Policy News from MHA: July 2017

Welcome to MHA's July policy bulletin

 

Much of July has seen Parliament getting business underway, with elections for Select Committees taking place, ballots for Private Members Bills and some Bills launched and starting their legislative journey.  There have been some key announcements: the Department of Health announced measures to tackle delayed transfers of care and improve data security in the health and social care sectors; and the news from the Department for Work and Pensions with a confirmation of a rise in State Pension Age being brought forward.  Parliament is now in recess until 5 September, although the Government is still very much active dealing with Brexit and associated issues.

Government: - Brexit - Charity and Voluntary Sector - Health and Social Care - HousingWorkforce and Skills - Other -

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

Ageing and wellbeing: - Wellbeing - Loneliness Mental Health - Ageing Population -  Technology - Exercise -

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

Finance and pensions: - Pensions and retirement income

Health: - Strategy - Joint Working - Funding - Health Inequalities

Housing: - Older people's housing choice - Sheltered Housing -  

Social Care: - Need - Quality - Regulation - Local Government -

Third Sector: - Volunteering, giving and trust - Regulation

Workforce and skills: - Social CareNursing

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

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Brexit

  • The Government has launched the Repeal Bill - formally known as the European Union (Withdrawal) Bill, which will repeal the European Communities Act 1972 and is designed to convert all existing EU legislation into British law. These laws will then be subject to amendment by the UK Parliament at a later date, though it is currently unclear which parts the Government will seek to amend after Brexit and which aspects will be retained in full.  It also allows Parliament (and where appropriate, the devolved Governments) freedom to make any future changes to its laws. The Bill was introduced on 13 July along with a policy paper, providing information on the parts of law that will be affected including: Devolution; worker’s rights; environmental protections; and consumer protections.  The legislation could face a difficult journey through Parliament, with Labour, the Liberal Democrats, the Scottish and Welsh Governments expressing concern over the “sweeping delegated powers” Ministers might have. Labour has vowed to vote against the legislation unless serious changes are made to the proposals, while the SNP are insistent that powers repatriated from the EU must be devolved.

  • Home Secretary Amber Rudd has ordered a "detailed assessment" of the costs and benefits of EU migrants to the UK to help shape its plans on how to manage immigration after Brexit. The Migration Advisory Committee will look at the regional distribution of EU migration, which sectors are most reliant on it, and the role of seasonal workers. An Immigration Bill is expected in the autumn - but the business lobbying group the CBI said businesses "urgently" needed to know what this would look like, and the Liberal Democrats have said the study had been commissioned a year too late. The Committee is due to report in September 2018. Meanwhile, Immigration Minister, Brandon Lewis has announced that EU-UK free movement will end in March 2019 and be replaced by a new immigration system.

  • Brexit negotiations have also been continuing this month, with much speculation on whether the UK will need to pay an ‘exit bill’ when leaving the EU. The House of Commons Library has published a briefing paper examining the issue.

  • Meanwhile, Liberal Democrat Peer, Lord Oates has introduced a Private Members Bill, European Economic Area (EEA) Nationals (Indefinite Leave to Remain) Bill. This aims to amend the Immigration Act 1971 to grant indefinite leave to remain in the United Kingdom to all EEA nationals, their family members and extended family members who are resident in the United Kingdom on the date of exit from the EU. 

Charity and Voluntary Sector

  • A new House of Lords Committee, has been established on Citizenship and Civil Society Committee, chaired by Lord Hodgson of Astley Abbots, to consider citizenship and civic engagement. The Committee has also launched its first call for evidence, looking into the following (amongst other things): the meaning of citizenship and civic engagement in the 21st Century; the impact of current electoral law on political engagement; the state of citizenship education and the role that it plays in creating active citizens. The call for written evidence closes on 8 September.

See the Third Sector section for more news

Health and Social Care

  • The Government has announced new measures to support the NHS and local government to reduce delayed transfers of care. It includes:
    • Clarification of how the Integration and Better Care Fund Planning Requirements 2017-19 will operate.
    • Joint guidance on implementing trusted assessors.
    • A performance dashboard showing how local areas in England are performing against metrics across the NHS-social care interface including delayed discharges, with plans for Local Government to free up 2,500 hospital beds.
    •  Consider a review, in November, of 2018/19 allocations of the social care funding provided at Spring Budget 2017 for areas that are poorly performing.
    • The CQC have been commissioned to undertake 12 reviews of local areas (Birmingham, Bracknell Forest, Coventry, East Sussex, Halton, Hartlepool, Manchester, Oxfordshire, Plymouth, Stoke, Trafford and York) to consider how well they are working across the health and social care boundary. A further eight reviews will be commissioned based on the performance dashboard and informed by LA returns. These reviews will commence immediately with the majority complete by the end of November, with a view to identifying issues and driving rapid improvement.
    • A comprehensive sector-led support offer from NHS England, NHS Improvement, Local Government Association, Association of Directors of Adult Social Services and the Better Care Support Team to support reductions in delayed transfers of care to all areas.

MHA comments:  We will be seeking to contribute to some of the area reviews, especially in Birmingham and Coventry, as we are keen to highlight our concerns about poor commissioning practice, such as dynamic online purchasing systems, which are used with providers for them to bid for packages of care.  We find this to be totally unacceptable practice, in our view this cannot possibly provide high-quality person-centred care. 

  • The Government has also responded to the Health Select Committee inquiry into Planning for winter pressure in A&E departments. There were 27 conclusions and recommendations in the Health Select Committee’s report and for the most part the response defends the current ways in which the NHS prepares for winter, as part of its year-round operational resilience planning. On the topic of delayed transfers of care and capacity in adult social care, the Government refer to the funding that has been given to Local Authorities and to the measures recently introduced above.
  • The Government has agreed to adopt a set of data security standards for health and social care recommended by Dame Fiona Caldicott, the National Data Guardian and the Care Quality Commission. The commitments are among the key features of the Department of Health's Your Data: Better Security, Better Choice, Better Care, a response to Caldicott’s Review of Data Security, Consent and Opt-Outs, which was published in July 2016. The review focused on the security of IT systems in health and social care and whether people are sufficiently informed about how their data might be shared. Key points to note are: NHS Digital will work with the health and care community to redesign and update the Information Governance Toolkit to support and underpin the new standards. This will take account of the relative needs and expectations of different organisations when considering their data security capability; From November 2017, the CQC’s well-led inspection framework will include the importance of meeting the data security standards. This will be supported by information from the redesigned Information Governance Toolkit; The NHS Standard Contract 2017/18 will require organisations to implement the NDG review recommendations on data security; People will have the choice to opt out of sharing their data beyond their direct care, which will be applied across the health and social care system.

MHA comments:  While the key focus of this report is the NHS, the Department of Health have made it clear it is also aimed at social care providers, with key implications about data sharing. As a large care provider, it will be important for MHA to understand the implications of these new data security standards and responsibilities across our organisation.  This will help us to be ready for their inclusion in CQC inspection frameworks from November and the General Data Protection Regulations in May 2018.

  • Baroness Finlay of Llandaff has introduced an Access to Palliative Care Bill, a Private Members Bill to obligate clinical commissioning groups to ensure that persons in their area have access to specialist and generalist palliative care and appropriate support services.

  • Lord Warner has reintroduced his Private Members Bill to create a right to die at home.

  • The Welsh Government has published a Parliamentary Review interim report, calling for new models of care to be trialed across Wales. Frontline staff, the public, and other public and voluntary organisations will be asked to work together to develop new models of care, to help hospital, primary care, community health and social care providers to work more effectively together. The models will be developed to work in different settings such as urban and rural, and take account of Welsh language needs. The report makes further recommendations including the need for:
    * a step change in the way the health and social care systems adapts to the changing needs of the population
    * the people of Wales, staff, service users and carers to have greater influence on new models of care with clearer, shared roles and responsibilities
    * new skills and career paths for the health and social care workforce with a focus on continuous improvement
    * better use of technology and infrastructure to support quality and efficiency
    * streamlined governance, finance and accountability arrangements aligned for health and social care.
    The final report will be published in later 2017. 

See the Health and Social Care sections for more news

Housing

  • The Government has launched a consultation to look at a range of measures to tackle unfair and unreasonable abuses of leasehold; in particular the sale of new leasehold houses and onerous ground rents. It will also consider the rights of leaseholders and freeholders in terms of services charges and communal areas. The consultation closes on 19 September.

MHA comments: We support the Government's focus on responding to what appears to very dubious practice in new leasehold houses and ground rents. We will be responding to the consultation to highlight how leasehold works in retirement communities, where it serves a useful purpose concerning communal areas and shared responsibilities.

  • Labour MP, Karen Buck has launched a Homes (Fitness for Human Habitation and Liability for Housing Standards) Bill, to amend the Landlord and Tenant Act 1985 to require that residential rented accommodation is provided and maintained in a state of fitness for human habitation; to amend the Building Act 1984 to make changes to the liability for works on residential accommodation that do not comply with Building Regulations. The next reading will take place in January 2018. 

