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.

 

 

 

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.

End of Year 2016

2016 New YearSo, as 2016 draws to a close, it’s a bizzare year to sum up.

On the personal front, it’s been a terrible one as we lost Dad in far too sudden circumstances.  We all miss him a lot.  It a strange thing to say when you ‘painted’ as this old hard-nosed individual but it’s a moment in life when both your parents have gone, of course we all must go through it, but it still a sobering moment for each of us.  Over Christmas, Lisa and I visited an Aunt of hers who is learning to live with Dementia, a dear lady I have known for 19 years who is struggling and in contrast before we left we travelled further north to visit my Auntie who is older but as sharp as a pin and in top form!  Old age is a strange journey and there is no play-book but what I do know is that this country has to wake up to the needs of an ageing population or we will sleep walk into an unpleasant society where old age is not celebrated but seen as a burden.  There are many things on the horizon but how we change our health and social care system and start building homes that address the needs of older people is right up there.

The highlight of the year for me as a Councillor, was being introduced to Her Majesty the Queen at the Home of Horse-Racing Museum official opening.  As we awaited her arrival I chatted with David Burnip the former CE of FHDC and asked him if he remembered my stance on the Palace House purchase and rescue, by the council, all those years ago.  He did, I was against it!  And we reminisced about the then District Council Leader Geoffrey Jaggard and his vision.  The day was all about the Racing Community and how Newmarket can capitalise more on being the world headquarters of Racing but without the decision taken by these two chaps all those year ago to rescue a tumbled down spooky old house and semi delicate yard, none of it would have been possible.  If you ever find yourself in Newmarket do go along as it’s a world class museum and the way it helps you understand of the science of Horse-racing is impressive. Not to mention the heritage and art which is just stunning.

On the national and international political front, it’s been a staggering year where the rule book has been ripped up.  You can see that Brexit is going to be the most complex, time consuming thing for our Government to get right and make sure our economy does not suffer more that it has too.  I suspect the history books will have a somewhat mixed view on David Cameron’s time as Prime Minister but I briefly met him at Felixstowe Docks 100 days from the Referendum and he spoke with passion and conviction that strangely was not the hallmark of the remain campaign which seemed to me to fail to make the points about access to the single market being vital to our economy and that the vast majority of those working in Britain from Europe where either here ‘Auf Wiedersehen Pet’ style contributing to our industry or here raising their families and paying their taxes, i.e. contributing not taking British jobs.  The government and our new Prime Minister must find a way to get the best possible exit we can and that won’t be easy.

Internationally we will shortly watch the inauguration of a new American President and I recall the hope and expectation that hung in the air at President Obamas’, I suspect the world will watch with different feelings at President Trumps’.

Here in Suffolk I have had the pleasure to lead the County Council and the frustration of Devolution.  I say pleasure to lead the County Council because it is.  There is lots more to do and we are doing it but I am proud of the staff, the Cabinet and my group and how they have all risen to the challenge of significantly less Government funding and our demand that the Council lives within its means and maintains a sensible level of reserves.  As I look about the sector our cautious, prudent approach puts us in a place that is very different from some councils beyond Suffolk, there begins to be real concern that some councils may start to run out of money and fail to deliver front line services, I have often said that unlike the NHS, if councils run out of money the cheques don’t just carry on being honoured, staff will not get paid and services will fail, not here in Suffolk.  As a political party, we pledged and have delivered 7 years of 0% base Council Tax rises only putting up the Council tax to pay for the National Living Wage which everyone agrees is the right thing to do for the lowest paid workers in our society.  However I say a frustrating year in terms of Devolution because across Suffolk we can see how it can help us reshape Public Services and be a part of how we create a community that addresses the needs of our ageing population at the same time as investing in new infrastructure to accelerate growth and housing, which is vital for the quality of life we will want to see.  Yet at the end of the year Suffolk has no deal.  Cambridgeshire does but not Suffolk. The Public surveys, the business leaders and their respective trade bodies and all councils agree we want a Suffolk based Devolution deal, will we get one, it certainly won’t be for the want of trying and or effort.

Looking ahead… well that’s another blog!

If you have been kind enough to read this, may I take the opportunity to wish you and your family a very Happy, Healthy and Successful New Year.

