Policy News from MHA: May 2018

Welcome to MHA's May policy bulletin

 

This month the prospective funding of the NHS and social care have been in the headlines again with a joint paper from the Kings Fund and Health Foundation along with a recent cross-party statement from three MP's. The Prime Minister plans to publish a White Paper regarding the UK’s position on Brexit and a revised Code of Fundraising practice means that charities and third party fundraisers must have a clear complaints procedure.

 

Government: - Brexit  - Finance and Pensions - Health and Social Care - Workforce and Skills

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

Ageing and wellbeing: - Wellbeing - Loneliness 

Dementia:- Care, Support and Wellbeing -

Faith

Finance and pensions: Charity finances - Older People's income -

Health and Social Care: Funding and Fees -NHS and Health 

Housing: - Older People 

Third Sector: - Trust and brands - Governance -

Workforce and skills: - Nursing 

Look Ahead: June and beyond: - Events of interest -

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Government

  • The House of Lords committee on citizenship and civic engagement has published its final report The ties that bind: Citizenship and civic engagement in the 21st century. The report highlights the areas in which the UK is currently successful in promoting a positive ‘civic journey’ and making a series of recommendations for how it might improve. The key recommendations are obviously focused on the theme of citizenship and include:
    • The government must re-prioritise citizenship as a subject taught in schools, creating a statutory entitlement to citizenship education from primary to the end of secondary education, and set a target which will allow every secondary school to have at least one trained teacher.
    • The unemployed should be encouraged to volunteer by having their social security status clarified, and more must be done to recognise and reward outstanding contributions made by volunteering.
    • The voter registration process must be improved, in particular by adopting the scheme which allows voter registration to take place at the same time as registration at universities, further education colleges and, ultimately, perhaps schools.

But there are also a number of recommendations that are directly relevant and of interest to the voluntary sector. For example:

  • The section on integration recognises there is a role for civil society organisations, and recommends local authorities prioritise funding of arts, sports, civil society orgs that work across communities. There’s a recommendation around focusing on areas with low social capital, including funding local voluntary organisations. There’s also a recommendation on government seeking views of communities feeling disregarded when they consult. 
  • The report notes the concern over lack of diversity in trusteeship, and has a recommendation to create a voluntary code of conduct to increase diversity among trustees (the new Charity Governance Code already has a section on diversity). clipboard image

Brexit

  • According to the Brexit Advisory Commission for Public Services, only a bespoke workforce deal with the EU would allow the public sector to recruit top-end talent as well as sufficient numbers of skilled workers and lower-skilled staff. They argue that only one of the options currently being considered for a future relationship with the EU would actually meet the public sector's needs  

  • The House of Lords recently overturned the Government's bill in an amendment concerning the UK’s membership of the European Economic Area (EEA), effectively the EU Single Market. The amendment to the European Union (Withdrawal) Bill obliging the UK to remain in the EEA was backed by 245 to 218 votes. MPs will now have to address and vote on the issue when the Bill returns to the House of Commons.

  • MSPs voted to withhold Holyrood’s consent from the EU Withdrawal Bill, the key piece of legislation paving the way for the UK’s departure from the European Union next year. Labour, Green and Lib Dem MSPs backed SNP members in rejecting the UK government legislation by 93 votes to 30. Holyrood’s approval is not legally necessary for the EU Withdrawal Bill to become law because Westminster can disregard its view. But such a move would spark the biggest political rift between the two institutions since the introduction of devolution in 1999.
  • Prime Minister Theresa May has announced plans to publish a White Paper setting out the details of the United Kingdom’s position on Brexit. The Government has described the proposed White Paper as the “most significant publication on the EU” since the 2016 referendum, the BBC reports. David Davis, the Exiting the European Union Secretary said the White Paper will include “detailed, ambitious and precise explanations” of the UK’s position. The Paper is expected to be published ahead of a key EU summit in June.
  • The Governor of the Bank of England (BoE) Mark Carney claimed recently that households were at least £900 a year worse off as a result of the Brexit vote. The comments were made by Mr Carney during a session of the Treasury Select Committee where he spoke about the cost of voting to leave the European Union in 2016. Mr Carney said that as well as households being £900 per annum less well off, the UK economy as a whole was as much as £40bn smaller as a result of the vote. Mr Carney also told the Committee that household incomes were significantly lower than previously expected. Despite the current strength of the global economy and the BoE’s emergency cut in interest rates after the referendum, the economy is 2% smaller than forecast, Mr Carney added. He does expect a gentle rise in interest rates over the year, while Britain’s rate of economic growth is likely to rebound in the second quarter, up from near stagnation at the start of the year. 

Finance and Pensions

  • More people in Britain should pay inheritance tax to ensure all older people receive free social care if they need it, according to Keighley's MP. Speaking in Parliament, John Grogan said it would be fairer to generate the necessary extra cash this way, instead of by raising national insurance.

  • Income tax will have to go up by 10p in the pound within 15 years to pay for long-term improvement in the NHS, a study says today. Health spending must increase from £154 billion today to £249 billion in 2034, or 3.3 per cent a year, just to maintain the level of service at present, according to the Institute for Fiscal Studies (IFS). However, chronic underfunding means the NHS needs even more in the short term, with the IFS suggesting an up-front boost of 4 per cent each year. If ministers want to improve the service, they must pay 5 per cent now and 4 per cent in the medium to long term.

Health and Social Care

  • The Scottish Government's consultation on loneliness closed recently. In the last parliamentary term, the Equal Opportunities Committee's report on Social Isolation highlighted that social isolation and loneliness were problems for Scotland and recommended the Government developed a national strategy to tackle it. The consultation is part of this process. A variety of organisations have responded including the Mental Health Foundation, Athritis Care Scotland, Faith in Community Dundee, Crossroads Fife and NHS Grampian.

