Policy News from MHA: September 2016

Welcome to MHA's September policy bulletin

 

Party conference season has meant that Parliament has been in recess for much of September, however some pieces of legislation have been moving forward and new inquiries launched. The Party Conferences have seen new leaders announced and confirmation of policy direction on key matters, although the Conservative Party conference is still yet to take place. Significant research on adult social care has been published and subsequently many in the sector have been lobbying Government, for the crisis in health and social care to be addressed.

Government:  - Party Conferences round-up - Progress of Legislation, Inquiries and Government policy - Brexit - Charities - Finance -  Health and Social care - HousingWorkforce -

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

Ageing and wellbeing: - Tackling loneliness through reading- Ageing and society -

Dementia: - Nursing Dementia Strategy Latest research news and data -

Health: - Technology -

Housing: - Social Housing -

Social Care: - Sector Analysis - Hospital Discharges - Regulation -

Third Sector: - Volunteering - Fundraising -

Workforce and employment: - Nursing - Older Workers -

Look Ahead: October and beyond

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Government

Parliament has been in recess for much of September, as the Party conferences are taking place. Parliament reconvenes on Monday 10 October.clipboard image

Party Conferences round-up (courtesy of DeHavilland)

Labour 25-28 September

  • Jeremy Corbyn MP has successfully defeated a leadership challenge from former Shadow Work and Pensions Secretary Owen Smith, winning 61.8% of the vote.  Closing the conference, Jeremy Corbyn said he was convinced his party can climb an "electoral mountain" to general election success.  The Labour leader said it could build support by focusing on the "needs and aspirations of middle and lower income voters". He also promised no "false promises" on immigration numbers and that the Party would ease the pressure on public services, reinstating the migrant impact fund and using “the visa fee levy for its intended purpose.” On Brexit, he said that Labour would resist a “Brexit at the expense of workers’ rights and justice” and that the Labour Brexit agenda would be based on cooperation and internationalism.

  • Economy: Shadow Chancellor John McDonnell MP warned that Labour had to be ready to fight an early general election. Regarding Brexit, he pledged to preserve access to the Single Market for goods and services, whilst addressing the impact of Freedom of Movement on wages and local public services and defending the rights of EU citizens living in the UK and UK citizens living in the EU. However, he added that Labour would not support the Transatlantic Trade and Investment Partnership (TTIP) or any other attempt at deregulation. On tax, he proposed banning companies who evaded tax from bidding for Government contracts and look to shift the tax burden from the poorest. He spoke of growing the UK cooperative sector and giving the 'right to own' for workers when their company faced a change in ownership or closure. He also proposed a 'real Living Wage' set in line with living standards, suggesting at least £10 an hour.

  • Health: Shadow Health Secretary Diane Abbott MP pledged to restore nursing bursaries and called for Freedom of Movement to continue for the benefit of UK’s health and social care sector. She said Labour would campaign against health sustainability and transformation plans (the current efficiency plans being drawn up by local health authorities) pledging to “reverse the tide of privatisation” by repealing the Health and Social Care Act 2012. She added that she would address the crisis facing social care in the UK and pledged to create parity of esteem between health and care.

  • Housing: Shadow Housing Minister Teresa Pearce MP criticised the policies currently impacting on housing associations (such as voluntary right to buy) and highlighted Labour’s commitment to “building over a million new homes over the next Parliament with half in social housing”, suspending the right to buy, adopting a three-year lease for private rented sector tenancies and introducing a national standard to ensure the fitness of private rented properties.

Liberal Democrats 17 -20 September

  • At the Liberal Democrat conference, Tim Farron MP announced his party would pursue a ring-fenced tax which would involve a one pence increase in either income tax or National Insurance to fund the NHS and care. The party has put together a panel of senior doctors and experts to examine the case for a "dedicated NHS and care tax". He said "If the only way to fund a health service that meets the needs of everyone is to raise taxes, Liberal Democrats will raise taxes... Let's create that National Health and Care Service."

  • During the conference Liberal Democrat Health spokesperson Norman Lamb MP joined forces with Conservative former Health Minister, Dr Dan Poulter MP and the former Labour Shadow Health Minister Liz Kendall MP, to urge the Prime Minister to establish a cross-party commission to confront the growing crisis in the NHS and social care system. In a joint statement, they argued that health and care services  face a serious existential challenge, and that partisan politics has failed to come up with long-term solutions to ensure that services are properly funded and sustainable for the future. Follow this link for the latest Sector Analysis research in Social Care.

