Policy News from MHA: December 2016

Welcome to MHA's December policy bulletin

 

The Government made a key announcement on social care funding this month, which resulted in criticism for its short term solution.  There were also a number of evidence sessions on adult social care and the long term sustainability of the NHS.  Housing and planning legislation progressed, as did the development of social housing policies.

Government: - Progress of Legislation, Inquiries and Government policy - Brexit - Charities and the Voluntary Sector Health and Social care - HousingPensions - Other -

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

Ageing and wellbeing: - Loneliness - Later life lifestyles -

Dementia:- Research news -

Finance and pensions: - Pension reforms -

Health: - NHS news -

Housing: - Social housing -

Social Care: - Care homes - Regulation -

Third Sector: - Fundraising -

Workforce and employment: - Nursing and health workforce -

Look Ahead: January and beyond

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Government

Progress of legislation, Inquiries and other Government policy

clipboard imageBrexit

  • The Institute for Employment Studies has warned that Brexit will “cause a severe shortage” of nurses in the NHS. The paper analyses data at national and trust level to map the regions and NHS trusts in England who may be most vulnerable to the associated risks of Brexit and population growth. The analysis forecasts that areas with a high projected rate of population growth of over-85s and above average employment of nurses from the European Economic Area are most at risk of facing greater pressures in those local health economies.

    MHA comments: It is good that this issue has been recognised for nursing in the NHS, but it is equally important for nursing and care workers in the adult social care sector.

  • A study by the National Institute of Economic and Social Research suggests that a major cut in immigration from the EU would produce a damaging long term hit to economic growth and deliver a boost of only 1% to the incomes of low paid workers.

  • The Lords EU Justice Committee published its report on Brexit: acquired rights, which considers the fundamental rights under EU law to live, work, study, and raise a family in an EU Member State of one’s own choosing. It finds that if the UK wants to preserve certain EU rights on withdrawal, it will have to ensure they are safeguarded in the withdrawal agreement. If EU citizenship rights are not safeguarded the consequences will be severe: EU nationals in the UK and UK nationals in other EU Member States could lose their right to live and work in their country of choice. The Sub-Committee received evidence suggesting that many EU nationals who have been in the UK for over five years - the minimum requirement for permanent resident under EU citizenship rules - may not be able to prove that they meet the criteria for permanent residence as an EU citizen. The report asks the Government to explain whether this consideration will influence the decision it makes on the cut-off point for deciding which EU nationals in the UK are given a permanent right to reside after Brexit.

  • Prime Minister Theresa May won backing from MPs over her timetable for Brexit talks to begin after conceding to demands to publish a plan ahead of triggering Article 50 and promising MPs a vote on the final “deal”. Labour agreed to back the Prime Minister on the condition that she produce a detailed negotiating strategy.  In the end only 89 MPs voted against the Government’s outlined plans.

  • Brexit Secretary David Davis told the Exiting the European Union Select Committee that the Government will not publish a plan for departing the EU before February and that talks  should be completed within 18 months, with a transitional phase of leaving the EU if necessary. However, the BBC reported that Sir Ivan Rogers, Britain’s Ambassador to the EU, has told Government that a post-Brexit trade deal might take 10 years. He has since resigned.

  • The House of Commons Library has published a briefing paper on Brexit and Data Protection, which looks at the current reform of EU data protection law, the interaction with UK law, and the potential consequences of Brexit in this area. The Library has also published a paper on Brexit: UK funding from the EUlooking at the funding received by the UK from EU institutions and considers the implications of Brexit on the EU as a source of funding for regional development, agriculture support, research and innovation and other areas.

Charities and Voluntary Sector

  • The Government has published new standards for goverment grants and dropping plans to include ‘anti-advocacy clause’ within contracts for grants. The anti-advocacy clause would have prevented charities and universities from lobbying as a condition of receiving public money. However, Neil Cleeveley, CEO of the National Association for Voluntary and Community Action (NAVCA) said "The key question that needs asking is will the standards tackle and ease the ‘chilling effect’ of the anti-lobbying clause? I am worried that the standards are worded in a way that means it is still possible for charities to be attacked for legitimate work to help people and communities have a say about their services."

  • The Government has announced new measures to help smaller charities help shape and deliver public services, including: Developing a placed based Public Service Incubator that helps small charities get commissioned and to record the barriers that small charities encounter in this process; Exploring the development of a commissioning kitemark, to show their commitment to small charity-friendly commissioning; and recruiting a voluntary, community and social enterprise champion, to help small charities contribute effectively to public services and function as an intermediary between government and the voluntary sector. Sir Martyn Lewis (former Chair of NCVO) will chair a voluntary sector-led implementation group on these proposals, to put them into practice.

  • The Government has commissioned an independent review of full-time volunteering by young people, which will look at how to increase participation in full-time volunteering (defined as 16 hours a week of social action for six months or more) by reviewing the opportunities and barriers faced by organisations that support young people. An advisory panel of experts from the private and voluntary sectors, will make recommendations to the government by October 2017.  The chair and members of the panel will be announced in early 2017.

