Hinterland - Friday, 9 February, 2018

This week, we look at the Local Government finance settlement, the challenge of dying at home for rural dwellers, less productive work, digital technology and the NHS, a café for people with disabilities – and disturbing news on rural hedgehog numbers.

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Call for NHS to do more to help terminally ill people die at home

This very interesting article flags up a real issue for those seeking to die at home in rural settings where the challenges of supporting people in this decision are more acute. It tells us:

The government’s health advisers are urging the NHS to do more to help terminally ill patients achieve their wish of dying at home.

The call by the National Institute for Health and Care Excellence (NICE) comes after figures showed that fewer patients were dying in hospital and more were passing away at home or in a care home or hospice.

Almost one in four of the 500,000 people a year who die in England do so at home. According to new data published by Public Health England (PHE) that is the highest figure for 12 years.

In 2016, accounting for all the deaths, 23.5% occurred in the person’s home, 5% more than did so in 2004, PHE said.

The percentage of people dying in hospital fell by 11% over the same period, from 57.9% in 2004 to 46.9% in 2016, according to PHE’s latest end-of-life care profiles.

PHE said the trend showed that more people were choosing to die at home, in the company of relatives and friends.

Research showed that four in five people approaching death wanted to end their days in familiar surroundings, at home, yet many were denied the chance.

“Patients should have the opportunity, wherever possible, to die in the place of their choosing, with their symptoms effectively managed,” said Gillian Leng, NICE’s deputy chief executive, responding to the shift away from deaths in hospital.

The number of people dying in a residential or nursing home also rose by 5%, from 16.8% in 2004 to 21.8% in 2012. The other 5.7% of deaths in 2016 happened at a hospice.

Local government finance settlement: Javid announces £150m of social care funding

This article tells us:

The housing and communities secretary has today revealed details of this year’s local government finance settlement, including £150m of extra funding for adult social care.

Sajid Javid made the announcement this morning, while also unveiling a further £31m for rural services, almost double the amount detailed in draft settlements.

The news has received mix responses, although many commentators have applauded government efforts to deal with the projected £2.3bn funding gap expected to develop by 2020.

In his statement to parliament, Javid said the further social care funding would not affect the commitments made to other areas of local government because the money will be taken from “anticipated underspend in existing departmental budgets.”

The secretary also confirmed the continuation of the social care precept, meaning councils can charge a further tax on residents, with returns specifically earmarked for social care.

Lord Porter, chairman of the LGA, said the government had not gone far enough to improve the situation for councils. He claimed that the extra funding would only solve issues temporarily and again urged ministers to allow authorities to keep 100% of business rate receipts.

“The additional one-off social care funding announced today is a temporary measure and needs to be compared against an annual social care funding gap of £2.3bn by 2020,” he commented.

“Councils in England face an overall funding gap that will exceed £5bn by 2020. We remain clear that the government needs to allow local government to keep every penny of business rates collected to plug this growing funding gap and provide the £1.3bn needed right now to stabilise the care provider market.”

Porter also said errors in the Valuation Office Agency data used to calculate the charges and awards councils will be subject to from the tariff business rates system meant more than half of councils would receive less money.

Yorkshire cafe serves up job skills for people with disabilities

An inspiring story of what can be achieved supporting people with learning difficulties into employment in a rural setting. This article tells us:

If you go to the Outside the Box cafe in Ilkley, West Yorkshire, at lunchtime you might struggle to get a table. Business meetings jostle for space with parents and toddlers, here to enjoy the artisan coffee and locally grown fruit and vegetables.

The cafe was set up as a charity by Ilkley Community Enterprise five years ago to provide unpaid work experience for adults with disabilities. Initially open just at lunchtimes, the cafe became so popular that it’s now open seven days a week, from 9am to 4pm. In 2016 it won Ilkley Business Forum’s Hospitality Business of the Year Award, and the following year it picked up the People’s Choice Award.

