At what age do we become ‘old’?

Here’s the column I wrote for the EADT and the Ipswich Star newspapers last week:

 I’d like to begin this week’s column with a question.

At what age do we become ‘old’?

As language changes and adapts, we as a society are good at filtering out certain anachronisms. The use of the word “elderly”, for example, is less common now. But we frequently use such catch-all terms as “older people” which, after all, is so general as to be almost meaningless.

We are all ageing and I would claim with some confidence that we all want to age well. So, if we are not “older people” now, we will all fall within this category one day.

We know that more of us in Suffolk will be aged 65 years or over in the coming years as a proportion of the population. We’re also living longer, with the gap between male and female life expectancy closing.

In addition, Suffolk is a fantastic county, with incredible assets, so it is no surprise that many people enjoy living here, retiring here and ageing here.

Unlike many other parts of the UK, we are a county without a city. Many of our greatest strengths centre around rural, country living with the benefits this provides as we support one another and look out for our neighbours. We enjoy significant formal and informal networks of support that see old and young living and working together, bringing out the best attributes of supportive communities.

I would argue our rapidly ageing population can be viewed in one of two ways: as an insurmountable, growing threat to our health and social care services, or as a great opportunity to adapt, innovate and prosper as a county.

I see this as an opportunity to be a forward-thinking county that values and welcomes its growing older population.

No single authority, organisation or sector can create this environment alone. We must work together and engage our communities if we want to see meaningful, sustainable change.

The last 10 years have seen major change. We have seen a move from centralised control to more personalised support and care delivered in the community. The coming years will bring about increasing change to our health and care services.

Inevitably, we will be working later into life which means the nature and shape of the county’s workforce will change.

Our predominantly rural setting also provides a challenge to the way  we reach potentially isolated communities. But we are already seeing examples of this in abundance, from well established schemes such as the Debenham Project to emerging opportunities created by social prescribing.

Thanks to the foresight of our health and care teams, we are already seeing the benefits of  learning what works well elsewhere. In the west of the county, we are testing out the Buurtzorg model of integrated health and personal care delivered by small teams of self-managed nurses working in the community, based on an approach developed in the Netherlands.

One issue that is perennially in the headlines is housing; more specifically, the need for more housing that caters for the changing needs of the UK population. If we are to curb the trend of 30-40 year olds living at home because they cannot afford to join the property ladder at one end of the spectrum, and 80 year olds living on their own in a five-bedroom home at the other, we all have to act now.

But the need is wider than this: as we build and adapt our homes, we must ask ourselves if they are they hardwired for the needs of an entire population. Is the surrounding transport network responsive to the needs of an ageing society? Above all, are we providing affordable, shared space that encourages an active lifestyle at every stage of an individual’s life?

Ultimately, we need to provide support for those with more complex needs, while enabling others to remain active and independent, without the risks of becoming isolated.

When it comes to being connected, the myth of an older generation out of touch with modern technology is not borne out by the facts. Nationally, more than three quarters of 65-74 year olds and over 40% of those aged 74 and over used the internet in the last three months.

From open access at our libraries and other information points, to the investment in countywide broadband, our older population is more switched on to new media than ever. This is clearly not the case for all, but the many advantages this brings – from online shopping to connecting with family – are often a valuable antidote to social isolation.

Which brings me back to my question: what we mean by “old”? There’s the old cliché that you are only as old as you feel, and that age is just a state of mind; with people living and working longer, and the cultural changes that this entails, we may be moving  closer to a society in which we need to reconsider and redefine every aspect of what we mean by ageing.

Most of us enjoy better life chances, and a higher life expectancy, than previous generations. Though not without exceptions, this affords us the opportunity to think about ageing differently.

 

 

 

As winter approaches

Here’s the column I wrote for the EADT and the Ipswich Star newspapers a couple of weeks ago:

With temperatures noticeably dropping outside, we are on the cusp of the period that causes the most anxiety among health and social care professionals.

As the Leader of a county council, my staff are bracing themselves for the unknown, but putting robust plans in place to ensure any ‘winter crisis’ is kept at bay – as I’m sure councils are doing across the country. However, planning for the forthcoming period and beyond has been made more difficult; with storm clouds gathering between Whitehall and councils because of fraught debates over delayed transfers from hospital.

The context behind this leads back to the government’s much-welcomed additional £2billion for social care last March, showing it was listening to our concerns over the fragility of the social care system.