See the Housing section for more news

 

Workforce and Skills

  • The Government has announced that it has accepted the recommendations of the Cridland report and will raise the State Pension Age to 68 to be phased in between 2037 and 2039, rather than from 2044 as was originally proposed.  Those affected are currently between the ages of 39 and 47, born between 6 April 1970 and 5 April 1978.  The Government has also committed to regular reviews of the state pension age in the years ahead.  Labour said the move was "astonishing", given recent reports suggesting increases in life expectancy were beginning to stall, and long-standing health inequalities between different income groups and regions in retirement.  The SNP said it remained opposed to raising the pension age beyond 66 and reiterated its call for an independent pensions commission to be set up to look at "demographic differences across the UK". Dr Anna Dixon, Chief Executive of the Centre for Ageing Better said If people are to work for longer, urgent action is needed from Government and employers to make the labour market fit for purpose... Employers must introduce flexible working arrangements that allow people to balance these pressures... With the right action and support now, older workers can make a valuable contribution to the workplace and UK economy, and reap the personal benefits of working in later years, including being more financially secure and socially connected.”  

  • Matthew Taylor, Chair of the Independent Review of Employment Practices in the Modern Economy published his report, Good Work: The Taylor Review of Modern Working Practices, calling for an end to the “cash in hand economy”. The Review also recommends that:
    · Organisations which have a "controlling and supervisory" relationship with workers should pay a range of benefits.
    · A new category of worker should be created called a "dependent contractor", with extra protections and clearly distinct from those who are legitimately self-employed.
    · Ensure that people particularly in low paid sectors are not stuck at the living wage minimum or facing insecurity but can progress in their current and future work.
    · There should be a fair balance of rights and responsibilities, everyone should have a baseline of protection and there should be routes to enable progression at work.
    · Make the taxation of labour more consistent across employment forms while at the same time improving the rights and entitlements of self-employed people.
    · Greater transparency amongst organisations about their practices and that all workers are able to be engaged and heard.
    · A more proactive approach to workplace health. 

  • Stephanie Peacock MP, has introduced a Bill to make provision about employment conditions and workers' rights - although the full detail is yet unknown and the next reading is not until April 2018.

  • A National Living Wage (Extension to Young People) Bill has been introduced as a Private Members Bill by Holly Lynch MP. It proposes to extend the National Living Wage to people aged 18 to 24, although the next reading is not scheduled until July 2018. 

  • A Bill to make provision about leave and pay for employees whose children have died, has been introduced by Kevin Hollinrake. No detail is available at the moment, but the next reading will be in October 2017. 

  • A Bill to prohibit unpaid trial work periods in certain circumstances, has been introduced by Stewart Malcom McDonald. The next reading will be in March 2018, when more detail will be available. 

Other

  • The Freedom of Information (Extension) Bill is a Private Members Bill that has been launched by Andy Slaughter MP. It aims to make providers of social housing, local safeguarding children boards, Electoral Registration Officers, Returning Officers, and the Housing Ombudsman, public authorities for the purposes of the Freedom of Information Act 2000; to make information held by persons contracting with public authorities subject to the Freedom of Information Act 2000; and to extend the powers of the Information Commissioner.  Further detail has yet to be published, although the next reading is not until June 2018.

  • A Financial Guidance and Claims Bill has been launched to combine three financial advice bodies into one, and establish a new statutory body with responsibility for provision of debt advice, money guidance and pension guidance. 

  • Baroness Young of Hornsey has introduced a Modern Slavery (Transparency in Supply Chains) Private Members Bill, to make further provision for transparency in supply chains in respect of slavery and human trafficking.

  • The Scottish and Welsh Governments have entered into a “formal dispute” with the UK Government over its deal with the Northern Irish Democratic Unionist Party. In a letter to the Treasury from the devolved administrations in Scotland and Wales argue that the decision to bypass the Barnett Formula – the formal mechanism for establishing devolved financial settlements – “undermines and discredits” the system.

  • Sir Vince Cable has been selected as Liberal Democrat leader unopposed and as such took up post with immediate effect. In accepting the role, Sir Vince declared continuity with the Liberal Democrats offering a route away from Brexit, but said that Brexit should not be the sole focus of the party and that it should have a strong message on societal reforms and inequality as well. 

  • Confirmation of Select Committee chairs have been announced.  There have been no changes to the key Select Committee Chairs of interest to MHA:

    ·         Communities and Local Government - Clive Betts

    ·         Health – Dr Sarah Wollaston

    ·         Public Accounts – Meg Hillier

    ·         Public Administration and Constitutional Affairs – Bernard Jenkin

    ·         Work and Pensions – Frank Field

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Ageing and wellbeing

Wellbeing

  • The All Party Parliamentary Group on Arts, Health and Wellbeing has presented the findings of a two-year inquiry into the practice and research in the arts in health and social care. Creative Health: The Arts for Health and Wellbeing discusses the return on the investment that art can bring to health and social care services; how art can help meet major challenges presented by ageing, long-term conditions, loneliness and mental health; and that the arts can contribute to wellbeing and a longer, high-quality of life. It concludes that the arts can: help keep us well,aid our recovery and support longer lives better lived; help meet major challenges facing health and social care, such as ageing, long-term conditions, loneliness and mental health; and help save money in the health service and social care. It makes 10 recommendations that include: the establishment of a national strategic lead to support the advance of good practice, promote collaboration, coordinate and disseminate research and inform policy and delivery;  that the Secretaries of State for Culture, Media and Sport, Health, Education and Communities and Local Government develop and lead a cross-governmental strategy to support the delivery of health and wellbeing through the arts and culture; that commissioners at a national and local level appoint an individual with responsibility to develop policy in the area; that the arts should be incorporated on prescription into their commissioning plans; that the National Institute for Health and Care Excellence (NICE) regularly examines evidence as to the efficacy of the arts in benefiting health and where the evidence justifies it, include it in its guidance.

MHA comments: We submitted evidence to this Inquiry, championing our belief in the benefits of Music Therapy.  MHA is mentioned in the report in terms of our collaboration with Live Music Now and a recognition in terms of good architectural design of our care homes. We would like to see proven treatment like Music Therapy for people with dementia, available on prescription, so that more people can benefit.

  • New research from Arts Council England has explored the contribution public libraries make to a range of national and local policy areasIn the report, Stand by me: The contribution of public libraries to the well-being of older people, it found that libraries can contribute significantly to the well-being of older people. More than one in three people aged over 75 uses a public library and through case studies it has identified four key ways in which libraries support older people: helping people in old age live in their own homes for longer; organising high-quality enrichment and social activities, helping older people to learn skills and meet people; enabling social care providers to target the right people, while some have launched services which in their own right; and actively expanding the reach of their services for older people either by encouraging more people to visit a library or by taking library services out of the library to other settings, such as care homes and hospitals. Examples include Wakefield’s dementia friendly library which organises high-quality socialising activities and Kent’s digital independence service plays a role in delivering adult social care. 

  • The Centre for Ageing Better have launched an online resource to support the UK Network of Age-Friendly Communities, offering information, insight, guidance and a place to share innovative ways communities can respond to our ageing society. Over time, the platform will develop to include a range of resources including evidence reports, toolkits and training.  The network currently includes Belfast, Brighton and Hove, Bristol, Coventry, Derry City and Strabane, Glasgow, Isle of Wight, Leeds, Liverpool, London Borough of Lewisham, London Borough of Southwark, Manchester, Newcastle upon Tyne, Nottingham, Salford Scottish Older People’s Assembly, Sheffield, Stockport and Stoke-on-Trent.

  • The Manchester Institute for Collaborative Research on Ageing (MICRA) has published a new report The Golden Generation? Wellbeing and Inequalities in Later Life, focusing on the growing number of older people in Greater Manchester and how a coordinated strategic response can create age-friendly policies to improve experiences in later life. It argues that using the all-encompassing label ‘older people’ risks presenting those in later life as one large homogenous group, rather than a diverse range of people with greatly differing life experiences. It highlights that the diverse characteristics, such as belonging to a black and minority ethnic groups or the LGBT community, put some groups at a much higher risk of experiencing inequalities in later life. It goes on the discuss the Greater Manchester Ageing Hub as a policy response to the opportunities and challenges of an ageing population and as age-friendly model and framework for ensuring social inclusion in later life, with an emphasis on co-design with older people and improving the quality of later life.

  • Councils will now be able to tailor their services to residents’ needs by drawing on a wide-ranging set of data concerning ‘wellbeing’. Local Wellbeing Indicators, are made up of data on things like job quality, anxiety levels, social isolation, green space and how physically active people are. Currently, Local Authorities rely on traditional metrics, such as unemployment and material deprivation, to build an idea of their residents’ wellbeing.The new Indicators, developed by researchers at What Works Centre for Wellbeing and Happy City will give ‘a real-world set of measures for data that follows people’s quality of life from cradle to grave.'

