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Rapid Ageing: A Caring Future
Delivering social care in the UK
Ruthe Isden: Public Services Programme Manager, Age UK
9th May 2012
Summary
Later life in the UK: who we care for now and in the future The social care system in the UK Funding and national framework Social care market and providers NHS and social care: two very different systems The big debates: personalisation, co-production,
prevention, integration and future funding
Later life in the UK
There are 10.3 million people aged 65 or over in the UK today
There are 1.4 million people are aged 85 or over – the people most likely to need care
These numbers will grow significantly in the future as people live longer and more people enter retirement
Looking ahead: Growth in numbers of older people 2010-2030
0%
20%
40%
60%
80%
100%
65-69 70-74 75-79 80-84 85+
Dilnot et al: Conclusions and recommendations of the Commission on Funding of Care and Support, 2011
Health and care in later life
4 million have a limiting longstanding illness, 40% of all people aged 65+
By 2030 there will be over 6 million with a long term condition
Over 820,000 people are estimated to be suffering from late onset dementia in the UK in 2010
By 2030 there will be over 1 million people with dementia 1 in 2 people will require care in older age
Main causes of care and support needs (all adults)
Humphries. R, The Kings Fund 2012
Who we care for and how: publicly funded care
Humphries, R: Social Care and the NHS, The Kings Fund, 2011
Numbers of people aged 65+ using publicly funded social care services 2004 – 2010
0
200
400
600
800
1000
1200
2007/8 2008/9 2009/10
Nursing home
Residential care
Communitybased services
Growing demand for social care services
Growing numbers of ‘the very old’ people aged over 80 BUT……
Improvements in healthcare driving life expectancy and better treatment of complex long term conditions that require specialised care
Smaller, more geographically disburse families More women in the workplace Changing attitudes and expectations – older people want
to be independent and self reliant
UK national framework
Social care is a local government responsibility, they decide what care to provide and how
National government sets minimum standards and criteria only
Funding is largely provided by national government grant, but it is not ring fenced
Last year national government provided £7.3 billion in funding, however some funding was drawn from the NHS
National system of regulation for service providers – mandatory registration with the Care Quality Commission
Using social care services in the UK
Anyone can approach their local council and ask for an assessment
of their needs
Everyone has to takea means test and, if they are eligible, thecouncil will charge
for services
A needs assessment is completed by a social worker or other health
professional
If someone falls within the council criteria a care
plan will be producedsetting out what
support they need
People are assigneda level of ‘need’ basedon the national criteria
The council will eitherprovide money (a direct
payment) or contractservices to meet
their needs
Eligibility tests – needs and means
Needs test has four levels: low, moderate, substantial and critical
The test looks at routine household tasks (e.g. shopping, cooking), personal care (e.g. bathing, dressing) and risk of harm (e.g. falling)
Means test measures both income and assets – if these are above a certain level then an individual is required to meet all or part of the costs of care.
Outside the state system
Informal care – 6 million people (1 in 8) are ‘informal carers’ looking after family members, partners or friends
Private care market – many people pay for their own care: – 170,000 (about 41%) people pay their own care home
fees– somewhere between 168,000-274,000 pay for their
own home care (difficult to estimate as many are unknown to councils)
Social care market and providers
Nearly 90% of formal care is provided by private or charity sector organisations
Part of deliberate policy aimed at developing a market in care provision to:– use competition to drive improvement in quality– create greater diversity of types of services– stimulate commercial investment in services
Mixed results – many critics argue it has made services more fragmented, less accountable and has not improved quality
Care in crisis?
Poor quality of care services with limited access to specialist help
Poor integration and care co-ordination ‘Geographical lottery’ – 82% of councils only support
people with substantial or critical needs Hard to access – 800,000 older people receive no formal
help High individual financial risk – many people risk losing all
their money before receiving help Poor support for carers – families find it difficult to get
help or information
NHS and social care: what’s the difference?
NHS Social care • Provides primary, secondary and tertiary healthcare services• Free at the point of need• Comprehensive, universal services• Fully funded through general taxation• Locally commissioned, but within a clear national system• Fairly little local variation in services provided
• Provides care in care homes, in day facilities and in people’s home• Means-tested and needs-tested at point of need• Local councils set local criteria and commission care• Far fewer national rules or guide lines• Huge geographical variation in types of services, funding and rules
The big themes: integration
‘ensuring social care, health and housing services operate together efficiently and effectively’
Key issues:– care co-ordination and complementary points of entry
to maximise benefits– professional integration – common culture and ways of
working– systems working outside silos and sharing budgets– shared vision and leadership across systems
Failure to integrate = inefficient use of resources, poor outcomes, crisis care and excess hospital admission
The big themes: personalisation
‘making social care services more responsive to individual needs and giving people great choice and control’
Key issues:– recognising people as ‘experts’ in their lives and
condition – ‘individuals know best what they need’– challenge ‘I know best’ professional culture and ‘gift’
model of care – challenging the medical model of care– providing of good information and advice – making sure services are accountable to service users
Big challenge in making personalisation work for older people who may lack mental capacity or have rapidly changing needs
The big themes: co-production and community solutions
‘working in partnership with service users to design and deliver services’
Key issues:– people not ‘passive consumers’ but able to contribute
to creating care and care relationships– engaging service users, families and the community in
designing health and care services and economy– building on community assets to find individual and
collective solutions Research demonstrates better, more cost-effective
outcomes
The big themes: prevention and early intervention
‘seeking to prevent or delay the need for social care services by maximising independence and health’
Key issues:– must change the way we think about and provide
health and care – otherwise demand for care services in future may become unsustainable
– often huge, unexploited potential to improve health and wellbeing through effective interventions
– early intervention – ‘a little bit of help’ – delivers huge long term benefits by maintaining independence
– must remove barriers to people investing in prevention
Life expectancy and healthy life expectancy
Shortest
Average
Longest
Shortest
Average
Longest
65 70 75 80 85 90 95
Years in good health Years not in good health
Years
Males
Females
The big themes: future funding issues
UK had a £500 million gap in funding 2010/11 – this is growing every year
Need to invest in prevention to improve cost-effectiveness of system overall in future
Getting the balance of spending right across older people’s services – inadequate social care funding has big impact on healthcare
Individuals must contribute, but there needs to be a fair way to manage and pool risk
Public spending on older people 2010/11
Social security benefits
Social care
NHS
£0bn
£50bn
£100bn
£150bn
Dilnot et al: Conclusions and recommendations of the Commission on Funding of Care and Support, 2011
Social care reform in the UK
‘Dilnot system’ – Capping care costs to protect individual wealth and
pool risk– Fairer means testing to protect people on lower
incomes– New system to create a ‘national offer’ that is the
same in all areas– Stronger role for the private insurance market– Greater emphasis on community solutions and
personalisation
Key messages
Care is increasingly a mixed economy with diverse solutions including family, community and state
Form must follow function Health and social care are two halves of a whole, it
is dangerous to invest in one and not the other Placing older people at the centre of creating care
is cost-effective and delivers better outcomes
Ruthe Isden
Public Services Programme Manager, Age UK
Contact:
By email: [email protected]
By phone: +44 203 033 1478
By post: Tavis House, 1-6 Tavistock Sq, London, WC1H9NA, UK