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Funding the care of our older population – who really pays the price?

Tim Barclay, CEO, Appello

With a wider remit following the cabinet reshuffle this month, the secretary of state for health and social care – Jeremy Hunt – has the unenviable task of finding funds to plug large holes in both the NHS and social care budgets. Some estimates are at around £2.5bn by 2019-20 for social care and a further £30bn by 2020/21 for the NHS.

Recently, we hosted a panel discussion with representatives from the Better Care Support team, the Association of Directors of Adult Social Services, Mears Group, Housing & Care 21 and Independent Age. The discussion asked how, we as a combined ecosystem responsible for the care and support of older people, will tackle the challenges ahead and make sure older people do not fall through the gaps between departments and funding pots.

Is integrated health and care really happening?

There is still much confusion over who funds services, and where to turn for health and social care when it’s needed. This is a view echoed by Alan Mears, Chief Executive of Mears Group, whose care teams provide support to around 300,000 people a year – “Are we integrating services, data, technology or structures? How can you draw a line between people receiving a health service or social care? We should not be having a debate about funding or who pays. These services should be integrated with funding coming from the same pot.”

I wholeheartedly agree with the original reasons the Government pushed for integration – that we need to put the individual at the heart of the care pathway. What I believe is missing is a decision-based metric that genuinely finds money from available resources irrespective of where that might be. At present, there seems to be little proven practice of a system that can arbitrate across those funding pots.

Who will fund integrated health and care?

Considering that the Government does manage to integrate services, there is still some question over where the extra funding will come from as Janet Morrison from Independent Age outlines; “We cannot keep up the pretence that if we all work a bit harder in health and social care we can make it work. The Government must start a public debate that addresses the funding that will be needed by individuals to fund their care in older age – is that social insurance?”.

The concept of individuals taking more responsibility for their own old age care is something that comes up again and again, but as Matthew West from the Better Care Support team mentions, the rhetoric needs careful consideration if it’s to be sold to the public. Mathew believes the Government must position it in a way that it is seen as an insurance, rather than an additional taxation, and the conversation must be about how the Government will share the care, health and housing risk with the public.

How can technology help reduce the financial weight?

We know that the task ahead for those responsible for looking after our older population is going to be a difficult one but there are some changes that can be made now. We have to start spending the money that we have in smarter ways. I feel frustrated that technology is not being used more widely to fill the gaps in funding and to better understand the needs of older people.

We also need to break down the outdated perception that older people will not want technology, we have found they absolutely do if you can demonstrate the benefits in terms of quality of life. Housing & Care 21 is a housing provider keen to break down this perception as Bruce Moore their CEO explains; “There is still a tendency to view technology the same way as we view care workers – it’s at the bottom of pile. Many personal alarm systems are straight out of the ark. In an emergency, an older person pulls a string and a stilted conversation ensues.

We have already introduced digital care systems that are allowing older and vulnerable people to live much more independently within assisted living developments – this means on the whole they are not in acute care.”

If we think again about how we are going to collectively manage the funding and availability of health and social care for older people, technology has to play a significant role in making care more effective and affordable, while keeping older people within their own homes and living independently for longer.

But, there also needs to be honesty from those delivering services whether health, housing or social care, and from the Government, about the changes that need to be made so that health and care can be delivered to those that need it.

 

 

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