Policy News from MHA: October 2016

Welcome to MHA's October policy bulletin

 

Parliament has gained momentum following the Party Conferences in September and early October, with several inquiries and pieces of legislation progressing including the Adult Social Care inquiry, the Apprenticeship Levy, Neighbourhood and Planning Bill and National Citizens Service Bill. This update also details changes made to people in Government, through by-elections, the Shadow Cabinet reshuffle and Select Committee changes.

Government: - Party Conferences round-up - People changes - Progress of Legislation, Inquiries and Government policy - Brexit - Charities - Health and Social care - Housing - Workforce -

Highlights of emerging research and policy in other areas of interest:

Ageing and wellbeing: - Inequalities - Ageing and urbanisation -

Dementia: - Risk reduction -

Health: - NHS Forward planning and transformation -

Housing: - Autumn Statement -

Local Government: - Funding pressures -

Social Care: - Sector Analysis -

Third Sector: - Volunteering - Fundraising -

Workforce and employment: - Nursing - Older Workers - National Living Wage -

Look Ahead: November and beyond

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Government

clipboard imageParty Conferences (summaries courtesy of DeHavilland)

Conservative Party

  • Health Secretary Jeremy Hunt said he wanted to deliver the safest quality of care in the world. He outlined Government measures to improve cancer treatment, mental health services and A&E departments and made a direct plea to the British Medical Association to resolve the dispute over the junior doctors’ contract. He also announced that from September 2018, the Government would fund up to 1,500 additional student places through medical school each year.

  • Home Secretary Amber Rudd's speech focussed on immigration, modern slavery and counter-terrorism. She announced a series of measures to tackle illegal immigration, including a consultation on steps to control work and study routes. At the same time controversial measures were revealed to force organisations to share how many foreign workers they employ, although this has since been diluted suggesting that such information would be now just be used to guide policy development to address skills shortages. 

  • In other speeches, Chancellor Philip Hammond spoke of Brexit and the economy, pledged that the Government would take whatever steps were necessary to protect the economy from “turbulence”.  International Trade Secretary Liam Fox's speech covered Britain’s future outside of the EU, stressing that the Government must up skill the workforce and invest in infrastructure to build an economy that “works for everyone”.  Culture Secretary Karen Bradley's speech outlined how culture and sport could bring people together and pledged that the UK Government would help all “digitally deprived adults” to reach a basic level of competence, through a new Statutory Duty in the Digital Economy Bill. Local Government and Communities Minister Sajid Javid announced a £3bn Home Builders Fund to build 225,000 new homes and that a Housing White Paper with "significant measures" would be published later this year.

  • In her closing speech, Theresa May declared that the Conservative Party would become the Party of working people, public servants and the NHS and stressed that Government would build a country that worked for everyone and would not shy away from market intervention and reform.

Scottish National Party

  • At the Scottish National Party, Nicola Sturgeon announced plans for a second Scottish independence referendum. She said "I am determined that Scotland will have the ability to reconsider the question of independence and to do so before the UK leaves the EU - if that is necessary to protect our country's interests." A draft Referendum Bill has been published for consultation seeking views on how a referendum should be run.

People changes

  • Following various changes in Government, five new Select Committee Chairs have been elected: Labour MP Hilary Benn takes the role of Exiting the European Union Committee Chair and Yvette Cooper MP of Labour was elected to chair the Home Affairs Committee. Conservative MP Damian Collins was elected to Chair the Culture, Media and Sport Committee, Conservative MP Stephen Metcalfe was elected Chair of the Science and Technology Committee, whilst SNP MP Angus MacNeil was confirmed Chair of the International Trade Committee.

  • Two by-elections have taken place this month.  In Batley and Spen, Labour retained their seat with new MP Tracy Brabin. The Conservative party held David Cameron's former seat in Witney, with Robert Courts elected as the new MP. He faced a strong challenge from the Liberal Democrat Party, resulting in a 19.2% swing and a 20,000 reduction in his majority.

  • Following the decision to allow a third runway at Heathrow Airport, Conservative MP Zac Goldsmith resigned, triggering a by-election for the Richmond Park seat in December. Zac Goldsmith announced his intention to stand as an independent candidate. The Liberal Democrats have confirmed Sarah Olney as their candidate.

