Social care law revamp proposed

 10 May 2011 Last updated at 19:12 ET By Nick Triggle Health reporter, BBC News  Ministers are looking to revamp the social care system in England A major revamp of adult social care law in England and Wales is needed to ensure fairer access to services, the Law Commission says.

The government advisory body said the current framework, covered by more than 40 laws, was "out-dated and flawed".

Instead, it said there should be a single piece of legislation so people were clear about their rights.

The report is the first of two reviews ministers will use to reform social care in England in the coming years.

An independent commission has also been set up to look at how social care - which is currently means-tested - should be funded.

It is due to report in July and will be followed by a white paper at the end of this year and legislation in 2012.

Wales is looking at its social care provision separately.

There is almost universal agreement that social care needs reforming, as councils struggle to meet rising demand because of the ageing population amid cuts in funding.

'Dog's breakfast'

The Law Commission report has been widely welcomed by charities, who say it provides a good blueprint for reform of the system.

Michelle Mitchell, of the charity Age UK, described the recommendations as a "one-off opportunity to replace this dog's breakfast with a clear, logical and consistent framework".

Social care law has developed "piecemeal" since the National Assistance Act in 1948, the Law Commission said. There are now over 40 separate laws and thousands of pages of guidance.

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This report provides foundation for the most significant single reform of social care law in 60 years”

End Quote Paul Burstow Care services minister This has resulted in a system that is confusing for users, and at times contradictory, the report said.

For example, people with conditions that vary over time such as bi-polar disorder or dementia can in theory be excluded from care.

Meanwhile, while there is no law placing a duty on councils to support elderly people, they do have legal obligations to look after those with disabilities and mental health problems.

The recommendations call for a duty for councils to assess the needs of carers, and say the NHS and local government should work together more closely.

Frances Patterson, the commissioner who led the review, said: "Today signals a significant step in moving us closer to a clearer and more coherent framework for adult social care."

Care services minister Paul Burstow said the recommendations would be carefully looked at.

He added: "This report provides foundation for the most significant single reform of social care law in 60 years."

Soft Drink Industry Fights Proposed Food Stamp Ban

 

The mayor wants to reduce obesity and diabetes by banning the use of food stamps to buy “sugar-sweetened beverages” in New York City.

Food and beverage lobbyists see the mayor’s plan as a well-intentioned but misguided and paternalistic effort. They say it would create a logistical bottleneck at checkout counters and stigmatize poor people using food stamps.

They also fear that restrictions on soft drinks would set a precedent for the government to distinguish between good and bad foods and to ban the use of food stamps for other products — an issue sure to come up next year in the Congressional debate on a new farm bill.

“Once you start going into grocery carts, deciding what people can or cannot buy, where do you stop?” asked Kevin W. Keane, senior vice president of the American Beverage Association, whose members include Coca-Cola and PepsiCo.

New York officials estimate that $75 million to $135 million in food stamp benefits are spent on sugar-sweetened beverages in the city each year. Such beverages, they say, are the single largest contributor to the obesity epidemic.

“This initiative will give New York families more money to spend on foods and drinks that provide real nourishment,” Mr. Bloomberg said in seeking federal approval. City officials noted that federal policy already bans the sale of soft drinks in school lunch programs across the country.

The mayor’s proposal would go further by banning the use of food stamps to buy carbonated and noncarbonated beverages that are sweetened with sugar or high-fructose corn syrup and have more than 10 calories per eight-ounce serving.

Food stamp benefits are paid for entirely by the federal government, and the city is seeking permission from the Agriculture Department to test its proposal in a two-year project. Because the proposal would define “food” more narrowly than federal law and regulations, food industry groups have unleashed a barrage against it.

President Obama, whose position on the New York plan is unclear, is in an awkward situation. The Agriculture Department, historically averse to restricting the use of food stamps, has said, “There are no bad foods, only bad diets.” The department rejected a somewhat similar proposal from Minnesota in 2004.

But Mr. Obama has set a goal “to solve the problem of childhood obesity within a generation,” and his wife, Michelle, is waging a high-profile campaign to promote healthy eating. The Web site of Mrs. Obama’s childhood obesity initiative (www.letsmove.gov) even urges Americans to “drink less soda or sugar-sweetened drinks.”

Opponents say that many factors, besides soft drinks, contribute to obesity. Moreover, they say, imposing restrictions on food stamps would require retailers to reprogram computers and embarrass some customers at the checkout counter.

While the American Beverage Association has led the opposition, the fight demonstrates how various parts of the food industry have united to thwart the mayor’s proposal. Beverage industry lobbyists have worked with the Snack Food Association, the National Confectioners Association, which represents candy companies, the Food Marketing Institute, which represents 26,000 retail food stores, as well as antihunger groups like the Food Research and Action Center and Feeding America.

Eighteen members of the Congressional Black Caucus recently urged the Obama administration to reject New York’s proposal. The plan is unfair to food stamp recipients because it treats them differently from other customers, they said in a letter to Agriculture Secretary Tom Vilsack.

While Coca-Cola and PepsiCo are among the largest contributors to the nonpartisan Congressional Black Caucus Foundation, a research and education institute, caucus members say their positions are not influenced by such contributions.

The number of food stamp recipients nationwide soared as the economy slumped. More than 44 million people — one in seven Americans — receive aid through the program, now known as the Supplemental Nutrition Assistance Program, or SNAP.

