Older People Are Not a Separate Entity

Today’s BBC Breakfast debate (@BBCBreakfast #LivingLonger) comes on the same day as the news that Saga will no longer be providing state funded care services ( Daily Telegraph - http://www.telegraph.co.uk/finance/newsbysector/retailandconsumer/11347858/Saga-withdraws-from-NHS-care-after-funding-cuts.html) and together they show the need for a more immediate, national rethink on care services in the UK.

Sometimes, contributors to the debates on care for older people seem to forget that, one day, they will be older too. Older people are not a separate entity within society, they are an integral part of society. We have to remember that many of those we label as elderly were also labelled as “rebellious youth” back in the 1950s and many of those with the “youth” label today will be the “older people” in 60 or so years. Too often there is a focus on “what to do about older people” rather than the recognition that many people that socially created label have, in fact, contributed hugely to the society that they are now dependent on for support.

Society also has to recognise that this is an issue that is relevant NOW, not further done the line as Governments like to portray it. Many older people need support and help today but, unfortunately they are being faced with reduced services because of cuts in spending as a result of a recession that was really no fault of theirs!

A part of the debate focuses on individual planning for the future, and while such things may sound good it can be idealistic rather than realistic because individuals have to cope with the ups and downs of real life. Those over 65 now have lived through many recessions (including two double dip recessions), annual inflations rates of up to 26% (1975), as well as periods of high unemployment in the country. Very often people are forced to live in the financial now rather than being able to plan for a future that is a long way off. We have seen a dramatic rise in the use of food banks over the last couple of years, have many of those forced into this can, realistically, put money aside for their needs in older age?

So while individuals can take some responsibility for planning for their future, government and society must recognise that this is not always possible and there must be a safety net to ensure individuals are sufficiently supported as they need it when they age.

Older people are not an isolated section of society, we are all older people in the making and when we talk about the needs of older people in society we are talking about our future too. The questions should not be about how society deals with an ageing population but about what would I want if that were me right now because that will be me in the future.

Social Care: A Culture of Unimportance

The Government’s Winterbourne View final report talks of a ‘culture of abuse’ being allowed to flourish within the establishment. This is nothing new there have been plenty of cases where this has happened and many commentators have mentioned this, we have periodic exposes of abusive culture within social care settings followed by a brief blustering of politicians yet these things keep happening.

The real issue that needs to be addressed in adult social care is the culture of unimportance that pervades society when it comes to the needs of the elderly and disabled in the country.

                                          

The Winterbourne report highlights this culture of unimportance. There is no Prime Ministerial forward promising whole Government action, there is not even a signature from the Cabinet Minister for Health. This should not distract from many of the good proposals in the report yet it, in terms of promoting social care as a national important area of policy it fails.

This is, obviously, only the latest in the line of things were the Government continues to cultivate the culture of unimportance around adult social care. The Dilnot Commission , set up as part of the coalition agreement,  submitted its final report in July 2011 and, since then, has largely been scrupulously avoided aside from the odd burst of political gusto when it seemed convenient. In the meantime the reality for many older people remains the same, sell your house to pay for your care.

Naturally Dilnot is itself a product of the culture of unimportance. The Commission was set up to tackle only how care is paid for, what has not been tackled is the ever tightening eligibility criteria for state support with care nor has the needs of other vulnerable adults, such as those with learning disabilities, had any consideration.

The social care culture of unimportance cannot just be ascribed to this Government, the previous Labour Government prevaricated and delayed taking action on social care producing a White Paper on 30 March 2010 just weeks before an inevitable General Election, and even then their ideas where merely a tinkering of what already existed rather than wholesale reform.  

The culture of unimportance that is allowed to flourish at Westminster inevitably and naturally trickles down to the rest of society. Undoubtedly if many average people in the street were to be asked what has been the most important issue discussed at Westminster this week the answer, inevitably, will be that of same sex marriage. While that is important in its own right surely the needs of the most vulnerable in society should take precedence and, although I don’t know the exact numbers, I suspect that the issue of same sex marriage will have a direct impact on far fewer members of the population than social care reform would.

