Policy News from MHA: November 2017

Welcome to MHA's November policy bulletin

 

The Government has had a busy month this November, continuing to juggle the negotiations for Brexit, coping with resignations and the delivering the Autumn Budget. It has also been business as usual, with the EU Withdrawal and Data Protection Bills making progress and significant announcements on the delay of the Adult Social Care Green Paper and publication of the Industrial Strategy. 

Delivering the Autumn Budget, Chancellor Philip Hammond said that his Government’s stewardship of the economy would prepare the UK for life outside of the EU and that this budget would create opportunities for Britain in the future. However, while he opened with Brexit, much of the budget was focussed on  technology development and housing.  He emphasised his desire for a balance between fiscal responsibility, continued investment and helping families to cope with the cost of living, although the overall economic forecast was rather gloomy.  We have prepared a summary of the Budget available here.

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

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

Ageing and wellbeing: - Wellbeing - Loneliness - Retirement

Dementia:- Care, support and wellbeing - Prevention -

Finance and pensions: - Older age and low incomes 

Health: - Delayed Transfers of Care -  Health and Social Care Integration  - Funding - Technology

Housing: - Health and housing - Supported housing - Investment and design

Social Care: - Care Homes Market Study Funding - Current and future need - Quality -

Third Sector: - Public engagement Fundraising - Governance - Regulation -

Workforce and skills: - Nursing -

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

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Brexit

  • The EU has said that talks on a post-Brexit trade agreement can't begin until the UK's "divorce bill" is agreed. The BBC reports the UK government has said it's willing to pay a Brexit "divorce bill" worth between 40bn and 55bn euros (£35bn-£49bn), up from the 20bn euros the prime minister said the country was prepared to commit to in September, although no formal offer will be made until the EU agrees to begin talking about a new trade deal with the UK.

  • The EU (Withdrawal) Bill has been debated at Committee Stage on three occasions. During one debate, the Government saw off several attempts to amend the Bill. Shadow Brexit Minister Matthew Pennycook sought to ensure that EU-derived employment rights, environmental protections, standards of equalities, health and safety and consumer standard could only be amended by primary legislation or subordinate legislation, but this was defeated. One controversial amendment that was accepted, was that made by EU Minister Steve Baker which agreed the fixed time and date of Brexit on 29 March 2019 at 11pm.  Brexit Secretary David Davis has also announced that a separate Bill, the Withdrawal Agreement and Implementation Bill, will also be brought forward to cover the final withdrawal agreement between Britain and the EU.  MPs will be able to debate, scrutinise and vote on the Bill, which would include the technical details of the agreement including EU citizens rights and the implementation period of the agreement. He added that voting on this Bill will be separate to the UK Government's commitment to give Parliament a vote on the principles of the final deal before the European Parliament votes on it.

  • The Government has presented the Trade Bill to Parliament. The Trade Bill will work together with the Customs Bill to put in place legal powers for the UK to operate a fully functioning trade policy after Brexit, as well as the ability to implement existing EU trade agreements. Other key measures include:
    • Enabling the UK to have continued access to £1.3tn worth of government contracts and procurement opportunities in 47 countries by creating the powers needed for the UK to implement the Agreement on Government Procurement (GPA) as an independent member instead of as part of the EU.
    • Establishing a new independent UK body, the Trade Remedies Authority, to defend UK businesses against trade fluctuations and unfair trade practices.
    • Ensuring the UK government has the legal abilities for gathering and sharing trade information as evidence to support UK businesses against surges in imports and unfair practices.
    Further tax-related elements of the UK's trade policy will be addressed in the Customs Bill, as part of the creation of a new UK tariff regime. This Bill is to be introduced before the end of the year.
     

  • The Nuffield Trust has published a briefing report that emphasises the importance for the NHS of the deals the UK reaches – or fails to reach – as it leaves the EU. The report, How will our future relationship with the EU shape the NHS?, explores five key areas, such as reciprocal health care arrangements and the approval of medicines and devices. It highlights the need to consider the rights of EU staff, securing cross-border treatment in Northern Ireland and safeguarding access to vital drugs, equipment and medical products. It also examines where the NHS might have greater freedoms and flexibility once the UK has left the EU and what benefits these could bring.

  • The Directory of Social Change have published new research which suggests charities face losing at least £250m a year after Brexit. In What does Brexit mean for UK charities’ European Union funding? It finds that charities benefited from £258.4m in EU funding in 2015, with £210.9m of that figure awarded to 295 charities in funds administered directly by the European Commission. They warn that the impact of a potential non-replacement of funding could disproportionately affect certain charities, causes or UK home nations – for example environment and conservation, or Scotland. 

Charity and Voluntary Sector

  • The Government will produce a new voluntary sector strategy that will "reaffirm the value that government places on civil society". In a written ministerial statement, Parliamentary Under Secretary of State for Sport and Civil Society Tracey Crouch said the strategy would "provide an opportunity to explore ways to build new partnerships within and between sectors and communities, so that we can better mobilise resources and expertise and find practical new solutions to the problems we face". A consultation on the strategy is expected to be launched in January.

  • David Knott has been promoted to Director of the Office for Civil Society, in the Department for Digital, Culture, Media & Sport. 

See the Third Sector section for more research news

Data Protection

  • The Data Protection Bill has been debated six times at Committee stage in the House of Lords. During the debates, Opposition Whip Lord Stevenson expressed concerns over the removal of rights via the EU European Union (Withdrawal Bill) as data protection is underpinned by the EU Charter of Fundamental Rights. However, the Digital Culture, Media and Sport minister Lord Ashton of Hyde reassured that the implementation of the GDPR in May 2018, already contained provisions to respect aspects of the EU Charter. In addition Lords Government Whip Baroness Chisholm of Owlpen moved amendments to the exceptions from the GDPR, allowing organisations operating in areas including health, social work, education and child abuse data to be exempt where necessary for the protection of an individual. This amendment was accepted by the House. 

Finance and Pensions

  • Chair of the Work and Pensions Select Committee, Frank Field MP has called for the creation of a minimum income requirement for people to be able to withdraw all of their retirement fund via pension freedoms, to prevent people claiming state benefits if they run out of money. Mr Field said that he always supported the drawdown system introduced with pension freedoms on “the proviso that you had to keep enough capital there to prevent you coming onto state benefits. Otherwise you would get into two subsidies – a subsidy tax relief to build up your pension and another call on tax payers to draw benefits again,” he said. Such a move would be a reversal of rules introduced two years ago which gave people total access to their nest eggs to do with as they want.  Sir Steve Webb, head of policy at Royal London and former pensions minister, said that Mr Field’s idea of a cap would “would block people from freedoms that they can currently access, with no intentions of claiming benefits”.

  • The Financial Guidance and Claims Bill was debated at Report Stage in the House of Lords. Introducing his amendment, Lord Sharkey outlined that the need to boost the current “exceptionally low” financial advice take-up among pension pot access or transfer candidates. Under the proposed wording, the Financial Conduct Authority (FCA) would be asked to require trustees or pension managers to ask applicants for access or transfer whether they had received information and guidance under Section 3 of the Pension Scheme Act 2015. If this was not the case, the FCA would have the power to require the trustee or manager to provide access to information and guidance before proceeding. Supporters of the amendment included former Pensions Minister Baroness Altmann, and Shadow Work and Pensions Spokesperson Lord McKenzie of Luton, who highlighted the “new risks” introduced by the Government’s liberalisation of pension fund access. Responding for the Government, Work and Pensions Minister Baroness Buscombe claimed that take-up was better than FCA figures appeared to show, as a “huge” number of people were using online guidance. She also noted work underway to improve guidance signposting. This amendment was accepted by the House.

