Policy News from MHA: October 2017

Welcome to MHA's October policy bulletin

 

As expected the focus of Government continues to be Brexit, however a significant development has emerged on the subject of supported housing, which could have important implications for MHA's Housing Association and other tenants. The Conservative Party and the SNP both held their Party Conferences this month - no big announcements were made in relation to older people, although adult social care was discussed at several fringe events and grabbed a few headlines. In the run up to the Budget several pieces of research have been published emphasising the crisis in social care in terms of funding, capacity and the need for a sustainable long-term solution. 

Government: - Brexit - Charity and Voluntary Sector -  Data Protection - Finance and Pensions - Health and Social Care - Housing - Party ConferencesWorkforce and Skills - Other

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

Ageing and wellbeing: - Wellbeing - Loneliness - Retirement

Dementia:- Care, support and wellbeing - Research News - Technology

Finance and pensions: - Older age and low incomes -

Health: - Delayed Transfers of Care - Health and Social Care Integration - NHS

Housing: - Health and housing

Social Care: - Regulation - Funding - Current and future need - Quality - Innovations and technology End of Life Care -

Third Sector: - Fundraising -

Workforce and skills: - Social care and nursing - Wellbeing at work -

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

______________________________________________________________________________________________________________

Governmentclipboard image

Brexit

  • The EU 27 member countries have officially concluded that "insufficient progress" has been made in Brexit negotiations to move discussions on to the next stage. They will next reassess progress on exit issues in December. However, European Council President Donald Tusk has said the EU will now begin internal preparations for the next phase of talks, including on future UK-EU trade. In its conclusions, the European Council: • Welcomed the progress made regarding citizens' rights and invited negotiators to build on the convergence achieved so as to provide the necessary legal certainty and guarantees to all concerned citizens and their family members; • On Ireland, welcomed progress on convergence on principles and objectives regarding protection of the Good Friday Agreement and maintenance of the Common Travel Area; • Noted that, regarding financial settlement, while the UK has stated that it will honour its financial obligations made during its EU membership, it has not given a firm and concrete commitment to settle these obligations.  At its next session in December, the European Council will reassess the state of progress in the negotiations with a view to determining whether sufficient progress has been achieved on each of the three above issues.  If so, it will adopt additional guidelines in relation to the framework for the future relationship and on possible transitional arrangements. 

  • Meanwhile Prime Minister Theresa May told a dinner of EU leaders that "firm progress" was being made in Brexit talks, and that she wanted to create a "dynamic" which "enables us to move forward together". A source told the BBC the prime minister said there was an increasing feeling "that we must work together to get to an outcome that we can stand behind and defend to our people". German Chancellor Angela Merkel said that there were "encouraging" signs of progress in negotiations and suggested trade talks could begin when EU leaders next meet in December.

  • Five of the biggest business lobbying groups have written to the Exiting the EU Secretary, David Davis, to call for an urgent transition deal, to keep trading relations as similar as possible for the immediate period after Brexit in 2019. The Guardian, reports that the letter states "we need agreement of transitional arrangements as soon as possible, as without urgent agreement many companies have serious decisions about investment and contingency plans to take at the start of 2018". The letter goes on to warn that a failure to agree a transition period of at least two years "could have wide-reaching and damaging consequences for investment and trade". The EU maintains that discussions with the UK on future trade can't happen until issues including the UK's leaving payment are resolved. The Prime Minister has said that "important progress" had been made on Brexit at the summit and she had a "degree of confidence" of making sufficient progress by December to begin trade talks, although that she signalled that there will be no transitional deal unless the UK settles its final trading relationship with the EU next year.

  • The Government has published two White Papers on the future of trade and customs after Brexit.

  • Immigration Minister Brandon Lewis has indicated that the Government will now publish its post-Brexit immigration White Paper in “late autumn” and added that there “will be an Immigration Bill in the New Year setting out the framework”.

  • The Exiting the EU Committee held an oral evidence session around the progress of the UK’s negotiations on EU withdrawal inquiry. The Committee heard evidence from four law professionals, questioning if there will be major implications of the Charter of Fundamental Rights not being retained under UK law. The lawyers stressed that approximately 375 court cases cited the Charter, creating problems in our justice system for cases relating to parental rights, children’s rights and human rights. The Committee have now re-opened the inquiry into the progress of the UK’s negotiations on EU withdrawal and are accepting written evidence. 

  • A new alliance has been formed to safeguard the interests of patients and the healthcare and research they rely on in the Brexit negotiations.  The Brexit Health Alliance brings together the NHS, medical research, industry, patients and public health organisations. It will be co-chaired by Sir Hugh Taylor, the former permanent secretary of the Department of Health, and Niall Dickson, the CEO of the NHS Confederation.  The Alliance has published a briefing paper warning that an end to mutual healthcare arrangements between the UK and EU would cost the NHS an extra £500m a year.  A total of 190,000 pensioners currently live in the EU and an unknown proportion of these could have no choice but to return to the UK if a deal over healthcare arrangements is not struck. The Brexit Health Alliance estimates that an extra 1,600 nurses would be needed to deal with returning pensioners, as well as doctors, other health professionals and support staff. 

    MHA comments: This is interesting analyisis which highlights yet further pressures on the health and social care sysyem, in addition to the pressures the sector already faces.  

Charity and Voluntary Sector

  • Four charity umbrella bodies have called on the government to provide more funding for the Charity Commission, but stress that this should not come from the regulator charging charities for its services. The Charity Finance Group, the charity leaders body ACEVO, the local infrastructure body NAVCA and the Small Charities Coalition, have written to Liz Truss, the chief secretary to the Treasury, asking for an increase in the grant given to the Charity Commission. The regulator’s funding has been reduced by £8m compared to 2010 and has been frozen at £20.3m a year until 2020.  The letter says effective regulation is crucial to public confidence in charities and described charging charities for regulation as a “charity tax” and said they are opposed to it because it would force charities to “hand over donors’ money to subsidise the regulator and threaten its independence in the eyes of the public”.

  • The Department for Digital, Culture, Media & Sport has published National Citizen Service (NCS) Guidance for Local Authorities to help LAs embed NCS into local areas and increase the number of young people from all backgrounds and circumstances taking part in the programme and increase participation in volunteering.

See the Third Sector section for more research news

Data Protection

  • The Data Protection Bill  was debated at its second reading in the House of Lords. Digital, Culture and Sport Minister Lord Aston of Hyde stressed the importance of updating the Data Protection Act 1998 following the rapid advancement of technology and sophistication of cyber-crime. The Opposition raised concerns that the EU General Data Protection Regulation (GDPR) was not printed in the Bill and would require new legislation following Brexit. The Opposition also criticised the Government for setting the “age of consent” for the processing of their personal data at 13 years-old, claiming that it would be illegal under the UN Convention on the Rights of the Child. During the conclusion, Labour outlined that they support the broad principles of the Bill, but would scrutinise some of the finer details.

  • NCVO has published a free webinar, What does GDPR mean for your charity? 

    MHA comments: This will be of interest to colleagues as our preparations for GDOR intensify. 

  • The Department of Health has published guidance setting out the steps all health and care organisations will be expected to take in 2017/18 to demonstrate that they are implementing the ten data security standards  recommended by the National Data Guardian, and further details regarding the assurance framework for April 2018 onwards. For social care providers, who do not provide NHS care through the NHS Standard Contract, there are no obligations to implement the requirements set out in this document in this financial year. However, it is highly recommended that social care organisations follow these steps in preparation for the new CQC regulatory framework from April 2018 onwards.

Finance and Pensions

  • The Financial Guidance and Claims Bill has been debated at Report Stage in the House of Lords. Liberal Democrat peer Lord Sharkey successfully introduced some amendments to tackle cold-calling and strengthen consumer protection. 

  • The Welsh Government has published it's Draft Budget 2018-19, outlining the spending, taxation and borrowing plans for the coming financial year. It carries added significance as the Welsh Government will have new tax and borrowing powers from April 2018. The Draft Budget includes two-year revenue plans for 2018-19 and 2019-20 – which include additional funding for NHS Wales and investment in childcare provision.  Three-year capital plans worth almost £5bn have also been published, which include the release of additional funding to build more affordable homes. In addition, a shortlist of four new Welsh tax proposals has been released. The National Assembly for Wales' Finance Committee will scrutinise the Draft Budget over the following eight weeks.  

See the additional Finance and Pensions section for more research news

Health and Social Care

  • The Government has published its response to the Communities and Local Government Select Committee inquiry into Adult Social Care. The inquiry had a number of recommendations, which the Government indicates it is addressing such as the £2bn in extra funding for adult social care for LAs in the spring Budget.  However the Government has rejected recommendations eight and nine, which called for standard process for assessing the costs of care and setting fair prices that reflect costs and an extension to the CQC powers to oversee a fair price for care. On the recommendation of how the funding of the social care system should be reformed, it suggests that a consultation will take place in ‘due course’.

  • A group made up of some of the UK’s largest health organisations has sent a letter to the Treasury, ahead of the Budget, calling for greater funds to support the precarious state of health and social care. Coordinated by the NHS Confederation and representing views from the Association of Directors of Adult Social Services (ADASS), the Academy of Medical Royal Colleges, NHS Providers, Carers UK, the Association of UK University Hospitals, the Royal College of Emergency Medicine and the Richmond Group, the letter urges the Chancellor to ensure that the NHS and the social care system have the stability and certainty required to deliver both high-quality care today and fundamentally transform care to meet the needs of our 21st century population. 