  • MHA comments: All our services work hard to prevent loneliness and provide good value for money in a safe and caring environment.
  • The Older People’s Commissioner for Wales has found that older people across Wales are often unable to access advocacy services, which play a vital role in helping people to make their voices heard and ensuring that their rights are upheld. In a recent report, Making Voices Heard: Older People’s Access to Independent Advocacy in Wales, also found that people’s legal rights to advocacy in certain circumstances are not always understood by health and social care professionals. The Commissioner announced the Welsh Government will be working with older people to take forward a programme of work that will support everyone to live healthy, prosperous and rewarding lives. Older People’s Commissioner for Wales, Sarah Rochira, said: “Ensuring that older people have a strong voice so they can participate in and guide decisions being made about their lives in a meaningful way is key to delivering high quality services and the outcomes that people want and need. To further demonstrate the Welsh Government's commitment to older people, it was announced that the Minister for Children and Social Care will become the Minister for Children, Older People and Social Care.

  • The Welsh Government has confirmed how a £50m a year fund that supports joined-up working between health, social care, housing and the third sector will be used to deliver care closer to people’s home over the next 12 months. The fund is being targeted at delivering effective integrated and preventative services for children with complex needs, people with learning disabilities, older people and carers. Money will be invested in projects that help older people maintain their independence, avoid hospital admissions and prevent delayed discharges, services that support people with learning disabilities, a National Integrated Autism Service and the national roll-out of a common IT system across Wales for health boards and social services. 

  • A recently produced survey conducted on behalf of the Department of Health and Social Care, by Ipsos Mori looks at the views of people aged 50 or over on health, ageing and support.  

    -People aged 50 and over are slightly less positive about their health than a year ago, but still take their physical and mental health seriously. Eating healthily is seen as important for both physical and mental health, though nearly half do not think a healthy lifestyle can prevent dementia.

    -Fewer people than last year say they would talk to their GP if they were worried about their memory. 

    -Loneliness continues to be seen as a big problem for older people and most think society is not doing enough to prevent it. 

    -Views are less positive than a year ago about whether the government has the right policies about care and support services, and about whether care and support services work well with the NHS to provide co-ordinated care. 

    -People continue to be more confident about the safety of older people in hospitals than in nursing or residential homes. 

    -Concern about meeting the cost of care and support services has increased since last year. However, this has not translated into greater action and people are still not preparing substantially for the financial cost of care and support they might need. 

  • See the Health and Social Care section for more policy and research news

Workforce and Skills

  • A bill designed to ensure nurse staffing levels in Scotland are safe has been published by the Scottish government. The Health and Care (Staffing) (Scotland) Bill places a legal requirement on NHS boards and care services to ensure appropriate numbers of suitably trained staff are in place. It will require Scotland’s health boards and care providers to have “suitable staffing in place to enable all patients to receive safe, high quality care”, said the government. The legislation, if passed, would require the use of Scotland’s existing workload planning tools to work out what safe staffing levels are.

See the Workforce and Skills section for more policy and research news

 

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Ageing and wellbeing

  • The rights of older LGBT people were discussed recently at an interactive workshop at the Ageing in Common Conference. Workshop participants came from a range of services including housing associations, care homes and home care providers. They were concerned that older LGBT people’s needs were not being met. The conversation began with a reflection on the resilience and dignity they witnessed in older LGBT people, often scarred by the past, but determined to enjoy later life. It was noted that some older LGBT people mistrust authority after years of poor treatment at the hands of doctors, police and employers. Participants shared stories about the struggles LGBT people face as they get older: 

    Potential actions for service providers emerged: review initial assessments to include questions about sexuality, make it clear that all questions can be reviewed later; it might take a while to build trust and confidence, ask questions about significant others and how they would like to be known, including the pronouns they prefer – ‘he/him; she/her; they/them’, raise the visibility of older LGBT people in the organisation, mark LGBT Pride and LGBT History month, for example, train staff in LGBT related issues, put policies in place to support change, give a clear message that discrimination will not be tolerated, provide visual cues to put older LGBT people at ease, for example rainbow lanyards, and pictures of trans people and same sex couples on promotional literature.

    Progress has been made in securing equality for LGBT older people, yet there remains a great deal to be done. Care providers have a role – in enacting their commitment to person-centred care – to ask the right the questions, listen carefully to the answers, and celebrate the rich diversity of older people.

Wellbeing

  • During Dying Matters Week 2018, Bev Fitzsimons, Head of Improvement at the Point of Care Foundation, has written about a programme of work, Living Well To The Very End, which looks to continually improve end of life and palliative care services, while empowering staff to see what a huge difference they can make to a person’s final months and weeks. As the Dying Matters theme asks ‘what can you do?’ it is good to reflect on what can be done to support the carers in the system to keep in touch with their humanity, while at the same time being able to carry on with their challenging jobs, especially in caring for people at the end of life.        

