Former Association of Directors of Adult Social Services head John Dixon explains how a review of age discrimination in health and care has informed the Equality Bill
The age discrimination review
John Dixon (this article’s author) chaired the advisory group that supported the work of Ian Carruthers, chief executive of NHS South West, and Bristol Council chief executive Jan Ormondroyd, who led the review.
The group’s remit was to advise on the implications for the sector of provisions in the current Equality Bill to end age discrimination and promote age equality.
Nobody likes to be regarded as holding ageist attitudes or discriminating against clients and carers because of their age. The review of age discrimination in health and social care, which reported in October, has led many of us to reflect on our own practice.
It is now vital for the NHS and councils to ensure that services are provided on a fair basis and that individuals do not receive unfavourable treatment because of their age.
First the good news – there has been clear progress across both sectors in addressing age discrimination over the past decade and, from our detailed discussions in the South West, staff want to end age discrimination as part of their work in transforming and personalising services.
Although many people have told us about excellent experiences, we have also heard about more negative attitudes in the form of inappropriate things said to older people. This was neatly summed up in the phrase “what do you expect at your age?”. People expect to be treated fairly and with respect and not judged by their age.
It is still the usual custom to have separate services for people above and below the age of 65, based on age, and not objective needs-based criteria. Social services departments and the NHS will need to identify when such services are examples of good practice because they are age-appropriate and when they are unfair, as they provide poorer care to people because of their age.
The law – when the Equality Bill is passed – will require that age-based differences can be “objectively justified”. During the financial challenges of the next few years, society, service users and their carers will ask whether the differences in care and treatment that they observe are fair and meet the needs of people at different stages of life.
In social care, our work has focused on the links with the Putting People First programme to personalise care. True personalisation cannot be discriminatory. The answer is not simple uniformity either in terms of service provision or financial packages but rather a focus on undertaking fair assessments for people of all ages. All too often we heard about assumptions that some needs require only cursory attention in the assessment process with older people. This is not only poor practice but will become actionable under the new legislation.
Improvements in assessments will impact on care packages and resource allocation. The “objectively justifiable” pattern of expenditure locally will be based on processes that reflect joint strategic needs assessments of local populations’ health and well-being and individual assessments.
At the same time as the age discrimination review was published, the Association of Directors of Adult Social Services published guidance on a common resource allocation framework. This looks at how councils should allocate resources to people based on their needs under personal budgets.
Both documents conclude that there is no single implementation model but local authorities will need to ensure that their approach is both compliant with the new law and credible to the public. Adass recommends that a single resource allocation system is adopted for all user groups to help reduce unfairness and discrimination.
The law will introduce a ban on age discrimination and a new duty to promote age equality. Councils will use both in their work with providers to ensure they are able to play their part in meeting the letter and spirit of the new legislation.
The review’s overall conclusion is that the Equality Bill will be effective in highlighting the need for action, but that ending age discrimination and promoting age equality are as much about changing attitudes.
It recommends the ban should be implemented in 2012, and during the lead-in, councils will be able to prepare for the legislation as one “building block” in their work on tackling the financial challenges on the social care system.
Adass is working with the review team on a resource pack to help councils and the NHS prepare for the legislation, including a practice guide from the Social Care Institute for Excellence.
The review provides a powerful stimulus to secure further improvement by showing that personalisation is key to ending age discrimination and promoting age equality.
John Dixon is the immediate past president of Adass and is executive director, adults and children, at West Sussex Council
H consults on ageism ban in health and social care