Councils have invested this money in making the system work better for patients, including raising care home fees, recruiting extra dementia nurses, and expanding rapid response services. This funding has helped reduce delayed discharges, and better supported the care needs of residents.

Initially, completely unrealistic targets were imposed on counties. Subsequently, 32 local authorities received letters asserting that if they do not improve discharge rates by November part of this £2bn funding would be withheld, or, equally concerning, diktats from Whitehall would be issued on how funding should be spent locally.

The imposition of targets and the positioning of NHS England has led to delays in agreeing details of the Better Care Fund (BCF), a further pot of cash for local areas to better integrate health services.

The concerns of Ministers are understandable. Rates of delayed transfers have continued to rise; a real issue for the health service but also a moral issue: no-one deserves to be stuck in hospital longer than they should do.

However, rising delayed discharges should be of little surprise when you consider the factors involved: the funding available for social care, rising demographics and demand, and, in particular whole system performance: two-thirds of delayed days are attributable to the NHS, not councils.

While Suffolk is not one of the 32 authorities that received a letter, just under half of those who were contacted are county authorities. Counties have faced a financial quandary unmatched in local government with 30% less funding per head of over 65s than in 2010 and face a £1bn black-hole in social care funding by 2020/21.

We must consider ways to use money in the system more effectively. This goes to the heart of why the current loggerheads between councils, NHS England, and the Department of Health is counterproductive and potentially highly damaging.

Counties have worked tirelessly with NHS partners to develop BCF plans, providing impetus to reduce demand. The prospect of this funding being withheld or placing it in a national body’s hands, could I fear, only worsen the situation. In this instance, centrally-led initiatives are no substitute for local knowledge and expertise.

Rather than short-term, centralist thinking, I believe we should channel our efforts into prevention and early intervention. People are living longer, meaning they are increasingly likely to have more complex conditions requiring greater levels of care.

This means there is also a need for personal responsibility as well – if people do things such as getting a flu jab, that will reduce the chance of receiving a serious illness and a visit to A&E. If people are unwell they should start by seeing their pharmacist and GP before visiting A&E, allowing those who really need emergency care to get it as quickly as possible.

Government may need to give health and social care additional funding in the Budget for the winter, but Ministers must also give local areas the opportunity to implement their BCF plans and deliver a preventative, community-based, approach.

Those 32 councils threatened with the prospect of having funding withheld must be given time to see the fruits of their labour. If not, investment by councils could go to waste and local partnerships with health will be permanently set back.

Fixing health and social care is not going to happen overnight. They are two very different beasts, multi-layered and steeped in years of bureaucracy and regulations.

That’s why whole-system reform is needed. We have failed to evolve the systems to match the demand, needs, expectations, and ultimately the money available to pay for them. It is this fundamental question we need to focus on in the forthcoming social care green paper, rather than who is to blame for delayed transfers.

Ultimately, it is revolution, rather than evolution, that is needed to unpick the systemic issues that drive the actions of both health and social care. But to make that happen, we need collaboration, not consternation.

Letter from the CCN to the Secretaries of State for Health & Local Government

fullsizeoutput_1cbeLast week I attended the National Children’s and Adult Services Conference in Bournemouth.  On the way down as Leaders from across the Adult Social Care Councils including me, received an email with a letter attached from SoS DH Jeremy Hunt and co-signed by SoS DCLG Sajid Javid about Delayed Transfers of Care, these happen when a person is medically fit for discharge form a Hospital and we are unable to put in place a suitable package of home or residential care quick enough, this is known in Health and Local Government as DTOC.

As winter approaches and with one of the worse Flu epidemic in the Southern Hemisphere seen in recent years (if you have not yet had the flu jab, I would recommend it, I paid £10 at my local chemist and apparently ASDA are doing them for £5) the NHS is extremely worried about the stress on hospital beds over the winter months, as they are expecting significant numbers of admissions for this simple but dangerous virus to vulnerable groups’.  So the need to feed up beds is important and there are two areas where local government is involved preventing people going to A&E in the first place and how quickly we can facilitate those who need a care package when they are ready to leave hospital obviously the more effective the system the more beds the NHS will have free to cope this winter.

