Recent media stories have focussed on the considerable difficulties that local authorities are having in providing social care for the elderly at a time of rising numbers of elderly people and the pressures of financial austerity. In the last few weeks, media reports have commented on some local authorities being close to collapse because of the funding pressures of the ageing population.
The phenomena of ageing populations has been known for many years as a UK and an international challenge. The increases in the proportions of the population which is deemed elderly (65+) and very elderly (80+) are forecast to continue and it is said that one in four children born today in the UK will live to be 100.
The aging population has implications in a number of areas such as health, housing, labour supply to the economy, pensions etc but one of the biggest challenges concerns social care for the elderly. The provision of social care to the elderly can range from giving a small amount of support to elderly persons living independently in their own home to the provision of 24-hour residential care and nursing care. As the numbers of elderly and very elderly increase so does the volumes of social care needed increase.
What is certain is that we cannot go on as we are. The well-known Barnet Graph of Doom suggests that if nothing changes then by 2022/23 the costs of adult social care and children's services will exceed the total budget of a local authority with nothing left for all the other services. Clearly, this cannot happen but it does indicate the grave problem facing local government.
The simple aim must be to reduce the proportion of the elderly going into residential (or nursing care) and increase the proportion receiving other forms of social care such as homecare, sheltered housing etc. This is not just about the costs involved but the feasibility of delivering increasing volumes of residential care given the current instability in the residential care market which does not seem likely to disappear in the near future. Also to be considered are possible problems with the supply of social care labour particularly because of BREXIT. A large proportion of social care is already provided by Eastern Europeans who may not remain in the UK
So what is to be done? Well in the short term, the only option appears to be for the government to provide additional funding to keep the ship afloat until a wide range of measures can be implemented to provide a greater degree of stability. To achieve this stability, in the longer term, there must be substantial changes in the way adult social care for the elderly is organised, funded and provided and in the interface between health and social care. This is especially true since austerity is set to continue for the foreseeable future.
Significant change is required in many areas and unfortunately, there are no easy options since all of the "low hanging fruit" has already been picked in the early years of austerity. What is being talked about here is a complex and potentially expensive exercise, which needs to be examined and evaluated carefully - one size will not fit all. The change process involved will, undoubtedly be difficult but it cannot be relegated to the "too difficult" box. This fact must be widely communicated, among staff, services users and politicians in that if we don't address these issues we face disaster - do nothing is not an option
Based on work I have done recently, I suggest there a number of key themes to be pursued including the following
• Improved co-ordination between central and local government of public housing policies for the elderly
• More pro-active working between local government and private housing providers regarding housing for the elderly
• The need to shift to a new service paradigm more appropriate to the challenges of the future and to reshape existing services in line with this paradigm. The emphasis must be to empower and give confidence to elderly people to look after themselves while proving a safety net in the case of difficulties
• The need to be pro-active about the potential for using technology in delivering services to the elderly.
• The strengthening of primary care and intermediate health care as a means of preventing elderly people from having to be admitted to hospital beds. This requires good partnerships between the various bits of the NHS and local government.
• The need to utilise spare capacity among other public service professionals and to stimulate voluntary support capacity in caring for the elderly
• Recognition that all of this implies considerable up-front investment plus a significant and management of the change process. There is a need for buy-in from all parties involved including politicians, service professionals and service users.
While not everyone will agree with everything, I have had to say on this matter, I think everyone will agree that it is imperative that action is needed. Popular culture has it that the Emperor Nero fiddled while Rome burned down. I want to argue that it is incumbent on central government, local government and NHS organisations to rise to the challenges and not continue fiddling.