Policy News from MHA: August 2018

Welcome to MHA's August policy bulletin

 

This month has seen the long-awaited Social Housing Green Paper launched as well as a consultation of the long-term future of the NHS whilst the Local Government Authority has published it's own Green Paper in advance of the Governments' that is due in Autumn. The Government has also launched it's Civil Society Strategy.

 

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 -

Finance and pensions: - 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: September and beyond: - Events of interest -

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Government

  • The head of health and social care in Edinburgh has declared the Scottish Government’s integration model of combining local health boards and councils needs “more time” to achieve the desired results. Judith Proctor has been in her post for three months after inheriting services that had been criticised in a damning report by the Care Inspectorate and Healthcare Improvement Scotland. The inspectorate found delivery of key processes had been “unsatisfactory”. However, the former nurse, who was head of the integration joint board in Aberdeen, said that although there were “teething problems”, she believed care services were improving. The integration of health and social care services came about following government legislation under the Public Bodies (Joint Working) Scotland Act of 2014.
  • The new Older People’s Commissioner for Wales, Heléna Herklots CBE, has set out her ambition to make Wales the best place in the world to grow older and is inviting a wide range of individuals, organisations and bodies, including older people, national and local government, public services, third sector organisations, the private sector and researchers, to work with her to improve the lives of older people. As she took up the post, she said that Wales has already delivered ground-breaking policies and legislation to improve older people’s lives, and that these innovations and good practice can be built upon to ensure that Wales continues to lead the way for older people. Speaking in Pontypool, Heléna said: “Wales has shown a strong commitment to improving the lives of older people, having developed the strategy for older people, which was a significant step forward, and creating the role of Older People’s Commissioner for Wales, the first role of its kind in the world. More recently we have also seen important legislation, as well as a strong focus on well-being and rights, which aim to make a meaningful difference to older people across Wales. I want to build upon these solid foundations, as well as on the excellent work undertaken by my predecessor Sarah Rochira, and I hope that the Welsh Government, local government, public services and the third sector, as well as older people, will work with me to improve older people’s lives and make Wales the best place in the world to grow older".

  • MHA comments: We welcome Helena Herklots' appointment and look forward to meeting and working with her to improve the lives of older people across Wales. 

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Brexit

  • A new project to help the social care sector in Wales plan its workforce requirements post-Brexit has been announced by the Welsh Government. £200,000 has been allocated from the Welsh Government’s EU Transition Fund to fund research into how the Brexit process could impact on the social care workforce in Wales, and to help the sector plan for any eventualities. The £50m EU Transition Fund was set up to help business, public services and others prepare for the impacts of Brexit.
  • A new briefing from the European Medicines Agency (EMA), based in the UK, has analysed the public health fallout of a no-deal Brexit. The EMA will relocate to Amsterdam and expects to lose 30% of its staff. As a result, the agency has begun cutting back on some core activities, including the scientific approval of new medicine and the handling of transfer requests that would allow the free flow of medicine between the EU and the UK. The impact will not be confined to the UK according to the Financial Times. Every month, 45m patient packs of medicine ship from the UK to the EU, and 37m move the opposite way. There are 694 medicines for which the EU marketing rights are held in the UK. Unless those authorisations are transferred, 400 of those drugs will no longer be available in the EU. Many companies are taking the necessary steps, but the EMA and companies estimate that 108 products are at risk of not making it in time. 
  • Prime Minister Theresa May announced last month that the Government would be issuing around 70 "technical notices" containing advice to individuals and businesses on how to prepare for the eventuality of leaving the EU without a deal.The article contains a list of 84 different areas which include EU citizens in the UK and workplace rights. 24 of these have now been issued and the rest will be published shortly. 

Finance and Pensions

  • The Government has announced plans to introduce a new tax-free personal savings scheme nicknamed a 'Care ISA'  to cover the rising costs of caring for an ageing population. The policy would allow any unspent funds in the Isa after death to be passed on tax free to the holder’s family. At present, when an individual dies, any money left in an Isa investment is automatically rolled into their remaining estate, which is potentially subject to the inheritance tax rate of 40%. Dr Sarah Wollaston, who chairs the Commons health and social care select committee, said the plans were “a colossal mistake” that would only serve as a solution “for a small minority of wealthy people” George McNamara, Director of Policy and Influencing at Independent Age also agrees that it may only benefit the wealthier part of society and goes further to say that it will not solve the social care funding crisis. 

Health and Social Care

  • The Local Government Association (LGA) has published it's own consultation on social care in advance of the Governments' Green Paper that has been postponed until Autumn. The LGA is hoping to kickstart a debate on how to pay for adult social care and support the services caring for older and disabled people. The organisation, representing local authorities in England and Wales, estimates that adult social services will face a £3.5bilion funding gap annually by 2025. Spending on these services currently accounts for about 40 per cent of council budgets and is threatening the future of facilities such as parks, leisure centres and libraries. The LGA has launched an eight-week consultation setting out options for how the system could be improved and radical measures to be considered given the scale of the funding crisis. These include increasing income tax, national insurance and council tax, and means-testing benefits such as the winter fuel allowance and TV licences. Richard Humphries, Senior Fellow at The King's Fund, said: 'The need for a long-term settlement for social care alongside that of the NHS has never been greater. The LGA's Green Paper is an important and welcome contribution to the debate.'