UKIP 15-17 September

Green Party 2-4 September

Progress of legislation, Inquiries and other Government policy

Brexit

  • The Guardian reports on a preliminary victory for those challenging Theresa May’s power to trigger Article 50. Mr Justice Cranston swept aside restrictions on publishing official documents before the hearing on 13 October. The decision also allowed the People’s Challenge, a crowdfunded group, to publish its full claim without any sections of it being redacted or withheld. It argues that “only parliament can lawfully ‘decide’ to leave the EU for the purposes of article 50[of the treaty]; and that the [government] may only ‘notify’ such a decision to the European council under article 50 once [it] has been properly authorised to do so by an act of parliament”.

  • Think tank Institute for Government has published a briefing paper assessing the Government's progess in planning for Brexit. It identifies that the Government will need an extra 500 new staff, costing up to £65m a year, just to plan its approach to Brexit and suggests the Government needs to be clear about plans to reach a negotiating position and how it will engage sectors beyond Whitehall.

  • The Health Select Committee has launched an inquiry on health and social care in the Brexit negotiations, to consider key issues and what outcomes should be sought from them. The Committee wants to understand what risks and opportunities for health and social care could arise from the UK's withdrawal from the EU, how the Government will mitigate the risks and take advantage of the opportunities.

  • Meanwhile research by Independent Age and the International Longevity Centre (ILC-UK) has indicated that care services for older people and disabled people could be at risk from Brexit, as nearly 80,000 workers in the sector in England do not have British citizenship and could lose their right to work in the UK. Over a million care workers are predicted to be needed in the next 20 years and restrictions on EEA workers could add a further 70,000 people to the shortfall.

Charities

Finance

  • The Government announced the development of the new Pensions Dashboard, involving Aviva, Aon, B&CE, HSBC, LV, Nest, Now:Pensions, Royal London, Standard Life, Willis Towers Watson and Zurich. All have agreed to work together to build the first prototype of the dashboard by March 2017.

  • In a debate on financial scams, Parliament heard that scams costs the economy some £52bn per annum and that the average age of a scamming victim was 74, therefore disproportionately impacting on older people. It results in victims suffering from anxiety disorders, affecting their capacity to live independently. Sarah Newton MP said that the Government was prioritising efforts to tackle the problem and welcomed academic research from Bournemouth University and the Chartered Trading Standards Institute, which had provided several recommendations, including that all agencies (such as banks), recognise their duty of care towards dementia sufferers; that data protection rules be strengthened to deal with “suckers lists”; and that banks and building societies provide safeguards for those who felt at risk. In legislative terms, the Government will develop a new requirement for the Information Commissioner to issue a statutory direct marketing code of practice as part of the Digital Economy Bill (see below for more information). Meanwhile, the Financial Conduct Authority’s new Ageing Population Strategy would address older consumers’ engagement with financial services, with a regulatory strategy and recommendations due in 2017.  The Commons Library has published a Briefing Paper on the subject.

Health and Social Care

  • The Public Administration and Constitutional Affairs Committee (PACAC) have reported findings from their inquiry into hospital discharges and found the incidence of unsafe discharge from hospitals to be unacceptably high. The report considers the investigations carried out by the Parliamentary and Health Service Ombudsman (PHSO) and found that the discharge failures identified by the PHSO report are not isolated incidents but examples of problems being experienced widely and remaining a persistent problem.  At a structural level, the split between health and social care means that interdependent services are being managed and funded separately, PACAC believe this to be political maladministration.  It urges the Government to take further steps to ensure the integration of health and social care is achieved and also recommends that the Government set out a route map by March 2017, demonstrating how arrangements for long-term, sufficient, sustainable and integrated funding for adult social care will be implemented.
  • During a meeting of the Public Accounts Committee on NHS funding, MPs heard from Simon Stevens, Chief Executive of NHS England.  He confirmed that the Government had made funding commitments for 2020/21 that were in line with those recommended in the Five Year Forward View, but that NHS England had not received the settlement it had wanted for 2017/18, 2018/19 and 2019/20, which meant that there would be a “bigger hill to climb” than was initially envisaged. He reported that local health and care systems were making significant progress on Sustainability and Transformation Plans (STPs) to help deliver £14.9bn of efficiency savings, but that staff and the public would need to be consulted before reforms outlined in local STPs could be implemented. He added that if hospital trusts managed to cut their collective deficits by two thirds they would be in a much stronger financial position than the previous year.