Health and Social Care

  • Secretary of State for Communities and Local Government, Sajid Javid announced that Local Authorities (LAs) could bring forward council tax rises to cover social care costs over the next two years. The measures were unveiled in the annual Local Government Finance Settlement and enable LAs to increase council tax by up to 6% over two years, ringfenced for social care, with a maximum of 3% each year.  Previously the policy was to spread the 6% increase had to be spread over three years.  In addition the £240m cut from the New Homes Bonus, which compensates councils for building new homes, would be spent on adult social care in 2017.  The Government suggests this would mean £900m extra for LAs over the next two years to fund social care services.  Labour argued however, that "no new money was being offered to tackle the crisis" and urged the government to reconsider a planned corporation tax cut to plug the social care funding gap.  Other critics have argued that increasing council tax for social care is flawed because areas of high deprivation, among those with the greatest demand for social care, have lower property values and therefore lower council tax incomes.

    The Institute for Fiscal Studies said "...council tax increases can be brought forward to raise money in the short term, but this will do nothing to plug the longer-term funding issues adult social services (and councils more generally) face. Furthermore, the new ‘Adult Social Care Grant’ ... is only available in 2017–18, and is largely a relabeling of money councils were going to receive anyway.  We calculate that yesterday’s announcements could increase the amount available to spend on adult social care by a maximum by £700 million over the next two years relative to previous plans. But they provide no boost to spending beyond that".  

    The Local Government Association indicated that the move would not deliver the funding required to plug the gap and that "The Government must recognise why social care matters and treat it as a national priority. There needs to be an urgent and fundamental review of social care and health before next year's spring Budget." 

    Professor Martin Green, CEO of Care England, said “...It is important to remember that this money will provide a temporary injection, but will not future-proof this sector. There has to be better accountability of how local authorities spend the precept: at present, few providers of frontline services have seen a meaningful change in the resources they have to provide care. A clear accountability trail is essential to progress. So too is an agreement on fair funding: we welcome the proposal of a Fair Funding Review, but call on government to engage with care providers in shaping its findings. We are also anxious to know the conditions attached the Adult Social Care Support Grant, and are concerned that this is not new money.” 

    Jo Miller, President of Solace (Society of Local Authority Chief Executives and Senior Managers) and Chief Executive of Doncaster Metropolitan Borough Council, said  "Whilst increasing the social care precept will give short term relief to a few local authorities, ultimately, relying on a regressive taxation system is not a long term solution to tackling the long term sustainability challenge our health and social care system faces. Likewise, taking money from the New Homes Bonus may alleviate short term pressures, but simply robbing Peter to pay Paul will not tackle a systemic funding problem. This needs a long term national solution that does not simply exacerbate existing imbalances."

    The Communities and Local Government Committee indicated that they will study the Government plans for social care funding, Chair of the Committee Clive Betts MP said "As a Committee we will want to examine the details of this announcement, including the move to provide additional funds from the New Homes Bonus rather than through the Better Care Fund, and we will press Ministers on the long-term future of social care in the New Year."

    In questioning the Prime Minister, the Liaison Committee (made up of the Chairs of each of the House of Commons Select Committees), reported that "The Prime Minister has confirmed that the Government is undertaking work to look at the longer term sustainable funding for social care. But this needs to be looked at together with NHS funding and not in isolation. We urge the Government to work on long term sustainable funding for an integrated health and social care system on a cross party basis at the earliest possible stage."

MHA comments: It is quite clear that this move will not solve the longer term funding issues for adult social care. The point made by Solace about not relying on the regressive system of Council Tax to fund social care long term is important. As are the concerns that increasing Council Tax for social care is flawed because it raises the least amount of money in the areas of greatest need, intensifying budget pressures. We echo calls across the sector for a long term solution.

  • Meanwhile the Communities and Local Government Committee heard oral evidence from Simon Stevens, CEO of NHS England and Stephen Dorrell, Chair of NHS Confederation as part of the Adult Social Care Inquiry. Simon Stevens said that pressures had been building on social care and that it should be the priority if additional funding was available. He said the number of older people “languishing” in hospital was a key problem for the NHS and that the National Audit Office estimate of an £822m cost for delayed discharges, was “probably an underestimate”. He said that shared assessments of patient needs and changes to the speed of services in responding to these assessments, were both key.  He said on integration, that it alone would not provide a full solution, but was needed and that decisions on budget pooling should be made locally. Stephen Dorrell echoed the need for additional funding for social care, stating that health and social care were “one and the same issue” and money proposed for the Better Care Fund should have been introduced as targeted assistance for social care. He noted a tendency to prioritise NHS funding at the expense of other local services. Finally, Simon Stevens argued that the UK needed to address widening social care funding pressures and suggested a “triple guarantee” for retirees that covered income, homes and care and that this should replace the pensions triple lock. Agreeing Stephen Dorrell  called for cross-party dialogue as this was an "urgent national priority".

