Road to freedom

Will you still need me when I’m 64?” asked The Beatles. “Will I still be respected to make my own choices?” is what some people might be wondering. Many people find that as they get older they increasingly hear an unwelcome and unfair message: it’s time to adopt an older person’s lifestyle.

People who use social care services are often the first to notice that they have crossed an invisible line once they turn 65. For example, some disabled people have been surprised to find they are no longer “disabled people”. This is because they are now officially classified as “older people” by social service departments and this change is a lot more than semantics. Moving into the realm of older people’s services can mean a reduction in services and restricted access to those they would ordinarily have used in the past.(1)

There is something amiss. Over the past century, we have seen unprecedented gains in life expectancy. By 2051, people over 65 are likely to account for over a quarter of the population.(2) Yet these demographic gains have not been matched by equal social gains in how society thinks and treats older people. Too many older people experience a depressing combination of age discrimination and social exclusion.(3)

There are signs that things are changing. Older people are challenging the stereotype that old age means vulnerability and incapacity to make decisions. This is helping to develop a new account of ageing that avoids both the stereotype of the “old and vulnerable elder”, as well as that of the “heroic third ager” who is in competition with the younger generation.(4) This more realistic account of ageing includes an understanding that the ageing process coincides with major turning points in people’s lives, such as bereavement, retirement and onset of disability or illness. As such, services need to be more focused on supporting people at critical transition points in their lives.

This new approach to ageing is helping to shape some directions in public policy. In 2005, the government published Opportunity Age, a white paper on managing demographic change, as well as the social care green paper Independence, Wellbeing and Choice. Between them, these documents set out an ambitious agenda for improving older people’s services and quality of life. They look to a future where all older people can be independent, have equal opportunities to work and to participate in society, unhindered by age discrimination.

Choice was a constant theme of both documents and has been at the heart of the government’s public service reform agenda. The main headline for social care has been the development of individual budgets – proposals to give older people more control over the resources that the state has allocated to meet their needs. This policy has been inspired by the model of direct payments, an option that has proved to be popular and successful, albeit on a small scale. In 2004, only 6,300 older people were recipients of direct payments although more than one million receive services from social services departments.

Individual budgets are a more user-friendly version of direct payments. Essentially they give people the advantages of choice, without the necessity of taking on the administrative burden of hiring and firing employees. Resources can be taken as a combination of cash (a direct payment); services brokered by an adviser; or council-commissioned services (the current default). The government is planning pilots of individual budgets, which will experiment with bringing together resources from social care, housing support and other funding streams.

Individual budgets deserve to be widely supported. Firstly, the experience of direct payments suggests that giving people greater choice and control can improve services and people’s quality of life. A 2004 study of older people using direct payments showed that they improved people’s satisfaction with services. This was because they enabled service users to tailor the service to factors that influenced their quality of life. This could be anything from helping people to enjoy art shows, to being able to watch evening football matches without having to go to bed before the final whistle.

Of course, there is a proviso that direct payments must be legally used to meet an individual’s needs according to their assessment. But this kind of choice can help services to deliver the intangible aspects of services, for instance good personal relationships. Furthermore, extending choice also marks a significant cultural change in the way society thinks about older people. Introducing the principle of choice helps to mitigate against unfair and unrealistic service responses, where people fall into categories of “disabled” or “old” with rigid assumptions about what those services should look like.

But if individual budgets are to offer people a genuine choice about care and public services, the right support needs to be in place. It has been shown that direct payments schemes are most likely to be successful when there is an adequately resourced support system in place.(5) The government’s consultation on the social care green paper showed that older people in particular wished to see increased provision of assistance to help access direct payments. The Institute for Public Policy Research recommends that there should be a duty on local government to ensure that brokerage and support systems are in place if people are to take up individual budgets with confidence and to the maximum effect.

We should remember that giving people more choice through individual budgets is just one part of the jigsaw for improving health and quality of life for older people. As well as a focus on individual choice, we also need to think of ways of promoting health and well-being for all older people.

Current government policy has high aspirations to move towards more preventive services that are geared to well-being. But to do so, we need to clear up confusion on what is meant by prevention, especially around low level services. It is well known that older people attach a high value on low level services.

But government thinking on low level services is unclear. The Department of Health takes a cautious position and wants to reach a greater understanding of the costs and benefits. In contrast, the Social Exclusion Unit within the Office of the Deputy Prime Minister gives a confident endorsement of the value of low level services, emphasising their contribution to quality of life. If prevention is understood as preventing isolation and promoting quality of life, as well as simply preventing illness, then the case for funding low level services is persuasive.

Extending choice and control for older people is part of a new approach to ageing. However, for older people to realise the benefits of greater individual choice, there is a need for effective support services and a clear strategy on promoting health and well-being.

Jennifer Rankin is a research fellow at the Institute for Public Policy Research where she has authored several publications and working papers on health and social care. Her main interests are mental health, social care and the future of public services.

Training and learning
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.

Abstract
The government’s proposals on individual budgets challenge stereotypes about age and have a lot to offer in delivering better services. However, an emphasis on choice should be accompanied by a clearer focus on improving health and promoting well-being of older people.

References
(1) H Clark, H Gough, A Macfarlane, It Pays Dividends: Direct Payments and Older People, Joseph Rowntree Foundation and Policy Press, 2004
(2) Department for Work and Pensions, Opportunity Age, 2005
(3) M Dean, Growing Older in the 21st Century, ESRC, 2004
(4) JRF, Older People Shaping Policy and Practice: Older People’s Steering Group at the Joseph Rowntree Foundation, 2004
(5) F Hasler, Clarifying the Evidence on Direct Payments into Practice, National Centre for Independent Living, 2003

Further information
J Rankin, A Mature Policy on Choice, ippr, 2005. Free to download at www.ippr.org
M Godfrey, J Townsend, T Denby, Building a Good Life for Older People in Local Communities, Joseph Rowntree Foundation, 2004. Available to download at www.jrf.org.uk
T Kirkwood, The End of Age – 2001, BBC Reith Lectures, 2001

Contact the author
j.rankin@ippr.org