Policy News from MHA: December 2017

Welcome to MHA's December policy bulletin

 

The Government has made progress with Brexit, although has faced rebellion on its key Brexit Bill.  Meanwhile, the Government also announced it was dropping the care cap, introduced in the 2014 Care Act and made several announcements of proposed changes in the housing sector, particularly focussing on consumer redress.

Government: - Brexit Charity and Voluntary Sector -  Data Protection - Finance and Pensions - Local GovernmentHealth and Social Care - Housing - Workforce and Skills - Other

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

Ageing and wellbeing: - Wellbeing - Loneliness - Inequalities in Later LifeRetirement

Dementia:- World Dementia Council

Finance and pensions: - Older People's income - Inheritance -

Health and Social Care: - Funding (Social Care) - Local System Reviews - Quality - Voluntary Sector  -

Housing: - Housing choice - Renting in older age

Third Sector: - Fundraising - Governance - Volunteering

Workforce and skills: - Health workforce

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

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Brexit

  • The European Council has decided to allow Brexit negotiations to move to the second phase. Acting on the advice of the European Commission's Chief Negotiator Michel Barnier, the leaders of the EU27 have agreed that "sufficient progress" has been made on the three phase one issues of citizens' rights, the financial settlement, and the Irish border.  Talks are set to resume in February, where negotiators will focus on the transition period, the  future relationship between the UK and the EU, and issues surrounding trade.

  • The Government suffered a major legislative defeat after the House of Commons backed a rebel amendment demanding a vote on the final Brexit deal. Conservative MP Dominic Grieve proposed an amendment to require the final deal reached with the EU to be approved in statute passed by Parliament. Eleven Conservatives joined Labour, the SNP and the Liberal Democrats in voting for an amendment to the EU (Withdrawal) Bill, insisting Parliament has a full vote on the agreement. The vote resulted in 309 for to 305 against. However, MPs voted in favour of setting Brexit at 23:00 GMT on 29 March 2019 - with the caveat that ministers can change it if necessary.  The EU bill has now completed its committee stage, with the next stages resuming in January.

  • The EU Committee has published its report Brexit: Deal or no deal, outlining the potential impact on the UK of leaving the EU without a deal, and examining the feasibility of a transition period immediately post-Brexit. The report states that 'no deal' would not only be economically damaging, but would bring an abrupt end to cooperation between the UK and EU on issues such as counter terrorism, police and security and nuclear safeguards. It would also necessitate the imposition of controls at the Irish land border. The Committee agrees with the Government that concluding all aspects of the negotiations before March 2019 would be the best outcome, but notes that the overwhelming weight of evidence suggests that this will be impossible. The Committee concludes that enshrining the Article 50 deadline of 29 March 2019 in domestic law would 'not be in the national interest'. The Committee also questions whether a legally binding transition deal can be reached in time to prevent damage to the UK economy. The Committee notes that the only secure legal basis for transition may be to use one of the two options available under Article 50, either to extend UK membership of the EU for a time limited period, or to set a date later than March 2019 for withdrawal to take effect.  Meanwhile EU Chief Brexit Negotiator Michel Barnier has said the Brexit transition period must end in December 2020. 

  • In a hearing of the EU Committee, Exiting the EU Secretary David Davis stated that the Government has not carried out impact assessments of leaving the EU on the UK economy– contrary to previous statements, adding that the Government had produced a "sectoral analysis" of different industries but not a "forecast" of what would happen when the UK leaves the EU.

  • The Government has responded to the Health Select Committee report which investigated the impact of Brexit on the health and social care sector, as well as reciprocal health arrangements. It indicates that the Department of Health is working to ensure the best outcome for the health and social care system. All policy teams within the Department of Health have assessed the implications of the UK’s withdrawal from the EU on their area and those that will be affected are undergoing detailed implementation planning for all scenarios. In addition, the response confirms that the Secretary of State for Health is invited to attend the Exiting the European Union Cabinet Committee when a matter directly affecting health arises to ensure the health sector is properly represented. On the subject of EU citizens working in the UK, in health and social care it states that It has been, and remains, one of the Government’s first goals in the negotiations to ensure that EU citizens in the UK can carry on living their lives as before and that “We have a detailed understanding of how many internationally trained staff work in the NHS and in adult social care and we will ensure that this informs our plans for the workforce.”

Charity and Voluntary Sector

  • A report by the National Audit Office on National Lottery Funding for Good Causes says that income for good causes from the lottery rose by 2% to £1.5bn between 2009/10 and 2016/17, although Camelot shareholder profits rose by 122% to £71m over the same period. However, in the 12 months from 1 April 2016, income for good causes fell by 15% to £1.63bn at the same time as Lottery sales fell by 9% to £6.93bn, compared with the previous year and a further fall in sales and income for good causes in 2017-18. The report blames unpopular changes to lottery games, increased competition and a trend away from draw-based games, which provide higher returns for good causes. The Public Accounts Committee has subsequently announced an inquiry following the report.

  • The Government has responded to the House of Lords Select Committee on Charities’ report, which was published in March 2017. The Government welcomes many of the committee’s 43 recommendations but stops short of promising any substantive change. In the response, the Government has rejected calls  to consider compelling large companies to give time off to their employees to volunteer as charity trustees. The Committee also suggested amending the Social Value Act 2013, so that the Government requires public sector commissioners to "account for" rather than just "consider" social value offered by bidding organisations. But the response says there "is not likely to be an opportunity for legislative changes in the near future".   In response to the Committee’s recommendation that the Office for Civil Society should work with other departments and business leaders to develop a new initiative to promote trusteeship, the Government says it will "consider new opportunities to promote charity trusteeship, and in particular to encourage greater diversity". Dan Corry, CEO of New Philanthropy Capital, said "Warm words are not enough to support the charity sector to deliver the impact so desperately needed. Given the lack of action in this response, it is a mystery as to why it has taken more than half a year… The pressure is really on the new civil society strategy [expected in the new year]."