  • In a hearing of the House of Lords Select Committee on the Long-term Sustainability of the NHS peers heard from Health Secretary, Jeremy Hunt, said that there was a “slightly fake debate” on funding pressuesand that the financial settlement had been negotiated, resulting in a £10bn increase for the NHS. He did agree that the proportion of GDP to be spent on the NHS would need to be increased in the face of an ageing population and that he thought this would primarily come from taxation. Committee member, Lord Warner asked what the Government’s long-term plan was for social care and whether there should be a public discussion of a national insurance system. Jeremy Hunt replied that the Government recognised the pressures in social care and where looking into longer term solutions, alongside the short term funding fix. He added that people needed to save for social care costs in the same way pensions were saved for and that implementing the recommendations of the Dilnot Review would be part of the solution, however he did acknowledge problems in getting insurance companies to develop products.

  • The Health Committee also held an accountability hearing with the Care Quality Commission (CQC), with CQC Chair Peter Wyman and CEO David Behan. They reported that they were confident that the CQC was now fit for purpose following previous criticism having almost completed a full round of inspections of all the providers they regulate. Going forward they expect inspections to be much more proportionate, targeted and risk based, "We have taken what we think we need to do next year on re‑inspections; we have made some allowance for the unknown that we need to respond to that is going to occur during that year; and we have assessed how many people will need to undertake that work next year and the year after to 2019‑20." They went on to say that they will complete all inspections of primary medical services and adult social care services by March 2017. In reference to the recent CQC State of Care report, they voiced concerns that smaller care providers are increasingly handing back contracts to local authorities because they were not being paid enough. They pointed out that the CQC only has market oversight responsibilities for larger providers and shared concern that "the issue is it the companies that are leaving the market and replacement care not coming in."  In written evidence, the NHS Confederation suggested the CQC's planned increases in regulatory fees from April 2017 was at odds with the move towards more light-touch inspections.

MHA comments: We will be responding to the CQC's consultation on annual fee increases making it clear that we do not support further increases in regulatory fees following increases over the past few years. The NHS Confederation make a useful point an increase in fees being at odds with a move to a lighter touch inspection regime.

  • The Draft Public Service Ombudsman Bill has been published setting out the Government’s plans for a new Public Service Ombudsman. The Bill would abolish the present Parliamentary and Health Service Ombudsman and the Local Government Ombudsman and create a new Ombudsman which would have a broad reach across Government departments and a range of other public bodies, including local government and the NHS in England.  The new body would be responsible for complaints about health and adult social care.

See the Social Care section for more news

Housing

  • The Neighbourhood Planning Bill has progressed to the House of Lords.  In the final reading in the House of Commons, some new clauses and amendments were made concerning compensation, rules around community involvement and consultations on Local Plans.  The Government removed Clause 28 from the Bill, which would prevent landowners who had land compulsorily purchased for a particular purpose seeking additional compensation should the land end up being used for a different purpose. The Department for Communities and Local Government has published some overarching documents relating to some of the key elements of the Bill. 

  • In the Autumn Statement, the Chancellor announced £200m of funding for a regional pilot of the Voluntary Right To Buy (VRTB) scheme for housing associations. The National Housing Federation have released details that the pilot will last for one year (2017/18) and will test one for one replacement and portability (where in the event that a tenant cannot purchase their current home, the option to port their discount to an alternative property of their own or another willing housing association). The new pilot will also test the application of the VRTB guidance, which details how the scheme will operate and will be made available to all housing associations at least three months before the pilot begins. However, the Government has not yet announced the region where the pilot will take place or the eligibility criteria for tenants.

    MHA comments: We will keep a watching brief on how this develops as this may have implications for MHA in its role as a housing association, depending on the location of the pilot.

  • The Work and Pensions Committee and the Communities and Local Government Committee have launched a joint inquiry into the Government's funding reform for supported housing. It will examine the planned changes for 2019/20, whether the new system will ensure that the varied rate of the LHA cap will not adversely affect tenants and providers in low-value parts of the country. It will also examine how existing tenants will be protected following the switch and ask whether the changes should be piloted. The inquiry will also look at the effect that uncertainty about the new model is having on the sector and explore whether separate funding models are needed for refuges and other short-term supported housing services, or sheltered housing services for the elderly, which would require a higher cap. How the localised funding pots would work, including how the money will be ring-fenced and which factors should be used to determine an areas allocation, are also investigated by the Committees. The deadline for written submissions is Friday 3 February 2017.

    MHA comments: We will be responding to this inquiry and the current consultation being run by the Department for Communities and Local Government on funding for supported housing.

  • The Communities and Local Government Committee have been hearing evidence from housing associations and new developments from the National Housing Federation, L&Q and Great Places as part of its Capacity in the homebuilding industry inquiry. In the discussion, the Committee heard how housing associations also needed certainty over what rental income they would receive in the future, which could be achieved by returning responsibility for rent-setting to the sector.  The Committee also heard about barriers to building new homes including access suitable land at a fair price.  The sector representatives also called for rethink of the Homes and Communities Agency’s plan to introduce annual fees.  For the same inquiry, the Committee also heard from Local Government representatives, who emphasised the main issue for Local Authorities (LAs) was not the number of planning permissions granted, but difficulties in securing section 106 agreements. LAs have an interest in facilitating housing developments as it allows them to collect larger amounts of council tax, therefore delaying developments is not in a council’s best interest. The representatives suggested councils should be able to place time limits on planning consents and introduce penalties for developers who failed to deliver new homesand create pools of local reliable developers. They also suggested that the main reason for the lack of new homes being built at the moment was that councils did not currently have the means with which to engage in house-building like they did in the past due to their inability to borrow and  pay for infrastructure.

