When The Who sang ‘I hope I die before I get old…’ it probably wasn’t a commentary on the care system in 1965 – but it might find a real echo today.
The collapse of the £800 million social care contract covering Cambridgeshire and Peterborough has thrown into stark relief the issues relating to how we arrange and pay for the care of our ageing and sick citizens. And in case we are tempted to think it is other people’s problem, it is really about how we pay for our own futures.
The UnitingCare contract was selected as the preferred bidder by Cambridgeshire and Peterborough Clinical Commissioning Group as lead provider of older people’s healthcare and adult community services (able to integrate services) with the intention of providing more joined-up care for patients. Its most eye-catching feature was the ‘Home’s Best’ strategy, a drive to work at the infamous interface between the NHS and social care to reduce unnecessary hospital admissions and facilitate early discharge. This recognised that, with a growing and ageing population, hospital admissions of people aged over 65 will grow by almost a third by 2020 unless concerted action is taken (and that the area would require a brand new hospital within five years).
All about the money
The problem the health system faces is how to provide for the increasing quantity and quality of care and treatment demanded, while simultaneously bearing down on costs. It is, of course, a circle that looks impossible to square.
Care homes operators protest that the system does not allow them to operate sustainably (with the final straw, ironically, being the government’s new ‘Living Wage’ which will raise the pay of many care workers). Homes are closing regularly, or being taken over by more ‘efficient’ operators.
Meanwhile local authorities have begun to signal that they will no longer be able to afford to provide care to all who need it. In his final media interview, outgoing Cambridgeshire County Council CEO Mark Lloyd (now head of the Local Government Association where he will remain close to the issue) was particularly candid in saying that in his view an increasing proportion of the work of cut back adult social services will inevitably have to transfer to families and volunteers.
Government has deferred the creation of a lifetime cap on care costs that would have offered certainty of the maximum amount individuals would need to contribute to ensure they would have a basic level of care for as long as they need it. At the same time, the government’s announcement that local authorities will be allowed to levy an extra two per cent on council tax bills will assist to some degree but it has been pointed out that this will inevitably accentuate existing inequalities as better off areas will be able to raise more while areas where citizens need greater support will raise less.
Give me hope
What can social innovators and social entrepreneurs offer to the situation?
Intriguingly, the recent InnovateUK ‘Long Term Care Revolution’ bidding competition for ideas that will revolutionise care of the elderly made only two awards, and would have been expected to promote entirely technological solutions. But the famous, now ageing inventor Heinz Wolff (who at 87 has brought his thinking to bear on the issue he is living out) was one of the winners with ‘Give and Take’, a system which enables individuals to ‘bank’ care credits by helping others, and which they can utilise on their own needs in the future. It is a system that will not be straightforward to create, as it relies on early adopters trusting that their contributions will indeed one day benefit them.
Some warning signals should be heeded. Mega solutions are difficult to translate into scale, and efforts in the field of ageing have proved to have their own specific challenges. For example, efforts by the Southwark and Suffolk Circle projects to design solutions to isolation and loneliness could not identify a sustainable business model to cover the costs of their operations.
Where is the love?
We need to ask ourselves what we would like for ourselves in the future (and indeed for ageing relatives now):
- would we prefer to live in our existing housing for as long as possible?
- or to move to somewhere purpose built – perhaps with a standardised downsizing facility available?
- can so-called institutional settings such as ‘care homes’ be a desirable possibility rather than the last resort?
- and what about ‘retirement villages’ – being created by charities in some places?
Whatever is done, key principles are certainty of contribution and outcome, value for money, choice and assurance of quality.
This is certainly a space in which social entrepreneurship needs to be more active. At Allia we are interested in the intersection of innovation, finance and property:
- innovation in technology that enables us to live at home for longer,
- financial products or systems that enable people to provide for themselves and their family members, or even to invest in provision for others for a reasonable return (social investments),
- and property solutions which are affordable and progressive, so they work for people of all incomes.
A relatively simple innovation like an intermediate care centre to tackle ‘bed-blocking’ at major hospitals would make a massive difference. Who could commission and finance this?
This is an area which is both an urgent social necessity as well as a place for the right entrepreneurs to make their names. And if someone can crack the business model for tackling loneliness, they will do us all a favour.