as ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’. Care homes judged by CQC inspectors as being inadequate may be placed into special measures. CQC chief inspector of adult social care Andrea Sutcliffe said care homes placed into special measures would have 6 months in which to improve or face the consequences. ‘People’s confidence in adult social | 3

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THE PARLIAMENTARY REVIEW Highlighting best practice Mr Kelly said the wellbeing of the individuals receiving care and support must always be the primary focus, and this was at the heart of the dilemma in classifying a care service as in need of special measures. ‘It seems to be another indication of the way in which inspection and regulation is changing as the emphasis shifts significantly from monitoring compliance to acknowledging the role of regulators in driving quality improvement,’ he said. ‘There appears to have been a high level of support for the fresh start approach at CQC, but rushing ahead with special measures remains problematic.’ CQC published more detailed proposals for the regime at the end of 2014, saying that where a care home was judged to require special measures the regulator would ‘signpost providers to potential improvement agency support (where they exist) and monitor progress against their plans. The onus is on the service to resolve the issues of concern.’ Lester Aldridge solicitor Peter Grose, who specialises in care sector law, said that once a care home was placed in special measures, the ultimate sanction would be cancellation of registration if improvements were not made. He added: ‘It is significant that CQC says that when a service is placed into special measures CQC will ‘liaise with the local authority and the CCG so that they can begin planning for service continuity (if they are not doing so already). Such notification will almost certainly result in a contractual embargo which might make improvements that much more difficult to achieve.’ CQC has now begun implementing the regime, announcing in June that it had placed two care homes in special measures. Improvement support agencies include the Social Care Institute for Excellence, Skills for Care and other care providers who are performing well. Some have questioned whether 6 months is a long enough to turn around a failing care home Demos: push NHS to sell surplus land to build more care homes Late last year the cross-party think-tank Demos published the report from its year-long Commission on Residential Care, chaired by former care minister Paul Burstow. The commission’s headline recommendation is that the NHS should sell surplus land next to hospitals to build enough care homes and supported living apartments to meet increasing demand. In announcing the commission’s finding and recommendations, Mr Burstow said that making NHS land available was just one of many reforms urgently needed by the care sector. The Demos commission’s final report calls for incentives, such as expedited 4 | review of the year

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CARE EDITION from their home through commissioner decision-making, allow them to decide whether or not to have CCTV in their property, and offer shared ownership of and decision-making powers regarding communal areas. The report also recommends: » The Office for Budget Responsibility should conduct regular 20-year projections to accurately predict future demand for care services and the financial and technological requirements in the sector. People needing support should have far greater choice about where they live planning permission and reduced purchase prices, to sell surplus NHS, Ministry of Defence or other state‑owned land to providers who are willing to reserve a percentage of space for state-funded care, or contribute to local authority services. The report proposes more co-location in the sector – combining care properties with educational institutions or community centres such as nursery groups or libraries. The Commission examined models used in countries such as the Netherlands and parts of the USA, as well as initiatives in Britain, and concluded that people needing support with tasks such as washing and dressing should have far greater choice about where they live, enabling them to maintain their normal lives while receiving care. Mr Burstow argued that, while there will always be a place for care homes, other options were urgently needed, and said housing and care costs should be separated, along with the introduction of individual tenancy rights, to give people moving into care homes the same security and rights as those moving into supported housing or care villages. The proposals are designed to prevent care-home residents from being moved » Dropping the term ‘residential care’ from registration, local commissioning and national policy and replacing it with ‘housing with care’, to better describe a spectrum of options. » Expanding the Care Quality Commission’s role to inspect local health and care commissioners, not just providers, to focus exclusively on the quality of care rather than surrounding accommodation, bringing care home inspections in line with the current scrutiny of extra-care villages. » Introducing an industry-wide ‘licence to practise’ to ensure that all care workers receive a minimum level of training before they are able to support people unsupervised. The licence could also be suspended or revoked in cases of malpractice or abuse. » Making housing with care a living wage sector, to boost staff morale, reduce turnover and help tackle negative perceptions that have damaged the sector. In 2013 the coalition government agreed to ease planning restrictions on building more housing on brownfield sites. The Demos report recommends extending this to allow office blocks, university land banks and military land to be converted into special housing for people needing care. review of the year | 5