  • Shadow Mental Health and Social Care Minister, Barbara Keeley led a debate on Adult Social Care, urging MPs to focus on the “crisis” in social care, which she claimed had come about after years of budget cuts by the Government. She argued that 400,000 fewer people were getting publicly funded care, claiming that the King’s Fund, the Health Foundation and the Nuffield Trust estimated that the funding gap in social care budget of £1.9bn for that year.  She raised the Conservatives’ manifesto U-turn on the “dementia tax” and restated Labour’s plans to create a national care service.  Responding for the Government, Care and Mental Health Minister Jackie Doyle-Price, explained that one in ten people faced significant costs that they had to meet with their own resources and that the Government had invested £2bn into social care to put it on more sustainable footing and alleviate pressures across the health and social care system. Conservative Health Committee Chair Dr Sarah Wollaston also contributed to the debate and said that the NHS was rapidly realising that health and social care could not be treated as two separate siloes.  She said that the Lords NHS Sustainability Committee had recommended setting up an office for health and care sustainability to provide good-quality, reliable data about the future needs of both systems. We must fund this properly not just now, in the short term, but in the long term, and we must come forward with solutions, but it is not just about funding. It is about staffing, and planning properly for a wider workforce across health and social care… unless we plan ahead for our future workforce, we will always be playing catch-up, as we do at the moment.

    MHA comments: These two items are just further demonstration of the pressing need for the Government to work with the health and social care sector a sustainable long term solution to make sure people get the right care at the right time, in the right place. 

  • The Government has published it's interim response to the Law Commission's report on Mental Capacity and Deprivation of Liberty.  The Commission were asked to conduct a fundamental review of the Deprivation of Liberty Safeguards provisions, with a priority to delivers real tangible benefits for individuals and their families.  It acknowledges that the current system is unsustainable and may be diverting resources from the frontline. The Government plan to engage with a range of stakeholders to understand in greater detail how these changes can be implemented and consider what enabling actions need to be taken to support the Mental Capacity Act’s “ethos of greater empowerment and care centred around people, their wishes and aspirations”.  The Government will provide its final response on the Law Commission report to the House in Spring 2018.

  • Rt Hon Ed Vaizey MP, co-chair of the All Party Parliamentary Group on Arts, Health and Wellbeing led a parliamentary debate on the Effect of the arts on health, calling for more to be to done to integrate the arts into our health and social care systems.  The debate was based on the APPG’s report on this issue, based on two years of extensive research and discussions with individuals and organisations from the worlds of health, arts, academia and politics. He argued that the inquiry provided considerable evidence to support the idea that arts-based approaches can help people to stay well, recover faster, manage long-term conditions and experience a better quality of life.

MHA comments: We provided information to support this debate on the beneficial effects of music therapy for people with dementia.

See the Health and Social Care sections for more policy and research news

Housing

  • During Prime Minister’s Questions, Conservative MP Kevin Foster asked what reassurances the Prime Minister could give about the ongoing support that the Government will give to the vital service of supported housing?  Responding, Theresa May said that that the Government would not apply the Local Housing Allowance (LHA) cap to supported housing, and would not implement it in the wider social rented sector.  The Chairs of the Work and Pensions and Communities and Local Government Committees welcomed the decision not to apply LHA to supported housing. Rt Hon Frank Field MP, Chair of the Work and Pensions Committee, said “Today’s announcement that Government has heeded our recommendation, and will take Local Housing Allowance out of the funding equation for supported housing, is an important step towards protecting and boosting the supply of this crucial support for the most vulnerable. We expect the full details in the Government’s final response to our joint report shortly.”

  • On 31 October the Government published the detail of the new measures for supported housing. In a statement Local Government Minister Marcus Jones MP said “All long-term housing will remain in the welfare system and a proposed ‘sheltered rent’ for sheltered and extra care housing will keep rent and service charge at an appropriate level, protecting the housing needs of older and vulnerable people.”  The key features of the new model, to come in to effect from 2020, are:  • Funding certainty: 100% of housing costs funding (rent and eligible service charge) will remain in the welfare system (subject to existing benefit rules); • Flexible and deliverable: the policy maintains the link to formula rent (partly based on local factors) and it is intended that the overall level for Sheltered Rent would reflect the variety of provision across the sector ;• Value for money: Sheltered Rent will increase value for money in this part of the sector by increasing cost controls in England. To do this, the social housing regulator will use existing powers to regulate gross eligible rent (rent inclusive of eligible service charges), as it already does for Affordable Rent. It would set an annual cap on gross eligible rent increases; and • People-focused: the new model will oblige providers to publish breakdowns of their service charges, to enable tenants to compare their service charges with those of other providers. The Government are consulting on the proposed model, which closes on 23 January 2018.

  • Following the initial announcement to abandon the cap, Shadow Housing Secretary John Healey led a debate on Supported Housing, welcoming the Prime Minister’s announcement, but argued that despite this, it was not known what the Government would do and it therefore had to get the policy right. He concluded by saying that MPs had “a good deal more to do” in influencing policy on supported housing. Responding, Local Government Minister Marcus Jones stressed the importance of delivering “a sustainable long-term funding model for supported housing” given the annual net fiscal benefit and cited the importance “of local strategic planning, partnership working, commissioning and oversight” and the need for a “joined-up strategic and holistic approach”. The reformed funding model had to be “flexible and responsive” and consider the needs of all supported housing client groups. 

MHA comments: We welcome the news that the Government have listened to the sector and will not be pursuing the LHA cap.  However we will consider the proposals published by the Government and how it will impact on our sheltered housing tenants in receipt of housing benefit and the impact on our provision.  We will be responding to the consultation.

  • The decision on the LHA cap, followed a debate earlier in the month on funding for supported housing, led by Peter Aldous MP. He highlighted rising demand for care and support due to demographic change and called for sustainable long-term funding for the sector.  He raised concerns about the impact of the Government’s plans to cap the LHA rate, with ringfenced top-up funding beyond that, stating that he was unsure that a “one-size-fits-all” LHA was appropriate. Responding Local Government Minister Marcus Jones insisted it was “vital” to introduce the Government’s proposed funding model for supported housing, ensure it was on a sustainable footing, and worked for providers, commissioners, tenants and the taxpayer. He made assurances that the Government was considering stakeholder responses to its recent consultation on these issues and would “announce the next steps shortly”. He did add that the Government was considering the issue of a banding system and that “there may well be a case for testing proposals in some way”. 
  • The decision also comes after a report from the Institute for Fiscal Studies, who found that capping housing benefit at LHA rates could mean the rents of 200,000 more social tenants would not be covered and would have a greater effect on housing association tenants than on council tenants because rents in these properties tend to be higher, particularly for low-income pensioner households and households without children
  • The House of Commons Library has published a research paper, Paying for supported housing.
  • During a meeting of the Communities and Local Government Committee on its Inquiry on Housing for Older People, MPs heard from experts at Jeremy Porteus (Housing LIN), Claudia Wood (from think-tank Demos) and Dr Brian Beach (International Longevity Centre UK). The main topic was that of downsizing and the Committee heard from Claudia Wood that about a quarter of people over 55 were interested in purchasing specialist housing and that more people were wanting to release the equity of their home to support their children rather than bequeathing it to them. Help to Buy and Help to Move schemes were incentivising older people to release equity. She also added that there were barriers to downsizing, included a combination of emotional, financial and practical barriers such as a lack of information. Jeremy Porteus added that a lack of attractive properties was also a factor.  It was said that the average age at which women in the UK moved to more suitable accommodation was 82, whilst this was 85 for men.  On the subject of how the housing market was responding to the needs of older people, he suggested there is a shortfall of available houses and that land prices and planning issues contributed to a slowing-down of building processes for specialist housing. Mr Porteus also raised the popularity of shared ownership and extra care schemes for those on lower incomes. The panel were in agreement and demonstrated how retirement housing could positively affect older people’s health, with fewer incidences of falls, shorter hospital stays and reducing loneliness.
  • The Government has announced plans for new measures to help create a fairer property management system.  It has launched a call for evidence, seeking views on: whether regulatory overhaul of the sector is needed; measures to protect consumers from unfair costs and overpriced service charges; and ways to place more power in the hands of consumers by giving leaseholders more say over their agent.  It also asks if a new independent regulatory body is needed - and if separate bodies should be established, for both leasehold and private rented management, and letting agents. The Government will consider changing the law so that all letting and management agents, across both the private rented and leasehold sectors, must be qualified and regulated in order to practice. Other measures to be considered include how transparency can be increased in the system so that tenants and leaseholders know what they are being charged for and why. The consultation closes Wednesday 29 November. 
  • The Communities and Local Government Committee has launched an inquiry into the Private Rented Sector, examining the role of LAs in the private rented sector. Written submissions are being accepted until Friday 24 November.
  • The Scottish Government has introduced measures to give older people greater access to affordable homes and access a range of home ownership schemes offered by the Scottish Government. These schemes can remove the requirement for a mortgage contribution and make older people a priority access group. It can also provide options that bring older people closer to family and care support, and are more affordable and suitable for their needs – including downsizing, or the option to buy a retirement or supported home. The schemes older people can now benefit from are: Open Market Shared Equity Scheme (OMSE); Help to Buy Scotland (Scotland); New Supply Shared Equity (NSSE).  Housing Minister Kevin Stewart MSP said “People are living longer… and I want to ensure they can access high quality and affordable housing that meets their needs and enables them to continue living independently.  As we age, our housing needs can change – we are responding to that with new and innovative solutions. These schemes will give older people the opportunity for home ownership that works for them.”
  • In Wales, the Regulation of Registered Social Landlords (Wales) Bill  has been laid before the National Assembly for Wales. The Bill has been launched in response to the Office for National Statistics (ONS) review of the statistical classification of Registered Social Landlords (RSLs) in September 2016. The ONS identified indicators of central and local government controls which led them to conclude RSLs should be reclassified to the Public Non–Financial Corporations sub–sector, for the purpose of national accounts and other ONS economic statistics.  The Regulation of Registered Social Landlords Bill has been introduced in order to remove or amend the provisions identified by ONS as being indicative of government control. This will then enable ONS to consider reclassifying RSLs in Wales to the Private Non-Financial Corporations sector, thus mitigating the impacts and budgetary concerns.