  • Independent Age have published a report The Obstacle Course: Overcoming the Barriers to a Better Later Life, which presents evidence and case studies on some of the obstacles that need removing so older people and their carers can access the most basic services and support. The report covers health and social care, income, managing change and loneliness. The testimonies included reveal what a difference early intervention can make, as well as where things are going wrong. They conclude that the UK is still not responding well enough, for a rapidly ageing population and remains under-prepared.

  • Age UK have estimated that nearly five million older people have been targeted by scammers.  Of those targeted, just over a tenth (12%) have responded to a scam – with more single older people responding compared to those in couples. As well as marital status, age seems to play a key role, with the findings showing that slightly more people in the 75+ age group pay up or give personal or financial information to the scammers. Worryingly the findings show that two-thirds (64%) of those targeted by scammers didn’t report it to an official channel, with well over a third (36%) only confiding in friends and family, and more than a fifth (22%) admitting they didn’t tell anyone at all because they felt too embarrassed.  In addition to the consequence of serious financial losses, the evidence shows that being scammed can seriously affect quality of life and wellbeing. Older people can experience embarrassment, shame, depression, social isolation and a decline in physical health, with some people even losing their independence and becoming more in need of care.  The findings are published as part of Scams Awareness Month.

Loneliness

  • Janet Morrison, Chief Executive of Independent Age, has published a blog which outlines A Loneliness Manifesto, as part of the ambitions for the Jo Cox Commission on Loneliness. Although aimed at older people, she suggests some of the ideas could be used throughout life, no matter what age.  She poses ten ideas including a National Loneliness Prevention Strategy; a national ‘Acts of Kindness’ movement; building on current models such as Age Friendly Cities and Age Friendly Museums; Community based commissioning; and engaging local populations in co-production.
  • The BBC iWonder section of the website has a feature on loneliness, which explores what loneliness is and what you can do about it. It also includes a short quiz to check how you feel personally.

Mental Health

  • The Local Government Association has published a report Being mindful of mental health, which sets out the role councils play in supporting the mental wellbeing of their communities, including older people. It calls on Government to use the reform of any mental health legislation to prioritise mental wellbeing, the prevention of mental ill health and the delivery of ongoing support.

Ageing Population 

  • The Office for National Statistics (ONS) has published its latest data on population growth, Overview of the UK population: July 2017. In states that in 2016 the population of the UK was 65.5 million and is continuing to age older with 18% aged 65 and over and 2.4% aged 85 and over.  The data can be examined at Local Authority level using an interactive map.

  • New analysis from Sir Michael Marmot at University College London, has shown that increases in life expectancy have halved since 2010, suggesting improvements in health have also slowed due to the increase in prevalance of dementia and lifestyle-related diseases. Between 2000 and 2015, life expectancy at birth increased by one year every five years for women and by one year every 3.5 years for men. But this compares to one year every 10 years for women and one for every six for men post-2010. The report highlights significant gaps in life expectancy in different parts of the country- the longest life expectancy in the country was in the richest borough, Kensington and Chelsea: 83 for men and 86 for women. By contrast, the lowest life expectancy was in the North: Blackpool, 74 for men; Manchester, 79 for women. In a supporting blog to the report he writes "Given that we show a big increase in deaths with dementia written on the certificate, and given the growth in the number of people aged 85+, there will be an increase in the need for social care. With cuts in funding, it is likely that there are unmet needs. It is tempting to link policies of austerity since 2010 to the slowing in increase in life expectancy since 2010. So far, I have resisted that temptation. What I would conclude, though, is that less generous spending on social care and health will have adverse impacts on quality of life of the elderly. It is urgent to determine whether austerity also shortens lives." Also see new analysis from Public Health England regarding life expectancy changes.

  • The ONS has also reported that both marriage and divorce is on the rise in people aged 65 and over. The number of marriages went up by 46% in the between 2004 and 2014 and whilst divorce is in decline in England and Wales, older people are bucking the trend. In the same period, the number of men divorcing aged 65+ went up by 23% and the number of women of the same age divorcing increased by 38%. ONS surmise that these increases are likely to be because people are simply living longer. However a significant change to inheritance tax rules made in October 2007, which allowed married couples or those in civil partnerships to transfer their tax-free allowances between each other for the first time may also have influenced. Although they also suggest that older people are more connected, economically and socially, with many still in work, than before and technology developments such as online dating could be a factor.

Technology 

  • In a blog by the Carnegie Trust, Lyndsey Burton, founder of Choose, a UK broadband comparison site and information resource, considers the findings from Ofcom's annual Adults' Media Use And Attitudes report in June 2017.  While she acknowledges the increasing take up of older people using technology, she highlights that digital exclusion still exists, resulting in reduced access to services, loneliness and decreased well-being. Despite the progress that’s been made in recent years, it would be unwise to become complacent, and to think that the problems of digital exclusion for older people are being inevitably solved.” She highlights the reports findings that although 27% and 15% of over-75s now use a tablet or smartphone, 73% and 85% do not. Of the 4.8 million adults that the Office of National Statistics say “had never used the internet in 2017,” 2.6 million were aged 75 or older. “There are still significant tasks ahead of the UK if it wants to keep older people in touch with online public services.…[and] even if we do manage to connect everyone to the internet, digital exclusion will be far from fixed. The drive to get people online has to be accompanied by a drive to teach them the skills necessary to making the most of being online.”

  • The Guardian reports a story about the development of an app developed in the Netherlands that allows older people to control traffic lights. Noud Rommen has been piloting the app. To get to the local shops he has to walk 100 yards, but to get there, the 71-year-old with mobility problems must negotiate a six-lane dual carriageway with a short pedestrian crossing time. “If I stick to the rules I can only get to the island halfway across before it turns red, so I have to press the button and wait again. But nobody wants to do that, so you try to cut between the traffic. It’s not good, but that’s what happens.”  He is one of 10 people in the Dutch city of Tilburg trialling Crosswalk. A sensor in the lights constantly scans the pavement on either side of the junction, and if it “sees” Rommen waiting when the button is pressed it adjusts the green-light time. The app comes pre-installed with one of four time settings, depending on the user’s level of mobility, to minimise delays to other traffic. Dynniq, the Dutch company that develops intelligent traffic systems and is helping the city council with the trial, explains the app works in combination with GPS and the software that operates the traffic lights, so there is no need to install extra devices. 

Exercise 

  • An awarding winning project, Fit Villages has helped reduce rural isolation and increased physical activity among older people in Suffolk, following an 18-month study by the University of East Anglia. The project brings physical activity to villages with limited provision for people to be active or exercise regularly. According to the study, the impact on the lives and individuals and communities has reached far beyond their physical wellbeing. The report showed:Participant’s weekly physical activity levels doubled over a six month period; Time spent walking increased by thirty nine minutes a week over the same time period; and a decreased time spent sitting in a day by over thirty minutes.  Alongside their physical wellbeing participants also felt a stronger sense of community and met with friends more often. It is run by Suffolk Sport in partnership with Suffolk County Council and Sport England.   

  • Researchers at the University of Cambridge and the University of East Anglia (UEA) have found that owning or walking a dog is one of the most effective ways to beat decline in later-life physical activity. More than 3,000 older-adults participating in the study were asked if they owned a dog and if they walked one. They also wore a small electronic device that constantly measured their physical activity level over a seven-day period. The study found that those with a dog were active for 30 minutes longer a day on average, far more than the researchers were expecting.  Project lead Professor Andy Jones, from UEA's Norwich Medical School said “We were amazed to find that dog walkers were on average more physically active and spent less time sitting on the coldest, wettest, and darkest days than non-dog owners were on long, sunny, and warm summer days. The size of the difference we observed between these groups was much larger than we typically find for interventions such as group physical activity sessions that are often used to help people remain active.” 

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Dementia

Causes, treatment and prevention

  • New research, presented at the Alzheimer's Association International Conference and combining the work of 24 international experts, has suggested that one in three cases of dementia could be prevented if more people looked after their brain health throughout life.  It identifies nine key risk factors including (in descending order of greatest impact): mid-life hearing loss, failing to complete secondary education, smoking, depression, physical inactivity, social isolation, high blood pressure, obesity and type 2 diabetes. These - which are thought to be modifiable risk factors - add up to 35%. The other 65% of dementia risk is beyond the individual's control.  The risk factor of hearing loss in middle age can deny people a cognitively rich environment and lead to social isolation and depression, which are among other modifiable risk factors for dementia.  Failure to complete secondary education was another major risk factor, and the authors suggest that individuals who continue to learn throughout life are likely to build additional brain reserves.  The researchers say they did not have enough data to include dietary factors or alcohol in their calculations but believe both could be important.  Lead author Professor Gill Livingston, from University College London said “Although dementia is diagnosed in later life, the brain changes usually begin to develop years before, with risk factors for developing the disease occurring throughout life, not just in old age. We believe that a broader approach to prevention of dementia which reflects these changing risk factors will benefit our ageing societies and help to prevent the rising number of dementia cases globally.”