See the additional Finance and Pensions section for more research news

Health and Social Care

  • The First Secretary of State and Minister for the Cabinet Office, Damian Green, announced that the Government will publish the long-awaited Green Paper on Care and Support for Older People by summer 2018, setting out plans for how Government proposes to improve care and support for older people and tackle the challenge of an ageing population. As part of this work the Government has begun a process of engagement with independent experts, stakeholders and users to shape the long-term reforms that will be proposed in the green paper. The independent stakeholders include:
    • Caroline Abrahams – Charity Director of Age UK
    • Dame Kate Barker – former Chair of the King’s Fund Commission on the Future of Health and Social Care in England
    • Sir David Behan – CEO, Care Quality Commission
    • Dr Eileen Burns – President of the British Geriatrics Society
    • Professor Paul Burstow – Chair of the Social Care Institute for Excellence
    • Jules Constantinou – President-elect of the Institute and Faculty of Actuaries
    • Sir Andrew Dilnot – former Chair of the Commission on the Funding of Care and Support
    • Baroness Martha Lane Fox – Founder and Executive Chair of Doteveryone
    • Mike Parish – CEO, Care UK
    • David Pearson – former President of the Association of Directors of Adult Social Services and Corporate Director for Social Care, Health and Public Protection at Nottinghamshire County Council
    • Imelda Redmond – National Director of Healthwatch England
    • Nigel Wilson – CEO, Legal and General
    Damian Green, said: “An ageing population needs a long-term solution for care, but building a sustainable support system will require some big decisions. In developing the green paper, it is right that we take the time needed to debate the many complex issues and listen to the perspectives of experts and care users, to build consensus around reforms which can succeed.” Once the Green Paper is published in summer 2018, it will be subject to a full public consultation.
    Responding to the, Margaret Willcox, President of the Association of Directors of Adult Social Services (ADASS), said: “We are pleased that Government has committed to publishing the long-awaited Green Paper on social care next summer, that it will be subject to public consultation, and that independent experts and sector stakeholders will be involved in helping to develop it for the benefit of older and disabled people... Adult social care cannot continue without sufficient and sustainable resources. The sooner long-term, sustainable funding reforms are established to address the perilous state of adult social care – including overspent council budgets, care providers closing, contracts being handed back to councils and an increase in quality challenges - the sooner the sector can help provide reliable, personal and dignified care to the increasing number of people of all ages who need and deserve it.”

MHA comments: We are pleased that the Government's commitment to publish a Green Paper on Adult Social Care will be honoured, but disappointed that it will not happen sooner. We have had many commissions and consultation on this issue, action is needed now.  We are also concerned about the lack of representation from the care provider sector amongst the expert stakeholders.

  • Ninety MPs of all parties have signed a letter calling on the Prime Minister and the Chancellor to set up a cross-party convention on the future of the NHS and social care in England. Led by former health minister Norman Lamb the Convention would work on a cross-party basis, engaging with the public and the health and care workforce, to confront the mounting pressures in the system arising from an older population and growing demand for healthcare. The letter asks for a non-partisan debate is needed to deliver a "sustainable settlement".

  • The Government has launched a new compliance scheme for social care providers that may have incorrectly paid workers below legal minimum wage hourly rates for sleep-in shifts. Social care employers will be able to opt into the new Social Care Compliance Scheme (SCCS), giving them up to a year to identify what they owe to workers, supported by advice from HM Revenue and Customs. Employers who identify arrears at the end of the self-review period will have up to three months to pay workers. A final deadline of 31 March 2019 has also been set by which employers must settle outstanding backpay, regardless of when they enter the SCCS after which they will be subject to enforcement action. Guidance has indicated that providers not entering into the SCCS would be offered no concessions. Derek Lewis, the chair of Mencap, said he was “dismayed” by the government’s announcement and called on the Government to provide funding to help providers deal with back payments. Professor Martin Green OBE, Chief Executive of Care England, added “Government needs to accept the responsibility for meeting the substantial costs of back dating sleep in costs and take full account of the reality that the sector has been operating for years within very contradictory guidance”.

  • The National Assembly of Wales’ Public Accounts Committee is undertaking an inquiry into the Welsh Government’s Supporting People Programme. The £125m scheme helps around 67,000 vulnerable people including older people, live in their own homes. In August, the Wales Audit Office criticised "inconsistencies" in the way funding was allocated and managed. Public Accounts Committee chair Nick Ramsay said "The Supporting People Programme delivers what are undoubtedly valuable services to vulnerable people in a range of different circumstances. However, the pace of progress is a concern and it is disappointing that the Welsh Government still does not have a good enough understanding of the programme's overall impact some 14 years on from its initial launch.”

  • The Scottish Government has published the Review of Targets and Indicators for Health and Social Care in Scotland. The review considered how targets and performance indicators can lead to the best outcomes for people being cared for, whether in hospital, primary care, community care or social care services. The report suggests that present system can be improved upon in terms of its effectiveness in improving services as many are fragmented and do not lend themselves to improvement interventions.

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

Housing

  • The Government’s intention to proceed with a large-scale regional pilot of the Voluntary Right to Buy scheme was confirmed in the Budget. The £200m regional pilot of the VRTB for housing association tenants will take place in the Midlands, running for two years starting in summer 2018.

    MHA comment: The Government has yet to confirm the specifics of the pilot and the eligibility criteria for tenants. Once more information is known, MHA will need to prepare for VRTB pilot for the schemes that fall within the Midlands region and be ready for any VRTB requests from our tenants.

  • The House of Commons Library has produced a background paper to the policy - Introducing a voluntary Right to Buy for housing association tenants in England

  • The Office for National Statistics (ONS) has recently completed an assessment of the housing associations sector in England and concluded that registered providers of social housing in England are private, market producers and as such they will be reclassified to the private non-financial corporations sub-sector for the purpose of national accounts and other economic statistics. This classification takes effect from 16 November 2017.  In 2016, ONS, classified Housing Associations as public bodies, which added housing association debt to the public balance sheet. The Government responded by including deregulation measures in the Housing and Planning Act 2016, removing the consents regime for the disposal of stock; abolishing the Homes and Communities Agency Disposal Proceeds Fund; removing and limiting regulator powers concerning constitutional changes and appointments; limiting Local Authority influence; and introducing a new regime to protect assets in cases of insolvency. 

  • The Homes and Communities Agency has published its Fees Statement 2017 to 2020, following the introduction of regulatory fees earlier in the Autumn. It includes background information on the regulator’s role, its approach to regulation and the measures it will apply to its work. 

  • The Communities and Local Government Committee has heard from a range of experts as part of its Housing for older people inquiry: including Sue Adams, CEO, Care and Repair England; Andrew Gibson, Vice Chair, Habinteg; and Julia Park, Head of Housing, Levitt Bernstein; Michael Voges, Executive Director, ARCO; Paul Teverson, Director of Communications, McCarthy and Stone; and Graham King, Head of Integrated Commissioning, Sunderland City Council. The hearing covered many topics including: the challenges older people face in terms of maintaining, repairing and adapting their family homes; fuel poverty amongst older people; building age friendly ‘lifetime’ homes; demand for specialist housing; provision for those on middle incomes; housing with care/extra-care; local plans for older people’s housing; demand for older people’s housing and the market response; event fees; and stamp duty.

  • A new draft bill has been introduced to ban letting fees. The draft Tenant Fees Bill (England only) will set out the Government’s approach to banning letting fees for tenants, aiming to bring an end to costly upfront payments. The Bill, will: Cap holding deposits at no more than one week’s rent and security deposits at no more than 6 weeks’ rent. It will also set out the proposed requirements on landlords and agents to return a holding deposit to a tenant; Create a civil offence with a fine of £5k for an initial breach of the ban on letting agent fees and creating a criminal offence where a person has been fined or convicted of the same offence within the last 5 years. Civil penalties of up to £30k could be issued as an alternative to prosecution; Require Trading Standards to enforce the ban and to make provision for tenants to be able to recover unlawfully charged fees; Appoint a lead enforcement authority in the lettings sector; Amend the Consumer Rights Act 2015 to specify that the letting agent transparency requirements should apply to property portals such as Rightmove and Zoopla.  In addition the Government has also launched a consultation on making membership of client money protection schemes mandatory for letting and managing agents that handle client money. The consultation closes on Wednesday 13 December. The Communities and Local Government Committee are also conducting pre-legislative scrutiny of the Government's proposals. 

  • The Government have announced that they will be looking to introduce “bold options” to improve consumer redress across the housing sector. Communities Secretary Sajid Javid indicated that in the New Year, the Government will consult with consumers and the industry, and look at options to explore how the overlap between responsibilities can be improve, such as introducing a single housing ombudsman to help provide more comprehensive redress for home owners, home buyers, tenants and landlords.

  • A working group has reported on Electrical safety standards in the private rented sector, following a clause in the Housing and Planning Act 2016, to consider requirements for electrical safety standards in the private rented sector, and their enforcement. The Working Group has concluded that legislation is necessary to improve electrical safety standards for tenants in the private rented sector. They recommended that the inspection and testing of the property’s electrical installation at 5 year intervals should be set out in regulations. They recognised the need to minimise cost burdens for landlords and agents whilst maintaining adequate protections for tenants and therefore have suggested that good practice and recommendations are set out in good practice rather than mandatory inspections and tests. 