  • MHA comments: Our award-winning chaplaincy team has developed an innovative and powerful approach to end of life care, called The Final Lap which recognises the value of each older person as a unique individual and emphasises making the most of the time left.
  • A recent report by the Centre for Ageing Better, says people over 55 make up 94 per cent of non-users of the internet, but digital-inclusion approaches tend not to cater for them. Charities and funders are being urged to rethink how they digitally engage with older people. The Digital Age: New Approaches to Supporting People in Later Life Get Online, says 4.8 million people over the age of 55 are not online. They make up 94 per cent of all non-users of the internet and are likely to be poorer, less healthy and less well educated than their peers, the report says. It claims that many existing approaches to digital inclusion fail to effectively target these people and suggests ways in which organisations could better help the ones who want to be online. The report recommends moving away from offering basic digital skills in favour of enabling people to do more specific things they need, such as gaining access to information and services or cheaper goods. "‘Basic digital skills’ are not ends in themselves and for many are neither the problem nor the solution," the report says. "Developing confidence to use the internet and a perceived value in doing so are the key issues to address.

Loneliness

  • Family doctors should be able to access a Wikipedia-style information page so they can refer patients to social activities to help combat loneliness, a leading doctor has said. At the same time, the Royal College of GPs argues that there should be a national public campaign highlighting the issue which affects millions of Britons. Loneliness is as bad for someone's health as obesity, said college chairwoman professor Helen Stokes-Lampard. Official statistics show that one in every 20 (5%) English adults feels lonely "often" or "always".
  • MHA comment: This chimes with the research that we have completed and we are glad the issue is continuing to be discussed.
  • Responding to Alzheimer’s Society recent report on rising A&E admissions for people with dementia last year, Niall Dickson, chief executive of the NHS Confederation, said: “One avoidable admission is one too many. Fifty thousand is a sign of a system that is not fit for purpose and is failing a generation of vulnerable people with dementia, as well as overstretched health and care staff. Hospitals struggled this winter under intolerable pressure and without new models of care and investment in health and social care services in the community, the position will only worsen. Our members have made it abundantly clear that the government’s promise of a long-term funding solution must include social care alongside with the NHS. There are ways to stop this from happening but it will require resources and political commitment.”
  • New software, created by scientists at Imperial College London and the University of Edinburgh, has been able to identify and measure the severity of small vessel disease, one of the commonest causes of stroke and dementia. The study, published in Radiology, took place at Charing Cross Hospital, part of Imperial College Healthcare NHS Trust. Researchers say that this technology can help clinicians to administer the best treatment to patients more quickly in emergency settings - and predict a person’s likelihood of developing dementia. The development may also pave the way for more personalised medicine. 

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Dementia

Care, support and wellbeing

    • Whilst it is important that people with dementia have opportunities and support to remain continent, such as easier unfastening clothes and walking aids sometimes a person actually needs continence aids such as wrap around products (similiar in style to nappies) or pant-style products. Selecting continence products for people with dementia should be based on a holistic assessment according to a recent evaluation that found that pant-style products promote dignity and independence in patients with mild-to-moderate dementia. 

    • Technology has been rapidly disrupting almost every sector. From improving the security of transactions within the finance industry through to virtual reality allowing people to view properties on the other side of the world, plenty of innovative organisations have emerged over the years, changing the way people operate and creating solutions to complex problems. One area that is now widely established, is that of medical technology, or medtech and its beginning to transform lives. Traditionally, technology used to support those with dementia has focused on alarms and telecare. It has now shifted, focusing on providing the best social care for those on their dementia journey, and reinforcing the importance of wellbeing as well as stimulating cognitive, physical and social activity. The pioneering Tovertafel – or as it’s known in English, the ‘Magic Table’, is an interactive light game, reflected onto a surface, which people of all ages can interact and play with. It stimulates a level of activity which is rarely seen in people living with dementia, sparking ‘moments of happiness’ not only for those using it, but also for those who witness it being played.

    • MHA comments: At MHA we pride ourselves on our high levels of care, support and innovation for our residents and are looking into the benefits of 'Magic Tables'
    • An initiative to raise awareness of new and creative ways of caring for people with dementia has launched at the Menier Gallery, in central London. The ‘Imagination Café London’ was a week-long, pop-up installation, open to the public, as part of a UK-wide tour this year. Devised by Professor Victoria Tischler, Head of Dementia Care Centre at the University of West London, the Imagination Café offers activities specially designed for people with dementia including visual art, archive object handling, music, storytelling and drama. It provides training to artists interested in working in dementia care which is led by artists who have themselves worked on Dementia and Imagination, ensuring that valuable skills and expertise are shared widely. Everyone is welcome to attend the café for a unique learning experience. At the Imagination Café is a welcoming, creative, communal space that showcases a variety of multisensory approaches that can be used in dementia care. These include a dementia-friendly afternoon tea courtesy of 'Nourish by Jane Clarke,' items selected from the Boots UK archive in multi sensory memory boxes, as well as visual arts displays and activities from Dementia and Imagination and Art in Residence by the Ben Uri gallery. Relevant information is provided courtesy of Dementia UK and the Alzheimer’s Society. Professor Tischler said: ‘I was inspired to create The Imagination Café after seeing artwork made by people with dementia as part of the Dementia and Imagination project. The art was not made to be exhibited but some of it is very accomplished and interesting. I thought that if it were framed and exhibited, many people may be surprised that someone with dementia could be creative, producing artwork that is complex, intriguing, or even beautiful.’ The Boots UK multi-sensory boxes have also been taken to care homes across the country as part of Dementia Action Week, which ran from May 21 to May 27. 