  • MHA comments: We welcome the LGA's Green Paper as it opens up the debate on social care and it's future funding.
  • More than half a billion pounds is being spent on free personal care for older people every year, according to Scottish government statistics which declare that £502 million was spent on providing care for the group in the 2016-17 financial year. This is up £372 million since 2007-08. Most of the increase is spending on people in their own homes. These costs have risen from £267 million to £379 million and is thought to reflect the success of the drive to keep older people in their own homes. More than 76,000 people in Scotland benefited from free personal and nursing care in 2016-17. This included nearly 31,000 people in care homes and about 46,000 in their own home. Under the initiative brought in by the Scottish executive in 2002 everyone over the age of 65 assessed as needing personal care was provided it free.

  • A refreshed joint strategy between the Scottish Government and COSLA, which champions independent living for older people within their community, has been launched. Announcing ‘Age, Home and Community’ with members from Age Scotland network groups, Housing Minister Kevin Stewart said 'When we published our original joint strategy seven years ago, we set out a vision to make housing and related support work well for older people. Alongside COSLA and other partners, we have updated our action plan to better reflect the needs and aspirations of older people – addressing the issues of isolation and loneliness while improving access to suitable housing. Having the right advice, the right home and the right support will enable older people to live independently for as long as they choose to do so.' Councillor Elena Whitham COSLA Community Wellbeing Spokesperson said 'The mid-point review of the strategy showed there is much to celebrate and case studies showed older people have benefited and improved their ability to live independently as safely at home. That said there is still work to be done to make living safely and independently at home a reality for many more aging people across Scotland.The publication also set out how our older peoples' housing strategy connects to other policies that affect outcomes for our aging population.'

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

Workforce and Skills

  • Think tank Global Future have produced a report, 100,000 carers missing, stating that the country’s social care system has become increasingly reliant on workers from abroad, with 222,000 employees in England, around 17% of the total, foreign nationals and that ending freedom of movement after Brexit could lead to 115,000 fewer social care workers by 2026. It's analysis of Office for National Statistics (ONS) data shows there is one care worker for every 3.4 people aged over 75 and to keep pace with the ageing population, the report said the sector would need to employ an extra 380,000 staff in the next eight years. Calling for Health and Social Care Secretary Matt Hancock to make the case for free movement for low-skilled social care workers, the report said the Government ‘must not lock out’ care workers and properly fund the system. 

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

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Ageing and wellbeing

  • The Centre for Ageing Better has refreshed its strategy in “Transforming Later Lives, with a focus on four priorities with ambitious goals for the changes it wants to see in society: 
    • Fulfilling work – to help employers to become age-friendly, so people can work for longer if they need or want to, so they can be financially secure and save for retirement.  
    • Safe and accessible homes – to ensure the homes people live in, support people to stay independent for longer, by working to make sure their housing stock is safe and accessible. 
    • Healthy ageing – to help more people to stay in good health and free from preventable disability for longer, so they can continue to be active and do the things they value.  
    • Connected communities – to create more age-friendly communities that make it easier to build and maintain close connections.

    • South East England Forum on Ageing (SEEFA) are arguing that society needs a new narrative on ageing. The notion that an ageing society is a major social and economic threat is so familiar and that older people are seen as dependent on working age people, make no contribution to and have little value in society. Negative portrayals of older people are commonplace: with the assumed cost of ageing, reinforcing a view that older people are non-productive beneficiaries of state support; at the same time, however, they are perceived as well off. Like any group outside the social mainstream, older people are routinely stereotyped and are the subject of many false assumptions and untruths. This matters because how older people are perceived and the assumptions made about them are bound to influence society’s response to ageing.    

    • MHA comments: We welcome SEEFA's call for a new narrative. At MHA, we are fully aware of the contribution that many older people can and continue to make to their local community and society as a whole.
    • Living Longer - How our population is changing and why it matters is a new report from the ONS looking into the ageing population. In mid-2016 there were 1.6 million people aged 85 years and over (2% of the total population); by mid-2041 this is projected to double to 3.2 million (4% of the population) and by 2066 to treble, by which time there will be 5.1 million people aged 85 years and over making up 7% of the total UK population. Meanwhile, the population aged 16 to 64 years is projected to increase by only 2% over the next 25 years and by 5% by 2066.

Wellbeing

  • One police force recorded an increase of 4,295% since 2007 in violent crimes against older people. Recently campaigners for older people’s rights said the rise of violent attacks “puts our society to shame”. The findings led to fresh calls for a change in the law to make the targeting of older people as a hate crime. The figures, obtained under Freedom of Information laws by the Express newspaper, show that 26 police forces in England and Wales recorded 7,379 violent assaults on over-65s in 2007. By 2016, the number of attacks had risen to 20,921, an increase of 183%. New figures for 2017 show the number of assaults rose again to 26,474, an increase of 258 per cent on the figures recorded 10 years earlier.