The enterprise team quickly realised that some of the adults they were working with needed something beyond the cafe, so they set up OTB Works in 2016. With an eight-week work club delivered in partnership with the North Yorkshire adult learning and skills service, the project helps members of the scheme prepare for work through qualifications in occupational and employability studies, cookery and customer service.

The club covers CV development, meeting employers and employees, and interview preparation.

The scheme’s first graduate, Imogen, now works in a local store eight hours a week. “Before Outside the Box, I spent my time just at home, doing nothing,” she says. “Now I have a job at Specsavers, I am out and about and never bored. OTB supported me in getting there.

“Before, I was left to my own devices. I would have been terrified even thinking about working – but I am much happier to go for jobs now with their help. I have lots more confidence, I am customer friendly and can do more than I thought I could.”

OTB Works has more than 55 members, aged from 17 to over 60, who have physical or learning disabilities. Most start working at the cafe before moving on to other opportunities – or doing both.

UK shift into less productive work

Very revealing article. We were talking to our friends in Upper Teesdale about just this phenomenon today. This article tells us:

Since the 2008 financial crisis, productivity has barely grown at all.

But new research now provides part of the answer to this puzzle.

The Office for National Statistics (ONS) suggests that it is not so much that we don’t have productive industries, it is just that more of us are working in the unproductive ones.

Productivity is the main driver of long term economic growth and higher living standards.

The study of changes in productivity before and after the credit crunch, shows that before it struck people were moving into more productive industries and productivity was growing at 2% a year on average.

But since then there has been a shift away from working in highly productive areas like mining to less productive ones like food and drinks services.

It seems too many cooks really can spoil the broth.

There was lower productivity growth in some industries as well, such as telecommunications and finance. The property sector saw a rapid growth in productivity.

However, the largest factor seems to be that far more people have found work in parts of the economy that are just not that productive.

There has also been a sharp decline in labour mobility, normally you would expect people to move from lower paid and unproductive industries to higher paid and more productive ones.

One reason for that might be that high house prices make it more difficult and less attractive to move around the country for new, better jobs.

Using digital technology to improve the public’s health: a guide for local authorities

There’s lots of cause for optimism for rural authorities in this report. It tells us:

In an era of constrained budgets, it is clear making the most of digital technology is essential. It can drive efficiency and deliver value for money in a multitude of ways as well as benefiting the health and wellbeing of individuals.

Digital public health is about so much more than apps and social media. Up and down the country councils have been working with their partners – both public and private – to innovate and pilot new ways of working.

For example, in Hertfordshire wearable sensors worn during an exercise class have allowed for a quick and accurate assessment of an individual’s fall risk instead of a half hour assessment taking place.

Meanwhile, in London a pilot where pharmacies used a handheld mobile device to test for irregular heartbeats has reduced the time from testing to treatment from 12 weeks to under three.

This report reflects a snapshot of what is going on. Five years from now the picture will look very different again. That is the nature of the fast-changing world of digital technologies. It is one we in public health cannot afford to be left behind on.

Hedgehog numbers in the British countryside have halved in the past 18 years

This is shocking news in terms of the profile of our spikey friends. The article tells us:

Hedgehog numbers in the countryside have halved since the turn of the century.

It is a more positive picture for the prickly garden visitor in towns and cities, where numbers have fallen by a third since 2000 but rates of decline have slowed, the State of Britain’s Hedgehogs 2018 report found.

They are not disappearing from urban green spaces as rapidly as they were 15 years ago and may even be returning, while numbers appear to be growing in some places where they are still found.

But with numbers “plunging” in the countryside, the groups behind the report, the British Hedgehog Preservation Society (BHPS) and the People’s Trust for Endangered Species, plan to engage with farming communities to halt declines.

Householders are also being urged to sign up as “hedgehog champions” and help them through simple measures such as putting out wet cat and dog food, leaving wild areas for them to nest and making holes in the fence for them to move from garden to garden.



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