See the Housing section for more news

Pensions 

  • The Work and Pensions Committee has called on the Government to create a “nuclear deterrent” and treble the amount the UK pensions regulator can fine employers. Making its recommendations in light of the problems at the BHS pension fund, the Committee was critical of the work of the regulator and argued that sweeping measures were needed to “nip inevitable disasters in the bud”. The Committee said interventions by the watchdog were “often clunky” and “concentrated” at stages when a scheme was in severe distress or had already collapsed.

See the Finance and Pensions section for additional latest news

Other

  • The National Assembly for Wales debated the Older People's Commissioner for Wales's Annual Report 2015-16. The report called for the Welsh Government to do more to address loneliness and isolation and suggested the Assembly should consider introducing an Older People's Rights Bill to extend and promote the rights of Wales's older people.

  • Liberal Democrat Sarah Olney won the by-election in Richmond Park. She received 20,510 votes, giving her a majority of 1,872 over her nearest rival, incumbent Zac Goldsmith, who ran as an Independent.

  • Conservative Dr Caroline Johnson won the Sleaford and Hykeham North by-election with 53.5% of the vote, securing a majority of 13,144. UKIP’s Victoria Ayling came second with 13.5% of the vote. As a consultant paediatrician working in the NHS, Dr Johnson has a strong interest in health policy.

  • Lord Freud, Minister for Welfare Reform, announced his retirement from his ministerial position at the Department for Work and Pensions from the end of December. Lord Freud oversaw the inception, development,and introduction of Universal Credit. The Government is expected to appoint a new Departmental spokesperson in the House of Lords, but this person will not assume the role of Welfare Reform Minister. 

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Ageing and wellbeing

Loneliness

  • In a new NICE quality standard Mental wellbeing and independence for older people, NICE urges councils, housing organisations and the voluntary sector to work together to identify vulnerable older people, suggesting those most at risk of isolation should be directed to appropriate activities such as dancing or art groups for example. Professor Gillian Leng, deputy CEO of NICE, said “Everyone is affected differently by ageing and whilst many older people can remain independent we need to do more to help those who can’t. There is no one-size-fits-all approach to promote and protect the mental wellbeing and independence of older people. Our new quality standard calls for older people at risk to be identified and offered appropriate activities.”

  • A new in-depth study Trapped in a Bubble by the Co-op and the British Red Cross has examined levels of loneliness and social isolation in the UK. It suggests that over 9 million people (of all ages) in the UK (almost one fifth of the population) report they are always or often lonely. It has found that life transitions can be key triggers for loneliness such as becoming a new mum, when children leave home, retirement, long-term health issues or mobility limitations, bereavement, and divorce or separation. They also found that loneliness can transition from a temporary situation to a chronic issue and can contribute to poor health, putting pressure on public services - to the cost up to £12,000 per person over the next 15 years.  The study also found loneliness is made worse by difficulties accessing public services and support, disappearance of social spaces and inadequate transport infrastructure. The report calls for everyone to play a role in preventing loneliness in their communities and the British Red Cross is responding with new services funded by Co-op for two years to provide support to reach over 12,000 adults who are suffering from loneliness across the UK. The Co-op is also enhancing its services and membership offer to help tackle the issue. 

  • Lancashire County Council has launched a report, Hidden From View, which aims to provide practical information and advice on understanding and addressing social isolation and loneliness, particularly in Lancashire but maybe useful to professionals and volunteers in the North West.

Later life lifestyles

  • The Centre for Ageing Better have published a new report The Benefits of Making a Contribution to Your Community in Later Life - an analysis of evidence on the benefits that older people derive from voluntarily helping others. Older people with fewer social connections, lower levels of income and education and poorer health may have the most to gain from helping others. However, the people who are most likely to volunteer are those who are already relatively wealthy, in good physical and mental health, and with high levels of wellbeing and social connections. People who could benefit most from developing new friends and increasing their sense of purpose and satisfaction in later life are losing out, because they are less likely to get involved. Dan Jones, Director of Innovation and Change at the Centre for Ageing Better, said: “Organisations that support volunteering should be confident that participation does make a difference in terms of wellbeing and increased social connections in later life, especially for people who are less well connected and active now. Funders should put more resource into volunteering schemes that would benefit those people most and meet the costs of supporting them to participate.”

  • In a separate study, research found that people who volunteered maintained their cognitive abilities and thinking skills. The research by the University of Southampton, involving over 9,000 people, suggested joining Neighbourhood Watch, a political party or community group could help people to stay sharp in middle age.  Participants in the study took cognitive tests at age 11 and were followed for four decades. Only 14%  took part in volunteering at the age of 33, rising to 25% at age 50, when their thinking was tested again. Professor Ann Bowling who led the study, said that a fifth of the difference in people’s cognitive scores could be attributed to volunteering and other factors thought to protect the brain, such as sport and education. She added The take-home message is that encouragement of social engagement through participation in civic activities and also physical activity over one’s life could potentially protect cognitive function in later mid-life.”

