Policy News from MHA: February 2018

Welcome to MHA's February policy bulletin

 

This month Brexit continues to occupy the headlines with ministers delivering a number of speeches on the 'Road to Brexit'.  Other government news includes additional funding for adult social care (£150m) announced by the Housing and Community Secretary and a number of reports looking at workforce pressures in Health and Social Care. Charities have also been on the front pages with the revelations about Oxfam and other overseas aid organisations while the Charity Commission have a range of measures and summits in response. 

 

Government: - Brexit  - Finance and Pensions - Loneliness Health and Social Care - Housing - 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 HealthNICE and SCIE quick guides  -

Housing: - Older People 

Third Sector: - Trust and brands - Governance -

Workforce and skills: - Nursing 

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

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Governmentclipboard image

Brexit

  • "The road to Brexit" - it's not a new journey, but recently there have been a number of speeches by ministers under that umbrella title saying more about the route and eventual destination. Boris Johnson attempted to reassure Remain voters, praising their "noble" belief in European solidarity and insisting they should feel "hope not fear" for the future. BBC political correspondent Ben Wright said it was 'a conciliatory tone we haven't heard much from cabinet ministers and a recognition of the deep divisions Brexit has opened'. Security, the devolution of powers, workers' rights and trade are all expected to be covered in the Brexit roadshow. It will end at the beginning of March with a speech from Theresa May. She has been under increasing pressure from MPs and Brussels alike to set out her vision for the UK's future and the transition period that will pave the way to it. 

  • The EU has published it's Draft Withdrawal Agreement today. It contains some controversial options relating to the Northern Ireland and Republic of Ireland's border. 
  • The Home Affair Select Committee has said that Britain is highly unlikely to have a new immigration system in place and ready to use on Brexit day in March 2019. A report from the Committee criticised the Government for not devoting enough staff and resources to preparations, and for failing to provide clarity to citizens and businesses.
  • The UK cannot afford to lose the EU staff currently working in health and social care, the Cavendish Coalition has warned. Its comments, published in the National Health Executive, come in response to the Homes Affairs Committee’s immigration report, which has criticised the “continued uncertainty” over the status of EU nationals. The committee has concluded that due to delays, and lack of decisions and resources, UK Visas and Immigration (UKVI) will not be able to effectively deliver two EU citizen registration schemes for existing residents and new arrivals by March 2019. The publication of the pending White Paper, expected to provide some answers, has been postponed, possibly until the end of the year. The Committee said 'the health and social care system remains under intolerable pressure and so we simply cannot afford to lose the talented EU staff we currently employ'. 

MHA comments: We concur with the Committee's concern about the pressures on the social care workforce which may be exacerbated by Brexit and the importance of resolving the uncertainty over the status of EU nationals working in the UK as part of our dedicated social care workforce. 

  • The BBC has reported on Prime Minister Theresa May's recent comments in which she indicated that she will contest a proposal to give residency rights to EU citizens arriving in the UK during a post-Brexit transition period. Speaking to journalists during her China trade mission, Ms May said that a citizens' rights deal agreed between the UK and EU in December was done "so on the basis that people who had come to the UK when we were a member of the EU had set up certain expectations." Continuing, she remarked that she had been clear "there is a difference between those people who came prior to us leaving and those who will come when they know the UK is no longer a member." In response, the Times suggests that Ms May's comments have put "the UK at odds with Brussels for the start of transition negotiations", while the Financial Times contends that she is attempting to show critics in the Conservative Party that "she is not going soft in negotiations with the bloc".  

  • During the Lords Committee Stage of the European Union (Withdrawal) Bill, no amendments were pressed to a vote. Plaid Cymru peer Lord Wigley called for the Government to adopt a Brexit negotiating position on membership of the Single Market and Customs Union which took into account an assessment of the impact on business. Shadow Health Spokesperson Baroness Thornton argued that the UK should maintain reciprocal healthcare arrangement, for example having the use of the European Health Insurance Card and access to EU-wide clinical trials. Brexit Minister Lord Callanan stressed that UK-EU co-operation on medical regulations was high priority, with talks in place seeking to retain the EHIC.

Finance and Pensions

  • The Financial Guidance and Claims Bill was debate at Committee stage in the House of Commons. Amendments were passed including measures to ensure the Financial Conduct Authority (FCA) could regulate claims management under the financial promotions regime and to ensure legal services regulators could continue imposing fee restrictions for PPI claims. A Clause was also accepted, introducing a cap on fees on financial services claims management activity and restrictions were introduced restricting cold calling by claims management companies.

  • Philip Hammond has asked the Office for Tax Simplification to review inheritance tax to make sure the system is “fit for purpose”. The Chancellor wants the review to focus on technical and administrative issues, and look at gifts rules and whether the current framework distorts peoples’ investment decisions. A date for the review has not yet been announced.

