Policy News from MHA: August 2017

Welcome to MHA's August policy bulletin

 

Parliament has been in recess during August, so there has been no progress on legislation but the Government has been busy publishing various Brexit papers, outlining their proposals for negotiations.  There have also been key announcements regarding Data Protection and the forthcoming General Data Protection Regulations, measures to tackles pension scams and measures to force public companies to publish CEO salaries. 

Government: - Brexit - Charity and Voluntary Sector -  Data Protection and IT - Finance and Pensions - Health and Social Care Workforce and Skills -

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

Ageing and wellbeing: - Wellbeing - Loneliness - Physical Activity -

Dementia:- Causes, treatment and prevention - Care, support and wellbeing

Finance and pensions: - Pensions and retirement income

Health: - Health Inequalities

Housing: - Older people's housing choice 

Social Care:Navigating the system - Future need and devlopments - Quality - End of Life Care - Funding -

Third Sector: - Fundraising and donations -

Workforce and skills: - Nursing and language 

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

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Brexit

  • The Department for Exiting the EU has published a series of position papers on the Government's aspirations on various Brexit related policy areas:

  • Customs Union: This paper outlines a plan for an interim customs union with the EU as it withdraws from the bloc. The proposal would see the UK remain free from tariffs on goods within the EU and at the same time Ministers would expect to be able to negotiate new international trade deals - something they cannot currently do from within the customs union. Once this temporary arrangement period expires, the UK would seek a "highly streamlined" border with the EU, or a new "partnership" with no customs border at all.  It was intended to provide reassurance to businesses, but Labour claimed it was a ploy to "gloss over" divisions within the cabinet. 

  • European Court of Justice (ECJ): The paper states that the UK would no longer be under the "direct jurisdiction" of the ECJ, although it does not rule out the ECJ keeping its jurisdiction during the Brexit transition after March 2019.  The paper outlines several models used by other countries that the Government says show there is no need for the ECJ to be the final arbiter, but some of these involve the ECJ having an influence on the outcome of disputes, for example by interpreting EU law in a way that binds a disputes panel, or for its past rulings to be taken into account. However critics say it will be impossible to avoid European judges having a role in enforcing new agreements drawn up with the EU.

  • Northern Ireland and Ireland: this paper states that the Government will protect the Common Travel Area and associated rights for UK and Irish citizens and uphold the Belfast (‘Good Friday’) Agreement.  It argues that it is essential to avoid a hard border or any physical infrastructure such as customs posts. Instead, the paper proposes a wide-ranging exemption under which small and medium-sized enterprises will not have to comply with any new customs tariffs, with a mix of technology and physical checks to monitor the compliance of bigger businesses which are engaging in international trade.

  • Continuity in the availability of goods for the EU and the UK: This document outlines an ambition to seek an agreement with the EU which allows the freest and most frictionless trade possible in goods and services, with four key principles: goods placed on the market before exit day can continue to be sold in the UK and EU, without any additional requirements or restrictions; avoid unnecessary duplication of compliance activities that have been undertaken by businesses prior to exit; continued oversight of products to ensure the necessary action can be taken for non-compliant or unsafe goods; and where goods are supplied with services, there should be no restriction to the provision of these services.

  • Confidentiality and access to documents:  This paper recognises the importance of continuing to respect obligations of confidentiality and to protect information exchanged while the UK was a Member State, and that arrangements agreed with respect to confidentiality and the handling of information produced while it was a Member State should be reciprocal, affording an equivalent level of protection to the UK and the EU after the UK’s withdrawal.

  • Data Protection and Transfers: This paper seeks to ensure that Britain's data protection laws remain closely aligned with the EU's and that personal data can continue to move back and forth between Britain and the EU. It calls for a substantial level of alignment on personal data laws with the EU following Brexit, including measures which may include mutual recognition of data protection rules and the UK Information Commissioner being involved in future EU regulatory development, although this has met with some criticism.

  • The full collection of Brexit papers is available here.

  • European Commission President Jean-Claude Juncker has since criticised the UK Government's Brexit position papers.  Mr Juncker said that none of the papers published ahead resumed Brexit talks in Brussels were "satisfactory". He added that an "enormous amount of issues" needed to be settled before the EU would consider moving on to a second phase of negotiations.

  • More than 70 charities, NGOs and trade unions have joined a formal alliance to scrutinise the European Union (withdrawal) Bill. Members of the alliance say it will be a platform to campaign for open and accountable law-making after the Bill is presented (the second reading is expected on 7 September). The alliance will scrutinise the legislation and offer legal and technical expertise from its members, who range from human rights lawyers to environmental scientists, check limits on the powers given to Ministers by the Bill and ensure standards are maintained after the UK leaves the EU. The alliance will be coordinated by Unlock Democracy and includes organisations such as Amnesty International, the Fawcett Society, Friends of the Earth, Greenpeace, Joseph Rowntree Foundation, Liberty, Lloyds Bank Foundation, Sustain and Unison. It will have a permanent member of staff in place to coordinate public campaigns, although it insists it willbe neutral on Brexit

    MHA comments:  This alliance could prove helpful in scrutinising the content of the Bill, given the magnitude and complexity it entails. We will monitor announcements from the alliance. 

Charity and Voluntary Sector

  • More than 100 charities have written to the Government calling for the law regulating lobbying to be overhauled. AgeUK, Greenpeace, and Girlguiding are among those claiming the Transparency of Lobbying, Non-Party Campaigning and Trade Union Administration Act 2014 prevented them from “engaging” during the General Election campaign. One of the signatories to the letter, Julie Bentley, CEO of Girlguiding said "All of society loses out when the voices of those affected by issues are silenced from the debate around solutions, at the very time that decision-makers are listening most intently." This latest letter follows a similar letter sent by third sector representatives to the former Civil Society Minister in June, which called the Act a "confusing and burdensome piece of legislation that ultimately harms our democracy" . 