  • New research has highlighted the scarcity of evidence on the prognosis of dementia with Lewy bodies, the second most common cause of degenerative dementia, which affects 100,000 people in the UK. The disease differs from more commonly understood forms of dementia, affecting visual perception and spatial awareness and attention, rather than memory, as typically associated with other forms of dementia such as Alzheimer’s, yet research is comparatively scarce. Professor Clive Ballard, of the University of Exeter, a co-author on the research, said: “Dementia has a number of sub-types, but until now the majority of research has focussed on the progression of Alzheimer’s Disease. We need to understand the long-term health outcomes of dementia with Lewy bodies in order to support millions of patients worldwide, as well as physicians and the provision of health-care services. It also helps inform the need for society to support for people with dementia in the community.” The research paper reported evidence that the combination of symptoms of Lewy bodies is particularly distressing for carers, and also leads to a particularly poor quality of life for people with dementia with Lewy bodies. The paper concludes that dementia with Lewy Bodies carries a higher cost to the health service than other forms of dementia, because of increased or longer-term use of high-cost accommodation such as nursing homes, increased pharmacotherapy, and increased use of outpatient care, community services and informal help.

Care, support and wellbeing

  • A large-scale trial led by the University of Exeter, has found that cognitive rehabilitation leads to people with dementia making satisfying progress in areas that enable them to maintain their functioning and independence. Cognitive rehabilitation involves a therapist working with the person with dementia and a family/carer to identify issues where they would like to see improvements. Together, they set up to three goals, and the therapist helps to develop strategies to achieve these goals. For example, some participants wanted to find ways of staying independent, by learning or re-learning how to use household appliances or mobile phones. Some wanted to manage daily tasks better, and worked with therapists on developing strategies to prevent them burning their food when cooking meals. 

  • Hospitals in England and Wales have taken steps to improve their dementia care, with over two-thirds of carers rating care as excellent or very good. However staff said they are not always able to access specialist dementia support, especially out of hours. The National Dementia Audit found that three-quarters of carers said the person with dementia was treated with respect by hospital staff. In addition, it revealed that 96% of hospitals now have a training framework for dementia care, up from 23%, compared to 2011 and 94% per cent of hospitals have created dementia champions to lead change and support staff. At least a quarter of hospital beds are occupied by people with dementia. Jeremy Hughes, CEO of Alzheimer’s Society said: "The spread of dementia training frameworks and the introduction of dementia champions in hospitals are encouraging first steps in addressing the challenges of good dementia care for all hospital patients. But this audit also reveals how much still needs to be done, even in such basic areas of nutrition and hydration."

  • According to a study by the University of Hertfordshire, dementia awareness training on its own will not improve dementia care or outcomes for patients in hospitals. The research, funded by the Alzheimer’s Society, reviewed approaches to make hospital environments more dementia friendly. The report found that in addition to dementia awareness training, it is important for senior team members with specific expertise in dementia care to work closely with hospital staff to support the continued development of skills in this area and promote their use among patients. Greater recognition of the changes to staff roles and responsibilities when caring for patients with dementia, and a flexible approach - that can accommodate the known limitations of ward routines - is also necessary to meet the needs of patients with dementia.  Changes must be endorsed by senior management, to give staff permission and confidence to adapt practices to provide good dementia care. The report also found that strategies to help staff understand behaviour that challenges them as communication of an unmet need can encourage staff to take action to help reduce distress, as well as enable patients to be more independent. 

  • The British Deaf Association - Scotland has been awarded us £150k to set up the Transforming the Deaf Dementia Experience project, a new initiative to improve the quality of life and well-being of Deaf people living with dementia and their carers.  The project, funded over three years, will identify and work with Deaf people who have dementia and their carers, enabling them to share and receive information, knowledge and experiences about living with and managing dementia through British Sign Language (BSL). The project will create a toolkit for carers and families with ideas and tips on coping strategies and communication strategies. 

  • Dementia Adventure has been awarded almost £500k from the Big Lottery Fund to help people living with dementia to connect with the outdoors. Dementia Adventure delivers holidays, training, support and research to improve the lives of people living with dementia and their carers. This new grant will be used to grow their work across the UK, through their social licence model, that seeks to train other organisations to replicate the work of Dementia Adventure in their communities. Each organisation will be equipped with practical skills and confidence to deliver enjoyable outdoor activities for more people with dementia including animal assisted therapy, gardening and nature and park walks, which has shown this to be beneficial in reducing feelings of isolation and a decline in well-being. Over the next three years, Dementia Adventure will work in partnership with The Abbeyfield Society, Care Farming UK, the Conservation Volunteers, MHA and Provide CIC. 

MHA comments: We are delighted to be involved in this exciting project which aims to improve the quality of life for people with dementia and look forward to hearing about the positive outcomes and learning created from this innovative project from the services involved. Live At Home services in Bradford, Ellesmore Port, Leeds and five services in Hampshire are participating.

 

In Brief:

  • Alzheimer’s disease and dementia are the biggest cause of death among women, according to Public Health England's report, Health Profile for England which is an analysis of population health data. It suggests that while life expectancy has been steadily increasing more of those extra years are now spent in poor health. Women can expect to live nearly a quarter of their lives in ill-health and men a fifth. The causes of death have shifted since the turn of the century, the analysis found, with the rise in deaths from dementia and Alzheimer’s the most significant features – alongside declines in other diseases. Also see analysis from University College London on life expectancy.

  • More than 1.2 million people are expected to be living with dementia in England and Wales by 2040. Researchers from the University College London say the predicted rise in the prevalence of dementia is largely down to people living longer, but add that the figures also show that the risk of developing dementia for each age group is falling – a finding they say suggests that preventive strategies are having an impact. “The growth in numbers of cases of dementia is not as large as we once anticipated,” said Sara Ahmadi-Abhari, an epidemiologist and co-author of the research, “But, nonetheless, the growth in the number of people with dementia is substantial.” 

  • Care provider, Care UK have selected the Association for Dementia Studies at the University of Worcester, as its new partner to help it invest further in its provision of care for people living with dementia. The initial phase of the partnership sees an 18-month contract where the University of Worcester will undertake a comprehensive assessment of current services from which it will develop a training course to be rolled out across its 114 homes, using the expertise and latest research from the University.

  • National charity Sense, have published a report on loneliness and disability, Someone cares if I'm not there, which also includes a chapter on loneliness and dementia and includes case studies of people's experiences.  It has been published as part the campaign by the Jo Cox Commission on Loneliness.

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Finance and pensions 

Pensions and retirement income

  • A new report from the International Longevity Centre-UK, The Global Savings Gap, has been published which examines the pension systems of 30 high income countries and regions, measuring performance according to affordability, adequacy and intergenerational fairness. It finds that low investment returns and interest rates, sluggish economic and wage growth and the gradual decline of Defined Benefit schemes means those entering the workforce today will face a hostile economic environment in which to build their pension pots. This ultimately means people will need to put more away in savings to achieve an adequate retirement income. Key findings include: A reliance on public provision plus any current mandatory pension schemes will only be sufficient to deliver adequate retirement incomes in 3 out of the 30 countries and regions they explored; If people fail to save in the USA and UK, it projects that they will face an intergenerational gap in excess of $10k a year (over 20% of earnings). The report considers a number of possible policy solutions to address such intergenerational savings gaps, including raising private pension coverage and contributions; raising financial capability with mass market advice and sensible defaults; facilitating longer working lives, and reducing inequality of retirement outcomes.

  • A gay man has won a legal battle to provide his husband with equal pension rights in a landmark discrimination case at the Supreme Court. The unanimous judgment, which could benefit thousands of couples, will ensure that should John Walker die first, his partner will have access to an income of about £45k a year for life. He was represented by Lawyers for the human rights organisation Liberty, who argued that a same-sex husband should enjoy the same pension rights as a widow. Under current law, Walker’s husband would receive only about £1k a year. Delivering the judgment, Lord Kerr said “The salary paid to Mr Walker throughout his working life was precisely the same as that which would have been paid to a heterosexual man. There was no reason for the company to anticipate that it would not become liable to pay a survivor’s pension to his lawful spouse. To deny his partner access to the funds would amount to discrimination on the grounds of sexual orientation.  The Supreme Court has ruled that an exemption in the Equality Act – letting employers exclude same-sex partners from spousal benefits paid into pension funds before December 2005 – is discriminatory and breaches EU equality laws.

Also see the Government section on Workforce and skills for news on the State Pension Age

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Health  

Strategy

  • The Local Government Association (LGA) has decided to withdraw its support from the Better Care Fund (BCF) Planning Requirements, which were published on 3 July. This decision was taken because of what it considered unacceptable last minute revisions to the guidance which placed much greater emphasis on delayed transfers of care from hospitals, along with tougher targets on meeting reductions and the threat of funding being withheld in areas deemed to be “poorly performing”. They have published some BCF Frequently Asked Questions to explain their reasons for withdrawing support for Planning Requirements; what this means for councils and their local plans.  Although the LGA has not endorsed the Planning Requirements but says it remains firmly committed to supporting local areas to deliver the best outcomes for local people and will therefore continue to participate in the BCF planning and assurance process and in graduation planning, to ensure that the best interests of councils and local populations continue to be met. New President of the Association of Directors of Adult Social Services (ADASS), Margaret Willcox has been interviewed by the Guardian on the subject.