Housing

  • The Secretary of State for Work and Pensions, Damian Green MP has announced the outcome of the Supported Housing Review.  The cap on Local Housing Allowance (LHA) rates for social rents from 2018, would be deferred until 2019/20, where a new funding model will be introduced. This includes core rent and service charges to be funded through Housing Benefit or Universal Credit up to the level of the applicable LHA rate. For costs above the level of the LHA rate, the Government will devolve funding to Local Authorities (LAs) to provide additional ‘top up’ ring-fenced funding to providers where necessary, reflecting the higher average costs of offering supported accommodation, compared to general needs. This is intended to give LAs an enhanced role in commissioning supported housing in their area and ensure a more coherent approach to commissioning for needs across housing, health and social care, using local knowledge to drive transparency, quality and value for money from providers in their area. David Orr, Chief Executive of the National Housing Federation said: “We welcome the fact that the Government has identified the amount of money needed to underpin supported housing and that it remains committed to maintaining this funding... However, we are still concerned about how the new proposed model is going to work in practice... There are still many unanswered questions – for example the size of the devolved funding, whether it will receive an annual uplift, and how the process will work locally. The new system is particularly problematic for sheltered housing... We urge the Government to explore other options for this sector." A bill will be published in January 2017 to put the proposals into legislation.

  • Damian Green also announced that the Government would introduce the rent reduction to supported housing from April 2017 as planned, with rents in these properties decreasing by 1% a year for three years, up to and including 2019/20. The existing exemption for specialised supported housing will remain in place.

    MHA comments: The definition of 'specialised supported housing' is not clear and we do not yet know if this will impact on MHA's housing association properties.

  • The Commons Library has published a round up of developments on Supported Housing. Follow this link for more social housing news.

  • The Neighbourhood Planning Bill has had its first reading. The Bill aims to speed up and strengthen the neighbourhood planning process by simplifying how plans can be revised as local circumstances change and ensuring that plans come into force sooner once approved by local people. There will also be a simplifying of the compulsory purchase order process. The Commons Library has  published an outline of the Bill.

Workforce 

  • The Public Accounts Committee has launched an Apprenticeships Inquiry following a recent National Audit Office report. Concerns were raised that the Department for Education has not set out how it will use the increase in apprenticeship numbers to deliver improvement in productivity, how it will influence the mix of apprenticeships in order to deliver the most value and what success will look like. Concerns of employers and industry representative groups also warned that the current approach is leading to a large number of narrow and overlapping standards, which may restrict the extent to which apprentices gain transferable skills. Written evidence to this inquiry, is being accepted until midday on Tuesday 4 October 2016.

MHA Comments: We are maintaining an interest in policy developments in apprenticeships.  Our current concern however, is the need for more detail on the Apprentice Levy, due to start in April 2017.  We need more detail about the funding bands, so that we can plan and think creatively about how we best use apprenticeships to meet the needs of the organisation.

Other

  • The Digital Economy Bill had its second reading and has been moved to a Public Bill Committee. Amongst other things, the Bill makes provisions about protection of intellectual property in connection with electronic communications, data-sharing and new regulations for direct marketing.

  • The Boundary Commission for England and Wales has published its proposed changes to parliamentary constituencies in 2018, which will reduce the number of constituencies in the UK from 650 to 600. It is estimated that Labour would lose 23 seats and the Conservatives, 17 seats.

  • The Public Accounts Committee has launched an inquiry into the Financial Sustainability of Local Authorities, following concerns raised by the National Audit Office.

  • The Scottish Government has set out its Programme for Government for 2016-17. It includes a Housing (Amendment) Bill which aims to that ensure registered social landlords (RSLs) continue to be classified as private sector bodies. The Office for National Statistics is currently reviewing the classification of RSLs and may classify RSLs as public corporations, as has occured in England. The programme also includes a Referendum Bill should the Scottish Government conclude that independence is the best way to protect Scotland’s interests in the Brexit process.