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.

Public Health: Post 2015 Challenge Conference

2014_11_05 Public Health Conference Plenary Group PictureLast Wednesday I travelled to London to meet with officers from the LGA to discuss aspect of my new portfolio responsibilities on The LGA Community Wellbeing Board and then it was off to the Mermaid Theatre for a Public Health Conference where we had been asked to provide a speaker for a closing plenary Question Time session about Public Health the local Government prospective going forward.

On the platform with me were Natalie Bennett, Leader of the Green Party, Cllr. Mike Roberts, a senior Labour Local Government figure in the LGA and the session was moderated by Tam Fry.

For my part in my opening few words I spoke about the role of Public Health and the landscape in which it operates and my opinion that the greatest single challenge ahead was their role in an evidence based approach to how we cope with an Ageing Population. The House of Lords Committee on Public Services and Demographic change warned in March 2013 in its report ‘Ready for Ageing? That the UK was ‘woefully underprepared’ for the social and economic challenges presented by an ageing society. For example, with the number of people living with long-term medical conditions is set to rise sharply, so a ‘radically different model’ of care will be needed to support people in their homes and to prevent pressure on the NHS. I think this can currently be seen manifesting itself at the sharp end with the debates about pressure on A&E frankly the tip of the Ageing Population and these debates will gather in strength and urgency as the realities of an Ageing Population and a lack of systemic planning hit home, we are simply not keeping up with the rising demand.

It was an interesting question time session and it is strange how you find yourself slipping into a sort political party mode at times. One of the reoccurring themes used by both Natalie Bennett and Cllr. Roberts was that this country is the 6th wealthiest in the world and so we should be able to do this and that. And so in response I had to do what Conservatives always seem to have to do! Both seemed to be determined to ignore the fundamentals of our underlying economic challenge, promising the earth with a default position of how we pay for it, lots more taxes. I hoped I interjected a sense of realism that Local Government and Public Health better look to itself for the solutions to the challenges ahead because there was not likely to be additional monies from Central government for many years to come. A really excellent Q&A session and well worth the trip form my point of view and I hoped the audience agreed.

LGA CWB TLAP BCC – how’s that for Local Gov speak!

TLAP LogoToday I reach a small milestone in my blogging as this is my 300th blog, probably does not mean much to you but it seems a long way from when I first logged into word press, set up an account and well had a go. If you’re one of those kind people who follow it, thanks for reading. I do try to be as brief as possible, sometimes I succeed and sometimes I don’t. Hopefully it gives a bit of an insight into the things I get involved in and am passionate about.

Speaking of which, last Wednesday I was in London representing the LGA Community Wellbeing Board at two meetings firstly the Building Community Capacity steering group and later at the TLAP Board Meeting. I wanted to be a part of the Building Community Capacity work as it is very much what I started in Suffolk as we came up with the Supporting Lives Connecting Communities Programme (SLCC) about how the Council can develop services that communities truly need that compliment rather than crush the work that existing in Communities now and to help build community based services where there are none. In short how to delivery more services to an ever growing number of people who need care services but with less money with which to do so.

In the afternoon, the main Board meeting took place, where I am able to give the programme a sense of what Local Government and Councillors need from the various work streams and how the reports and initiatives its provides and funds can help Local Government can make its services more relevant and personal to those who need them.

The latest papers to shortly be available from their web site and being launched at this week’s National Adult and Children’s Conference in Manchester are called ‘Shaping the future- information, advice and brokerage in the context of the Care Act’  – essentially 3 reports co-badged with ADASS, DH and LGA to support the Care Act implementation.

I’ll pop the links to those papers up when they are on the TLAP website, the other recent ones that I think are useful reading are:

‘Getting Serious about personalisation in the NHS’ – Partner publication to the IPC (integrated Personal Commissioning) with ADASS LGA and NHS England http://bit.ly/1rxvKeD

‘No Assumption: a narrative for personalisation, co-ordinated care and support in Mental Health’ – with National Voices and NHS England http://bit.ly/1ywCMoU

‘A Wealth of information: your questions on personal health budgets answered’ – NHS Confederation briefing produced in partnership with TLPA http://bit.ly/1mG7gPW

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