Social Care Reform and the Impact on Older People

Older people campaigning

Age NI has been calling for a fundamental review of social care for a number of years and as such we welcome Transforming Your Care and Who Cares? The Future of Adult Care and Support.

The key proposals in TYC in relation to older people are similar to the key calls that Age NI has been progressing: care at home; prevention; re-ablement; a shift in spend from acute to social care; quality and consistency of social care and older people’s expectations.  In addition we have been calling for a public debate on funding social care to ensure that it is fair and sustainable which is also recognised within TYC and is being progressed through the DHSSPS review of social care.

The reform of social care by the DHSSPS must be a comprehensive package of legal, policy and funding reform with the voices and experiences of older people central. 

Areas of Concern

1) Transforming Your Care

The TYC Report whilst taking on board the majority of Age NI recommendations, we remain concerned over some aspects. For example there appears to be an over emphasis on nursing care in preventing admissions to acute care, managing end of life care and taking on a great clinical role. In addition, there is a suggestion that residential care is slowly declining, those in residential care are not permanent residents and this is due to the provision of supported housing schemes.

An examination of the Strategic Implementation Plan and the Population Plans appear to focus on reablment as the means to reduce emergency department admissions and reduce the need for continuing long term care. Whilst we are supportive of reablement this needs to be located within a broader overarching strategic framework of prevention. Reablement alone will not deliver the necessary changes to enable older people to remain independent and to live at home. 

However, one our major areas of concern is the issue of rights and entitlements. We can clearly see how the concept of ‘benevolent prejudice ’ in the TYC report has influenced the section on older people. Compare the two statements below and you can see how the language in the latter statement (physical disability) and the first statement (older people) differs. 

Older People

“When people are provided with information and advice on the services that are available to them, they are in a position to make an informed choice as to the most appropriate care delivery for their particular needs.” (page 67)

Physically Disabled

“The current service-led approach should be replaced by a more person-centred model in which statutory health and social care acts as an enabler, working in partnership with the disabled person and their family / carers to help people access the support that meets their individual needs. This may include some of the traditional residential and daycare services, but will increasingly reflect a wider range of needs.” (page78).

It is vital that we do not allow stereo typical views of older people as frail, vulnerable, dependent and in need of services and support to obscure the potential of older people. The statement above clearly displays these stereotypical views of older people. This paternalistic attitude masks the contribution of older people and therefore constrains the TYC in its direction for older people. .

2) Who Cares

Although at an early stage of discussion, the DHSSPS reform of social care and support must ensure that rights and entitlements are upfront and centre of this discussion. We have called on the Law Commission to undertake a similar exercise as their counterparts in GB on legal reform. The legal framework surrounding adult social care is out of date, fragmented and complex, for both the user and professionals.

In addition, the balance of responsibility needs to be carefully considered to ensure that we have a fair and sustainable system for funding social care.  The Dilnot Commission made detailed recommendations on the funding of social care for England and Wales, a similar exercise must be carried out to consider the  particular circumstances for Northern Ireland.

And as highlighted above we must not let our assumptions of older people as frail and dependent to determine the scope of this review. The social model of disability and concepts of independent living apply equally to everyone in need of care and support and age should not be the determining factor.

Age NI’s Tests for Reform / Indicators of Success

It is important that the future reform and funding for adult social care will propose radical and realistic reforms that will be capable of delivering the transformational change that is needed. We have developed a number of simple tests based on our vision and underlying principles and values for this reform:

  • Quality: It must ensure delivery of high quality, personalised services that promote the dignity and rights of older people and place a stronger emphasis on prevention.
  • Clarity: It should promote simplicity and clarity be based on rights and entitlements and build in the advice and support people need to navigate the system.
  • Equality and Human Rights: It should be founded on human rights and equality principles to secure equal participation for older people.
  • Independence: It must promote independence, enable older people to exercise informed choice and control over the services they receive.
  • Sustainability: It must provide a long term funding settlement that strikes the right balance between the individual and state funding.
  • Affordability: it should deliver a settlement that is affordable to prevent disproportionate costs for those on moderate to low incomes and those with long term or high cost disabilities. 

Therefore it may be helpful to frame the debate about the future direction and funding of adult social care in terms of finding the answers to these three questions:

  1. What quality and outcomes should services achieve, how can they do this, and how much will this cost?
  2. What should be the scope of services that everyone is supported to access, from ‘that little bit of help' through to nursing and end of life care?
  3. How should the cost of the system be allocated between individual and collective responses, and what mechanisms can be utilised to facilitate this?

Although most of the focus to date has been on funding social care, the third question above, it is in fact impossible to answer before there is a consensus on the first two, which will determine the cost of the system.

Age NI Advice Line:
0808 808 7575

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