  • The Welsh Government has also published its Programme for Government for the coming five years It includes commitments to double the capital people can keep when entering residential care to £50k, develop and implement a new national dementia plan and develop a nationwide and cross-government strategy to address loneliness and isolation. Meanwhile the Land Transaction Tax and Anti-avoidance of Devolved Taxes (Wales) Bill has got underway and aims to change the Welsh property tax regime, where Stamp Duty is replaced with a Land Transaction Tax.

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Ageing and wellbeing

Tackling loneliness through reading

  • The Reading Agency has launched a project to provide reading activities for older people following a £2.1m grant from the Big Lottery Fund. Reading Friends will work with local communities and partner organisations, who are passionate about reading and befriending older people, people with dementia and their carers. Resources will be provided to support reading activities such as one-to-one and group social reading, book chats, themed and reader curated book lists, book gifting and author events.  It aims to build supportive and dynamic social networks, keep people mentally active and culturally engaged.  The project will launch in July 2017.

Ageing and society

  • The Ready for Ageing Alliance has published Still not ready for ageing, an assessment of Government action on planning for an ageing society. They suggest lack of appropriate housing, lack of personal savings, under-funding in health and social care, the under-employment of older people and the issue of isolation and loneliness are all big problems that are not being comprehensively addressed. The Ready for Ageing Alliance calls for: the creation of a permanent commission on Demographic Change which would focus on making progress in responding to our changing society; and a single Government point of contact responsible for leading and responding to the challenges and opportunities of ageing.

  • The Intergenerational Foundation has published research, which they suggest reveals that the young and old are growing part. The Generations Apart? The growth of age segregation in England and Wales report finds that over the past 25 years profound changes have taken place in where younger and older people are likely to live. The dominant trends have been that young people have moved in large numbers into gentrifying neighbourhoods in big city centres, while older people have become much more concentrated in suburbs and rural areas. The result has been a rapid increase in age segregation. They set out a range of recommendations which seek to make age-diverse neighbourhoods the norm rather than the exception.

  • Lynda Gratton and Andrew Scott, Professors at the London Business School, have written an article which suggests that the great opportunities raised by longevity must overule outdated notions of a traditional life: school, work, retirement.  They argue that the current focus is on dealing with ageing and later life issues such as pensions and healthcare, but suggest that longevity is not just about ageing, but rather it has crucial implications for all ages. "Already, people are marrying and having children later, creating mid-career breaks, taking time out to explore, building their own businesses, going back to education. This is already leading to a redefinition of age – how many times have you heard that 70 is the new 60, or 40 the new 30?" 

  • New research from Swansea University, The Drive for Life: academic challenges older driver safety myths, has challenged the idea that older people are dangerous drivers. Analysis of data on vehicle accidents showed that drivers aged 70 are involved in 3-4 times fewer accidents than 17-21 year old men. By observing older drivers, the study found that most mistakes made occurred on right turns, overtaking and when they felt under pressure from other road users. Young men are more likely to be involved in incidents resulting from driving too fast and losing control. The research has also found that alternatives to driving must be improved to safeguard older people who are forced to give up driving, as this lifestyle change is associated with a huge deterioration in health and wellbeing, including depression, feelings of stress and isolation. 

In brief:

  • The Office for National Statistics' latest report on longevity indicates that a newborn baby boy could expect to live 79.1 years and a newborn baby girl 82.8 years if mortality rates remain the same as they were in the UK in 2013–2015 throughout their lives. Life expectancy at birth has increased by 13.1 weeks per year on average since 1980–1982 for males and 9.5 weeks per year on average for females in the UK. The statistics also report that the number of people aged 100 or over has quadrupled over the last two decades. In the last decade, the number of centenarians has risen by 65% or 5,720. There has also been a dramatic increase in the number of people aged over 105, with 850 people reaching the age of 105, in 2015 compared to 130 in 1985.

MHA Comments: Each year our Director of Chaplaincy and Spirituality reviews the age profile in our care homes.  At the end of December 2015, we had 85 residents aged 100 or over and 7 aged 105 or over. Our oldest resident was 108!

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Dementia

In brief:

  • The Department of Health has published an updated Dementia Nursing Strategy, which aims to support all nurses to be responsive to the needs of people with dementia, continue to develop their skills and expertise and achieve the best outcomes for people with dementia, their carers and families.  This refreshed strategy builds on the original strategy, published in March 2013.

