Policy News

MHA Policy News is a monthly round-up of policy and research news and issues, relating to older people. Topics covered include:

• Government policy and legislative changes (including Brexit, Elections, Party Conference coverage)
• Ageing (including wellbeing and older workers)
• Dementia
• Finance and pensions
• Housing
• Health
• Social care (including related regulation and local government news)
• Third sector (including fundraising and volunteering)
• Workforce and skills issues

To subscribe and have MHA Policy News delivered by email each month, please contact us at policyandresearch@mha.org.uk

 

MHA Policy News August 2018

This month’s hot topic is that the Local Government Association has published it’s own consultation on social care ahead of the Government’s Green Paper. The NHS have opened a consultation ‘Developing the long-term plan for the NHS’ which ties in with the additional funding that has recently been pledged to the NHS Housing. This month sees the Government’s much delayed Social Housing Green Paper being published and linked to a consultation. The number of people aged 85 and over needing 24hr care is set to double by 2035 and the Government has launched it’s Civil Society Strategy to enable charities to play a bigger role in the provision of public services.

Useful insight is that according to recent research there could be 115,000 fewer social care workers if freedom of movement is limited after Brexit. The Royal College of Nursing has launched multi-agency guidance to help healthcare staff understand their safeguarding responsibilities to protect those at risk of abuse. The RIBA have published a document that looks at age friendly house design and includes intergenerational shared living. Other countries have ‘more progressive systems’ than England regarding social care provision according to recent research and whilst charities agree that diversity is an important topic for senior leadership but they do not often show this in practice.

It’s good to know that the new Older People’s Commissioner for Wales, Helene Herklots, has started her appointment and wants to make Wales the best place in the world to grow old. The national campaign to end ‘pyjama paralysis’ has helped cut the length of time many people spent in hospital. It’s good to know that the Midlands Voluntary Right to Buy Pilot was launched this month for social housing association tenants. NICE have published a guide for home care managers regarding record keeping and ordering medicines and major regulatory changes about the disqualification of trustees came into force on 1 August 2018.

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MHA Policy News July 2018

This month’s hot topics include the fact that Theresa May will be taking over Brexit negotiations with Dominic Raab (Secretary of State for Exiting the European Union) deputising when necessary. The NHS is to receive additional funding of £20.5bn a year as part of a new five-year spending plan towards financial security. Housing and health were originally under the same minister when the NHS was set up and the question is asked whether this should be the case again. The Mental Capacity (Amendment) Bill has been introduced to the House of Lords and will replace the current system known as Deprivation of Liberty Safeguards (DoLs) whilst charity legacy income reached a record high of at least £2.8bn in 2017, partly due to the rise in house prices.

Useful insight is that nine in ten local councils think increased tax is crucial to stabilising the adult social care sector and the funding shortfall. Constipation is the most prevalent bowel management problem in older adults especially during hospital admission which can delay discharge back to social care. An online calendar designed by an architect is being used by housing associations in Manchester to minimise loneliness and increase social interaction. The quality of care has deteriorated in some areas as a result of the increase in the minimum wage according to the London School of Economics and the Directory of Social Change have produced a list of seven top tips for a well-functioning Board.

It’s good to know that the CQC has recently released a report ‘Beyond Barriers’ which draws together the findings from 20 local system reviews and looks at the improvements that could be made. The New Philanthropy Capital (NPC) have produced advice and recommendations on putting the Charity Governance Code into practice whilst the new NHS and social care hubs in Wakefield, West Yorkshire are helping to keep people out of hospital. It’s also good to know that the new Secretary of State for Health and Social Care, Matt Hancock has outlined his three priorities – workforce, technology and prevention.

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MHA Policy News May 2018

There were a number of hot topics this month including that the NHS needs more funding to cope with a ‘technological revolution’ according to Jeremy Hunt. The Kings Fund and Health Foundation have analysed funding pressures for the social care sector and provided some alternative options. The housing industry is being challenged from within the sector to design more age appropriate housing instead of waiting for policy decisions and charities and third party fundraisers must have a clear complaints procedure according to the revised Code of Fundraising Practice. The Prime Minister, Teresa May has announced plans to publish a White Paper setting out the details of the UK’s position on Brexit.