See the Third Sector section for more news

Data Protection

  • The Department for Digital, Culture, Media & Sport (DDCMS) has announced plans to formally bring the General Data Protection Regulation (GDPR) into British law in the new Data Protection Bill, to be published soon.  The EU GDPR legislation comes into force on 25 May 2018 and will bring in stricter requirements for organisations that process data and increased fines. DDCMS has published a statement of intent on the proposed bill, which makes clear that the Government intends to maintain the requirements of the GDPR after the UK leaves the EU in 2019 "in order to create a clear and coherent data-protection regime." In a letter to accompanying the announcement, Matt Hancock, the Minister of State for Digital, said the Government would work with the Information Commissioner to ensure that guidance was available to help organisations navigate the new requirements.

  • The Government has launched a consultation on measures which would mean that any organisation providing “essential services” could face large fines if cyber-attacks or IT failures lead to a failure in service provision. The plans are part of a consultation on the implementation of the Network and Information Systems (NIS) Directive from May 2018. The NIS Directive relates to loss of service rather than loss of data, which falls under the General Data Protection Regulations (GDPR). Operators will be required to develop a strategy and policies to understand and manage their risk; to implement security measures to prevent attacks or system failures, including measures to detect attacks, develop security monitoring, and to raise staff awareness and training; to report incidents as soon as they happen; and to have systems in place to ensure that they can recover quickly after any event, with the capability to respond and restore systems. The consultation closes on Saturday 30 September.

Finance and Pensions

  • Following a consultation on a package of measures aimed at tackling pension scams in December 2016, the Government has responded and outlined its intended next steps on the following measures: a cold calling ban in relation to pensions which will include emails and text messages and a potential fine of up to £500k and enforced by the Information Commissioner’s Office; a tightening of HMRC rules to stop scammers opening fraudulent pension schemes; and tougher actions to help prevent the transfer of money from occupational pension schemes into fraudulent ones. It is estimated that over 250 million cold calls are made every year aimed at convincing people to move their pensions savings into fake trusts. The scams often involve encouraging people to invest in foreign property or wine collections with the lure of higher yearly returns – only for the money to be stolen once transferred. Figures from The Telegraph show people have been conned out of £43m by pension scammers in the last three years, with the average victim losing £15k.  Legislation will be needed to make the changes, with a possibility of a Bill in early 2018. 

Health and Social Care

  • According to a new poll of 101 MPs commissioned by Independent Age, only 1 in 10 responding MPs in England (10%) believe that the current social care system is suitable for the UK’s ageing population. 86% of the MPs believe a cross-party consensus is needed for a lasting settlement on health and social care. Only 1 in 5 of the Conservative MPs agreed there is sufficient funding for social care services in either their constituency (21%) or in the UK (21%).  Fewer than 1 in 10 of the Labour MPs say they agree that there is sufficient funding for social care services in either their constituency (8%) or in the UK (7%).

Workforce and Skills

  • The Government has introduced measures aimed at increasing boardroom transparency in publicly listed companiesthat will: force all listed companies to reveal the pay ratio between CEOs and the average pay of employees; all listed companies with significant shareholder opposition to executive pay packages will have their names published on a new public register; and seek to ensure the employee voice is heard in the boardroom. The measures are due to come into effect in June 2018 are and will affect around 900 companies. The Labour Party has accused the Prime Minister of backtracking on her plans for boardroom reform and suggested the plans had been “watered down”.

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Ageing and wellbeing

Wellbeing

  • New research from the Global Council on Brain Health involving the University of Exeter, has concluded that doing puzzles and mind games isn’t the most effective way to keep our brains healthy as we get older. The research showed that people who play a brain game several times, despite getting better at the game, show little improvement in overall thinking abilities. However more challenging learning activities such as learning a language, practicing tai-chi, taking photography classes or investigating genealogy are important, as well as social engagement and physical activities to keeping brains sharp. The research also highlights that we should be maintaining our brain health from as young an age as possible. Age UK's Chief Scientist, James Goodwin said “Even though it's never too late to learn something new, the overwhelming message from the report is that you shouldn't wait until later life to try to maintain your brain health. The younger you start challenging yourself with mentally stimulating activities, the better your brain function will be as you age.”

  • The Scottish Government has offered additional funding to a project which helps older people benefit from cycling, with a view to rolling the scheme out across Scotland. Cycling Without Age began in Denmark and encourages volunteers to take older people for bike rides, using trishaws and is currently running a pilot project running in Falkirk, recently featured on BBC Three’s Amazing Humans series

Loneliness

  • The Carnegie UK Trust has published a report, The Place of Kindness Combating Loneliness and Building Stronger Communities, which explores how we can encourage kinder communities. The report finds that it can be hard to talk about kindness and that there are many things that get in the way of acting in a friendly, generous and considerate way. It identifies that, along with creating spaces and places to act in kindness, the simple fact of talking about it has a powerful effect on our behaviour.  Zoe Ferguson, the report’s author said “In offering kindness or asking for help, we feel the risk of getting involved in a difficult situation, of being asked to give too much, of being seen as needy or even of being rebuffed.  In general, we tend to perceive greater risk in engaging with people than we did in previous generations. People manage that sense of risk by formalising the way they make relationships, like becoming a befriender through a charity, for example, rather than visiting elderly neighbours.  However, we found that people miss informal relationships and a sense of community… The solution to isolation and loneliness does not lie solely in providing services, though they might be required for those in crisis. We need to move away from the idea that providing ‘community’ is someone else’s job. The answer lies in the humanity of individuals.”  