  • Public Health England has published new data, which examines the deaths of people recorded with dementia between 2012 and 2014. Figures show the number of deaths with a mention of dementia was increased from 6.6% of all deaths in 2001 to 15.8% of deaths in 2014. They indicate that this is most likely due to an increase in awareness and recording of dementia. However the findings also suggest: that people who live in more deprived areas die with dementia at a younger age than those who live in more affluent areas; and people with dementia are considerably more likely to die in hospitals and care homes and less likely to die at home.

  • A new care home dementia study suggests there has been a failure to reduce antipsychotic prescribing. A study by five universities found that there was no sustained reduction in the prescribing of antipsychotics to dementia patients in UK care homes, following the Government’s 2009 National Dementia Strategy, which recommended a review of their use in light of potentially serious side effects. The research examined prescribing data between 2009-2012, in over 600 care homes across the UK, and found no significant decline in antipsychotic prescribing rates over the period.  In addition, it found that care homes in the highest prescribing 20% were more likely to be located in a deprived areas and that care homes in the lowest prescribing 20% were more likely to be served by a single GP practice.

MHA comments: Our staff will work collaboratively with residents, their families and healthcare professionals to ensure that people are supported wherever possible in the reduction or elimination of antipsychotic prescribing and administration.

  • Alzheimer's Research UK has published Treatments of Tomorrow: Preparing for breakthroughs in dementia, which outlines a number of challenges and pressures in the healthcare system that may present problems for the roll-out of potential disease-modifying treatments of the future. The report recommends a number of actions including: Better ‘horizon scanning’ to help forewarn the NHS about new treatments and diagnostic tools in development; Early discussions about the impact of disease-modifying dementia treatments between regulators, the NHS, the pharmaceutical industry and charities; and scope for drugs companies and the health service to agree early or conditional access to new disease-modifying treatments where appropriate, alongside ongoing ‘real world’ data collection to understand longer-term effects.

  • Patients in the early stages of Alzheimers are being signed up to a large scale clinical trial of a monthly injection, which scientists say can slow symptoms or even halt the condition altogether.  Alzheimer’s Research UK Chief Executive David Reynolds, said that the treatment could be available on the NHS in the next five years if the benefits were found to outweigh side effects.

  • A new short course Reminiscence Arts in Dementia Care: training and apprenticeship, has been launched by the European Reminiscence Network, in partnership with the University of Greenwich. It is designed for arts practitioners, community arts workers, occupational and arts therapists, group workers, reminiscence practitioners, staff from health and social care services, who are interested and/or experienced in positive approaches to dementia care.

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Health

Technology

  • The Department of Health (DH) has announced the development of a new one-stop NHS website where patients will be able to book appointments, order prescriptions and access medical advice. The NHS.uk website will also enable patients in England to register with a GP, download their own medical records and compare how well their local health service performs against others for areas including cancer, dementia, diabetes, mental health, learning disabilities and maternity care.  A new online triage system for the NHS’s 111 service will be piloted with patients and clinicians, where patients will be able to enter symptoms online and get tailored advice or a call-back from a healthcare professional. The NHS.uk system is scheduled to be ready by the end of 2017.

  • DH has also published its latest report on Assistive Technology - research and development. This annual report provides information about the wide range of government funded projects supporting the development, introduction and evaluation of assistive technology that might increase the range of activities and independence or wellbeing of disabled and older people.

In brief:

  • A review by the King's Fund suggests that the district nursing service in England is at "breaking point", with unmanageable workloads leaving patients at risk. The review found there had been a big drop in nurse numbers, causing delays and fewer visits. It describes a service where staff had been left "broken and exhausted" by the pressures being placed on them caring for the frail and vulnerable. NHS England said attempts were being made to increase staffing.

  • The British Medical Association (BMA), have published a report examining the relationship between health and ageing, suggesting that the ageing population and its families are being failed by a flawed and fragmented health and social support regime. The report, Growing Older in the UK, pinpoints how the health and life chances of older people of this and future generations are harmed by holes in the safety net of health, social and other welfare services. It identifies how older people’s health and that of their carers is affected by experiences throughout their lives as far back as childhood – such as childhood trauma or growing up in cold homes.