    • Keeping active helps prevent the onset of dementia, but once the disease has taken hold, working out more does nothing to slow its progress. Moderate to more intense exercise does not help people with dementia and may even make it worse, according to a major study which had hoped to find it slowed down the progress of the disease so that gym sessions could be offered as treatment by the NHS. Regular exercise and an active life are thought to help prevent or delay dementia, and some small studies have been done in dementia patients with positive results. But a trial found that gym exercise did nothing to slow down the progress of the disease. “I was disappointed by the results, although I probably wasn’t completely surprised,” said Prof Sarah Lamb.
    • The Prime Minister has given a speech recently on science and a modern Industrial Strategy. First, as part of the Artificial Intelligence and Data Grand Challenge, the United Kingdom will use data, artificial intelligence and innovation to transform the prevention, early diagnosis and treatment of diseases like cancer, diabetes, heart disease and dementia by 2030.
    • Age Scotland have created a document - Early Stage Dementia: A carers guide to creating a dementia friendly home, accepting  a that for most people living with dementia, it is important to them that they can remain in their own home for as long as possible. With that in mind, this guide looks at the changes in the home that carers can make to allow people living with dementia to remain independent, safe and comfortable in their own home.
    • Staff at a care home are redecorating the communal rooms in dementia-friendly colours to create a relaxed environment for its residents. The team at Wordsworth House in Hapton, conducted research to identify the best colours to help residents living with dementia feel at ease. The staff from the dementia unit, led by Unit Manager Collette Sharples, decided that the walls could use a splash of colour, and thought that considering the effects of different colours on the brain would not only brighten up the home, but would also help the residents


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Faith

  • For faith-based charities, a common challenge is attracting supporters who are not necessarily religious or belong to a specific denomination. NfpSynergy have recently released some findings from research carried out in November 2017 that could help faith-based charities think about how to do this differently and effectively. NfpSynergy have found a general warmth towards religious/faith-based charities. Across Britain, 3 out of 10 people in Britain are very likely or quite likely to support them if it was a cause they believed in.

  • MHA comments: We value the support we receive from the Methodist community and other Christian communities, and also that from people of other faiths and none.

  • More than 3,500 churches and 200,000 volunteers are working on health and social care initiatives that are “plugging the gap” left by funding cuts and limited resources,  and stepping in to support the overstretched NHS, according to the Cinnamon Network, a charity that connects faith-based organisations. Sarah Mullally, the new bishop of London, said the charity’s report – called The Church’s Impact on Health and Care – showed the important contribution being made by the voluntary sector and specifically the church to promote health.She said: 'The NHS is under considerable pressure: increasing public expectation, increasing life expectancy, improvements in technology and limited resources. If we are able to improve our health and the health of the community, [the church] can contribute to the better use of those limited resources.'

Finance and pensions

Charity finances

  • Government has 'no plans' to limit fundraising platforms' fees, says minister The government has said it has no plans to limit the fees charged to charities by online fundraising platforms. In an answer to a written question submitted to parliament recently, by Stephanie Peacock (Labour MP for Barnsley East), Tracey Crouch, the Minister for Civil Society, said "there are currently no plans to limit the fees charged" by online fundraising platforms. Ms Peacock's question asked what assessment the government had made of the fees charged on Gift-Aided money by online fundraising platforms. There has been increased media scrutiny in recent years of the fees charged to charities when they receive donations through online fundraising platforms, such as JustGiving. 
  • MHA comments: MHA uses various fund-raising platforms and appreciates the on-going financial commitment from our supporters. There are a variety of ways to donate, including from fund-raising events and legacy gifts. For more information, see the MHA website.

Older people's income 

  • People over 40 should pay a tax of hundreds of pounds a year because this helped Japan to solve an elderly care crisis, experts have said. At the heart of the Japanese system is a strong commitment to long-term prevention of loneliness and ill health, a stark contrast to England’s short-term approach, according to the Nuffield Trust. It is driven by budget constraints, which is focused increasingly only on those with highest needs. Services in Japan are available both to frail or sick older people and also to healthy ones, with clubs and activities for healthy over-65s promoted as part of the system

  • Separate proposals to bridge a generational divide by giving £10,000 to all 25-year-olds have already provoked a backlash from older people. A commission on intergenerational fairness set up by the Resolution Foundation think tank proposed that the “citizen’s inheritance” could be used to help those aged 25 to buy a home or pay for education. The Foundation also offers other suggestions such as an NHS levy for those above State Pension age, work support for millennials (£1bn 'Better Jobs Deal' that offers practical support and funding for younger workers, housing support for millennials (halving stamp duty rates to encourage moving, pilot community land auctions) and millennial pensions. 


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Health and Social Care  

  • A Clinical Lead Occupational Therapist at London’s Royal Free Hospital has commented on how ward colleagues have been working to end PJ paralysis and how the current 70-day challenge has encouraged more wards across the Royal Free London NHS Foundation Trust to take on the campaign too. The #endPJparalysis campaign was launched as a small quality improvement project last summer on Ward 10 North, which provides care for older people. The project aimed to increase the number of patients out of bed and dressed at lunchtime by 25 per cent. It has now spread across the UK and internationally. The Occupational Therapist was delighted to report that they had achieved our target, although this has been difficult to maintain during winter with more patients requiring extra care. However, what has been the biggest change is the mind-set and approach of colleagues, with the project embedding an ethos that it is everyone’s responsibility to encourage and assist patients to sit out of bed, get dressed and preparing to go home. The campaign has also created joy in work for the team by building strong relationships between healthcare assistant (HCA), therapy and nursing staff. At the Robert Jones and Agnes Hunt Orthopaedic Hospital, staff actually donned their pyjamas to work to help encourage patients to get up, get dressed and keep moving to prevent deconditioning while in hospital. 