See the Third Sector section for more research news

Data Protection

  • The Data Protection Bill is progressing in the House of Lords. Concern has been raised ensuring the Government would be implementing the right to data protection in domestic law. Consequently an amendment has been agreed that specific reference is made for data to be processed lawfully, refer to the right to have personal data rectified and strengthen the language around standards for limitations. 

  • The National Data Guardian (NDG) has published the National Data Guardian for Health and Care 2017 report: Impact and Influence for patients and service users. The publication marks three years since Dame Fiona Caldicott was appointed as the first NDG, looks back over this first term of office and describes future priorities. It sets out a clear case for the independent advice and challenge the role provides to ensure that confidential data collected by the NHS and social care services is properly safeguarded and used appropriately to improve care. It also anticipates the NDG role being place on a statutory footing during this Parliament.

Finance and Pensions

  • The Work and Pensions Committee says Government should act now, through the Financial Claims and Guidance Bill, to ban pension cold calls and make people either take or expressly opt out of guidance before they can access their pension pot. Rt Hon Frank Field MP, Chair of the Committee, said: "Low saver engagement and high financial value makes pensions rich pickings for scammers offering fantastical returns or seemingly clever advice. The strongest weapon in the armoury against this is good advice and guidance - people just aren’t taking it.  Making guidance the default option combined with the ban on cold calling would be a simple but big step forward in consumer protection in the era of pension freedoms. The Government should use the Bill that has just arrived in the Commons to legislate to protect pensions now."

See the additional Finance and Pensions section for more research news

Local Government

  • The Government has published the provisional local government funding arrangements for 2018 to 2019 and has suggested that councils will now see two years of real terms increases in resources available over 2015 to 2020. Announcing the funding, Sajid Javid also indicated that the threshold for triggering an automatic local referendum was being increased from 2% to 3% of core council tax, coupled with a 3% additional "precept" permitted to authorities with social care responsibilities, will give councils freedom to raise council tax by up to 5.99% from April 2018 without a local referendum. However, the Local Government Association (LGA) said it would raise just £250m a year towards a funding gap expected to reach £5.8bn by 2020. In addition, the announcement also indicated that 10 new areas have been selected for business rates retention pilots (where LAs can retain 100% of business rates) in the 2018 to 2019, building on previous pilots originally launched in Liverpool, Greater Manchester, West Midlands, West of England, Cornwall and Greater London in April 2017, which will also continue into next year. In a bid to sharpen the incentives for councils to deliver more new homes, councils that fail to achieve housing growth above baseline will not receive any New Homes Bonus payments.  In response Lord Porter, Chairman of the LGA, said “Years of unprecedented central government funding cuts have left many councils beyond the point where council tax income can be expected to plug the growing funding gaps they face. Local government faces an overall funding gap of £5.8 billion by 2020. Only with fairer funding, new powers and fiscal freedoms over the next few years and beyond can councils ensure children and adults receive the care they deserve, desperately-needed homes are built and roads are maintained to high standards and other services are protected, such as maintaining our parks and green spaces and running children’s centres and libraries.” Niall Dickson, CEO of the NHS Confederation, which represents organisations across the healthcare system, said "This is another missed opportunity. Already there are nearly 1.2 million older people in England not receiving the basic care they need, and councils are struggling to pay for the care of adults with learning difficulties. Councils will be able to raise more money for social care with higher council taxes, but that is unlikely to prevent further cuts next year and falls short of what is needed. The National Living Wage, welcome though it is, has to be paid for and the pressures are enormous. A long-term solution which goes beyond temporary fixes is long overdue."

MHA comments: Local Government funding arrangements are of key interest in the wider social care debate. council tax increases are simply not going to provide the long term funding solution that is needed. 

Health and Social Care

  • The Government has confirmed its intention to scrap the £72k planned care cap, which was part of the Care Act 2014. The care cap, which was going to be implemented from 2020 and would have limited the amount that people in England would have to pay towards their social care costs. Health minister Jackie Doyle-Price confirmed plans for a new consultation on social care reform, saying that there would be “initial engagement over the coming months” which will shape the long-term reform of the sector and be set out in a green paper. Speaking in Parliament, she explained: “Once the Green Paper is published, it will be subject to a full public consultation. The Government recognise that there is broad agreement across Parliament that reform of social care is a priority, and we look forward to working with parliamentarians to hear a range of views. The Prime Minister has been clear that the consultation will include proposals to place a limit on the care costs that individuals face. To allow for fuller engagement and the development of the approach, and so that reforms to the care system and how it is paid for are considered in the round, we will not take forward the previous Governments plans to implement a cap on care costs in 2020.” Responding Barbara Keeley MP, Labour’s Shadow Cabinet Minister for Social Care, said: “In abandoning their pledge to cap care costs, the Government has left vulnerable people facing catastrophic costs for their care, while wasting £1m of taxpayers’ money on the Dilnot Review.”

MHA comments: The Green Paper, due in the summer, provides an opportunity to develop an innovative long term approach to the funding of social care. Cross-party agreement is essential to avoid the cycle of reviews and commissions and develop the fundamental change that the system needs.  

  • Speaking at a Communities and Local Government committee’s inquiry on Housing for Older People, Housing Minister Alok Sharma, said that the social care green paper will address issues around the housing needs of older people (Q236), as high quality housing is important for the health and wellbeing of older people, and that it could reduce the costs of health and social care. The green paper will look at the provision of housing and the “interdependence” of having good quality, fit for purpose housing in order to reduce the number of hospital admissions, and quickly get people back into their homes after a hospital stay.