  • Junior doctors suspended strike plans in September and future strikes, following concerns for patient safety. The BMA has continued to voice opposition to the imposed contract changes and whilst it would not go ahead with the industrial action, it was “planning other actions over the coming weeks”. Meanwhile the junior doctors judicial review that argued that Jeremy Hunt had exceeded his powers, has failed in the High Court.

  • Public Health England have published the 2016 Health Profiles, which provide a snapshot of health and wellbeing for each local authority in England using a range of key health indicators, including life expectancy and causes of death.

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Housing

small building imageSocial Housing 

  • A report by the King's Fund and the New NHS Alliance, The Economics of Housing and Health: the role of housing associations, looks at the economic case for closer working between the housing and health sectors. It demonstrates how housing associations provide a wide range of services that produce health benefits, which can both reduce demand on the NHS and create social value. The report also includes case studies of the economic benefits that housing associations can provide.

  • The Homes and Communities Agency has published its annual Social Housing Sector Risk Profile 2016.  The profile aims to help registered providers sustain their financial viability by setting out some of the main challenges facing the sector and highlighting how the regulator will seek assurance that boards are managing those risks effectively. 

In brief:

  • Sasha Dudley and her partner Peter Taylor in Croydon became the first tenants to exercise their Right to Buy from one of the five housing associations piloting the new Voluntary Right to Buy (VRTB) scheme.

  • A new blog from the Centre for Ageing Better explores Future proofing our homes and neighbourhoods: time to get back to basics. Claire Turner looks at the importance of ensuring that our homes and neighbourhoods are suitable for our ageing population.

  • A report by thinktank Strategic Society Centre, Valuing Retirement Housing, uses a range of datasets to estimate the savings retirement housing can generate for local and central government, the NHS and private individuals. It estimates one extra person moving into specialised retirement housing could save £9,700 over 10 years due to fewer falls, reduced usage of home care and reduced residential care. It also estimates one extra person moving could generate savings of £18,600 over 10 years to local authority social care costs due to reduced entitlement to means-tested support and reduced spending on equipment and adaptations.

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Social Care

Sector analysis

  • New research from the King's Fund and Nuffield Trust, Social care for older people: home truths (coupled with findings from the Real Lives research outlined below), finds that social care for older people is under massive pressure, with increasing numbers of people not receiving the help they need. The picture they present is; of social care providers struggling to retain staff, maintain quality and stay in business; of local authorities making unenviable choices about where to make reductions; a range of complex causes behind delays in discharging older people from hospital; and that the voluntary sector are keeping services going even when funding has been curtailed.  Increasingly access to care depends on what people can afford and where they live, rather than on what they need. They suggest that under-investment in primary and community NHS services is undermining the policy objective of keeping people independent and out of residential care.  The Care Act 2014 has created new demands and expectations but funding has not kept pace and local authorities have little room to make further savings, and most are likely to be unable to meet basic statutory duties. 

    The report recommends that policy-makers need to address three major challenges in shaping the development of social care over the next five years, focusing on how to: achieve more with fewer resources – for example, through better commissioning and integrated care; establish a more explicit policy framework, which makes it clear that primary responsibility for funding care sits with individuals and families; reform the long-term funding of social care because reliance on additional private funding is unlikely to be sufficient or equitable. Commenting on the report, Professor Martin Green OBE, Chief Executive of Care England said: “Adult social care is a huge challenge for this Government.  This report reaffirms what providers have been telling us: that without adequate resources the sector will simply crumble.  It is dangerous to underestimate the potential role and capacity of the independent sector in supporting NHS sustainability and reducing delayed discharge numbers, which continue to rise... The King’s Fund has shown definitively that under-funding, combined with shortages of nurses and care workers, is putting unprecedented strain on providers”.  Phil McCarvill, Deputy Director of Policy at the NHS Confederation said: Insufficient social care funding is now the most urgent threat to the NHS and the wider health and care system... If we are to truly join up health and care then we need to support people to receive the care when and where they need it. Inadequate funding in one part of the system has a profound impact on the other parts to deliver the right care. Without this, local coordination and planning will become increasingly disjointed and the care individuals receive will suffer."

  • The King’s Fund and the Nuffield Trust also interviewed individuals with experience of using social care services in their report Real Lives: Listening to the voices of people who use social care. The aim of this study was to examine personal experiences of people needing care and support and their carers. It illustrates the key issues and challenges facing local authorities, policymakers and those who depend on services.