Useful insight is that the Scottish Government is bringing forward energy efficiency targets by a decade. Also Care England has initiated 152 Freedom of Information requests to councils regarding commissioning activity. Older people are not the age group that gives most to charity, despite them being the focus of many fundraising campaigns, whilst the Older People’s Commissioner for Wales has found that older people across Wales are often unable to access advocacy services. An interactive map has been developed looking at provision to reduce delays in transfer.

It’s good to know that social landlords are using technology to enable residents to live independently for longer and that Skills for Care has updated its ‘Good and Outstanding Care Guides’ to help care providers improve their services. The Information Commissioners’ Office could be granted the power to carry out surprise inspections under proposed changes to the Data Protection Bill. Various hospitals are encouraging patients to get out of their pyjamas and get dressed in a 70 day challenge and the Scottish Government has published a bill to ensure nurse staffing levels are safe for the NHS and care providers.

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MHA Policy News April 2018

This month’s hot topic is that the National Audit Office has said the Treasury failed to account for the whole EU budget, possibly increasing the cost of Brexit by at least £10bn. As many as 350,000 NHS patients may be entitled to ‘personal health budgets’ which would give them the right to select and pay for treatments they want or need and the Social Care Minister, Caroline Dineage has hinted more short-term funding may be available. The Fundraising Regulator has released guidance on new audit requirements and according to recent research, planning rules are fuelling a housing 'crisis'.

Useful insight has come from the Government’s recent defeats in the House of Lords regarding the EU Withdrawal Bill. NICE have developed guidance for recipients of care to know what to expect and recent research has highlighted that different areas in the country are ageing differently, even at city level. The Social Change Agency is looking into ineffective digital campaign tactics and encouraging changes. The NHS needs £50bn more by 2030 in England according to Lord Darzi, a former health minister and leading surgeon.

Good to know that the Welsh Government has increased the limit of savings that people can retain before having to self-fund residential care costs. Poor housing is estimated to cost the NHS £1.4bn per year. A Citizens Assembly on Social Care will be created as part of the funding inquiry. The Charity Commission has introduced changes to the Annual Return Update which includes reporting on the rewards and benefits received by Trustees. A humanist chaplain has been appointed for the first time to lead a team of NHS chaplains and volunteers.

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MHA Policy News March 2018

The hot topics this month include Jeremy Hunt’s speech on the forthcoming Social Care Green Paper, his seven key principles and his suggestion of a longer term funding strategy for the NHS and social care. It also includes research into the issues of older people's housing and the expected shortage of appropriate housing. The Institute of Fiscal Studies has forecast that adult social care spending pressures look set to worsen as council's finances change. The Charities Aid Foundation have published research which shows that recent bad publicity about Oxfam and other aid agencies has barely dented public trust in charities.

Useful insight has come from the National Audit Office (NAO)’s conclusion that one in ten councils face running out of money in the next three years. Also a renewed Memorandum of Understanding (MoU) has been signed by over 25 government bodies and organisations in the health, social care and housing sector to encourage more joint working. The Your Care ratings have been published with MHA’s Mayfield achieving a perfect Overall Performance Rating of 1000 out of 1000 .The Institute of Fundraising has published a guide to major donor fundraising, partly as a response to the imminent introduction of the GDPR.

Good to know that funding for health services in Scotland will increase by more than £400 million next year. NHS England have recently confirmed that Delayed Transfers of Care (DTOC) fell by more than a fifth in January. It has also announced plans to recruit and deploy hundreds of pharmacists into care homes to support more appropriate use of medication. The NCVO has released updated guidance on volunteers and the law, to help organisations understand their legal rights and obligations when managing volunteers. 

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MHA Policy News February 2018

There were several hot topics this month including the Government’s announcement of an extra £150m for adult social care, smart technologies for houses that may help to keep older people safe and independent, and the CQC have completed two Local Area Reviews (Oxford and Plymouth). Marie Curie have published a survey highlighting that some patients are dying alone as NHS staff are too stretched to spend time with them. The recent Oxfam revelations and the subsequent Charity Commission response have also been in the headlines.

Useful insights come from the Chartered Society of Physiotherapy who have found that hip fractures cost the NHS and social care £1bn a year. The Stronger Foundations report includes lessons from other countries regarding successful housing with care models. In addition the NCVO has published it’s annual report looking at political, economic, social and technological (PEST) trends for charities. Almost two thirds of voters support putting an extra 1p on income tax that would be ring-fenced to solve the NHS and social care funding crisis.