See the Finance and Pensions section for more research news

Loneliness

Meet the Minister

  • The newly appointed Minister for Loneliness, Tracey Crouch has been discussing her personal experience and the challenges ahead of her. Loneliness is an experience that many people can relate to, and one she will use in her new role. The MP told how work has already begun implementing actions aimed at tackling loneliness, after the Government the recommendations of the Jo Cox Commission on Loneliness, and speaks of her own experience of loneliness, which affects 9m people across the UK. She stated that there is no one-size-fits-all solution and that it’s really important to stress that because loneliness is quite subjective, and there’s not one single problem, there’s not one single solution. Part of her “phenomenal” challenge over the coming weeks and months will be to bring in a metric to measure loneliness and to develop a cross-Government strategy that will be used to tackle loneliness in people of all ages. “What the Jo Cox Commission found was significant evidence of loneliness within all parts of society.” Ms Crouch said: “People are beginning to talk about it a lot more. We’re beginning to recognise the health impact of loneliness and therefore why it’s important to remove the stigma around talking about loneliness in order to ensure that we have better physical and mental wellbeing. All partners, central and local government, and businesses and community groups as well, must recognise that they have a role to play in combating this and they will actually benefit from there being less isolation and loneliness in their areas.“ She is also looking into a Government fund to support initiatives working on loneliness and is talking to the Social Care Minister to develope the Government’s loneliness strategy. Tracey Crouch’s top tips for tackling loneliness: - “Bring an old hobby back, things you used to enjoy but for various reasons no longer do, like learning to paint or gardening.”- “Going along to a sports club or physical activity like a Zumba class is great for making new friends and stay fit”. - “And making new connections. Volunteering or making new connections can improve your mental health but it’s also a fantastic way to meet people.”  

 MHA comments: It's good to hear from the Minister about how she sees her role and the insights she has into the issue of loneliness. This will be of interest to our colleagues in Live at Home. 

 

Health and Social Care

  • Housing and communities secretary Sajid Javid has announced he will provide an additional £150 million for adult social care services in 2018/19. He has said 'this will be taken from anticipated underspend in existing departmental budgets, and will not affect existing revenue commitments made to local government. This will be allocated according to relative needs and we will expect to see councils use it to build on their progress so far in supporting sustainable local care markets'. Councils have welcomed the government’s decision to give them an extra £150m in funding for social care over the next financial year, but the Chairman of the LGA warned 'The additional one-off social care funding announced today is a temporary measure and needs to be compared against an annual social care funding gap of £2.3 billion by 2020'
  • A survey by the Local Government Information Unit (LGiU) think tank and The Municipal Journal has revealed that 95% of councils plan to increase council tax and 93% expect to increase service fees, reports the BBC. The survey comes after the Government warded off the possibility of a backbench rebellion and MPs agreed to the 2018-19 local authority funding settlement, the Financial Times reports. The Government agreed to give an extra £150m for adult social care, as well as lifting the cap on council tax increases that local authorities could introduce without a referendum. The loosening comes after the imposition of emergency spending controls at Northamptonshire County Council.

  • The Welsh Assembly have announced a £100m plan to transform health and social care in Wales, especially to deal with winter pressures.
  • Care providers can now download new guidance from the Local Government and Social Care Ombudsman to help them provide clearer cost information in their contracts for service users. Based on learning from its investigations, the Ombudsman’s guide offers good practice on how to approach Funded Nursing Care (FNC) payments and ensure contracts properly reference them. The guidance explains the Ombudsman’s approach to handling complaints about funding where FNC payments are involved, along with links to other resources which may be of help.
  • Deprivation of Liberty Safeguards Inquiry - The Joint Committee on Human Rights have launched an inquiry into the Right to freedom and safety: Reform of the Deprivation of Liberty Safeguards. Following the Cheshire West case in 2014, the Supreme Court ruling resulted in an enormous increase in the number of of applications for Deprivation of Liberty safeguards. The Government asked the Law Commission to look at ways to reform the legislation in this area and they reported in March 2017, calling for DoLS to be replaced ‘as a matter of pressing urgency’ with a new scheme called the Liberty Protection Safeguards (LPS). In October 2017, the Health Minister issued an interim response to the Law Commission’s report, undertaking to engage in a further period of consultation and promising a final response in spring 2018. The Joint Committee is calling for evidence into the proposed reforms.
  • See the Health and Social Care section for more policy and research news

Housing

  • Communities Secretary Angela Constance has said the Scottish Government will take “new and innovative” approaches to the housing challenges of Brexit and an ageing population, The Herald reports. She stressed the importance of “high quality affordable housing” to the Chartered Institute of Housing (CIH) conference. Speaking ahead of the conference in Edinburgh, Ms Constance said: 'High quality affordable housing is about more than just bricks and mortar – it provides safe, warm homes, helps create a fairer Scotland, and delivers great economic benefits. As we look to the challenges that lie ahead, that will become ever more important.'

  • The CLG's report on Housing for Older People makes a variety of recommendations including additional funding for home improvement agencies, a range of measures to overcome the barriers that older people face when moving, and building all new homes to accessible standards to make them age-proofed. 'We were very pleased to see that many of ARCO's policy priorities were considered, and in many cases have been adopted by the Select Committee’ say ARCO. 'We provided ...evidence to the Inquiry, including facilitating a visit to a retirement community, giving oral evidence, and submitting research and analysis'. 