    Key findings include: Access - interviews with people with experience of using social care services provided examples of poor-quality care and situations in which individuals have needed to rely on family, friends or the voluntary sector to provide them with additional support; Personalisation - Successive governments have encouraged personalisation, however the increasingly acute needs of service users, pressures in the recruitment and retention of qualified staff and capacity issues in primary care and community nursing,  have threatened the ability to comprehensively achieve objectives; Market pressures - the volatility of the provider market has negative impacts on people’s wellbeing with, for example, long-standing relationships with care workers being broken and a sense of disempowerment resulting from a feeling of being treated as a ‘package’ rather than a valued individual;  Staffing - Providers are struggling to recruit and retain good quality care staff and there are high vacancy rates, particularly for qualified nurses. Whilst interviewees gave positive examples of care, some participants also described situations of poor quality care and not knowing whether their carers were suitably qualified.

Hospital discharges

  • The University of Birmingham, School of Social Policy has published new research Who knows best? Older people’s contribution to understanding and preventing avoidable hospital admissions, which presents findings from interviews with 104 older people, exploring their experiences of emergency admissions. The research focused on whether the older people felt it was appropriate to be admitted to hospital and whether they thought anything could have prevented their admission. The report concludes that ignoring these personal views could be detrimental to ensuring older people get the appropriate care they need.

  • Outcomes from an RVS pilot scheme find that support for older patients after they were discharged from hospital led to a reduced rate of readmission and improved patients’ welfare. The ‘Hospital to Home’ service in Leicester and Leicestershire saw a reduced rate of patients aged over 75 being readmitted within 30 days, 9% compared to 15% nationally. The pilot scheme was staffed by 143 Royal Voluntary Service volunteers, who offered six weeks of practical and emotional support to patients aged over 55 who lacked a social network. 

MHA Comments: Our Live at Home scheme in Horsforth, Leeds has been successfully running a similar home from hospital scheme, in partnership with the British Red Cross since 2014 and have so far prevented at least 48 re-admissions amongst the 306 older people supported.

  • The Wakefield Care Homes vanguard, sponsored by NICE, has reportedly improved the quality of care of its residents by bringing services together and making them more personal for older people in supported housing and care homes.  According to NICE, it has also led to significant reductions in hospital admissions, attendances in A&E and ambulance call outs. The Wakefield vanguard project aims to tackle loneliness and fragmented care by joining up services for older people in supported housing and care homes. It has established an enhanced primary care service, providing a named primary care professional to care home managers and created a multidisciplinary care home and extra care living scheme support team including therapists and nurses, who work closely with a community geriatrician and pharmacists, and carry out comprehensive assessments of residents.

MHA comments: Our Warde Aldam Care Home is one of the vanguard care homes involved in this project. The project has enabled it to build on its already strong links with local community health services, which has helped the home reduce avoidable hospital admissions and provide more responsive health care within the home. The home has also built excellent links with local volunteer services and created an effective support network for relatives, such as a carer support group for 13 women whose husbands have dementia.

Regulation

  • The CQC has raised concerns that nursing homes are increasingly struggling to provide an adequate standard of care. In their recent board report (page 3), CQC’s chief executive David Behan notes that nursing homes continue to receive worse ratings on average than other providers, with 36% rated as requires improvement and 4% rated as inadequate. However the report acknowledges the difficulty in recruiting nurses and the decrease in the number of places available.

  • In an article, John Kennedy,former Director of Care Services at the Joseph Rowntree Foundation, writes about What makes a care home outstanding? He suggests that "outstanding care homes share three common attributes: 1. They have an outstanding manager who is well supported and valued.  2. They have sufficient resources to do the job well and these resources are invested in the service - an outstanding care home wholly reliant on state funding is an incredibly rare thing. 3. The provider organisation’s values and ethos are clear and effectively translated from the board room to the floor of the care home. Profit is never the raison d’être of these care homes."

  • Philip Davies MP has inquired about the average cost of a CQC inspectionIn response Health Minister Philip Dunne MP said that the average cost per inspection for 2015-16 was: £107,500 for hospitals, £6,600 for primary medical services and £4,100 for adult social care.