  • New research on loneliness and social isolation has found evidence to suggest they represent a greater public health 'hazard' than obesity. US researchers from Brigham Young University, Utah, sought to determine how loneliness and social isolation influence the risk of early death by conducting a meta-analysis of previous studies. The first analysis included more than 300,000 adults across 148 studies, while the second comprised 70 studies involving more than three million adults.  The study found that both loneliness and social isolation can increase the risk of premature death by up to 50%, whereas obesity raises the chance of dying before the age of 70 by around 30%.  Lead author Dr Julianne Holt-Lunstad, said people should be preparing for retirement socially as well as financially, because for many people the workplace is their biggest source of companionship. "Being connected to others socially is widely considered a fundamental human need—crucial to both well-being and survival. Yet an increasing portion of the population now experiences isolation regularly."  She recommended a greater priority be placed on research and resources to tackle this public health threat from the societal to the individual level. For instance, a greater emphasis could be placed on social skills training for children in schools and doctors should be encouraged to include social connectedness in medical assessments

  • The Calouste Gulbenkian Foundation has released a series of short podcasts as part of its Transitions in Later Life programme. The podcasts are part of a wider project helping people in mid to later life feel better supported to manage changes as they age, particularly as there is are few apparent resources on how to plan emotionally and psychologically for retirement.

  • Public Health England has launched a new tool for helping to identify the most cost effective mental health programmes.  The tool was developed in partnership with leading economists at the London School of Economics (LSE) and identifies programmes that are proven to reduce the incidence and/or risk of mental health problems at all stages of life: children and young people, the working age population and older people. Mental health problems represent the largest single cause of disability in the UK. The cost to the economy is estimated at £105 billion a year.Examples of programmes identified in the Return on Investment tool are: Workplace: wellbeing programme - every £1 invested results in an estimated saving to society of £2.37 (over 1 year); Workplace: stress prevention - every £1 invested results in an estimated saving to society of £2.00 (over 2 years); Collaborative care for physical health problems - every £1 invested results in an estimated saving to society of £1.52 (over 2 years); Older people: tackling loneliness through volunteering and social activities - every £1 invested results in an estimated saving to society of £1.26 (over 5 years). Alongside the tool, PHE has published several other evidence-based resources that will help local areas create effective public health systems that can prevent as well as treat mental ill health. 

    MHA comments: All of the research and projects listed in this section, will be of considerable interest to our colleagues running our Live at Home services.

Physical Activity

  • A study being run by the University of Birmingham aiming to help older people stay fitter and live independently for longer, is expanding its programme to engage more people aged over 65.  Project REACT (REtirement in ACTion) works with older people who are starting to find everyday activities such as walking, climbing stairs and getting up from a chair difficult, to take part in a specially designed 12-month physical activity and social programme. The project is testing whether a decline in mobility and physical function can be slowed, stopped or even reversed. Participants are randomly allocated to one of two groups on the study; group one is the physical activity programme and group two is a social and educational programme. REACT is based on LIFE, a US programme which successfully proved that physical activity prevents loss of mobility in older adults. The study as a whole is recruiting almost 800 people over the age of 65 from urban, suburban and rural communities.  

  • The National Institute for Health and Care Excellence (NICE) has published draft guidelines, suggesting that traffic lights should be altered to allow longer time for older people, the disabled and parents with small children to cross the road. The Physical Activity and the Environment draft guidance also proposes that councils should also ensure that bins, street furniture, hanging baskets and parked cars do not obstruct those with mobility problems.  Supporting research from University College London has found that many people over the age of 65 walk far slower than the estimate of 1.2 metres per second which forms the basis for crossings.  On average men over the age of 65 walk at 0.9m/s and women move at 0.8m/s. The draft guidance is out for consultation until 2 October. 

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Dementia

Causes, treatment and prevention

  • Public Health England have published an evidence review showing that changing some behaviours in midlife can reduce the chances of getting dementia in older age. The series of papers explore the primary prevention measures for people in middle-age and evidence of dementia risks associated with: physical inactivity; smoking; diabetes; hypertension in mid-life; obesity in mid-life; and depression.

  • The dementia research game Sea Hero Quest, is being further developed into a virtual reality game. Sea Hero Quest tests a players ability to navigate, one of the first abilities that can be affected by dementia.   The original smartphone app amassed 3 million players and data from their game-playing has helped to establish that the sense of direction declines consistently after their teenage years; that men generally have a slightly better sense of direction than women; and that the Nordic nations outperform the rest of the world, although it is not yet clear why.  The move to running the game on a virtual reality platform will enable further investigation of navigation skills, with a goal of establishing a new way of diagnosing the disease.  Max Scott-Slade, from the computer game developers Glitchers said, "The value for us is to create this much richer dataset, we're capturing 15 times more data from the VR version because we're separating out where the head looks and where the boat's moving [in the game play]." Dr David Reynolds, of Alzheimer's Research UK, said "What we really want to be doing is identifying people with dementia 10 or 15 years earlier than we do at the moment.  A game like Sea Hero Quest and understanding how we navigate will help us get to that much earlier diagnosis."

Care, support and wellbeing

  • People with advanced dementia could be helped to interact through a non-verbal communication technique known as ‘Adaptive Interaction’, developed by researchers at the University of St Andrews. In the latter stages of dementia, those living with the condition can lose the ability to use and understand spoken language. Adaptive Interaction facilitates connection and brings comfort through a “behaviour matching” technique, reciprocating the movements and vocalisations of those individuals. Tests of the technique showed positive responses from individuals and improved communication, reducing further agitation and distress.  Dr Maggie Ellis of the School of Psychology and Neuroscience said “We have seen amazing results when using each individual’s non-verbal language – people laughing when they didn’t before, showing more interest and increasing the physical contact they have with those around them.  Although they cannot speak, [they still have] a set of fundamental communication skills that we can use to communicate with them.”