  • New figures from the Government show that 1.1 million additional homes have been built since 2010 and the number of new homes in England has risen by 15% over the past year - 217,350 net additions. Whilst welcoming the rise, Communities Secretary Sajid Javid also announced action against 15 LAs that have failed to produce a local plan setting how and where they expect to meet their residents’ needs for new homes. More than 70 LAs still do have not had a local plan adopted but 15 of these (Basildon, Brentwood, Bolsover, Calderdale, Castle Point, Eastleigh, Liverpool, Mansfield, North East Derbyshire, Northumberland, Runnymede, St Albans, Thanet, Wirral and York) have given particular cause for concern having missed deadlines and failed to make progress. These LAs have until 31 January 2018 to explain why they haven’t yet published a plan and have been served notice of posisble Government intervention. Without a local plan, the Government suggest, it can mean uncertainty for local people, piecemeal speculative housing development and also means the right investment in local infrastructure isn’t made.

  • In its Housing need and the National Planning Policy Framework (NPPF) inquiry, the Communities and Local Government Committee has examined proposed changes to the way the need for new homes is calculated for each LA, in a one-off evidence session with the Housing Minister, Alok Sharma. He indicated that the Government intended to publish a draft NPPF early in 2018 ready for consultation, with the final document coming forward in Spring. In order to give LAs greater flexibility, Mr Sharma said measures such as using smaller sites, diversifying the range of people building, and building sooner after planning permission is granted would help this. On Social housing, he said he wanted to see the number of stakeholders building homes diversified, but conceded that it would likely be the private sector in charge of building social housing.

  • According to Scottish Housing News, the Scottish Government’s Chief Planner is to withdraw the housing and infrastructure draft planning delivery advice from 1 December 2017. John McNairney has written to all local heads of planning about the decision which he said will allow the government to focus resources on the changes emerging from the ongoing planning review. In the letter, he said that efforts to develop the guidance was hindered by “a number of areas of continuing disagreement and some concerns over the weight to be attached to the draft advice” He added that a “strong policy position” remains on planning for housing, despite the withdrawal of the advice.

  • HM Land Registry has published a new Business Strategy which covers the direction it will take over the next 5 years.

  • The Mayor of London Sadiq Khan has published the draft London Plan, a strategic document that sets the capital’s overall planning strategy. The Plan includes measures to increase the number of affordable homes, to increase housing density, to protect the green belt, improve fire safety standards and support sustainable transport. A consultation on the Plan will run until Friday 2 March 2018. 

    See the additional Housing section for more research news

Workforce and Skills

  • The Government is expected to conclude whether it is clinically appropriate to define specific nurse-to-patient ratios across different activities in the new year, health minister Philip Dunne has revealed. Speaking at a Health Select Committee inquiry on the Nursing Workforce, he also admitted that there is no defined dataset that clearly quantifies what the staff vacancy level is across the NHS, although his team is working to change that.

  • The Business Secretary Greg Clark has launched the Government's Industrial Strategy, described as the Government's long-term vision to boost the economy, build on the country's strengths and embrace the opportunities of technological change. The paper outlines a series of Sector Deals, where the Government will partner with organisations to drive growth opportunities in: Construction; Life Sciences (coinciding with the announcement that the Government had secured a major strategic investment by life sciences company MSD); Automotive and Artificial Intelligence. Work will also continue to develop other sector deals. The Strategy also includes four "Grand Challenges" to “take advantage of global trends to put the UK at the forefront of the industries of the future". These include: Artificial Intelligence; Clean Growth; Ageing Society; and Future of Mobility.

    On Ageing Society the paper focuses on harnessing the power of innovation to help meet the needs of an ageing society. It announced a forthcoming “Healthy Ageing” programme designed to help older people maintain “their chosen lifestyle, and stay independent for longer”, it will explore opportunities to work with consumer markets with the aim of developing the innovation of products and services for older people.  The Strategy also included a pledge to build on the Government’s Fuller Working Lives Strategy in order to promote the benefits of older workers to employers across the UK. Furthermore, it included the reiteration of the Government’s pledge to work alongside businesses to offer more flexible working hours for older people. The Government will continue to add data and evidence to the evaluation of the Right to Request Flexible Working regulations. Lastly, the government will also encourage care businesses to access emerging opportunities provided by the Growth Hub network (local public/private sector partnerships led by the Local Enterprise Partnerships)

    Responding Rebecca Long-Bailey MP, Labour’s Shadow Secretary for Business, Energy and Industrial Strategy, said: “This is a White Paper made up of re-announced policies and old spending commitments, showing once again that this is a Government short on details and new ideas. What detail there is concentrates on a few elite industries in which Britain already has an advantage, and will do nothing to help the millions of people who work in low productivity and low wage sectors such as retail, hospitality and social care, or those based outside the “Golden Triangle” made up by London, Oxford and Cambridge.”

    MHA comments: We welcome recognition of the importance of our changing demographics in the strategy.  We are keen to see action as a result and look forward to more detail on the Healthy Ageing programme, where we hope to see greater inclusion of the health and social care sector.

 

  • Earlier in the month, the Industrial Strategy Commission, a joint initiative by the University of Manchester and the University of Sheffield, published its report following an independent inquiry into the development of a new, long-term industrial strategy for the UK. It argues health and social care should take a central role in the industrial strategy. This role has multiple dimensions:
    • Organisations that directly deliver health and social care collectively constitute a substantial proportion of the overall economy and employ a large number of people, so the productivity of their activities should be in focus.
    • Technological innovations raise people’s expectations of healthcare, but also have the potential to increase the productivity and effectiveness of the health and social care system, creating new markets for new products amongst health and social care supplyiers.
    • Suppliers such as pharmaceuticals, biotech and medical technology – are strong in the UK, representing substantial value creation and export potential.
    • Finally, the health and well-being of the population at large is closely connected to the wider economy. A sick workforce is not a productive workforce, and inequalities in health across the UK translate directly into lost productivity.
    It recommends that: Future increases in public spending on health should come with the strict expectation that investment should be used to raise productivity; There should be a rethink of procurement for both health and social care, with the aims of improving purchasing practice in the short-term to accelerate the adoption of new technologies and of looking for ways to stimulate innovation especially in domiciliary social care; the new Industrial Strategy should aim to achieve higher productivity and better health outcomes by ensuring more skilled and satisfying jobs in the health and social care sector; Health and social care services should be integrated, but this should be steered by the goal of achieving better outcomes for people’s wellbeing and not purely by reducing costs.

  • A report from the BBC, indicates that there has been a big fall in the number of workers starting apprenticeships since the introduction of the government's Apprenticeship Levy in April 2018. According to Department for Education figures, in the last three months of the 2017 academic year, 48,000 people began an apprenticeship, compared with 117,000 for the same period last year. However, it has also said it expected there would be an initial drop-off in the number of people starting apprenticeships following the introduction of the levy. Minister of State at the Department for Education Robert Halfon said: "Initially the number of starts has gone down, but I suspect over the coming year they will go back up again." The Association of Employment and Learning Providers, whose members include independent trainers, employers and further education colleges, said it had already made clear to the government what needed to be done to improve the number of apprenticeships. "There needs to be appropriate flexibility of off-the-job training. In addition, employers without levy funding should not be charged for training 16-24 year old apprentices," said CEO Mark Dawe.
    Verity Davidge, head of education and skills policy at the manufacturers' organisation the EEF, said "Accessing the funding has proven complex and difficult to unlock in time and employers have struggled to get their heads down the complex rules and restrictions in accessing funds.” 

    MHA comments: We agree - it is a complex system and the off the job training requirements are a big barrier for social care apprenticeships.
  • During a financial debate on the Parental Bereavement (Leave and Pay) Bill (Private Members Bill), Gill Furniss MP outlined that the Bill suggests two weeks’ paid leave to any employed parent who loses a child under the age of 18. Parents employed with more than 26 weeks’ continuous service should be eligible to receive statutory parental bereavement pay. The Bill outlines that employers would be able to reclaim some costs from the Government. The estimated cost to HM Treasury of 2 weeks’ paid leave at the statutory flat rate is £1.77m per year. The Bill has received cross-party support with Ministers outlining that the costs are contributing to a justified case for support.

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

Other

  • Rachel Reeves MP led a debate on loneliness in the House of Commons, providing an “opportunity for colleagues from across the House to share the impact of loneliness in their communities, but also to celebrate the local interventions that are making such a difference to so many people.” As part of this debate she said “We also need systems in place to measure loneliness properly. At the moment, loneliness is measured in the English Longitudinal Study of Ageing. However, we have spent this year talking about how loneliness affects us all [through the Jo Cox Commission on Loneliness], not just the elderly. We need Government commitment to measure loneliness at a national level, and we need Local Authorities supported and resourced to do more locally. By supporting local authorities to uncover what is working, we can pump resources into interventions that really make a difference to all our constituents. As the Royal College of General Practitioners has said, loneliness should not be disregarded as a minor problem. Our GPs need to be supported to give not just clinical prescriptions but social prescriptions as well. They could encourage patients to get out into the community, using volunteers—befrienders and others—to ensure that people who are struggling most get the support and access to the local services that so many people have spoken about powerfully today.”

