The cost of long-term care is high and will continue to rise. Such is the concern that a coalition of 15 organisations, Caring Choices, launched four months ago, has organised a series of UK roadshows to address the question of how our future care needs will be funded, and the respective contributions of the state and individuals.
The government says it will not make a decision on future funding until it has seen the feedback from these roadshows. However, action needs to be taken now to manage the costs of long-term care through prevention as local authority expenditure on adult social care rose to £14bn in 2006, a 4% increase from 2005. The application of fair access to care criteria is tightening so that only people with critical and substantial needs in some councils will receive any service at all. This is despite the counter-intuitive belief that prevention and early intervention result in increased independence and reduced long-term care costs.
National pilot projects such as the Department of Health Partnerships for Older People Projects (Popps) are being evaluated to provide evidence to support this claim, although the likelihood of finances transferring from acute health care to preventive social care are unlikely given the rising costs and demands for health care. The challenge will be making these projects mainstream services when DH funding ceases.
This means that local authorities need to manage services now that will help them to reduce long-term care costs as well as meet urgent needs. This presents a considerable challenge, but is a requirement of the Commission for Social Care Inspection’s proposed outcome framework for performance assessment. This has three outcomes that address the need for preventive services: improving quality of life economic well-being and maintaining personal respect and dignity.
Councils need to support and develop community services that meet the low level and moderate needs of older people without compromising the level and quality of services provided to those most in need.
Direct payments and individual budgets are leading to more people paying for their care. The market needs to expand, not just for them, but for those who self-fund and those who do not meet the eligibility criteria. Services to meet diverse needs, signposting to these services, information, advocacy and brokerage to help people navigate the system are required. This should be an area of development for councils.
The baby-boomer generation is more affluent than previous generations, although many are asset-rich/cash-poor and need to be able to release equity from their properties or come to other arrangements supported by financial advice. Councils need to ensure that everybody has access to a needs assessment, including self-assessment. While councils have a statutory responsibility to carry out an initial assessment regardless of whether a person intends to self-fund, there is plenty of anecdotal evidence to suggest that this is not the case and self-funders are encouraged to manage without social services support.
Third sector partnerships
By stimulating the market so that new providers of flexible low-level support services emerge and by working with third-sector organisations to develop information and advocacy services, the needs of self-funders will be better met as well as those with low-level needs and people receiving direct payments. The investment required from councils is time spent working with the third sector and local community to support the development of these services.
Lincolnshire and North Lincolnshire councils have done this through the Popps pilots. Lincolnshire Council mapped the range of services provided across the community and approached the third sector to discuss how they could fill the service gaps. This led to a wider range of services.
North Lincolnshire Council set up Fresh Start to provide more opportunities for older people. It is working in partnership with the third sector, which is leading on the development of social enterprises to create some of the services that older people say they want.
In East Sussex, another Popps project has established a navigator service to identify and support people with low-level needs. The service, provided by a local voluntary organisation, uses trained navigators to put people in touch with organisations that can provide the services these people need. The navigators also have budgets and are able to access equipment.
Working with communities to develop services that are planned and managed by local citizens is an aspiration of the government white paper, Strong and Prosperous Communities. But achieving this is a challenge for statutory agencies. It requires councils and their partners to work differently to reach communities. Third sector bodies can provide a bridge between statutory agencies and the local community as they are able to cultivate deeper levels of trust than statutory agencies.
This approach was successful in Northampton where Age Concern was funded by the primary care trust and council to work with the local community to improve health outcomes. Age Concern worked with a small group of older people who volunteered to take on the project. They focused on healthy eating and falls prevention. The number of volunteers has increased into a considerable network and they are providing services in Northampton to improve the health of local people.
Examples include a year’s booking of school healthy eating events, organised and run by Age Concern volunteers older people meeting mothers in mother and baby clinics to distribute food blenders and talk about preparing baby food from fresh ingredients cookery lessons for widowers health and well-being courses for older people who go on to establish and run courses themselves tea dances with older people with live music. The list goes on and each initiative extends the community networks and encourages different generations to come together to help each other. The cost to the PCT and council is minimal but the benefits are huge.
There has been a lot of research supporting the benefits of community networks as informal, reciprocal support means that as well as receiving help, people are able to support others. Feeling needed and valued is important for good mental health and research has found that feeling part of a community is central to a good life in old age.
Time banks are another excellent example. Introduced to the UK in 1998, there were 40 such banks by 2001 and this is likely to have risen. They work in a similar way to the babysitting circle concept. People register the services they can offer, for example, sitting service, dog walking, DIY, cooking, driving, gardening. They are awarded points every time they provide a service to another person on the register. These points can be used to buy a service they need from another person on the register.
People are remembered for what they can do rather than the problems that they have. They benefit from feeling needed and valued as well as receiving a service that helps keep them independent. It would not be too resource-intensive for a council to help a voluntary organisation set up such a scheme, and there could be substantial improvements in health and social care for the participants.
There are other examples of community support networks that need little investment. Telephone trees are used commonly in the US. They could be used for older people who feel vulnerable, living alone, to contact each other at a certain time each day through a cascade system to check that they are well.
Although these examples are not costly or resource-intensive they require councils to work differently, building strong partnerships with the third sector and local community and being open to innovation from all parts of the community.
The costs of long-term care will continue to rise and a long-term solution is needed from the government. Meanwhile, councils can – and must – take positive action to manage the costs of long-term care through prevention.
Deborah Klee is an independent consultant. She was previously head of older people strategy at the Healthcare CommissionThis article appeared in the 23 August issue under the headline “On a tight leash”