  • Labour Leader Jeremy Corbyn has completed his Shadow Cabinet reshuffle, with those of interest to MHA include: Shadow Home Secretary – Diane Abbott; Shadow Secretary of State for Business – Clive Lewis; Shadow Secretary of State for Work and Pensions – Debbie Abrahams; Shadow Secretary of State for Health – Jonathan Ashworth; Shadow Secretary of State for Communities and Local Government – Teresa Pearce (standing in for Grahame Morris); Shadow Secretary of State for Culture, Media and Sport – Tom Watson; Shadow Minister for Housing – John Healey; Shadow Minister for Mental Health and Social Care – Barbara Keeley; and Shadow Minister for Local Government and Housing - Roberta Blackman-Woods.

  • UKIP Leader Diane James quit after 18 days . Commenting on her resignation, she said: “It has become clear I do not have sufficient authority, nor the full support of MEP colleagues and party officers to implement the changes I believe are necessary and upon which I based my campaign.” Nigel Farage has returned as interim leader.

Progress of legislation, Inquiries and other Government policy

Brexit

  • The MPs who will sit on the new Exiting the European Union Select Committee have been elected. This 21-member committee will oversee the work of the Department for Exiting the European Union. Conservative Party MPs include: Alistair Burt, Maria Caulfield, Michael Gove, Andrea Jenkyns, Jeremy Lefroy, Peter Lilley, Karl McCartney, Craig Mackinlay, Dominic Raab and John Whittingdale. Labour Party MPs include Pat McFadden, Seema Malhotra, Emma Reynolds and  Stephen Timms.  Two spaces have been set aside for SNP MPs, whilst the Liberal Democrats, DUP, SDLP and Plaid Cymru will each have one seat. Changes to members in other Select Committees will follow due to the creation of this committee, the new International Trade Committee and the Labour reshuffle .

  • The Commons Library has published a research paper Brexit: implications for the housing market and construction industry, summarising early indications of the impact of the vote on the UK housing market and house building industry. The topics covered include: construction industry confidence; the housing market; house prices; house builders' shares; the labour market; and potential policy responses. It highlights that the social housing sector has identified an opportunity arising out of the Brexit vote to press for the development of more housing at sub-market rent, with the National Housing Federation having put an offer to the Government setting out the sector’s readiness to build “through the uncertain times following the vote to leave the EU” and has requested flexibility to invest in a variety of tenures. See the Housing section for more.

  • In a Commons debate Exiting the EU Secretary, David Davis MP, said that “Five out of six migrants who are here either already have indefinite leave to remain or ​will have it by the time we depart the [EU]” (10 October 2016). However analysis by Full Fact suggest this is unsubstantiated.  They write that a high proportion of EU citizens in the UK are likely to be entitled to a special status under EU law by the time of Brexit, but whether that matters afterwards depends on what the Government decide. "There are figures to suggest five out of six citizens of EU countries, living here at the moment, could have clocked up five years of living here by the time the UK leaves the EU. That would make them eligible for ‘permanent residence’, provided they meet other criteria too. But we don’t know how many people will actually be eligible even if this does play out, we don’t know how many will leave before then, and we don’t know whether this status would be recognised after the UK leaves."

Charities and Voluntary Sector

  • The National Citizens Service Bill has had its first reading, which intends to secure the future of the National Citizen Service. The NCS has been running for five years and is a voluntary personal and social development programme for 16 and 17-year-olds, which runs for two to four weeks in the school holidays, providing skills development, social action and adventure. The original aims were to give young people the opportunity to develop the skills they needed to be ‘active and responsible citizens’, mix with people from different backgrounds and get involved with their communities. The Bill will create a National Citizen Service Trust, established by Royal Charter and make the it accountable to Parliament and the public.  Former Prime Minister David Cameron has announced he will become the chairman of NCS Patrons. NCVO welcomed the Bill, recognising that the NCS has made a big difference for lots of young people. However, they suggest further collaboration with the voluntary sector could help NCS reach its potential, particularly as a starting point for life-long volunteering.  Meanwhile, the National Audit Office confirmed it is investigating the value for money provided by NCS.

  • The Small Charitable Donations Bill, has progressed to Public Bill Committee Stage. This Bill will make a number of amendments to the legislation which underpins the Gift Aid Small Donations Scheme. The purpose of these changes is to simplify the scheme and extend access to smaller and newer charities. The Commons Library has published a briefing paper outlining the Bill and NCVO have published an analysis of the Bill and implications for charities.

    MHA comments: This Bill is aimed at smaller charities, however we will keep watch as it develops, as other implications for larger charities could arise as it progresses.

