The forgotten million
This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government
NCAS conference 18 October 2013
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Last month I visited the superb Woodside Care Home in Bath.
Woodside has a scheme where GPs make regular, proactive visits. This provides great reassurance and has reduced hospital admissions by 40 per cent.
The Care Quality Commission has praised Woodside for its kindness and warmth, regular assessments of residents’ needs, joined-working, and encouragement of activity and independence.
That’s exactly what I saw.
Staff who treated residents as they would their own parent or grandparent.
Managers who had braved difficult conversations about end of life care with residents and their families.
GPs who visited residents regularly with a seamless interface of care between the home and the local NHS.
Thoughtful, proactive, skilful, world-class care.
I was put to work helping with sandwiches, cakes and drinks – fantastically straightforward compared to many tasks the professionals face. But the kind of job that makes a real difference to quality of life if it is done with humour and kindness, as it clearly was there.
Dealing with complex medical conditions takes real skill. Developing a bond with someone who may not have long to live takes courage. Helping a person with intimate tasks demands both respect and compassion. And devoting yourself to the care of others – often with little public recognition - takes moral fibre. So let me start by thanking you and your teams for the remarkable, unsung contribution you make to our national life.
The forgotten million
Everyone’s care matters equally. I am deeply moved and hugely impressed by the best of children’s services, who help to ensure that everyone – whatever their background – has the right start in life. No work could be more important than that. But I want to focus on older people today.
And inspiring though the care at places like Woodside is, we all know there are many places that do not meet those high standards.
We also know there is a broader problem of loneliness that in our busy lives we have utterly failed to confront as a society.
There are now around 400,000 people in care homes. But according to the Campaign to End Loneliness, there are double that number – 800,000 people in England – who are chronically lonely.
46 per cent of people aged 80 or over report feeling lonely some of the time or often.
Some five million people say television is their main form of company. That’s 10% of the population.
And apart from the sheer cost of human unhappiness, there are massive health implications too.
Loneliness is as bad for one’s health as smoking fifteen cigarettes a day.
It is actually worse for you than obesity because it increases the risk of heart disease, blood clots and dementia.
Lonely people have poorer function in daily activities. They drink more. They are more likely to undergo early admission into residential or nursing care.
And perhaps we should talk not about the cost in terms of human unhappiness, but the cost in terms of avoidable human unhappiness. Because each and every lonely person has someone who could visit them and offer companionship. A forgotten million who live amongst us - ignored to our national shame.
This challenge cannot be solved by ministerial or local government diktat. But there is a great deal we can do to make things better and today I want to talk about three areas in particular.
The first is the need to apply rigorous, unflinchingly high standards of care – not just in the NHS, but in the social care sector too.
Last month a court found that an 86-year-old Bedfordshire care home resident with Alzheimer’s was picked up by the scruff of his neck and dumped in a wheelchair, having initially been ignored on the floor after a fall. He has since died.
His name was Albert Riches.
It is an outrage that anyone should be treated like this, let alone a vulnerable, older man. But it was not an isolated case.
112,000 cases of alleged abuse were referred to English councils in 2012-13, the majority involving over-65’s. And of those that have been investigated, nearly half have been partly or fully substantiated.
Something is badly wrong in a society where potentially one thousand such instances are happening every single week.
I totally reject the notion that such talk undermines the workforce as a whole.
In reality, the opposite is true.
When failings are not tackled head-on, dedicated staff face the double whammy of both having to deal with the individual tragedies and taking the hit to their own profession’s standing.
An Age UK survey this year found that just 26% of the general public are confident that older people who receive social care are treated with dignity.
What is worse is when lecturers in ethics legitimise such behaviour by saying – as was reported last month - that “compassion is not a necessary component of healthcare.” If compassion does not run through every vein of the health and social care system then we are betraying not only an entire generation of vulnerable older people, but our own values too.
The only way to deal with poor standards is total transparency.
Which is why I am delighted that this year, for the first time, we have appointed a Chief Inspector of Social Care, Andrea Sutcliffe. She is putting together a comprehensive new rating system for social care providers, working closely with the sector. Like all our new chief inspectors, she will act as a champion of the people who use the services.
The nation’s whistleblower-in-chief.
From April 2014, there will be new style inspections against five key questions – is it safe; effective; caring; responsive and well-led – and Andrea will start giving ratings to care homes from October 2014. All locations – some 25,000 in total - will be inspected by March 2016 and then receive official ratings. These will be accessible to the public online and easy to understand.
She is absolutely right to demand that they all pass a “good enough for my mum” test and to denounce a tick-box culture. The involvement of “experts by experience”, residents, carers, and specialist inspectors will make a huge difference.
Andrea is also going to gather opinions on covert filming. It is of course vital that people’s privacy and dignity are fully respected. But covert filming has already helped to uncover abuse, inspectors need solid information, and I understand why more consideration is being given to this.
