With finances stretched, getting better value for money from our social care system means making some tough choices on spending.
Interviewing social entrepreneur Hilary Cottam on the Today programme yesterday morning, presenter Evan Davies confronted one of the biggest problems in tackling chronic loneliness among the elderly: how do we take innovative projects like Cottam’s Southwark Circle and make them available on a national scale?
The Circle is connecting around 5,000 people in Southwark through practical help and learning new skills. But with around five million older people saying that television is their main source of company according to the Campaign to End Loneliness, isn’t this just tinkering at the edges?
Countries like the Netherlands and Germany think so. They have long recognised that investing in local networks on a national scale to bring people together is the best way to cope with the future demands of an ageing population and keep people well and healthy.
Both countries are restructuring their care systems to place more emphasis on what people can do for each other to compensate for the anonymity of modern life and prevent an over-reliance on the state.
Some older people need professional care just to get by. But the vast majority need the kind of everyday help and human contact the state can’t provide. Somewhere along the line, however, we mistook the welfare state for being the frontline of care, when its aim should be to prevent need arising in the first place: a safety net after everything else has been exhausted.
This doesn’t mean the state has no role, it means it has a different role.
Leeds city council has been investing for years in community support and mutual networks to reduce the social isolation that ruins the lives of so many of its residents. Rather than stale day care centres that are anathema to an increasingly assertive older population, Leeds is investing in ‘community connectors’ to help set up local activity groups where local people offer their skills for everything from baking and ‘cooking for one’ clubs to walking stick making groups.
Together with Leeds 37 neighbourhood networks this helps reduce pressure on families and carers, lower hospital admissions and delay entry into expensive residential care – staggeringly the third highest reason for people ending up in a home is because they are lonely and fearful.
But this has required sustained local investment when heavy cuts are being made to social care funding. Leeds can only free up funding for these local gems by closing council-run care homes. It is making these difficult choices because it knows that with over-85s expected to double in number by 2035, ever larger numbers of people prematurely ending up hospitals and care homes is not sustainable.
In the Netherlands they have called this the ‘over-turn’. Radical reforms are flipping the social care system on its head, starting with what the community can do rather than statutory services. In the UK the government’s answer is a nostalgic appeal for a return to an ‘old-fashioned sense of neighbourliness’ that is just not up to the task.
With finances stretched, getting better value for money from our social care system means making some tough choices on spending. Labour is facing up to this challenge with Andy Burnham’s vision for whole-person care.
But while integrating health and social care is the right solution for the long-term, more immediate changes need to be made to the way social care funding is organised to deal with the urgent pressures on the NHS and local authorities.
Moving investment into the community to keep people at home, in contact with mutual support networks like Southwark Circle and out of places of last resort is the only way to face up to the long term challenges of an ageing population.
Labour now needs to craft an answer on how.