See the additional Housing section for more research news

 

Party Conferences

Conservative Party Conference, 1-4 October

  • Despite a series of mishaps, Prime Minister Theresa May delivered her keynote speech to the 2017 Conservative Party Conference, announcing a series of policies, including: a pledge to invest an additional £2bn in affordable housing, which housing associations will be able to bid for and will have the flexibility to use to build homes for social rent where it is needed; confirming certainty over social rent levels at CPI+1% for five years from 2020; ensuring councils release more land for housing; to revive a plan to introduce a price cap on energy bills; to reform organ donation rules in England in favour of an opt-out system; to undertake a major review of university funding and student financing.  She also stated that the Government had commissioned a review of the Mental Health Act which will be led by Regius Professor of Psychiatry at King’s College London, Professor Sir Simon Wessely.

  • Jeremy Hunt, the Secretary of State for Health announced a number of commitments to support recruitment and retention in the NHS, including measures to: support affordable housing by using NHS land to build additional affordable housing for NHS staff; improve nursing recruitment by a 25% in placements for student nurses, and a further 5,000 nursing associates trained through the apprentice route in 2018; and increased support for offering flexible working for all NHS staff, through a new mobile app to support more flexible access to bank working - piloted initially across 12 trusts. 

  • In his conference speech, Chancellor Philip Hammond announced: an extra £300m to improve rail links in the North of England, helping to link existing infrastructure with projects such as HS2; and £10bn funding would be made available to extend the Help to Buy scheme and help home-buyers.

  • Speaking at a fringe event entitled Social care and the ‘just about managing’ – who cares for the carers?  Nigel Keohane Research Director at the Social Market Foundation said that the Conservative Party had traditionally looked to the family as being carers.  He went on to talk about the UK’s ageing society and the fact that people’s needs were therefore becoming more complex. He added that the declining birth rate meant that there were fewer potential carers.  Jackie Doyle-Price MP Minister for Care and Mental Health, said that families needed to start thinking about their future care needs, because the "taxpayer should not necessarily be propping up elderly people staying in housing they could not afford to keep". Ms Doyle-Price then said that the country needed to have a discussion about what the obligations the individual had to care for their relatives.  She believed that people wanted to look after their relatives, but it was often difficult due to work commitments.  Ms Doyle-Price did not believe that anyone wanted to pay more tax to fund social care. Replying to a question from Chair on whether housing and social care should be linked or separated, Ms Doyle-Price said that the issue of care needed to be dealt with across the generations. She spoke of the importance of good social housing, but said that many people were living in inappropriate houses, so pathways for people to downsize should be created.  In response to a final question from the Chair on where the debate should start, Ms Doyle-Price said that the real fundamental issue was that people increasingly looked to the state to provide things for them. She concluded by saying that the question that Government should be asking itself was “how do we support families to best support themselves”. (Summary courtesy of DeHavilland)

  • Speaking at a fringe event The Future of Social Care: the choices facing the Conservative Party, Cllr Izzi Seccombe, Leader of Warwickshire County Council and Chair of the Local Government Association (LGA) Community Wellbeing Board, led a debate calling for immediate and urgent measures from central government in order to close the social care funding gap, and ensure sustainability for the future.  Over the past ten years, local government social care budgets had been cut by between 35-40%, and this, accompanied by an ageing population and increasing demand for social care, was causing significant pressure. She argued that social care should receive parity with the NHS in terms of esteem and focus.  On the proposed Green Paper on social care reform, Cllr Seccombe was adamant that there should be no more commissions, instead demanding action to resolve the issue. She stated that the LGA was requesting to be directly involved in the production of the green paper to ensure this was the case.  On funding adult social care, she stated that, as opposed to increasing council tax, she preferred a more long-term, lifetime solution possibly linked to income tax or National Insurance which could build for the future. Richard Humphries of The King’s Fund set out what should form the basis of the proposed Green Paper, including a long-term plan and framework that describes the future of social care within a complex, twenty first century economy and society and that policy must be made on a cross-party basis - consensus and co-operation were required to achieve genuine effective reform. He stated that there was no need for another commission or independent review as the options and costs well reviewed and set out already, including taxation, social insurance schemes which include an entitlement to care, and direct charges and he argued that the right formula lied in balancing these three elements. Mark Lever, CEO of the National Autistic Society argued that decisions were now being made on financial grounds rather than based on the needs of care users. He stated that this was short-term thinking and that investing in social care ultimately meant that care users did not need to resort to NHS care. He further stated that the 2014 Care Act was widely welcomed, but had since been routinely breached. Care packages were being reduced purely on the basis of finance and cost cutting as opposed to because of a re-evaluation of need. (Summary courtesy of DeHavilland)

SNP Party Conference, 8-10 October

  • Scotland's First Minister and SNP Leader Nicola Sturgeon delivered her keynote speech calling for the Scottish Parliament to be given full control of immigration policy and committed to oppose the EU (Withdrawal) Bill and any attempt to “undermine devolution”. Other key announcements included: a commitment to closing Scotland’s educational attainment gap; councils that did not use all allocated funding for building affordable housing would lose it; by 2020 they would deliver 30 hours of free childcare a week for every three and four year-old, in addition to every two year-old and double the annual investment in childcare from £420m to £840m; young care leavers would receive new support, specifically that they would all be exempt from council tax; a new Climate Change Bill to set new, ambitious targets to help Scotland meet its obligations under the Paris Accord; establish a new publicly owned, not for profit energy company by the end of the current Scottish Parliament in 2021; create a new £6m Rural Transport Infrastructure Fund; and reiterated a commitment to lifting the 1% public sector pay cap.

Workforce and Skills

  • The Work and Pensions Committee held an oral evidence session on the Taylor Review of Modern Working Practices inquiry. Matthew Taylor who led the Government’s Review of Modern Working Practices back in July, proposed a recommendation that individuals who are on a zero-hour contract should receive a higher minimum wage than those on a contact, prompting employers to shift individuals to small contracts, guaranteeing some work. However, comments by the Committee outlined that this would reduce flexibility for people who rely on zero-hour contracts due to other commitments. Of the six recommendations by Matthew Taylor, the Committee also greatly scrutinised the recommendation of a different minimum wage for those on contracted hours with those not on contracted hours. 

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

Other

  • The All Party Parliamentary Group on Ageing and Older People have launched an inquiry into Human Rights and Older People. Launching the inquiry chair Rachael Maskell MP, has written a blog outlining the reasons behind the inquiry which will examine global perspectives on older people and what is happening the UK, aiming for a Charter on the Rights for Older People. She writes “Pensions, social care or perhaps a national scandal highlighted by a documentary; this is the only time older people get any attention from Government…. Nations of South America and many in sub Saharan Africa are calling for a UN Charter on the Rights for Older People. We have seen how such rights have transformed the lives of children, giving them not only the protections they need, but the space to flourish. So why is the story so different for older people here in the UK?.. We must understand the huge asset that older people are to our nation and the enormous debt of gratitude that we owe to those with more years than ourselves. We also need a Government that is committed to solving the range of challenges we face and to ensure security and dignity for all.”

  • The Government has published draft legislation to lower the cost of energy bills by giving Ofgem the power to cap standard variable tariffs. The cap is unlikely to come into effect before this winter, however, and will only run until 2020, with the option of an extension to 2023 if the energy regulator feels it is necessary. 

  • The Transport Committee is launching a new inquiry into the licensing arrangements for community transport minibuses and the broader sustainability of the community transport sector, which provides essential access to transport to many vulnerable and potentially isolated people. The deadline for written submissions is Friday 3 November.

  • A report from the Institute for Government and the Chartered Institute of Public Finance and Accountancy has found that the government has spent over £10bn in five years just to keep troubled services going, such as hospitals and prison  and argues that the extra funding is not solving underlying issues that public services are facing. In the analysis of health and social care services, it finds that hospitals are spending more with no sign of improvement in key pressure points; adult social care is lacking a clear plan for what happens once emergency funding has run out; and GP numbers are not rising despite plans to improve services. The report calls for urgent action on policy and decision-making in order to deal with the building pressures on public services.

Back to top

______________________________________________________________________________________________________________

Ageing and wellbeing

Wellbeing and exercise

  • Age UK have identified that nearly half of adults surveyed (1,700) aged 55+ have experienced depression and anxiety. The most common triggers are reported to be the death of a loved one and financial worries, yet worryingly 35% of people said that they did not know where to go for help and support. Older people report that when they were growing up, society did not recognise mental health problems so it is not something that their generation is comfortable discussing. Age UK, working with NHS England are hoping to encourage older people to seek help and are calling for GP’s to spot the warning signs. 