MHA comments: We welcome the Minister's recognition of  the importance of the right housing in later life and the interdependencies between health, housing and wellbeing.

  • The Health Committee has resumed its inquiry into Sustainability and Transformation Plans (now Partnerships) which was cut short earlier this year by the general election. The inquiry is looking at: how effective have STPs been in joining up health and social care across their footprints, and in engaging parts of the system outside the acute healthcare sector, for example primary care, LAs public health, mental health and voluntary sector partners; and how effectively are they engaging local communities and their representatives; how will the development of STPs into Accountable Care Systems (ACSs) change the delivery of care in an area; what public engagement will be necessary to enable STPs/ACSs to succeed, and how should that engagement be undertaken. The closing date for written submissions is Friday 19 January 2018.

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

Housing

  • The Department for Communities and Local Government have announced major reforms to the leasehold system following a recent consultation. The proposals includes a ban on leaseholds for almost all new build homes and changes so that ground rents on long leases – for both houses and flats – are set to zero. The announcement does mention that the proposals will not apply to 'a few exceptional circumstances where leasehold is still needed – such as houses that have shared services or built on land with specific restrictions' - however it is not yet clear whether that would include retirement living schemes (see p.10 of the consultation document for a summary of issues relating to retirement housing.

MHA comments: We responded to this consultation, highlighting that leasehold arrangements are very common in retirement living schemes for older people, as they have additional costs, such as communal areas, age-friendly design and security features, which leasehold arrangements help to fund. While we support the Government’s intention to limit the sale of leasehold new-build houses to prevent some of the unacceptable practices that have been publicised, we emphasise the importance that any Government action in this area, should not inadvertently limit the ability to develop new retirement housing. 

  • The Government has announced plans to launch a single ombudsman for social and private sector housing. A consultation will be launched in the new year on a new Housing Ombudsman – a single, transparent and accountable body with a remit that covers the whole of the housing sector, including both private and social landlords and the providers of new build homes. Secretary of State for Communities and Local Government, Sajid Javid said he wanted to act because the present system had “all kinds of issues and inconsistencies” with a “confusing number of schemes in place and gaps in protection”. There are currently four organisations that can deal with housing complaints: the Housing Ombudsman, the Property Ombudsman, Ombudsman Services: Property, and the Property Redress Scheme. These overlapping schemes, however, do not provide full coverage of the potential issues that consumers might encounter, nor do they cover all parts of the market – particularly for private rental tenants or buyers of new private homes. Mr Javid also raised the issue of tenants whose landlords are charities, whose only recourse was to the Charity Commission, which does not specialise in housing issues. 

  • The Government has issued a positive interim response to the Law Commission’s report on Event Fees in the Leasehold Retirement Sector. The Housing and Planning Minister Alok Sharma MP has stated that his ‘officials are currently working with colleagues across government to align these recommendations and help ensure that they can be fully implemented’. A formal response is expected in the new year. 

  • In her interim report for the Independent Review of Building Regulations and Fire Safety, Dame Judith Hackitt has said that she has been "shocked" by some of the practices she has seen, “As the review has progressed, it has become clear that the whole system of regulation, covering what is written down and the way in which it is enacted in practice, is not fit for purpose, leaving room for those who want to take shortcuts to do so.” The report adds that “Changes to the regulatory regime will help, but on their own will not be sufficient unless we can change the culture away from one of doing the minimum required for compliance, to one of taking ownership and responsibility for delivering a safe system throughout the life cycle of a building.” A final report is expected in the spring.

  • The Planning (Scotland) Bill has been introduced to the Scottish Parliament, intended to strengthen the planning system and create a simpler, more effective system of development plans. The Bill sets out our proposed high level changes to the overall framework under which planning operates, although the detail of how the new provisions will work in practice will be contained within secondary legislation and guidance. 

  • See the additional Housing section for more research news

Workforce and Skills

  • The Scottish Government has published its National Health and Social Care Workforce Plan setting out how the Scottish Government, COSLA (which represents local councils) and social care partners will work together to develop new ways of recruiting nurses and care workers, and improve national and local workforce planning. Actions include: new models of care delivery – including care provided by small, self-managing teams in their localities (e.g. the Dutch ‘Buurtzorg’ neighbourhood care model is currently being trialled in Aberdeen); a national campaign to promote social care as a career choice; development of flexible training and education routes; and the roll-out of workforce planning tools. This is the second part of the National Health and Social Care Workforce Plan to be published, following recommendations for the NHS announced in 2017.

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

Other

  • The Welsh Government’s Health, Social Care and Sport Committee has published its report on loneliness and isolation, recommending that Welsh Government published its loneliness strategy before 2019 and takes a cross-departmental approach to maximise the contribution of all policy areas. It also recommends assessing the impact and value of intergenerational connections and that the Government works with the voluntary sector. Older People’s Commissioner for Wales, Sarah Rochira, said: “The findings… not only provide an important reminder of the scale of loneliness and the devastating impact it has on people’s lives, but also make clear the need for far more action, with strong leadership from the Welsh Government, to tackle this modern epidemic and major public health issue. I strongly welcome the Committee’s recommendations and their focus on ensuring a more joined-up approach – across government departments, our public services and the third sector – to prevent and tackle loneliness and isolation.”

  • Following the publication of the final report from the Jo Cox Commission on Loneliness, a new All Party Parliamentary Group (APPG) on loneliness will be launching in early 2018. 

