25 May 2018
If the Environment Agency were faced with a problem at the mouth of a river, they would not seek to solve that problem by focussing all their efforts on that part of the river, but would move up stream to tackle the causes. In the same way the route to reducing demand on social and hospital care is to move further upstream and tackle the reasons why people need more care.
A major cause of hospital admissions for older people over 65 is trips and slips that lead to broken bones, a stay in hospital and for many moving from home to residential care. Falls prevention needs to be a big focus in the Green paper and this can be achieved by building more purpose built homes for older people that are wheelchair accessible and are designed to prevent slips and trips. For people who don’t wish to move home adaptations are essential, and encouraging older people to exercise and strengthen their core muscles will also help to prevent falls. Chair yoga, swimming and gentle walking groups for older people not only help with loneliness but help to prevent falls so they are a real win win.
For people living with dementia it is important that they remain in familiar surroundings for as long as possible in order to prevent rapid deterioration of the condition. Home adaptations to make kitchen cupboards transparent to make it easier for people to find things, and the use of technologies that remind people to take their medication, have lunch and go for a walk, can all enable people living with dementia to remain at home for as long as possible. Dementia-friendly communities that wrap around the home can provide even more support for people as they step out of their front door.
Loneliness in the modern world is absolutely toxic and is estimated to cost the NHS £10bn per year, and that does not include the costs to social care. Local housing policies that aims to keep families and communities together is a great first step in preventing loneliness. Local commissioning of smaller charities and voluntary groups is essential in helping combat loneliness as people trust the local brands they have known all their life, and prepared to volunteer for them or receive their help. Large scale commissioning maybe more economical but it is killing off smaller groups and making loneliness worse.
The Green Paper needs to take a health in all policies approach at both central government and local government level in order to ensure that by solving problem A, they have not created health problems C, D and E. An example of this includes removing the local connection criteria for shared ownership homes which contributed to breaking up families and loneliness in older people. We need to at least prioritise local people in order to keep families and communities nearby.
All these measures promote independent living and reduce demand on social care. More emphasis and resources need to be placed on prevention and the role that districts play in two-tier areas, and in unitary areas often this role is down played in order to focus on social care. If we carry on focussing on social care and ignoring prevention we will always have a health and social care problem for older people. This is not only costly in terms of money, but it is cutting peoples’ lives short and removing some of their quality of life.
The current system is broken. It needs a complete overhaul to ensure that it works with modern demands of people living longer and growing more frail as they age. But that does not necessarily mean they cannot live independently with a system that supports them.
In the same way that the Environment Agency looks upstream to their problems, the Green Paper needs to step back and focus on preventing the reasons that so many people end up needing hospital and social care. It will mean the government needs to be brave as it is always easier to throw more money at the current problem, but that will only provide a temporary fix before yet more money is needed again – and ultimately this is not fair on the people we represent.