Good to know is that the Care Home Open Day is on Saturday 21^st April 2018 and events will be happening across the country. The Minister for Loneliness, Tracey Crouch is looking into a Government fund to support initiatives to alleviate loneliness. Also the NICE and SCIE have published a variety of quick guides based on NICE guidelines and quality standards for care home managers.

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MHA Policy News January 2018

There were several hot topics this month including from Government where loneliness has been elevated into the political arena, as the Sport and Civil Society Minister, Tracey Crouch MP, is now responsible for overseeing Government action on the issue. Also the recent publication of the report from the Commission on Dementia and Music, highlights the benefits of music therapy for people with dementia.

Useful insight comes from Japan, where the city of Matsudo has been implementing city-wide dementia-friendly policies since 2010. It also comes from the All-Party Parliamentary Group on Hunger, which suggests that over one million older people are at risk from malnutrition and proposes ways this could be addressed. The Health Select Committee has published its report on the Nursing Workforce, finding that too little attention has been given to the retention of nurses.

Good to know is that the Public Accounts Committee has published its report on Funding NHS Continuing Healthcare, which criticises the complexity of and access to the process for care home residents. The Competition and Markets Authority have also produced draft guidance for consultation, on charging fees after death in care homes to end bad practice. The blue badge scheme will possibly be expanded to cover people with dementia.

Full article

MHA Policy News December 2017

There were several hot topics this month including from Government, where news came that it has cancelled the introduction of the cap on care costs and plans for significant reform to the leasehold system and proposals to streamline the various housing ombudsmans. The Jo Cox Commission on Loneliness, also published its final report after a year-long campaign on loneliness and called on the Government to create a national strategy with a lead Minister. The CQC also published their latest Local System Review reports, including an interim report following the first six reviews.

Useful insight comes from the publication of the Scottish Government's National Health and Social Care Plan, seeking to develop new ways of recruiting nurses and care workers, and improve workforce planning. The Centre for Ageing Better also published research findings that highlight huge disparities between groups of older people in terms of health, wealth, social connections and housing. Think tank Demos, also published findings from their research on public views of social care, including awareness of how the system works currently, who should pay for it and what funding models could be used in the future.

Good to know is recognition from Housing Minister, on the interdependency of health and housing for older people and plans to ensure housing is a key part of the forthcoming Adult Social Care Green Paper. . Finally, NCVO have launched of a Commission on Charity Tax, which will investigate taxes in the sector for the first time in approximately 20 years.

Full article

MHA Policy News November 2017

There were several hot topics from Government this month including the Autumn Budget 2017 and the publication of the Industrial Strategy, which highlighted the UK’s Ageing Society as one of its grand challenges. In addition, the Government announced its intention to proceed with the regional pilot of the Voluntary Right to Buy for Housing Association tenants. The delay of the Adult Social Care Green Paper was also hot topic - the paper has been delayed until summer 2018.

Useful insight this month came from a report by the BBC regarding poor take up of apprenticeships, since the introduction of the Apprenticeship Levy. Delayed transfers of care (DTOCs) are frequently in the news and the latest figures for September, suggest a reduction in DTOCs compared to the same period in 2016. Other useful insight comes from Demos and their research into the barriers in expanding the supply of retirement housing and from the publication of the Competition and Markets Authority's report following a year-long study into the care home market.
Good to know is an innovative measure to improve the A&E experience for the over 80s in Norwich and are several pieces of research offering up ideas and solutions for how the social care funding challenge could be addressed. NCVO has also published research on the ways in which the public get engaged with the voluntary and public sectors.

Full article

MHA Policy News October 2017

Hot topics this month include the announcement that the Government's plan to introduce a cap to Local Housing Allowance will not be applied to supported housing. The announcement follows recent Parliamentary debate and research published on the issue, which raised concerns about the implications this would have for people in receipt of housing benefit and living in supported housing. More detail of how funding of supported housing will be reformed, has since been announced, with the proposed introduction of 'Sheltered Rent'.

Delayed transfers of care also continues to be a hot topic and this month there a details of both good practice examples, patient experiences and latest data. In addition, there are several pieces of new research and data on the state of the adult social care sector worth a read. In particular consumer research from Which? details people's experiences of looking for a care home, either for themselves or for relatives. It warns that in some part of the country there will be a shortfall of places in the near future.