  • First Secretary of State Damian Green has resigned after having been found to have breached the Ministerial Code due to "inaccurate and misleading" statements over what he knew about claims that inappropriate material was found on his office computer in 2008. A cabinet re-shuffle is underway.

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Ageing and wellbeing

Wellbeing

  • A blog by Katharine Orellana at the Institute of Gerontology and Social Care Workforce Research Unit at King’s College London, details her experiences of a research study into  the role and purpose of day centres for older people. Between 2014-17, she spent fifteen months collecting data at four generalist day centres for older people. This involved visiting several day centres, investigating what they offer, who uses them, why and how, what they contribute to the lives of those involved with them, how they are perceived and how they relate to health and social care services. Her findings suggest that the perception of an outdated service model, is unfounded and that they are ‘highly policy-relevant’. She found that day centres enhanced the quality of life of and made a unique contribution to their attenders’ lives. They provided what older people with high support needs have said they valued: social interaction, being able to make a contribution, control, independence, continuity, self-esteem, humour, mental health (including a sense of purpose), safety, getting out and about and physical activities. Thinking of the future, the study identified the potential for their development and optimisation to improve older people’s health and wellbeing, to support carers and to maximise the impact of health and social care services. An evidence briefing summarises the study’s findings, their relevance and implications for commissioners.

    MHA comments: This research will be of interest to our Live at Home schemes who provide similar co-created services to those of day centres.

  • A new study from Australia of care providers, children of care recipients and church members, born between 1946 and 1961, found that higher levels of spirituality appeared to reduce anxiety about ageing and improve health and wellbeing outcomes. However, levels of spirituality were not directly related to levels of religious affiliation. The study found that increased spirituality provided a buffer against adverse life events and resilience in concerns about future frailty, loss, and fears of dementia.

MHA comments: We understand the importance of spirituality in relation to ageing and just as important as physical and mental wellbeing, which is why spritiuality is a key element of all of our services, provided for free through our chaplaincy service, with 140 Chaplains who are a source of counsel, advice and guidance, for people of all faiths or none at all.

Loneliness

  • The final report from the Jo Cox Commission on Loneliness, Combatting loneliness - One Conversation at a Time: A Call to Action, has been published and calls on the Government to create a national strategy with a lead Minister to combat loneliness, as well as establishing a national indicator of loneliness, supported by annual report. It also calls for a programme to develop the evidence around ‘what works’ in tackling loneliness and an innovation fund to stimulate ideas and provide seed funding for communities. The report does acknowledge that Government action alone cannot solve the problem. "Tackling loneliness is a generational challenge that can only be met by concerted action by everyone - governments, employers, businesses, civil society organisations, families, communities and individuals all have a role to play.” The report's release coincided with the launch of three Royal Voluntary Service projects set to tackle loneliness and isolation in Mrs Cox's former constituency of Batley and Spen. The schemes - partly financed by the Jo Cox Fund set up in her memory, include lunch clubs, activities, and workshops as well as a new Community Connections befriending programme. The government said it welcomed the commission's work and tackling social isolation and loneliness is of "huge importance" and indicated that new initiatives will be announced next year.  A new All Party Parliamentary Group (APPG) on loneliness will be launching in early 2018 and a partnership between the British Red Cross and Co-operative Group will create a new Action Group to take forward the Commission’s work and recommendations, while another of the Commission’s partners, the Campaign to End Loneliness, will lead a public campaign.

MHA Comments: The Jo Cox Commission on Loneliness has successfully rasied the profile of the issue, over the past year and the final report offers opportunities for action, such as services that we provide through Live At Home. 

  • Lancaster University researchers are working on a €2.9m project exploring whether technology could be the key to tackling the UK’s loneliness epidemic by better connecting older adults with their communities. The project involves over 100 older adults across Europe to co-create apps and digital services to deal with complex social issues such as isolation, exclusion and access to services. The UK part of the Mobile Age project,  will inform policy for the EU and UK government around reducing social isolation and loneliness. As part of the project, a new app is being co-created initially in the South Lakeland area, to connect users to social opportunities available in their chosen area based on their preferences, as well as offering real-time information on factors that research suggests discourage older adults from venturing out – such as weather and levels of daylight. The app will also provide clear information on what the route is like, including its terrain, whether it’s walkable, transport services and toilet facilities along the way. Professor Niall Hayes said “Older adults are a largely untapped source of smart, sociable people but they are at risk of being excluded from the digital age as they often cannot access the information that others have at their fingertips. Rather than isolating them from the digital world, our research looks at co-creating something that works for them – opening up a brand new world of information that should create more social opportunities and a greater feeling of community… We are working with local charities, support services and the local council and anticipate that lessons learned in this project will help shape local digital services in the future.”

Inequalities in later life 

  • The Centre for Ageing Better have published a new report Inequalities in later life, which highlights huge disparities between groups of people in terms of health, financial security, social connections, and housing, with the negative impacts for those who are worse off accumulating as they grow older. The report identifies that older women in particular, are more vulnerable to financial difficulties than older men, with both their employment history and family circumstances impacting on pension income and the ability to save. People from BAME backgrounds and some from LGBT are also disproportionately disadvantaged. The review highlights that severe inequalities for older people are largely a product of poverty and disadvantage throughout life. Poor education and work opportunities, along with lack of social connection can have long term consequences, often made worse by factors such as reduced income in retirement and the impact of having many long-term health conditions. The Centre for Ageing Better suggest that Government policies and employers’ practises need to change to enable women to stay in or return to the labour market and this should mean increasing the quality, affordability and availability of childcare, and helping carers stay in work. In addition, state pension and auto-enrolment schemes should not penalise those without an uninterrupted, full time employment history.

