As Age NI attends ‘Caring for an Ageing Population’ Seminar in Belfast today, Anne O’Reilly, Age NI Chief Executive delivers her perspective on social care in NI.
Last year we spoke to approximately 1,000 older people and asked them what care, one of the UN Principles on Ageing, meant to them. Older people resoundingly told us the hallmarks of care are dignity and respect; quality; having a voice; choice; and access. More can be done to put dignity, choice and independence at the heart of the social care system. It means creating a culture of independence and interdependence, moving away from fostering dependence. It involves social care which will focus on the capabilities of all older people, regardless of their limitations.
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 meaningful way. A hospital bed costs £261 per day versus an average of £13.19 per hour for a domiciliary care package – the way forward should be clear.
The reality for older people in Northern Ireland is that our current system of social care is broken. The narrow reach of a needs assessment often ignores the outcomes that older people want from the provision of care, such as transport, housing, personal identity, social and intimate relationships. 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.
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. 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. 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. 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 re-ablement offers the opportunity to compress the morbidities that drive those levels of expenditure to a shorter period at the end of someone’s life. 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.
Fixing the social care system must be a priority not only for the incoming Minister for Health, but for the Executive as a whole. With the policy debate likely to include planning policy, housing policy, social security policy, workforce planning to name but a few, political leadership will be required across the next Executive. It’s time 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.
Download the Agenda for Later Life 2011 (PDF 827KB)