Health and Social Care

  • The Community and Local Government Committee's Adult Social Care inquiry has been receiving oral evidence.  Appearing at the Committee, Ray James, immediate past president of the Association of Directors of Adult Social Services (ADASS) said, “I don’t think there is evidence anywhere in the world that integration alone will solve the scale of the challenges we face in adult and social care. It has to be both – adequate resources and integration... this system is not sustainable with the current assumptions about GDP and levels of funding when you look at demand going forward.” Sarah Pickup, deputy chief executive of the Local Government Association, said that social care funding would stay at the same amount from 2009-2010 to 2019-20, meaning it was facing “10 years of flat cash for social care in the face of demographic pressures, inflation, Deprivation of Liberty Safeguards, the Care Act and all the other pressures and expectations that have come our way”. In a separate appearance, Professor Martin Green, Chief Executive of Care England raised the issues of new and additional costs to care providers, very low local authority fees, failed Costs of Care exercises and the variability of commissioning practice.  He said “I am pleased that the committee has listened to evidence about the pressures placed on providers of social care, including the rise in regulatory costs and the increased wage bill from the National Living Wage. I was also pleased to take part in a session that offered the Committee a picture of the demographics. This morning, I was keen to outline that the sector could not provide ambitious, future-facing care for rising numbers of older people with complex needs for £2.24 per hour.”

MHA comments: we have contributed to this inquiry and the concerns we raised have been echoed in this oral evidence sessions. We wait with interest to hear the Committee's conclusions from this inquiry.

  • MPs from the Health Select Committee including Conservative Committee Chair Dr Sarah Wollaston MP, have said that the government is incorrect to keep claiming it is allocating an extra £10bn to the NHS in England over the next five years. In a letter to the Chancellor, they suggest that say using the figure gives the "false impression that the NHS is awash with cash".  The letter states that a substantial part of the extra funding for the NHS comes from cuts to other areas, such as public health. Dr Wollaston added "The point is that I think the government needs to actually look at the demand pressures in the NHS and social care, which are very unlike other departments."

  • The Commons Library have published briefing paper - The Future of Attendance Allowance, which summarises developments since the Government's announcement in December 2015 that it would consider giving the administration responsibility to councils.  It also summarises reactions to the proposals from local government bodies and other stakeholders.

    MHA comments: we contributed to the consultation which covered this proposal to move the responsibility of Attendance Allowance to local government and will keep a watching brief for the Government's decision.

  • In the draft Welsh budget 2017/18, the Welsh Government have pledged to raise the amount older people can have in savings from £24,000 to £30,000, before they have to start paying for care and have allocated £4.5m to local government to fund this commitment. The ambition is to eventually raise this rate to £50,000.

  • See the Social Care section for more analysis on the state of the social care sector.

Housing

  • The Neighbourhood Planning Bill has progressed to Committee Stage, where it will be considered by the Public Bill Committee. Various amendments have been mooted including a proposal from Housing Minister Gavin Barwell to allow County Councils the power to create a local plan where a District Council has failed to do so. Shelter have published a short guide to the Bill and suggest it is "a welcome step towards a strong, positive planning system."

    MHA comments: This Bill will impact on how local planning decisions are made, including issues relating to older people's housing. We support the view of ARCO, who suggest the Bill presents opportunities to establish a clear and definitive outline of housing-with-care and ensure that planning authorities commit to build a sufficient numbers of housing-with-care units within their localities.

  • Lord Gary Porter, Chair of the Local Government Association (LGA) has pledged to oppose proposals for a new duty on councils to provide supported housing. The comment comes as the Government announced plans last month to change how Local Housing Allowance will work for supported housing. Speaking at the Conservative Party conference he said “If anybody is talking about giving us [local government] new duties, they need to go away and they need to go away very quickly. You cannot solve problems by making councils have duties to do things. You have to give us the means to will the outcome.” The Government is set to publish a consultation on supported housing funding soon.

  • The Homeless Reduction Bill (a Private Member's Bill sponsored by Bob Blackman MP) has progressed to Committe Stage after securing cross-party support. The main features of the bill are to remove the “priority need” category and the requirement of being physically homeless before a person is housed. Councils will have a duty to help those at risk of homelessness 56 days in advance  and to provide them with support for a further 56 days to secure accommodation.  It aims to move away from box-ticking to trying to help people in flexible and creative ways. There are concerns about the ability to implement the policy in areas like London and other areas facing significant housing pressures.

  • See the Brexit section for a summary of implications for Housing and Construction implications.

Workforce

  • The Government has published updated guidance on the new Apprenticeship Levy, with some changes to address concerns of employers, including: an extra 20% of funding to train 16 to 18-year-olds; increased funding for employers to train apprentices in the poorest parts of England; increased funding for employers who take on apprentices under 24 years old who are in care or who have special educational needs; and an increase from 18 to 24 months for businesses to spend the vouchers.