    MHA comments: We are pleased to see that Parliamentary time has been given to this important topic.  It is also great to see reference made to social prescribing as a solution that could be successful if given Government support. 

 

  • People changes: Sir Michael Fallon announced his resignation from the position of Secretary of State for Defence following allegations of inappropriate behaviour. Gavin Williamson has been appointed as the new Secretary of State for Defence, he previously held the position of the Chief Whip. Deputy Chief Whip Julian Smith has been promoted to the role of Chief Whip. Former Employment Minister Esther McVey has been appointed to the role of Deputy Chief Whip.

    Priti Patel also resigned as International Development Secretary over her unauthorised meetings while on holiday in Israel. She has been replaced by Penny Mordaunt.

    In other changes:
    • Transport Minister Lord Callanan has been appointed Brexit Minister.
    • Lord Henley has been appointed Business, Energy and Industrial Strategy Minister.
    • Scotland Office and Wales Office Minister Lord Duncan of Springbank has become Scotland Office and Northern Ireland Office Minister.
    • Communities and Local Government Minister and Wales Office Minister Lord Bourne of Aberystwyth has been appointed Communities and Local Government Minister and Wales Office Minister.
    • Former Whip Baroness Sugg has been appointed Transport Minister.
    • Baroness Stedman-Scott has become a Government Whip.
    • Home Office Minister Sarah Newton has become Work and Pensions Minister.
    • PPS to the Leader of the House of Lords Baroness Evans of Bowes Park Victoria Atkins has become Home Office Minister.

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Ageing and wellbeing

Wellbeing and exercise

  • Teaching health and social care to professionals such as pharmacists and ‘Meals on Wheels’ staff to deliver exercise interventions, could be key to curtailing the UK’s growing ageing crisis. A new report from ukactive and Life Fitness says innovative solutions for keeping older people active and independent could save billions of pounds in NHS and social care costs by preventing disease. Looking at ageing in residential care, at home and in the community, the report notes the effects of ageing and loss of fitness are often conflated, placing older adults at greater risk of ill health due to the widely-held belief they should ‘take it easy.’  The authors recommend a National Activity Therapy Service (NATS) that would see signposting to physical activity opportunities and practical advice on how to be more active feature in every contact between carer professionals and patients. The service would also see specially-trained exercise professionals embedded into GP centres. Professor Sir Muir Gray CBE, Chief Knowledge Officer to the NHS, said: “There’s an answer to ageing and it’s called physical activity. By maintaining good fitness levels throughout our later years, we can protect ourselves against many of the diseases commonly associated with old age – such as heart disease, type-II diabetes and dementia – to live ably and independently at home.”

  • Research by Anchor and the Centre for Future Studies, suggests automated checkout machines and lack of seats in shopping centres or on High Streets are putting off older people from going shopping adding to loneliness and isolation. They predict up to £4.5bn annual losses by 2030 if retailers continue to fail to attract the “grey pound”. The study suggests 24% of older people are deterred from shopping by automated checkouts and 60% are worried that there will be a lack of seating if they need to rest. CEO of Anchor, Jane Ashcroft CBE, says: “Going shopping is something most of us take for granted and yet many thousands of older people feel excluded from our high streets. This is an issue not to be overlooked, as it increases older people’s isolation and loneliness, in turn affecting health and wellbeing. It’s also important for retailers who are missing out on huge amounts of revenue. We must value older people - everyone should have the chance to live life to the fullest, regardless of age.”

  • GPs should be advising older people to engage in physical activity to reduce their risk of cardiovascular disease, according to researchers from Cambridge and Amsterdam. The study conducted by the researchers found that in patients aged 65 or over who were moderately inactive, the risk of cardiovascular disease fell significantly by 14% compared to those who were completely inactive. Risk also fell by 13% and 12% in elderly patients who were moderately active and active respectively. Dr Sangeeta Lachman of the Amsterdam Medical Centre said “Elderly people should be encouraged to at least do low intensity physical activities such as walking, gardening, and housework. Given our ageing population and the impact of cardiovascular disease on society, a broader array of public health programmes are needed to help elderly people engage in any physical activity of any level and avoid being completely sedentary.”

Loneliness

  • Derbyshire Trusted Befriending Network  has published findings of new research into the value and impact of voluntary befriending services. The report, Befriending in Derbyshire, has found that loneliness and isolation does not just make people unhappy - it also has a serious impact on physical and mental health and life expectancy. Those who receive support from Befriending Services say that it reduces isolation and improves their social and community connections, independence and wellbeing. They also found that for every £1 spent on providing volunteering the social benefits and cost savings to other services are worth £8.59.
  • As part of its annual Companionship at Christmas campaign, care homes belonging to Abbeyfield Society will open their doors for six weeks to provide overnight stays, meals and entertainment for people affected by loneliness, completely free of charge.
  • Also see the House of Commons debate led by Rachel Reeves MP on loneliness.

MHA comments: 

Retirement 

  • A combined study by the British Household Panel Study and Understanding Society followed people aged 50–69 years old from 1991 to 2015.  It suggests that more and more people are “un-retiring”, finding that almost one in four retirees returned to paid work. Mostly people unretired quickly, within about four to five years, although once somebody has been retired for around ten years, their chances of returning to paid work were low. This research highlights how many retirees are ready to be reengaged in the workforce and that Government and employers should not forget about them.

  • The International Longevity Centre - UK have published a 'State of the Nation' factpack When I'm 64 that explores retirement transitions and compares the experience of today’s 64 year olds with earlier generations. Inequalities in life expectancy after 65 by LA area have been rising, particularly for women. These inequalities are strongly related to local differences in health and disability, education, skills and training and employment. The average healthy life expectancy for those at 65 in the ten-worst performing English LAs is 7.4 years. In contrast, the ten best performing LAs have an average healthy life expectancy that is almost twice as long at 13.6 years. Tower Hamlets is the worst performing LA with only 6.5 years of healthy life expectancy at 65, while Richmond upon Thames is the best performing LA with 14.5 additional years of good health expected. Ben Franklin, Head of Economics at ILC-UK said “This year’s factpack shows that in some areas, such as life expectancy, we continue to be making gains, but that these gains have not been shared by everyone. Supporting longer, healthier lives must be a critical priority for government and employers. Only through such an effort will we be able to succeed in a number of key policy areas, such as: raising State Pension Ages and securing a sustainable health and care system. Moreover, given the tightening of the labour market, and uncertainty over future migration policy, it is more imperative than ever that employers find ways to retain older workers”.

  • The Centre for Ageing Better has commissioned a multinational team, led by Dr Martin Hyde from Swansea University to carry out a rapid evidence review and data analysis on the experience of the retirement transition. Although many people are working for longer and there has been an increase in self-employment. This evidence review will help to give a better understanding of how people experience this transition. Aideen Young, Evidence Officer, Centre for Ageing Better said “While retirement is widely considered to be a time of relaxation and leisure, this is far from reality for many individuals. This transition can be difficult and stressful. It can result in the loss of structure and social contacts provided by work with an attendant loss of identity, purpose and social support.”

  • Another research report from the Centre for Ageing Better Addressing worklessness and job insecurity amongst people aged 50 and over in Greater Manchester raises concerns about the chronic worklessness experienced by the over 50s, with data showing this age group experience an ‘unemployment trap’ – they are more likely to be out of work than younger age groups, and once unemployed they struggle more than younger jobseekers to get back into employment. Currently, almost 3.6 million (33%) 50-64 year olds in the UK are not in work. Within this, 27% are recorded as not engaged in the labour market in any way. An estimated that around 1 million of the over 50s who are out of work left employment involuntarily due to issues such as ill health, caring responsibilities or redundancy.  Jemma Mouland, Senior Programme Manager at the Centre for Ageing Better, said “Too many older workers are currently being pushed out of the workforce because of poor health, caring responsibilities or redundancy. Once they have lost their job, over 50s struggle much more than any other age group to get back to work, which is costly personally and financially for them, with impacts lasting well into later life. Given that we are all working for longer and our workforce is ageing, we need urgent action to break this vicious circle.” The research highlights three key areas where progress can be made;  National government - increased flexibility in the benefits system and rethinking services to reflect the complex challenges that over 50s face in returning to work; LAs - integrating employment, skills and health support offered to older job seekers from statutory and community services and ensuring it is tailored to their personal circumstances; and Employers - offering flexible job opportunities and taking a positive approach to recruiting older workers.