  • A report from the Mayor of London's office, which considered the effectiveness of a pilot scheme has found that the lives of older Londoners can be transformed by getting active in their local communities. Over 700 people in 22 boroughs took part in the Mayor of London’s Get Moving scheme, aimed at improving the health and wellbeing of older Londoners. The pilot project funded 16 community organisations to run free physical, social and creative activities, particularly targeted at more isolated groups of older people.  A report on the five-month scheme, found that those taking part experienced less day-to-day pain as a result of regular activity, and an increase in their ability to do everyday tasks such as housework. Older Londoners also reported that learning new skills improved their confidence and mental wellbeing, as well as their physical stamina.  The greatest benefit reported was reduced social isolation, with people making new friends and feeling engaged with their communities.City Hall plans to build on this by working with health and social care providers, local authorities, community organisations and arts and leisure providers to develop local opportunities for older Londoners to get active. Organisations will use the report’s findings to develop programmes that actively involve older people as both leaders and volunteers and create ways for different generations to connect.

MHA comments: It is encouraging to see a wider range of evidence about the benefits of volunteering and getting involved in your local community. We know from our Customer Research in 2015 that our Live at Home service provides wide benefits for both members and volunteers. 87% of our Live at Home volunteers who took part in the research, told us they felt part of something special when volunteering with us.

  • The Government’s chief medical officer, Professor Sally Davies, says those aged 50-70 should delay retirement or volunteer to stay mentally and physically active. In her annual report on the health of the nation Baby Boomers: Fit for the Future, she suggests that people of retirement age might do well to stay in work if they can, or else get involved in community and voluntary activities that will keep both mind and body in better condition, “We’re not saying you must stay in work... Stay active, stay in the community. Don’t become isolated, is the message, whether it’s staying in work, volunteering or working with the family. All of that is good for long term health, both physical and mental.”

  • In an article for Demos, former Pensions Minister Baroness Ros Altmann, argues that the over 50s are a major untapped resource for employers and that we need to change the way we think about retirement and suggesting overcoming barriers to later life working can boost prospects for both old and young, for businesses and the economy as a whole, "Employers should consider the 3’R’s – ‘R’etain older workers to keep these skilled workers; ‘R’etrain older workers to ensure their skills are updated and ‘R’ecruit older workers by eliminating age discrimination in the hiring process."

  • The Centre for Ageing Better has commissioned the Centre for Local Economic Strategies, to carry out research and co-design work to address worklessness and job insecurity amongst people aged 50 and over in Greater Manchester. The research and co-design project will develop and test a new approach to support these people and is part of the Centre for Ageing Better’s commitment to help more people live good later lives.

  • The International Longevity Centre UK (ILC-UK) have published a report which considers spending habits in later life. In The Missing Billions: The economic cost of failing to adapt our high street to respond to demographic change they look at barriers to consumption in later life, which has been shown to steadily fall with age and how this decline appears to be persistent over time. While financial constraints are likely to be one of the main reasons for a drop in spending, they appear to be less of an issue for older people and therefore considers the ‘health barriers’ on consumption. It finds that:
    • Older people with a walking difficulty spend on average 14.5% less than those without such a disability.
    • People aged 50+ with poor eyesight spend 9-10% less on leisure and eating out.
    The report also explores the ‘connectivity barriers’, such as proximity to shops and amenities, especially for people living in rural areas; lack of access to a private means of transport, such as a car; and lack of access to the internet. Findings include:
    • Living in a rural area is associated with 12.1% less spending on clothes and 7.8% less on leisure activities, regardless of age, income, health barriers, and having access to a car.
    • People living in rural areas spend on average 7.2% more on eating out than those who live in urban areas.
    • 56% of people aged 75+ living in rural areas have no access to the internet, yet a lack of internet access is associated with 28% lower spending.

In brief:

  • The National Infrastructure Commission prepares a National Infrastructure Assessment once every Parliament. Their most recent a discussion paper, focuses on population and demography and forms part of a series looking at the drivers of future infrastructure supply and demand in the UK and plausible scenarios to 2050. It contains some useful analysis of population projections, an analysis of where people will live and an analysis of household composition and behaviours.

  • A new not-for-profit organisation, run by over-60s for the over 60s called Ergsy is providing a free online library of self-help videos for the over 60s, covering various topics including health, legal, money, care and welfare.

  • A new study has shown that the way we measure time differs depending on our age. In the study, researchers from Washington University in St Louis wanted to see how people in different age brackets approached a challenge where they were required to plan ahead. They did this by asking two groups of people, one of college students and one of people in their 60s-80s, to complete some time-based tasks by a deadline. Participants were asked to take part in an 11-minute-long quiz, but to estimate how long the quiz took. Some participants completed the quiz in silence, others were played music while they worked. The study revealed that older and younger people estimate time differently. While older people are more likely to rely on their ‘internal clock’ to measure the passage of time, the younger group tended to use the external marker of music to measure time passing.

