All Change - New Horizons for Local

Government

The Future of Care for Older People

December 2011

National demographics

Numbers of people aged 80 and over will increase from 2.3 million to 4.4 million by twenty years time.

Nationally, big differences between rural and urban populations, eg, by 2030 the population aged 75 and over will have increased on average by 47% in urban areas and by 90% in rural areas.

Already 60% of all hospital beds are occupied by people aged 65 and over, 40% of whom have a dementia.

The rate of admissions of older people to hospital in the last ten years has grown at nearly double the rate for the whole population. 2

National wealth

Average pensioner incomes have risen faster than average earnings since the mid-1990s, increasing by 44 per cent in real terms between 1994/95 and 2008/09.

Occupational pensions are increasingly significant, accounting for over a fifth of average gross income for single pensioners and over a quarter of average gross income for pensioner couples.

Nearly 50% of all housing equity is held by people aged 65 and over some £3 trillion worth of property assets.

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Regional demographics

In the West Midlands the population aged 80 and over will grow from just over a quarter of a million to just under half a million, in the next 20 years.

By 2030 over a 100,000 older people it is estimated will have a dementia with some 30,000 people per annum being admitted to hospital after a fall.

In Shropshire and Herefordshire by 2030 nearly a third of the population will be aged 65 and over.

However, 76% of the older peoples population across the region are home owners.

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Government policy

To increase the personalisation of care through giving care users the funding to purchase in the care market.

To shift LAs from being providers and purchasers of care to being ensurers of care supply for all.

To reduce regulation through reducing the inspection regime and promoting the growth of personal assistants.

To increase diversity in the market place through encouraging different forms of enterprise.

To resolve the future funding of care.

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The care market

Residential care – Private, fragmented and diminishing.

Home care – Private, fragmented and growing.

Specialist housing – Public, still represented by sheltered housing, extra care still small.

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Care market questions

Who is residential care for? DO we need to tackle perverse incentives

in home care? Will personalisation increase costs? How do we make sure voluntary

organisations deliver independence rather than provide a step up onto the care pathway.

If there is less regulation who determines and measures quality.

How do we fund and support capital investment?

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Potential impact of government policy

Could bring more people into some element of state funding depending on the threshold levels.

In the short term we could see more care organisations fail.

In the longer term could increase the use of residential care.

Does little to reduce demand or promote efficiencies.

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What needs to happen – seven pillars

of wisdom?

1. Understand demand for high intensity care.

2. Target interventions.3. LA funding to support individual and

community endeavour rather than replace it.

4. See older age as an issue for the whole local authority not just social care.

5. Integrate at the point of delivery not just strategic management.

6. Stop seeing providers of care as the enemy.

7. Stimulate private housing with care for older people.

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1. Demand for care

Failure to deal with or plan for bereavement.

Extreme old age. Social isolation / living alone. Poor health service performance.

− dementia, − falls, − stroke, − continence

Ageism

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2. Target interventions – falls as an

example

Patients with first fractures are not flagged up for secondary prevention. Only around half of A&E and MIU routinely screen people who have had a fall for risk of future falls.

Many of the exercise programmes being provided are not evidence based.

Less than half of falls admissions are screened for osteoporosis risk.

Care homes were the usual place of residence in 10% of non-hip fractures and 22% of hip fractures. Although they only make up 4.5% of the population.

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3. Using funding like gold dust

Need to move population from seeing care as an acquisition to a service available as and when needed.

Testing the value added benefits the voluntary sector brings.

Focussing funding for carers.

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4. A holistic LA approach

Is strategic planning old age focussed and tested?

What does business support offer the care sector?

Start focussing on outcomes rather than cost and volume.

Make sure Public Health delivers VFM. Recognise that better health in the

community means hospital closures.

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5. Integration

Start to integrate services at the front end. Persuade clinical commissioning groups of

the financial gain. Stop signposting.

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6. Work with providers

Framework agreements often not worth the effort.

Set standard terms and conditions for contracting.

Be clear about price v quality. Better understand business and recognise

vulnerability not always good for consumers.

Incentivise good performance that reduces demand.

Incentivise diversity, recognise the kinds of choice people really want.

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7. Stimulate private sector specialist

housing development

Health and care will not sustain people in the community on their own.

Using housing equity to fund housing that reduces demand is better than using housing equity to fund care.

Understand local market issues and how the LA can help to overcome them.

Help to support housing that offers ‘Wow’ rather than ‘has it come to this’ design and development.

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Delivering the future

“"We can't solve

problems by using the

same kind of thinking

we used when we

created them." Albert

Einstein