In brief: 

  • The Guardian reports that the ageing crisis facing Britain, the US and other wealthier nations could be partly addressed by adopting initiatives being developed in poorer countries.  Low and middle income countries have been forced to be “innovative and ingenious” in finding low-cost and effective solutions for to address the challenges of their ageing populations. Some of the initiatives include: Chile - has devoted an entire city to experimenting with older people's care; Brazil - increasing the involvement of older people in democracy through old people’s councils; south-east Asian nations - training volunteers in older people's care; Finland and South Korea - establishing job creation schemes for older people.

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Dementia

Care, support and wellbeing

  • The Beth Johnson Foundation has published Experiences of Being, which explores the positive effect of using drama, music and dance in care homes especially in helping people living with dementia. In partnership with Anchor, the study provided activity workshops which found that creative activities can soothe and stimulate at the same time, bring back memories from the past, and help to engage under-used but still active areas of the brain. The benefits included improved wellbeing and an increased quality of life. The workshops strengthened the self-esteem and self-confidence of residents, while musical activities helped improve cognitive ability and memory recall. On a physical note, the sessions inspired increased movement and physical exercise from residents through the encouragement of dance or subtle actions with hands or feet.

  • A new practice guide Dementia Pathways – Housing’s Role has been launched to help housing practitioners offer suitable support to people affected by dementia. The guide is one of the outputs from a larger research study on housing’s role in dementia carried out for CIH Scotland. It provides recommendations covering four separate pathways, each representing one of four key stages in a typical dementia journey, namely: assisting and supporting early diagnosis; early assessment of the suitability of the home of someone living with dementia; enabling a person with dementia to remain at or return home quickly; and ensuring holistic consideration of assistance and support as dementia progresses. For each pathway, the guide considers the role of housing within that stage, provides examples of emerging practice from the sector and a checklist of what housing practitioners should know and do, before concluding with a series of practical recommendations for how housing practitioners in Scotland can make a real difference to people affected by dementia, their families and carers.

  • New research from The University of Manchester is showing how being connected with their local community has reaped enormous benefits for people with dementia. The research is part of a five year study investigating how people living with dementia, and their partners, experience their local neighbourhoods. The findings suggest that familiarity with people in local shops, cafes, local streets and acts of kindness by neighbours, such as taking the bins out each week, has a huge effect on their wellbeing. The researchers also found that people with dementia could have a valuable role in their neighbourhoods by ‘keeping an eye’ out, collecting newspapers and caring for grandchildren. Fifty-six people -29 with dementia and 27 Family carers - from across Greater Manchester were interviewed about their experience for the study. Research Associate Sarah Campbell said: “These findings together indicate how the neighbourhood operates through a series of links between people and place from the dementia café, to the local newsagents, and the neighbour two doors down… understanding the nature of support available in neighbourhood settings is crucial to ensuring everyone affected by dementia is able to live life as best they can. Routines and habit are also an essential part of everyday life in connecting people to their neighbourhoods and to others. Such as using the same routes to walk the dog, or visiting the same café or attending dementia peer support groups.” 

  • Puzzler Media has joined up with dementia specialists Unforgettable to launch a bespoke magazine to engage and occupy people living with dementia and their carers. Puzzles & Pastimes includes a range of activities to suit those living with dementia – in its early and mid-stages. The specially designed content includes puzzles, colouring and other activities, alongside nostalgic images and easy recipes designed to stimulate the mind – subsequently sparking memories and conversations. A detachable booklet for carers is included, containing practical tips and advice on how their loved one can get the most out of the puzzles and other activities. Puzzler Media’s Publishing Manager Mark Whiteway said, “Some readers resort to children's puzzles as their sight and memory deteriorate, so we wanted to produce a dedicated magazine that would allow solvers to enjoy the benefits of puzzles for as long as possible, whether alone or in the company of a carer.” James Ashwell founder of Unforgettable.org addedThere are very few printed products designed to engage, stimulate and occupy those living with the condition, so we were delighted to team up with Puzzler Media.”

    MHA comments: This will be of interest to all our services working with people with dementia.

Prevention

  • According to a new study from University College London, the risk of developing dementia is around 3.5 times higher in frail older adults than in their non-frail peers. The study found that frailty affects around 17% of older adults in England and those who were frail at the start of the study had a greatly increased risk of developing dementia over the next ten years. The findings also revealed that adults on the verge of becoming frail already had almost twice the risk of developing dementia. Lead author of the study, Dr Nina Rogers said, “Dementia is very difficult to manage, so the best thing we can do is to find ways to delay its onset and to slow its progress. We know that there are simple things you can do to reduce the risk of frailty, like doing lots of physical exercise, so those are the things to focus on because the knock on effect might lead to a reduction in the risk of developing dementia.” The researchers analysed data from 8,722 participants from the English Longitudinal Study of Ageing (ELSA). The people who participated in ELSA were followed-up every two years over a 10-year period. 

  • The Department of Health has launched a Dementia 2020 Citizens’ Engagement Panel online hub. The hub aims to act as a portal to enable people take part in the research. It is open to anyone who lives in England and has had a diagnosis of dementia or are the carer of someone with dementia.

MHA comments: This will also be of interest to all our services working with people with dementia, giving an opportunity for them to participate in research and share their experiences.

In brief: 

  • The National Association of Local Councils (NALC) has signed a strategic plan with the Alzheimer’s Society in a bid to help local communities fight dementia. As part of the plan, NALC it aims to help members to develop the awareness, skills and understanding needed to recognise and support people living with dementia. It also aims to improve the safety and wellbeing of people living with dementia in local communities.

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Finance and pensions 

Older people's income 

  • A report for the Intergenerational Commission, As good as it gets? The adequacy of retirement income for current and future generations of pensioners focuses on recent strong growth in the incomes of pensioner households and reductions in pensioner poverty, compared to weaker incomes for current working age households and the challenges younger generations are facing in accumulating wealth. It suggests that anxiety is building that current retirement outcomes may not be sustained for future generations of retirees, as their prospects are particularly uncertain given both the big shifts in pensions policy currently in train and the fiscal costs associated with rising longevity and the baby boomer generation entering retirement. This report presents detailed findings on the adequacy of retirement incomes for recent cohorts of retirees in Great Britain, along with projections of future adequacy both across and within generations for all of today’s working age adults.

  • The House of Commons Library has published a briefing paper giving an overview of the main issues currently raised in connection with Pension Credit, including the fact that in 2015/16 around 1.4 million households entitled to it, did not claim it - totaling £3.3bn in unclaimed benefit.

    See the Government Finance and Pensions section for more policy news

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Health  health staff graphic

Delayed transfers of care

  • The latest statistics for delayed transfers of care, suggest Government targets for reducing delayed transfers of care look set to be missed despite figures falling to their lowest levels since April 2016. In September the total number of delayed days was 168,302, 14.5% lower than September 2016 and in the past two months, the number of delayed days attributable to social care has fallen by more than 10%. Experts welcomed the reductions but warned they were “unlikely” to free up enough beds for winter or to meet targets.

  • The NHS is to open its first Accident & Emergency unit for older people at the Norfolk and Norwich University Hospital. The new unit aims to ensure quicker assessment of patients aged over 80 by specialist geriatricians and nurses, in a bid to ensure they can be given the right help as quickly as possible. The new unit estimates it will see around 50 patients a day. Dr Frankie Swords, head of medicine at the trust, said "For older patients, we know that the earlier we can assess a patient, the quicker we can get them back to full health, regain their independence and avoid hospital admission.”

Health and Social Care Integration

  • The CQC has published its Local System Review for Stoke-on-Trent, to understand how people move through the health and social care system, with a focus on older people aged over 65. It found that older people living in Stoke-on-Trent sometimes have poor experiences of care and do not always have access to the right care, in the right place at the right time because the health and social care system, led by Council and Clinical Commissioning Group, is not working in a joined up way that is meeting their needs. They were not working to an agreed, shared vision and there is a lack of whole system strategic planning and commissioning with little collaboration. This meant that:
    • People found it difficult to access a GP appointment in a timely way and as a consequence many people went straight to A&E or were referred to A&E by their GP.
    • Older people often had poor quality experiences when they were admitted to hospital, including long waits in A&E before being admitted to a ward that met their needs.
    • Older people were often delayed in hospital after they were ready to return home or move to a new care setting.
    • People’s needs and care packages in the community were not reviewed as regularly as they should be. This meant that people may have been at risk of entering into crisis if their needs had changed. It also represented a missed opportunity when people’s conditions might have improved, to release capacity in home care services that could be used to support other people who need care.