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Dementia

In brief:

  • A new interactive light game for people with mid- to late-stage dementia is being trialled in UK care homes. Tovertafel (or Magic Table) is a series of interactive light games specifically designed for people with mid- to late-stage dementia. Tovertafel was developed by PhD student Hester Le Riche, who wanted to create something to stimulate activity – physical, mental and social – in people with later stage dementia and that also could be in the care home’s communal area, used in groups and required no special supervision. Tovertafel consists of a portable white box hung from the ceiling projecting interactive images on to any surface below and currently has eight different games.

  • Researchers at Ludwig Maximilian University in Munich have found an early immune response in individuals with a genetic predisposition to Alzheimer‘s, where their brain’s showed abnormal immune reactions as early as about seven years before the expected onset of dementia. These results demonstrate that in cases of Alzheimer‘s, inflammatory processes in the brain evolve dynamically and are precursors of dementia. These immune responses can be detected by means of a protein in the cerebrospinal fluid "TREM2", offering physicians the possibility to trace the progression of the disease.

  • Professor Bart De Strooper has been appointed as the leader of the UK's first Dementia Research Institute, which will take a cross-discipline approach to pioneer new treatments to tackle neurodegenerative disorders which include Alzheimer’s, Parkinson’s, Huntington’s disease and vascular dementia.  The hub of the new institute will be based at University College London.

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Finance and pensions 

In brief:

  • The Organisation for Economic Co-operation and Development (OECD) has criticised pension reforms introduced under former Chancellor George Osborne, arguing that they could lead to some people outliving their savings. In its Pensions Outlook 2016, which assesses policy issues regarding strengthening pension systems and funded pension plans, it said that the market for annuities had been “negatively affected” by the abolition last year of the requirement to buy an annuity. It argues that people should be encouraged to buy one with at least some of their pension savings, to protect against the possibility of a person outliving their pension savings.

  • The House of Commons Library has published a research paper on Pensions and pensioners' incomes: Social Indicators, which reports that over the decade to 2014/15, average net pensioner income grew by 19% in real (RPI-adjusted) terms, compared to a 10% real fall in average full-time earnings over the same period. It also reports that the distribution of pensioners’ incomes became wider during the '80s and early '90s as incomes rose more quickly for better-off pensioners. In the last 10 years growth has been more evenly spread, except for the poorest pensioners where incomes have grown more slowly than those with average and above average incomes. In other analysis it finds that 26% of pensioner households got means-tested benefits in 2014/15, having fallen steadily from a high of 39% in 1995/96. 17% of pensioner households have income from earnings, up from 11% 20 years earlier.

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Health  

In brief:

  • An NHS England scheme to transform care for millions of disabled people and people those with long term conditions is being rolled out to six new areas in Birmingham and Solihull, Nottingham City, Hertfordshire, Islington, Sheffield and Nottinghamshire. These areas will become early adopters in NHS England’s plans to improve care for people with complex needs. The Integrated Personal Commissioning programme (IPC) is aimed at joining up health, social care and other services, including the voluntary and charity sectors, to help people, carers and families have more control over their care needs. It will help ensure that, as health services move towards more local commissioning, those with the most serious needs can still access the best care for their circumstances. The programme, in partnership with the Local Government Association is already working in 12 areas of the country.  Another key part of the IPC programme is increasing the number of people with a personal health budget (PHB). NHS England has set a target of at least 50,000 PHBs in place by 2020/21.

  • NHS England has announced £101m of new funding to support and spread the work of the new care model vanguards.  The vanguards are partnerships of NHS, local government, voluntary, community and other organisations that are implementing plans to improve the healthcare people receive, prevent ill health and save funds. Considerable progress has been made since the vanguards were launched in 2015 and there is emerging evidence that they are making significant improvements at a local level. This includes reducing pressure on busy GP and A&E services. In addition to the funding, the vanguards will continue to receive support from NHS England and other national bodies to implement their plans, including how they harness new technology including apps and shared computer systems. They are also receiving help to develop their workforce so that it is organised around patients and their local populations.

  • New analysis from The King's Fund has found that the number of admissions to hospital is rising steeply and are outstripping increases in the NHS budget. It highlights the potential for rising hospital admissions to jeopardise the plans set out in the NHS five year forward view, which is based on an assumption that growth in hospital activity would be reduced to 1.3% a year rather than the current rate of a 3.6% increase per year. The paper argues that finding ways of moderating demand for hospital care should be prioritised and that the best hope for this lies in strengthening community services.

  • BBC analysis of delayed discharges from hospital, suggests that more than one in 10 patients in England face long delays for a hospital bed after emergency admission. The analysis of NHS figures showed nearly 475,000 patients waited for more than four hours for a bed on a ward in 2015-16 - almost a five-fold increase since 2010-11. Hospitals reported using side rooms and corridors to cope with the growing number of "trolley waits". NHS bosses acknowledged problems, blaming "growing demand" on the system. But doctors said hospitals were now dangerously overcrowded, with three quarters of hospitals reporting bed shortages as winter hits.

  • An essay by Lord Kerslake considers What if the NHS had to balance its books like local government? Using his experience as council CEO and most recently as Chair of King’s College Hospital NHS Foundation Trust, he questions how NHS organisations would go about balancing their books each year, if they had no bail outs from central government.