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THE PARLIAMENTARY REVIEW Highlighting best practice ‘Personal independence is wrongly linked in the public mind with remaining in one’s own home,’ said Mr Burstow. ‘In the UK and around the world we have seen great examples of how residential care can reinvent itself. It is no longer a last resort, but a respected part of a continuum of “housing with care”, which is enabling people to lead bigger and more fulfilling lives.’ Demos chief executive Claudia Wood said housing with care was a vital part of the vision outlined in the Care Act in early 2014. ‘The time for small‑scale solutions is over,’ said Ms Wood. ‘The Commission is calling for bold changes in the way residential care is inspected, commissioned and built to ensure the sector is fit for purpose and can meet the needs of an ageing population.’ Regulator resumes ratings regime In October 2014 the Care Quality Commission (CQC) began to implement its new approach to regulating social care in England, an approach that reintroduces a rating system, an earlier quality ratings system having been abandoned by the regulator’s predecessor, the Commission for Social Care Inspection. While welcoming the new approach, care providers have warned that a continued squeeze on social care budgets means better services are increasingly difficult to deliver, and some providers are closing down as a consequence. The CQC is now inspecting services against what the regulator says matters most to the people who use them – are they safe, caring, responsive to their needs, effective and well led? The CQC then awards an overall rating of ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’. By March 2016, the CQC expects to have rated every adult social care service in England. Following its public consultation and testing in mid-2014, the CQC published the questions (called ‘key lines of enquiry’) that its inspection teams now use to guide them on their visits, as well as descriptions of what care would look like for each of the four ratings. The CQC says the guidance will be used by its inspection teams when they inspect care homes and community services to help them be consistent when making their judgements. For care providers, it will help them to understand the sorts of things that the CQC’s inspection teams will be focusing on and help them know what the CQC will be looking for when awarding its ratings. Separate key lines of enquiry and ratings characteristics have been published for residential care homes (with and without nursing) and community services, including homecare (where people receive care The CQC is now inspecting services against what matters most to the people who use them 6 | review of the year

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CARE EDITION in their own homes) and supported living services. Care homes and other registered care services must now display their current rating on each premises where care is being delivered (unless care is being delivered in a person’s own home), at the main place of business and on the care provider’s website. Few would dispute that the reform of the CQC inspection regime was long overdue, and the industry has broadly welcomed the new system as a positive force for change, with services needing to go above and beyond compliance in order to receive a rating of good or outstanding. Many care providers, however, are concerned that the pressure to deliver better-quality care is at odds with the fees they can realise, particularly from state-funded clients. Austerity measures have seen local authorities restrict their social services budgets and raise eligibility criteria to make funding available to fewer people. Adult social care budgets are forecast to reduce by £0.5 billion this year (2015–2016), following 5 years of cuts totalling £4.6 billion. Ian Wilkie, a director of Healthcare Property Consultants, commented that there are signs that this imbalance of increased regulatory expectations, coupled with downward pressure on fees, is starting to bite. ‘We are beginning to see the closure of established care beds, where seasoned operators are, in effect, throwing in the towel and taking the view that the path of least resistance is to sell their properties for redevelopment rather than continue an increasingly fraught battle with regulators,’ he said. ‘These are not necessarily the smaller converted properties we may expect, and recent examples of this amongst our own clients include two substantial, purpose-built care homes with an aggregate provision of more than 150 beds.’ Mr Wilkie recalls a similar combination of events around the turn of the millennium, where increased pressure on local authority fees combined with a new regulatory environment resulted, at its peak, in the loss of 10,000 beds per annum from the care sector: ‘If CQC continues down the path of imposing stricter regulatory demands on clients with no heed being taken of the funding available to provide such care, then it is likely we will see a similar pattern today.’ Sector investment – the REIT rationale Healthcare as part of the ‘alternatives’ asset class is attracting more investment interest from institutional and retail investors alike. The UK’s elderly care sector in particular is seeing an increased level of investment activity, benefiting from the favourable underlying population dynamics that are driving demand in the sector. Not only is the number of 85-year-olds set to double in the next 20 years but the average life expectancy beyond retirement age is also increasing rapidly. Just 40 years ago the average retiree lived for 2 years post-retirement compared with 20 years today. In its 2015 UK Healthcare Property Review, commercial property consultants Knight Frank said that the summer of 2014 saw some outstanding transactions, with activity not witnessed since 2007. In its overview it said: ‘The US REITS [Real Estate Investment Trusts] have dominated media headlines with their recent acquisitions, in particular review of the year | 7