The letter were somewhat condescending and effectively suggest we alongside the other 80 or so local councils responsible for DTOC are failing.  However it was a step back from the threats made earlier in the year about fines and direction of budget if the situation did not get sorted out.  Very DoH, not very DCLG but in this repsect DCLG is very much the junior partner to the might DoH.  During the course of last Wednesday at the conference it emerged that there were in fact three different letters issued, and our was the middle one not praising us but not summonsing us to Department of Health (DoH) as about 32 Councils will find themselves having to go before a panel of experts at DoH, and for experts read people who work in Whitehall, or more precisely civil servants who work in DH in Whitehall who will want to see plans for a lower DTOC target in those areas or they will re-direct monies spent of Adult Social Care to hospitals which will not deal with the issues and probably make them worse.  Adult Social Care cannot be fixed by a summons from DoH, it needs careful partnership working on the ground in each area surrounding a hospital. .  At the conference, we referred to these as naughty step letter and which one you were on – a very flippant comment given the seriousness of the issue but given the patronising letters, as if our social work teams are not working hard to provide the care packages, which they are, its the right term to use.

The issues are complex and the impression you get from the letters is that its entirely Local Governments fault and so DoH can swoop in, divert money to hospitals and all will be right with the world, sorry but this is nonsense.   Fundamentally Local Government needs funding to provide the care, it’s as simple as that, and the threat is that if local Government does not improve then it will have funding withdrawn is worrying.  this is not about simply demanding more money for Local Government has stepped up and made the savings the Government has called for but there comes a point.  Across the county grown up discussion with Hospitals and Clinical Commissioning groups are building a long term system to handle discharge and withdrawing money will not improve that one bit, quite the reverse in fact.

So, on behalf of the County Councils Network on Friday I wrote to both Secretaries of State pointing out the position of CCN member Councils and our concerns.  In Suffolk we work closely with our Acute hospitals planning prevention, avoiding having to go to A&E and when people are admitted discharge planning starts straight away, in West Suffolk the hospital’s enlighten CE Stephen Dunn has contracted beds in a Care Home with nursing to provide people a different setting to recover, what used to be called Convalescence.  As our population ages we are going to need to see a return to this sort of step down care, from our hospitals.

Another false dawn?

fullsizeoutput_1bf4Last Wednesday I was in London for the County Councils Network AGM held this year in the main Hall of the Chartered Insurance Institute in the heart of the City of London, which given the discussion I wanted to have with fellow Leaders was quite fitting setting as the sun shone through the Institutes historic stained-glass windows with the logos & formation dates of the various Great British Insurance companies formed since the 1700’s, depicted.

After the formalities of the AGM we moved into a discussion on the coming Green Paper on Social Care and I led a discussion in my capacity as spokesperson for Health and Social Care on our initial ideas by tabling a discussion paper for Leaders to feedback if they agree that the areas we are considering lobbying on are the right ones and what the emphasis should be.  These are senior gatherings from across the Country of those Councils which provide support for some 48% of all older people and those with Learning and Physical Disabilities, so our thoughts  are based on our practical knowledge of delivering a system and thus I would say important to help Government shape the coming bill.

In my opening remarks, I said that what we must lobby for and encourage from across the sector from ADASS to our MPs that this must not another false dawn.  I have been a Councillors since 2006 and in that time, I have seen successive Governments seek to tackle this issue of funding and the nature of the Health and Social Care integration and indeed if I think there has been false dawns on the Local Government side there is perpetual motion on the NHS side.

We have seen with Gordon Brown’s free Social Care at home proposals which ended in disarray as utterly un-costed, but hey there’s a Labour Government for you, to the collapse of the Westminster cross-party discussions when they accused each other of promoting a Death Tax in the run into the 2010 elections.  Next up we had the Andrew Dilnot Report which fizzled out when the then Chancellor decided far too expensive and so set a higher cap and that came to nothing.  To the recent Conservative Manifesto which was accused of being a Dementia Tax by Labour within hours of being unveiled.  On the NHS side, we’ve seen the arrival of the CCG from the old PCTs, the creation of the Health and Wellbeing Boards, some of which genuinely have shifted the notion of how to tackle an Ageing Populations other not so much.  And now the notion that on DTOC DCLG or is that the NHS will start withholding money from Upper Tier Councils if there is an excessive wait for patients once declared medically fit for discharge and too long a wait for a social care package to be found.

