Charteris

So why did these 78 organisations choose the Daily Mail for their letter last week?

Hardly a paper most of them are likely to read. However from an impact point of view it has hit the Tory target really well and got referred to across the media last week. The Mail is really poking the government hard on this one, with their ‘Dignity for the Elderly’ campaign. Today Labour kept the pressure up with some headline earning news, after a ‘Freedom of Information’ exercise on the differing costs of Domiciliary Care across the nation and general reduction in the amount of ‘paid for’ care being provided by Councils. The pressure is on and the Minister was unavailable for the BBC this morning.

In his absence a very sanguine Richard Humphries from the Kings Fund told the BBC Today Programme that the 11% reduction is not at all surprising in the light of the spending reviews and policies of both the last two governments. A representative from Brighton Council gently explained the apparent high cost of Domiciliary Care which was perfectly sound and just made the comparisons from the FOI exercise look quite banal. Labour’s shadow minister talked about all parties working together on this one.

What exactly are they going to do?

Nothing seemingly – the White Paper (Caring for Our Future) should have been published at Easter and now has not made it into the Queens Speech, so there is no legislation tabled. This does seem to be in the ‘too hard’ pile.

So far no one seems to be listening to two very bright ideas to help solve this conundrum, both of which get very little mention from the much hailed Andrew Dilnot report.

1. It is well known but not really recognised that we give too many people too much care for too long. We’ve got to measure it out much more carefully and encourage people to regain as much of their previous independence as we can. This is extremely good for them and their loved ones and costs government a lot less. Such an approach defies the notion that today’s level of expenditure on social care is the starting point for all the demographic time-bomb doom merchants.
2. When a person needs a change of domestic setting, let’s not make this an irreversible move into residential care.  It’s an old fashioned word but convalescence can deliver great outcomes – like recovery, for example – such that a person can get back home. Too often it is a death sentence, with the home being sold to fund a place in institutional care. If the home did not need to be sold then an escape route back to independent living would be possible. Too little thought has gone into the use of equity release which could give people this possibility in life. It works by releasing money from the value of an older person’s house to pay for convalescent care which is only repayable after their death from the proceeds of their estate.

Both these ideas start with a very optimistic but also very sensible thought which we all have; that we can get better. If we can get better – even if it is just a bit better – then we will need less care because we can do more for ourselves. Even if we don’t get better then we can still strive to enjoy what we did before but in different ways. Maybe we get a friend to drive us to church or the pub, rather than walking. It’s still about regaining as much as we can of our lives and ensuring we continue to enjoy those things that are most important to us. Too often, different, far more pessimistic expectations are set and the social care system then is set up to deliver those. 

The future for older people should be seen as very bright, surely?

• we can remain active and independent for longer
• we are not so subject to the killer diseases
• we can connect with more descendants than ever (maybe three or four generations)
• we have hard won wisdom to offer them.

The only ‘but’ is that all this means that later in life we are likely to meet our end quite slowly from a degenerative disease. This is the bit everyone is currently fixated by – the cost to provide a dignified end. What we are missing is reaping the savings made possible by prolonging happy independence for as long as possible by only giving people what they need. Here could be, both a better life lived, and at a lower cost to us all.

Turning these ideas into practice is not fanciful or terribly difficult. We have helped one mid-sized local authority’s adult social care department and its care provider market to make the first idea practical – it is generating better outcomes for people at lower cost. It is now described by Professor John Bolton as “perhaps at the forefront of adult social care in England”. There are pockets of activity exploiting bits of the second idea but it needs bringing together. We are looking for a local authority, residential home provider and a financial services company who would be prepared to let us help them with designing convalescent homes, short stays at which are funded by equity release. 

Most of us are needlessly seeing through a glass darkly on this one which is causing total stultification. It’s time the practical optimists got a chance to influence this long delayed white paper and actually start the process of caring for our future.

Jeremy Labram, Principal