Workforce and Skills

  • The number of people working in care is not meeting the country’s growing care demands and unmet care needs are increasing, according to a recent report by the National Audit Office (NAO). While many people working in care find it rewarding, there is widespread agreement that workers feel undervalued and there are limited opportunities for career progression, particularly compared with similar roles in health. In 2016-17, around half of care workers were paid £7.50 per hour or below (the National Living Wage was £7.20 in 2016-17), equivalent to £14,625 annually. This, along with tough working conditions and a poor image, prevents workers from joining and remaining in the sector. Four-fifths of local authorities are paying fees to providers that are below the benchmark costs of care and in 2016-17, the annual turnover of all care staff was 27.8%. The vacancy rate for nurses more than doubled between 2012/13 and 2016/7. The NAO has described social care as a 'Cinderella service'

     

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

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Ageing and wellbeing

Wellbeing

  • Older people are often assumed to want amiable companionship in later life rather than passion-fuelled romance. But a survey of 2,002 older Britons, by Independent Age,  suggests 52% of over-65s feel they do not have enough sex, and nearly a third are happy to have sex on a first date. It also found one in 10 over-75s have had multiple sexual partners since turning 65. The charity Independent Age said its survey showed age was "no barrier to having a sex life". 

  • What is meant by 'frailty'? The Centre for Policy on Aging published an article looking into the term 'fraility' in social care and what was understood or implied in their usage. 'Frailty' is a concept more commonly used in the medical environment than in social care. It may describe a stable state of health, in contrast to deteriorating health, or a combination of physical and mental disabilities. In social care, it is used as a reason for care home residency, particularly among older residents, to distinguish from residents with dementia. It has been loosely used to describe anyone over 65 with a chronic illness and is sometimes seen as a way of ‘problematising’ older people. This study looks at the various views of frailty adopted by different professions and the consequent issues arising from being ‘separated by a common language’.  

  • Professor Chris Phillipson takes a global look at age friendly cities: How can we build ‘age-friendly’ cities? He argues that the impact of population ageing on the economy and health care is much discussed, but where older people live is also important. Mostly, this will be in cities, with 25% of their populations likely to be over 60 by 2030. This raises urgent questions about how cities adapt to ageing populations, and how the resources of cities be harnessed to improve the lives of older people. One response has been the move, led by the World Health Organization, to create ‘age-friendly’ cities, with the development of the Global Network of Age-Friendly Cities and Communities. Launched in 2010, the Network has grown from a handful of members to one covering over 500 cities and communities across the world. Some of the key actions arising from this have included challenging stereotypes of older people; re-designing and improving access to outdoor spaces; strengthening support networks within neighbourhoods; and campaigns tackling social isolation and loneliness.

Loneliness

  • Radio 4 are conducting a survey into loneliness. We all feel lonely at certain points in our lives, but for some people that loneliness becomes chronic. To help Radio 4 discover who feels lonely and what can be done to help them feel more connected, they are asking as many people as possible to take part in the BBC Loneliness Experiment. They’ve been working with leading psychologists in the field of loneliness in a collaboration with Wellcome Collection to create this survey and hope to answer some questions which haven't been researched before.  

MHA Comments: It's great to see this experiment being run by the BBC. Loneliness is such a major issue that can affect many people at various stages in their lives. We encourage everyone to take part in this survey!!

Followers don't equal friends

  • Christiano Ronaldo has 120 million. Barack Obama has 53 million. Donald Trump has 24 million. This, of course, argues Mark Easton, refers to Facebook followers. Is Donald concerned that Barack has twice as many cyber-mates as he does? Or does he take solace in the fact that Hillary Clinton only has 10 million? But then, on this side of the pond, Jeremy Corbyn has 1.4 million. Theresa May can only manage 550,000 while Vince Cable has just 11,600. …. We've never been so connected, but for millions, this is the age of loneliness. There are risks in muddling loneliness and being alone. Some people do like their own company and revel in the qualities of solitude. The American essayist Alice Koller determined to become a hermit, and from that experience wrote a series of essays called The Stations of Solitude. 'Loneliness, however is bad for our health. Seriously bad. Doctors have known this for decades'.

MHA comments: This chimes with some research that we carried out in September 2017 exploring the level of people's social contact which found that people who got the majority of their social contact online were more likely to describe themselves as lonely compared to those who had their contact face to face or by phone. 

In brief:

  • SCIE’s new briefing for local authority commissioners shows examples of emerging good practice and suggests how to create a better commissioning environment in particular with regards to loneliness and social isolation.

  • How do older people’s real-life retirement plans match the active ageing agenda set out by policy makers? This study, carried out in England, Italy and the USA by the University of Westminster, finds that while older people’s retirement plans substantially align with the active ageing agenda, there is a need to do more to promote genuine freedom of choice around leaving the labour market and to provide greater support for informal, family carers. While in England and the USA participants often planned to stay active in the labour market post-retirement, this was much less true in Italy.

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Dementia

Care, support and wellbeing

  • Just one hour of social interaction a week can improve the lives of residents with dementia in care homes and save money, a study, published in PSOL Medicine has found. Previous research has shown that care home residents may have as little as two minutes of social interaction a day. Increasing that to an hour a week, when combined with personalised care, reduced agitation and aggression, and improved quality of life, according to a trial carried out by researchers from the University of Exeter, King’s College London and Oxford Health NHS Foundation Trust. The WHELD (Well-Being and Health for People With Dementia) approach, which combines staff training, social interaction, and guidance on use of antipsychotic medication, was beneficial in residents with dementia living in care homes in the United Kingdom, according to the article. 