  • Care England has initiated 152 Freedom of Information requests to councils to gather date on commissioning activity in 2018/19. The move is part of an investigation into how councils are responding to the challenges and opportunities of supporting a sustainable local care market. Professor Martin Green OBE, Chief Executive of Care England said: “Care England is keen to work with commissioners and other stakeholders using an evidence based approach. Real lasting change must be driven by understanding what works and what can be improved, and Care England’s spreadsheet is a step forward towards a more rounded mature conversation and joint working.”
  • One of the world’s leading healthcare experts, Professor Don Berwick, says the NHS will be the best system in the world if it succeeds in integrating care, getting people and organisations to work together. Professor Berwick, a former adviser to Barack Obama, says the NHS is teeming with people who have built modern services fit for the 21st century and it would be smart to learn from them while creating the future NHS. He said the fragmented nature of the NHS could be solved if all local health and care organisations, including local government with social care, worked in partnership and pooled resources, a movement which is underway.
  • Recently Hospital on BBC Two revealed first-hand the pressures that are facing health and social care teams across the country, with an emphasis on the challenges teams are facing managing delays in transfers of care. Helen Jones, The Director of Adult Social Services for Nottingham City Council, who took part in the programme alongside colleagues from the NHS, Council and other agencies in the city, closed out the programme by saying "If this were a business, you'd be investing in social care. If we can help people live lives in their community, that is cheaper for society...but my fear is, in a year, it will look exactly the same, but a little worse and we'll just think that's the norm. It is so not acceptable." Glen Garrod, President of the Association of Directors of Adult Social Services (ADASS) said: 'Nobody who works in adult social care will have been surprised at the extraordinary dedication that Helen Jones and her team at Nottingham City Council have displayed, not only in finding ways to help health colleagues free up much needed beds, but also for championing social care and doing all they can to provide the very best care they possibly can for vulnerable adults in their communities....This programme is an incredibly powerful watch, and I’d recommend it to all ADASS members and indeed anyone interested in how social care is provided.'

  • GPs need to fight back against cuts to social prescribing schemes driven by pressure on local authority budgets, the RCGP vice chair has warned. Professor Martin Marshall told the Londonwide LMCs conference last week that social prescribing schemes had been 'shutting down because they are run by local government, and local government doesn't have the resources'. His comments came in response to a Greenwich GP who told the conference he was not sure how he would cope 'if it wasn't for social prescribing and signposting people with complex problems'. An RCGP report last week, meanwhile, said that placing dedicated social prescribing staff in every practice could ease GP workload. The report cited evidence that demand on GP services dropped by 28% on average following a referral to a social prescribing scheme.

  • MHA comments: Some of our Live at Home schemes receive referrals under social prescribing schemes. Whilst we can see the value of these, we echo the need for adequate funding to support these schemes, including the end providers of activities.
  • The Care Quality Commission has published its findings following a local system review of Liverpool. This report is one of 20 targeted reviews of local authority areas looking specifically at how people move through the health and social care system, with a focus on how services, such as hospitals, community health services, and care homes work together. The report found that there was a clear strategic direction for health and social care in Liverpool, focused on the needs of people living in the city. However, the experiences of people using health and social care services varied. People were not always seen in the right place, at the right time by the right person; there were inconsistencies in commissioning and provision of services. Local people were not actively enabled to participate in service planning and delivery, and a comprehensive public engagement strategy was needed to facilitate meaningful public involvement in shaping the future direction of the city. In addition, people using services and their carers were not always supported to take control in making decisions about their care, although they were keen to do so

  • The latest NHS England figures have revealed a fall in the number of Delayed Transfers of Care. There were 154,600 total delayed days in March 2018, of which 102,600 were in acute care, down from 199,600 in March 2017, of which 132,800 were in acute care. Almost two-thirds (61.6%) were attributable to the NHS, with social care responsible for 30.7%, down from 37.2% in March 2018, and the remainder a combination of both.
  • An interactive map has been developed looking at provision to reduce delays of transfer called Home from Hospital This interactive map, developed by Foundations and the Housing LIN, highlights examples of where housing organisations and services are, or have been actively supporting hospital discharges and helping to get people home. This map also displays NHS England-reported data showing the number of delayed discharges of care from hospital arising from housing issues (showing the period between January – December 2017).
  • MHA comments: Our Horsforth Live at Home scheme works with the local Red Cross on a project helping support isolated older people on discharge from hospital and aiming to prevent re-admission.
  • The recent announcement by the Prime Minister to bring forward a new long-term funding settlement for the NHS means it is timely to look at how health spending in the UK compares to other countries and how the NHS measures up on some of the key resources this spending pays for. Although it can be difficult to find data on health care resources on a comparable basis across countries, international comparisons can still provide useful context for the debate about how much funding the NHS might need in future. The Kings Fund has focused specifically on a small number of key resources – staff, beds, equipment and medicines – using data from the Organisation for Economic Co-operation and Development (OECD):
    • Our analysis of health care spending in 21 countries shows that the UK has fewer doctors and nurses per head of population than almost all the other countries we looked at. Only Poland has fewer of both.
    • The UK has fewer magnetic resonance imaging (MRI) and computed tomography (CT) scanners in relation to its population than any of the countries that were analysed.
    • Of the countries that were looked at, only Denmark and Sweden have fewer hospital beds per head of population than the UK, while the UK also has fewer beds in residential care settings than comparator countries. While lower numbers of hospital beds can be a sign of efficiency, the growing shortage of beds in UK hospitals indicates that bed reductions in the NHS may have gone too far.
    • Skills for Care has updated its ‘good and outstanding care’ guide that helps adult social care providers improve their service and prepare for inspection. The guide, which reflects changes to CQC inspections in November 2017, draws on tips and practical examples from providers already rated good and outstanding. Skills for Care’s CEO, Sharon Allen, said: “Skills for Care has helped services to prepare for inspection so their workforce has the skills, knowledge and confidence to provide high quality care and support. This updated edition reflects the further changes to CQC inspection introduced in November 2017. It offers a wealth of knowledge designed to help any employer be a good or outstanding provider.” 