Useful insight also comes from the Brexit Health Alliance and their analysis of the implications if mutual UK/EU healthcare arrangements ended.

Interesting research this month includes the correlation between maintaining close relationships, the feeling of loneliness and the development of dementia, plus some useful insight from Alzheimer's Research UK who have developed two dementia maps based on Westminster constituencies and Clinical Commissioning Group areas and explore the prevalence of dementia in different parts of the UK.

Full article

MHA Policy News September 2017

September has been a busy month in Parliament and for Government, with several Bills being launched and Committees being re-established. As expected, Brexit is dominating the agenda in the House of Commons and Lords and in Whitehall, however developments have been underway in the data protection and housing world.  The Scottish Parliamentary session also got underway with key developments in health and housing.  From mid-month Party Conference season got underway with the Liberal Democrat and Labour conferences taking place.

This update has information on the latest research from the London School of Economics, which shows that every £1 spent preventing loneliness can save £3 in reduced health costs. The Office for National Statistics,  has also published their 6th annual update on national wellbeing data, which has some useful insight. 

This month's hot topic in Housing is the report from the Local Government Association who have calculated that 400,000 specialist homes for older people will be needed over the next 20 years.  Good to know is the contribution that Housing Associations can make in helping older people out of hospital into homes with the right care and support.

Also this month, research about social workers was published, who have reported that they are struggling to support people in need because of a lack of funding in the system. The British Red Cross, have also criticised the progress of local authorities in implementing their Care Act duties to prevent, delay or reduce the need for care.

Full article

MHA Policy News August 2017

Parliament has been in recess during August, but the Government has been busy publishing various Brexit papers, outlining their proposals for negotiations.  There have also been key announcements regarding Data Protection and the forthcoming General Data Protection Regulations, measures to tackles pension scams and measures to force public companies to publish CEO salaries.

Ageing and wellbeing - Loneliness continues to be a hot topic and the latest research suggesting that it presents a greater public health hazard than obesity. There has also been some useful insight from Public Health England who have published a 'Return On Investment' tool for mental health services and programmes, including those addressing loneliness in older people.

Housing - two reports this month highlight some of the difficulties for people looking to downsize. There is also some insight from someone working on the development of an NHS Healthy New Town in Cambridgeshire, which is considering the needs of older people in every aspect of the development.

Social Care - the Competition and Markets Authority have published some interesting consumer research as part of its care home study, providing insight and experiences of finding the right care home. Healthwatch England has also publsihed research on quality in care homes and home care provision.

Third Sector - there have been numerous insight reports on different aspects of fundraising include gender differences in donations, the success of marketing emails and relationship fundraising.

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MHA Policy News July 2017

Much of July has seen Parliament getting business underway.  There have been some key announcements: the Department of Health announced measures to tackle delayed transfers of care and improve data security in the health and social care sectors; and the news from the Department for Work and Pensions confirming of a rise in State Pension Age being brought forward.  Parliament is now in recess until 5 September, although the Government is still very much active dealing with Brexit and associated issues.  Indeed the Migration Advisory Committee have been commissioned to analyse the distribution of EU migration and the sectors most reliant on it.

Health - there has been continued scepticism about the effectiveness of Sustainability and Transformation Plans, with two separate reviews critising the lack of involvement of Local Authorities and the Voluntary Sector. The National Audit Office, have also investigated and raised concerns NHS Continuing Healthcare (CHC).  

Housing - Local Authority housing plans have been found to be lacking in terms of older people's housing or the ageing population. Meanwhile the social value of social housing has been demonstrated to be worth £486m a year, saving the NHS and social care services millions of pounds.

Social Care - Quality Matters was launched by the CQC, a guidance report, which sets out a single view of quality and a commitment to improvement. The CQC have also published the State of Adult Social Care Services report, which covers three years of inspection reports and highlights quality successes and challenges.

Workforce and Skills - Nursing vacancies are a hot topic again, with two sets of data indicating a 16% increase in NHS vacancies over the past year, and another report highlighting a 44% decrease in District Nurses since 2010.  Skills for Care has also published an analysis of the social care sector workforce, which shows a 19% growth in numbers a the latest projections of what will be needed in the future.

Click here to read the full round up.