  • A report in the British Medical Journal has called for change to the current thinking that exercise is only for the young. Scarlett McNally, an orthopaedic surgeon and lead author of the report, said: “Social care can be preventable because the risk of disease, disability, dementia and frailty can be reduced. We need individuals to understand how to get active every day and to help their friends and family to be active.” The report suggests that by encouraging older people to exercise and remain active, the need for social care is potentially reduced, saving the NHS thousands in social care funding. Exercise also supports older people to remain independent and potentially stay in their own homes longer.

  • new five year partnership between Leeds City Council, Leeds Older People’s Forum and the Centre for Ageing Better has been announced to build on Leeds’s commitment to become an “Age-friendly City”.  It is estimated that by 2021 the number of people in Leeds aged 50 and over will increase by nearly 25,000, an increase of 8% since 2011. The partnership will look at three key areas; making transport more accessible, boosting community activity amongst those aged 50+ and improve housing for people in later life. The partnership will also be working closely with older people across Leeds to respond better to ageing-related issues experienced by residents. 

  • new dance project to tackle inactivity in older people in the most deprived areas of the country has been launched. The £500k dance scheme led by One Dance UK will “disguise” physical activity as fun and will be taking place in areas such as Bradford, Doncaster and Leeds. Older people will play an active part in the programme as volunteers, advisors and champions, which organisers say will bring communities together to reduce social isolation. The project, supported through Sport England’s Active Ageing fund, also represents a change in focus for the government body tasked with building the foundations of community sport in the county. “Being active is one of the most important things people can do to maintain health and wellbeing as they age, said Mike Diaper, Executive Director at Sport England. 

  • The Sporting Memories Network, a charity which uses the power of sporting memories to tackle loneliness, dementia and depression has been granted almost £500k to help get older people exercising. The charity works with community groups and organisations to use a shared love of sport to spark conversations and new friendships among older people at weekly volunteer-led groups.As well as reminiscing about sport and allowing group members to tell their stories through sporting memories, the groups have also begun to include exercise and the playing of accessible sports.  Leeds Beckett University’s Centre for Dementia Research will be working with the Sporting Memories Network and group participants throughout the project to study the impact the approach has on supporting people living with dementia to become more active in their daily lives.

  • According to research by University College London and the University of Manchester, two thirds of adults over 60 rarely or never use public transport, even though it’s free and brings health benefits. Researchers analysed data from over 7,000 adults from the English Longitudinal Study of Ageing (ELSA) and found that those who did not use public transport had a faster decline in walking speed compared to those who used public transport frequently. Lead author Dr Patrick Rouxel said, “Despite having free travel, and being mobile, older people are not using public transport for a number of reasons. This is mostly because of the lack of infrastructure and availability of transport. Those who use public transport frequently are more physically active and have stronger lower limb muscle strength than non-users of public transport. So making public transport more accessible to older people could prevent some age-related declines in functional mobility,” Co-author, Professor Tarani Chandola from the University of Manchester added, “Using public transport more than once a week is not only environmentally friendly, but it has all these other benefits such as maintaining people’s health and physical activity and reducing their social isolation."

MHA comments: Many of these pieces of research and projects highlight the importance of keeping active in later life and the impact this can have on physical and mental wellbeing. Many of our Live At Home services provide similar activities to promote exercise, improve balance and promote over all wellbeing.

Loneliness

  • A study in East London by Tower Hamlets Health and Wellbeing Board will investigate what factors contribute to loneliness. Trained volunteers will investigate the thoughts of 600 men and women who experience loneliness in order to understand what factors contribute to this feeling. Tower Hamlets council’s public health director Dr Somen Banerjee explained “The East End has high deprivation and low income in a densely-populated urban environment. Brought together it can create high levels of loneliness. It’s important to know more about people’s perception of loneliness and what we can do about it.” One of the projects in the study aims to tackle loneliness among people in care homes by matching them with a community volunteer on the basis of a shared interest or hobby, encouraging meaningful relationships to residents and the volunteers.

Retirement 

  • UK-wide study by Centre for Ageing Better and Calouste Gulbenkian Foundation UK Branch (CGF)  revealed that one in five adults who retired in the last five years admitted finding it difficult. Most retirees do little to plan for this major life change, the survey suggested, with over half of people who had retired in the last five years revealing they didn’t seek any advice or help to prepare (56%). The data also revealed that only around half of UK workers planning to retire in the next five years are looking forward to it, (56%), with 41% worried about managing their money, a third concerned about feeling bored (33%) and missing their social connections from work (32%), and nearly a quarter worried about losing their purpose (24%). Some 17% of workers are worried about being lonely in retirement. The study will advise the Centre for Ageing Better by exploring how the process of retirement affects people and what kinds of intervention and support could help people to better manage the transitions.

Back to top

_________________________________________________________________________________

Dementia

Care, support and wellbeing

  • NHS Improvement’s nursing directorate has launched an evidence-based framework to support and enable directors of nursing and medical directors to achieve ‘outstanding’ care standards for those living with dementia during their stay in hospital. The framework consists of eight standards and draws on learning from organisations that have achieved an ‘outstanding’ rating through CQC hospital inspections, and integrates policy guidance and best practice with opinion from patients and carers.   

Research news

  • Alzheimer’s Research UK has published two interactive dementia maps, using statistical analysis to identify dementia ‘hotspots’ across the UK.  The maps are based on Westminster constituencies and Clinical Commissioning Group areas.  According to the data, coastal constituencies in the south of England have the highest number of people living with dementia per head of population – with Christchurch, in Dorset, topping the list.  In Christchurch, 2,400 people have dementia, (2.8% of its overall population) – compared to an average per constituency of 1.3%. The top five constituencies with the highest level of dementia per head of population are: • Christchurch: 28 per 1,000 people • New Forest West: 27 per 1,000 people • North Norfolk: 24 per 1,000 people • Clacton: 24 per 1,000 people • Worthing West; 24 per 1,000 people.   The five lowest constituencies (with 4-5 per 1,000 people) are: • Poplar and Limehouse • West Ham • Bethnal Green and Bow • Manchester Central • Hackney South and Shoreditch.  The new online interactive tool is part of the charity’s Dementia Statistics Hub.  

    MHA comments: This may be of interest to local Live at Home colleagues who a redeveloping services to meet needs. 

  • Researchers from Loughborough University have studied six years of data based on the lifestyles of 6,677 people aged between 52 and 90 to see if there was any correlation between maintaining close relationships and conditions such as Alzheimer’s disease. They found that men and women who reported being single had a 35%-44% higher risk of dementia. This meant that being in a close relationship, not necessarily a marriage, meant the chances of developing the disease were about 60% less. Professor Eef Hogervorst, of Loughborough University, said the healthier lifestyles of married people could be a key factor in the results.  She said “It might be because other studies often found that married men on average have healthier lifestyles than single men – such as better diets, less alcohol, less smoking and more and earlier health services visits. Another explanation could be that married couples will try to cope with dementia symptoms on their own for longer before health services are involved. Single people will need help to cope with their symptoms earlier.  On the other hand, having close relationships independently reduced the risk by 60%.  We did not find that social isolation per se increased risk but that feeling lonely did, by 44%.”

Technology

  • A Northern Irish start-up has developed a headset that could spot early signs of dementia. BrainWaveBank is testing the headset, which monitors electrical brain activity to spot patterns that could be early indicators of brain conditions and which users wear while playing games on a phone or tablet device.  The “electroencephalographic” data is then sent via Bluetooth to BrainWaveBank to analyse. The company has been funded by Innovate UK, the Government’s tech investment arm, and is currently testing its headset with around 90 people. The headset is worn for between 15 and 20 minutes and is designed to test memory, reactions and other functions and it could go on sale to the public in three years.

Back to top

__________________________________________________________________________________

Finance and pensions 

Older age and low incomes 

  • According to research by Age UK, half of UK workers aged 40-64 won’t have enough money to retire when they reach their State Pension Age. A third (35%) of those surveyed expect to be working the same hours in their current job in their late 60s, a quarter (25%) expect to be working fewer hours in their current job, and just over a fifth (21%) do not expect to be working in their current job at all by this point.  Of all those who expect to stop working or to reduce their hours before their late 60s, just under a quarter (23%) cited poor health as the likely reason, while over a quarter (28%) felt their job would be too physically demanding at that stage. Only 17% of those who expect to stop working said that this is because they would be financially secure enough to give up their job. The research coincides with a new Age UK public policy paper Creating a career MOT at 50, calling for a 'career MOT at 50' for all to help people plan their later working lives and explore how they can put enough money aside for the future while there's still time to make a difference.

  • In a blog by Kingsley Purdam at the University of Manchester, he explores The Forgotten Welfare Gap in Older Age and explains how welfare reform and austerity has affected growing numbers of older people. He outlines how ongoing research into food insecurity shows older people are at risk of under-nutrition because of poverty, or because they don’t get the support they need to shop, cook and eat. Interviews with older people using foodbanks have highlighted the challenges many older people can face. Some were having food parcels delivered by the foodbanks as they were unable to go themselves or did not want to be seen going. He also raises concerns that as size of the older population continues to grow, the reductions in LA spending on social care raise concerns about their long-term welfare.