    MHA comments: This will also be of interest to our colleagues in our Claybourne care home in Stoke on Trent.

  • NHS Employers and the Sustainable Development Unit will co-deliver a new campaign in 2018, aiming to give health and social care organisations an opportunity to work together to share effective sustainable practice, and support the sector in raising the profile of interventions that deliver health and efficiency benefits across the NHS, public health and social care. The campaign will feature a range of engagement activities in 2018, including regional events, templates, digital assets to support local activity, and an opportunity to submit examples of good practice in time for the Sustainable Health and Care Awards in September 2018.

Funding

  • Think tank, the Institute for Public Policy Research (IPPR) has published a report Mind the gap: The case for more funding for health and care, exploring the impact of austerity on the NHS and social care. It highlights that the NHS is well into its most austere decade ever, whilst funding for social care has declined every year since 2010. The system has attempted to respond to this crunch in resources by increasing productivity – which it has done – but there is now overwhelming evidence that it is also resulting in growing deficits; increased waiting times and the re-emergence of rationing. This paper argues that without further investment in health and care there the health and care service will continue to lag behind the curve. Better quality care will be technically and scientifically possible but will not be delivered without an increase in funding. The evidence suggests that the combined funding gap in health and care will increase to £8.4bn in 2020/2021 and £28.6bn in 2030/31.

Technology

  • An evaluation study of online GP consultations, suggests the use and effectiveness of them are "limited". The study, carried out by the University of Bristol, evaluated eConsult - where patients can submit their symptoms to a GP electronically - piloted in 36 GP practices across Bristol, North Somerset and South Gloucestershire. It discovered 38% of the online consultations led to a face-to-face contact and a further 32% led to a phone consultation, to be able to reach a clinical decision. However, it also found that usage was low with two online consultations per 1,000 patients, with usage also lowest out of hours, especially at the weekend. It concludes, that online consultations were not an immediate solution for efficiency savings, but could improve access for some patients, the researchers found. Some of the issues they found were due to limitations of the eConsult system itself, which has potential for improvement. Other issues were associated with the way practices advertise and implement these types of systems. Dr Jeremy Horwood, said: "While our study focused on a particular system in a regional GP consortium, there are lessons here for any GP practice considering moving to an electronic consultation system. There is a central government drive to move to these systems. However, our research shows that they need to be carefully implemented and effectively marketed to yield the benefits that politicians are hoping for. Online consultations may have value for some patients, such as straightforward medical enquiries, but they cannot replace face-to-face consultations in situations which are more complex."

  • Meanwhile, a 24-hour service has been launched for NHS patients in greater London, offering GP consultations via videolink on smartphones. The pilot scheme aims to enable patients to check their symptoms through the mobile app and then have video consultations within two hours of booking. The new free service has been launched by a group of London GPs and the online healthcare provider Babylon. Patients joining will leave their existing practice, with their records transferred to a group of five central London surgeries. The Royal College of GPs has warned the service may not help patients with complex needs. Prof Helen Stokes-Lampard, said: "We are really worried that schemes like this are creating a twin-track approach to NHS general practice and that patients are being 'cherry-picked', which could actually increase the pressures on traditional GPs based in the community. We understand that with increasingly long waiting times to see a GP, an online service is convenient and appealing, but older patients and those living with more complex needs want continuity of care and the security of their local practice where their GPs know them." 

In brief:

  • The number of applications to detain people through Deprivation of Liberty Safeguards (DoLS) for their own safety has reached the highest level on record. New figures from NHS Digital show that applications in England reached 217,235 during 2016/17, an increase of 11% and the highest since they were introduced in 2009. Meanwhile, thousands of applications have taken more than a year to be completed - despite the recommended time-frame of just three weeks. The reported backlog of cases that were not completed as at year end increased by 7% to 108,545 over the year. 

  • The University of Aberdeen is to lead the first audit of specialist geriatric medicine services for older people in Scotland in collaboration with Health Improvement Scotland and the British Geriatrics Society. Despite older people being a major user group of acute medical and surgical services in the UK, the detail has not been systematically assessed throughout Scotland. The overarching aim of Scottish Care of Older People (SCoOP) is to provide information that can be built upon for better understanding of standards of care and areas for improvement. This will provide benchmarking tools to further improve the care standards for older people across Scotland for the benefit of patients, public, NHS and policy makers. 

  • The OECD (Organisation for Economic Co-operation and Development) has published its Health at a glance 2017 report, outlining the latest comparable data and trends on different aspects of the performance of health systems in OECD countries. The analysis of the UK health system finds that the overall health of Britons is similar to the OECD average and that access to care is generally strong but that the indicators for quality of care are below the OECD average. 

  • New Philanthropy Capital have published new research Keeping us well: How non-health charities address the social determinants of health, exploring how charities addressing issues such as housing, education, friends and communities, family, employment, money and resources, are increasingly recognised as the important drivers of health outcomes and life expectancy.

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

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Housingsmall building image

Health and Housing

  • A new report from the Centre for Ageing Better, The role of home adaptations in improving later life has evidenced that making small changes to older people’s homes, such as installing handrails, ramps and level-access showers, alongside carrying out simple home repairs, could play a significant role in relieving pressure on the NHS and social care and reduce costs by millions of pounds each year. It argues that making these kinds of small changes to homes earlier, alongside repairs to homes, should be a greater priority for local services, and could help to avoid or delay use of NHS and social care. It includes new analysis from the Building Research Establishment showing that, installing home adaptations and undertaking home repairs in order to reduce falls on stairs, can lead to savings of £1.62 for every £1 spent, and a payback period of less than eight months. Installing minor home adaptations and making improvements to housing can lead to overall savings of at least £500m each year to the NHS and social care services in the UK through a 26% reduction in falls, which account for over four million hospital bed days each year in England alone. 

    An accompanying report Room to improve: The role of home adaptation in improving later life summarises the findings of a systematic review of the best recent scientific evidence on how home adaptations can contribute to improving later lives. Home aids and adaptations can also increase people’s ability to perform everyday activities by 49%, and reduce depressive symptoms by 53%.

  • A Housing LIN case study focussing on housing and health from Caerphilly-based housing association United Welsh, explains how a new wellbeing partnership between United Welsh and Cardiff and Vale University Health Board called Wellbeing 4U, is drawing from housing expertise to improve the patient and GP experience across 25 surgeries in Cardiff and Barry. The project uses a Social Prescribing model, involving the team co-locating in GP surgeries with the aim of delivering public health priorities through social intervention, therefore assisting GPs and patients to improve their health and wellbeing.

  • Also news on a new practice guide Dementia Pathways – Housing’s Role has been launched to help housing practitioners offer suitable support to people affected by dementia.

Supported housing

  • Another case study from the Housing LIN Kindliness – developing peer support within Sheltered Housing in Dorset, outlines interventions which can be used to engender a culture change to optimise peer support and kindliness in sheltered housing environments.

  • In addition, the Housing LIN also takes a look at Your Homes Newcastle’s new older people’s housing scheme, Tree Top Village in Walker, Newcastle. Walker is a post-industrial community, which has been devastated by the demise of coal and heavy industry and the collapse of shipbuilding and power generation manufacturing. Numerous initiatives to regenerate the area over the last 25 years have struggled to arrest the decline. Tree Top was designed to become the centre piece of the wider Walker Regeneration Programme.

  • The Chartered Institute of Housing have launched a major new project by aims to help shape the future of social housing. Rethinking social housing, aims to explore fundamental questions about the future of social housing by understanding and challenging the perceptions of social housing; stimulate a wide-ranging debate about the future of social housing; make the case for social housing; and influence and shape the direction of future housing policy and feed directly into the Government’s social housing green paper. Terrie Alafat CBE, CEO of the Chartered Institute of Housing, said: “The government has committed to conducting a top-to-bottom review in its green paper but we want people who live and work in social housing to lead the debate about where it goes next.” The sponsors of the project are Sovereign, Home Group, Peabody, InCommunities, Optivo, PA Housing, Riverside Group and South Liverpool Homes. 