  • New analysis from Age UK suggests older carers are providing nearly 54 million hours of care a week in England. In 2015/16, well over two million (2,299,200) people aged 65 and over provided care – a 16.6% increase on five years ago when the figure was 1,829,200. Over 400,000 of these unpaid carers are aged 80 and over and they provided 12.7 million hours of care in 2015/16 – a 12.7% increase from 2009/10. The report highlights that most older people willingly take on the task of helping to care for a loved one, however, leaving older people to shoulder too much, can also put these older family carers’ own health at risk, and many of them are coping with health problems themselves. In addition, nearly a third (29%) of informal carers aged 65+ are experiencing feelings of loneliness. Carers UK’s CEO Heléna Herklots CBE said: “Given the clear correlation between longer caring hours and loneliness, revealed by Carers UK’s own research as well as Age UK’s, we cannot afford to continue ignoring the issue of isolation which carries such a heightened risk of mental and physical ill-health. We know that regular breaks from caring make a significant difference to combatting this loneliness, yet access across the UK remains inadequate and patchy. The Government must couple any measures to address shortcomings in our social care system with tangible improvements to respite access.”

Retirement

  • A research report from ILC-UK, Exploring Retirement Transitions, looks at how increased longevity and population ageing are changing the way individuals move from work into retirement. In response to the challenge of fairness, access to various forms of flexible work is often seen as the key means for older people to continue working. However, according to new analysis in this report, access to flexible working opportunities may be exaggerated. Professor Sarah Vickerstaff, Professor of Work and Employment, Kent University  said: “In the popular imagination the process of retirement has changed dramatically, with the old cliff edge of retirement for men, working full-time and then just stopping, being a thing of the past, the evidence from the longitudinal data sets and the organisational case studies suggest access to flexible work or gradual retirement is untypical”.

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Dementia

In brief: 

  • Harry Johns, CEO of Alzheimer’s Association, has been elected as the new Chair of the World Dementia Council and Jeremy Hughes, CEO at Alzheimer’s Society, has been elected Vice Chair. They will begin their roles in Spring 2018, to lead the World Dementia Council’s mission to overcome barriers to research and innovation; to increase global investment in dementia; to improve treatment and care for people with dementia; and to meet the G8 Dementia Summit’s commitment to find a cure or disease-modifying medicine by 2025.

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Finance and pensions 

Older people's income 

  • The latest Pensioners’ Incomes Series (2015/16) from the Department of Work and Pensions has found that recently retired pensioners’ incomes have increased, with those over 75 receiving a lower income than those under 75 or recently retired – possibly a reflection of those under 75 still undertaking some form of employment. Single male pensioners had a higher average income than single female pensioners. Single pensioners in the North East and Wales had the lowest levels of average income relative to the UK average, while single pensioners in Scotland and the South East had the highest average incomes. Pensioner incomes amongst couples were lowest in Wales and the West Midlands and highest in the South East.

  • A study by the Organisation of Economic Co-operation and Development (OECD) suggests that the UK’s State Pension is the least generous of all the most advanced economies in the world. The report finds that the average pensioner can expect to receive just 29% of what they earned at work. Only South Africa – which isn’t a member of the OECD – is less generous. However, once “voluntary” pensions – such as auto enrolment or workplace pensions – are taken into account, the UK model fares better in comparison. When voluntary pensions are included, the average UK pensioner receives 62% of his or her working income. This is still lower than the OECD average of 69%. Pension systems in Japan, Germany, France, Italy, the United States, Canada, the Netherlands and Ireland all pay out a higher proportion of working income.  In response a spokesperson for the Department of Work and Pensions said that 11 million people will be saving into a workplace pension by 2018. “We have taken decisive action to address our changing population through a new, generous State Pension, retaining the triple lock and protecting the poorest through Pension Credit… but there’s always more to do.”

  • The latest ‘state of the nation’ UK Poverty 2017 from the Joseph Rowntree Foundation indicates that almost 400,000 more children and 300,000 more pensioners are now living in poverty than in 2012/13. The report examines how UK poverty has changed over the last 20 years for specific cohorts of people – on pensioner poverty in notes the success of reducing poverty among pensioners from 29% in 1996/97 to 13% in 2012/13. But goes on to say that a small part of this success has been reversed in the last few years, with pensioner poverty rising to 16% by 2015/16. In the past seven years for the poorest, both benefit income and private pension increases have tailed off, while housing costs have risen.

Inheritance

  • A new analytical report from the Resolution Foundation’s Intergenerational Commission, The Million Dollar Be-question: inheritances, gifts, and their implications for generational living standards, suggests that millennials (those born in the 80s and 90s) will enjoy the largest and most wide-reaching ‘inheritance boom’ of any post-war generation but it will be too late and too unequally shared to solve the generation’s current home ownership and wealth inequality challenges. The Foundation’s analysis finds that the large sums of wealth accumulated by older generations will provide a major boost to younger generations’ wealth accumulation and living standards in years to come. They predict that inheritances are set to more than double over the next two decades and peak in 2035, as the generally high-wealth baby boomers progress through old age. However, the Foundation notes that while inheritances and gifts have a large and important role to play in boosting the wealth of younger generations, they are not a silver bullet, because inheritances will be distributed unequally and arrive far too late in life. For millennials who can expect an inheritance, the Foundation estimates that the most common age at which millennials inherit will be 61. The Foundation also notes that depending on the funding system in place, social care costs could significantly reduce the amount of wealth bequeathed at the end of lives.