  • Andrew Bailey, CEO of the Financial Conduct Authority (FCA) has set out the big public policy issues and key challenges facing the regulator relating to an ageing population including consumer credit, long-term savings and retirement provision. Firstly, he raises concerns that there is a clear risk that the savings rate for retirement is for many people too low to meet their expectations of a good retirement. In addition, consumers are being asked to take responsibility for increasingly complex financial decisions in later life, including planning for retirement and periods of ill health, the move towards mainly online and digital financial services and the exploitation of vulnerable older people. He indicates that the FCA will be publishing its pension strategy later this year setting out for the first time the FCA’s assessment of the major regulatory issues and has started discussions with other stakeholders regarding the sustainable supply of credit to support late life.

  • Energy regulator Ofgem will extend the prepayment safeguard tariff to 1 million more vulnerable households this winter. However it warned that the proposed price cap for 12 million consumers on energy bills, promised by the Prime Minister in her conference speech, is unlikely to take effect before winter. The regulator said it would wait for legislation to be in force before it would take action on standard variable tariffs. 

    See the Government Finance and Pensions section for more policy news

Back to top

__________________________________________________________________________________

Health  health staff graphic

Delayed transfers of care

  • The Guardian reports on a two models that are proving successful in reducing delayed discharges. Hospital trusts and their community health and social care partners are being encouraged to adopt a “discharge-to-assess” (D2A) or “home-first” model.  In east London, Tower Hamlets Together, a collaboration of health and social care organisations, has piloted D2A. The average length of hospital stay is down and there has been a dramatic fall in the number of patients ending up needing long-term care.   The approach is now a formal “care pathway” within the admission avoidance and discharge service operated by the East London NHS foundation trust. Running seven days a week from 8am to 6pm, it is staffed by two social workers, four occupational therapists (OTs), two physiotherapists, three nurses and one rehabilation support worker.   Patients are given an assessment on the day of referral, if required, and receive up to six weeks’ community input post-discharge. Short-term night care is also possible. The full social care assessment process starts two weeks after discharge, to fully address the change in needs. Another example in Kent, where Medway Foundation NHS Trust, working in partnership with Medway CCG, Medway Council and Medway Community Healthcare, a community interest company, has developed the Home First initiative – to provide support for patients who are medically fit to be discharged, but still require additional home support. It has created a single point of access for all coordination of a patient’s discharge, where transport is arranged for patients, who are assessed in their own homes by an OT within two hours of leaving hospital. The care package may also involve telecare and wraparound care, with people ringing to make sure medication is taken. 

  • Conversely Healthwatch England have published a new briefing What happens when people leave hospital and other care settings? which provides the views of over 2,000 people about their experiences of being discharged. It has found that in July 2017, the latest month for which data is available, an average of 5,861 NHS beds a day were occupied by patients who didn’t need them, up 23.4% compared with July 2015.  It suggest that the majority of delays are still caused by the NHS (55.9%), but that there has been a significant increase in the number of delays attributed to social care services, which now represent 37.4% compared with 30.4% two years ago.  The three main issues they identified by the patients involved were: 1. People still don’t feel involved in decisions, where people often aren’t given the information they need, such as about their medication or where to go for help out of hours. 2.People continue to experience delays and a lack of co-ordination between services, such as waiting for medication and transport, and because care homes or family members were not notified that they were about to be discharged. 3. People feel left without the support they need after leaving hospital, such as leaving care without adequate care plans or ongoing support in place, which in some cases led to re-admissions. 

  • A study by Age UK has concluded that almost four million bed days have been lost since 2011 due to problems transferring patients into community care once they have received hospital treatment. The number of days lost is still on the rise with patients struggling to access post-hospital care in the community or in their homes. The largest increase was between 2015-16 and 2016-17 when a 27% increase was recorded in the number of beds being taken by people who could be moved to other arrangements. It finds that in the last year more than 950,000 days were lost, which has an estimated cost to the system of £173m.  Over this period there has been a trend towards more older people staying in the community through homecare rather than going into care homes and nursing homes.

  • NHS Digital have report published findings from the Adult Social Care Outcomes Framework (ASCOF) in England for the period 1 April 2016 to 31 March 2017. The ASCOF draws on data from a number of collections, and measures how well care and support services achieve the outcomes that matter most to people. One of the  domains concerns delayed transfers of care.  It finds that at an England level both delayed transfers of care from hospital and those which are attributable to social care per 100,000 population have risen each year from 2013-14 to 2016-17. 

  • A new survey by the Association of Directors of Adult Social Services (ADASS) has revealed that 16 councils were fined for delayed transfers of care in 2016/17. The survey showed that individual fines were as high as £281k. Of these, ten councils paid the fine. So far in 2017/18, eight councils have been fined, with fines as high as £100k. Six councils have paid the fine. Only half of the respondents believed their agreed delayed transfer of care targets were realistic for both social care and the NHS. Margaret Willcox, president of ADASS, said it was ‘frankly bizarre’ that authorities should face further sanctions.

    MHA comments: This seems extraordinary that councils are being fined, when the money could be used to provide the care they are trying to deliver.  

Health and Social Care Integration

  • The Care Quality Commission has published its findings from its first local system review of Halton in Cheshire. This report is the first 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. The review found that there was a strong commitment and a shared vision across the local authority and the Clinical Commissioning Group (CCG) to serve the people of Halton well. 

  • The CQC has also published its findings in its review of the health and social care in Bracknell Forest, Berkshire. The CQC found that the health and social care system in Bracknell Forest was working effectively with an integrated approach that was having positive outcomes for older people. Reviewers found there was a system-wide commitment to serve the people of Bracknell Forest well, and most older people living in the area received good quality health and social care services in a timely way. There was evidence of strong strategic leadership between Bracknell Forest Council, Bracknell and Ascot CCG and providers, with a well-established, collaborative approach to designing and delivering services.

    MHA comments: We welcome these local system reviews, however it has been hard to hear the provider views in these reports.

  • A CQC report examining Quality of Care in a Place in the London Borough of Sutton, has concluded that there are strong and strategic ties between the borough's care organisations. Professor Steve Field, chief inspector of primary care services, said "The London Borough of Sutton has shown just what can be achieved when everybody in the system works together to support joined up care." 

  • The House of Commons Library has published a research paper outlining the latest policy and developments on Health and Social Care Integration including information on the proposed review of LAs Better Care Fund allocations for those not meeting targets on delayed transfers of care.

NHS

  • Health Secretary Jeremy Hunt, has announced a salary supplement for trainee GPs.  From 2018, surgeries in hard-to-recruit-to areas will benefit from a new scheme – the Targeted Enhanced Recruitment Scheme – which will offer a one-off payment of £20k to attract trainees to work in areas of the country where training places have been unfilled for a number of years.  The Department of Health has also asked Health Education England to make sure many of the 1,500 additional medical training places that will be funded from next year are located in priority areas, including rural and coastal communities.

  • The BBC reports that the performance of hospitals across the UK has reduced with targets for cancer, A&E and planned operations being consistently missed.  It highlights only one service run by Luton and Dunstable NHS Trust has managed to hit all three targets each time over the past 12 months.  The findings were revealed as the BBC launched its online NHS Tracker project, which tracks targets on: Four-hour A&E waits; 62-day cancer care and planned operations and treatment. The BBC research has found: Wales has consistently failed to hit its targets. In 2012-13 it did not hit any of its monthly key hospital targets and in 2016-17 it was the same. The last time a target was achieved nationally was 2010; England has seen the biggest deterioration. In 2012-13 it hit its key hospital targets 86% of the time, but in the last year it has missed every monthly target; Scotland is the only part of the UK to hit its targets during the last 12 months, but has only managed to hit do that three times over the summer in A&E when pressures tend to be at their lowest.  The analysis also finds that the north-east is the top performing region in England, where services have hit their key hospital targets 71% of the time in the past year.  Hospital staff have described how shortages of doctors and nurses, a lack of money and inadequate room in A&E departments in particular was making it difficult, sometimes impossible, to see patients quickly enough.  

  • The new CQC chief inspector of hospitals in England Professor Ted Baker, has said that the NHS is not fit for the 21st Century and that the system had not adapted to deal with the growth in the population. In an interview with the Daily Telegraph, he said "The model of care we have got is still the model we had in the 1960s and 70s… One of the things I regret is that 15 or 20 years ago, when we could see the change in the population, the NHS did not change its model of care. It should have done it then - there was a lot more money coming in but we didn't spend it all on the right things. We didn't spend it on transformation of the model of care." 

  • The NHS have published new guidance that will require health staff to ask patients about their sexuality, which will record the sexual orientation of all adult patients or service users across all health services and LAs where it may be relevant to record this information.

  • How does the NHS in England work? - The King's Fund have produced a helpful animated video exploring the NHS system in England.

    See the Government Health and Social Care section for more policy news 

Back to top

_________________________________________________________________________________

Housing

small building image

Health and Housing

  • Research from health economists at Bangor University has revealed how housing improvements can lead to health benefits.  Working with Gentoo Housing Association and Nottingham City Homes, the researchers evaluated the costs and outcomes associated with social housing improvements and found a link between warmer homes and improved health for social housing tenants and reduced NHS service use.  The results showed that retrofitting new energy efficient combi boilers and double-glazed windows has a positive impact on the health status, health service use, and fuel poverty risk of social housing tenants. Additionally, small improvements to main tenant happiness, life satisfaction, anxiety and well-being were also found. Professor Rhiannon Tudor Edwards said “A year after receiving housing improvements from Gentoo, tenants reported improved health status, less use of outpatient and emergency NHS services, that they could heat an extra room in their home and that they felt more secure financially with respect to fuel bills”.  After the housing improvements had been installed, six month household health service use costs reduced by £95 per home, equating to a 16% reduction in household NHS costs. On average a 69% reduction in hospital outpatient appointments was observed per household, as well as a 46% reduction in accident and emergency attendance and a 10% reduction in GP visits. For this cohort of 228 homes alone it is estimated that the NHS saved over £20k in six months after completion of the housing improvements. It was also found that the health status of main tenants significantly increased by almost 8% and financial satisfaction increased by 7%. Professor Edwards added “More needs to be done to ensure that everyone in the UK lives in a ‘healthy’ home which is warm and free from damp. This research could influence healthcare commissioners, councils and housing associations to work together to improve health through better housing.”