    • Bishopstown Court care home in Cork, Ireland, have been taking part in laughter yoga - a therapeutic alternative combining laughter exercises with yogic breathing for a complete wellness workout, and all without a joke being told. “It's truly an exercise program that's fun for everyone and can transform quality of life,” said instructor Deborah McCann. “Older people face isolation, loneliness and sickness more than younger people and unfortunately don’t have as many reasons to feel good or laugh but laughter yoga brings a sparkle, a little joy, and something different than the traditional entertainment like music, films or exercises.”

Funding and fees

  • A recent statement by Nick Boles (Conservative), Liz Kendall (Labour), and Norman Lamb (Liberal Democrat) could not have been clearer: Spending on the NHS and social care needs to increase by substantially more than inflation over the next 20 years and should be paid for by a dedicated tax. This initiative follows hard on the heels of a letter to the Prime Minister in March from 98 MPs, drawn from across the political spectrum. The letter made the case for establishing a parliamentary commission on health and social care to examine, among other things, future demand for care and funding options. MPs who signed the letter argued that a cross-party approach to these issues was urgently needed and that the commission should report before Easter 2019. Politicians are coming together to speak out because of growing pressures on the NHS and evidence of widespread public concern. Survey evidence shows that the public is increasingly anxious about the state of the NHS and that there is support for tax rises to increase funding. Tax rises are now backed by a majority of supporters of all the main parties, including 56 per cent of Conservative supporters, up from 33 per cent in 2014.

  • MHA comments: The current financial situation of the NHS and social care does not seem sustainable and we would ask that the Government recognises the real cost of care when they publish their Green Paper to also influence the levels and levys set by the local authorities.
  • Over 12 million people will soon benefit from better joined up NHS and social care as four more areas, covering four and a half million extra people, have recently been given more control to improve local services. NHS England chief Simon Stevens and Ian Dalton, head of NHS Improvement, have called on the NHS to ‘supercharge’ integration as Gloucestershire, West Yorkshire and Harrogate, Suffolk and North East Essex and North Cumbria will join the ten areas already part of the integrated care development programme. The ten existing areas, covering around seven million people already, have seen improvements to A&E performance, cancer treatment times and waits for operations at the same time as they have taken decisive steps to strengthen general practice and join it up with hospitals and mental health professionals. 
  • The Health Foundation and The King’s Fund have highlighted a worrying lack of progress on social care reform, in extensive new analysis of funding pressures and options for change. The authors point to low public awareness and lack of agreement on what should be done as major barriers to progress, despite political consensus on the need for urgent action. They conclude that reforming the current system will be expensive, but that if reform is chosen, England is now at a clear ‘fork in the road’ with a choice between a better means-tested system and one that is more like the NHS; free at the point of use for those who need it. The report finds that the current system, which sees fewer people receiving publicly-funded care every year, will lead to a funding gap of £6bn by 2030/31. Returning to levels of access and quality last seen in 2009/10, before the current period of austerity, would increase the gap to £15bn. More fundamental reforms would also significantly increase the cost of social care. Introducing free personal care for all older people with needs above the current threshold would be an extra £14bn. Protecting people from having to sell their homes by implementing a cap on the lifetime costs of care would require £12bn. With the population over 75 set to double, demand for health and care is projected to rise dramatically over the next 30 years.

  • NHS and Health
  • Emergency admissions in the NHS increase by almost half in a decade due to rise in sicker patients, new research shows. New research published by the Health Foundation looks at trends in emergency admissions over the past decade. It finds that one in three patients admitted to hospital in England as an emergency in 2015-16 had five or more health conditions, such as heart disease, stroke, type 2 While the number of emergency admissions has increased by 3.2% each year on average over the last decade, the number of beds dedicated to these patients has grown only by 0.3% per year. diabetes, dehydration, hip fracture or dementia. This is up from one in ten admitted patients having five or more conditions in 2006-7.  While the number of emergency admissions has increased by 3.2% each year on average over the last decade, the number of beds dedicated to these patients has grown only by 0.3% per year.
  • NHS needs extra funds for a 'technological revolution' to cope with the biggest challenge to face the health service in 70 years, in order to survive, Jeremy Hunt says. Writing for The Daily Telegraph, Jeremy Hunt warns that “the biggest risk” facing the country is if a future funding boost is spent without a “dramatic transformation of modern healthcare”. Mr Hunt says the NHS must build on its legacy of “leading the world in medical breakthroughs” by pioneering services such as patients being diagnosed using artificial intelligence and test results being delivered via smartphone.
  • In brief:

  • As many as one in three people who die in hospital could spend their final days at home or in more appropriate care settings, but only if the government is prepared to increase investment in community-based health and social care, according to a new report from the Institute for Public Policy Research think-tank (IPPR). End of Life Care in England says that increased investment in long-term care outside hospitals in England could enable many more people to spend their last days and weeks at home, or in a more suitable setting.

  • Former Attorney General Dominic Grieve has backed a campaign to install CCTV in every care home. The Tory MP said equipping all communal areas with cameras would help end abuse. “There have clearly been horrific instances of abuse against residents in care home and the risk of this happening is well known,” the Beaconsfield MP said.....“Requiring the public parts of care homes to be monitored by CCTV would contribute to reducing the possibility of abuse and make detection easier where it has occurred.”