  • The Chief Coroner, Peter Thornton QC has called for amendment to the law so that deaths of people under Deprivation of Liberty Safeguards (DoLS) do not automatically trigger inquests. In his 2015-16 annual report, (page 33) he writes that bereaved families are being caused distress by an “unwanted” duty for inquests to be carried out into deaths of anyone under a DoLS order and that this was causing “unnecessary” work for coroners and giving councils extra costs. Coroners are required to hold an inquest for anyone who dies while subject to the DoLS as they are considered as having died in “state detention” under the Coroners and Justice Act 2009.  The number of inquests has increased and coincided with the increase in DoLS authorisations  following the Supreme Court’s landmark ‘Cheshire West’ ruling in March 2014. The Chief Coroner has proposed that such cases should be removed from the category of “in state detention” under the 2009 act. Meanwhile, The Guardian reports that in 2015-16, local councils approved over 195,000 DoLS applications, the highest number since the system began in 2009 and a big rise compared to 138,000 applications in 2014/15.

  • Minister for Health Lord Prior is establishing a Burden Reduction Challenge Panel in partnership with NHS Providers, NHS Confederation and Care England. The panel will look at evidence of both the burdens and benefits of current NHS and social care regulatory activity and will then challenge their use and necessity. Regulatory activity judged to be unnecessary by the panel and relevant officials will be amended or removed. The panel’s first session will focus on data and information requests, at both national and local level.

In brief:

  • Housing & Care 21 has announced a decision to dispose of its home care service and is in the process of seeking a new provider to take it over.  Housing & Care 21 said it was taking the decision because of squeezed council budgets and the difficulty in recruiting good quality care workers and to enable them to focus entirely on retirement housing and extra care accommodation.

  • Age UK has sold its older people's alarms service to the Axa insurance company. More than 50,000 people wear the alarms, worn as a pendant or wristband, allowing them to alert an emergency call centre if they fall or become ill while at home. The sale comes as investment was needed to keep up with technological advances.

  • The BBC has published a guide to understanding the cost of care at a local area level. The guide aims to help people understand the social care system for people aged 65 and over and the costs involved, across the UK.

  • NICE has published quality standard guidance for Social Care for Older People with Multiple Long Term Conditions quality standard (QS132).

    MHA comments: we contributed to the consultation of this quality standard, calling for greater ambitions for personal outcomes and clarity of the care coordinator role.

  • Gillian Baranksi has been appointed as the new Chief Inspector for Care and Social Services Inspectorate for Wales, from 10 October.

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Third Sector

Volunteering

  • The Government's Office for Civil Society and Nesta have launched three grant funds totalling £4m to encourage people over 50 to volunteer, focussing on research, support to grow new ways of mobilising the time and talents of people aged over 50 and to trial intensive volunteering placements for people over 50, approaching or in retirement.

  • Research by the Royal Voluntary Service has identified nearly half of 55-74 year olds (46%) volunteer, 22% formally and 36% informally each year. This equates to 1.4 billion hours per year (949 million informal and 464 million formal). To encourage more older people to volunteer, the charity recommends: the  need for flexible volunteering experiences; the promotion of volunteering to people approaching State Pension Age with promotional material; volunteering 'on prescription' from GPs; and employers supporting volunteering opportunities as part of a pre-retirement plans for their employees.

    MHA comments: Many of our volunteers are aged 55 and above and in our customer research, quite a few stated that volunteering for Live at Home service or in our care homes helped fill their time after retirement in a meaningful way. Our volunteers talk about benefitting as much themselves as the people they help.

Fundraising

  • NCVO have published a report by a working group tasked with developing good practice recommendations on how charities should communicate with their donors for fundraising purposes, including how they manage and use donors’ personal data. Charities’ relationships with donors; A vision for a better future stems from research looking at people’s willingness to share their personal data with charities, based on their experience of donating and the communications they have received from charities. This feedback has helped to shape seven recommendations, the principal of which is "Charities should acquire an individual’s consent for fundraising through all channels of communication, and should minimise their reliance on indirect consent and ‘legitimate interest’ alone."

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Workforce and employment

Nursing

Older workers

  • Business

  • Also

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Look Ahead: October and beyond

MHA will be taking an interest in the following milestones:

  • 7-13 November: National Trustees Week
  • 23 November: the Chancellor's Autumn Statement

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Some information sourced from DeHavilland

 
 

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