The culture of unimportance MUST end and social care must take its rightful place alongside the other major areas of social policy. As society continues to age the implications for social care are significant, more and more people will need social care services and it is societies duty to ensure those needs are met.

Personally I feel it is obviously right that social care should have its own Cabinet Minister and Department for Social Care and have started a e-petition to this effect (click here to sign) as I believe that this will be a start to raising the importance of social care nationally. Yet beyond this we do need those in charge now to stop treating social care as a side issue to other areas of social policy and start treating social care with the importance it needs in order to ensure the well-being of the millions who need social care services.

Social Care Users are Not All Elderly

Half a million people under the age of 65 receive council funded social care services. That is around a third of all those receiving services and there is a danger they become excluded in the wider social care debate.

We have seen some excellent initiatives in dementia recently, albeit maybe not going quite far enough, but we need the social care debate to encompass all those who need societies support in life. The funding debate in social care has almost exclusive focused on the Dilnot proposals and how elderly care is paid for. How much should older people contribute to care they receive, what should be the threshold for capital etc. This debate has little to with those under the age of 65.

Similarly we have seen the debate of health and social care integration. There is no doubt that the two are related but more so in relation to elderly care than the support needed for those under 65. Those with physical or learning disabilities and those with mental health issues do need support in health but they need support in daily life, support with housing needs and support with employment and welfare in order to live as independently as possible.

The number of those under 65 receiving council funded services has, in line with the general trend, declined slightly but this does not mean there are less people needing societies support, simply that the eligibility criteria for receiving support has tightened and the fact that support centres have closed because of the budgetary constraints on local authorities meaning less support being available to many.

As with all areas of social care there are many who do not appear on the statistics but that does not mean they are any less deserving of societies support. In addition there are many families who provide support for individuals who also need our help. The changes in demographics and the ageing nation applies to those with physical and learning disabilities as it does to the general population and there are an increasing number of elderly parents still caring for a child without the support of society.

Social care is wider than just health and should be treated as equally as any other area of social policy.

The health and social care integration debate and the focus on elderly care detracts from this wider function of social care and marginalises those who are under 65 and who need more than just health support in social care settings.

We need to raise ALL social care into the spotlight and social care needs to have the same Government input as Education, Welfare, Health and Employment therefore it needs a cabinet minister for social care as this will put it on an equal footing with these other areas of social policy.

Please take the time to sign my e-petition calling for a Cabinet Minister for Social Care - http://epetitions.direct.gov.uk/petitions/39701

Focus on Elderly Care

Over the last four years the number of people receiving council funded adult social care services has fallen by 17.5% and, given that in certain areas such as people with learning disabilities the numbers have increased, the majority of the decline in funded services has hit older people who are targeted under ever tightening eligibility criteria for Local Authority service.

This, of course, flies in the face of what we know about the population in general, the population is increasing and people are living longer so, in fact, we should be seeing an increase in the numbers of people accessing funded social care services, therefore we are seeing a bigger decline in services than the figures initially suggest, even if the numbers were to remain static it would, in real terms, still be a decrease.

Unfortunately much of the policy obsession (obsession used in a limited sense!) is focused on implementing the Dilnot proposals and focused on how much individuals should pay for their care. What this misses is the numbers of people who have no way of paying for their care and are entitled to local authority funded services, the numbers of which are decreasing at an alarming rate despite the fact they should be increasing.

In cases where older people do not meet ‘eligibility’ criteria the role of providing care and support goes to family and friends who, in essence, provide a free service for the state or, if they receive carers allowance, for the princely sum of £58.45 a week (subject to providing a minimum of 35 hours care - so £1.67 per hour!) and many do not receive the allowance because they have an ‘overlapping’ benefit. Research by Carers UK and the University of Leeds shows that, over the past ten years the number of those providing care has increased by 9% with the biggest increase in those aged over 65.