Loneliness

  • Janet Morrison, Chief Executive of Independent Age, argues that 'we can't tackle loneliness if we don't start with how people make friends. One of the biggest problems when we talk about loneliness is that we are talking about the symptom of a problem not the cause. Loneliness is actually the symptom of living alone and having insufficient high quality relationships. Moving people into shared living is not the whole solution however, as people can still feel lonely in these environments. Older people living in multi-generational households are also not necessarily less lonely, they can feel excluded from the busy-ness of the younger lives around them. Recent comparing loneliness amongst those living in their own home, in sheltered housing or care homes  showed that although those the majority still counted their ‘real friends’ as those that were formed prior to their move, which is why maintaining those relationships when a person moves is so essential.  
  • Mike Niles has set up the charity b:Friend in Doncaster. It comes out of his own experience of loneliness and his desire to change the situation for older people who may also be feeling lonely. It’s a befriending service matching younger volunteers to older people to combat loneliness. It sounds very similar to a Live at Home Scheme. 
  • MHA comments: MHA have been providing support to older people through their Live at Home Schemes for 30 years, including in Doncaster. We welcome the involvement of other organisations who are working to combat the effects of loneliness and isolation, and have been in contact with b:Friend regarding working together.
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Dementia

Care, support and wellbeing

    • A single blow to the head can cause the same creeping brain damage as is found in dementia patients, according to a study that throws new light on links between professional sport and the disease. Scientists have discovered that one injury can generate abnormal proteins such as those associated with Alzheimer’s disease, and that they gradually spread through the brain. The research, carried out in Glasgow and Milan, is being hailed as the first evidence showing how an impact on the skull can silently trigger chronic health problems such as poor memory and confusion years later. 

    • Armchair karate has been helping older people with dementia in Northumberland stay physically active, after a nurse purchased equipment so they could test out their “best jabs” at the care home she runs. The activity has been adopted to help try and maintain the strength and movement of the residents at the Oaks Care Home in Blyth. The idea for using martial arts came about when registered mental health nurse and home manager, Ann Mielnik, saw a YouTube video of a 93-year old woman doing the activity. The day after, Ms Mielnik purchased training pads for carers to wear while residents throw their “best jabs”. According to Ms Mielnik, the older people have welcomed the idea, with the home gaining positive responses from the residents and their family since the activity was introduced in June. “Residents absolutely loved it. It helps them to exercise. It also helps their well-being because they're cheering each other on,” said Ms Mielnik. As all of the residents have dementia, the activity is one of many to help them stay active and brainstorm their minds through physical activities and recreation, said those behind the initiative.

    • People who are teetotal in middle age are at greater risk of developing dementia than those who drink moderate amounts, especially for wine drinkers, a new study has found. Researchers found abstinence was associated with a 45% increase in the chances of getting dementia by early old age, compared to those who drank within recommended limits, which is up to a bottle and a half of wine a week. People who drank above the 14 unit guideline were also at increased risk, the team from University College London and French institute for health, Inserm, found. Their risk of developing dementia increased incrementally the more alcohol they were consuming. Dr Doug Brown, Chief Policy and Research Officer at Alzheimer’s Society, says: “Despite being one of the UK’s top causes of death, we are still unable to cure, slow down, or even prevent dementia. By finding evidence that drinking lots of alcohol, and also drinking no alcohol at all both increase dementia risk, this study supports other work that continues to question whether drinking up to the equivalent of six glasses of wine per week might have a protective effect against dementia... However, as this is an observational study we need longer trials to explore whether this is actually the case.'

    • A dementia-focused community development is set to open its doors to its first residents this month in Hampshire. The Brendoncare Otterbourne Hill facility offers a full-range of care and support for those wishing to live independently through to end-of-life-care. Brendoncare Otterbourne Hill offers 20 purpose-built one and two bedroom apartments for individuals and couples affected by dementia, enabling them to live together in their own home with ‘shared’ care, respite and emergency support available 24 hours a day
    • MHA comments: As a provider of services for older people, we offer Live at Home Schemes, retirement living and care home facilities to help with the journey of dementia and ageing more generally. 
    • Non-drug approaches should be prioritised in treating agitation in people with Alzheimer’s Disease, according to the Alzheimers' Society based on recent research. The research, led by the University of Michigan, provided guidance on the management of behavioural and psychological symptoms in people with Alzheimer’s Disease.Sally Copley, Director of Policy, Campaigns and Partnerships at Alzheimer’s Society, said: “Many people with dementia have behavioural and psychological symptoms, such as agitation and psychosis, which are distressing for them as well as their carers. We desperately need to find ways of reducing these symptoms without negatively impacting the person’s quality of life. Drug treatments can have harmful side-effects so it’s heartening to see these researchers advocating psychological interventions instead.' 

    • MHA comments: This research chimes with our experience of using music therapy in our care homes to help reduce the agitation that some people with dementia can experience. Medication has it's place but non-drug approaches are very much welcomed. 
    • Rates of dementia diagnosis are higher among black ethnic groups compared to white and Asian groups in the UK, a new University College London-led study has found. Researchers from UCL Psychiatry analysed data from 2,511,681 people, including 66,083 who had a dementia diagnosis, from The Health Improvement Network primary care database between 2007 and 2015. The study has looked at differences in dementia diagnosis rates among different ethnic groups in the UK. The paper, published recently in the journal Clinical Epidemiology, suggests that black men and women are more likely develop dementia than their white or Asian counterparts. More research is needed to understand why people in certain ethnic groups are more likely to develop dementia. It could be that factors such as level of formal education, financial deprivation, smoking, physical activity, mental health and some mid-life health outcomes, which all affect dementia risk, differ between the groups. Other research has found that South Asian people may have a lower genetic risk of getting dementia.