  • A new study has found that A&E attendance among people with dementia in their last year of life is increasing. While there has been a general drop in the number of people with dementia dying in hospital, researchers from King’s College London found that over three quarters of people with dementia were seen in A&E in their last year of life.  The paper’s main findings include: Out of 4,867 people with dementia who had died, 79% had at least one A&E attendance during their last year of life; A&E attendance became more common the closer people were to death, with just under half (45%) having an A&E attendance in their last month of life, and a fifth of people with dementia attending A&E in their last week of life; People living in a care home had fewer A&E attendances, which may be because plans were put in place to avoid this; The likelihood of attending A&E increased over time: people who died in the most recent year studied were 1.6 times more likely to attend A&E then in the previous years.  Lead author, Dr Katherine Sleeman from the Cicely Saunders Institute at King’s College London, said “Recognition of the need to improve end of life for people with dementia has been increasing. This includes enabling them to be cared for in their home or a care home. However, our results show a worrying increase in the reliance on emergency care. In light of the current pressures on the health service, our ageing population and the associated increase in deaths from dementia, there is an urgent need to look at ways we can provide better support for care in the community.”  Co-author Professor Robert Stewart added “Most people with dementia have a number of other health problems as well as difficulties arising from the dementia itself. Sometimes people do need to be taken to A&E and sometimes time in hospital is needed; however, this is often distressing and disruptive and most people want to keep it to a minimum.”

In Brief:

  • Plans for £15m dementia village in Canterbury, have been put forward as part of a wider housing project of 4,000 homes. The village is based on the pioneering dementia village, Hogeweyk in Amsterdam and would provide a home and community for 250 people with dementia.

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Finance and pensions 

Pensions and retirement income

  • The Institute for Fiscal Studies has reported that more than one million women aged 60 to 62 have become poorer as a result of delays to their state pensions and are £32 a week worse off. However while poverty for this group has increased, it has not impacted greatly on their material deprivation (that is people saying that they cannot afford a range of important items). It does also add that employment rates have increased for this age group. Campaign group Women Against State Pension Inequality (WASPI) commented,
    "Once again, this shows that the Government has implemented State Pension Age reforms without adequately considering the full impact of these changes on the women affected."

  • The House of Commons Library has published a paper looking at the timetable for increasing the State Pension Age and the review set up to look at how it should increase in the longer term.

  • An article from the BBC, considers Death of retirement: Can the UK afford the state pension? They outline that the State Pension costs more than £100bn a year but those costs will rise in the coming decades. The Office for National Statistics projects that the cost will double to £200bn by the mid-2030s and double again to £400bn in the 2050s.  The reason is simple, according to Michael Johnson, a research fellow at the think tank the Centre for Policy Studies, "From 1940 to 2010 the state pension age didn't move at all. In 1940 it was 60 for women, 65 for men, as it was in 2010. But life expectancy over that 70-year period had increased by around 17 years, so we are faced with a fundamental problem that this is something we should have addressed a very long time ago and didn't and therefore to address it now makes it much, much more challenging." 

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Health  health staff graphic

Health inequalities

  • According to a new survey published by Gransnet and the Parliamentary and Health Service Ombudsman, of over 600 Gransnet members, older vulnerable people are often reliant on relatives to raise concerns when things go wrong in hospital, yet over half (51%) of family members with a concern say it is difficult to complain about the hospital care or treatment of an older relative.  The Parliamentary and Health Service Ombudsman suggested that there are far fewer complaints from older people than would be expected given older people’s high usage of NHS services.  The survey also reveals wider concerns about communication with older patients and their families: 2 in 5 (40%) participants did not feel they were kept informed about their older relative’s condition in hospital and were not given enough opportunities to discuss their care and treatment; and 1 in 3 (33%) respondents felt they were not adequately involved in decisions about their older relative’s care and treatment.  Poor communication is a factor in around one third of all complaints the Ombudsman service investigates about the NHS in England.

  • The Medical Technology Group (MTG), a coalition of patient groups, research charities and medical device manufacturers, has published a report The North-South NHS divide: how where you are - not what you need - dictates your care, suggesting that patients in the south of England are waiting longer to access vital medical treatments such as pacemakers, cataract surgery, and hip and knee replacements than those in the North. The report examined data from all 209 Clinical Commissioning Groups (CCGs) from across England to find out how effective they are at giving patients access to medical technology. It found that nine out of the ten CCGs that performed worse when measured against the NHS 18-week ‘referral to treatment’ target were in the South. In cardiology for example, figures ranged from 100% of patients receiving treatment within 18 weeks in North Durham, while Medway CCG failed to hit the target for half of its patients. The report also revealed that waiting times are steadily increasing across all CCGs. NHS performance reached a peak in late 2012 when nearly 19 out of 20 patients (94.8%) were referred to a consultant within the 18-week timeframe. However, in April this year the figure had declined to nine out of ten, with almost three times more patients (380,000) waiting longer than 18 weeks for treatment compared with 130,000 in November 2012. The MTG report sets out eight recommendations for addressing the current variation in NHS services, including: Publication of aggregate waiting time figures so patients can compare the performance of their local NHS against other regions; The creation of a tribunal board to rule on commissioning decisions made by local CCGs; and inspections of the worst performing CCGs by NHS England.

  • The Faculty of Dental Surgery at the Royal College of Surgeons has estimated that across England, Wales and Northern Ireland at least 1.8 million people aged 65 and over have an urgent dental condition such as dental pain, oral sepsis (a dental infection that can lead to blood poisoning) or extensive decay in untreated teeth.  The report makes a number of recommendations to improve oral healthcare for older people such as calling for key health and social care professionals to receive training in oral health, and for regulators to make standards of oral care part of their assessments of hospitals and care homes. The Faculty also believes Government, health services, local authorities, care providers, regulators and the oral health profession should work together to improve access to dental services for older people. Professor Michael Escudier, Dean of the Faculty said “Many of us know what it’s like to have excruciating tooth or gum pain. It puts you off your food and makes it difficult to do daily tasks. For older people the effects are even worse. It can be very isolating, making people reluctant to socialise with friends and family, and will have a significant impact on their quality of life.  As well as causing pain and making it difficult to speak, eat and take medication, poor oral health is linked to conditions in older people such as malnutrition and aspiration pneumonia.” 