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THE PARLIAMENTARY REVIEW Highlighting best practice HCREIT’s purchase of Gracewell Healthcare. However, UK institutions have reacted in spectacular fashion, such as M&G’s acquisition of a portfolio of Priory Group assets for c. £230  million and Spire’s successful public flotation. The Scottish Independence Referendum had no impact on the sector and the calendar year is on track to finish on a high as a wall of buyers close in on a limited supply of stock.’ Kenneth MacKenzie, managing partner of Target Advisors, which negotiates on behalf of Target Healthcare REIT, a Jersey-based specialist investor in UK care homes, said about 15% of those over 85 years old were expected to make use of residential care of one form or another, and, to meet this demand the UK’s ageing care-home stock needed to be substantially upgraded – about 85% of UK care homes being more than 10 years old. ‘This presents a clear investment opportunity for those real estate investors willing to invest in modern, purpose-built healthcare facilities run by quality care operators,’ said Mr MacKenzie. ‘Investing in the elderly care sector, however, is not without its challenges and there have been a number of high-profile cases in recent years which have evidenced this. As in any service-led sector, there is the potential for reputational issues as a result of poor provision of care which investors must seek to insulate themselves from. The lessons first expressed by Florence Nightingale in the 19th century about ensuring high standards of care, both clinical and social, still hold true today – in our experience, if the underlying care fundamentals are strong, then the financial performance typically follows.’ While the overwhelming mood is positive and the direction of travel is for gradually rising values over the next few years, many pundits have pointed out that the REITs’ appetite for investment in British care homes will be tempered by constraints on profitability, particularly for those facilities that rely on state-funded clients for their occupancy. ‘Care funding remains firmly on the agenda with a burgeoning gap in terms of the cost of elderly care between those residents paid for out of government funds and those who are self-funded, with the latter in effect subsidising the government shortfall with very little by way of care service differentiation,’ said Kenneth MacKenzie. ‘Investors need to be engaged with the care providers, sensitive to the local market conditions About 15% of those over 85 years old are expected to make use of residential care of some form It is likely that the REITs’ appetite for investment in British care homes will be tempered by constraints on profitability 8 | review of the year

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CARE EDITION and seek to avoid single operator risk by investing alongside a range of well‑established, quality care operators. Ensuring these elements are addressed is the key to accessing consistent, stable returns over the long-term.’ The specialist care sector, with facilities such as those catering for younger adults with physical or learning disabilities, has also seen a raft of substantial corporate deals, with more action in the past 12 months than the previous 9 years. Private equity was involved at some point in every transaction, and these deals have all been for multi-site corporates, focused on operators providing first-class care in reasonably high-quality settings. Health and social care integration – the Manchester experiment Getting better cooperation across the great divide between the health and social care systems has challenged politicians for at least the last 40 years, but despite all the best efforts of policy-makers – from the joint finance initiatives of the 1980s to the special funds currently available for collaborative working – the gap still yawns. The pace of political discussion has quickened with ever-more widespread recognition that the crisis of hospital bed occupancy is directly related to the scarcity of community-based alternatives, with the rationing of the latter being in the hands of adult social services departments. Local authorities’ services have suffered under the government’s austerity programme, and however much councils have tried to protect social care, it has had to take a share of the hit. The result is that eligibility criteria have been tightened so that many thousands fewer receive state-funded residential or domiciliary services than was the case 5 years ago, day care has almost ceased to exist, and support for the families and carers of disabled and other vulnerable people has been severely restricted. The result is ‘hospital bed-blocking’ or ‘delayed discharge’ – people who might well have been helped in residential care or in their own homes are instead a dmitted to hospital. Hospital patients whose medical needs have been substantially met cannot be discharged due to a lack of communitybased services to support then through a period of rehabilitation. Politicians are now talking of a much more radical organisational integration, which could only mean the transfer of adult social care management to the NHS. It was announced in late February that Greater Manchester would become the first English region to get full control of its health spending, as part of an extension of devolved powers. review of the year Greater Manchester will become the first English region to get full control of its health spending | 9