     

  • More than one in three people in England diagnosed with dementia are not getting the follow-up care they are entitled to, a charity has said. The NHS specifies that everyone diagnosed with the condition should have an individual care plan that is reviewed at least once a year. But Age UK found that as of November, out of the 458,461 people with a recorded diagnosis of dementia, only 282,573 had a new care plan or at least one care plan review on record in the previous 12 months. The care plans are supposed to set out the tailored support someone should receive, and are meant to be reviewed regularly with a health professional as a person's condition progresses and changes. Care plans are equally important for family members who are often providing significant amounts of care for their loved-one. In light of these figures Age UK has recently launched its 'Promising Approaches to Dementia' report which identifies a number of interventions that are evidenced, cost effective and scalable, and which could be replicated by NHS Trusts, care providers and primary care services. The services highlighted in the report include projects which provide counselling for the newly diagnosed; encourage people to get involved in arts and crafts activities; and help people to reminisce through dance.

  • MHA comments: In MHA we truly understand the importance of high quality person centred care and the opportunity for people with dementia to take part in a whole range of activities to stimulate and fulfill them. Our innovative Music Therapy service is a great example of how MHA approaches dementia care differently. We also work with other partners to explore opportunities to test different types of arts and dance activities. 
  • The Montessori approach has had positive results in the US, Canada and Australia and is now being introduced in the UK to help people with dementia. Normally associated with children, it may come as a surprise that Montessori education methods can be highly effective for supporting people with dementia. This alternative approach to schooling was founded by Italian educator Maria Montessori in the early 20th century. Adapting these methods for people with dementia sprang from conversations between an Ohio Montessori schoolteacher and her psychologist husband in the 1990s. This approach has since been adopted in the US, Canada and Australia, where the results have been positive. Individuality lies at the heart of Montessori for Aged Care, which recognises that there are different types of memory: declarative memory – the facts we learn, such as dates; and procedural memory – the things we learn that are embedded and are less easily forgotten, such as catching a ball. Thus, a way of helping a person with dementia keep some physical strength could be to do ball-based exercises, rather than something more complicated that they may struggle with. By breaking down activities that require procedural memory, such as dressing, into small tasks and repeating them, it is possible to teach people to do certain things for themselves again.

  • Heavy drinking triples the risk of dementia including early cases of the disorder, the largest study of its kind concluded. Scientists said that severe alcohol misuse could directly cause brain damage but that the priority now was to pin down exactly what level of daily drinking increased the risk of dementia. While some research has linked heavy drinking to dementia other studies found that moderate levels of alcohol may protect against the disease. In the latest study French researchers looked at people with a hospital diagnosis of alcohol dependence or other drink-related conditions among 1.1 million people with dementia. Dependence is defined as craving or preoccupation with alcohol drinking despite clear harmful consequences. Drink-related disorders were the lifestyle habit most strongly related to having dementia, higher even than smoking and high blood pressure, they reported in The Lancet Public HealthJulie Breslin, of Addaction, who runs a project targeting drinkers aged over 50, said: “With more than 25 per cent of the adult UK population exceeding recommended weekly alcohol guidelines, it is imperative that this link is made clear to the public so they can make informed choices to reduce their dementia risk. Alcohol consumption and related harms are increasing in older adults but reducing in younger people, and as our ageing population grows we may start to see conditions such as alcohol-related dementia become more common.”

  • A new Alzheimer’s Society report to be published in the International Journal of Geriatric Psychiatry asked researchers, people with dementia, and the professionals who support them to help create a roadmap for the research needed to deliver improvements to the care available for people with dementia. With input from Public Health England, the Department of Health, the National Institute for Health Research, the Economic and Social Research Council and academics from 11 universities, the roadmap offers five key goals:

    • Increase knowledge of risk factors to prevent future cases of dementia.
    • Maximise the benefits of seeking and receiving a dementia diagnosis.
    • Improve quality of life for people affected by dementia.
    • Enable the dementia workforce to deliver improved practice.
    • Optimise quality and inclusivity of health and social care systems.

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Finance and pensions 

Older people's income 

  • Royal London have floated the idea of a new 'care pension' where people approaching retirement would be able to make tax-free payments into a dedicated scheme designed to protect them against long-term care costs. The proposals were devised by Sir Steve Webb, the pensions minister in the 2010-15 coalition government and now Policy Director at Royal London. He hopes that the scheme could build up accumulated funds of billions of pounds and help solve the funding crisis in social care. Pensioners would have to use the cash to buy a care insurance policy that would pay out if they needed care later in life. The policy would cover all nursing fees, meaning those who signed up would never need to sell their homes or spend life savings on care.  

  • More than one in five British adults who aren’t already retired (21%) plan to sell their home, downsize and live off the profits as part, or all, of their retirement plan, according to new survey results out today from pensions consultants LCP and research analysts YouGov. More than one in six (16%) indicate that they don’t plan to retire at all.The results also show that views appear to change the older people get, with far more of those 55 and over (44%) indicating they don’t plan to rely on their home as their pension (compared with 32% overall). This could either be because the current cohort of those 55 and over have a more generous pension provision, or because people are less willing to give up their home as they get older. Taken together, the survey suggests a dependency upon investing in housing, rather than formal pension arrangements.