In brief:

  • Health Secretary Jeremy Hunt has launched a plan to expand the mental health workforce, aiming to tackle the ‘historic imbalance’ in workforce capacity and improve mental health services. The plan has been developed by Health Education England (HEE) together with NHS Improvement, NHS England, the Royal College of Psychiatrists and other key mental health experts.  All major specialisms will see an expansion in numbers, with the plan targeting areas where there are forecast to be particular shortfalls as demand on services increases. It concludes that there should be: 2,000 additional nurses, consultants and therapist posts created in child and adolescent mental health services; 2,900 additional therapists and other allied health professionals supporting expanded access to adult talking therapies; and 4,800 additional posts for nurses and therapists working in crisis care settings, with the majority of these (4,600) being nursing positions.  The Government has committed £1.3bn to transform mental health services.

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Housing

Older people's housing choicesmall building image

  • Estate agents are reporting a surge in inquiries from home owners looking to downsize but they are struggling to find homes for them to move to, research from Key Partnerships suggest. 44% of estate agents have seen a rise in inquiries from older home owners looking to downsize in the past year, however 62% of estate agents say that would-be downsizers have unrealistic expectations about how much they will raise from moving to a cheaper home.  In addition, 56% of estate agents say there is a shortage of homes on the market suitable for downsizers and 68% warn there are not enough homes available for older buyers who are less mobile. 

  • Meanwhile a cash incentiveintroduced by Moray Council in Scotland, to encourage tenants to downsize has been unsuccessful. Created in consultation with tenants, the voluntary scheme (mainly aimed at older tenants) offered both practical and financial assistance of at least £1,900 to help with moving home. In April, that offer was increased to include an extra £400 bonus payment to cover unforeseen moving costs. It is estimated that there are empty bedrooms in about 400 council homes and it was hoped the initiative would help reduce the 3,500 people on the waiting list for homes in the region.

  • However in a related article the Centre for Ageing Better warn that Downsizing is not a silver bullet.

  • Legal & General has taken its first step into the retirement housing market by acquiring an existing operator with ambitions to build 3,000 homes for older people in the next five years.  The insurer has paid £40m for Inspired Villages (previously known as English Care Villages), with the price including two existing retirement villages in Warwick and Cheshire.  English Care Villages was established in 2008 and worked with not-for-profit organisations such as Places for People and the Anchor Trust to run its homes.  The schemes are built around a central ‘village square’, surrounded by various facilities for residents including libraries, restaurants and cafes. Homes are priced between £250k and £375k, and residents have the option to pay for care as and when they need it.  Phil Bayliss, head of Legal & General Capital’s later living team, said “It is widely recognised that the UK is under-prepared to support its ageing population. We believe our long term capital can deliver significant housing, health and wellbeing benefits for those in later life.”

  • Think tank Demos have launched a new research project Encouraging supply and demand in older people’s housing, to explore options that would encourage greater demand for and supply of retirement housing, including care villages and extra care housing. It will involve extensive qualitative research with citizens and experts as well as rapid evidence assessments and economic modelling. The project will also consider the ways in which older people can be encouraged to move into these forms of housing, including financial incentives; as well as the financial factors which currently thwart supply – in particular focusing on the impact of the current Community Infrastructure Levy and s106 regimes on the viability of retirement housing schemes and the options for their imminent replacement. They aim to set out a range of possible options to improve both demand and supply, and identify the most feasible way forward as the Government engages with the sector in order to implement the proposals as set out in the Housing White Paper.

  • A blog from the Housing LIN, explores the opportunities new towns present to plan and build communities, which could enable older people to lead healthy and fulfilling lives. The specific town in question is Northstowe, a new town of 10,000 homes in South Cambridgeshire. It is one of ten ‘demonstrator sites’ in NHS England’s Healthy New Towns programme, where the needs of older people are being taken into account in every aspect of development, not only in the design and build of properties to address housing needs, but also the ways in which older people will inhabit the new town overall. The public spaces are to be welcoming and inclusive, the recreational opportunities available to all ages, and people will be enabled to stay active and healthy as they age, with the support they need to stay independent at home. The development is being supported by research by the Centre for Regional Economic and Social Research (CRESR), at Sheffield Hallam University, who are assessing the housing needs and preferences of current and future generations, and estimating what future provision will be required. 

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Social Care

Navigating the system 

  • The Competition and Markets Authority (CMA) has published a report on the consumer research part of its Care Homes Study. The in-depth interviews with 102 representatives of people living in care homes, 16 residents of care homes, and five social workers, explores how people navigate the care home sector across the UK, including the customer journey when choosing a care home and experiences within the care home.  The key themes that emerged across the research include: there was often limited time to make decisions about which care home to choose; there was limited engagement with the details of the ‘system’; there was a perceived lack of information and support when choosing a care home; there was a perception that options were limited – the availability of spaces generally and availability of a space in the right home; people felt powerless to control the situation.  The research identifies that a move into a home was commonly triggered by an event, such as a fall or stroke that made it clear that a resident was no longer safe to live in their own home and representatives felt rushed in making decisions. While researching care homes was relatively easy, because of this limited timeframe, people often said they only visited a small number of homes, which seemed inadequate compared to the magnitude of the decision. The research reveals that the relatives placed less confidence in regulatory reports, preferring their own experience of visiting the home and meeting staff as a more valuable measure of the quality of the home.  The research also established an absence of engagement with the different parts of the care system – partly due to a lack of planning for future care, but also little understanding of what funding options were available.  There was a sense that Local Authorities could do more to explain how needs assessments, financial assessments, and funding systems worked and why and when they were required. 

