Time for a healthy debate on ageing

An ageing population is a warning sign to plan today

WE ARE all very well aware of the growing challenges in life expectancy and demographics. It is estimated that 50% of all children born today will reach their 100th birthday, while in 15-20 years retired people will outnumber those in work. In a short space of time resourcing and delivering services to the elderly will become one of our greatest challenges.

This doesn’t have to be the case. A sustainable system can be developed but it means that we have to start to care about and plan for our long-term care needs now. This will require a step change in culture and a step change in personal financial planning, but this can and must be done without delay. We need to educate our children that making provision for long-term care is an act of good citizenship, akin to pension planning for retirement.

Accompanying this there needs to be a hard dose of realism in relation to what we can and should expect from future care services. Quite simply, the majority of individuals do not think about future care planning in later life, and there is no clear understanding about what they expect both from local authorities and from private care providers. This must change.

Both the UK Government and the Welsh Assembly Government have rightly said that issue of future care provision must be tackled in the current Paying for Care consultation. However, the content of the Green Papers published by both administrations has been a little disappointing. Having further debate on issues like how we increase personalisation of care and how we ensure better joined up services is all well and good; but in relation to how we pay for future long-term care, firmer systemic proposals, which had a clear strategic vision and most importantly, were tangibly costed, would have helped.

Both the government and the public are fully aware that a general taxation model is unfeasible, so too is a model based entirely on full insurance, as it will not obtain political consensus for a number of reasons. We therefore naturally come to a middle-way: a partnership model, where the government and the individual shoulder an equitable share of the cost.

The bottom line is that at the very least, my generation in their mid 30s need to start preparing for the future. It’s simply no good thinking that your pension contribution is enough preparation. It isn’t and we are kidding ourselves if we think it is. What the Government should have done was spell this out clearly from the outset and then lay out how it would ensure the system was robust and fair so that there would be confidence and buy-in from all sectors and wider public at large. At a time when the general public’s confidence in government, in politics, in banks, and in insurance companies, is at an all time low, it is the fundamental job of government to instil confidence in any future system of care. The government should have demonstrated that it had a more definitive understanding about the levels of care required in the future based on much harder questions like what sort of care will any future funding package pay for? Will it be just for acute need, low level need or both? How many people are doing to require a greater level of domiciliary care? How many people are likely to require long-term residential or nursing care?

On the basis of these questions the Government should have conducted medium and long-term projected modeling based on the vast array of information that is already available around dementia and identified what they expect the future of care to look like and in doing this set government departments to work together on the issues of building planning, health and social care, transport and environment. If government believes in sustainability, then little is happening now to promote a sustainable model of living in the future. Paying for care does none of these things.

We need to work on the basis that the model of care will shift towards the person’s home – particularly as we know that two thirds of people living with dementia do so in the community either alone or with a family member. With a significant public health challenge to meet, with the government needing to focus on preventative measures and individual responsibility for maintaining good long-term health, we will see people staying as long as possible in the comfort of their own homes. The majority of people with dementia will want to stay as independent as the condition will permit and as long as they, their family and carers are comprehensively supported, then this is what we should be striving for. Of course this brings its own demands. We need to approach it holistically, reappraising entire concepts like where we live (our homes) and how we live (our communities).

Doing this need to encompass the planning process and building regulations so that all new build is disability proofed during the design process which means homes being fully adapted ready to meet all the future demands of society and expand smart housing programmes as well as developing new housing estates for elderly people are developed. Village models have been developed in Arizona that have been specially built for the over 60s, with a range of facilities and social activities geared to the residents, fully supported by a range of on site medical services. One has 4,500 properties in this community.

However, we should not lose the sight of the need to provide good quality residential care where it is needed. Where people are unable to live in their own homes, then they should have the next best thing – to live in a caring, medically supportive environment. Those with higher dependency needs, such as dementia care, need to be in a person-led system where the individual is place firmly at the centre of service planning and where the public, private and voluntary sectors work together to deliver the best possible outcomes.

Merevale House in Warwickshire is a superb example of the levels of care that can be achieved. It delivers what it does primarily because of the dedication of its specialist trained staff. Having spoken to many nursing consultants specialising in dementia care, they have told me that the knock-on effects of poor staff training and interaction ‘dilute’ the patient care experience and they suffer the consequences with the person losing their remaining skills and far more quickly than they should, thus accelerating them into more complex and costly institutional care. Staff should be trained in close collaboration with academia, enabling them to access the most modern theories and practical courses Welsh universities have to offer. They must be provided with a clear career pathway to ensure development in the sector. We must attract the best people into the sector not the lowest common denominator. We cannot have people working with vulnerable adults who are paid the same as supermarket check-out staff and possess less training.

To make all this work, we need a regulatory framework and system that is fit for purpose. Last Tuesday in the Assembly we debated the 2008-09 annual report of the Care and Social Services Inspectorate Wales (CSSIW). My contribution to the debate was to call for the Assembly Government to get tough on poor performance including, in some cases, poor performance by our regulatory body. We know that there are problems with the quality and provision of a variety of services within social services and care but there is a fundamental problem at the heart of CSSIW itself. The Welsh Assembly Government needs to address this as a matter of urgency to ensure that our organisations and services are properly regulated and inspected and that services are able to improve.

One of the problems that has emerged through the amalgamation process the Care Council with the Social Services Inspectorate was the combining of two different cultures of inspection, people with experience of either the care sector or local authority services. Many of those now carrying out inspections within CSSIW were people who used to inspect social services. They may have years of experience of inspecting social services but they are not very good at inspecting care homes, where a lot of our vulnerable elderly people may be looked after. This simply isn’t good enough.

We must ensure that the very best care providers in the sector are maintained and the worst and repeat offenders are weeded out and driven out of the market. There is no place for care home providers driving down costs in order to reap 30% profit margins to the detriment of their residents. Caring has to be their number one priority and this is the most crucial factor to any care homes success and that has to be effectively demonstrated.

We need a future system of care where people can be sure their care needs are supported. A system which raises the quality of care in people’s homes and residential homes. A system which reverses the decline in productivity in the social care sector. A system which ends the scandal of people being forced to sell their home or lose their lifetime savings simply because they are unfortunate enough to need long-term care. A system which guarantees the very best for our older citizens, ensuring they receive the care and dignity they deserve.