  • See the Government Finance and Pensions section for more policy news

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Health and Social Care  

Care Home Open Day

Care Home Open Day will be Saturday 21st April 2018 and will coincide with the Queen’s Birthday and International Care Home Open Day! The theme will be ‘Linking Communities’. Sign up now at www.carehomeopenday.org.uk 

Integrated Care Systemshealth staff graphic

  • NHS England has recently changed the name of accountable care systems to integrated care systems, which describes more accurately the work being done in the 10 areas of England operating in this way. The Kings Fund have looked at the work under way in these systems and at NHS England’s proposals for an accountable care organisation contract.
  • Nigel Edwards of the Nuffield Trust looks at the risks and oportunities for commissioning as we move towards integrated care. NHS England’s decision to consult on new contracts for accountable care organisations (ACOs), alongside the two legal challenges that have been mounted on the status of these potential organisations, have brought the world of NHS commissioning firmly into the public eye. While the focus of the debate has remained on whether or not these new organisational arrangements will result in increased privatisation within the NHS, there has been less attention on the impact they may have on the nuts and bolts of NHS commissioning.

  • Financial pressures and the development of integrated care systems have provided the best opportunity since the creation of the NHS for local government and health leaders to “remake” their relationship, according to NHS England’s director for acute care. Professor Keith Willett said the two sectors’ difficulties in overcoming 'financial, cultural and operational differences' had prevented them 'adapting to public need'.

CQC Local Area Reviews

  • A lack of joined-up thinking in Oxfordshire’s health and social care system is holding back improvements to patient care, according to a new report by the health watchdog. A review by the Care Quality Commission (CQC) found there was little collaboration and “no shared vision” between the five organisations responsible for providing care in the area. 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 work together. The reviews look at how hospitals, community health services, GP practices, care homes and homecare agencies work together to provide seamless care for older people living in a local area. According to the CQC, the problem is also contributing to Oxfordshire’s on going battle with bed-blocking with the system’s complex discharge pathway in need of streamlining. 

  • The Care Quality Commission has also published its findings following a local system review of PlymouthThe review found strength and commitment amongst system leaders to deliver a fully integrated system in order to meet the needs of the residents of Plymouth. This process had already begun with integration between the CCG and local authority, with innovative risk sharing agreements and a significant shared budget. However, the city faced significant pressures in relation to finance and flow of people through the system. In order for this to succeed moving forward key challenges need to be addressed including, primary care capacity, continuing healthcare and organisational budgets. At the time of the review, people’s experiences of health and social care services in Plymouth were varied. More people were attending A&E, being admitted and staying longer than necessary. Recent work undertaken by the system had led to some improvements, However, Derriford Hospital remained under pressure.

MHA comments: We are keeping a close eye on the publication of the CQC Local Area reviews with a particular interest in Birmingham and Coventry where we submitted evidence.

Funding and fees

  • Almost two thirds of voters back putting an extra 1p on income tax to solve the funding crisis engulfing the NHS and social care, a new poll for the Observer has found. The Opinium survey, found that 65% would be happy to pay an extra penny in the pound ring-fenced for health and social care, even after being shown what the increase would actually mean for their personal tax bill. It found that the NHS and health was the priority issue for voters, with 68% of voters identifying it as important. Brexit was in second place on 42%, with immigration a concern for a third (33%) of voters.

  • A new ring-fenced tax to fund the NHS and social care has been proposed by a panel of health experts. The panel, set up by the Liberal Democrats, says the NHS in England should be given an extra £4bn on top of inflation in the next financial year. It has suggested replacing National Insurance with the new tax to close the funding gap. They suggest that people over 65 who are still working must start paying national insurance to help to meet the cost of their own care. National insurance should be ring-fenced, or hypothecated, for the NHS and social care to end the need to use council tax to pay for the needs of the elderly, say experts who want £9 billion in funding over the next three years.

  • A combination of Brexit, red tape and a lack of government resources has put Scotland’s independent care sector on the brink of a crisis, according to one of its main players. Robert Kilgour, the chairman of Renaissance Care, which runs 12 care homes in Scotland,was reported in The Times as saying that the sector could no longer absorb the increasing costs passed on to it by the government. Extra costs incurred by complying with the Scottish carers living wage and the apprenticeship levy, along with the shortage of nurses compounded by the decision to leave the EU, were combining to produce a “perfect storm”, he said.
  • It is widely accepted that the system for funding social care is in urgent need of reform, but there is little sign of a long-term solution on the horizon. In this report we consider five different approaches, setting out the implications of each. Against this background, the Health Foundation and The King’s Fund are undertaking work exploring options for the future funding of social care. This paper considers the following approaches to funding social care for older people in England: 

    • Improving the current system
    • The Conservative Party’s proposals at the time of the 2017 general election (a revised means test and a cap on care costs)
    • A single budget for health and social care
    • Free personal care
    • A hypothecated tax for social care 

Social Care Wales

  • Social Care Wales have recently published their response to their consultation on Transforming Care in the 21st Century, which ran for 12 weeks between 24 July and 16 October 2017. The report provides a summary of responses and details how they have modified their proposals in light of the feedback eceived about proposed changes to:

    * registration fees
    * qualification requirements
    * employers’ code of practice
    * fitness to practise rules.