    • A group of carers from Abicare has donated 50 handmade 'twiddle muffs' to the Royal Gwent Hospital  for dementia patients. The aids are knitted hand-warmers with buttons and other accessories inside for people to play with, keeping their hands, and minds, stimulated. The chaplain's office will distribute the aids throughout the health board and to people who are cared for at home.
    • Seven healthy habits can reduce the risk of dementia by 70 per cent even after retirement, a study has concluded. Each improvement in lifestyle cut the risk of dementia by an extra 10 per cent and people should amass as many as possible to protect their brain as they age, researchers said. Previous studies have suggested that staying slim and exercising from middle age can preserve thinking skills in later life. Researchers aimed to test the combined effect of these plus moderate drinking, not smoking, eating plenty of fruit, vegetables and fish, and keeping control of blood pressure, cholesterol and blood sugar.  Dr Sara Imarisio, Head of Research of Alzheimer’s Research UK, said 'This large study of over 6,000 older people in France adds to a wealth of existing evidence indicating that what is good for the heart is also good for the brain.. As well as these seven aspects of healthy living, staying mentally active and socially engaged have also been linked to better brain health in later life. Staying healthy doesn’t have to mean running marathons or sticking to intense diets, and modest changes in lifestyle can have a big impact on our health in the long-term. Anyone who has concerns about their heart health, or their brain health, should speak to their GP.

    • A technique that helps people living with dementia to see satisfying progress in achieving everyday goals, is now being trialled by Sunrise Senior Living UK. The University of Exeter is leading a 12-month programme to train carers in goal-orientated cognitive rehabilitation. It entails practitioners working with people living with dementia and their carers to establish goals that are most important to helping people maintain their lifestyle, ranging from cooking food, to remembering the names of loved ones.

    • Allison O'Kelly, a nurse from east Cornwall is preparing to travel to the other side of the world to research how dementia affects the lesbian, gay, bisexual and trans (LGBT) community. Allison developed an interest in the LGBT community and dementia after working with a trans-woman who developed Alzheimer’s disease and became confused about her identity. Through her own research, Allison, who is a Queen's Nurse and clinical lead for memory services at Cornwall Partnership NHS Foundation Trust (CFT), found a lack of research into this group of people in the UK. Although interest is growing in the UK, Australia is leading the way in providing training and services for the LGBT community. Allison applied for a Winston Churchill Memorial Trust (WCMT) fellowship award. After being shortlisted and interviewed in Westminster in January 2018, she was selected out of more than 1,000 people to take her studies overseas. The WCMT carries forward Sir Winston Churchill’s legacy, by funding UK citizens from all backgrounds to travel overseas in pursuit of new and better ways of tackling a wide range of the current challenges facing the UK. She plans to learn best practice from a range of experts and trainers in Australia. Whilst travelling, Allison will meet LGBT elders and people with dementia, along with their families and carers to understand their experiences, meet with key figures in the LGBT and dementia community, and attend professional conferences.

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Finance and pensions

  • Robert Kilgour argues that the 0.7% foreign aid target should be scrapped and invested in social care instead. He states that Rwanda’s tyrannical dictator Paul Kagame, who last year received £62m of British money in aid decided to spend £30m of it on a sponsorship deal for his favourite football club, Arsenal. Robert believes that this is the latest example of how aid is wasted at a time when the health and social care system is creaking so badly the Prime Minister has been forced to pledge an extra £20bn a year of spending – leaving the Treasury wondering how to fund it. He argues that there is a lot wasted on aid that would be better spent on UK health and social care.
  • MHA comments: We can't comment on Robert Kilgour's personal opinion but the forthcoming Social Care Green Paper will hopefully address some of the long-term funding concerns that Robert refers to.
  • Crisis-hit Northamptonshire county council has voted to push ahead with a radical cuts strategy to reduce services to a bare legal minimum, as it attempts to close a financial black hole which it says could grow to £180m within three years. The strategy aims for “radical service reductions and efficiencies” across a range of areas, including children’s services and adult social care as it moves to a stripped back “core offer” to residents. Matthew Golby, leader of the council promised that no residents would be put in danger by the cuts, and that the council would meet its legal obligations to deliver vital services. Adult social care will also come under scrutiny, and it is likely the council will look to raise or introduce fees and charges for services. Support for people with learning disabilities will also come under scrutiny. East Sussex county council is also struggling financially and may be limiting it's services to the bare legal minimum. Derby city and Derbyshire county councils have written to the government raising their concerns regarding the lack of funding. 
  • MHA comments: MHA continues to work with organisations such as Care England to press for the true cost of care to be fully funded by local government and health bodies and hopes that this will be addressed in the forthcoming Green Paper.  

 

Older people's income 

  • Just one in ten people over the age of 55 have put aside money to pay for care in old age, according to new research published by consumer group Which? The research comes just one day after it emerged that the UK government is considering a new “care ISA” to tackle the crisis in social care provision. Ministers will publish their a long-awaited green paper on social care later this year, which will make several alternative proposals for raising the money needed to tackle the funding gap for care for older people. 