If like me you are involved in this issue is an extremely complex once that requires the NHS to work in collaboration with local government.  DTOC fines are not going to help one little bit by taking further funding away from already stretch services and making the relationship not one of collaboration but performance fines.  In 2010 we moved away from this culture and now through the influence of the mighty NHS we seem to be moving backwards.

So, there is a lot riding on the Green paper from solving the ridiculously complex funding grants and taxes currently in place from the BCF to the National Adult Social Care precept, a threshold here and a cap there – all of which seems to me avoids a fundamental question – how do we, as a nation, pay for Social Care often seen through the prism of Free NHS services. To my mind its relatively simple a per head of population funding formula irrespective of BRR and we will to have a contribution from people’s property wealth but given the Russian roulette of Dementia and frailty we should cap this so people can reasonable expect to be able to hand down much of what they have worked hard for over the years. Equally that the NHS must be required to work with Local Government to shape and deliver communities that service our residents not in shiny new hospital buildings but in the communities in which we all live together.  So, can we have a green paper that is more than activity more than another false dawn and genuinely starts to address the issues of our ageing population.

I’ll be presenting a draft lobby paper to the CNN Conference in November for sign off by the County Council Leaders as our contribution to this debate and when completed I will put up a link to it here.

Things have to change

Last Monday in my role as Chairman of the Improvement and Efficiency Panel of the East of England Local Government Association (EELGA) I chaired a conference at the Cambridge Genome Campus Conference Centre, probably the most impressive venue in East Anglia.  The conference was entitled Positive Ageing and co-convened by the Eastern Academic Health Science Network (EAHSN), which is an organisation within the Health system dedicated to new learning and bringing technology to the fore in the Health world, the other co-sponsors were NHS Confederation and Public Health England.

About 200 people from across the region’s Health and Social Care system gathered to hear speakers and life experiences of older age and how we, as a system, can help shape a positive vision and reality for people as they age in our communities.  An ageing population is often talked about but just living to a ripe of age is not enough it has to be a positive experience or what the point and that is the point I made in opening the Conference.

Here is conference brochure summary of what the day entailed:

‘With a significant ageing demographic the East of England is well positioned to be at the leading edge of accelerating the testing and scale up of self-care technology and health services in a way which can help make ageing work better for everyone.

This conference, led by Eastern AHSN, the East of England LGA, Public Health England and the NHS Confederation, will bring together NHS, local government, industry and academia stakeholders and aims to strengthen emerging solutions, new ways of working and shared plans for achieving healthier and happier ageing across the region.

In particular it will look to:

  • support the STPs to meet their ambitions on this agenda
  • identify opportunities to work collaboratively to further positive ageing agenda
  • position the region at the forefront of the UKs research and innovation communities.

The conference will be structured around six themes which include:

  • Defining successful ageing – What are the real demographics of ageing?
  • Sowing health habits – What can we do to ensure our own health and increase the chance of both a long life and a healthy life?
  • Rethinking work – How can society ensure the health and economic benefits of work for more people into older life?
  • Breakthroughs in technology – How can new research and innovations radically change our concepts of what old age means?
  • Connecting with others – How can we develop caring communities and multi-generational social networks?
  • Preserving purpose – How can health and social care systems focus on maintaining quality and purpose of life above the drive for extending life?’

And here is the link to the presentations from the day and if you have a look please look out for the Buurtzorg Health Care Model as that is a programme I am championing here in Suffolk and is a part of our contribution to the national debate about how we re-shape the healthcare system to better serve the changing age profile of our communities.

http://www.eelga.gov.uk/events/east_of_england_positive_ageing/

 

 

 

The battle for Row Heath

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Over the past 11 year years I have had the honour of representing my community on Suffolk County Council and as elections approach I start my campaign full of beans.  After 11 years on a council it might seem that you might have done everything but far from it, Local Government is changing and resident’s expectation of the services they want and need is also changing. On the one hand, there is considerable less money in Local Government that there used to be, in the past 7 years Suffolk County Council has saved over £200M yet delivers more services that ever before. We done this by being business like in our approach to the way the council runs.

People want faster better services such as road repairs and want to know that Children are protected, we have prioritised Children Services and protected the budgets with which hard working teams go about their business, and this is recognised by OFSTED who rate our Children services as good.  For older residents who can’t afford their own care, we make sure they are looked after with love and dignity, and quite right to, we do this by making sure we have a robust relationship with providers of services, holding them to account, ever mindful we are the holders of the public purse.