    After carefully considering all the feedback and discussing it with the Welsh Government, it was decided to:

    * increase registration fees in line with the proposals, but with a lower fee for social care workers
    * change the qualification requirements as set out in the consultation, but offer additional options for domiciliary care workers with three or more years’ experience
    * make minor changes to the employers’ code to reflect some of the helpful suggestions received from respondents
    * amend the Fitness to Practise Investigation Rules 2017 in line with the proposals.

    These changes will take effect from April 2018. 

    NHS and Health
  • Pressures on the NHS in England have increased over winter 2017/18, including ambulance handover delays, bed occupancy, norovirus bed closures, and accident and emergency diverts. Over the winter months, NHS England releases 'daily situation report' data which measures pressure on acute hosptial services. For 2017/18, the data currently covers the period 20th November to 28th January. The House of Commons Library provides a summary of this and is undated periodically thoughout the winter. 
  • Vulnerable and elderly people are stuck in an “endless cycle of avoidable hospital re-admissions”, according to a report by the British Red Cross  that blames an inadequate social care system for the failings. Patients are being sent home from hospital, without the right care in place, only to go straight back to emergency departments – multiple times a year on many occasions with hospitals failing to notice the problem.  The report said emergency hospital re-admissions have risen by almost 23 per cent in the last five years, with the number of people being re-admitted within 48 hours now accounting for one out of five of all emergency re-admissions. The charity argues that while a patient might appear to be medically fit enough for discharge, repeated visits to hospital signal that something might be amiss in their home environment.
  • Dying patients are being failed in their final days because the NHS is under too much pressure to care for them properly, nurses have warned. Patients are being left stranded in hospitals rather than being allowed to die at home or in hospices, a survey of NHS nurses claims. Others are dying alone because staff are too stretched to spend time with them, the report found. Almost all nurses – 94 per cent – say they have witnessed patients dying in hospital when they had expressed the desire to die at home, in a hospice or care home setting. The survey of more than 600 nurses, conducted by Marie Curie and Nursing Standard journal, found most nursing staff believe it is now a 'common occurrence.
  • Scientists have created the most advanced wearable technology: a second skin that performs heart scans currently only available in a hospital. The elastic dsplay, which sticks to the body, has an integrated sensor system which wirelessly transmits the wearer's biometric data to a smartphone. While previous research managed to monitor temperature and muscle strength with stick-on sensors, this new incarnation can perform an echocardiogram - a sonogram of the heart. The team from the University of Toyko, say that these could be mass-produced one day as an ultra-thin smart bodysuit for people in care homes, allowing relatives or staff to track their vitals and spot emergencies immediately.

NICE and SCIE quick guides

In brief:

  • Hip fracture patients in England and Wales are waiting up to 80 days to get rehabilitation treatment after leaving hospital, according to a survey of nearly 6,000 patients. The Chartered Society of Physiotherapy said people face a "postcode lottery" over waits, with only one in five people being seen within a week. IThe delay was putting people at increased risk of ill health and falls and there should ideally be no break between rehab in hospital and home, but failing that the wait should be no more than a week. Hip fracture is the most common cause of injury related death in adults. It costs the NHS and social care £1 billion per year. Hip fracture will affect one in three women over 50. Hip fractures are more prevalent than breast cancer.
  • The Department of Health and Social Care has been accused of ignoring repeated warnings about stagnating life expectancy, from academics who are demanding an urgent inquiry into whether austerity policies could be driving the trent. The academics said that in recent years there had been 'one of the greatest slowdowns (in life expectancy improvements) for both sexes since the 1890s', with rates even declining for some groups.  

  • Care homes have received awards for using the LPZ audit tool over the last year to improve the monitoring and recording of quality indicators for their residents. The Landielijke Pravelentiemeting Zorgkwaliteit (LPZ) tool was developed by Maastricht University in The Netherlands and is now used in a number of countries. Nursing and residential homes in the East Midlands are the first in the UK to use LPZ, which measures the prevalence of common care issues such as pressure ulcers, continence, nutrition, falls, restraint and pain.
  • See the Government Health and Social Care section for more policy news 

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Housing

Older People

  •  Housing LIN have presented a refreshed briefing on the Private Rented Sector entitled Why older people need more market rent housing: new opportunities for older people, local authorities, developers, investors and providers. The latest statistics in the English Housing Survey published last month reveals that that there has been an increase in older people renting. This briefing argues that there is a need for more market rent housing for older people, in addition to other tenure options. 

  • The recent report, Stronger Foundations - International Lessons for the Housing-with-Care Sector in the UKdiscusses the issue of terminology around later life housing and housing-with-care in the UK and other international contexts. Appropriate housing options to facilitate ageing in place can be a powerful tool to address the growing need for housing and social care in light of an ageing population. However, the UK lags behind a number of other countries in the provision of specialist later life housing. This research explores what the UK can learn from other countries who have a more robust specialist retirement housing and housing-with-care sector. This report, supported by the Associated Retired Community Operators (ARCO) and Legal and General Capital looks at terminology around later life housing and housing-with-care. It then highlights how the housing-with-care sector varies across countries and the state of the sector in the UK. The report then goes on to look at three areas: legislation, financing, and planning. It ends with some of the lessons that could help development of the housing-with-care sector in the UK.