  • NHS England has announced a new set of performance targets for the ambulance service which will apply to all 999 calls. The new targets aim to save more lives and remove “hidden” and long waits suffered by millions of patients, including reducing lengthy waits for frail older people. Call handlers will change the way they assess cases and will have slightly more time to decide the most appropriate clinical response. As a result cardiac arrest patients can be identified quicker than ever before, with evidence showing this could save up to 250 lives every year. The redesigned system will focus on ensuring patients get rapid life-changing care for conditions such as stroke rather than simply “stopping the clock”. Currently one in four patients who need hospital treatment – more than a million people each year – undergo a “hidden wait” after the existing 8 minute target is met because the vehicle despatched, a bike or a car, cannot transport them to A&E. The new system is backed by the Association of Ambulance Chief Executives, the Royal College of Emergency Medicine, the Stroke Association and the British Heart Foundation amongst others. 

Joint working

  • The Local Government Association (LGA) has conducted a survey of councillors (81 responded) concerning Sustainability and Transformation Plans (STPs). Key findings suggest: Not a single respondent had reported that their full council had been “very engaged” in their STP; While more than 90% of responding councillors know about STPs, just 21% said they felt sufficiently engaged in their STPs; Less than 25% of responding councillors are confident that their STP would deliver on its objectives or bring benefits to their local communities. The LGA is calling for the NHS to act now to involve councillors as equal partners in STPs.  It says that STPs should be more democratically accountable through local health and wellbeing boards, which should also be given a legal duty to sign off the plans. Chair of the LGA’s Community Wellbeing Board, Cllr Izzi Seccombe, said “If local politicians and communities are not engaged then we have serious doubt over whether STPs will deliver on their objectives and bring benefits to communities… For STPs to work, they need to be a genuine partnership between clinical, professional and political leaders, driving forward the change of local health and care for the better.”

  • Recognition of the voluntary, community and social enterprise sector’s potential in health and social care is vital but still limited, a new report finds. While there are examples of positive local partnerships, the difference that these organisations can make is not consistently understood. The report calls for health and social care commissioners to focus on co-design of services and says that guidance available from the NHS should be re-worked to reflect this. The report is a one-year update from an NHS-backed review which found that people in England face significant health inequalities which voluntary organisations help address in often innovative ways. The VCSE Health Review was the largest ever review of the voluntary sector’s involvement in statutory health, wellbeing and care outcomes. The report also raised concerns that most Sustainability and Transformation Plans (STPs) are not being produced in cooperation with local voluntary organisations.

    MHA comments: We welcome both the LGA survey findings and the VSCE Health Review update as it chimes with our experience in the challenge for third sector providers to get involved in these really important transformation plans.  

  • A major study led by the University of Hertfordshire has found that healthcare provision to residents in care homes across England is often ‘erratic and inequitable’.  The Optimal Study found that a narrow focus by NHS decision makers on care homes as a drain on resources, rather than as a solution, resulting in short-term interventions that compromise relationships between NHS and care home staff, and affect care home staff confidence in being able to meet residents’ health needs. The study, which involved seven UK universities,  did also identify several examples of successful partnership working between NHS and care homes. A video involving participants is available here.

  • A report conducted by the Professional Record Standards Body (PRSB) has found that care homes need better digital information sharing following hospital discharge. According to the survey of more than 260 care home respondents, care home workers needed better handovers to care homes, better planning by hospitals ahead of discharge, higher quality discharge summary information and appropriate discharge times for their service users. Ian Turner, PRSB advisory board member and chair of the Registered Nursing Home Association, said: “For those living in care homes, hospital visits and other temporary changes to care can be unsettling. By ensuring that correct care and medication information is shared between relevant professionals, we can make the process of transfer safer and more comfortable for the service user.” The survey, commissioned by NHS Digital, found that care homes reported differences in receipt of discharge summaries, with 27% not receiving summaries.

  • A new report from Localis  has argued the integration agenda should not be held back by issues of funding, something which the Government should address in the forthcoming social care green paper.  Rebooting Health and Social Care Integration - An agenda for more person centred care, suggests that integration should be focused on giving greater independence and control to all people receiving care, including a dramatic expansion in the usage of NHS Personal Health Budgets. 

Funding

  • Health Secretary Jeremy Hunt and NHS England CEO Simon Stevens have announced £325m of capital investment for local projects aiming to help the NHS to modernise and transform care for patients. Local capital investment schemes in 15 areas of the country have been given the go ahead and examples include: in Greater Manchester, hospitals will deliver significant improvements in urgent and emergency care by concentrating services in four hub sites across the city, expected to save around 300 lives each year in general surgery alone; in Bedfordshire local doctors and nurses are developing a primary care hub on the site of Bedford Hospital, which is expected to improve access to same-day appointments for around 50,000 patients and reduce the number of patients attending the hospital’s A&E department unnecessarily; in Derbyshire an ‘Urgent Care Village’ will be created at the Royal Derby with GP services, a frailty clinic and mental health services, to ensure patients receive the right care in the right place, first time, and avoid going to A&E unnecessarily.  The funding was originally announced in the Spring Budget in March. 

  • The National Audit Office has published findings of its investigation into NHS continuing healthcare (CHC). CHC is a package of care provided outside of hospital that is arranged and funded solely by the NHS for individuals who have significant ongoing health care needs.  The number of people assessed as eligible for CHC funding has been growing by an average of 6.4% a year over the last four years.  Key findings from the investigation include: In most cases eligibility decisions should be made within 28 days but many people are waiting longer. In 2015-16, almost 25,000 assessments took longer than 28 days; There is significant variation between CCGs in both the number and proportion of people assessed as eligible for CHC. In 2015-16, the number of people that received, or were assessed as eligible for, funding ranged from 28 to 356 people per 50,000 population. There are limited assurance processes in place to ensure that eligibility decisions are consistent, both between and within CCGs;There is a shortage of data on CHC, which makes it difficult to know whether eligibility decisions are being made fairly and consistently; Between 2011-12 and 2015-16, the number of people that received, or were assessed as eligible for, CHC funding during the year increased from 125,000 to 160,000 and spending increased by 16% and in 2015-16; NHS England estimates that spending on CHC, NHS-funded nursing care and assessment costs will increase from £3,607m in 2015-16 to £5,247m in 2020-21. However, NHS England wants CCGs to make £855m of savings on CHC and NHS-funded nursing care by 2020-21 on its prediction of growth. The plan is to do this by reducing both administrative assessment costs and the overall cost of care through reducing variation in spending, and ensure that CCGs interpret the eligibility criteria more consistently.

    MHA comments: We welcome this investigation into CHC funding.  We are concerned about how individual CCGs are approaching the use of CHC funded care. A number of our care homes have identified issues with both access to CHC funded care for new residents who need it and reviews of existing CHC funded packages.

  • NHS Providers has warned that the health service needs an extra £350m in order to cope with the pressure of winter. Its Winter Warning report draws on a survey of members who say only a fraction of the £1bn tranche of extra funding provided in the March budget to help free up hospital beds is reaching the NHS. The report states “Our member survey shows that only 28% of trusts have been able to secure a commitment from their local authority that the extra social care funding will be spent in a way that directly reduces delayed transfers of care (DTOCs) and frees up NHS capacity.” 

  • Postcode rationing is on the rise as Clinical Commissioning Groups (CCGs) struggle to balance their books, according to an investigation by The British Medical Journal. The investigation, which draws on Freedom of Information data from 169 CCGs in England, reveals a recent surge in the number of individual funding requests (IFRs) submitted by doctors for treatments that are no longer routinely funded locally. The data show that the overall number of IFRs received by CCGs in England has increased by 47% in the past four years and requests over the past 12 months alone have gone up by more than 20% from 60,400 to 73,900, suggesting that CCGs are under increasing financial pressure. There is substantial variation around the country, but the types of treatment being restricted include cataract removal, hip and knee replacements, and mental health care. 

Health inequalities

  • Public Health England (PHE) has published the Health Profile for England, which analyses a wealth of population health data to give an overall picture of the health of England. It finds that people are living longer than ever – life expectancy in England has now reached 79.5 years for males and 83.1 years for females. However, much of the extra time is spent in poor health and there are major health inequalities between different population groups. In the richest areas, people enjoy nearly 20 more years in good health than people in the poorest areas.  Some of the report’s more notable findings include: diabetes makes the top 10 causes of ill-health and disability (morbidity) for the first time; the two biggest risk factors behind levels of ill health are excess weight and high blood sugar; lower back and neck pain are the biggest causes of ill health; while deaths from heart disease and stroke have halved since 2001, it’s still the biggest killer of men; the biggest killers for women are Alzheimer’s disease and dementia.  Duncan Selbie, CEO of PHE said “Good public health is not defined by health policy alone. Our health profiles show a high-quality education, a well-designed and warm home, a good job and a community to belong to are just as important. The more we consider the impact of all policies on population health, the sooner we can focus on preventing poor health instead of only dealing with its consequences, especially for those from the most deprived communities.  Also see analysis from University College London on life expectancy.