Some public health groups and academics support the city’s proposal. Prof. Kelly D. Brownell, director of the Rudd Center for Food Policy and Obesity at Yale, said the New York project was “a test worth doing.”

“Through the SNAP program,” Mr. Brownell said, “the government spends hundreds of millions of dollars a year buying beverages that have been linked to risks for obesity and diabetes. These conditions cost the government and taxpayers billions of dollars a year in costs paid by Medicaid and Medicare.”

Some of the big industry groups have signed up lobbying firms. The Duberstein Group, led by Kenneth M. Duberstein, a chief of staff to President Ronald Reagan, reported that it had received $100,000 in the first quarter of this year to lobby for the Grocery Manufacturers Association on various issues, including proposals to restrict the use of food stamps.

Ellen Vollinger, legal director of the Food Research and Action Center, is leading efforts to assemble a loose coalition of food industry lobbyists and antihunger groups opposed to restrictions on the use of food stamps. Participants in the coalition said that another Washington lobbyist, Michael K. Torrey, had helped coordinate their efforts.

Mr. Torrey refused to discuss his role in those efforts. However, James A. McCarthy, president of the Snack Food Association, whose members include Kraft and Frito-Lay, a unit of PepsiCo, confirmed that Mr. Torrey was “under contract with us.”

In his latest lobbying report, for the first quarter of the year, Mr. Torrey said he had received $30,000 from the association to lobby Congress and the administration on issues including “the preservation of choice” in the food stamp program.

Jean Daniel, a spokeswoman for the Agriculture Department, said the agency was actively reviewing New York’s proposal. “We have a lot of questions,” Ms. Daniel said. “We have been going back and forth with the state on the questions.”

While some food companies openly oppose the New York proposal, others declined to comment and referred questions to antihunger or industry groups.

Susan Davison, director of corporate affairs at Kraft Foods, whose products include Kool-Aid and Oreo cookies, referred questions to the Food Research and Action Center. In an e-mail, Kirstie Foster, director of corporate public relations at General Mills, referred questions about the SNAP program to the Grocery Manufacturers Association.

And Brian Kennedy, a spokesman for the association, referred questions to two other trade groups, the Food Marketing Institute and the National Grocers Association, which oppose New York’s proposal.

 

The Texas Tribune: Children’s Hospitals See Peril in Proposed Budgets

Despite some efforts to ease the blow to pediatric health care providers, Texas’ proposed budget cuts will most likely have a disproportionate effect on children’s hospitals. The financial implications will not mean halting operations, or necessarily curbing care, advocates for the hospitals say. Instead, said Ben Melson, chief financial officer at Texas Children’s Hospital in Houston, the result will be cutting back on expansions needed to serve a growing population and on efforts to recruit and retain the best specialists and faculty.

The reason for the heavier impact hinges on Medicaid, the joint state-federal health care program that covers nearly three million needy children in Texas. State lawmakers, facing a huge budget shortfall, cannot find the multibillion-dollar savings they need without cutting already skimpy rates for Medicaid providers.

Children’s hospitals generally have much higher Medicaid populations than the average hospital — meaning rate reductions hit them harder. Their advocates estimate that the House’s budget would cost the hospitals a combined $275 million over two years; they say the version under consideration in the Senate would cost them roughly half that amount.

For Driscoll Children’s, where about 70 percent of patients are on Medicaid, the concern is not about preserving his bottom line, it is about just trying to break even. Both budget proposals “would essentially leave me a negative cash flow of about $10 million a year,” Mr. Woerner said.

Both the House and Senate versions of the budget lower Medicaid outpatient rates for children’s hospitals by 10 percent and reduce payments for nonurgent emergency room care. The House version goes even further, cutting inpatient children’s hospital rates, as well as all doctor and dentist reimbursement rates, by 10 percent.

While the Senate’s budget sharply reduces financing used to draw down a hefty federal match for children’s hospitals, the House’s zeroes it out altogether — at a loss of roughly $60 million, including the federal match, over the next biennium.

Bryan Sperry, president of the Children’s Hospital Association of Texas, said that on average, nearly 60 percent of the patients at the seven nonprofit children’s hospitals he represents are on Medicaid. In South Texas, Mr. Sperry said, that figure can reach 80 percent.

He estimates that for most Texas hospitals a 10 percent cut in the Medicaid rate would represent a loss of 1 percent of net patient revenue — but that for children’s hospitals, it would be up to 5 percent or 6 percent.

“We’re more dependent on Medicaid than any group of hospitals,” Mr. Sperry said. “Anything that happens to it has a big effect on us.”

Mr. Melson, of Texas Children’s Hospital, said his hospital stands to lose $4 million to $6 million a year through the proposed Medicaid cuts.

“We’re a high-acuity provider; we see a lot of critically ill children in our hospital,” he said. As the number of children in Texas continues to rise — it is expected to spike by another one million over the next decade — “we want to make sure we can continue to grow,” Mr. Melson said.

Mr. Sperry said children’s hospitals, which receive roughly one million outpatient visits and 500,000 emergency room visits a year, can “make it through the next two years” with the current Senate budget proposal, which could come up for a vote in the upper chamber as early as next week. The House version would be much tougher.

Regardless, Mr. Sperry said, lawmakers need to consider the long-term implications of clipping the wings of the hospitals that teach 70 percent of Texas’ pediatricians-in-training, especially as the country faces a growing shortage of physicians and specialists.