In brief:

  • Commissioned by Keepmoat Regeneration / ENGIE, the Housing LIN have shared a report, which sets out the case for developing specialist retirement housing for people aged over 55. It collates the research evidence and good practice of the reported benefits of this type of accommodation together with the savings to the public purse where they apply.

  • Community Building for Old Age: Breaking New Ground provides an update on an earlier case study for the Housing LIN, on the UK’s first senior cohousing community in High Barnet. It describes an initiative conceived and driven by a group of older women who, understanding that living alone as they grew old could leave them vulnerable, looked to each other to develop and share their social capital. 

  • A further case study from the Housing LIN features The Orangery, an extra care scheme for older people in the Sidley neighbourhood of Bexhill on the South coast. The case study highlights the scheme’s key design features and reflects on The Orangery’s first year of operation, giving lots of practical information.

    See the Government Housing section for more policy news

Back to top

_________________________________________________________________________________

Social Care

Regulation 

  • The CQC have published its response to the recent consultation on the next phase of inspectionFrom 1 November 2017: • The CQC will regulate services using a single assessment framework for adult social care, in order to reflect changes to the sector, new best practice guidance, and how providers may develop their services in future. The process will be simplified by aligning the questions we ask of different sectors and the characteristics that reflect a rating. • New guidance on how CQC monitors, inspects and regulates adult social care services will be made available and replace the Provider and Inspector Handbooks, to ensure both providers and inspectors use the same guidance documents. • Providers that are repeatedly rated as requires improvement  will have to complete an improvement action plan to show how and by when they will improve their overall rating to good. • Every service will receive a comprehensive inspection and there will be focused inspections, targeted on areas of concern, risk or improvements, informed by insight and information collection. From January 2018: • The CQC will introduce an online process for collecting information from providers via a statement of quality and how providers are supporting continuous improvements. Providers will need to update this at least once annually, although more frequent updates can be made to record changes in quality, including improvements. This process will first be used with a small number of providers, gradually rolling out to all providers. Our aim is for full implementation by early 2018/19. From April 2018: •The CQC will introduce a maximum inspection interval of 30 months for comprehensive inspections for services rated as good and outstanding. Although they will continue to follow up and respond to risks and concerns through the use of focused inspections at any time. 

    MHA comments: We have been preparing for these changes and colleagues will be embedding these changes into our internal quality assurance processes.

  • A periodic report from  the National Audit Office on the CQC suggests that it has improved as an organisation, but now needs to overcome some persistent issues with the timeliness of some of its regulation activities including registration and publication of inspection reports. The report found that the CQC has completed its inspection and rating programme comprising more than 28,000 provider locations, which provides a benchmark of the quality of health and social care services. It has significantly reduced staff vacancies and is increasing its focus on cost savings. In addition, the CQC has improved how it measures its performance, and takes action to correct poor performance.

  • This House of Commons Library briefing describes the main functions of the UK’s health and social care professional regulators and outlines some of the prominent debates surrounding this area of policy and the case for reform. 

Funding

  • NHS Digital have published Adult Social Care Activity and Finance Report, which has recorded a 3.3% increase in overall social care spending this year compared to 2015-16 and a 1% annual rise in real terms. The ability of councils to raise the council tax social care precept by 2% for the first time raised an additional £382m. But the report found that there has been “minimal change” in social care activity and said this could be due to the increasing costs of provision. The number of requests to councils for support grew by 0.2% to 1.8m. The report said 58 in 1,000 people aged over 65 and nine in 1,000 people aged 18-65 received long-term support. A total of 868,000 people received social care, a decrease of 4,000 on last year. Councils reported factors such as the introduction of the national living wage and an increase in support for people with complex needs as reasons for the rise in expenditure. The report found the average weekly cost of residential care for a person over 65 rose from £549 to £565 this year, while the weekly cost of nursing care for the same group increased to £606 from £563. Responding Niall Dickson, CEO of the NHS Confederation, which represents organisations across the healthcare system, said “No one can take any comfort from this. In real terms and in the real world this is a tiny increase to a budget that is woeful. The reality is that thousands of vulnerable people are not receiving the support they need and the health service is every day being placed under intolerable pressure as a result.  The Government has promised to put this right and it is now time for them to get on with that.”

  • The Local Government Association (LGA) has published Adult social care funding: State of the nation - October 2017. In the report the LGA estimates that local government faces a funding gap of £5.8bn by 2020. £1bn of this is attributable to adult social care and includes only the unavoidable cost of demography, inflation and the National Living Wage. This figure excludes other significant pressures, including the potential costs associated with ‘sleep-ins’, which include both historic liabilities and future costs, as well as any resources to address unmet need. In addition to the £5.8bn gap, by the end of the decade, a bare minimum of £1.3bn is required immediately, and in future years, to stabilise the adult social care provider market. The consequences of under-funding include an ever more fragile provider market, growing unmet need, further strain on informal carers, less investment in prevention, continued pressure on an already overstretched care workforce, and a decreased ability of social care to help mitigate demand pressures on the NHS. It adds that one off grants, the council tax precept and increases in improved Better Care Fund (BCF) funding have been helpful, “but each mechanism has its limitations and they do not deal with all short-term pressures, let alone address the issue of longer-term sustainability.”  It also indicates that local government remains committed to the integration of health and social care in the interests of ensuring joined-up services that achieve the best outcomes for individuals requiring services. They also add that the Government’s main vehicle for driving integration forward operationally, the BCF, has lost credibility “far from giving practical manifestation to the ambition of integration, the BCF has only served to recast that ambition in increasingly narrow terms.”

  • According to analysis by LaingBuisson, commissioned by the County Councils Network to analyse the impact of the Conservative manifesto proposals for social care in England, has found that the Government’s proposed cap on social care costs would cost county councils £330m a year if introduced.  It found the threshold would take many private fee payers into state support by as many as 56% in one county. 

  • The House of Commons Library has published several briefing papers on social care. Firstly, an overview of adult social care, which examines the key funding pressures on the sector.  A second briefing paper examines Government reviews and policy proposals for paying for care since 1997. The third paper explores Social care: Conservative manifesto's commitments on the means-test including the £100k limit. 

Current and future need

  • A survey by Which? has found that 48% of people who had arranged care for themselves or a loved one in a care home said there weren’t any places in at least one of the local homes they considered. Almost one in five people (17%) told the consumer watchdog they had settled for a care home they had reservations about, and 16% opted for a home away from friends and family. The survey also revealed half of those who need a care place are also having to wait for a bed, and 25% of care arrangers who found a bed said they felt guilty or annoyed they couldn’t find a more suitable home. Which? suggests this is indicative of a wider trend that could see almost nine in 10 council areas across England facing a shortfall in care home places by 2022. This shortfall is predicted to be particularly acute in 14 LA areas, which could face a shortfall of 25% or more in the number of care home places needed. Half of these are London boroughs.  According to the analysis, Bracknell Forest, in Berkshire, is set to see the biggest shortfall with 53% more care places needed by 2022 than are currently available. Lewisham (48%), Harringey (38%), Hartlepool (35%) and Milton Keynes (33%) are also predicted to fall significantly short in providing enough places in five years’ time if the rate of extra provision isn’t increased. It has launched a campaign calling for the Competition and Markets Authority's inquiry into the care home market to go beyond immediate issues around quality, fees and complaints and "confront the creaking care sector now, recognising that the national picture masks huge differences in the number of care home places available at a local level".

  • According to research by Aegon, 21% of  surveyed adults (651 surveyed in total) anticipate they won’t need residential social care in their old age.  Of those that think they will need care, 67% don’t believe it will be until they are 80 or older. In addition, 80% of people believe the average time needing care is over three years, and 30% think it is more than five years. However, it was also found that almost nine in ten believe there should be an absolute limit to the amount an individual pays, and most are unwilling to sacrifice their home. The research shows that approximately a quarter of UK adults believe the government should pay for all the costs of social care, however, two-thirds think they should be shared. 

Quality

  • The CQC have published The State of Health Care and Adult Social Care in England 2016/17, an annual assessment of health and social care in England, looking at the trends, examples of good and outstanding care, and identifies factors that maintain high-quality care. It finds that the quality of health and social care has been maintained despite some clear challenges. As at 31 July 2017, 78% of adult social care services were rated good (71% were rated good at 31 July 2016) as were 55% of NHS acute hospital core services (2016: 51%); 68% of NHS mental health core services (2016: 61%) and 89% of GP practices (2016: 83%).  Most people are receiving good, safe  care, however they warn that as the system continues to struggle with increasingly complex demand, access and cost, future quality is precarious.  They identify that with the complexity of demand increasing across all sectors, the entire health and social care system is at full stretch.  Commenting on the report Professor Martin Green OBE, CEO of Care England, “This is the second year in a row that the Chief Inspector at CQC has had to outline the precarious state of social care to Parliament.  Parliament can ill afford to ignore the warnings from CQC; there is an urgent need for a long term funding settlement that will reach the frontline and support sustainable quality services. There is a lot of uncertainty in the sector and by dragging its heels on the social care Green Paper, Government simply cannot abdicate responsibility for those in need of care, especially those funded by LAs."