In brief:

  • The UK has been rated first out of 11 countries in a report comparing international healthcare systems by the Commonwealth Fund. The report compared the UK to healthcare systems in the US, Switzerland, Sweden, France, Germany, the Netherlands, Canada, New Zealand, Norway and Australia. The Commonwealth Fund’s report ranks the UK first overall and first for care process (prevention, safe care, coordination, and patient engagement) and equity (comparison of performance for higher- and lower-income individuals). The UK also scores highly in terms of getting value out of the money the tax payer puts in. However, whilst the UK comes first overall, there is room for improvement in health care outcomes. Commenting the Nuffield Trust said “These results provide only a partial view of health care quality and how patients and physicians answer the questions may be affected by their own experiences and expectations; which are likely to differ across countries, cultures and population groups. For example, if the British are generally positive about their health care system and have lower expectations than say the Norwegians, the UK system will score better.” 

  • The latest official NHS performance figures show that in May, hospital-based A&E units in England treated just 84.6% of patients within their four-hour target time, despite a requirement to treat 95% within that time. This was down on both the previous month (85.7%) and May last year (85.4%). 

  • The Innovate UK Blog has published an essay on Predictions: Future of Healthcare.  Which has examples of their predictions include: Health scanning and data will start before birth, scanning will take place in the womb which will create a basic profile of a person’s health and create treatment plans from the very start, taking into account predisposition to certain diseases and how to manage conditions; Going to the doctors will be radically different. Medical scanning will be efficient and simple – with a full body scan akin to walking through an x-ray machine at the airport; or even a breath sample will be enough to detect illnesses, which will free up a doctor’s time to focus where it is needed most; Even a trip to the hospital will become more automated, with robots transporting patients, while algorithms and AI will be used to diagnose and treat patients, freeing up doctors and nurses to spend more time with patients one-on-one; Gene editing and nano-technologies will create massive shifts in both treatment and recovery time, from re-growing limbs to treating dementia and cancer.

  • See also the Government section on Health and Social Care

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Housing

Older people's housing choicesmall building image

  • Law firm Irwin Mitchell has found that less than 10% of Local Authorities have both an older persons’ housing planning policy and allocated development sites for such housing despite an ageing population. The firm examined the current and emerging local plans of the 329 Local Authorities in the UK to look for policies on retirement housing and care homes. Carl Dyer, head of planning at Irwin Mitchell said “Our population is ageing - this is a well-known and documented phenomenon happening slowly and over an extended time period. It is exactly the sort of change which our planning system should be able to anticipate and plan for, but that is simply not happening.”

  • New research from the University of Sheffield School of Architecture invited older people to co-design housing projects, aiming to respond to a shortage of well-designed, high-quality, appropriate and attractive housing in the right place for this market. The Designing for Wellbeing in Environments for Later Life (DWELL) research project looked at the contribution design can make to ensuring mobility and wellbeing are at the heart of older people’s housing and neighbourhoods.  The research showed that the preferred models of housing that work for older people also work for everyone else, which would allow people to remain in one place throughout their life course. The preferred home has the ability to adapt to changing needs; has two-to-three bedrooms with lots of storage (for a lifetime’s possessions); space for buggies or charging mobility scooters; accessible bathrooms; and is supported by the ‘internet of things’. Access is step-free and there is access to a private open space.  Housing for older people needs to be close to shops, services and cultural facilities, and connect well to the public realm. The research also concluded that the current housing market models doesn’t work older people and the policy levers are ineffective. A wider diversity of players is needed in the market, and more subsidised housing must be built for those who have no choices. 

  • Lord Best, Chair of the All-Party Parliamentary Group (APPG) for Housing and Care for Older People has launched an inquiry into housing for older people in rural communities, because it believes older rural people suffer from both a lack of affordable housing, as well as access to social care, poor public transport and slow or non-existent broadband. The inquiry will bring together peers, MPs, housing providers and other rural organisations to consider recommendations to ensure that older people in rural areas can enjoy appropriate housing and access adequate care and support at home. The inquiry will report in April 2018.

Sheltered Housing

  • Research by Demos, entitled The Social Value of Sheltered Housing commissioned by Anchor, Hanover and Housing & Care 21, reports that the social value of sheltered housing is worth £486m a year.  It suggests that supported housing saves the NHS, emergency services and social care services at least: £300m per year from reduced length of in-patient hospital stays; £12.7m per year from preventing falls by residents of sheltered housing; £156.3m per year from prevention of falls which result in hip fractures; £17.8m per year from reduced loneliness.  The report highlights how sheltered housing presents a very effective resource to tackle the primary drivers of health and care costs among older people – namely poorly insulated houses, falls and loneliness. 

  • The National Housing Federation has launched a Local Economic Impact Calculator to help housing associations generate evidence of their economic contribution to local areas and is free, easy-to-use tool available to all members. 

  • The National Housing Federation commissioned Homeless Link to produce a new report, Statutory Protection for the Future Funding of Supported Housing, which explores current Government proposals on the future funding of supported and sheltered housing. It includes the setting up of a ring-fenced fund, from 2019, under the control of Local Authorities to replace Housing Benefit payments over and above Local Housing Allowance levels. Based on interviews and discussions with Local Authorities, housing practitioners and other stakeholders the report concludes that if the proposals go ahead: there should be statutory enactment and distribution of the ring-fenced fund to ensure that the fund is spent on housing activities; statutory guidance should include a duty to produce a supported housing strategy in each Local Authority area; develop separate arrangements for sheltered housing.

In brief:

  • The Lightbulb Case Study details an ‘invest to save’ project in Leicestershire to help people stay safe and keep well in their homes for as long as possible. It includes Local Authorities, GPs and other health/care professionals. The project covers: minor adaptations and equipment; wider housing support needs (warmth, energy, home security); housing related health and wellbeing (such as falls prevention); planning for the future (housing options); and housing related advice, information, and sign-posting.  The service also includes a specialist Hospital Housing Enabler Team based in hospital settings, to identify and resolve housing issues that are a potential barrier to timely discharge and also provide low level support to assist with the transition home from hospital to help prevent re-admissions.

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Social Care

Need

  • Research conducted by Ipsos MORI has found that whichever measure of unmet need is used, over half of older people with care needs have unmet needs. They also discovered unmet need affects people eligible for Local Authority support as well as those who are responsible for funding their own care and support. The report also warned those who live alone are particularly vulnerable as they lack the social and practical support offered by a co-resident carer.  Unmet care needs can lead to frustration and a loss of purpose and is related to social isolation and mobility. Research Director, Dr Margaret Blake said “This research shows that the causes of unmet needs for care and support are wide-ranging, and that lack of Local Authority funding is only one part of the problem.”

  • A report from the Royal College of Occupational Therapists has called for an end to a "high volume, low cost" approach to social care, which they say leaves many older people missing out on vital services.  The study pointed to inequality in access to occupational therapy, which helps people continue with everyday tasks such as dressing, washing or getting to the shops. They report suggests that providing the right care initially can prevent the need for more expensive longer-term care. The authors also call for more occupational therapists to be employed within primary care, such as GP surgeries, to help older people adapt to ageing, increasing frailty and health problems.  Julia Scott, CEO of the Royal College of Occupational Therapists, said in her foreword "Too often, councils tell people what social care service they will get, based on what it is most efficient to provide, instead of asking what they really need… rather than seeing a person as whole, social care services often see a "set of care needs which need to be addressed".

Quality

  • The Care Quality Commission (CQC) has launched the Quality Matters initiative, co-led by partners from across the adult social care sector.  The guidance report sets out a single view of quality and a commitment to improvement.  It is a shared vision on how quality care and support can be achieved and person-centred care becomes the norm for all. This piece of work has been jointly developed to ensure that staff, providers, commissioners and funders, regulators and other national bodies all play their part in listening to and acting upon the voice of people using services, their families and carers. A summary action plan has also been published, setting out six priority areas to make progress on improving quality in the first year.  These include: 

    1.Acting on feedback, concerns and compliments; 

    2.Measuring, collecting and using data effectively; 

    3.Commissioning for better outcomes; 

    4.Better support for improvement; 

    5.Shared focus areas for improvement;

    6.Improving the profile of adult social care

    Development of the vision and guidance has come from across the sector, including: the Department of Health, Association of Directors of Adult Social Care, CQC, Care Provider Alliance, Local Government Association, NHS England, NICE, SCIE and several more.It has been endorsed by Care England and other organisations such as the Royal College of Nursing, NHS Improvement and Volunteering Matters to name a few. 