  • Research conducted by Scottish Widows’ think tank, The Centre for the Modern Family has published a research report The Cost of Care, which explores the growing pressure on families and individuals to provide support to older relatives in need of practical and financial care.  The research surveyed over 2,000 people and it suggests that people in the UK generally underestimate the cost of care. On average, the respondents estimated that residential care would cost £549 a week, compared to a real average of £866. 25% of people admitted they have no idea how they would cover these costs for themselves or a relative and only 15% of people said they are saving money on a monthly basis to pay for their own care when the time comes, and almost half 49% say they avoid thinking about the issue because it makes them feel stressed.  A lack of understanding of the benefits system was also apparent, with almost 24% of people claim they would need, or expect, to rely entirely on state support, but 42% admit they don’t actually understand what benefits – both practical and financial – they would be entitled to. 

Future need and developments

  • A study led by Newcastle University estimates that an extra 71,000 care home places will be needed in England over the next eight years to cope with rising numbers of older people unable to live independently. The Cognitive Function and Ageing Study compared levels of dependency for those aged 65 years and over in England in 1991 and in 2011 – 15,000 adults in total. Adults were classed as high dependency if requiring 24 hour care, medium if they needed care at regular times each day, low if they required care less than daily or were independent. The authors estimate that if rates of dependency remain constant, there will be an additional 190,000 older people with medium care needs, and 163,000 with high by 2025 compared to 2015.  Additionally, the study projects an increase in the number of people with low dependency – generally looked after in the community – of 885,000 by 2025. The study highlights the need for adequately trained professionals to care for older adults with complex needs.Professor Carol Jagger, said If dependency prevalence remains constant, we estimate that by 2025 there will be an additional 353,000 older people with substantial care needs. While many of these people will live in the community, at current rates of provision, this will mean a shortfall of more than 71,000 care home places by 2025. Our findings have considerable implications for relatives as older people will have complex needs, requiring sustained input from family carers or social care teams to support independent living.”  The research also revealed that between 1991 and 2011, life expectancy increased for both men, from age 77.9 to 82.6, and women, from 81.5 to 85.6. Over this time, the proportion of years that an adult aged 65 could expect to live independently declined from 73.6% to 63.5% for men, and from 58.0% to 47.3% for women. By contrast, the proportion of years living with low, medium or high dependency increased. 

  • A separate study, by property consultants JLL, found that since 2002 an average of 7,000 new care home beds had opened in the UK every year, but by 2026 there would be an additional 14,000 people needing residential care home places per year.  Lead researcher James Kingdom said "We're currently building half the number of care home beds every year that we need. We know that over the course of the next decade there is going to be 2.5 million more over-65s, and as a result that means there is going to be demand for care home beds. To fix that, we need to double the rate of delivery" But the Association of Directors of Adult Social Services representative Glen Garrod, said "There is a danger of looking to residential options when we haven't fully exhausted all those that might help people stay at home - which is where most people would prefer to be." The research was commissioned by BBC Radio 4's You and Yours programme.

  • Hampshire County Council is to begin using Amazon Echo technology, aiming to help older people live independently in their homes for longer. It will provide 50 adult social care clients with a modified version of the device to remind people when to take medication or check when their carer is due to arrive. It will also connect to other technology in people’s homes such as movement sensors so it can remind people to have a drink when they enter the kitchen.  The Council is working directly with Amazon to trial the devices.  

    MHA comments: This may be of interest to Live at Home colleagues in Hampshire, where we are working cloesly with Hampshire County Council to expand Live at Home services. 

Quality

  • Healthwatch have published a report which documents What's it like to live in a care home? Findings from the Healthwatch network. Over the course of a year, local Healthwatch staff and volunteers across England visited 197 care homes across 63 different local authority areas and spoke with residents, their families and staff, compiling people’s experiences with observations to produce 140 reports. The report identifies three key themes: The quality of care varies between homes, but also within the same home, with too few homes getting the basics right every time; Good care homes meet all people’s health and care needs, working seamlessly with other services when their residents need additional support; and the best residential services are the ones that focus on enabling people to continue living as if they were still in their own home.  As well as identifying poor practice and buildings, the report also highlights several examples of good practice.

  • Another report from Healthwatch, Home care services: What people told Healthwatch about their experiences, analyses the experiences of 3,415 people, their families and front line staff over two years. Most people had positive things to say about their home care, with one of the most positive things being that it enables them to remain in their own home and to maintain as much independence as possible.  However, the research identified four areas where people's experiences could be improved: Care planning – People spoke a lot about staff who were unfamiliar with their clients’ care plans. In cases where it was a staff member’s first visit to a client, they often didn't have enough time to read the care plan in advance; Skills and qualifications – Many people said they valued the dedication and experience of staff sent to care for them. However, people said that some care workers lacked experience and basic skills, such as the ability to wash someone or make them breakfast; Consistency and continuity - All local Healthwatch found problems with staff coming at different times and even missing appointments; Communication and feedback – Providers need to make greater and more regular use of feedback to address problems early and prevent minor issues turning into complaints. 

End of Life care

  • Research by the Marie Curie Research Centre at Cardiff University, with 108 specialist palliative care providers has been published, aiming to better understand the role of specialist palliative care in providing support to care homes in England. Key findings included: generally positive relationships with the homes they supported; despite an increased focus in healthcare on the involvement of patients and carers in the assessment of care, patient and carer reported outcomes were rarely mentioned; the high turnover of care staff, clinical staff and managers in residential and nursing homes was seen as a major challenge that inhibited support to care homes and residents; and language barriers and cultural differences, particulrly different cultural beliefs around death were cited by many as a challenge. 