  • NHS Digital has published findings from its annual Personal Social Services Adult Social Care Survey England 2016-17.  It has found that 70% of people receiving social services care feel "as safe as they want", an increase of 1% from 2015-16. Other key findings in this year's report include: 65% of service users were extremely or very satisfied with the care and support services they received; There was a general increase in the proportion of service users who needed assistance with activities of daily living including getting in and out of a bed (or chair); feeding themselves; dealing with finances and paperwork; bathing; getting dressed; and using the toilet; 68% of service users in the community reported that they have enough choice over the care and support services they receive; and 45% of service users reported they had as much social contact as they would like. But 22% reported that they did not have enough or had little social contact with 16% reporting they had some social contact but not enough and 6% reporting they had little social contact and felt socially isolated. 

Innovation and technology

  • The Guardian reports on Cambridgeshire County Council’s approach aiming to reduce adult social care need, by commissioning Care Network Cambridgeshire to deliver a county-wide community navigator service. The service has helped achieve a 30% reduction in level of need due to early interventions, such as by providing equipment, community support and less intrusive services. It service has volunteers acting as local points of contact and working with often isolated older people to identify what would support them, such as help around the home and assistance with benefits. Volunteers also assess what skills and interests older people have, to enable them to contribute to society. The service takes an asset-based approach by placing people’s skills, networks and community resources (their assets) alongside their needs to improve care and support. This led to the flourishing of community-based services and networks, such as befriending groups and social clubs. 

  • A care home in West Yorkshire has been trialling an innovative program designed to improve balance and reduce the chances of residents having falls. Seven residents from Czajka Care Group’s Brookfield Residential Care Home took part in a new training program using Nymbl – a comprehensive system for measuring, tracking and improving balance – and were found to have an increased level of independence, activity participation and enjoyment after just four weeks. The residents attended four weeks of group balance training classes with a coach. Post-training evaluations were conducted to see improvements in the resident’s balance. The results showed that every resident who completed in the training classes improved their Balance Index. The increases ranged from a 4% to 24% to 24 improvement, with residents who attended the most classes, achieving the highest improvement in their balance.

  • Southend Borough Council has become the first in the UK to introduce a robot as part of its social care team.  ‘Pepper’ will be used with vulnerable people such as those with dementia and children with learning difficulties. The child-sized robot can speak 12 different languages and communicates through videos and sensory games. It is currently the first robot with the ability to recognise principal human emotions and adapt its own behaviour to make independent decisions. 

End of Life Care

  • The National End of Life Care Intelligence Network has published a briefing on The Role of Care Homes in End of Life Care. It recognises that care homes are becoming an increasingly important place for end of life care as the population ages because the weeks, months, and sometimes years before death are marked, by frailty and increasing need for support and care. It is also recognised that for many people the acute hospital setting may not be the best place to provide end of life care.  It provides statistics, trends and explores the indicators of potential need for end of life care for people aged 75 years or older.  The report also recommends that all Clinical Commissioning Groups and LAs should consider their local care home and nursing home when commissioning and planning end of life care services for their local older population.

  • Researchers from King's College London have found that deaths occurring in care homes in England and Wales could more than double in the next 25 years if recent trends continue. They argue that investment is urgently needed to ensure all care homes are prepared to support residents as they reach the end of their life. The study shows that the number of people dying in care homes is increasing, while the number of people dying in hospital declines. Death at home is also slightly more common. This is in line with most peoples' wish to die in the place they usually live. Using official mortality data on over 5,500,000 people and population forecasts, the researchers quantified future increases in the number of people dying in different settings, to help guide planning of health and social care. From 2004 to 2014, the proportion of deaths that occur in care homes increased from 17% to 21%, with numbers rising from 85,000 to 106,000 per year. If this trend continues, the number of people dying in care homes will double to nearly 230,000 per year by 2040. In this scenario, care homes will overtake hospitals as the most common place to die. 

  • A new survey from Malnutrition Task Force and Age UK highlights that having conversations around dying and death is still very much a taboo subject and avoided by many people.  The research reveals that over a third of people aren't comfortable bringing up the subject with a relative or close friend and two in five people admit they do not know their loved ones' wishes around dying, such as what their preferred type of burial would be.  The poll of over 2,000 people found there are a number of barriers preventing people speaking openly about death, such as: 50% said they would be worried about upsetting the other person; 30% said they would be worried it would offend the other person; 25% would simply not know how to bring up the subject; 22% said it would make them feel too upset; 20% don't think they would be able to find the right time and place to have the conversation; and 19% said it isn't something they would want to think about at all.  The organisations have produced a new book and film to help people explore and approach this subject.

    MHA comments: It is good to see the recognition of the importance of End of Life Care.  This has been on MHA's agenda for over a decade and our Final Lap training supports our care homes to be places where death and dying a faced openly, positively and with support.  We have been shortlisted for the Third Sector Care Awards for our End of Life care. 

    See the Government Health and Social Care section for more policy news

Back to top

__________________________________________________________________________________

Third Sector

Fundraising

  • NFPSynergy have published 10 key points from research on Major Donor analysis. Some of these include:  Britain's wealthiest people gave approximately £3.2bn to charitable causes in 2016, up 20% from 2015; The USA remains significantly ahead of any other country in terms of giving; the Charities Aid Foundation have found a correlation between charitable giving and volunteering time, suggesting that greater levels of volunteering could yield results in terms of money donated to philanthropic causes.  The research also considers how major donors decide which charities to support and why do some wealthy individuals not give at all? 

  • US-based software company Blackbaud has completed a £95m takeover of the fundraising platform JustGiving, after regulators gave the green light to the deal.  Blackbaud said in a statement that the acquisition, doubled its investment in peer-to-peer fundraising and would add to its TeamRaiser and everydayhero platforms and would result in more charitable giving. Mike Gianoni, President and CEO of Blackbaud, said "Blackbaud is committed to accelerating the impact of individuals and organisations pursuing global good with modern, mobile-first and integrated cloud software.  As we marry JustGiving’s leading innovation in social giving with our unmatched cloud solutions for social good, we can power game-changing breakthroughs that strengthen the entire social economy."

  • Meanwhile, the Fundraising Regulator has agreed that it will update the Code of Fundraising Practice to include standards for online giving platforms, following a number of concerns have been raised in the media and by parliamentarians about online giving, including possible fraudulent activity, oversight over the end-use of funds, and transparency about fees charged by sites.  The changes come following a meeting between the charity regulators and the a number of online giving platforms.

MHA comments: Any changes to standards for online-giving platforms will be of interest to our fundraising colleagues. 

See the Government Charity and Voluntary section for more policy news

Back to top

__________________________________________________________________________________

Workforce and Skills

Social care and nursing 

  • The Nursing and Midwifery Council have published the outcome of their English Language and Nursing consultation, which includes changes to their English language policy from 1 November. The changes to their English language requirements will include: accepting a wider number of tests, with the Occupational English Test (OET) the first to be approved; allowing nurses and midwives trained outside the EU/EEA to provide evidence of their English language capability by providing evidence that they have undertaken a pre-registration nursing or midwifery qualification taught and examined in English or have registered and practised for a minimum of one year in a country where English is the first and native language, and a successful pass in an English language test was required for registration.  These changes will bring the options available for those trained outside the EU/EEA more closely in line with those from the EU/EEA.

    MHA comments: We contributed to the consultation on this, highlighting the challenges that the current language requirements are creating and we welcome their positive response.

  • According to recruitment agency Reed, advertisements for jobs in the social care sector have increased by 64% since last year. Reed said that 10,747 roles in social care were advertised on its site in September, up from 6,543 in the same month in 2016. The firm suggested that this was due to both the sector, which already employs 1.5 million workers, expanding, and a number of EU workers leaving the country. James Reed, chairman of Reed, said  “There is a perfect storm brewing: an ageing population in the UK; European workers uncertain about taking or staying in jobs over here; successive chancellors keen to balance the books; and historically low pay rates.” The figures released by Reed also show that job vacancies in health and medicine increased year-on-year by 19%, growing from 8,480 to 10,084. 

  • The King’s Fund also report that the number of nurses and health visitors has fallen for the first time in four years.  In June 2016 there were 283,674 ‘full-time equivalent’ nurses and health visitors employed by the NHS in England but in June 2017 there were 282,603 – a reduction of 1,071. The King’s Fund said the figures were “worrying”, adding that having enough nurses was “essential” for delivering safe care for patients. The report attributes the reduction in the number of nurses from the EU joining the UK nursing register since the Brexit referendum, along with changes to language testing requirements and an increasing number of EU staff leaving the NHS. In addition, the number of staff leaving the NHS due to ill-health or to improve their work-life balance has seen a sharp increase over the last few years. The King’s Fund has also indicated that the government’s decision to scrap bursaries for student nurses has led to a reduction in successful applicants to train to be a nurse.

  • Scottish Care Inspectorate has reported that more than a third of social care services across Scotland have reported unfilled staff vacancies in the past year and almost half of those faced difficulty recruiting the right staff. In the past year, 35% of services reported having one or more staff vacancies. Care homes for older people (59% of services), housing support services (57% of services), care at home services (57% of services) and care homes for adults (51% of services) were the main service types with the largest proportion of individual services reporting vacancies. Karen Reid, CEO of the Care Inspectorate said “We expect to see more innovative solutions embraced by care providers and funders. Social care services, local authorities and the NHS must continue working across traditional boundaries to deploy staff in a way that puts people’s needs at the heart of staffing decisions. There are some excellent examples of innovative practice which are truly person-led, and we want support more of them. 