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

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Health and Social Care  

Funding - Social Care

  • New research from think tank Demos shows that more than 57% the public believe that the individual has greater responsibility than the State in meeting the costs of their care. Yet the research also reveals that there is a gap between citizens’ expectations and the realities of the preparations they will be able to make for their futures. 1 in 4 people believed that if they need care in the future they will receive these services free of charge, with a further 16% unsure of whether care is free or not. The research also found a lack of awareness is met with poor preparation for these potential costs – with just 41% of people reporting taking steps to prepare for believing they are saving “to a great extent” for the costs of care in later life. Demos found that the majority of people believe they will either ‘save-up’ or ‘down-size’ to a smaller property to cover the general costs of retirement and any care they might have to pay for, although focus groups revealed an aversion to the prospect of moving in late life. Demos’ polling and focus groups revealed support for a modest tax increase to help fund care in later life, but the majority did not want to see a wholly tax-funded care system, free at the point of need - although most were in favour of a safety net for the poorest and most vulnerable. Based on these findings, Demos recommends that Government consider: a co-payment approach which shares costs between the individual and state, but also one which enables individuals to better prepare and contribute to their portion of the costs; a series of measures to help working age and current older people prepare for paying for their care,, covering insurance and equity release options, with a strategy to work with the financial services sector to develop appropriate products; develop a comprehensive public awareness-raising programme, akin to the pensions auto-enrolment campaign, with a strong message about the limitations of the role of the state in social care funding and the ways in which individuals can prepare for these costs. Commenting, Demos Director Claudia Wood said: “It is interesting that while the public are more open to the prospect of having to take responsibility for retirement and care costs in later life, few still are making any effort to prepare financially. The Government cannot allow the public to remain poorly informed and complacent about their need for care when they get older, how much it will cost, and how much they will need to pay.”

  • Responses to a Freedom of Information (FOI) request by insurance company Royal London to LAs has revealed a postcode lottery of care, Royal London has revealed. They sent FOI requests to 150 LAs, of which 125 responded. The replies show a huge variation in both the amount councils will pay towards care home costs, and the extent to which people have to ‘haggle’ with their LA to get a good deal. Steve Webb, Director of Policy at Royal London said: “We have uncovered a disturbing patchwork of support for people needing residential care, which varies hugely depending on where you live. The most worrying variation is the extent to which residents are expected to haggle with the council in some parts of the country. Whilst responding to individual needs and circumstances sounds like a good thing, it is very likely that older people who have vocal family members to support them will be able to strike a better deal. Local authorities must be very careful to ensure that they do not take advantage of the poor bargaining power of vulnerable elderly people, leading them to accept the cheapest care provision rather than the most suitable”.

  • A judge has dismissed a judicial review brought by Care England against Essex County Council, which claimed the LA had breached its Care Act duties, challenging its decision setting the fee rates it would pay as too low. Care England argued that Essex council had fixed the fees it offered to providers under a new commissioning framework at a level “significantly below their costs of care”, contravening section 5 of the Care Act, which stipulates LAs must promote an efficient and effective care market and “have regard” to ensuring its sustainability. But in a judgement Mr Justice Lavender concluded that section 5 duties “cannot be viewed in isolation” from other pressures on local authorities’ resources. Professor Martin Green OBE, CEO of Care England said: “It is particularly disappointing that the judge hearing this case formed the view that the Councillor who made the decision had carried out a sufficient enough enquiry into the sustainability of the Essex care home market; when that enquiry was based not on the information that had been presented to him by Council officers, but on his own knowledge and assumptions. Despite the court’s ruling, Care England remains particularly concerned that the Council’s decision jeopardises the sustainability of the care home market in Essex”.

  • Independent Age has published what it considers to be the six key areas needed to deliver a social care funding solution for now and the future, including: demand, funding and responsibility, quality, integrated care, technology, and sustainability and value for money.

health staff graphicLocal System Reviews

  • The CQC has published its findings following local system reviews of Hartlepool and Manchester. This reports are part of 20 targeted reviews of LA areas looking specifically at how people move through the health and social care system, with a focus on how services work together. In Hartlepool, the review was generally positive and found that there was a strong commitment and a shared vision across local health and social care partners, including Hartlepool Borough Council and NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group, to serve the people of Hartlepool well. it found health and social care professionals were highly dedicated to supporting people using services, their family and carers.

  • In Manchester, they found that there was a sense of a true partnership between health and social care services, based on a period of time building relationships across the system, including voluntary, community and social enterprise agencies and leaders of both Manchester City Council and NHS Manchester Clinical Commissioning Group envisaged that the current challenges in health outcomes for Manchester would be addressed through the radical transformation in the integrated commissioning of care services. However, the system in Manchester has significant problems that must be addressed in the immediate future: People’s experiences of receiving services differed across the city; there were high numbers of emergency admissions to hospital; and once people were in hospital, they were more likely to remain there for longer than they should.