MHA Policy News June 2017

June was a busy month in politics with the General Election and subsequent deal between the Conservatives and DUP. The Queen's Speech took place, setting out the legislative programme for the next two years, with a much-reduced programme of legislation due to Brexit. Many key issues of interest to MHA found in the non-legislative announcements.  Brexit negotiations also got underway and the helpfully the Government's published its proposals on the rights of EU nationals after Brexit.

In the Health arena, there came the announcement of new Accountable Care Systems, which look set to control funding and integration in several local areas.  It was also great to hear that the VSCE Health and Wellbeing Alliance is now established an should help develop some better links between the Government and the third sector.

There were also several useful reports published: from JLL who report how retirement living properties hold their resale value; two research reports exploring what older people want from retirement living; and a report that explores the value of sheltered housing in relation to savings in the NHS.

Following the election the focus on adult social care has not gone away, as ADASS publish their latest report on the state of social care from the perspective of Local Authority Directors of Adult Social Care. Useful insight also comes in the form of the update paper from the Competitions and Market Authority study on the care home market.  While we would challenge some of their conclusions, they do highlight some key issues about the funding crisis within the sector. In addition, there are details on a collection of ideas on improving quality in care homes, including the importance of accessing outdoor space, a join approach being taken in Bolton and some new tools on personalisation.

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MHA Policy News May 2017

One of this month's hot topics is the publication of the General Election 2017 party manifestos - in this edition we've summarised the key policy proposals of most interest to MHA.

Continuing to be a hot topic, is yet more evidence of the care funding crisis, with reports from Age UK, Scottish Care, LaingBuisson and the Institute for Fiscal Studies, all calling for action to address the issue for the longer term.

Useful insight comes from two Committee inquiry reports, published just before the end of Parliament: firstly the Work and Pensions and Communities and Local Government Committees, who offer an alternative to the Local Housing Allowance cap in the Future of Supported Housing inquiry; and secondly the Communities and Local Government Committee conclude that in the Capacity of the homebuilding industry inquiry, there is not enough competition between building companies and this needs to change to stimulate the building industry.

Useful insight also comes from an interim report from think-tank Localis, who are looking into health and social care co-ordination.  Their initial thoughts focus on "co-ordination rather than integration" and a desire across all stakeholders for truly person-centred care.

We also came across useful reports that consider the changing pattern of mortgage borrowing and how this will impact on spending power and retirement income in the future.

Good to know is Welsh Government support for Social Prescribing as an important form of intervention. Meanwhile, Halton Clinical Commissioning Group (Runcorn and Widnes) has published its Social Prescribing Manifesto for Wellbeing, which offers a very public commitment to adopting non-medical approaches to improving wellbeing.

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MHA Policy News April 2017

Not unsurprisingly, this month's Hot topic is the surprise announcement of a General Election scheduled for 8 June. However a few other ‘hot’ things were published this month including: an alert from the Charity Commission, following deregulation measures for Housing Associations. And two new reports have been published, which lend more weight for the need of a long term solution for social care funding.

Useful insight comes from news of a proposal for a Health Data Lab to support the voluntary sector in demonstrating their contribution to health outcomes.  There are also some useful case studies of voluntary sector collaboration in health and social care. Independent Age also published analysis, which provides Useful insight into wide regional variations in quality of care across the country.

Good to know In a last minute frenzy of legislative activity before the Election, Royal Assent has been granted to the Bus Services Bill, the Digital Economy Bill, the National Citizens Services Bill, the Neighbourhood Planning Bill and the Pension Schemes Bill - to name a few!  There was also the launch of the UK Collaborative Centre for Housing Evidence.  CaCHE will be led by the University of Glasgow and aims to advance knowledge of the housing market, provide robust evidence to inform housing policy and practice across the UK.

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MHA Policy News March 2017

This month's hot topics included a highly critical report from the Adult Social Care inquiry; the publication of the Next Steps on the NHS Five Year Forward View and the change it will bring. The Law Commission's also published recommendations for changes to Deprivation of Liberty Safeguards and for the introduction of standards for Event Fees in retirement housing.

Useful Insight came from the Social Mobility Commission looking at the 'bank of Mum and Dad' and future home ownership.  There were also detail of several innovative projects trying to tackle the issues of delayed transfers of care. Anchor also reported on the development of an audit tool for specific support for LGBT residents in care homes. 