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Health and Social Care  

  • Hallmark Care Homes has joined forces with The Together Project, a not-for-profit social enterprise that runs creative activities to unite different age groups to tackle loneliness. From September onwards, Hallmark Homes in England will begin to host weekly Songs & Smiles sessions for residents, 0-4 year olds and their parents from the local community. Some of the residents will also be involved in facilitating the sessions by acting as welcomers as children and parents arrive

  • Patients are being put at risk because of a lack of staff awareness about discharging them from hospital, a report has said. Poor relationships between GPs and hospitals also meant patients staying in longer than necessary, it added. The Healthcare Inspectorate Wales (HIW) report said "significant attention" was needed at hospitals. A Welsh Government spokesman said systems were being rolled out to improve the situation. 
  • Last month the Care Quality Commission published it's report, Beyond Barriers: How older people move between health and social care in England which analysised the local area reviews. Glen Garrod, the President of the Association of Directors of Adult Social Services, has responded and said: “This report is a valuable contribution to our ongoing national conversation about how we provide a ‘whole person’ approach to meeting people's needs. This is essential if we are to provide the tailored, individual approach to social care that the people we support desperately need...The benefits of good collaboration between health and care organisations around the needs of an individual, including sector-led improvement, greater transparency and greater trust among colleagues, cannot be overstated. We need an approach that breaks down barriers to collaboration, not builds them back up.
  • A report by Healthwatch Surrey has highlighted and commended some positive interventions by Surrey Downs CCG in improving hydration and nutrition among older and frail care home residents in the region. Since launching their Quality in Care Homes (QiCH) programme in January 2017, the clinical commissioning group has worked successfully with one third of the 71 care homes in Surrey Downs, helping to effect a reduction in hospital admissions due to urine infections, falls and complications stemming from existing cardiovascular and respiratory conditions.

  • The number of people aged 85 and over needing 24-hour care is set to double, says a new study, as an expert warns the care system is "at breaking point". The study, published in the Lancet Public Health journal, analysed the projected health needs of the elderly in England between 2015 and 2035. It found that the number of 65-year-olds and over needing round-the-clock care is also set to rise by a third. The government says adult social care reforms will be set out in the autumn.
  • NICE have published a quick guide for home care managers providing medicines support. Adults may need support to manage their medicines safely and effectively, and for some people this will be provided as part of a home care service. This quick guide covers two important aspects of medicines support – record keeping and checking and ordering medicines. Information includes:                                                      Completing a medicines administration record (MAR)
  •                         Making sure medicines are available when needed
  •                         Managing over-the counter medicines
    •                   What to expect from health professionals
    • The Royal College of Nursing (RCN) have launched the UK's first guidance to help healthcare staff more effectively protect adults who are at risk of abuse or neglect because of the level of care they need. The College was asked by NHS England to lead the work, which has involved over 30 other Royal Colleges and professional organisations involved in healthcare. The new document, Adult Safeguarding: Roles and Competencies for Health Care Staff, outlines the professional standards that all staff at healthcare organisations will need to meet if they are to be involved in adult safeguarding. Work on it began in January 2018. The ground breaking new guidance is aimed to safeguard anyone over the age of 18 at risk of abuse, harm or neglect because of their need for care and/or support, who are unable to safeguard themselves. It is designed to counter both emerging and common forms of abuse, such as "cuckooing", where unscrupulous people move in and take over someone's home, possessions and finances; people trafficking and modern slavery; domestic abuse; and internet abuse, such as being as being the subject of non-consensual online pornography. The new roles and competencies cover everyone from receptionists and porters to consultants and board members. There will be five levels, depending on the nature of a person's role, and a mandatory training session is recommended to begin within the first six weeks of staff starting a new role within a healthcare organisation. Depending on the level of competency required, staff will be required to refresh their skills within every three-year period. It will cover staff working in everything from hospitals to care homes and those who help people to stay living in their own homes and is designed to stamp out all types of abuse.

Funding and fees

  • Age UK's recent report has found other countries have 'more progressive systems' than England when it comes to social care provision, by either providing a non-means tested basic level of care (Germany), capping the amount of co-payment for all (at 10 per cent in Japan) or using a more generous and gradual means test (France). Meanwhile, England has been described as having the strictest means test for its citizens, compared to other countries. Whilst Japan and Germany started the process of social care reform long ago, the charity said ‘here in England we have been painfully slow to get going’.  The authors admitted that they did not find a “magic bullet” solution – every country is facing some problems – they concluded England comes across “rather badly” compared with other systems.

  • NHS and Health
  • The new NHS ten year plan must succeed where previous initiatives have failed and finally put community services front and centre of improving care for the public according to the Community Network. They argue that key priorities of the forthcoming NHS plan must be the acceleration of integrated care and the spread of a community based model to manage population health and care. A letter to NHS England and NHS Improvement has been written by Matthew Winn, chair of the Community Network.The letter, addressed to NHS England Chief Executive Simon Stevens and NHS Improvement Chief Executive Ian Dalton, calls for the 10 year plan to accelerate changes to how people access health and care services and offer more integrated care. It adds that the NHS Confederation-commissioned report by the Institute of Fiscal Studies and Health Foundation Securing the future: funding health and social care to the 2030s said it is likely we will need to double acute hospital provision over the next 15 years to meet growing demand if there’s not more care in the community and closer to people’s homes.