  • The Care Quality Commission has announced that Jane Mordue has been appointed as the Chair of Healthwatch England, a committee member of Healthwatch England since 2012.  Her former experience includes being the Deputy Chair of Citizens Advice and the Vice Chair of the Gangmasters’ Licensing Authority.

See the Government Health section for more policy updates

 

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Housing

small building imageSocial Housing

  • Following a review of the Homes and Communities Agency (HCA), the Government has decided to split the HCA in two - with one part dealing with investment and another dealing with regulation, although the measure will not change the regulatory framework or powers.  This proposal is currently out for consultation until 27 January. The National Housing Federation has welcomed the move, saying "We have always argued that the regulation and investment functions are distinct and that the institutional architecture should reflect this. This will streamline processes and increase effectiveness across the organisation and help to foster the right environment for housing associations to deliver the houses our nation needs. We will maintain a close dialogue with the HCA throughout the implementation process.”

  • Nick Walkley has been announced as the new CEO of the Homes and Community Agency. He was previously CEO of Haringey Council and Barnet Councils.

  • Inside Housing has reported that the deregulation measures  for Housing Associations will come into effect on 6 April 2017.

  • This House of Commons Library has published a briefing paper on the Local Housing Allowance and the social rented sector, which details the Government's intention to apply Local Housing Allowance rates to tenants in receipt of Housing Benefit in the social rented sector.

In brief:

  • The Institute for Fiscal Studies has published a 'think piece' on The case for the abolition of stamp duty. The paper proposes means to streamline the way in tax on house sales is collected. It describes how the economic reach of stamp duty is in practice very limited and causes a range of problems. It proposes how the scope of Stamp Duty Reserve Tax could be expanded to cover the transactions in relation to which stamp duty currently raises revenue for the Exchequer and that stamp duty can and should on that basis be abolished.

  • The House of Commons Library has published a briefing paper on Devolution Deals and Housing, which outlines the housing aspects of devolution deals that have been agreed between the Government and local areas. The includes which housing and planning powers will be devolved under the deals, what progress has been made towards implementation and which other powers local areas have asked for.

  • The Scottish Government has launched consultation on proposals to increase planning fees, which includes raising the maximum fee to £125k for major applications.

See the Government Housing section for more policy updates

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Social Care

Care Homes

  • The Competition and Markets Authority has launched a market study into care homes for older people, to review how well the market works and whether people are treated fairly. The study will assess how people find the experience of choosing a care home, explore whether the current regulation and complaints system gives residents adequate protection and examine how well care homes are complying with their obligations under consumer law. The market study will also evaluate the effectiveness of competition between care homes in driving quality and value for money for residents and taxpayers. It will also consider how Local Authorities and other public bodies purchase and assign care home places and how they encourage and shape local supply.

    MHA comments: This is an important market study and we will be keeping a close eye on how it develops. As a large care home provider, the CMA have asked us to provide a raft of information for the study by the end of January.

  • The Royal Bank of Scotland has published its second annual review of the care home market, the Care Home Benchmarking Report 2016/17, focusing on residential and care homes. The analysis is based on data from 156 homes, including SME and corporate providers and identifies a number of market trends, including: increases in the use of agency staff, among both care and residential homes; a correlation between lower maintenance spend and inspection findings; and staff costs as a percentage of turnover typically being 52% at residential homes.

Regulation

  • The CQC is due to bring in external consultants in 2017 as it continues to struggle to meet its targets to produce reports on time. In a paper by CEO David Behan published for the December Board meeting, no directorate is meeting its objectives for the timeliness of reports. The CQC has highlighted this problem before, but the Executive Team has now agreed to source external consultants to “re-examine the issue of report timeliness from an independent perspective” for each directorate, starting in January 2017.

  • The Law Commission has announced a delay to the review of Deprivation of Liberty Safegauards, postponed from December 2016 to March 2017. The Commission indicates that the reason for the delay is the complexity of the task of drafting legislation on such an important issue.

  • The Social Care Institute for Excellence (SCIE) has produced a new film exploring the Mental Capacity Act and how to use it, as part of its Mental Capacity Act Directory.

In brief:

  • A social experiment involving intergenerational care has been piloted by Bangor University, which brought together pre-school children and older people at a day care in a centre for older people in North Wales. A temporary setting was created for the children and adults to share time, space and activities over three days, montiored by psychologists from the University. The experiment was filmed for a TV programme on S4C, Hen Blant Bach. "The results were amazing and we saw a really positive change in the older people during the week. With an ageing society and increased pressure on young families because of the cost of childcare, intergenerational care could be revolutionary" said Arwyn Evans from Darlun production company.

  • A new digital home care platform has been launched in the UK for older people and patients with chronic illnesses, which aims to streamline access to home care. The service - Vida - uses a digital platform to connect patients with carers, taking level of need, care specialisation, location, culture, gender and interests into account to tailor the matches between carer and the individual.

  • The Local Government Association has produced a summary briefing on social care, which outlines the current the position of Local Authorities in terms of funding and services.