  • The National Institute of Health Research (NIHR) has published a report on Advancing care: research with care homes based on three themes: maintaining good health and quality of life, managing long term conditions associated with ageing and ensuring a good quality end of life.  It features published and ongoing studies alongside views from care home staff and researchers.

    MHA comments: This may be of interest to care home colleagues.

Regulation

  • The CQC has published a report The State of Adult Social Care Services 2014 to 2017, which presents findings from their programme of adult social care inspections. Key findings include: four out of five adult social care services in England were rated as good or outstanding overall. Nearly a fifth of services were rated as requires improvement. 343 locations (2%) are still rated as inadequate; there are differences in performance from region to region, with the East of England showing almost 10% more locations rated as good or outstanding than the North West; the measures of ‘safe’ and ‘well-led’ have the poorest ratings, with around a quarter requires improvement and inadequate; Caring was the best rated key question – 92% good and 3% outstanding.  Community social care services (such as supported living and Shared Lives) were rated the best overall. Nursing homes remain the biggest concern; Generally, smaller services that are designed to care for fewer people were rated better than larger services.  

MHA comments: At MHA we are totally committed to providing great quality care and have introduced a new approach in 2016 to help us drive forward our quality improvement programme.  Insight such as this undertaken by the CQC provides a helpful picture.

  • The CQC has published new Key Lines of Enquiry (KLOEs) for inspections, replacing the previous separate versions for different types of service, published in 2015, which the CQC felt duplicated many of the KLOEs.  This new version aims to simplify the KLOEs. The CQC has indicated they intend to begin using the new KLOEs from November, all this is dependent on a final piece of consultation on inspections currently taking place.
  • The CQC has also published its Annual Report and Accounts 2016/17, which highlights the milestone of completing their comprehensive inspection and ratings programme of all NHS trusts, adult social care services, GP practices, out of hours, NHS 111 and independent healthcare providers that were registered at the start of the programme. This has involved more than 45,000 inspections and has provided a baseline of care quality. 

  • The CQC has published their latest Safer Management of Controlled Drugsreport, which sets out key changes to legislation, provides an overview of prescribing data and prescribing trends for controlled drugs across England in the primary care sector and also makes three recommendations to strengthen existing arrangements. 

  • A national General Data Protection Regulations (GDPR) working group has been established, chaired by NHS England and including representation from CQC.  It will develop guidance to support health and social care organisations in understanding what they need to do to comply with the GDPR when it comes on line in May 2018. 

Local Government

  • The Local Government and Social Care Ombudsman (LGO) has revealed it is seeing more complaints related to reduced local government resources. In its Annual Report and Accounts for 2016/17, the LGO said it had upheld 53% of complaints where it had carried out an investigation. The LGO also made nearly 4,000 recommendations during the year. Of these, more than 600 were to improve services for the public by recommending councils and care providers make policy and practice changes.  17% of complaints were about Adult Social Care. 

  • Councils have been awarded funding for projects which use digital technology to transform and improve social care. As part of the Local Government Association’s Local Investment Programme, funded by NHS Digital, 16 councils will each receive up to £50k towards their projects. The funding is based on five themes: Sharing information and integrating services; Enabling people to interact with care services through digital channels; Promoting independence and wellbeing through the use of digital services and technology; Integrating commissioning through the improved use of information and analysis; and enabling care professionals to work from any base at any time.

In brief:

  • About 8% of the UK population living in private households acted as informal carers last year and the Office of National Statistics (ONS) calculates that it would cost £56.9bn to replace these unpaid carers with paid workers.  The ONS links the rise in unpaid care by family members to "a rapidly ageing population and a higher life expectancy".  Women are more likely than men to be informal carers, with women making up 59% of carers.  

  • Meanwhile, in its annual State of Caring 2017 report, Carers UK have found that unpaid carers are reaching ‘breaking point’ as they struggle to take even a day away from care responsibilities. 4 in 10 (40%) of unpaid carers have not had a break in over one year, whilst one in four (25%) had not received a single day away from caring in five years. The research also charts a growing anxiety around the level of support that will be available against a backdrop of cuts to adult social care services. Almost a third (29%) of carers are worried that practical support for them might be reduced in the future. Already, more than a third (34%) of carers reported a change in the services they or the person they care for receives and, of these, four in ten (39%) experienced a reduction in the amount of support offered by social services.

  • The first nursery in the UK to share the same site as a care home and where children and residents will meet daily for activities will open in September in London. Apples and Honey Nightingale will operate a 30-place full daycare setting in the grounds of Nightingale House, a residential care home for Jewish men and women, based in Clapham and run by charity Nightingale Hammerson. 

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Third Sector

Volunteering, giving and trust

  • The Government's annual Community Life Survey for 2016/17 has shown a reduction in volunteering levels in all the major categories over the past year. The proportion of people who said they volunteered at least once a month fell from 47 % in 2015/16 to 39% in 2016/17 and the percentage of respondents who volunteered at least once a year also fell, from 70% in 2015/16 to 63% last year.  The survey also found that volunteering fell across most age groups since 2013/14 and among both men and women.  However, respondents to the survey numbered 10,256, compared with 3,256 in 2015/16.  In terms of giving , older people and women were found to be more likely to give to charity than younger age groups and men. Three-quarters of respondents to the 2016/17 survey said they gave to charity in the four weeks before completing the survey, donating an average of £22, which was the same as in the previous year.  Kristen Stephenson, volunteering development manager at the National Council for Voluntary Organisations, said that this year's survey used a new methodology, so people would have to be careful about how they interpreted the findings.  She said it was still "really positive" to see that volunteering levels "remain high and stable".  "However, we also know that there are still barriers to address if we are to encourage more people to volunteer, this is why we are asking the government to consider requiring employers to allow time off work for charity trustees, which is already the case for magistrates or school governors."

  • The Commission on the Donor Experience has published a report of 526 suggestions it has made to improve fundraising. The 18-month project was sparked by the fundraising scandals of 2015.  Research commissioned to accompany the report found that nearly a quarter (23%) of the 1,040 people surveyed felt they had been emotionally blackmailed by charities. Qualitative research accompanying the survey found that participants felt fundraisers were over-reliant on emotional language and appeals were seen as manipulative. Participants said they understood why charities used emotional appeals, but many said it often left them powerless, upset or frustrated when they were unable to donate.  To avoid this, the Commission said such appeals should focus on the beneficial power of the charity, rather than the gravity of the problem they were trying to solve.

  • NfpSynergy has published a new report exploring what charities are trusted to do by the public and how they are trusted compared to other sectors. Involving 1,000 people, the research has found: Charities are seen as an ‘accurate’ source of information, coming second after only ‘family and friends’ out of a list of ten sources; Charities are also seen as an ‘unbiased and impartial’ source of trusted information, again coming second after ‘family and friends’; When the public were asked who were trusted sources of commentary on UK policy, people who run charities were in the top five on the list after healthcare professionals, scientists, and academics and just above economists. British politicians were fourth from bottom; Charities are trusted to have a positive impact on society (a great deal or quite a lot) by 64% of the public; However, charities are less trusted to use personal data wisely at only 53%. 

  • Commissioned by the Institute of Fundraising, this report is a synthesis of the current research that has been carried out into major donors and philanthropic giving. It considers: How do major donors decide which charities and causes to support? Why do major donors continue to give?

  • The Law Commission has published a consultation on proposals to change the rules around making a will. It is considering whether texts, emails and other electronic communications should be recognised as a valid will in exceptional circumstances.  Law Commissioner, Professor Nick Hopkins, said making a will should be straightforward but the law was "unclear and outdated". "Even when it's obvious what someone wanted, if they haven't followed the strict rules, courts can't act on it.  And conditions which affect decisionmaking - like dementia - aren't properly accounted for in the law. That's not right and we want an overhaul to bring the law into the modern world.  Our provisional proposals will not only clarify things legally, but will also help to give greater effect to people's last wishes."  Remember A Charity welcomed the Law Commission’s proposals and consultation to overhaul the current laws on Wills, saying that this could be ‘critical’ for legacy giving.  The consultation closes on 10 November.

    MHA comments: We will look at the proposals in this consultation, to consider the implications for the older people we serve and those who choose to give us a legacy.

Regulation

  • The Fundraising Preference Service was launched on the 6 July. A member of the public can now visit the website and submit a request to cease communication from a specific charity/ies of their choice. It received over 4,000 suppression requests in its first six days. 

    MHA comments: We have not had any supporters ask to be removed from our database through the Fundraising Preference Service to date.  