  • MHA comments: MHA has a surveillance policy around the use of CCTV on our premises. As it states: 

         - We aim to reassure and encourage people to use various channels of communication before seeking to install any form of                        surveillance. However, if a person considers surveillance necessary, MHA will work with individuals to resolve and reassure their              concerns.                                                                                                                                                                                    - We hope that no person, relative / representative or member of staff will experience reasonable cause for suspicion of harm that              requires surveillance evidence to deny / confirm the occurrence of abuse.  However, MHA will work and cooperate with individuals to        resolve and reassure their concerns.
  • Schoolchildren in Wrexham have teamed up with care home residents and helped redesign zimmer frames to prevent falls by making it easier for residents to identify their own frame. Pupils from Ysgol Bodhyfryd visit Hillbury House Care Home where the children interview them and help give their walking frames a makeover. The school make weekly visits to the home, sending different groups of children. The children have designed the frames based on the residents' hobbies and interests. Current resident Ray, who was an owner of a record shop in Wrexham for ten years had his walking frame given a musical theme by 11 year-old Ethan Tyzack.
  • An initiative helping improve communication between care homes and hospitals has been adopted by three Caring Homes’ services. Belmont House, Garth House and Home of Compassion in Surrey have taken up the scheme with all Caring Homes’ services scheduled to sign on to the initiative by 2020. The Red Bag contains standardised information about the resident’s general health, any existing medical conditions they have, medication they are taking, as well as highlighting current health concerns.  It also has room for personal belongings (such as clothes for day of discharge, glasses, hearing aid, dentures etc) and it stays with the patient whilst they are in hospital
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Housing

Older People

  • Julia Ashley, chief executive, Central & Cecil Housing Trust, says that she was concerned but not surprised when she read Knight Frank’s recent report on retirement housing highlighting the “chronic undersupply” of age-appropriate homes in the UK. She argues that the industry sector as a whole is too quick to blame planning policy, a shortfall in available land, a falling market etc. Whilst she accepts these points are clear reality, they can be used as barriers to finding solutions. Ms Ashley argues that at no time in our lives do we 'suddenly revert from wanting fun in our lives; to travel, go out with mates, keep fit, read, sing, learn, walk, engage with nature, and so on. Nor do we suddenly want to sit alone in a flat on the edge of town that is too small, or be grateful for someone to prepare a meal that we have had to choose the day before and look forward to our weekly outing to the bingo.' The challenge is for house builders and housing associations to design good buildings with age demographics in mind, before waiting for local planning policies to co-ordinate health, care and building together.

  • MHA comments: No one area or industry sector can solve all of the issues regarding housing design and availability on its own. MHA is looking forward to the Governments Green Paper which should address some of these issues, and as a housing provider endeavours to be innovative in the provision of accommodation in the meantime. 
  • A variety of technology is being developed and utilised by social landlords. An application called Kradle provides online care notes that staff can update as soon as they finish their shift meaning information is less likely to be lost. Echo-show type device gives older people the ability to order a meal or get shopping delivered from a local store. A sensory system with sensor bars around an apartment can monitor the individuals’ activity even to when the fridge is opened, or the toilet is used, which may sound like a Big Brother style of intervention. This actually allows many people to stay living independently for longer than if they did not have these measures in place.

 In brief:

  • The Government recently responded to the consultation on Regulating Letting and Managing Agents, indicating that it will create a unified code for managing rented or leasehold properties in the UK. While ARCO welcomed the Government’s move towards higher standards, they argue that this may also mean that the ARCO members could be bound by rules designed for millions of general needs properties in the UK, and not for the specialist discipline of running complex developments which include housing, care, leisure and food and beverage services. ARCO commit to keeping their members updated and will work with the Government to clarify their position regarding the sector.

  • The Scottish Parliament has given majority backing for proposals to bring forward energy efficiency targets by a decade. Following the publication of the Energy Efficient Scotland Route Map earlier this month, which details plans for making all buildings warmer and greener, the Scottish Government moved that targets would be in place by 2040. However, a cross-party consensus has been reached by the Scottish Conservatives to bring Scotland’s energy efficiency target forward by 10 years. The party’s energy spokesman Alexander Burnett also won backing for all homes to reach the EPC ‘C’ rating by that date, where feasible. The Aberdeenshire West MSP said: “The Scottish Conservatives have repeatedly called for the SNP’s energy efficiency target to be brought forward from the current date of 2040. We strongly believe we can achieve transformative change in energy efficiency across Scotland – with all properties achieving an EPC rating of ‘C’ or better by 2030.'

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Third Sector 

Trust and brands

  • An emotional journey: How charity brands can cut through the noise is NfpSynergy's free report that looks at the role of emotions in the public's relationships and engagement with charity brands using in-depth data analysis. Although donors usually say that impact and effectiveness lie at the root of their decisions, in practice, there is little evidence that rational deliberation bears any major role in donor decision making. The research was carried out under the assumption that donor decisions are trending towards quick, emotional choices, rather than deliberative decisions. This report includes four key concluding points to keep in mind when attempting to take any supporters on an emotional journey:

    - Charities and causes are about passion and emotion.

    - Each charity need to understand the emotions it invokes in supporters.

    - It’s a choice whether the charity, its brand and its campaigns all invoke the same emotion.

    - It’s a long term journey to build positive emotions.