  • Urgent action is required to reverse the shortage of housing for older and disabled people as Scotland struggles to meet the needs of a rapidly ageing population, according to a new alliance of charities and other organisations. Age Scotland, the Scottish Older People’s Assembly, Castle Rock Edinvar, and McCarthy and Stone have joined forces to launch the Older People’s Housing Coalition to put older and disabled people’s housing needs at the centre of the planning system. The coalition is urging the Scottish Government to make housing for older people and those with disabilities a specific priority in its Planning Bill, with clear national and local targets similar to those for affordable housing. Planning authorities should be obliged to identify appropriate sites close to local shops, GPs, services, and transport links.

 In brief:

  • Smart technologies for the elderly could save billions in health and social care costs, according to a new IMechE report. Healthy Homes: Accommodating an Ageing Population  found that at 78,000 adapted new homes a year will be needed over the next decade, presenting a huge opportunity for construction firms and technology manufacturers. The IMechE is calling on the government to introduce financial incentives for construction firms to build these homes, and on manufacturers to step up their efforts to develop retrofitting technologies that let the elderly stay in their homes for longer. Institute of Mechanical Engineers

  • King’s College London have released findings from an online survey of local authority telecare managers carried out between November 2016 and January 2017 looking at support for older people. It found that local authorities are using telecare in the following ways: to delay and reduce the need for care and support (97%), to enhance quality of life for people with needs for care and support (90%), to help with safeguarding (85%) and to prevent carer breakdown (84%).
  • ESCR funded research report, 'ODESSA: Optimising care delivery models to support ageing-in-place', published by the University of Sheffield brings together international research on current long-term care delivery models for older people and assesses the key factors that allow them to live independently for longer. It investigated new and innovative ways of adapting a person's home so that they can live independently for longer and avoid going into residential care as well as making it easier for them to access public services such as health and social services.

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Third Sector 

Trust and brands

  • Oxfam has been in the news recently and not for reasons the charity is proud of.  After revelations about sexual exploitation by aid workers in Haiti and Chad, the charity says it will set up a commission to investigate past and present allegations of exploitation by staff and devise ways to make sure sex offenders cannot reoffend somewhere else. As a result of the recent publicity, Third Sector have completed a poll and 41% of respondents said they were much less likely to donate to Oxfam after the scandal, and 20% said they were slightly less likely to donate. But the scandal has had less of an impact on other charities, with 65% saying it had not influenced their perception of other aid organisations and 67% saying it would not change how likely they were to donate to them. 61% of respondents said the scandal had not changed their perception of charities in general and 70% said it would not affect their donations to them.

Governance

  • The Charity Commission will set up a taskforce to handle a surge in safeguarding reports after the Oxfam crisis, the regulator has announced.

  • The Charity Commission has also announced a suite of measures to help ensure charities learn the wider lessons from recent safeguarding revelations involving Oxfam and other charities, and to strengthen public trust and confidence in charities. The Secretary of State for International Development has already announced a joint DfID/Charity Commission safeguarding summit with charities and umbrella bodies working internationally. As the Commission has consistently made clear, the need to strengthen and assure safeguarding is not limited to charities working internationally. The Charity Commission is therefore announcing today a second summit for charities and umbrella bodies working in the UK, to be co-chaired by the Minister for Civil Society, Tracey Crouch MP. The summit will be an opportunity to reaffirm how vital it is that safeguarding is a key governance priority for charities. Both summits will involve charity regulators in Scotland and Northern Ireland to ensure a coordinated approach across borders.

  • The Commission is consulting on draft guidance for charities on their relationships with connected non-charitable organisations. It includes detailed guidance, at a glance summary and a checklist that charities can use. Charities can work with other charitable and non-charitable organisations to further their purposes and make a difference for their beneficiaries. Setting up or maintaining a close relationship with a connected non-charitable organisation can provide benefits to charities, but it can also expose charities to additional and sometimes significant risks. The Commission has prepared this draft guidance to help trustees understand the risks and challenges that such relationships can bring and by setting out what we expect trustees to do to deal with them.

    This consultation closes at 5pm on 15 May 2018.

  • In Brief: 
  • Who benefits most from Gift Aid – charities or higher-rate taxpayers? The new National Audit Office–University of Birmingham Tax Centre, concluded that every additional £1 spent on tax incentives given to UK taxpayers is generating only £0.27 more in donations. In other words, charities would get substantially higher donations if the value of the Gift Aid relief were given directly to them. There were also unexpected findings about the impact of Gift Aid on the lowest income group. Blog by Jonny Mood, NAO

  • The King’s Fund have produced a report for the Department of Health looking at how and why clinical commissioning groups (CCGs) and local authorities engage with the voluntary, community and social enterprise (VCSE) sector. They found a wide variation, with some commissioners seeing their role solely as stimulating a market of providers, with no particular interest in creating a strong VCSE sector. Others, however, had made a clear choice about the value of the VCSE sector as a critical player in developing asset-based approaches to care, engaging VCSE organisations as key partners in co-production of health and care outcomes. 

  • NCVO has published its annual report for members and it identifies the political, economic, social and technological trends (PEST) likely to affect your charity in 2018 and beyond. 

  • The East Anglian Air Ambulance has worked with the mobile payments platform Thyngs, to develop the option of donating using fingerprint technology. In what is believed to be a first for charities, it is replacing one-off credit and debit card payments with recurring Apple Pay and Google Pay subscriptions, allowing donors to tap or scan fundraising materials with their smartphones to enter the charity’s lottery as well as set up regular donations or provide contact details using their fingerprints. 