Older people's housing - investment and design

  • Research from think tank Demos, Unlocking the Market, has explored the options available to encourage greater demand for and supply of retirement housing, including care villages and extra care housing. It has considered the ways in which older people can be encouraged to move into these forms of housing, including financial incentives; as well as the financial factors which currently thwart supply – in particular focusing on the impact of the current CIL and s106 regimes on the viability of retirement housing schemes and the options for their imminent replacement. The project involved qualitative research with citizens and experts as well as evidence assessments and economic modelling. The research has found that:
    • Development taxes (Section 106 and CIL) are scuppering retirement housing development
    • There is evidence of a looming crisis in the supply of housing for older people, as current policy favours developers building starter properties, rather than also supporting older people to downsize
    • Focus groups with older people found widespread support for policies to help them downsize, including stamp duty exemption; practical help with moving; and opportunities to “try before you buy”
    • Economic modelling, showing the impact of planning charges on the viability of retirement developments concludes only an exemption from these charges will tackle chronic under-supply in the face of significant and rapidly growing demand.

  • The Housing LIN have published An Occupational Therapist’s Access Checklist – a Practical Tool, which has been developed as a quick reference tool, to support decisions when making recommendations for the design of accessible and inclusive housing, when there may be a case to be made for exceeding the minimum requirements laid out in the Building Regulations. It provides comparative information from a selection of design guidance on access specifications for dimensions and layout, from minimum requirements to more generous provision. It is arranged as a list that details specific aspects of accommodation from the parking and approach to communal access, and internal layouts. 

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Social Care

Care Home Market Study

  • The Competition and Markets Authority (CMA) has published its final findings following a year-long market study of the residential care homes. It reports that:
    • The current system for providing care is not sustainable without additional funding. The CMA’s financial analysis of the sector has identified a funding shortfall of £1bn a year across the UK because councils are paying fee rates for the residents they fund which are below the costs care homes incur. 
    • Beyond the challenges of continuing to meet existing needs, the sector must grow substantially as the population ages. However, uncertainty about future funding currently means that there is not enough investment in new accommodation, particularly for council-funded residents.
    • Many people choose care homes during an emotionally traumatic time, but the basic information and support needed is often not available to help them navigate the system and make informed choices.
    • There needs to be greater protection in place for people in care homes. Residents and their families often find it difficult to raise concerns or make complaints, and the systems for redress and feedback need to be improved. There is also too great a risk of residents being treated unfairly, and in breach of their rights under consumer law. 
    As a result, the CMA is taking direct action under consumer protection law, and has also made a range of recommendations to government and others. These include:
    • Taking enforcement action and raising concerns with some care homes, who charge large upfront fees that are not fair or transparent, and charging families for extended periods of up to 4 weeks after a resident has died. An investigation is ongoing into some care home providers.
    • The CMA will also be consulting on new guidance on fees charged after death, along with separate, wider guidance for care homes on the standards of behaviour that they should be meeting to comply with consumer law. 
    • Better long-term planning and oversight. For sufficient new care homes to be built, planning and commissioning by councils must improve to give investors greater confidence in the funding environment. The CMA is now calling for an independent body to oversee and support planning at a council level in England and Northern Ireland.
    • Better support for families and prospective residents. More support is needed to help people make informed choices. 
    • More effective consumer protections for residents and easier complaints processes. 

MHA comments: We have contributed evidence, experience and views to the CMA, thorughout the period of this study. We welcome the recognition that many LAs are paying fee rates that are well below the real cost of care and the need for more sustainable and confident environment for the development of new care homes. We work hard everyday to support potential residents and their families to choose the right home and the right care for them and welcome any steps that help people navigate the system more easily. 

Funding

  • An interesting analysis by the BBC asks Have there been two decades of failure to reform social care?, which explores what previous Governments have done (or not) to address the growing crisis in social care. It follows the lack of reference to social care in the Autumn Budget 2017, “A politically-charged Budget has passed with no mention of social care, despite a growing sense in recent years that the system of support for older people and younger disabled adults is on the point of crisis… For the past two decades, successive governments have known something needs to be done. They've published at least 300,000 words in formal consultations, policy papers and commissions on the subject. But little radical change has been made to a system many agree needs to be completely rethought.”

    The London School of Economics have also published a blog on the issue, The UK’s problem with long-term care: short-term thinking. “Long-term care is a policy chestnut which seems to resurface every couple of years, under UK governments of all colours. Each time there is extensive analysis and review undertaken; much handwringing about how costly any approach will be; and various options are considered and rejected. Green Papers, White Papers and even legislation may follow, before the process grinds to a halt once more, and the issue is parked in the ‘too difficult’ red box until such time as it becomes expedient to have another go. So here we are again…”

  • An increase of 1% to National Insurance (NI) contributions could bring in £5bn of funding to help bolster the struggling social care sector. In a paper by Independent Age and think tank IPPR compared NI contributions to increasing inheritance tax, removing the triple lock on pensions and means-testing the Winter Fuel Payment. Increasing contributions would cost the poorest working-class families in Britain around £20 each year while the richest 10% in the country would see an extra £1,220 in contributions. Means-testing the Winter Fuel Payment would raise just £1.8bn - not enough to plug the funding gap. In addition, moving from a triple to a double lock on pensions would create no immediate additional revenue.  

  • Further research from Independent Age and the Institute and Faculty of Actuaries (IFoA), suggests that nine in 10 people who pay for their own care in England would not benefit if the ‘cap’ on care costs, currently set at £72k went ahead. Set at this level, would take a typical pensioner over 6 years to reach the cap, which is double the average life expectancy for someone in residential or nursing care. The new research examines different scenarios and how over a 10-year period a cap set at £35k, £72k and an ‘all-inclusive cap’ of £100k would affect total care costs for typical pensioner households, compared to the current system of no ‘cap’. If a £35k or £72k cap were introduced, a typical older person would end up paying more than £150k over six years in residential or nursing care and up to £300k over ten years. This is because they would still have to contribute to their daily living costs well after they had reached the cap. However, introducing a cap on costs at £100k that includes all costs of care (an ‘all-inclusive cap’) would benefit up to four times as many people and within two to three years. Marjorie Ngwenya, IFoA President, said: “If the government hopes to encourage people to be prepared to meet some of their social care costs in old age, it must provide clarity around the care cap level along with clear, easy-to-follow guidance on what this covers. In our actuarial capacity, we have looked at the numbers, considered the long-term risk and recommend a higher ‘all-inclusive cap’ of £100k. Our research also reveals that once our proposed cap is reached, it almost eliminates the vast amount of regional variation in the amount people would have to pay towards their care.”

  • The House of Commons Library have published a Research Paper - Social care: paying for care home places and domiciliary care (England), which summarises how care is paid for in England.

Current and future need

  • The Family and Childcare Trust have published findings from their second annual Older People’s Care Survey, estimating that over 4.2 million people aged 75 and over in the UK live in areas that do not have enough care to meet demand. The most severe shortages continue to be felt by the most vulnerable older people. While 81 per cent of respondents in the UK said they had enough availability for care home places, that figure falls to 46 per cent for home care and 37 per cent for nursing homes with specialist dementia support. 

Quality

  • In its annual review the Local Government Ombudsman reports that is has upheld 63% of adult social care complaints in 2016-17, 10% higher than the average across all sectors. The proportion of investigations upheld during 2016-17 rose 5% year on year, while the number of investigations completed – 1,214 – was up 9%. The Ombudsman’s Review of Adult Social Care Complaints reveals councils and care providers implemented more than 1,300 recommendations to put things right for people in 2016/17, making around 180 procedural changes and commitments to train staff on nearly 50 occasions.

  • Analysis of CQC data by consumer watchdog Which?, suggests that more than half of care home places in some parts of England are in facilities rated as ‘inadequate’ or ‘requiring improvement’, according to analysis. It finds that the lack of good quality care is particularly acute in the London borough of Westminster, where seven in ten (69%) beds were found in care homes rated poor or inadequate. In Manchester and Wakefield, three in five beds (58%) are in care homes rated as poor or inadequate, closely followed by Kirklees (57%), Portsmouth (56%) and Tameside (55%).

  • A new quick guide Understanding intermediate care, including reablement from NICE and SCIE aims to help people who use services, their families and carers to understand what they can expect from intermediate care and reablement services.