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THE PARLIAMENTARY REVIEW Highlighting best practice Chancellor George Osborne said the region’s £6 billion health and social care budget would be taken over by councils and health groups, with the scheme coming into force from April 2016. ‘This is what the NHS wants to see as part of its own future,’ said Mr Osborne. ‘It’s also about giving people in Manchester greater control over their own affairs in that city, which is central to our vision of the “northern powerhouse” – so it’s a very exciting development.’ The plan would see local leaders, and ultimately Greater Manchester’s new directly elected mayor, control how budgets are allocated. A shadow Greater Manchester Health and Wellbeing board will be appointed, which will work closely with existing clinical commissioning groups of GPs. The board is expected to run from April, before control of the budget is handed over a year later. Private-sector providers of social care have long argued for a better integrated system of health and social care, and the case for reform has most recently been made in a pamphlet that advocates change to a joinedup integrated health and social care system linked to academic health and science centres. The pamphlet – Away From the Past and to a Sustainable Future: How the UK’s Health and Social Care Systems Can Be Reformed to Better Align With the Needs of Today’s Society – is co‑authored by brothers Ian and Stephen Smith, each a heavyweight in the social care and health sectors. Ian Smith is chairman of Four Seasons Health Care, the UK’s biggest independent health and social care provider. Stephen Smith is a professor of medicine, and set up the first academic health and science centre at the Imperial College Healthcare NHS Trust in 2007. Despite a growing consensus around the need for integrated care, the system has proved resistant to change. The authors examine the reasons for this resistance and propose measures to accelerate productive reform. They believe the country needs to move to integrated care organisations that will remove boundaries between health and social care, with each patient having a ‘case manager’ who would navigate them through the system. Chancellor George Osborne – devolving spending to Manchester is part of his vision of a ‘northern powerhouse’ Cross-subsidy under threat from new council commissioning rules The cross-subsidy of publicly funded care home residents by self-funders has been common practice for many years. Occasional grumbling aside, people tended not to talk about it too much because it suited them not to. Local authorities could get away with paying lower fees, and providers were content for the cross-subsidy if it meant the sustainability of their businesses. With the coming into force of the Care Act 2014, however, this elephant in the room can no longer be ignored. For the first time, the Act provides that local authorities must arrange services for self-funders. When local authorities arrange such care, they are unlikely to be able or willing to accept different fees to those paid by local-authority funded service users. Care users, especially when they are supported by advocates, families and deputies, can be expected to ask local authorities to arrange their care, knowing they will only have to pay local authority rates, rather than the fees that homes charge 10 | review of the year

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CARE EDITION to self-funders who approach them directly. That likelihood is compounded by the fact that service users will have to engage with local authorities in order to set the clock ticking on the £72,000 cap for care costs. As they will already have had an assessment by the local authority, it is only a small further step to ask the local authority to arrange the care. The provision is not expected to come into force fully until 1 April 2016. However, from 1 April 2015, local authorities have the power to make such arrangements. Writing in the sector magazine Caring Times in March, specialist lawyer Jonny Landau said it was clear that there would be at least some cases where local authorities will approach providers to ask them to provide care for self-funders, almost certainly at local authority rates. ‘Strategically, in response to this threat, the best approach for providers may be to fragment services into two categories: basic care homes that cater for state-funded residents subject to the usual rates of local authorities, and high-end homes that provide a hotel-type experience for self-funders,’ said Mr Landau. ‘Some providers may opt to specialise in only one of the two types of home, or provide both, perhaps developing separate brands for each.’ Major care home operator Four Seasons Health Care implemented this latter strategy at the end of last year. Mr Landau said there may be other options for care homes that were used to relying on the cross-subsidy and were not part of a group that could fragment in this way. ‘If the local authority fees really are so low that they must be cross-subsidised, they can challenge the fees,’ he said, acknowledging that the costs of this may be prohibitive for individual providers. ‘What can providers do when the local authority makes an approach on behalf of a self-funder? One option is to refuse to accept self-funders arranged by local authorities but that may mean losing the prospective residents altogether. Another option is for providers to make it clear to local authority commissioners that while they will happily accept self‑funders through the local authority, they will continue to charge their self‑funded rates. It remains to be seen how that strategy would play out. Local authorities may play ball, telling service users that care homes are able to charge whatever fees they wish. Local authorities will, after all, then continue to benefit from the cross‑subsidy. However, such an approach is unlikely to satisfy self‑funders, their representatives or the Local Authority Ombudsman.’ The overall impact of the new provision may well be a fragmented care system: a budget sector for funded residents, and a luxury sector for self-funders. The days when residents lived in the same homes regardless of their funding source may be numbered, and providers will need to make strategic plans to adapt. Self-funders who ask local authorities to arrange care services are unlikely to be willing to pay higher fees than funded users review of the year | 11