  • The NHS has subsequently opened a consultation, 'Developing the long term plan for the NHS' that closes on 30 September 2018. The development of the long term plan for the NHS will need to be based on the advice and experience of clinical experts, staff and other stakeholders, including representatives of patients and the public. As part of this process the NHS are asking that all those who rely on and work in or alongside the NHS have the opportunity to contribute their ideas and insights.
  • A national campaign to end “pyjama paralysis” has helped reduce falls and pressure ulcers and cut the length of time people spent in hospital, according to an evaluation. The 70-day challenge, launched by England’s chief nursing officer Professor Jane Cummings earlier this year, has seen hundreds of hospitals across the UK take steps to ensure patients got up and dressed and took part in activities instead of being stuck in bed. In all, the drive has given back more than 710,000 days to patients, according to those behind the scheme. An evaluation shows it has led to reductions in falls, pressure ulcers and shorter lengths of stay, as well as improvements in patients’ experience of hospital care.

     

     In brief:

  • The Care Provider Alliance worked with NHS England and NHS Improvement to produce a Quick Guide, Hospital Transfer Pathway - 'Red Bag' which aims to help local health and social care systems to develop effective and efficient arrangements for Hospital Transfer Pathways (more commonly known as the ‘Red Bag’ initiative). 

  • A no-deal Brexit could increase the risk of a Europe-wide pandemic, according to the British Medical Association. The doctors union warned in a new briefing paper that crashing out of the EU without a deal will leave the UK more vulnerable to outbreaks of deadly infectious diseases. It says that the UK’s ability to coordinate responses to emerging threats, such as the current outbreak of measles or seasonal flu, will be seriously undermined, making it harder to stop infections spreading across borders.

  • Staff at Keate House decided to add colour and life to their basement space by introducing Keate Street. Hand painted walls give the street a unique feel especially as the shops have all been given personal names relevant to the homes history.  Keate Street has been designed to encourage and promote independence. The street includes a new sweet shop, a refurbished salon, cinema and training room and also a street café.
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Housing

  • Thousands of social housing association tenants are being given the opportunity to realise their dream of home ownership, as the Midlands Voluntary Right to Buy Pilot launched recently. Communities Secretary Rt Hon James Brokenshire MP said this is the first step in helping housing association tenants get a foot on the property ladder. This follows measures announced in this week’s social housing green paper, to make it easier for residents to progress into home ownership. The existing Right to Buy programme for council tenants backs families who have worked hard, paid their rent and have a sense of pride in their home. Government is providing £200 million for this Voluntary Right to Buy pilot, with places allocated via a ballot to ensure fairness for applicants. After working closely with the National Housing Federation to make this launch a reality, money from the discounted sales will then be used to fund replacement homes. Speaking at the launch, Communities Secretary Rt Hon James Brokenshire MP said: "This government is committed to providing opportunities for people to get a foot on the property ladder and to have a place they can call their own."Our £200 million investment into the Midlands Voluntary Right to Buy Pilot is the first step in helping housing association tenants realise their dream of home ownership."

  • The Government’s much-delayed Social Housing Green Paper was published recently and the consultation relating to it is open until 6th November 2018. The aim is to rebalance the relationship between residents and landlords. Almost 1,000 residents of social housing contributed their views at events across England, Another 7,000 added their thoughts and concerns online.
    Five principles will underpin a new, fairer deal for social housing residents:
    -a safe and decent home
    -improving and speeding up how complaints are resolved
    -empowering residents and ensuring their voices are hear so that landlords are held to account
    -tackling stigma and celebrating thriving communities (challenging the stereotypes)
    -building the social homes that we need and ensuring they can act as a springboard to home ownership
  • The National Federation of Builders (NFB) welcomes the Social Housing Green Papers' approach to solving existing social housing problems but warns that proposed changes do not go far enough. Proposed changes to the definition of social housing now include shared ownership and equity percentage arrangements. The NFB agues that this change may not actually deliver new homes where they are most needed, although the number of social housing a local authority sees built, will likely increase. Richard Beresford, chief executive of the NFB, said: The social housing green paper proposes solutions to existing problems but stops short of radical reform. Not lifting the local authority borrowing cap will undoubtedly be seen as a missed opportunity.... previous commitments to replace council housing at a rate of ‘one for one’ are not referenced, therefore public housing stock may continue to be depleted at a rate faster than councils can afford to replenish it."

Older People

  • A new publication by RIBA called Age Friendly Housing: future design for older people looks at the challenges we face in providing homes for older people as the population ages. The book looks at the challenge of an ageing population, the impact of government policies, approaches to new build projects, the social value of shared space, ensuring the importance of home, and at the use of technology. It considers several possible approaches in ensuring age-friendly housing is integrated with the community, including intergenerational shared living.
  • Thousands of extra homes, specially designed for people with disabilities, mental health issues and older people who need extra support, will be created over the next three years with an additional £76m a year for specialised housing announced by Government. The fund is run in partnership with Homes England for schemes outside London, and the Mayor of London for London-based schemes, who implement the programme. Providers can bid for money through Homes England and the Mayor of London’s office to build these specially designed new homes. Minister for Care Caroline Dinenage said: No one should have to go into a residential home or get stuck in hospital because of a lack of specialised housing adapted to suit their needs. This programme provides a vital life line for some of the most vulnerable people in society to live their own lives in a home that works for them. We want the fund to be used to its maximum potential so more homes can be created, more quickly, ensuring that thousands of people are supported to live independently in their own homes, benefitting both them and their carers.