There are costs to looking after someone on a full time basis, particularly when it means giving up full time employment, not only are there the financial implications but also there is evidence of impact on health, well-being and social exclusion. There is help available for carers and many receive local authority assessments but, in terms of the wider social care picture, very little has been done to redress the increasing numbers needed to meet the shortfall in local authority provided services.

Despite these facts the plight of the most needy older people is still being overshadowed by the focus on who pays for care, and while this is important it is only a small part of the overall social care picture.

We need to widen the social care debate at national level which is why I have started an petition call for a Cabinet Minister for social care – I hope  you will take the time to sign  and pass on to others - http://epetitions.direct.gov.uk/petitions/39701

Lest We Forget

            Many elderly people who use care services are, generally, over the age of 80 and they have lived through a great deal in life.

            My Nan, for example, turned 90 this year. She not only lived through the Second World War, she gave birth to my father in 1943 in Bermondsey, London.

Can anyone, nowadays, imagine what it would be like to bring up an infant under what was, effectively, the German Bomber flight path to the Capital?

My Nan now has advanced Parkinson’s disease and relies on carers coming to her Warden-Assisted home to get her up and put her to bed. She can do very little in between times.

            My Nan is, of course, not alone there are millions of elderly people relying on carers, either paid or unpaid, to help them live their daily lives and to them it must seem nonsense when we talk of austerity. Austerity is, surely, living through rationing and experiencing such delights as powdered egg (I’ll be honest and say the thought of it makes me cringe). Austerity is living part of your daily life in bomb shelters in the fear of losing your home or your life.

            The same generation has lived through economic good and bad times since then, from ‘never having it so good’ in the 60’s through the three day week and electricity blackouts of the 70’s and all else up till now. Surely having been through all of that they should be able to enjoy economic stability at the end of their lives and know that their care provision is not impacted by the banking/government created recession that we are in today.

            Why should those who have been through and seen so much bear the brunt of failed policies and economic mismanagement?

            Social Care is an important part of our society yet it seems those in Westminster fail to see the impact it has on those who need social care services, their families and those who provide care services. Social Care is about peoples’ lives not about political expediency, social care should be about providing the best possible services not just those that are financially viable.

            When David Cameron stood outside Downing Street as he took office he said. “I want to make sure that my Government always looks after the elderly, the frail, the poorest in our country”. Two years on and they are still waiting

            Every year politicians stand at the Cenotaph and, quite rightly, honour those who have fallen in conflict yet they also need to honour those who survived and provide the best possible support and care services, let’s not impose under-funded services on those who deserve better.

Let's Get Social Care Out of the Darkened Corner

The Health & Social Care Act 2008 received Royal Assent on 22^nd July 2008 but the bulk of the provisions relating to social care where not put in force until 1^st October 2010. So, in essence, there was a two year gap between the final stage of the Parliament and the implementation of the Act. Of course, this is just the end of the process, a bill has to travel through the parliamentary process. For example, the controversial Health & Social Care Act 2012 had its first reading in Parliament on 19 Jan 2011 and received Royal Assent on 27 Mar 2012, probably an extreme example but it highlights the length the process can take.

What’s the point of that little tour of the Parliamentary process?

Simply speaking, the current Government has three years, at the most, left and unless they take action soon on social care there will not be any changes to the current system while this Government is in power, if they do, eventually, legislate it will be left to the next Government, whoever they are, to implement any changes made. And, more importantly, it could be close to three years to see any substantive change in the social care system (always assuming the Government put any substantive changes in a bill!).

To most of us in the sector such prevarication on social care is not unusual and not just limited to the Government in power at present. I won’t repeat the gist of my previous blog (Politicians Seem Clueless About Social Care) but suggest what we need is a radical approach to reforming social care at the very top.

When Ivan Lewis was named care minister in 2006 he promised a radical review of social care, unfortunately that never happened and the first announcement of a consultation on social care came only once Alan Johnson took over the role of Health Secretary from Patricia Hewitt a year later. This suggests that any real action on social care is decided by the senior minister who sits on the cabinet.