Good to know - the House of Lords recommendations for stronger charities and the news of research funding worth £2m will help to improve rehabilitation for older people with frailty moving. It was also Good to know  that CQC are introducing of new equality objectives, which will feature in their inspections.

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MHA Policy News February 2017

This month Brexit has continued to dominate the Government's policy agenda, with the EU (Notification of Withdrawal) Bill progressing speedily through Parliament. However the spotlight on the NHS and Social Care funding crisis has remained with several reports making challenging headlines for the Government. There were also a number of favourable and critical reports scrutinising the 44 NHS Sustainability and Transformation Plans. 

Housing also shared some of the limelight with the publication of the Housing White Paper and a new inquiry launched on Housing and Older People. There were also a number of interesting reports focused on retirement living - looking at the impact on longevity, preferences around urban living and specific provision for LGBT communities.

In the Third Sector new guidance has been published by the Information Commissioner's Office and the Fundraising Regulator.

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MHA Policy News January 2017 

This month the focus has been on mainly focused on Brexit, with a key speech from Theresa May, the Supreme Court judgement on Parliamentary involvement and the subsequent EU (Notification of Withdrawal) Bill.  The Government has also continued to face challenges over NHS, particular winter pressures and social care funding.  Meanwhile legislation has been moving forward with the Neighbourhood Planning Bill and the Royal Assent of the Small Charitable Donations Bill.

Findings from the Voluntary Right to Buy pilot evaluation were published this month, with useful insight for shaping the policy as it develops.  There were also a few papers published on older people's housing choice and design.

For the Third Sector focus has continued on fundraising and data protection, with the Information Commissioner's Office continuing to scrutinise practice in the sector. 

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MHA Policy News December 2016

The Government made a key announcement on adult social care funding this month, which resulted in criticism for its short term solution.  There were also a number of evidence sessions on adult social care and the long term sustainability of the NHS. The Competition and Markets Authority also launched a market study of care homes.

In the Health sector, the key news this month has been issues of delayed discharges and developments in the NHS, including the expansion of  the Integrated Personal Commissioning programme and additional funding for new care model vanguards.

Housing and planning legislation progressed, as did the development of recent social housing policy.  There were also proposals for changes to the social housing regulatory body, the Homes and Community Agency.

For the Third Sector, the Fundraising Regulator made an announcement on the detail of the forthcoming Fundraising Preference Service.

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MHA Policy News November 2016

This month the Government published its Autumn Statement. While it was generally viewed as a 'sober' affair, it has resulted in uproar from many across the local government, health and social care sectors, due to the lack of response or acknowledgement for the crisis in funding for social care and the NHS. Numerous papers and research were published to outline the issues facing health and social care, the need for more funding and a different, more strategic approach.  Click here to go straight to a summary of the Autumn Statement.

In addition, Brexit is clearly taking up a lot of the Government's time since the summer and this month was no different with many legal uncertainties and challenges arising.  Several pieces of legislation and inquiries also progressed including the Adult Social Care inquiry, the Apprenticeship Levy, Neighbourhood and Planning Bill and National Citizens Service Bill.

This update also includes a number of reports have been published on the challenges facing the Health sector, including innovative practices on integration and community approaches to healthcare. In the section on Social Care, research is highlighted on public perceptions of the care sector and research on carers.

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MHA Policy News October 2016

Parliament has gained momentum following the Party Conferences in September and early October, with several inquiries and pieces of legislation progressing including the Adult Social Care inquiry, the Apprenticeship Levy, Neighbourhood and Planning Bill and National Citizens Service Bill. This update also details changes made to people in Government, through by-elections, the Shadow Cabinet reshuffle and Select Committee changes.

This update also details the latest news in dementia research, the latest plans in NHS sustainability and transformation and the latest sector analysis.

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MHA Policy News September 2016

Party conference season has meant that Parliament has been in recess for much of September, however some pieces of legislation have been moving forward and new inquiries launched. The Party Conferences have seen new leaders announced and confirmation of policy direction on key matters, although the Conservative Party conference is still yet to take place. Significant research on adult social care has been published and subsequently many in the sector have been lobbying Government, for the crisis in health and social care to be addressed.

This update also has the latest information on the voluntary right to buy and the latest research on hospital discharges from The King's Fund.

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