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

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Third Sector 

Public engagement

  • NCVO has published Getting Involved: How people make a difference report, part of a series of publications aiming to improve understanding of civil society and public engagement. This report looks at who gets involved, how and where people get involved, and whether participation has changed over time. Key findings include:
    1. there is no overall decline in involvement, but trends differ slightly according to activity. While levels of volunteering and charitable giving remain relatively stable, there have been falling memberships in trade unions and religious organisations. Significant growth has been seen in active participation in ethical consumerism which is based more on individual actions and more embedded in people’s everyday lives or driven by lifestyle choices.
    2. Over 50% of the UK population is a member of an organisation, over one in four people formally volunteer once a month, including 700,000 charity trustees, and about one-fifth is involved in social action in their community. Around six in 10 people donate to charity in a year, with a quarter giving every month.
    3. People are involved in a wide range of activities in many different places, at a local, national and international level, within organisations and groups, online and offline. This is not just in the voluntary sector, significant numbers are also engaged in public services e.g. in health and care sector, as school governors and in public libraries. Virtual volunteering has provided people with flexible opportunities to give their time and technology has led to new ways of giving, including crowdfunding platforms, contactless payment and digital currency.
    4. Diversity is an issue. Levels and type of involvement vary a lot according to demographics, with people in higher social grades and a higher level of education being more likely to engage, particularly in more formal activities, such as trusteeships. Despite the growth in online opportunities, the divide continues to exist. There is a need to better understand what drives people to get involved and what prevents them from engaging. A good understanding of individual context and the wider environment is key to the development of opportunities that people are drawn to and able to engage with.

MHA comments: This provides valuable insight into helping MHA shape its volunteering offer.

Fundraising

  • The Christian Opinion Panel, has published findings from is latest Giving Survey (546 respondents), which explores UK Christians’ attitudes to charitable giving. Key findings include:
    • Of the 531 participants that answered the question, 'do you give to charity?' 87% said they do give to charity with only 13% saying they do not, although of those who do not give to charity, 72% of these people said they give to their church.
    • 98% of participants feel that giving to charity is important and most support 1-2 charities, giving monthly.
    • Religious charities and charities that support young people are the most popular amongst our survey participants. 6% respondents gave to older people’s charities
    • Most people were made aware of the charities they support through TV
    • advertising. 79% of survey participants said they were engaged with the charities they support.
    • Almost 1 in 2 of our survey participants volunteer for charitable causes

  • An online survey of more than 2,000 people, conducted by Google on behalf of giffgaff, found that 40% of respondents said that they do not give to charity at Christmas. The study showed that 18% of respondents said they gave up to £10, 14% said they gave between £11 and £20, and 13% donated between £21 and £50 during the festive period. Researchers found that 3% of people said they gave £200 or more to charity at Christmas, with people aged 18 to 24 the most generous individual age group. 

  • Facebook has launched a new tool in the UK that enables people to raise money online. Anyone over 18 can fundraise across categories including education, medical, animal, crisis relief, personal emergency, funeral and loss, community, and sports.  Facebook said: "Personal Fundraisers will make it simple for people to connect with their communities and raise money for the people and things they care about. People can now create a fundraiser on Facebook and easily reach their friends in a few taps with the relevant information." In addition Facebook have announced that it is scrapping fees on charity donations.

  • The Fundraising Regulator's Board have agreed changes to Section 17 on Static Collections (e.g. static collecting boxes - either floor standing or on counters in shops, pubs, hotels, hospitals, reception areas etc) in the Code of Fundraising Practice, in response to the concerns raised by fundraisers including: data protection issues raised as a result of volunteers’ personal contact information being revealed to the public as is currently required; Resourcing issues created as a result of charities having to sign certificates of authority or letters for each individual volunteer; The clear identification of agency/company collectors who undertake static collections on a charity’s behalf; and Clarity over who is responsible for collections and what the Organisations' responsibilities are as a result. The changes aim to allow greater flexibility for charities to determine which contact details (those of the organisation or of the volunteer) are appropriate to provide on their authorisation certificates.

    MHA comments: Any changes to the Code of Fundraising Practice will be of interest to our fundraising colleagues. 

  • A Government-commissioned report Growing a Culture of Social Impact Investing in the UK, suggests that the Government should work with social impact investment organisations to develop an awareness-raising campaign to show people the power they could have in applying their own values to investment choices. The report has been produced by an advisory committee set up to examine how to grow the culture of social impact investment and savings in the UK. It also says the financial services industry should develop consistent standards and more products with the individual investor in mind. The other main recommendations are for Government to strengthen competence and confidence within the financial services industry, develop better reporting of non-financial outcomes and "maintain momentum and build cohesion across initiatives".

Governance

  • New research from the Charity Commission involving around 3,500 trustees, indicates that charity boards are not reflective of the communities charities they serve. The majority (92%) of trustees are white, older and above average income and education and men outnumber women two to one. The research also finds that charity trustees, who are overwhelmingly volunteers, feel positively about their role and about the personal reward and satisfaction it gives them. It also highlights that trustees’ contribution to charities amounts to a monetary equivalent of around £3.5bn a year. 

Regulation

  • Speaking at the NCVO trustee conference, Simon Entwisle of the Information Commissioner's Office (ICO) indicated that the ICO will take a proportionate approach to charities that struggle with the GDPR. "If a deterrent of a much smaller amount has been sufficient in the past for a particular type of breach, we won’t be adding a few noughts to it just because the legislation allows us to." Guidance on the ICO’s approach to fines will be released before the GDPR came into force. He played down concerns about the ICO’s approach to data protection once GDPR was enacted and said that the regulator was not looking to punish organisations unduly. "If you can demonstrate that you have the appropriate systems in place, then you will find the ICO to be proactive and pragmatic, aware of the pressures you are facing in these challenging times," he added.

  • The National Audit Office has published its report on the progress made by the Charity Commission. The report focuses on the progress that the Commission has made since the NAO’s last report in 2015 and says the regulator has made good progress on digital transformation, has sped up its registration processes and its board has become more strategic, but adds "it is important that it continues on this trajectory". The report also says the link between the commission’s key performance indicators and statutory objectives has improved, although reporting could be better, and its approach to managing change is also better. It says the commission is "embracing a risk-based approach, but legacy systems and lack of usable data are barriers to improvement".

See the Government Charity and Voluntary section for more policy news

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Workforce and Skills

Nursing 

  • New figures from the Nursing and Midwifery Council show an increasing number of nurses and midwives leaving profession, a continuation of previous trends. Over the last 12 months the number of UK graduates leaving the profession has increased by 9% and the number joining remains static when compared with the previous 12 month period. The number of nurses and midwives from Europe leaving the register has also increased by 67%, while the number joining the register from the EU has dropped dramatically by 89%.

  • A new Health Foundation report Rising pressure: the NHS workforce challenge has highlighted that national policy and planning for the NHS workforce in England is not fit for purpose. The report also found high staff turnover and instabilityacross the NHS, and a drop in the number of trainee nurses.
    • The NHS workforce increased by 2% in the year to April 2017, but this masks critical variations – a rise in managers and consultants but a drop in nurses (0.2% decrease in the year to April 2017) and GPs (0.7% decrease from December 2016 to end of June 2017).
    • Increasing admissions and decreasing nurse numbers risks overstretching nurses and undermining progress made in nurse numbers since the Francis report. Outside hospitals there have been declines in community nurse and health visitor numbers.
    • 1,220 fewer students had started undergraduate nursing degrees in England this year, based on data from the end of the university clearing round. While the number of 18 and 19 year olds increased, there has been a big fall in older students.
    • The Government is aiming to recruit 2,000 GPs from overseas over the next three years, but just 38 were recruited in the first six months of 2017.

In brief:

  • The Department of Health has begun to work on a project to build a new version of the National Minimum Dataset for Social Care (NMDS-SC), the online service that pulls together a range of data from organisations in the sector.  It has indicated that it regards the existing system as no longer fit for purpose following an earlier examination, and plans to commission a discovery report on a replacement. One of its priorities will be to make it as easy as possible for users to input data. The system makes it possible for anyone in social care to add data – on subjects including pay rates, demographics and qualifications.

  • The Skills Platform, part of Skills for Health, has launched a new free toolkit designed to support those responsible for delivering the Care Certificate to new employees as part of their induction and for upskilling current employees working in health and social care.

    See the Government Workforce and Skills section for more policy news

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Look Ahead: December and beyond

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

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

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

  • 15 Dec: Jo Cox Commission on  Loneliness - manifesto report expected

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

  • 21 Dec - 8 Jan: Parliamentary recess

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

  • Dec: Consultation from the Charity Commission on fee charging for regulation expected

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

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

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

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

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

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

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

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

Events

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

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

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

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

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

  • NCVO Charity Regulation Conference 2018, Monday 5 February 2018, 9.30-17.00, London £162 (early bird) / £180 membership rates
    This event is a chance to for organisations to discuss compliance and legal issues in relation to charity regulation and governance, including speakers from the Charity Commission and the Fundraising Regulator.

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Some information sourced from DeHavilland

 
 

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