     

  • Older people are not the age group that gives most to charity, despite most charities focusing their fundraising efforts on them, a survey has found. The Future of Giving report, published by the bank Barclays recently and based on a survey of 2,017 UK consumers and 301 charities, says that people aged between 35 and 54 claimed to give the most to charity. Researchers found that people in this age group gave an average of £265 last year to charities. Over-55s reported giving an average of £168. But the report says that 63 per cent of charities surveyed said the over-50s age group was where they drew most of their support from. Those aged under 35 said they gave £246 last year, the survey showed, but 57 per cent of that age group said they were more likely to donate today than they were three years ago. The report says this suggests charities should focus their fundraising efforts on younger people. Street giving was found to be the most popular way to give, with 48 per cent of donors saying this was how they donated. But 74 per cent of charities said they believed this method was in decline. 

Governance

  • Charities and third-party fundraisers must have a clear complaints procedure and make it publicly available, according to a new rule added to the Code of Fundraising Practice. The code now also includes a requirement that charities investigate complaints fairly, proportionately and without undue delay, the Fundraising Regulator, which oversees the code, has announced..... To coincide with the new rule, the Fundraising Regulator has published guidance explaining what a good complaints procedure would look like and how donor concerns should be handled. The updated code and the guidance both call on organisations to regularly review the complaints they have received in order to use any lessons learned to inform future fundraising activity.

  • MHA comments: Our complaints process is currently being updated although the most recent one can be found on our website.
  • The Information Commissioner’s Office could be granted the power to carry out surprise inspections of charities and other organisations under proposed changes to its powers in the Data Protection Bill. It might also become an offence for any organisation, including charities, to destroy or falsify information that the ICO is investigating. The ICO has opened a consultation on the proposed changes, which are detailed in an updated version of the watchdog’s regulatory action policy and have been added to the draft Data Protection Bill.

  • The charity sector was given a head start on businesses in preparing for the General Data Protection Regulation because of the fines issued by the Information Commissioner’s Office, John Mitchison of the Direct Marketing Association has said. Speaking recently Mitchison, head of preference services, compliance and legal at the DMA, said the fines had led the sector to begin preparing for the new law, which came into force on 25th May 2018, earlier than they might otherwise have done.The ICO handed out fines totalling £181,000 to 13 charities across six months in 2016 and 2017 after the Daily Mail and The Mail on Sunday newspapers carried out investigations into fundraising practices involving several major charities. The fines were issued as penalties for breaching existing rules under the Data Protection Act 1998, but Mitcheson said they had changed the way charities approached the introduction of the GDPR

    In Brief: 
  • The latest Charity Financials Top 100 Fundraisers report reveals how much the UK’s largest fundraising charities spent in the last financial year to accumulate their fundraising income. The report, written by Professor Cathy Pharoah at the Centre for Giving and Philanthropy, Cass Business School, finds that across the top 100 fundraisers, average fundraising costs were 17% as a proportion of fundraising income, which stood at £5.6 billion in 2016/17. As a proportion of total income, which was £9.1 billion, fundraising costs were 10%, meaning that the top 100 fundraising charities spent £910 million on generating this type of income in the last financial year. These fundraising averages lie within a very wide range, from 38% of total income (Crisis) to 0.6% (The National Trust, with high volunteer and member involvement). The overall variation is likely to relate to the way that charities compile and allocate their income in their annual report, as well as differences in spending. 

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Workforce and Skills

  • A recent paper, Tackling Low Pay in the Charity Sector: An Action Plan from the Living Wage Foundation says grant-makers should champion fair pay by ensuring funded projects pay a living wage. Government commissioners should also favour bids by charities that pay staff a living wage, according to a plan to address "endemic low pay" in the voluntary sector. The plan is based on the views of 300 respondents to an online survey run by the foundation. Respondents (80% of whom were voluntary sector staff), identified government cuts and a "race to the bottom" by commissioners as one of two main causes of a squeeze on wages. The other was lack of awareness about the living wage and public perception that charity work should be voluntary or low paid. The survey was conducted after Low Pay in the Charity Sector, a report published in November by the foundation in partnership with 12 funders, the National Council for Voluntary Organisations and Cardiff Business School, revealed that 26 per cent of charity workers were paid below the living wage. The UK workforce average is 22 per cent. The government's national living wage is £7.83 an hour for people aged 25 and over. It increases to £9.15 an hour in London. The foundation says it should be £8.75 an hour (£10.20 in London) for everyone over 18. The Scottish and Welsh governments, and more than 90 local authorities, consider the living wage as part of their procurement processes. The report urges commissioners in Westminster to do likewise by giving "favourable weighting" to bids submitted by organisations that give employees a living wage.

  • MHA comments: MHA recognises the value of our workforce and is proud to be a 'Real Living Wage' employer. We review salaries annually to ensure we continue to pay a fair wage to all our staff.

Nursing

  • Nurses who work in the care sector are under-valued compared to those in health, according to an influential committee of MPs, which has called for a national recruitment campaign to tackle negative perceptions and showcase care nursing as an important and rewarding career.
  • MHA comments: MHA suggested that nurses in the care sector are vastly under-valued compared to those in the NHS as part of our consultation response to the Government. This was in readiness for the Green Paper and we look forward to the Government's response.
  • The Royal College of Nursing has called for the proposed NHS pay deal to be extended to those working in social care. Jeremy Hunt must extend the recent NHS pay deal to nurses and care workers in social care, general practice and the independent sector to avoid a “dangerous imbalance” that is harming patients, the Royal College of Nursing has said. In a letter to the Health Secretary, Janet Davies argues the social care sector delivers more patient care than NHS hospitals and urges additional funding to “level the playing field” to avoid people being “drawn away” from where they are needed

In Brief:

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Look Ahead: June and beyond

Events

Listed below are details of relevant seminars, workshops and conferences that may be of interest to readers:

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Some information sourced from DeHavilland

 
 

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