  • The CQC has also published its interim report on the first six local system reviews it has undertaken. The report identifies:
    • A strong commitment and enthusiasm from organisations and staff working across health and social care services, but there are too many examples of people not being treated in the right place, by the right person at the right time.
    • While in most systems, leaders were working well together, the focus on individual organisational drivers is distracting from the ability of the wider system to work effectively for the people it serves.
    • System-level leadership accountability is difficult to identify.
    • Although all areas have local Health and Wellbeing Boards their effectiveness as drivers of transformational change or forums to hold wider system oversight is variable.
    • Relationships between system partners play a major role in the coordination and delivery of joined up health and social care services that meet the needs of the local population. Without good relationships between system partners that work together to achieve positive outcomes for people who use services, outcomes for individuals, families and carers are significantly compromised.
    • Coordinating and aligning strategies at local, regional and national levels is required.
    • Planning for surges in demand which occur throughout the year, including winter must involve all partners within a system including social care, primary care, voluntary, community and social enterprise (VCSE) providers. 
    • People’s choice about their health and social care is limited in many of the systems we reviewed due to a shortage of capacity and range of options.
    • The availability of social care was a challenge in the areas we have visited, especially in nursing homes, specialist care homes (for example, care homes specialising in dementia care), and in domiciliary care.
    • Health and social care commissioners do not consistently have robust systems in place to be able to predict demand and proactively shape the structure of the market supply (planning for capacity, workforce and skill mix, quality, and innovation).
    • Workforce capacity was a major issue in all areas visited and the CQC were not assured of effective joint workforce strategies across systems in any of the areas to address this. While some local systems are working proactively to develop career pathways within the care sector, the competition from other sectors is making recruitment and retention of staff a significant challenge.
    “From our early findings we have concluded that without a system wide focus that brings together partners from across health, social care, VCSE and independent sectors it is challenging to provide people with safe, effective, compassionate, high-quality care across the health and social care system. The whole person approach to flow of people through the system is being overshadowed by the drive to meet individual organisational targets. With a narrow focus on achieving their individual metrics and targets the ability for organisations and staff to collaborate and provide joined up care and support for people is hindered. Where we saw systems working well together we found that people had a safer and more caring journey.”

  • The CQC have also announced eight additional areas that are to be reviewed between February and April 2018:  Bradford, Cumbria, Hampshire, Liverpool, Northamptonshire, Sheffield, Stockport, Wiltshire.

    MHA comments: Without recognition of the key, valuable role social providers bring to the overall local health and social care system and the need to develop a long term funding solution, it is unlikely that local systems will be able to consistently deliver joined up care and support.

Quality

  • The Health Foundation has published Some assembly required: implementing new models of care outlining case studies on improving care for patients at the end of their lives in Leeds, and for care home residents in Rushcliffe, Nottinghamshire. It captures experiences of those working on the vanguard sites of the new care models programme. The report sets out 10 lessons for making improvements across local health and care services for those patients who are in most need of joined up care and emphasises the value of local co-creation and testing of new care models.

  • A new report from the King’s Fund explores the experiences so far in 15 areas of England working on delivering Enhanced Health in Care Homes. It finds: •Enhanced health in care homes is realistically achievable in any area of England. A history of joint working between relevant organisations – NHS, care homes and LAs– is useful but not essential and, in some cases, significant results can be visible within a few months.
    •Better ways of measuring impact, including effects on care quality and quality of life, are needed. Care home residents should be involved in defining what 'good' co-ordination of care looks like.
    •Those in leadership roles need to constantly reinforce equal partnerships and avoid historical patterns of making decisions without consulting care homes, accepting lower access to health care for care home residents, or assuming that care home staff need additional training to enable co-ordinated care, but NHS staff do not.
    •Enhanced health in care homes requires skilled leadership. Networks and communities of practice are essential to support leaders at all levels and share learning.
    •More clarity is needed on expectations for access to health care for care home residents; resourcing enhanced health in care homes and understanding return on investment; and appropriate use of public funds to support training and information systems in independent care homes.

MHA comments: We welcome the findings around the need for equal partnership and proper access to and resourcing of healthcare for those in care homes. 

Voluntary Sector

  • A community interest company led by Sir Thomas Hughes-Hallett (a former CEO of Marie Curie), has been created called HelpForce, with the aim of doubling the number of volunteers in the NHS from 78,000 to 150,000by 2021. HelpForce will launch a five-year fundraising campaign in 2018 to generate £5m and is supported by the British Red Cross and the Royal Voluntary Service, along with NHS England and the professional services firm Deloitte. NHS England funding will support pilot programmes to develop and test new interventions involving volunteers in five NHS trusts. Sir Hughes-Hallett said "One of the commitments I have made to the unions is that this is about relieving staff and improving healthcare. It is absolutely not about saving money. Volunteers were rarely integrated into NHS strategies or service delivery plans, and this is a missed opportunity." He added that did not envisage HelpForce becoming a large national organisation but rather a catalyst for bringing together and scaling up best practice. HelpForce is also working with the King’s Fund to develop the HelpForce learning network, which will share examples of volunteering innovation in healthcare. 

In brief:

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Housingsmall building image

Housing choice

  • The NHBC Foundation have undertaken research looking at Moving insights from the over-55s: what homes do they buy? It investigated the reasons why the over-55s move and what types of homes they buy. A number of features were found to be particularly important to these purchasers, including reduced maintenance, low running costs and the availability of warranty. When they moved, although many households downsized (39%), many either same-sized (33%) or upsized (28%) in terms of the number of bedrooms they had. The study concludes that the over-55s should not be stereotyped as people who are winding down to retirement and universally inclined towards the idea of downsizing or moving to specialist housing. Many are active people, who are prepared to use their wealth to pay to move to a larger home that meets their aspirations for space and flexibility. For some, downsizing is a logical choice and it suggests more could be done, in terms of design, to make downsizing a choice of preference for those people who are interested in taking this step.

Renting in older age

  • Research by Scottish Widows, suggests 1 in 8 retired people in the UK, will be living in rental accommodation in 15 years, treble the current number. The study also found that 42% of the average retirement income will be spent on rent and the average renter planning to retire in 15 years’ time needs to save an additional £525 every month into their pension, some £6,300 a year, on top of current pension contributions, or work for an additional 5.1 years to cover growing rental costs in retirement. However, 67% of 50 to 64 year olds planning to rent in retirement have no plans to increase their pension contributions to cover this shortfall. Prospective renters, however would consider relocating for cheaper rent - 39% of those planning to rent in retirement would relocate, rising to 65% in London. Robert Cochran, retirement expert at Scottish Widows said, “Whilst some people may choose to rent later in life, we also need to ensure it’s a more sustainable, secure option for an ageing population, many of whom will have no choice. We’re therefore urging the Government to consider ways to refine the housing market to better suit older renters through options such as open ended tenancy, with predictable rents and protection.”