  • The system of sick pay and GP “fit notes” is to be reviewed by the Department for Work and Pensions, in a bid to address the growing cost of long-term sickness to the NHS and suggested getting people back to work had major benefits for health. The review will also examine changes to the controversial work capability assessments undergone by disabled people in order to obtain welfare.

  • The Business, Energy and Industrial Strategy Committee has launched an inquiry into the Future world of work, focussing on the rapidly changing nature of work, the status and rights of agency workers, the self-employed and those working in the 'gig economy'. The inquiry also looks at such as low-pay and poor working conditions for people working in non-traditional employee roles. The deadline for written submissions is Monday 19 December 2016.

  • An interim report on the future of the State Pension Age beyond 2028 has been published, which considers the changing demographic, economic and behavioural landscape. The Pensions Act 2014 requires the government to review the State Pension Age during each Parliament. The current review is gathering evidence and will make recommendations to the government in 2017. The interim report marks the start of a consultation running to 31 December 2016. TUC General Secretary Frances O’Grady said The review has made a good start identifying the challenges ahead, and making sure that the needs of carers and the self-employed are not overlooked... But hiking up the retirement age will not help, especially in parts of the UK with lower life expectancy. We should instead remove barriers faced by those who choose to work into later life."

MHA Comments: We support the Centre For Ageing Better's view that the State Pension Age review needs to consider the persistent health inequalities of older people across the country. We also recognise the choice of many older people who need and want to work in older age and the importance and value that they bring to the workplace. It is important that older people have flexible working practices to enable people to work and manage any health conditions and caring responsibilities they may have.

  • See the Workforce and Employment section for more on older workers.

  • The Government has published the Pension Schemes Bill, which introduces a new supervisory regime for money purchase Master Trust schemes.  Operators of master trust schemes will have to show: those involved are "fit and proper"; schemes are financially sustainable; governance and administration are sufficient; and that there is adequate continuity strategy.  It also introduces a regulation-making power by which the Secretary of State will be able to override contract terms between the trustees and service providers.

Other

  • Think tank Reform, have produced an analysis of the UK public sector from a business perspective. Amongst the findings of a public survey, it finds that 57% of respondents feel that the NHS is the top priority for the government compared with Brexit at 33%. The report also presents the results of interviews with public sector leaders and some of the themes that came out of these discussions included the need for continued transformation and funding for the NHS and for greater collaboration and a flexible workforce in the public sector.

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Ageing and wellbeing

  • The UCL Institute of Health Equity has published an analysis of inequality entitled Inequalities in Mental Health, Cognitive Impairement and Dementia Among Older People, commissioned by the Department of Health.  It states that the skills, abilities and knowledge increase the resilience and adaptability of the brain and its functioning. It suggests learning and education throughout life is important to increase the efficiency and flexibility of the brain, helping to reduce the risk anddelay the onset of mild cognitive impairment and dementia in later life. In turn it builds the resources people have to cope with the conditions, which are dependent on maximising our environmental, economic and social resources. It concludes that historically and at present, Government policy places greater emphasis on diagnosis and access to treatment rather than addressing the main drivers for these mental health inequalities. 

    MHA comment: We recognise the benefits of lifelong learning and strive to keep people activeand recognise the whole person and not just their conditions. We do this with the help of volunteers across all our services in care homes, retirement living and Live at Home schemes.

  • Help Age International have published a report which considers future trends in demographics and urbanisation. Ageing and the city: making urban spaces work for older people highlights that the number of older people living in cities is significant and growing, contrary to popular belief that older people primarily live in rural areas. They argue that despite the growing number of older people in cities, physical, social and economic barriers prevent many from living with dignity and safety. They add that the development of cities centred on car use has left urban environments hostile to older people, unwelcoming and polluted. It discourages the use of streets and public spaces – restricting participation in community life, contributing to social isolation, making street-based, informal work unsafe, and leading to unhealthy, sedentary lifestyles.  The report recommends a shift towards reduced car use and traffic speeds and the promotion of cycling, walking and public transport.

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Dementia

Risk reduction

  • According to new findings from the British Social Attitudes survey, commissioned by Public Health England (PHE), more than a quarter (28%) of the British public is unable to correctly identify any potentially modifiable risk factor for developing dementia. They suggest this is particularly concerning when there is growing evidence that a third of dementia cases could be a result of factors potentially in our control.  27% believe that there is nothing anyone can do to reduce their risks of getting dementia.  Dr Charles Alessi, Senior Dementia Advisor at PHE said "Dementia is not an inevitable part of ageing. What’s good for the heart is good for the brain and simple steps like giving up smoking, reducing alcohol intake, losing weight and taking regular exercise can reduce your risk of developing dementia in the future."

