Age NI spoke at the Caring for an Ageing Population seminar in Belfast yesterday (7 April). The following sets out the full speech, with a PDF version available for download below.
Age NI is delighted to be here today to outline it’s view on why we believe a fundamental review of social care is needed and what we believe some of the first principles of a new social care system should be. It’s also timely that this conversation is happening on the day that we launch our annual policy report, Agenda for Later Life – an annual assessment and commentary on the impact of government policy on the lives of older people. Health and social care is one of the areas we’ve commented on this year, and today’s comments build on that analysis.
Last year we spoke to approximately 1,000 older people and asked them what the UN Principles on Ageing, one of which is care, meant to them. Older people resoundingly told us – the hallmarks of care are dignity and respect; quality; having a voice; choice; and access. This is the other element of analysis that has gone on to inform today’s comments.
‘A situation without parallel in the history of humanity’ – UN World Report on Population Ageing, 2008.
Population ageing, alongside climate change, is one of the greatest transitions we will witness in the 21st Century. A transition such as this presents significant risks and opportunities for public policy, and nowhere is this clearer than in the Social Care Agenda. Notwithstanding the fiscal environment, more can be done to put dignity, choice and independence at the heart of the social care system, and to match the effort to deliver person centred care services with person centred care policy. This will involve shifting the language of care from one of services to one of needs and outcomes; it means creating a culture of independence and interdependence, moving away from fostering dependence. At its heart, it involves social care which will focus and build on the capabilities of all older people, regardless of their circumstances. Even in the context of finite resources, more can be done to meet this agenda. Supporting and enabling older people to age in their community is what older people want for themselves, but requires policy attention to deliver in a strategic and meaningful way. Evidence also demonstrates that this approach makes economic sense. A hospital bed costs £261 per day versus an average of £13.19 per hour for a domiciliary care package.
In shifting the language of care, we can begin to have a conversation about how assessments for social care can engage older people in identifying the outcomes they want for themselves from the services they receive, rather than assessing an individual’s suitability for a particular service. The current narrow reach of a needs assessment often ignore the outcomes that older people want from the provision of care, such as transport, housing, personal identity, social and intimate relationships, developing and maintaining a sense of belonging to and participating in communities. There is some great practice happening out there through care facilities – meaningful efforts to focus on older people’s appetite and capability to remain engaged. A residential unit in Armagh has been working with Age NI on two major campaigns – the campaign to secure an Older People’s Commissioner and the current campaign to influence the upcoming elections. The unit has invited Age NI staff in to engage with older people, brief them on the issues and encourage participation in campaigning activity. Age NI’s own residential home, Meadowbank, specialises in caring for older people living with dementia. We recently engaged a community artist to support 8 older residents to paint with a view to putting an exhibition on in the local community. Both initiatives have been hugely successful in engaging older people in issues and initiatives which promote continued participation in the community and in the issues which affect them.
The reality for older people in Northern Ireland is that our current system of social care is broken. The system is currently struggling to meet assessed critical and severe needs. Moderate and low level assessed needs are not being prioritised or met. The lion’s share of resources and formal care provision is happening in residential and nursing facilities, and we have yet to experience the full impact of public expenditure cuts yet to come.
Recent answers to Assembly questions show a downward trend in the number of assessments taking place across Northern Ireland, despite a growing proportion of the population who are over 85. . ‘People First ‘reinforces the view that older people should be cared for at home, and this is what older people want for themselves, but an analysis of the figures show that the numbers of older people entering residential or nursing care has remained fairly static since. What is clear is that recommendations for domiciliary packages, arising from statutory assessments, have been falling since the middle of 2009 – at a time when the Minister tells us that he has allocated an additional £58 million to support an extra 1500 people in the community. .