  • The Welsh Government has announced an additional £1m funding for the delivery of the End of Life Care Delivery Plan 2017-2020 (published in March 2017). The three year plan outlines how the Welsh Government intends to improve services for patients and their families across Wales. It covers all aspects of palliative and end of life care, delivered by both primary and secondary care and the voluntary sector. To ensure patients’ experiences are consistently improving, the allocated funding will be used for activities such as providing additional training for health professionals to initiate difficult conversations about End of Life Care with patients and their families. The funding would also be used to support the development of an all Wales streamlined, advanced care planning electronic record system, to take forward research priorities and to support GP clusters in Wales. In addition the funding, will support projects that aim to get people in Wales talking more openly about dying, death and bereavement through awareness raising activities and online resources.

Funding

  • A ‘persistent lack’ of Local Authority funding is pushing care homes closer to the brink of failure, according to a new market study from accountants Moore Stephens. It found that 16% of care home companies in the UK are exhibiting warning signs they are at risk of failure, an increase of 4% over the past year. The lack of council funding combined with the increase to the National Living Wage (NLW) had placed a ‘significant burden on care home companies’.  They also warned the growing use of agency staff, who are brought in due to the difficulties in retaining and recruiting skilled staff, had pushed costs up even further. 

  • Welsh care providers and Local Authorities (LAs) and have won a Supreme Court dispute against local NHS Health Boards, over responsibility for paying for the work done by registered nurses in social rather than health care settings. The case before the Supreme Court concerned the funding of nursing care for residents who require some nursing care but for whom healthcare is not a primary need. Local Health Boards had interpreted what they would pay for following a survey which asked nurses to record and categorise the time they spent on different tasks: direct and indirect nursing care time, non-nursing care time and other time (which included stand-by time, paid breaks and time receiving supervision). The Boards then developed a flat weekly rate based on some of these activities but would not cover the costs for all.  This was challenged by 11 care providers and all (but one) Welsh LA.  The Supreme Court ruled Health Boards should fund all the services provided by a registered nurse.  Giving judgement, Lady Hale said that the provision of an overall, holistic, person-centred plan for each resident who needs some nursing care requires the nurse to engage in social and personal tasks as part of that care and that some caring tasks could not sensibly be parceled up between nursing and non-nursing care. 

In brief:

  • SCIE Associate and Social care and health policy consultant, Richard Humphries has published a blog on the Department of Health site, which considers the pressures on hospitals and the social care system, “…focusing simply on getting the numbers down creates a real risk of hitting the target but missing the point – how to ensure people get the right care, in the right place, at the right time.” He believes now is the time to open up discussion on the benefits of intermediate care.

  • NHS Digital has published The Personal Social Services Survey of Adult Carers in England 2016-17, a survey of over 55,000 carers. It found that: 21% of carers surveyed have been providing unpaid care for over 20 years; 90% of carers aged 85 and over (22,100) have a caring responsibility for someone aged 75 or over;  71% of carers were extremely, very or quite satisfied with the support or services they received; Of all carers, 76% report ‘feeling tired’ and 64% report they experienced ‘disturbed sleep’ as a result of their caring role; 40% of carers who reported the most serious financial difficulties also felt socially isolated. 

  • The Care and Support Alliance (CSA) has appointed Caroline Abrahams, Charity Director of Age UK, and Mark Lever, Chief Executive of The National Autistic Society, as co-chairs. They replace Vicky McDermott, Chief Executive of Papworth Trust who is leaving the adult social care sector.

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Third Sector

Fundraising and donations

  • Research published by the Institute of Fundraising, has found that women are more likely to donate to charity than men, with 54% of women saying they had given to a charity collection in the past 12 months, compared with 40% of men. The survey of 2,000 people also suggests women engage with voluntary organisations on a deeper level than men, and were also more likely to sponsor someone for charity, donate goods, make regular monthly gifts and volunteer. The only area where men showed greater support was in the sum donated, with an average gift of £29 compared with £23 by women. The institute said there was no single reason why women said they engaged more with charities but the results should prompt voluntary organisations to rethink how they target men in their campaigns.

  • Marketing emails from charities are less likely to be opened than emails from any other sector, according to research from the Direct Marketing Association (DMA). The DMA’s Email Benchmarking Report 2017 found that 14% of marketing emails were opened, but that only 1.6% of people clicked on a link in the email in 2016 - down from 1.8% the previous year. The report looked at more than 37 billion emails from DMA members across 2016 and found that the top three most opened emails were from organisations in the travel sector (21%), utilities sector (15%) and retail (15%). Charity emails were the least likely to be opened compared to any other sector, with only 6% of emails being read - behind publishing (8%) and finance (10%). However the charity sector was the sector most likely to send emails which actually reached a recipient, with a delivery rate of 99%, compared with the average of 98%. The report said high delivery rates suggested the organisations had up-to-date mailing lists and used best practice to produce clean data.  

  • A report from fundraising think tank RogareRelationship Fundraising: Where Do We Go From Here? Breaking Down the Barriers, suggests there is not enough support within the sector for relationship-based fundraising. Relationship fundraising can be broadly defined as fundraising that is based around a long-term, sustained relationship with regular donors, rather than trying to persuade people to give one-off donations each time they're asked.  The report identifies a range of what it describes as cultural issues, such as a "lack of support from board and senior management" and a failure to invest. It also says there is reluctance to spend money on relationship fundraising because of public pressure to keep administration and fundraising costs low.  It suggests that part of the solution, is to ensure that information about relationship best practice and research is widely available and that fundraiser success is measured not just by financial metrics but also by how satisfied donors are. Rogare will be developing a set of metrics by which to gauge the success of relationship fundraising and establish an award for best use of relationship fundraising.

    MHA comments: We are interested in the idea of set of metrics to gauge the success of relationship fundraising, which are potentially more sophiscated than simply the amount raised.

