Margot James MP: How to keep older people out of A & E - and also improve their care

Margot James MP is PPS to Lord Green, Minister for Trade and Investment, Chairman of the All Party Parliamentary Group on Trade & Investment and the MP for Stourbridge. Follow Margot on Twitter.

Attendance at A&E has increased by 50 per cent in the past decade, hospitals face ever-greater pressure on this department, and knock-on effects across their services. During the Easter recess, I did some research and met two NHS Trust CEOs, the Chair of my local Dudley Clinical Commissioning Group, the regional director of NHS Direct and the CEO of the West Midlands Ambulance Trust. They confirmed that many cancellations of elective procedures were directly caused by unusually high numbers of urgent cases coming through A&E. So it is imperative that we understand the issues driving this surge in attendance.
 
The Health Secretary was quite right to identify the GP contract agreed in 2004, which led to a steep decline in GP out of hours commitment, as a factor causing increased pressure on A&E. Some 90 per cent of GP practices do not now provide out of hours services in the evenings or at weekends, and there has been an extra four million people each year using A&E since the GP contract changed. The inadequacy of the out of hours service was mentioned by everyone I spoke to in the NHS. We had a good service in this area before 2004, and it has not been fit for purpose since; Dr Laurence Buckman’s outburst recently does not change this fact.

Margot James MP: My colleague Daniel Kawczinski is wrong, wrong, wrong about UK Trade and Investment

By Margot James MP, PPS to Lord Green, Minister for Trade and Investment and Chairman of the All Party Parliamentary Group on Trade & Investment. Follow Margot on Twitter.

Writing in response to Daniel Kawczinski’s piece for Platform last week, in which he criticised the performance of UKTI, the first point to make is that although Britain’s exports are improving there is still a long way to go to make up the ground we have lost in the last few decades.

The Government’s central strategy since 2010 has been to re-balance the economy, away from the South East to the regions, from services to manufacturing, from a ballooning public sector to a revitalised private sector, and from consumption and imported goods to savings and exports.

The trade deficit has fallen from 4% of GDP to 1% of GDP. Exports to the growth markets outside the EU are up 30% on two years ago.  Since 2010 there have been 47 UKTI trade delegations to China alone involving 458 companies.  The UK Automotive industry posted its first trade surplus this year since the bad old days of 1976.

So what of the specific criticisms Daniel makes in his article?  Overall he is sceptical that Britain will meet its’ export goals of doubling the number of SMEs that export and he cites a low figure of just 25,000 companies exporting at the moment. In fact the current number of exporting SMEs is far more than 25,000, it is closer to 250,000.  This is still not as many as in Germany and France, but it is a great deal healthier than the picture Daniel painted in his article.

Margot James MP: The Government should use NHS savings to start properly funding adult social care

Margot James is the Member of Parliament for Stourbridge.

Social care has never been free at the point of delivery in the same way as health care.  There has always been a means test for social care. And the distinction between health and social care has meant that more and more care, especially in cases such as dementia, has been redefined as social care by stealth.

The first decade of the 21st century saw an assault on older people’s care.
Eligibility criteria were tightened. In 2005 half of all councils provided support to people assessed as having moderate care needs;  by 2011 that figure had fallen to just 18 per cent of councils. Moreover it is a reflection of the last government’s priorities that while spending on older people’s social care increased by less than one per cent between 2004 and 2010, the NHS saw increases of 27 per cent, the police of 20 per cent and schools 12 per cent.

Home care and residential care were increasingly privatised.  There is nothing wrong with that in principle, but the budgets were not sustainable given the demographic changes. Local Authorities were, and still are, paying rates significantly less than the cost of provision.

The means test for residential care is a cliff face.  If your savings, including your home, exceed £23,250 you are liable for the cost of care. It is this injustice that the Dilnot Commission seeks to remedy. Amongst many improvements recommended by Dilnot is the raising of the threshold to £100,000 and a cap on the total amount any one person would pay at between £25,000 and £50,000.  The Dilnot Commission has costed its proposals at £1.7 billion. Those working at the front line however are nervous of how this new money will be found.

Margot James MP: What room does the UK have for improving the quality of public services in the present economic outlook?

Margot James is the Member of Parliament for Stourbridge.

The Chancellor is doing all he can, given the worrying global economic picture, to apply creative thinking to find solutions that minimise the risk of unforeseen liabilities to the taxpayer in the years to come. With the possibility of the collapse of the Euro now being openly discussed in Frankfurt and Brussels no one can rule out the possibility of a second recession. From which the UK, although better placed than most countries, would not be immune. I would expect the Treasury to be drawing up contingency plans for this possibility whilst planning for modest growth in the hope that the more pessimistic voices are proved wrong.

The present crisis in the Euro and huge debt burden in the United States is shining a light on the lack of competitiveness of the West versus the developing economies. The rate of youth unemployment across Europe, the UK’s slide down the international league tables of educational attainment, and the lower rates of productivity compared with developing countries are the warning signs that, unless radical action is taken, the transfer of economic power to the developing world will gather pace.

Western economies, including our own, will have to reduce further the cost of entitlements and drive faster the improvements to productivity in public services as well as the wider economy. Therefore we need a contingency plan which embraces the possibility of substantially greater private and third sector provision of public services.

Margot James: How to deliver more for less in health and social care

Margot James is Conservative Party Vice Chairman for Women and PPC for Stourbridge.

I met the head of Adult Learning Disabilities and mental health at Dudley Council for a briefing on services and current issues the other day.

With the economy in a state of near ruin it is especially important that we protect what the media call ‘front line services’ for such vulnerable groups of people. Sadly if we are not very careful, such groups will suffer a disproportionate share of the cuts that are now being discussed by all political parties.

In just over an hour with the excellent head of service, Mr Richard Carter, I identified four areas where we could make substantial savings without affecting either the quality or the extent of the service received by those with learning disabilities and mental health needs.

Firstly, Dudley Council employ 70 social services staff ‘seconded’ to the Walsall & Dudley Mental Health Trust. Such large scale secondments are always problematic. Who are such staff accountable to? We have three bodies, the Local Authority, the Walsall and Dudley Mental Health Trust and the Primary Care Trust all trying to manage parts of a service that clients and carers assume is coming from one source. 

Try being the carer going between all these organisations – I’ve done it myself with older people and its almost a full time job!  We should consider merging all three groups under one management structure and budget. Definite savings at no detriment to service – in fact in my view such a move would enhance service.

Secondly, out of a total budget of some £24m for learning disabilities within the Local Authority, some £10m is spent on residential care.  The cost of caring for some of the clients with more complex needs can reach £3,000 per week.  These are private homes charging the taxpayer a great deal of money and their books should be scrutinized. Local Authorities account for almost 100% of their income.  The Councils should work together to drive down costs whilst maintaining standards.