In brief:

  • The Law Commission has published its latest Programme of Law Reform with 14 projects including on Residential Leasehold and Unfair Terms in Leasehold, which look at ways to improve the way in which the law works for the citizen or businesses in these areas. 

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Third Sector 

Fundraising

  • New research from the Charity Commission and the Fundraising Regulator highlights the generosity of the British public at Christmas and suggests that younger people are savvier about the charities they donate to than other age groups. 44% of 18 – 24 year olds said that they would give up their smartphones for the month of December to raise £500 for a charity of their choice, compared with under a third of the rest of the population. They also intend to make the highest financial donation to charity this Christmas, with an average pledge of £31.29. This generosity is backed up by a strong awareness among that age group about the importance of making basic checks on a charity before giving, suggesting that young people are making informed choices about who they give to. Over half of young people said that they usually do checks on a charity before donating to them, compared with just 29% of over 75s.

  • The Fundraising Regulator has indicated that it will not produce another full report on complaints received by major fundraising charities until 2020.  The regulator and its predecessor, the Fundraising Standards Board, previously produced an annual complaints report each year. However, the regulator has said that it would be reviewing the content and purpose of the report in order to try to collect more useful data from participating charities. A new version of the complaints report, which would be published in the summer of 2020 and cover the 2019/20 financial year. The regulator said it would produce shorter interim reports in the meantime, using data from about 60 charities that spend the most on fundraising.

  • Stephen Dunmore, CEO of the Fundraising Regulator, will stand down in June 2018. Lord Grade, who has been chair of the regulator since November 2015, will continue in post until Christmas 2018, at which point it is expected he will step down.

Governance

  • The Charity Commission has is issued a safeguarding alert to charities as regulatory advice, following a number of serious incidents reported to the Commission, and recent public interest about accusations of harassment in the work place, including media reporting about some safeguarding incidents which have affected charity beneficiaries, charity workers or other persons coming into contact with charities. It highlights that the Commission’s recently updated safeguarding strategy makes clear that safeguarding should be a key governance priority for all charities, not just those working with groups traditionally considered at risk.

  • NCVO have launched a Charity Tax Commission to undertake a thorough review of the existing tax treatment of charities and the principles that underpin it, and to develop recommendations for change if it identifies gaps or inefficiencies. It has been 20 years since the Government last reviewed charity taxation and the voluntary sector has evolved significantly, with fundamental changes to the way charities operate and the role they play in society. Against this backdrop, the commission will conduct a thorough appraisal of existing charitable reliefs and make recommendations to ensure that charitable tax reliefs are producing the public benefits intended in the most effective way. The Treasury and HMRC will join the commission as observers. The findings and recommendations of the commission, which aims to complete its work within 18 months, will help inform the Inquiry into the Future of Civil Society chaired by Julia Unwin CBE, which is due to conclude in 2019.

Volunteering

  • The National Citizen Service (NCS) is for the first time generating more economic benefits for the country than it costs to run its programmes, according to a new evaluation report, undertaken by Kantar Public on behalf of the Office for Civil Society. It found that the NCS’s summer programme delivered total benefits of between £136.3m and £287.7m, compared with the programme’s total costs of £118.9m. The autumn programme in 2016 also performed well, delivering between £32.7m and £66.5m benefit against total costs of £22.6m. The latest evaluation follows reports by the National Audit Office and Public Accounts Committee, which found the cost of running the NCS was "unjustified", that the NCS Trust – which runs the programme – lacked transparency and that it was struggling to meet participation targets. 

See the Government Charity and Voluntary section for more policy news

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Workforce and Skills

Health workforce

  • Health Education England has published a draft workforce strategy Facing the facts, shaping the future: a draft health and care workforce strategy for England to 2027. It argues that the NHS needs radical action to improve working conditions, staff retention rates and become a model employer for staff. It sets out a range of measures to improve productivity, boost training and retention, open up new routes into nursing and prepare the future workforce for technological advances that are poised to transform modern medicine. Views are being sought on this draft strategy until 23 March 2018. 

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Look Ahead: January and beyond

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

  • 15 Jan: Scottish Government - Consultation on the Draft revised code of conduct for registered property factors, consultation closes

  • 18 Jan: Care Quality Commission - Consultation on registration fees, consultation closes

  • 23 Jan: Department of Local Government and Communities - Supported Housing Models (Sheltered Rent), consultation closes

  • 23 Jan: Department of Health - Regulation of Health Professionals, consultation closes

  • 30 Jan: APPG on Older People - Inquiry into human rights and older people, written submission deadline

  • 31 Jan: National Assembly for Wales - Inquiry into the cost of caring for an ageing population, written submission deadline

  • 31 Jan: Care Quality Commission - Business Impact on the use of and recent changes to adult social care guidance, consultation closes

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

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

  • Jan: Update to NHS Continuing Healthcare National Framework

  • Early 2018: Launch of the All Party Parliamentary Group on Loneliness

  • 8 - 20 Feb: Parliamentary Recess

Events

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

  • 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. 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 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.

  • NCVO Charity Regulation Conference 2018, Monday 5 February 2018, 9.30-17.00, London  £180 membership rate
    This event is a chance to for organisations to discuss compliance and legal issues in relation to charity regulation and governance, including speakers from the Charity Commission and the Fundraising Regulator.

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

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Some information sourced from DeHavilland

 
 

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