  • The Church of England has chosen 40 churches around the UK to trial contactless payment alongside the traditional collection plate. The churches will be equipped with the contactless payment devices to accept payments of less than £30, and will use them to take donations and collections as well as payments for things such as hall hire. The trial, announced last month, is expected to start in the autumn and run until the end of the year, with full roll-out to all dioceses expected to happen in 2018.

In Brief:

  • Figures from the Fundraising Regulator show there have been over 6,300 requests to block communications in its first month, although more than 4,000 of those came in the six days after its launch.  

  • The House of Commons Library have published a round up of statistics on the size, income and activities of the charity and voluntary sector. It includes data on social investment, National Lottery funding, charitable giving and rates of informal and formal volunteering. 

  • Also see the Government section on Charities and Voluntary Sector for more news.

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Workforce and Skills

Nursing and language

  • The BBC has reported on the experience of Polina Ralutin, an experienced nurse from the Philippines, looking to become a nurse in the UK. The process involves passing the IELTs exam to test her knowledge of the English language. But she was surprised to find she had to analyse a text on jam-making for the exam. She told the BBC's World Tonight programme "I had to look at a diagram of the process and describe how to make it - there was a time limit, and it was very difficult to achieve in almost perfect English - how to make jam." Polina passed the exam, but she knows several other nurses who failed, and she believes the test is too difficult.  The Nursing and Midwifery Council is looking at whether a different type of test might be required.  CEO Jackie Smith says: "We are working with organisations and agencies and asking them what they think might be a viable alternative. We will put that back to the council to see if that is something that could be offered without compromising public protection."

    MHA comments: Our Teaching Care Home project is working on the same challenge relating to the IELTs exam and how best to support some of carers who are qualified nurses from overseas to become registered in the UK. 

In Brief:

  • A systematic review from What Works Wellbeing reveals that teams who spend time bonding as a group have higher wellbeing and perform better.  Successful examples of team activities found: involved everyone – including people who might be reluctant to interact in shared activities; had more than a one-off activity and carried on over time – examples ranged from as few as three one-hour workshops to a more extensive programme delivered over several years; and had input from someone external to each work group. Outsiders often offer fresh perspectives on issues, bring new skills and experiences. The study found that it doesn’t have to be a big or complex activity to bring benefits. Simply spending time on a shared project, like mentoring programmes, action planning groups, social events or workshops, all were shown to have positive effects.

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Look Ahead: September and beyond

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

  • Summer: National Audit Office – CQC Value For Money study expected
  • 8 Sept: Citizenship and Civic Engagement Committee, call for evidence deadline
  • 14 Sept - 9 Oct: Parliamentary recess (Party Conferences)
  • 16-19 Sept: Liberal Democrats Party Conference
  • 19 Sept: Tackling unfair practices in the leasehold market, consultation deadline
  • 24-27 Sept: Labour Party Conference
  • 29 Sept: Services Fit for the Future, Quality and Governance in Health and Care in Wales - White Paper, consultation deadline
  • 1-4 Oct: Conservative Party Conference
  • 3 Oct: NICE - People's experience in adult social care services, consultation deadline
  • 16 Oct: Social Care Wales, Transforming care in the 21st century (workforce standards and profile), consultation deadline
  • 27 Oct: Migration Advisory Council, EEA-workers in the UK labour market, consultation deadline

Events

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

  • National Housing Federation Housing Exhibition, 19-21 September, Birmingham, FREE. This year's Housing Exhibition explores nine themed areas over two days in our two seminar theatres, including: Asset management, maintenance and repairs; Housing finance; Housebuilders and developers; Digital and technology; Social innovation and community development; Advisory, consultancy and legal; Transformation and change management; Recruitment and training; and Data and analytics. 

  • Brighton's fifth annual Older People’s Festival, 25 September. A range of events and entertainments in venues across the city.

  • The 4th National Conference of the Older People’s Diabetes Network (OPDN) 27 September, London, £25. Led by the network’s Clinical Lead Professor Alan Sinclair.  This event and network is for anybody working in, or with an interest in, the field of older people with diabetes.

  • Nursing after Brexit – Breakfast Briefing, 29 September 9am-12.30pm, London, £195+VAT. The NHS faces a potentially severe shortage of nurses. With Brexit fast approaching, what can you do to protect your service, your staff and your patients?  Hear what the potential fallout might be, and what you can do to future-proof your service. 

  • Wellbeing and Cost-effectiveness in Policy, 4 October, What Works Wellbeing, London, FREE.  This one-day course in partnership with LSE will offer new ways to measure the direct relationship between any policy or programme and its impact on people's wellbeing. It draws on fresh, practical thinking from Lord Gus O’Donnell, Professor Richard Layard and other leading policy and wellbeing experts.

  • Future of Commissioning, 11 October 2017, The King’s Fund, London £200(+VAT). This event aims to help understand how commissioning is changing. The move towards place-based systems of care in England will require commissioners to work in more collaborative and strategic ways when planning and commissioning services for their local areas. Developed in partnership with NHS Clinical Commissioners, this event aims to help prepare health and care commissioners for the changes that face them.

  • The Future of Older People's Housing, 19 October 2017, Housing and Care21, Birmingham, £50. The conference aims to provide an opportunity for debate, bridging the gap between those who deliver services on the front line and those who carry out the research that shapes and influences those services, creating an open environment for an exchange of ideas and expertise.

  • Fuller Working Lives: Supporting Older Employees in the Workplace, 8 November, London, £150. Hear from the Department for Work and Pensions on how to implement the Fuller Working Lives strategy, including best practice examples on enabling older employees to fulfil their roles to the fullest whilst ensuring they are supported through to retirement.

  • Shaping Tomorrow Care England Conference, 16 November 2017, 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.

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Some information sourced from DeHavilland

 
 

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