    MHA comments: We welcome the important message that dementia is not an inevitable part of ageing and support any opportunities to challenge misconceptions and perceptions about dementia and opportunities to increase and improve the public's understanding of dementia.

  • Meanwhile, Edinburgh University's Alzheimer Scotland Dementia Research Centrehas produced a shortlist of environmental factors that may contribute to the risk of developing dementia. The list includes exposure to air pollution and a lack of vitamin D, although researchers are keen to highlight that the understanding of risk factors is continually developing.

  • A new study by Alzheimer’s Research UK has highlighted the lack of research into dementia prevention and risk factors and calls for changes to the way risk reduction studies are funded and carried out. Key barriers include: The length of time needed to investigate potential prevention for diseases like Alzheimer’s, where changes in the brain occur several years before symptoms appear; difficulties in understanding the complexities of how different risk factors interact with each other; inconsistent methods and study designs, which hinder the ability to pool or compare results of different studies; and a lack of researchers with expertise in public health working on dementia. The paper points to several measures that could improve prevention and risk reduction research, including agreed international standards for study design and apply experience from fields with more established risk reduction research, such as cardiovascular disease.

  • Six universities have been awarded a total of £4.3m by the Medical Research Council to enhance the overall dementia research capacity in the UK. The funding has been awarded to: University of Bristol to develop computational approaches to analyse behaviour and derive ‘signatures’ relevant to dementia based on health-related behaviours at home; Cardiff University to research immune pathways relevant to dementia and the development of stem cell models of neurodegenerative disease; University of Edinburgh to explore the role of myeloid cells in dementia;  Kings College London to support projects focused around cell interactions and the effects of neuroinflammation; University of Manchester to discover new ways to diagnose dementia and new targets for drug development; and University of Oxford for cell imaging analysis and targeting signaling pathways.

  • Exercise may be associated with a small benefit for older people who have memory and thinking problems, according to research. The small study involved 70 people with an average age of 74 with vascular dementia.  Half of the participants took part in one-hour exercise classes three times a week for six months, while the other half received information each month about vascular cognitive impairment and a healthy diet, but no information on physical activity. All of the participants were tested at the beginning and the end of the study and again six months later on their overall thinking skills, executive function skills such as planning and organising and how well they could complete their daily activities. Those who exercised had a small improvement on the test of overall thinking skills compared to those who did not exercise. Six months after the participants stopped the exercise program, their scores were no different than those who did not exercise.

In brief:

  • The Commons Library has published a briefing examining the policies in England to improve dementia diagnosis, care, support and research. It also outlines the devolved dementia strategies in Scotland, Wales and Northern Ireland.

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Health

NHS - forward planning and transformation

  • The King's Fund have published an analysis of NHS England's progress on its Five Year Forward View - Policy changes to implement the NHS five year forward view: a progress report.  The report argues that most progress in implementing the Forward View has been made in the new care models programme, the development of sustainability and transformation plans (see below for further information) and in plans to devolve more responsibility in Greater Manchester. But with two out of the five years covered by the Forward View already elapsed, much remains to be done to align national policies with the improvements in care it is seeking to bring about.  It suggests more rapid progress is needed in the development of payment systems to support new care models, in the regulation of care systems and organisations and in the use of contracts to support primary and acute systems and multispecialty community providers. The law on procurement and tendering also needs to be clarified to avoid unnecessary delays and cost in implementing new care models.

  • Sustainability and Transformation Plans (STP) are place based, multi-year plans built around the needs of local populations (called footprints). STPs are intended to drive a "genuine and sustainable" transformation in health and care outcomes between 2016 and 2021, but also deliver efficiencies to close the NHS funding gap.  There are 44 footprint areas developing STPs - listed hereTwo areas have published draft STPs this month - Birmingham and Solihull and North Central London: 

- The Birmingham and Solihull STP is focussed on digital initiatives including an integrated universal patient administration system (covering 1.8 million people), a footprint wide data sharing platform and citywide wi-fi. It also suggests selling and upgrading estates and a reshuffle of governance and leadership. These projects all require additional funding to get off the ground, something NHS England has already warned will be in short supply.  The STP says if nothing changes, the footprint will need 430 hospital beds equating to roughly another new hospital in five years, leading to an overall system funding shortfall of an estimated £721m.

- The North Central London STP which covers Camden, Haringey, Islington, Barnet and Enfield, also proposes digital solutions to create a “seamless” shared care records across health and social care and create new “population health management system”. Prevention plans are also key and include encouraging every member of the public sector workforce to become “a champion for prevention”, and ensuring that working and living environments promote good health. The plan also includes developing an estates strategy and a workforce strategy where staff are “part of the wider NCL workforce, not just part of a single organisation”.