 In brief:

  • Ministers recognise that supported housing is a vital service for some of the most vulnerable people in our communities, and last year consulted on possible alternative funding options. Having listened to views from providers, stakeholders and councils, the government has decided housing benefit will remain in place to fund this accommodation. Housing Minister, Kit Malthouse MP, said: Protection of the most vulnerable has always been our primary concern, and following our consultation, the case for keeping supported housing in the welfare system became clear. The sector also recognised that our aim of improving the quality of homes must be addressed, and we look forward to now working with partners to make sure we have strong measures in place. The Chartered Institute of Housing support this and state that the Government has made right decision on funding for short-term supported housing. Head of Policy Melanie Rees said 'this type of housing provides vital support for some of the most vulnerable people in our society, people who have been victims of homelessness or domestic abuse for example, and it is absolutely right that it will continue to be funded by the welfare system.'  Cllr Izzi Seccombe, Chairman of the Local Government Association’s Community Wellbeing Board, said: “This announcement will give councils and housing providers the certainty to sustain and invest supported housing for some of the most vulnerable people in our communities. A sustainable funding model for supported housing is critical to ensuring councils can reduce homelessness and help older and other vulnerable people.'

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Third Sector 

Trust and brands

  • NfpSynergy have produced a report looking at the facts and figures of the Welsh and Scottish charity sectors. In 2016 the third sector in Wales had a total income of £2 billion, of which 21% of this was from public giving. Over a third of the public in Wales would prefer their charity donation to be spent in Wales. 59% of the Welsh public, trust charities compared to 15% of the Welsh population that do not. Looking within the data the Welsh public are reflective of the British public, with both women and young people (age 16-24) being more likely to trust charities, at 61% and 67% respectively. This places charities below the NHS, that has the trust of 79% of the Welsh public, but far above other institutions such as insurance companies and the Westminster Parliament, that are both distrusted by 48% of the Welsh public. This trust in charities has increased over the last few years, moving from 56% in May 2016 up to the 59% mark in June of 2017. This story of increased trust by the Welsh public is reflected across all institutions apart from the BBC which has declined over recent years.
  • Regarding the Scottish charity sector, it had doubled in size in terms of finances in the decade of 2003-2013, reaching £4.9 billions in 2013. 23,700 charities have registered with the regulator, and Scotland currently has 3.6 charities per 1000 people, compared to 2.4 in England. One in five people in Scotland volunteered in the last year (a total of 1.3 million). The top five charitable activities, in terms of numbers of organisations operating within that sub-sector, reported by the SCVO are: social care (34%), community, social and economic development (16%), culture and recreation (14%), education and research (5%) and environment and animals (3%). This contrasts with the Scottish Public’s favourite causes to donate to: medical research, animal welfare and children and young people.
  • The government has launched a new “big society”-style strategy designed to enable charities to play a bigger role in the provision of public services, from social care and homelessness to libraries. Ministers say they want to help the public sector, private businesses, charities and volunteers to work together more closely to solve social problems, build stronger communities and create a fairer society. It comes out as local authorities – a key source of funding for many local charities – warn that voluntary groups will have to take on the delivery of services that councils can no longer afford because of funding cuts. The Civil Society Strategy promises £165m in funds taken from dormant bank accounts and charitable trusts to support community foundations, set up organisations to get disadvantaged people into employment, and tackle financial exclusion. It also includes plans to launch “innovation in democracy” pilots in six regions around the country are also included in the document, to trial ways for people to take a more direct role in community decision-making through possible online polls, apps or “citizens’ juries”. One criticism of the strategy is that is mentions 'new initiatives to support local communities' whilst thousands of volunteers, up and down the country, who still maintain village halls, run Brownie packs, drive old people to appointments, organise youth groups, staff charity shops and raise money for local schools. This is the Big Society in action. 

Governance

  • Major regulatory changes about the disqualification of trustees are in force as of 1 August 2018. A number of these were included in the Charities Act 2016, so trustees may not be aware that they could be automatically disqualified, and either must step down or apply to the Charity Commission for a waiver. Trustees will need to sign a form to attest that they don’t have certain criminal records or convictions. The Charity Commission have created guidance to make sure charities don’t fall foul of the new rules. 

      

    In Brief: 
  • Everybody agrees diversity is an important topic when asked about it. We all want to put the issue ‘front and centre’, and make it ‘core to our organisation’s mission’. A recent NPC survey showed that only 7% of charity leaders think that diversity at board level was not particularly important or brought no particular benefits so the vast majority believe that diversity at board level is positive and brings benefits. Data on the lack of diversity in the sector shows a different picture however. Specialist trustee recruiter Inclusive Boards says that the boards of the top 500 charities by income are less diverse than those of UK’s biggest companies in terms of ethnic makeup. They also found that almost 80% of senior leadership teams lack any ethnic minority professionals. Executive recruiter Green Park reviewed senior roles across the 100 largest charities in the UK and found for example that 8.1% of senior positions in major UK charities are held by ethnic minority leaders. In their annual pay survey ACEVO includes questions about diversity at charity CEO level. Their first published ethnicity data in 2008 showed that 4.2% of respondents reported being from a BAME background. For the 2018 survey this figure was 3% so in ten years, the figure had actually reduced. People agree that diversity is important but the statistics show that there are gaps in putting this into action. 