Obviously the Health Minister is generally more concerned about Health Care rather than Social Care as evidenced by this Governments pushing through the 2012 Act despite opposition from many health professional organisations. Social Care seems to occupy a tiny corner within the Department of Health thinking.

But why does social care sit in the Department of Health?

Social Care is not a minor area of public policy to be handily attached to what appears to be the most appropriate Ministry.

The number of people receiving local authority funded services in 2010/2011 was 1.6 million and this excludes people who pay for their own care and people deemed by social services as not having sufficient need level to qualify for support and who are cared for by unpaid family members etc., so true figure of those who may need social care services is considerably higher.

Skills for Care estimate that the social care workforce also numbers 1.6 million. So, at a minimum, 3.2 million people are involved in social care services. Add to this the fact that Skills for Care also “work closely with the 40,600 organisations that offer social care people who use services, carers and with other key stakeholders” and it is hard to see why social care does not get much more attention than say the Department of Culture, Media & Sport which has a Cabinet Minister in Charge.

It is also important to remember that social care is not just about health, although that may play a significant part in end of life care etc. the role of social care is to support and care for individuals in their day to day living and health remains the responsibility of health professionals. The public often only connect social care with elderly care but it goes beyond this and beyond the remit of health.

For adults below the age of 65 who need social care services much of the focus is on appropriate housing, employment opportunities and living independently. The latter of which is also a focus of social care for the elderly. Social care is about maintaining links with society and maintaining social well-being in addition to health well-being.

We need action on social care and we need political consensus rather than political paralysis. Let’s start by achieving consensus that social care should not sit in a darkened corner of the Department of Health and it deserves its own Ministry with its own Minister who sits on the Cabinet and has the opportunity to bring forward legislation but more importantly to show that Westminster is truly serious about working for the millions in the country who receive or are involved in delivering, social care services.

Politicians Seem Clueless About Social Care

It seems evident that politicians do not know what to do about social care. The predominant method over the last few years appears to be simply to avoid doing anything substantial by having endless consultations and a constant tinkering around the edges (e.g. we are on the third regulator since 2003). It is not a political party specific phenomenon as all three main parties seem to be struck by the same malaise.

But why? Political parties are, generally, very sure of the best ways to do things (whether the public agree with them or not) and will forcefully set out their agenda to improve aspects of public policy for the greater good. Education, Welfare & Health, for example, have all been dealt with by the current Government and dealt with early in the terms of previous administrations yet social care has, and continues to be, something that eludes substantive action.

One of the reasons for this is, simplistically, the time factor. At the inception of the ‘welfare state’ post World War Two social care was a small consideration to those in power. After all in 1950 life expectancy was around 68, therefore those who drew from the state pension scheme aged 65 were only expected to draw on the state for three years or so. Similarly the impact of older people on the National Health Service was much more limited. In addition those with physical and learning disabilities were not expected to have much impact on the state because of their poor life expectancy.

So, in essence, social policy has largely focused on the under 65 population and political parties have, and continue to, have that as their primary focus.

Unfortunately for them the real world has crept up on them and now they seem at a loss how to respond.

Life expectancy today is around 79 years of age and rising. The life expectancy of people with disabilities has risen even more dramatically and we now have a greater need to support and care for people with age related illnesses, diseases such as dementia and provide suitable care and support for people with disabilities to meet their needs as they age.

In fact figures suggest that the UK has (or will soon have) more people over the age of 65 than under 16. Something that politicians have not quite grasped yet and something society has not yet come to terms with, as, it seems, we need to gear our society towards the needs of older people.

Society has changed and social policy needs to change with it but all politicians seem to be clueless in how to achieve this and afraid to make bold policy decisions. Now, obviously they are afraid that such boldness may cost them precious votes but until bold measures are taken, and social care bought to the fore of social policy the people who will suffer are the people who most need societies help.