Locally, housing for our younger people so they can start to get on the housing ladder is vital, as is new schools and school places. As the housing arrives we want better facilities in our communities and we also want to know that if we reach a stage in life that we can’t use a car that our lovely rural villages do not become traps.  On all these fronts, I try to be a strong voice for Row Heath advocating locally, in Ipswich and nationally for our area. Today for instances I am in Cambridge meeting senior officials about the future of RAF Mildenhall a set of decisions that will affect the economic prospect of Row Heath for years to come.

We have a number of plans we will be putting forwards in our manifesto, all careful costed out.  Labour Finance Spokesperson on the county council Len Jacklyn is on record as saying ‘It is predicted that finances should improve over the next four years and spending now on statutory costs will begin to pay off in 2020’. A truly scary comment as they have been to all the same conferences I have been and at not one of them did it predicted that the finances will improve much.  Their Financially Dangerous Manifesto makes promises they could not hope or maybe even be allowed to fulfil or maybe Labour have some Corbinista moneytree nightmare where he takes power and removes the Council Tax cap and they can go back to the good of days of treating your hard-earned money as their personal piggy bank.  It’s well worth having a look at their bizarrely already published Manifesto it is truly Financially Dangerous.

So, what a contrast we have spent the past year working on our manifesto, carefully costing it every step of the way. And I can’t wait to get it launched and be out their explaining to residents how we are going to take Suffolk forward.

In the meantime, as I am out and about I am asking residents to fill in my survey or do it on line.  The one for my Division Row Heath is http://www.surveymonkey.com/r/RowHeath please do click through and take the survey, as I am very keen to hear your views.

 

Budget Day

Budget

This Thursday is Suffolk County Council’s Budget Day. It’s important for two reasons, it’s when we set the bulk of your, and my, Council Tax bill and we set the money each service will get to provide frontline services for the year ahead.

Budgets are important to Councils because until like the La, La, Land of the NHS finances where massive deficits mean little, in Local Government if you run out of money, wages are not paid and services shut down.

Every year the Conservative administration pour over the figures in the £500M budget starting almost as soon as the last budget is set. And whilst the figures are huge and services are vital such as protecting vulnerable children from abuse, the process is little different from how we budget at home.  We save money for big projects like a house extension or in the council’s case the two new Bridge projects. We have some money set aside for emergencies and the unexpected (reserves) and we plan for renewing smaller items like the computer, (major IT system changes) all of which is based on assumptions of our income in the coming years.

That may sound a bit simplistic but it’s essentially it’s the same process we go through at home.  For Local Government, as to future prospects all the future income indicators are poor as we face less money over the next few years’ from Government. So we maintain reserves to ensure we can sustain services and deal with the unexpected. It may at times be a little bit boring but we are prudent and careful with your money.

Just as in life then there are the neighbours or in our case the opposition Labour and Lib Dems.  Like the neighbour’s flash new car, always out there promising the world, spend, spend, spend for tomorrow never comes, we’ll get more money from somewhere, why have reserves, live for today. The Jeremy Corbin view of the world, it all look like fun and of course the sun will come out tomorrow, Happy Days.  But then again the last time they were allowed to be in control in Suffolk we all know how that ended, budgets not keep to, failing services and finally booted out of power, for raising the Council tax by 11.9% in one year and 18.5% in the next trying to keep the show on the road – ‘What rubbish’ I am told that was then this is now, but you see I don’t think it is rubbish, I think it’s a mind-set that has not changed one bit.

So we may be a bit cautious, we may be a bit tough in how we negotiate but, we have delivered 7 years of 0% raises in the base Council Tax and carefully applied the National Adult Social Care Precept to give our lowest paid, mainly care workers, a welcome pay increase and rightly so.  I hope in May people will allow us to carry on running the council, we will be innovative in our approaches and have lots of new ideas about how we go about things over the next 4 years building on the work these past 4 years but we will always, always be prudent and carefully with the budget and our reserves, ever mindful of the need to protect the most vulnerable in our communities and ever mindful it’s your hard earned money.

But remember those flash neighbours (and apologies to my neighbours who are all lovely people and not part of this reference!), if Labour and the Liberal were in power when they run out of the council’s money, guess who’s money they’ll come after, yours!

Thursday’s meeting is web cast so please log-in and have a watch.

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