On top of this, we have a very specific set of drivers for social care policy in Northern Ireland which need to be considered. The recent refresh of Professor Appleby’s 2006 report demonstrates a 9% greater level of need in Northern Ireland as opposed to England. Northern Ireland fares worst of all UK constituent countries in terms of disability free life expectancy. Pensioner poverty and fuel poverty among older people, both significant risk factors in terms of health, are on the increase in Northern Ireland. Also, recent figures have predicted that instances of dementia are projected to increase by 200% over the coming 40 years, with Age NI figures suggesting that care for someone living with dementia are in the region of £18,000 per annum.
All of these figures demonstrate the increasing pressures our social care system will come under over the coming years. The worrying point is that the foundation for these pressures is a system that is already creaking at the seams.
Age NI believe that older people requiring care in Northern Ireland risk falling behind their counterparts in terms of the policy attention being paid to this issue. In England, three interdependent pieces of work will combine later this year into a proposed white paper on social care. Currently, the Law Commission have been reviewing Adult Social Care law in England and Wales, and have consulted on proposals to change existing statutes. The Department of Health recently launched a consultation on a new vision for Adult Social Care, and by July of this year, the Dilnot Commission, looking at the funding of long term care and support, is due to report. The likelihood is that the Dilnot Commission specifically will have a knock on effect on Northern Ireland, as the outcomes may include recommendations on the use of the secondary care system - UK wide benefits to fund the provision of care.
The challenge in Northern Ireland is not unique. We need to turn the social care system on its head. Inherent in this is an appropriate shift of care delivered through institutions to care delivered at home. Equally important is a shift from treating illness to preventing it. Recent evaluation of the Partnerships for Older People Projects in England demonstrated that for every £1 spent in early intervention, £1.20 savings were identified in the system – specifically on emergency hospital admissions.
Recent research commissioned by Age NI demonstrated that:
The average annual cost of providing health and social services to an adult male or female ranges between £1,000 and £2,000 up to the age of 64 years. It ranges between £2,000 and £4,000 for a man or woman aged between 65 and 79 years, rising sharply for a person over the age of 80 years, to a maximum of £12,000 for a woman aged over 85 years.
A new social care system, spanning prevention, rehabilitation and reablement offers the opportunity to compress the morbidities that drive those levels of expenditure to a shorter period at the end of someone’s life. Indeed evidence suggests that reductions in the provision of social care can have a knock on effect of increasing demand for other health services, specifically emergency care.
Some of this work is already occurring in the system. The development of the Service Framework for Older People’s Health and Wellbeing is currently setting standards to embed promoting health and wellbeing in older people’s services. NGO’s, the HSCB and Trusts are also engaged in debating how services can be re-configured to better promote rehabilitation and independence. These approaches are welcome but must become more strategic in nature, and be supported by political leadership with a relentless focus to bring forward a fundamental review of the social care system. We believe that the budget announcement of an ‘Invest to Save’ fund offers some basis to invest in the re-modelling of social care services and could be the up-front investment the system requires to support change.
Moving forward, it is clear that fixing the social care system must be a major priority not only for the incoming Minister for Health, but for the Executive as a whole. With elements of the policy debate likely to include planning policy, housing policy, social security policy, workforce planning to name but a few, it is clear that political leadership will be required across the next Executive. A recent report from the Joseph Rowntree foundation highlighted that while devolved administrations had the power to bring forward different policies, with the exception of Scotland, it has not been high on the agenda’s of those administrations. This is borne out by the continued use of 1993’s People First policy as the key policy document governing the continuing delivery of social care in Northern Ireland. The time has come to move away from tinkering at the edges and to engage in a fundamental review of social care, a review which must lead the way in developing a social care system that puts dignity, choice and independence of older people at it’s heart; a care system that provides quality, safe services; a care system that meets all level of needs; a care system that prevents poor health; a care system built on enabling older people, whatever their capabilities and a care system that holds a vision of older people continuing to engage and participate; a care system that is fair, sustainable and protects older people.
Age NI - Caring for an Ageing Population (PDF 177KB)