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.

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/

 

 

 

3% National Adult Social Care Precept rise

 

health-funding

Last year the Government surprised many with the very welcome change from Minimum Wage to National Living Wage, a pay boost for the lowest paid in our society, which has been universally welcomed.  But it also must be paid for and the LGA and the CCN spoke for the entire Care industry in saying we have to, have more money to pay for this, so the Government introduced a new Tax, the National Adult Social Care Precept set at 2% of the Council Tax or in places such as Suffolk 2% of the County Council element of the Council Tax.

You can argue the merits of local v national, property or income based taxation as much as you like but the 2% did not quite cover what we paid to our providers to fund this increase in pay.  We are, this year, asking for the additional 1% Government has allowed, taking this tax to 3% and every penny raised with be spent on Adult Social Care for our most vulnerable residents.

In Suffolk, we carefully negotiate both the rates we pay for residential and home care, ever conscious that we are the holders of your hard-earned money you pay in Council Tax and balancing that, with the need to make sure that employers pay the higher National Living Wage and can attract the staff they need to provide the vital quality of care we would want for our own families.

This year we will not be putting up the base Council Tax for the 7th year running fulfilled our manifesto commitment when we were elected in 2013.  As a Conservative administration, we are philosophically opposed to increasing Council Tax and only do so to pay for those things that we rightly must provide to the most vulnerable in our society.

Protecting Vital Funding

health-funding

Last Wednesday at the LGA I presented a paper to the Community Wellbeing Board about Adult Social Care funding, firstly looking at how we take forward our campaign to have the coming new requirements fully funded, how we protect social care funding in the next parliament and how we influence a future Better Care Fund (BCF); so a couple of small subjects then!

What did come out loud and clear were colleagues insights into the pressures facing their adult social care departments locally. Across the country councils are facing really difficult decisions and trying to protect Children and vulnerable adult social services at the same time as absorbing the re-balancing this country has to make in just how much we, as a nation, spend, no easy task. It was a really good discussion where we also considered the principles and features that should underpin a future BCF, which hopefully will inform negotiations into the next spending review which we all know is coming irrespective of who wins the coming election.

Of course the pooling of Health and Social Care Budgets under Health and Wellbeing Boards is to be welcomed and encourages as a step forward in designing a system in which we make sure our A&E department are only having to dealing with real accidents and emergencies not the failure of the system to cope with an ageing population. Equally we need a system where we stop seeing too many older and disabled people left languishing in hospital beds for too long or consigned to residential care because we lack the capacity to help them live independently for longer.
Even with Health and Wellbeing Boards and increased and accelerated pooling, one of the key difficulties still remains. In real terms the NHS budget are being protected but councils are struggling to protect spending on Adult Social Care set against the backdrop op of the 30% reductions in overall Local Government grant funding that will be seen across the past 5 years and what looks from all parties as if it may well be another 20% cut over the course of the next parliament.
All of these figures are quite general but they give a sense of the scale of this issues before Local Government and of the funding gaps councils are having to address.
That’s why last the meeting concluded that we should reinvigorate the ‘Show us you Care’ campaign with a sustainable funding lobby position with that its core, calling on Government to protect adult social care funding to make it sustainable for the future. This is of course not just essential for social care but for all of the other services that will tip into failure if this problem is not tackled. Equally if cuts are leveled across social care as well as the rest of local government funding then to protect this most vital of front line service, other areas of service delivery will struggle. The next government must make the distinction between general grant funding and that spent of social care, not ring fencing as I don’t think that is the right discussion but a way sustainable way forward for NHS and social care funding for without that, the NHS will fail to cope with our ageing population.

Hospital A&E Winter Pressures & Social Care

A&E sign imageYesterday saw the latest figures for A&E waiting times published and Addenbrookes Hospital at Cambridge, our local major trauma centre declared a ‘major incident’ which are early warning light systems that we have a problem, of course all businesses have peaks and troughs but these figures are particularly worrying is that it’s not a harsh winter rather mild actually and we are out of the ‘perfect storm’ period of closed GP Surgeries over the Christmas period. All of us must use the right services at the right time but interestingly records show that predominately those who present at A&E are right to do so, so what’s the problem? Essentially it is our ageing population, that long talked about issue is now starting to ‘bit’, with unplanned admissions of elderly people at the front end and bed blocking at the far end. With bed blocking perhaps being the first signs that the cuts in local government funding to provide social care and an increasing number of people needing services are making discharge of elderly patients ready to go home increasingly problematical. The figures bring into focus the need for the whole system to work better from GP services, to pharmacists, out of hour’s services, intermediate care beds (that’s what used to be called convalescence) to social care.

The debate rages about Health and Social Care which is the single biggest interface and spend area for Local Government (about 40% of most upper tier authorities budgets) and the NHS spends about £1 in every £6 of national total spend. As Portfolio Holder for Health and Social Care integration at the LGA’s Community Wellbeing Board and LGA CWB Health and Wellbeing Board Ambassador for the East Midlands I firmly believe we have the structures in place to tackle an Ageing population but need Westminster’s continued backing for the Health and Wellbeing Boards to be the place this integration is championed by and driven forward from.

The danger is that as the issue starts to impact hospital’s ability to cope with admissions, Government looks towards the NHS to quick fix the problem and I tend to think reading between the various lines out there, not least Simon Steven’s, the new CE of the NHS, 5 year vision speech, the NHS is quietly lobbying to take control of social care.

This would have two fundamental impacts firstly the cost of social care would rise dramatically, as frankly however well the NHS does things it never does them cheaply. Local Government is the most cost effective part of government for a reason, firstly it’s local, and secondly, and far more importantly, Local Government is articulating a different approach to services built around community capacity and how communities and individuals develop care services in part for themselves. This cannot be done centrally or nor by organisations trying to begin to learn what this thing called ‘community’ and ‘capacity’ is all about. Much of Local Government has for some time been cutting costs and at the same time working differently with communities and developing services in communities and to dismiss it as not clinically valid (in the NHS sense of the word) and start again is a serious mistake. Local Government and the health services in their many forms, through the Health and Wellbeing Boards must be the start and finish point for Health and Social Care integration to solve these problems as our population ages.

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