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THE PARLIAMENTARY REVIEW Highlighting best practice Free social care at end of life? Social care should be free to everyone at the end of life, said a report by the Commons Health Committee released in early March. The MPs’ report called for better recording of what people want in their last days, and said there was ‘unacceptable variation’ in the care received by people in England. Former care minister Norman Lamb said the then-coalition government was looking carefully at a policy of free end‑of-life social care. End-of-life care is defined as applying to people expected to die within 12 months – and about half-a-million people die each year in England and Wales, and most of them have an incurable or progressive illness. The health committee report, based on evidence from clinicians, charities and palliative care experts, found ‘great variation in quality and practice across both acute and community settings’, and has recommended that one senior person in each NHS trust and social care provider organisation be given the responsibility for monitoring how end‑of-life care is delivered. According to The Cicely Saunders Institute, which conducts research into palliative care, approximately 53% of deaths occur in NHS hospitals, with around 21% occurring at home, 18% in care homes, 5% in hospices and 3% elsewhere. This is despite the fact that two-thirds of people say they would prefer to die at home and 29% say they would prefer to die in a hospice. The committee said that too often staff felt they lacked the confidence and training to talk about end-of-life issues with patients, and recommended all staff be given relevant training on care planning, and that bereavement support should be offered to families. It also said it wanted the government to ensure that no one died in hospital, rather than at home, ‘for want of a social care package of support’. Former care minister Norman Lamb said the coalition government was looking carefully at the costs and benefits of such a policy. ‘We know that, thanks to the hard work of health and care staff and carers, many people already receive good end-of-life care,’ he commented. ‘We are determined to improve further, and by April, 70% of clinical commissioning groups should be capable of using electronic records to share end-of-life care choices across the health and care system so people’s wishes can be respected.’ Mr Lamb said that, when this happened, more people will be able to die where they want to be, at home with loved ones. However, Dr Jane Collins, chief executive of charity Marie Curie, said the current situation had to change. ‘We see a big difference depending on the diagnosis, so you’re more likely to get good care if you have cancer. Most people say they do not get the care and support they need, and still around half of people in the UK die in hospital despite this being the more expensive Dr Jane Collins, chief executive of Marie Curie Norman Lamb 12 | review of the year

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CARE EDITION option and the place where most people say they would not want to die. The challenge for the next government is clear – there needs to be a dramatic improvement in access to high-quality care in the community, available for people early on in their illnesses so that they can live well and stay out of hospital for as long as possible.’ The health committee report said every care provider should have a model in place that would deliver personal, bespoke care to people at the end of life. It said people with dementia should have equal access to end-oflife care as those dying as a result of other conditions, and that particular attention should be paid to discussing and documenting their wishes as early as possible following diagnosis. MPs welcomed the focus on end-of-life care by the Care Quality Commission, recommending that the commission monitors both acute and community health care providers’ move to the new approach in their inspections and as part of its thematic review. The Prime Minister’s Dementia Challenge 2020 – political priorities for dementia From whichever political perspective one is coming, there is no denying David Cameron’s personal commitment to action to combat dementia. The Prime Minister’s Dementia Challenge 2020 updates and extends a similar document launched in March 2012. Dementia is a growing global challenge. As the population ages, dementia has become one of the most important health and care issues facing the world. In England, it is estimated that about 676,000 people have dementia, and the condition has a huge impact on those who have it, their carers and families, and society more generally. ‘The fall-out on people’s lives can be simply catastrophic,’ said Mr Cameron in his foreword to the Dementia Challenge document. ‘With the numbers of people with dementia expected to double in the next 30 years and predicted costs likely to treble to over £50 billion, we are facing one of the biggest global health and social care challenges – a challenge as big as those posed by cancer, heart disease and HIV/AIDS.’ The Dementia Challenge document identifies two headline goals – by 2020 the Prime Minister wants England to be: » the best country in the world for dementia care and support, and for people with dementia, their carers and families to live » the best place in the world to undertake research into dementia and other neurodegenerative diseases. review of the year The number of people with dementia expected to double in the next 30 years | 13

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