MHA comments: It is important that if STPs are truly about transformation in health and care outcomes, integration and stronger partnerships with care providers are essential to have a a greater impact on increasing preventative measures and reducing delayed transfers of care. We will continue to monitor the publication of STPs and look for opportunities for MHA to shape their development.

  • New research from the University of East Anglia has shown that, patients’ physical activity does not necessarily increase following hip replacement surgery.  Hip replacement is one of the most common elective operations, with more than 620,000 procedures performed in the UK from 2003-2013. The most prevalent cause for needing surgery is osteoarthritis (93%) and the need to reduce pain in movement. The study compared differences in physical activity of over 1,000 patients, pre and post-surgery.  Indicators for physical activity after surgery included whether patients were walking longer distances, walking more quickly, cycling and climbing stairs. However the researchers found no clear evidence of a change in physical activity following surgery, suggesting that patients need to be encouraged to be more physically active following surgery and further investigation is needed into how other personal characteristics or pre-existing conditions might also influence physical activity.

In brief:

  • Age UK have published a report Hidden in plain sight - older people's mental health, which suggests that the current availability of mental health services does not meet the increasing demand from the UK's ageing population. It reports that currently 3 million people in the UK over the age of 60 are live with depression. This is set to rise to 4.3 million in the next 15 years due to the growing number of older people in our society. The report finds that over a third of Mental Health Trusts in England have no policies for providing integrated care for older people with both mental and physical health needs, despite growing awareness of how mental health problems such as depression impact an older person's physical health and vice versa.

  • The Department of Health has announced plans to change how community pharmacies are funded. New measures will include a reward system for pharmacies that are provide a high quality service.  Government spending for pharmacy will remain at around £2.6bn a year. People in isolated areas with higher health needs or in areas of high deprivation will have access to a pharmacies through a new pharmacy access scheme. The Pharmaceutical Services Negotiating Committee raised concerns that the measures would force some pharmacies to close and have a knock-on effect for the NHS and social care.

  • The BBC reports that waiting times in A&E units in England over summer 2016, have been worse than every winter for the past 12 years. Colder months are traditionally the most difficult for hospitals, but this summer one in 10 patients waited for over four hours in A&E during June, July and August, with 90.6% of patients seen in four hours. The target is 95% in four hours. Other key targets were missed for cancer, routine operations, ambulance response times and delayed discharges.

  • The new contract for junior doctors in England started roll out from the 5 October, with obstetrics and gynaecology trainees being the first to transfer to the new terms and conditions of service. Junior doctors have staged several strikes in protest at the imposition of the contract. The British Medical Association has described it as a "watershed moment for the NHS" and has written to NHS trust chief executives asking them to pause the introduction of the contract if certain conditions are not in place.

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Housing

small building imageAutumn Statement

  • The National Housing Federation (NHF) has published its Autumn Statement submission, setting out five measures that it says would deliver a step change in affordable housebuilding. They suggest that these proposals would support housing associations to work in partnership with the Government to build homes to buy, rent and part-own in every part of the country, delivering a housing offer for everyone. The measures are:

1. Flexible funding – The Government has already identified £7bn for housebuilding. By investing this flexibly, housing associations could build more homes, more quickly.
2. Additional investment – Building more affordable homes must be part of the Government’s active industrial strategy. £3bn would allow associations to build an extra 100,000 houses. 
3. Innovative products – Flexible funding frees associations up to innovate further.
4. Access to land – Government has identified enough public land to deliver 160,000 homes. It should give associations priority access to this in return for speeding up building rates.
5. Unlocking private finance – NHF understand that up to £4bn of unused government guarantee capacity currently exists. This should be allocated to affordable housebuilding.

In brief:

  • Birmingham City Council has passed a policy to issue Compulsory Purchase Order (CPO) against undeveloped land. The policy has been adopted due to a huge housing shortage in Birmingham. However, the Council suggests the policy will be used to incentivise developers to develop rather than 'bank' undeveloped land.  The Council has an existing CPO policy for empty homes.

  • Also see Government - Housing section.

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Local Government

Funding pressures

  • The Local Government Association (LGA) submission to the Treasury ahead of the Autumn Statement revealed the immediate pressures threatening the stability of the care provider market could amount to at least £1.3bn. It also said councils estimate that by 2019/20, a further £1.3bn will be required to deal with the additional pressures brought about by an ageing population, inflation and the cost of paying the National Living Wage. "Our analysis shows the sheer scale of the funding crisis we face in social care, both now and in the near future, as well as the damage done from the historic underfunding of adult social care," said the chairman of the LGA's community wellbeing board Cllr Izzi Seccombe. "Councils, care providers, charities and the NHS are all united around the need for central government to fully fund adult social care. This is essential if we are to move away from just trying to keep people alive to ensuring they can live independent, fulfilling lives, as well as alleviating the pressure on the NHS."