Andrea’s determination to combine her role as whistleblower-in-chief with celebrating the best of care is something I fully endorse.
Just as we know how good all our local schools are thanks to rigorous, independent inspections by Ofsted, I want us all to know how good our local care is. Simple, resident-focused inspections which look at the things that really matter, rather than simply the boxes that have been ticked.
And end up with an Ofsted-style rating that tells us in plain language if a service is outstanding, good, requiring improvement or inadequate.
And we will underpin this by legislating in the Care Bill to give the CQC statutory independence over the content of its inspections. Ministers must never again lean on the CQC over the issuing of news about quality inspections. Sunlight is the best disinfectant, and the biggest weapon we have to drive up standards, making sure failings are exposed as quickly as possible.
Training and development
1.6 million people work in the care industry, so the second area we need to focus on is improving their training and development.
Lyn Romeo, the newly appointed and first Chief Social Worker, will support and challenge social workers to ensure that vulnerable adults get the best possible help, with improved safeguards for residential and domiciliary care.
Camilla Cavendish’s review into healthcare assistants and support workers expressed deep concern at variations in training standards, and she wrote, damningly, that she had “been struck by how disconnected the systems are which care for the public,” adding “the NHS operates in silos, and social care is seen as a distant land occupied by a different tribe.”
We will issue a formal response soon but hope to adopt many if not all of her recommendations.
My department is also spending £12 million on the Workforce Development Fund for training and we will work closely with Skills for Care and the National Skills Academy Social Care to improve skill levels in adult social care. And we are doubling to 100,000 the number of apprentices that get high-quality training and support by 2017.
All of which I hope will make a big difference.
Social care funding
The third area we need to address is funding.
I recognise there have been cuts in funding to local authorities as we seek to deal with the deficit. Perhaps less recognised is that funding per head for adult social care fell under the last government too. But politicians of all parties need to be honest that the pattern of gradually reducing funding in the face of an ageing population is simply not sustainable – and we need to change the model.
Let’s talk about the money we have allocated first.
We have committed an additional £7.2 billion, including a contribution from the NHS budget, for adult social care over the course of this parliament.
On top of the Dilnot reforms, we are committed to increasing government investment in social care through a £3.8 billion pooled budget for health and social care in 2015-16. It comes on top of an extra £200 million for social care in 2014-15.
But those reforms do something else as well.
By implementing a cap on care costs of £72,000, they make it possible for people to plan for their social care costs in the same way they plan for their pension. Which will lead to a dramatic increase in planned funding being put aside to fund end-of-life care costs.
Our objective is to be one of the first countries in the world where, as part of their pension plans, most people save throughout their lives for their likely care costs.
But even additional financial support will not be adequate unless we also change the model.
It is high time we closed the gaps that see people being sent round the houses, breakdowns in communication, and wrangling over budgets.
Which is why rather than simply adding £2 billon to existing support for social care in 2015-16, we are combining both into a £3.8 billion single health and social care transformation fund. To access this, each local plan will have to offer genuinely integrated care: joint commissioning, joint provision, seven-day services, full record-sharing and professionals accountable for seamless, joined-up care.
I have asked for all integration plans to be approved and in place by next April because although the funding does not start until April 2015, many authorities will want to start earlier as the potential for both improving care and making savings is immense.
A social solution
But this is not just a government – or even a local government – solution.
There has to be a social solution too.
My wife is Chinese and I am struck by the reverence and respect for older people in Asian culture. In China and Japan, it is quite normal for elderly parents to live with their children and their families. The Indian government has even announced recently that it plans to name and shame people who abandon their parents.
Let me be absolutely clear. There are occasions where it’s right and necessary for older people to go into care homes and no family should feel condemned for taking that difficult decision.
In those countries, when living alone is no longer possible, residential care is a last rather than a first option. And the social contract is stronger because as children see how their own grandparents are looked after, they develop higher expectations of how they too will be treated when they get old.
If we are to tackle the challenge of an ageing society, we must learn from this - and restore and reinvigorate the social contract between generations. And uncomfortable though it is to say it, it will only start with changes in the way we personally treat our own parents and grandparents.
Professor Tom Kirkwood of Newcastle University’s Institute for Ageing and Health talks of a 29-hour day. For every decade we live, life expectancy goes up two years – which works out as five hours for every 24 we live.
So we are putting aside five additional hours at the end of our lives for every day we live.
And the cruel irony of the pockets of failure that let the whole system down is that old age can be wonderful. Freed from the responsibility of work - and having cast off some of the stresses and preoccupations that can dominate earlier years - many older people thrive like never before, even as they battle infirmity.
Not everyone can have healthy last years. But our ambition must be that everyone has happy ones.
And all of us in this room share that ambition - indeed are dedicating their lives to meeting it.
We may have different roles to play, but together we can challenge society, celebrate and promote best practice, and agree that “good enough” is never enough.
And if we persist, we can do something even more amazing: really and truly make this country the best place in the world to grow old in.