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Workforce and Skills

Nursing

  • The government has said it wants the next pay award for nurses and other Agenda for Change staff to “recognise their hard work” but that the overall package must be “fair and also affordable” according to an article in Nursing Times. The newly rebranded Department of Health and Social Care has published its evidence to the NHS pay review body for the 2018 to 2019 pay round, reiterating the end of the 1% cap on salary rises previously signalled by ministers and confirmed by the chancellor in his autumn budget speech.

  • Social housing and care providers have a responsibility to change the narrative around women and care, says Jane Ashcroft, Chief Executive at Anchor.  'It’s hard to remember a time when gender issues were more high profile. But there’s one element which remains woefully under the radar. When it comes to caring for older people, the general consensus is that it’s women’s work. Housing and care providers, both mainstream and specialists, have a responsibility – and an urgent need – to change the narrative'. New research by Anchor has found that women feel a much greater burden of responsibility for supporting elderly relatives than men. According to the King’s Fund, about 80% of all jobs in adult social care are done by women; the proportion in direct care and support-providing jobs is even higher, at 85-95%. Historically, there has been some logic to the imbalance. Female life expectancy was longer than male so, generally, the older people needing support were more likely to be female and want female carers. Also the flexible hours which sometimes come with such roles were more suited to women who needed to juggle work and family commitments.

In Brief:

  • Migrants working in the adult social care sector contribute £4.4bn to the English economy annually, according to figures released to mark the One Day Without Us (1DWU) event. 1DWU celebrates the contribution to the UK of migrants, many of whom say they feel unwelcome since an escalation in pro-Brexit rhetoric after the 2016 referendum. The figures, from the New Economics Foundation thinktank, show that if migrants in the sector stopped working for one day there would be a £17m shortfall.
  • Skills for Care and the Care Provider Alliance have launched a project to explore the scale of the challenges for employers when drawing on the talent of black, Asian and minority ethnic (BAME) staff. It will explore good practice and aims to offer practical proposals to overcome the obstacles being faced. 

  • The deadline for organisations with 250 employees or more to publish their gender pay gap data is 4th April 2018

  • The Equality Act 2010 (Gender Pay Information) Regulations 2017 Employers are required to report:
    • The overall gender pay figures calculated using both the mean and the median based on the snapshot date of 5 April.
    • The number of men and women in each of four salary quartiles, based on the employer’s overall pay range. This will show how the gender pay gap differs across the organisation, at different levels of seniority.
    • Separate information on the mean and median gender pay gap relating to bonuses.
    The report must be signed by the chief executive, and will appear on the government’s dedicated website and the employer’s own website for at least three years.
  • See the Government Workforce and Skills section for more policy news

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Look Ahead: February and beyond

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

  • Early 2018: Information Commissioner's Office - consultation on GDPR sanctions expected

  • Early 2018: Department of Digital, Culture, Media and Sport - consultation on Voluntary Sector Strategy

  • Early 2018: Update to NHS Continuing Healthcare National Framework

  • Early 2018: New Housing Ombudsman consultation

  • Early 2018: Consultation on Charity Commission fees

  • 7 Mar: Long-term funding of adult social care inquiry, submission deadline

  • 13 Mar: Chancellor's Spring Statement

  • 14 Mar: Fundraising Regulator – Online fundraising platforms, consultation deadline

  • 23 Mar: Health Education England Facing the Facts, Shaping the Future, A health and care workforce strategy for England to 2027, consultation deadline

Events

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

  • Future of Care conference, Tuesday 13 March, London (Standard rate - £299 plus VAT) This event for care home owners and managers, healthcare professionals, and key decision-makers gives an opportunity to learn about trends shaping the future of care.  Rosie Seymour, Deputy Director of the Better Care Support team will participate in a panel session on:How local government, the NHS and provider sector can work together to ensure better social care for future generations; How local government could commission and manage care services for older people to ensure sustainability in the future; How to re-orientate focus toward preventative services to deliver better results for older people. 

    The panel will be chaired by Nadra Ahmed OBE, Executive Chairman, National Care Association; other panellists include Rt. Hon Professor Paul Burstow, Chair of the Social Care Institute for Excellence (SCIE); and William Roberts, Care Home Lead, New Care Models Programme, NHS England. The conference will take place in London on Tuesday 13 March; click here for more information or to register your attendance.

  • Supporting feedback and complaints and duty of candour incidents across health and social care (Scotland), various dates and venues, 9.30am -4.30pm, FREE
    A number of events are taking place for the implementation of the model Complaints Handling Procedures for the NHS and Social Work, as well as understand the social care complaints process. The events will also enable staff to prepare themselves and their teams for the introduction of the new Duty of Candour, which will come into force on 1 April 2018. These will take place on:
    8 March 2018 - Crieff Hydro, Crieff
    21 March 2018 - DoubleTree by Hilton Hotel Glasgow Central

  • The Future of People Powered Health 2018, 2nd May, London 9:00am - 5:30pm Join professionals, campaigners, commissioners and policymakers to explore how we can create a more people powered approach to health and wellbeing. 

  • Care England 2018 Conference & Exhibition 14 November, London.  The speaker presentations will focus on the effective use of data & technology in the social care sector. Please click here to book your delegate place

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Some information sourced from DeHavilland

 
 

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