  • Collective body London Councils, which represents all 32 boroughs and the City of London, has also made a submission ahead of the Autumn Statement, warning that current funding levels are unsustainable and that boroughs in the capital face a significant reduction in “core spending power”. It warns that some London boroughs are already spending more than 70% of their budgets on social care, and as London has larger than average population growth across all age groups this is set to place noticeably bigger demands on them to deliver children’s services and school places, as well as health and social care for older people and those with physical and learning disabilities. Councillor Claire Kober OBE, Chair of London Councils said “Even with the assumption that all boroughs will raise council tax, which is unlikely, the scale of these funding cuts coupled with inflation and a rise in demand for services means London will be facing a funding gap of £2bn in 2020. Local government must be given the tools to meet rising demand for services and it is vital that stable and sustainable funding models are put in place to allow our city to grow enough to meet these demands... Government has a responsibility to ensure local councils are not left to deal with these huge rising pressures alone with funding settlements which simply don’t add up."

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Social Care

Sector analysis

  • The Care Quality Commission (CQC) has published its annual report for 2015/16. State of Care, which considers evidence of inspections, information received through their market oversight function and external data, has found that the sustainability of the adult social care market is approaching a tipping point and the fragility is now beginning to impact both on the people who rely on these services and on the performance of NHS care. The combination of a growing and ageing population, more people with long-term conditions and a challenging economic climate, has meant a greater demand on services and more problems for people accessing care. This in turn is translating to increased A&E attendances, emergency admissions and delays to people leaving hospital, affecting the ability of a growing number of health trusts to meet their performance and financial targets. They suggest strong leadership and collaboration will be important to ensure services improve and quality is maintained.  David Behan, chief executive of the CQC said “The good news is that, despite challenging circumstances, most people are still getting high quality care and there are encouraging levels of improvement taking place. This is something to celebrate. However, there continues to be wide variation in quality, some providers are struggling to improve and there is emerging evidence of deterioration in quality... While there are no easy answers or quick fixes, what distinguishes many of the good and outstanding services is the way they work with others – hospitals working with GPs; GPs working with social care and all providers working with people who use services. Unless the health and social care system finds a better way to work together, I have no doubt that next year there will be more people whose needs aren’t meet, less improvement and more deterioration.”

    MHA comments: This is yet further evidence of the increasing challenge facing the adult social care sector, echoing the findings  documented by the King's Fund and Nuffield Trust last month and evidence currently being given to the Community and Local Government Committee's Adult Social Care Inquiry. We support the view from Care England's CEO, Professor Martin Green "The CQC is a trusted voice, and is right to use its role to highlight sector difficulties: now the government must take heed and action to reverse a trend of gradual but definite erosion of this sector, a lifeline for many vulnerable people."

In brief:

  • The UK Home Care Association (UKHCA) has reported that nine out of 10 councils in the UK are failing to pay realistic prices to support older and disabled people in their own homes. In The Homecare Deficit 2016 they calculate that the minimum price councils should be paying for care provided at home is £16.70 per hour, but the average is more than £2 less.  The UKHCA said the situation was threatening the future of the market and warned providers were struggling to recruit staff and maintain quality, noting growing numbers of organisations were handing back contracts to councils. Councils said they had been left with little choice given the squeeze on their finances by the government. See the Local Government section for more.

  • The Kings Fund has produced a new analysis of New Care Models: Emerging innovations in governance and organisational form and the different approaches being taken by multispecialty community provider (MCP) and primary and acute care systems (PACS) vanguards in contracting, governance and other organisational infrastructure. It focuses on developments at five sites: Dudley; Sandwell and West Birmingham (Modality Partnership); Salford; Northumberland; and South Somerset (Symphony Project). Some of the vanguards are continuing to use informal partnerships, but others are opting for more formal governance arrangements, whilst commissioners are grappling with how to contract for the new systems and providers are exploring how to work together within emerging partnerships, how to allocate funding and how to share risk and rewards.

