Peter Robinson (DUP) spoke at the Caring for an Ageing Population seminar in Belfast yesterday (7 April). The following sets out his full speech, with a PDF version available for download below.
"The issue of how we look after our older generation is clearly a crucial one. I feel I should declare my vested interest at this stage.
DUP Ministers have a strong track record of making devolution deliver for the province’s older people. Going right back almost twelve years, I announced the programme to deliver free fares for older people while my DUP colleague in DSD first introduced the Warm Homes Scheme.
More recently we have legislated to create an Older Person’s Commissioner, making Northern Ireland an example of best practice internationally when dealing with the rights and interests of older people.
How we look after our more vulnerable citizens says a lot about us as a society, and caring for older people will be a key public policy challenge over the next number of decades.
The demographic changes are difficult to imagine. Northern Ireland will look very different. Within fifteen years one person in every five will be over 65 years old. By 2056 it is predicted that there will only be two working age people for every one over the age of 65.
The number of dementia sufferers in the province, will more than double, rising to 50,000 by the middle of the century, and current annual health and social care costs for dementia of £200 million will double within twenty years.
The challenges are immense. As a responsible Government we must plan now for the needs of our society in the years ahead.
Across the water, the Dilnot Commission - on the Funding of Long Term Care and Support - has been established. I believe that we need to produce a specific long-term strategy in Northern Ireland for Caring for our Older People. We need to think ahead to the services that are going to be required.
We also need to look at the quality and cost-effectiveness of existing care. My Party proposes a Dignity Charter for Older People to provide certainty for senior citizens and their families that the care they receive in hospital and other settings will be of the highest quality, and that they will receive a nutritious meal and have their personal hygiene attended to promptly and appropriately.
People understandably want to remain in their own homes as long as possible and, since institutional care can be much more expensive, as custodians of public finances, it is in everyone’s interests that we facilitate people to remain at home.
Approximately 12 million hours of domiciliary care are provided each year in the province to tens of thousands of people, but I believe it can be done more efficiently.
There is a wide variation in costs across our trusts, and in comparison with the rest of the United Kingdom. There is disparity around the amount of care different local trusts provide. And there is also a huge difference between the rates for domiciliary care currently being paid for independent sector care compared with trust provision.
In Northern Ireland approximately half of domiciliary care is provided by the statutory sector and half by the independent sector. On the mainland, only 20% is still provided by the statutory sector - a ratio, actually matched by one of our five trusts, the South Eastern.
Opening up social care to proper tendering and allowing the most cost-effective provision is clearly essential. It is important to remember that the quality of service is not a risk since all sectors operate under the same Regional Domiciliary Care Standards and are inspected every year.
Calculations by the Independent Health Care Providers organisation, indicate that domiciliary care by trusts is costing more than £7 extra per hour than the independent sector are being paid.
It has been suggested that a shift from 50:50 to the 80:20 ratio of the South Eastern Trust and Great Britain could save £23 million per year. In GB such a shift took only five years to achieve, with the potential to speed that up significantly through upfront redundancy and redeployment schemes.
There is a more general point in relation to health care and public services more broadly. Research in various parts of the world, shows that charities and the voluntary sector can deliver public services for up to 30% less. Academic research in England and Australia clearly indicates that quality can even be improved, with costs reducing by close to one third.
For example, the Julius Public Services Industry Review commissioned by the Whitehall Department formerly known as BERR (Business, Enterprise and Regulatory Reform) in July 2008 found:
“clear benefits, to both users and taxpayers, in subjecting incumbent service providers to competition. The academic literature typically found the cost savings from competitive tendering to be between 10 per cent and 30 per cent (including when the in-house team won the bid) with no adverse effect, and sometimes an improvement, in service quality".
The Australian Government has, since 1996, been involving the voluntary sector in delivering more and more public services delivering up to 30% more services for every pound spent. Their Industry Commission reported that:
"Competitive Tendering and Contracting reduced the ongoing costs of service provision: savings ranged from 10 to 30 per cent in over half of the services studied."
The Australian Government also found that by involving the voluntary sector and others in delivering services, their equivalent bodies to our Health Trusts became more cost-efficient in running any services which they retained in-house.:
"The savings appear to be significant regardless of whether an in-house or external bid wins."
We have to ask the question, is Northern Ireland being left behind on the world stage with approximately 98% of the health and social care budget still being delivered by Health and Social Care Trusts.
Two thirds of hospital beds here are occupied by those over the age of 65 and since acute beds are the most costly use of health resources, we need to invest more in intermediate interventions to prevent the need for hospital admissions.
During 2008-9 there were 62,933 emergency admissions for people aged 65 and over, with an estimated resultant cost of £215 million. In 2009-10 the total number was again just under 63,000.
Prevention and re-ablement are essential. We want to allocate an increasing percentage of the overall health budget to health promotion and disease prevention.
We need to increase investment in intermediate care and rehabilitation, such as providing sufficient resources for a range of modifications including - fitting hand and grab rails in older people’s homes to prevent falls and the subsequent treatment costs for hip fractures.
Laing and Buisson found in 2008 that postponing entry into residential care by adapting people’s homes saves over £28,000.
We are keen to develop more specialist nurses in chronic illnesses such as diabetes, heart failure and respiratory disease, particularly in community based multi-disciplinary teams.
The Chronic Illness Management Service has seen bed days reduced by 59% and savings of £1,493 per patient realised.
We should seek to replicate elements of the Partnership for Older People Projects in Scotland which have-
- promoted health;
- delayed any need for higher intensity care;
- and reduced overnight hospital stays, use of Accident and Emergency Departments, therapist appointments, GP phone calls and appointments and visits to practice nurses.
The teams which conduct care assessments need to be fully resourced to ensure these assessments are conducted swiftly, and that individuals who no longer need to be in hospital are not detained there for prolonged periods. Dedicated discharge teams in hospitals could allow the leaving of hospital to become a prompt and relatively painless process.
The issue of fuel poverty is a crucial one in Northern Ireland. Older people are unfortunately still dying unnecessarily. There were 756 excess winter deaths in the province in 2009/10. Many older people entitled to financial assistance are not aware of that, or do not claim.
Automatic benefit payment has been suggested to assist. We would be keen to pilot this idea, for example for Pension Credit. The expectation is that people realise what they have been missing and subsequently apply, and this would have the potential to add in excess of £1 million per week into the Northern Ireland economy.
We are keen to see the extension of the Warm Homes Scheme with a more flexible approach to permit those with oil or gas boilers to receive repairs or upgrades.
We also want to use the new devolved justice powers to legislate to increase sentences for attacks on older people, and we are already considering whether there is a need for new laws to provide protections against the many forms of elder abuse.
Finally as I close, I am keen that there should be a greater focus on the positive contribution, experience and potential of our older people.
A Positive Ageing Strategy may be one way of achieving this. Schemes such as the Prince’s Initiative for Mature Enterprise allow older people to demonstrate their skills in establishing new businesses. Older people must be provided with the freedom to play a full and active role in the community in Northern Ireland."
Caring for an Ageing Population - Peter Robinson (PDF 174KB)