     

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Workforce and Skills

  • Women will have to give up work to look after their ageing parents and grandparents unless EU care workers are given priority after Brexit, ministers have warned. The Department of Health said that in a "worst case scenario" if EU migrants are barred from coming to the UK there will be a shortfall of 6,000 doctors, 12,000 nurses and 28,000 care staff within five years. In a 37-page dossier it said that there will be a "wider risk to labour market participation" because growing numbers of people, "especially women", will have to give up their jobs to provide "informal care" for loved ones. It highlights mounting Cabinet tensions over the end of free movement and the UK's post-Brexit immigration policy, which is due to be unveiled by the end of the year. This annoucement was then followed by general 'twitter outrage' at the perceived sexism although woman are proven to be more likely to be informal carers for family members than men. There are already over 6.5 million people supporting loved ones, from taking a seriously ill partner to hospital appointments, to helping a disabled brother or sister with washing and dressing, to caring full time for an older parent

Nursing

  • Thousands of NHS staff have had their pay rise wiped out because they have had to pay more into their pension. Teachers and other public sector workers, who were also awarded pay rises last month, will face a similar squeeze. In March the government announced a 6.5 per cent pay increase over three years for NHS staff; lower-paid workers would get a bigger rise. The increases took effect last month but some staff found that their net pay had barely gone up and others were paid less thanks to the way their pension contributions were set.

  • MHA comments: MHA values all of our staff and our nurses have recently received a pay rise which recognises their training, hard work and commitment to the care of older people.

In Brief:

  • NHS England is currently in the process of recruiting more pharmacy professionals to work with care homes to improve both the safety and effectiveness of medicines and residents’ quality of life. There is a need for better medicines optimisation in the nation’s 20,000-plus care homes. Three-quarters of 75-year-olds in the UK have more than one long-term condition and, as a result, more than half of this age group are taking five or more drugs. Yet one pharmacist describes care homes as a ‘healthcare black hole’ because they can be seen as low priority, even among GPs. Residents have professional in-house care rather than being looked after in their own home by untrained family members. However, a lack of medicines knowledge among care home staff can lead to over prescribing and hospital admissions.

 

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Look Ahead: September and beyond

Events

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

  • Infection Prevention in Care and at Home One Day ConferenceSunday 30 September 2018, Scottish Event Campus, Glasgow. This one-day conference is tailored for those who work providing services for people in care and those receiving care at home and will be run by the Infection Prevention Society. This day is relevant for all staff and in particular those senior staff with the accountability for infection prevention within the organisation. The cost to attend is £95 and this includes access to the UK’s largest infection prevention and control exhibition offering you the opportunity to view new and innovative products and discuss your requirements with company professionals. A large poster area will also be displayed throughout the conference within the exhibition hall.

  • The Power of Music in Health and Social Care -  The University of Nottingham is delighted to announce The Power of Music in Health and Social Care Conference in partnership with Room 217 on 12 October 2018. Further information will follow shortly but if you would like to register your interest, please email: powerofmusic@nottingham.ac.uk MHA are supporting this financially and Ming, our Chief Music Therapist will be one of the speakers.

  • National Care Forum Managers Conference, 12 - 13 November 2018, Kenilworth, Warwick. The theme for this year is Health and Well-being - looking at the people we provide care and support to, as well as our staff. Caroline Dineage, MP, Minister of State at the Department of Health and Social Care will be one of the speakers as will MHA's CEO, Sam Monaghan.
  • Care England 2018 Conference & Exhibition, Logging On on 14 November 2018, London.  The speaker presentations will focus on the effective use of data & technology in the social care sector. Caroline Dineage, MP, and Ian Trenhom, new Chief Exceutive of the Care Quality Commission will both be speaking. Please click here to book your delegate place.
  • Fundraising Now Conference, 28 - 29 November, 2018, London. The conference will cover the following topics:

    covering the following topics: Gift Aid, Legacy fundraising, Fundraising and GDPR, Safeguarding, Storytelling, Charity Digital Code,        Creative Campaigning, Crowdfunding, Diversity and fundraisers, and Diversifying income.

  • International Longevity Centre Future of Ageing Conference Thursday 29 November 2018, Copthorne Tara Hotel London, W8 5SY. Early bird tickets are now available. They are expecting over 250 attendees.Caroline Dineage, MP, Minister of State at the Department of Health and Social Care will be speaking at this conference as well as the previous two events listed - plenty of chances to hear her speak of her priorities and focus. Other speakers include Baroness Ruth Lister, Emeritus Professor of Social Policy and former Head of the Child Poverty Action Group, Dr Paul Dornan, Child Poverty expert in the Department of International Development at Oxford University and Ashwin Kumar,Chief Economist, Joseph Rowntree Foundation.

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Some information sourced from DeHavilland

 
 

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