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Third Sector

Volunteering

  • The Nuffield Trust has published findings from an evaluation of seven social action projects in Harnessing social action to support older people: Evaluating the Reducing Winter Pressures Fund. The aim of the Fund was to scale up and test projects that used volunteers to support older people to stay well, manage health conditions or recover after illness and thereby reduce pressure on hospitals. The organisations supported by the fund included national and local charities and the projects included community-based support, supporting discharge from hospital wards, and supporting individuals in A&E department to avoid admissions.  The projects offered a wide range of services to older people – both direct (e.g. help with shopping or providing transport) and indirect (linking with other services). The evaluation resulted in a mixed set of findings - there was evidence of services that had made an impact by providing practical help, reassurance and connection with other services that could reduce isolation and enable independence. Those involved with the projects felt that volunteers and project staff could offer more time to users than pressurised statutory sector staff, which enabled a fuller understanding of a person’s needs while also freeing up staff time. But the analysis of hospital activity data in the months that followed peoples’ referral into the projects did not suggest that these schemes impacted on the use of NHS services in the way that was assumed, with no evidence of a reduction in emergency hospital admissions, or in costs of hospital care following referral to the social action projects. The one exception was the project based in an A&E department, which revealed a smaller number of admissions in the short term.

Fundraising

  • The UK is still the most generous country in Europe, but has slipped to from sixth to eighth in the world, according to the latest Charities Aid Foundation (CAF) World Giving Index 2016. The report measures how many people have donated, volunteered and helped a stranger in the past month to arrive at an overall giving score. It surveyed 148,000 people in 140 countries as part of the Gallup World Poll. Myanmar retained the top spot, with an overall giving score of 70%. The USA was second and Australia was third. The UK had an overall score of 54%. Broken down 69% of people surveyed  in the UK said they had donated money (74% in 2015), 61% of respondents said that they helped a stranger and 33% had volunteered. Globally, the UK was seventh this year in terms of donating to charity and second in Europe, behind Iceland. 

  • The Fundraising Regulator and Information Commissioner's Office have agreed a memorandum of understanding (MOU), which sets out plans for regulatory co-operation and information sharing between the two organisations. The MOU states that subject to any legal restrictions on the disclosure of information, both parties will alert the other to any relevant or potential breaches found while undertaking their duties, provide relevant supporting information and keep each other updated with the progress of these cases.

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Workforce and employment

Nursing

  • Health Education England have announced the launch of training places for the new Nursing Associate. Eleven sites have been chosen to deliver the first wave of training that will start in December and run over a two year period. The sites offering places are mainly health trusts, but educational institutions, care homes, acute, community and mental health trusts and hospices are also involved.
    The role aims to bridge the gap between health and care support workers, who have a care certificate, and graduate registered nurses and offers opportunities for health care assistants to progress into nursing roles.

Older workers

  • Andy Briggs, CEO of Aviva UK and Ireland Life, has recently been made the Government's Business Champion for Older Workers.  In an interview with The Telegraph he suggests that there is an “unconscious bias” amongst employers meaning they do not support employees with carer responsibilities and wants them to be more flexible. “Very often someone in their fifties or sixties has carer responsibilities. As a result they need to be more flexible in their working hours, maybe work from home a bit more, maybe not work full-time. Businesses just haven’t really thought about it or addressed it and therefore haven’t geared themselves up for it." He is keen to break the “social norms” about retirement too,“If people have been diligent and saved enough that they’re clear they can afford the standard of living they like in retirement and would like to stop working, good luck to them. Go for it and really enjoy your retirement. For those that think that’s the norm and that’s what they ought to do and once you get to 60 or 65 you ought to retire, my really strong message to them is: ‘No, you don’t have to.’ You can work as long as you want to, that’s entirely your choice.” He suggests employers should keep data on what proportion of their staff are older workers and is considering a policy for this information to be made public.

  • See the Government Section on Workforce.

National Living Wage

  • The National Living Wage (NLW) is likely to rise to around £7.50 an hour next year, 10p lower than expected in March because of the weaker outlook for pay in the wake of the Brexit vote and the value of the Sterling, according to new analysis by the Resolution Foundation in Low Pay Britain 2016. The new forecast of £7.50 an hour would still mean that a full-time worker on the NLW will receive an annual pay rise of around £600.

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Look Ahead: November and beyond

MHA will be taking an interest in the following events and milestones:

  • 7-13 November: National Trustees Week
  • 23 November: the Chancellor's Autumn Statement
  • 25 December: Proposals for regulations and policy supporting the Private Housing (Tenancies) (Scotland) Act 2016, consultation closes
  • 31 December: State Pension age independent review, consultation closes
  • December: Deprivation of Liberty Safeguards, findings from the review by the Law Commission published
  • December: Housing White Paper from the Department of Communities and Local Government

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Some information sourced from DeHavilland

 
 

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