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Third Sector

Fundraising

  • The Fundraising Regulator has announced its plans for the Fundraising Preference Service (FPS), which will launch in spring/summer 2017.  The FPS intends to enable individuals to select charities that they no longer want to receive any communications from. At the same time, charities will be required to increase their compliance by seeking affirmative consent for contact on a regular basis from donors and supporters.  In summary:
    • The opt-out from specified charities will apply to all charities and all forms of communication with a named individual (email, text, telephone and addressed mail).
    • The FPS will be IT-based but with a telephone service to support those who are vulnerable or without IT.
    • The Regulator will notify specified charities of suppression (those people opting out) and monitor compliance, through a largely automated system.
    • There will be signposting to the Telephone and Mail Preference Services.
    • Accompanying guidance will explain how the public can best manage their contacts with charities.
    • Opt-out will have the statutory force of a Data Protection Act Section 11 notice to cease direct marketing.

    MHA comments: It is good to finally have more clarity on how the FPS system will work. MHA will be implementing new processes to ensure we are compliant with the new approach.

  • An investigation by the Information Commissioner's Office resulted in fines for the RSPCA and British Heart Foundation (BHF), after the charities were found to have breached the Dat Protection Act by “wealth screening” donors, tracing and targeting new or lapsed donors by piecing together personal information obtained from other sources and trading personal details with other charities. Donors were not informed of these practices and therefore unable to consent or object. Subsequently the Charity Commission announced that it opened compliance cases into both charities, where it will assess whether the trustees of each charity have acted in accordance with their duties under charity law. The RSPCA has apologised and confirmed that is no longer processing data in this way, although the BHF is considering whether to challenge the decision. The Fundraising Regulator also published a joint alert with the Charity Commission on compliance and data protection for charities.

  • The Institute of Fundraising has published new guidance on Treating Donors Fairly to support fundraisers engaging with donors in vulnerable circumstances.

In Brief:

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Workforce and employment

Nursing and health workforce

  • Health secretary Jeremy Hunt has announced a number of  NHS workforce changes that focus on flexible working, career progression and leadership. Key measures include: Development of a ‘skills escalator’ to progress staff through entry-level apprenticeships to a nursing degree apprenticeship; A new programme and review to encourage more clinicians to go into senior managerial roles; A major review of the assessment and appraisal process for junior doctors, aiming to make it simpler and more helpful; Proposals are in development for a progression path to help nurses reach advanced practitioner level and the NHS Leadership Academy is to send 30 students each year to world-leading universities (such as Yale), as part of a fast-track development programme to support more clinicians to move to senior management level; The NHS will also partner with British universities to offer an NHS MBA for senior NHS professionals, with the first students enrolling in September 2017; and from 2018, HEE will double the number of places on the graduate management scheme. The Health Secretary also announced has written to the chair of the Nursing and Midwifery Council to seek agreement to regulate nursing associates, with work starting as soon as possible on the necessary legislation. The Government will consult next year on whether the physician associate role should also be regulated and reviewing the viability of a career path for advanced nurse practitioners who wish to become doctors.

  • The Department of Health have published a factsheet outlining information on the new nursing degree apprenticeship, which will enable people to train to become a graduate registered nurse through an apprentice route.

In brief:

  • The number of agency workers is set to reach one million by 2020 on current trends, according to new research from the Resolution Foundation. The current number in agency work stands at 865,000 – a rise of 30% since 2011. The think tank estimates a full-time agency worker gets £430 less than an employee in the same role. The report follows the Government’s call for a review in to UK working practices, with a team of four experts set to tour the UK to explore how the "gig" economy is affecting workers' rights. New technology combined with new business models – such as Deliveroo and Uber – has led to a rise in workers doing short-term, casual work. The Foundation says many agency workers are disadvantaged not only by lower pay, but also because they are not entitled to the same sick or parental leave pay, and they are more easily dismissed. The report finds that women accounted for 85% of the growth in the type of work, and that health and social care were the most common sectors for agency workers, followed by manufacturing and business activities.

  • The House of Commons Library has published a briefing paper on Social Work Regulation, providing an overview of social work reform and the regulation of the social work profession in England.

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Look Ahead: January and beyond

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

  • 20 December - 9 January: Parliamentary recess
  • 9 January: Homes and Communities Agency consultation on introducing fees for social housing regulation, consultation closes
  • 11 January: CQC Provider Fees consultation, consultation closes
  • 13 January: National Housing Federation consultation on housing association rents, consultation closes
  • 16 January: The Competition and Markets Authority study of UK market for care and nursing homes works, call for views on the scope closes
  • 22 January: Scottish Government, Review of the Scottish National Health and Social Care Standards, consultation closes
  • 27 January: Department for Communities and Local Government, Social housing regulation - using a Legislative Reform Order to establish the Regulator as a stand-alone body, consultation closes
  • 3 February: NCVO - new Charity Governance Code, consultation closes
  • 3 February: Work and Pensions Committee and the Communities and Local Government Committee, Supported Housing Funding inquiry, deadline for written submissions
  • 13 February: Department for Communities and Local Government, Future of Supported Housing (LHA cap), consultation closes
  • 14 February: CQC consultation on regulation of NHS Trusts and new care models, consultation closes
  • March: Law Commission Deprivation of Liberty Safeguards Review, report due
  • March: Chancellor's Budget

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Some information sourced from DeHavilland

 
 

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