  • The Fundraising Regulator published changes to six key areas of the Code of Fundraising Practice, following a consultation earlier this year. The Code changes include new requirements regarding: charity trustees; the fundraising ask; solicitation (disclosure) statements; raising concerns about fundraising practice (whistle-blowing); charity collection bags; fundraising agreements and monitoring third party compliance.   Charities have a grace period of up to four months to implement the changes. 
  • The Charity Commission has published its Annual Report and Accounts 2016/17, which has shown that inquiries rose from 52 in the 2015/16 financial year to 187 in 2016/17. The report says there was an increase in the number of "charities being referred for inquiry in order to deal with serious regulatory concerns". The report also reveals that the commission used the powers it gained under the Charities (Protection and Social Investment) Act 2016 a total of 26 times, including 18 times in April and May this year. The Act, which came into force in March 2016, gave the commission new powers to issue warnings to charities and to disqualify people from serving as trustees. The number of applications to register a charity rose from 8,198 to 8,368, and 6,045 were successful.
  • The Charity Commission has published a case report setting out cases that arose in relation to campaigning and political activity by charities in the run up to the General Election 2017 and explains what regulatory action the Charity Commission took in each case. It covers: visits to charities by prospective parliamentary candidates; publishing educational material with political commentary or analysis; providing explicit support for candidates and political parties; use of charity material by candidates and political parties; political activity by charity employees and trustees; and links with non-charitable organisations.

  • A new Charity Governance Code has been launched, developed by NCVO, ACEVO, Association of Chairs, ICSA (The Governance Institute), Small Charities Coalition, Wales Council for Voluntary Action and with oversight from the Charity Commission. It has been developed provide a clear set of governance standards which charities and their trustees can aspire to and work toward. There are seven principles which make up the new code: organisational purpose; leadership; integrity; decision-making, risk and control; board effectiveness; diversity; and openness and accountability.

  • The Fundraising Regulator has published an Annual Review to mark its first anniversary. 

In Brief:

  • Catherine Johnstone, former CEO of the Samaritans has been appointed as the new CEO of the Royal Voluntary Service.

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Workforce and Skills

Social Care

  • New analysis from Skills for Care shows the adult social care workforce continues to grow, with 1.45m people now offering care and support across England. Skills for Care’s Size and Structure of the adult Social Care Sector and Workforce in England 2017 report reveals that workforce numbers have grown by 19% to approximately 1.58m job roles since 2009. There are now around 20,300 organisations offering social care across England, and around 70,000 adults, older people and carers who receive direct payments employ their own staff. The report contains a new projection that if the workforce grows proportionally to the projected number of people in the population aged 65 and over then 500,000 new jobs will be needed by 2030 to meet demand. 

  • Authorities across the South West are supporting a campaign to raise the profile of care and the positive role of care workers in a drive to recruit the right people to the sector. Sixteen local authorities across the South West, with Health Education England, are supporting the campaign, to establish a regional approach to raising the profile of care. An especially inspiring element to the campaign is the first-hand personal accounts from real care and support workers, who talk passionately about their love for care work. The campaign website www.proudtocaresw.org.uk features interviews with care and support workers, and links to recruitment portals where care providers across the region advertise their vacancies.

  • A new study from Skills for Care looking at successful recruitment and retention of workers in adult social care reveals quality training, positive working conditions, flexibility and competitive pay rates are key to recruiting and retaining social care staff who have the right values and behaviours to deliver quality care and support. Skills for Care collected evidence from 140 adult social care organisations who have staff turnover rates of less than 10% to look at what they do to keep their staff after they have successfully recruited them. 

  • Care England has launched results of a survey on pay.  Key findings include: 96% of providers expected their overall staffing budget to increase this year and all expected further increases over the next 3 years to keep pace with demand. Staffing budgets make up the bulk of costs for providers; Only 10% of providers expected profit margins to increase in 2017/ 18 and this slightly increased to 15% projecting an increase in profit over the next 3 years. Conversely 55% of providers were projecting a fall in profits up to 2020; As a consequence providers were projecting a decrease in the number of Local Authority placements taken on, with 32% projecting a decrease in placements accepted in 2017/18 which increased to 45% of providers projecting to take on less Local Authority placements over the next 3 years.

Nursing

  • Vacancies in the National Health Service have increased by 15.8% over the last 12 months, according to the latest figures from NHS Digital. Full-time equivalent posts rose from 26,424 in March 2016 to 30,613 in March 2017, the highest number on record.  More than 86,000 NHS posts were vacant between January 2017 and March 2017.  Nurses and midwives accounted for the highest proportion of shortages, with 11,400 vacant posts in March 2017. 

  • The Nursing and Midwifery Council has warned of an escalating staffing crisis in the NHS as the number of nurses has decreased for the first time in almost a decade, with thousands of nurses leaving the profession.  

  • A new analysis of the nursing shortage problem suggests that the shortage of district nurses is a factor in delayed discharges form hospital. The number of district nurses in the UK has fallen by 44% since 2010, according to the analysis of NHS data by consultancy Christie & Co. They argue that District and other community nurses play a crucial role in treating people in their own homes or in care homes when they might otherwise be referred to hospital. It also notes that overall shortages of nurses, coupled with falling numbers of applications to nursing courses and a recent fall in the number of EU nurses coming to work in the UK in the wake of the Brexit vote, had all contributed to a nursing crisis.

  • The number of people applying for UK university places has fallen by more than 25,000 (4%) on 2016, data from admissions service UCAS shows. The figures show a sharp decline in those applying to study nursing courses - down 19% - and a continued fall in the number of mature students, notably in England and Northern Ireland. The number of EU students planning to study in the UK has fallen by 5%. It is the first decline since fees were last increased in England, in 2012. There has also been a significant drop in mature students (those aged 25 and over) in England and Northern Ireland - down 18% (11,190) and 13% (220) respectively. Fees in England will increase to £9,250 in 2017 and student loans are subject to an increase in interest rates - rising from 4.6% to 6.1%. From 1 August, new nursing, midwifery and most allied health students will no longer receive NHS bursaries - instead, they will have access to the same student loans system as other students. 

  • NHS Improvement has launched a major programme to improve staff retention in hospitals across England and bring down the leaver rates in the NHS by 2020. The programme will offer a wide range of support, including: a series of masterclasses for directors of nursing and HR directors to discuss ways to improve retention; further work with NHS Employers to explore how we can help build on its current national retention programme; targeted support for all mental health providers to improve the retention rates of all staff groups within these trusts; piloting and rollout of a tool designed to help trusts understand why staff leave and a tool for analysing staff survey results; guidance and webinars on how to improve retention rates. 

  • The Scottish Government has published its The National Health and Social Care Workforce Plan, setting out how it will work with partners to secure sustainable NHS staffing alongside its programme of change in health and social care. It includes measures seeking to increase the supply of nurses include extended ‘return to practice’ programmes, improved recruitment and retention, particularly in rural areas, and support to attract and retain staff. A follow-up plan will be published in the autumn, covering social care, with a third for primary care around the end of the year. A combined plan will be published in 2018.

In Brief:

  • The Centre for Ageing Better has commissioned the University of Westminster to carry out employer focused research to better understand how we can make workplaces more age-friendly. The research will focus on three important aspects of age at work: facilitating and supporting flexible working; preventing age bias in recruitment; and maximising the benefits of mixed-age teams.

  • A group of charities, led by the Scout Association and including the British Red Cross, Age UK and Girlguiding are among 11 voluntary organisations bidding to establish a social sector degree apprenticeship in 2018.  The initiative aims to harness the enthusiasm for change of 16 to 24 year-olds, and charities supporting the initiative could offset tuition fees against the apprenticeship levy.  If the newly formed Institute for Apprenticeships approves the idea, it will work with the charities, as well as Queen Mary University of London and the University of Liverpool, which are also backing the initiative, on developing a curriculum.

  • Former social care minister, Paul Burstow has been appointed as Social Care Institute for Excellence's (SCIE's) new chair.

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Look Ahead: August and beyond

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

  • 20 Jul - 5 Sept: Parliamentary recess
  • 4 Aug: Welsh Government Draft Supporting People Programme Guidance and Outcomes Framework - consultation deadline
  • 8 Aug: CQC Adult Social Care Inspection Methodology - consultation deadline
  • 21 Aug: Social Care Wales’s new research and development strategy - consultation deadline
  • 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

Events

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

  • Health and Care Innovation Expo 2017, 11 and 12 September, NHS England, Manchester, £120 plus VAT. Speakers include:  Jeremy Hunt MP Secretary of State for Health, Simon Stevens, CEO, NHS England and Professor Sir Bruce Keogh, National Medical Director, NHS England. Expo 2017 will explore the most important developments across health and social care, including: The achievements and lessons of the New Care Models vanguard programme; Delivering Sustainability and Transformation Plans; Building and maintaining the right structures for collaborative, prevention-focused services; New digital technology solutions supporting transformation of health and care services; Accelerating the uptake of successful innovations across health and social care

  • Doing Dementia Design, 14-15 September, Liverpool, £120-150 A two day conference organised by Liverpool Dementia Action Alliance to promote the adoption of dementia-friendly principles in the design of all buildings, places and spaces, sharing latest research and developments, aiming to influence public policy, professional practice, education and training. 

  • 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.

  • 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. 

  • 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.

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Some information sourced from DeHavilland

 
 

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