  • The Scottish Social Services Council (SSSC) has opened the Register to 45,000 people working in care at home and housing support services across Scotland, the biggest single group of workers to register with the SSSC. They will join the 100,000 people already on the Register, including managers and supervisors and people working in social work, adult care, children’s day and residential services.  People on the Register must meet a number of criteria including having a qualification, working to the SSSC’s Codes of Practice and a commitment to continuing to learn and improve their skills and practice throughout their career.  Anna Fowlie, SSSC CEO said “Registration with the SSSC is a step towards making sure we have the right people with the right skills and values for the job. Too often we hear about times when things have gone wrong, so it’s important to highlight that most people working in these services do an excellent job and should be valued and recognised for the challenging and life-changing work they do.

  • NHS England is set to invest £10m into expanding the GP and pharmacy flu vaccine programme amid a raft of new measures to curb winter pressures this year. In a letter sent to CCGs and trusts from Pauline Philip, National Urgent and Emergency Care Director at NHS England, she announced the flu vaccine would be made available to care home workers free of charge under the expanded scheme.  Commenting on NHS England’s decision to offer complimentary flu vaccinations to care home workers, Professor Martin Green OBE, CEO of Care England, said “We applaud NHS England’s policy to offer free flu jabs to workers in care homes. Care England has long campaigned on this issue. In the past the independent sector has been overlooked and providers have had to foot the bill themselves which in a climate of severe financial pressures has been difficult. Being ready for winter and offering extra capacity to the already stretched NHS is yet another area where the independent sector can help”.

  • NHS Employers have produced this useful infographic, which outlines the different routes into nursing for employers. Until recently, the routes to developing registered nurses within the workforce have been limited, with the university degree being the main way to train this group of staff.  The introduction of the nursing degree apprenticeship gives a new opportunity for employers to train nurses, while the creation of the new nursing associate role can help to be a bridge between healthcare assistants and graduate registered nurses.   

Wellbeing at work

  • New research into the commutes of 26,000 people has shown how journeys to work impact on wellbeing. The study finds that every extra minute of commuting time reduces job satisfaction, reduces leisure time satisfaction, increases strain in people’s lives and worsens mental health. The effects of commuting on employee wellbeing were found to vary depending on the mode of transport used to get to work: 1. Those who walk or cycle to work do not report reductions in leisure time satisfaction in the same way as other commuters, even with the same duration of commute. 2. Bus commuters feel the negative impacts of longer journey times more strongly than users of other modes of transport.  3. Meanwhile, longer duration commutes by rail are associated with less strain than shorter commutes by rail, possibly because those on longer rail journeys are more likely to get a seat and to have comfortable conditions to relax or even to work. 4. Those who work from home are found to have higher job satisfaction and leisure time satisfaction, but working from home is clearly not possible for everyone on a daily basis.  The overall message for employers is that job satisfaction can be improved if workers have opportunities to reduce their time spent commuting, to work from home, and/or to walk or cycle to work – such commuting opportunities are likely to be good news for employee wellbeing and retention and hence reduce costs to businesses.

    See the Government Workforce and Skills section for more policy news

Back to top

__________________________________________________________________________________

Look Ahead: November and beyond

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

  • 6 Nov: Department of Health - Expansion of CQC inspections, consultation deadline

  • 7 Nov: Care England Judicial Review against Essex County Council, hearing

  • 7 - 13 Nov: Parliamentary Recess

  • 9 Nov: Department of Communities and Local Government - Planning for the right homes in the right places, consultation deadline

  • 22 Nov: Autumn Statement

  • 24 Nov; Charity Commission, Annual return for 2018 - information collected from charities, consultation deadline

  • 29 Nov: Department of Communities and Local Government  - Protecting consumers in the letting and managing agent market, call for evidence closes

  • 1 Dec: Scottish Government, - Consultation on Fire and Smoke Alarms in Scottish Homes, consultation closes

  • 8 Dec: Fundraising Regulator- Code of Fundraising Practice and Data Protection, consultation closes

  • 20 Dec: Homes and Communities Agency - Value for Money Standard, consultation closes

  • 26 Dec: Department of Health - Regulation of nursing associates in England, consultation closes

  • Dec: Competitions and Market Authority – Care Home Study, report expected

Events

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

  • Being 'in the moment' with music, Monday 6 November,  HOME, Tony Wilson Place, Manchester 10.30am - 4pm, FREE An interactive workshop exploring how we might better understand the experiences of people with dementia when they engage with music.  Featuring: a Music in Mind taster session, led by Manchester Camerata;  testimony from people living with dementia about their musical experiences; an interactive session exploring how to research musical experiences; and an overview of research exploring 'in the moment' experiences of people living with dementia.

  • Cultural and Personal Reflections on Dementia, Tuesday 7 November, Exeter Phoenix, 5-7pm, FREE  Dr Alex Hillman will be sharing images like those we often view on TV to encourage audience members to reflect on how dementia is portrayed in mainstream media, and how this media depiction may shape their own views, as well as the experiences of those who live with the condition. Steve Milton from Innovations in Dementia – a community interest company that works collaboratively with people with dementia to enhance their lives – will then lead a discussion focusing specifically on how we can shift the way people with dementia are, often negatively, defined and described in the media.  The event is part the Economic and Social Research Council’s annual Festival of Social Science and is part of the Improving the Experience of Dementia and Enhancing Active Life (IDEAL) Project at the University of Exeter. 

  • Everyday places: Why neighbourhoods matter for people living with dementia. A visual and interactive exhibition, Wednesday 8 November, Manchester Central Library, 11am - 3pm, FREE A free drop in event to take part in a conversation about neighbourhood, neighbouring and the experience of people living with dementia. The event is part of a study funded by the ESRC and NIHR 'Neighbourhoods and Dementia' [2014-2019]. The 'Neighbourhoods: our People, Our Places' project has made a use of a creative blend of audio, visual and sensory methods to explore the role of neighbourhoods in the lives of people living with dementia living in different parts of the UK and in Sweden.

  • Making quality improvement everybody’s business, Friday 10 November, online event, FREE Professor Don Berwick and Professor Jane Dacre talk about the key things the NHS can do to empower patients and staff to drive improvements in front line clinical care. Learn from examples of approaches being used in practice, including examples from the new care models programme.

  • Norfolk Care Convention, Wednesday 15 November, Norfolk Showground, FREE. At the Norfolk Care Convention will see the launch for a call to action for the biggest transformation in the Norfolk care market in decades.  

  • Shaping Tomorrow Care England Conference, Thursday 16 November, London, £125 for members. The conference aims to provide an unrivalled opportunity to hear and debate the views of leading sector figures from government, regulation and commissioning on a topic of national importance. 

  • The Future of Ageing Conference, Wednesday 29 November, ILC-UK, London, £210. This conference focuses on the importance of ageing. ILC-UK argue that more people need to be convinced of this - businesses, entrepreneurs, people managers, and marketing professionals to work with the charity sector and policy makers and politicians, who can deliver change. ILC_UK need to help provide the evidence to make the case for action.

  • Improving Hospital Discharge and Reducing Delayed Transfers of Care in Your Area, Wednesday 29 November, Westminster Briefing, London £150. This event will examine hospital discharges and delayed transfers of care and explore a whole-system approach to integration, culture change and new ways of working.

  • Enhanced health in care homes: lessons from good practice on embedding integration, Tuesday 5 December, The Kings Fund, London, £72 for care home managers (£240 other). This conference is for care home providers, health care providers, and commissioners who are thinking through how to improve the quality of life and health care for people living in care homes.It will share lessons from the six vanguards for enhanced health in care homes, and other local examples of good practice, to enable attendees to learn from initiatives that have worked well and can be replicated across the country.

  • Integrated Care Summit, Thursday 7 December, Congress Centre - London, £245. The Integrated Care Summit will offer delegates the chance to exchange knowledge, experience and new ideas in the design and delivery of the integrated health and social care agenda. Leading policy makers and informative best practice sessions will provide valuable learning as local authorities and the health sector work to pool budgets and join up health and social care across the country.

  • End of Life Care in 2018: Personalisation, Patient Empowerment & Coordination, Tuesday 23 January 2018, 11.00am - 3.30pm, London, £195 or £145 for two or more places (Early-Bird 10% discount until Friday 17 November). This event aims to provide an up-to-date brief on the latest national policy changes for end of life care, and explore what can be expected moving forward. Learn how to promote personalisation and choice for your patients and hear national good practice from colleagues in the provision of end of life care.

  • Care Home Inspections: Meeting the Updated CQC Assessment Framework, Thursday 25 January 2018, 11.00am - 3.30pm, London, £195 or £145 for two or more places (Early-Bird 10% discount until Friday 3 November) The Care Quality Commission’s new updated assessment framework for community and residential adult social care services comes into effect this winter.   Attend this Westminster Briefing to hear the details of these latest changes alongside a comprehensive overview of the guidance on care standards for care homes. Explore best practice from around the country and gain a practical understanding of how you can best prepare for your next inspection and improve your service.

Back to top

_____________________________________________________________________________________________________________________________________

Some information sourced from DeHavilland

 
 

blank space

© 2018 MHA