Guy Hands’ View

17 July 2015

Individual need must be the focus of elderly care

The increase in life expectancy highlights the need for better elderly care. Even as the debate between domiciliary and residential care continues, it is evident that the existing divide between health and social care needs to be replaced, argues Guy Hands.

The NHS, as always, was a major battleground during the election. But while there were plenty of angry clashes and big promises over funding, almost no attention was given to the crisis in social care.

Yet how our growing elderly population is supported is not just one of the most serious challenges facing the country but at the heart of the NHS’s problems.

Now and then

If social care budgets continue to be raided to find extra cash for the health budget – we will find things in the NHS will get worse, not better.

What is needed is a radical rethink of how older people get the care and the support they require – something largely overlooked when the NHS was created. It is easy to understand why. Life expectancy in 1948 for men was 66. The decision to leave the provision of social care – supplied and funded by local authorities – outside the overarching NHS framework was understandable.

The picture today is very different. Thanks in part to the success of the NHS – male life expectancy has now reached 79. Female life expectancy has risen from 71 to 82 years. Nor will this welcome trend slow.

Recent official forecasts suggest a baby boy born today can expect to live until 91-years-old.

Longevity is one of the modern world’s great achievements. The problem is our years of healthy, independent living do not always expand at the same pace with all the pressures this brings.

In the UK, health spending on retired households is double those under 65. The cost of community and hospital healthcare for those over 85 is three times that for those between 65 and 74.

What makes these pressures worse is that many elderly patients are being kept in hospital far longer than is medically necessary because of a lack of care alternatives. This is a bad outcome for everyone, costing the tax payer more, blocking beds as well as opening up elderly patients to hospital borne infections.

The state of finances

Given the dire state of the public finances, no one can sensibly argue against the need to control public spending. But there is a compelling case that cuts in funding, which have seen a 25 per cent reduction in those receiving publicly funded social care over the last five years, have been a false economy.

No one gains if the result is elderly patients kept in expensive hospital beds or seeking help at accident and emergency.

We have also seen that when at home, care is promised and in place, it too often falls below the standard needed. Domiciliary visits can be so short that it is impossible for any carer to do all that is required.

Yet even this level of home care can cost more than a place in a residential home. In fact, research commissioned by Four Seasons Health Care has found the total cost to the public purse of just two hours of domiciliary support a day can be more than round the clock care in a good residential home.

Local authorities prefer domiciliary support provided by mobile carers as it is cheaper for them than a care home place. But that is not the same as cheaper for the tax payer who has to foot the bill for supplementary social benefit payments.

It is another way the present fragmented system lets everyone down. There is an understandable attachment to returning patients to their own home.

And for many, this is the best option if proper care is provided.

Real empowerment

But there is nothing empowering about sitting alone waiting for a mobile carer to come in three or four times a day so that you can go to the lavatory – or change you if too late. Nor is it possible for a carer to find time in the same 30 minute visit to also prepare and provide a meal and administer medication.

A residential home, in comparison, provides constant care and company. It is why surveys show those who live in them have a more positive view of care homes than those that do not and are more satisfied with their quality of life than people receiving domiciliary care.

But instead we risk a dramatic fall in care home places. The fees that councils are paying for places have fallen in real terms by five per cent in the last three years to below what’s required to fund quality care and provide investment to improve facilities and expand places.

In contrast, fees for private places have, over the same period, increased by 10 per cent.

If these cuts are not reversed, care will suffer and thousands of beds will be lost at a time of rising need. It is inevitable, too, that quality care increasingly becomes the preserve of the wealthy – against the ambitions of the new government to bring the country together.

The answer to all these grave challenges lies in replacing the existing divide between health and social care with a truly integrated and comprehensive care system based on the needs of each individual.

Get this right and we will take a major step towards building a health and care system fit for the future. Get it wrong and the funding problems of the NHS will inevitably continue to get worse.

Guy Hands is founder and chair of Terra Firma Capital Partners

This article appeared in the Health Service Journal on 17th July.

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