How we care for the UK’s rapidly ageing population is a huge challenge for the public sector. The number of over-65s is expected to rise from 10 million today to more than 16 million by 2030. Rising at an even faster rate is the number of people aged 80 and over, which is set to double to six million by 2030.
This is a major resourcing issue for both the NHS and local government, which provides non-healthcare services such as personal care at home, community meals, residential care, day centres, equipment and adaptations to homes.
In the shorter term, supporting increasing numbers of older people, within a context of squeezed resources and major changes in social care, is tough to achieve. Looking ahead, I don’t believe the situation is sustainable without national reform of the care system
The Local Government Association recently highlighted a growing financial crisis in adult social care due to the combined effects of the ageing population, growing demand, rising service costs and cuts in government funding. It all adds up to an immense challenge for the directors of adult social care services. What do they see as the way forward, and what motivates them to get the job done?
Dawn Warwick, director of adult social services at the London Borough of Wandsworth, believes that it is important to see this as a good news story rather than a problem. She says: “We’re living longer, healthier and more independent lives. It really frustrates me that this is often seen as a negative thing.”
However, the consequence of longer lives is that some people do have health and care support needs – particularly the very old. Ruth Lake, director of adult social care at Leicester City Council, says elderly care presents a significant social challenge. “In the shorter term, supporting increasing numbers of older people, within a context of squeezed resources and major changes in social care, is tough to achieve,” she says. “Looking ahead, I don’t believe the situation is sustainable without national reform of the care system.”
At the local level, Lake’s strategies include clear priorities, honest communication and harnessing community resources. Without major reform, she says, services will have to focus in on the most vulnerable citizens. ?Andrew Ireland, corporate director of families and social care at Kent County Council, agrees that the challenge is to do things differently. “We are not too far away from the moment when meeting the statutory responsibilities for adults’ and children’s social care is about all any council will be able to do,” he says. “Clearly, that’s not a sustainable position.”
Reducing the number of people who go into residential or nursing care would save a lot of public money. This involves a shift in focus towards promoting independence rather than simply “looking after” older people. The trend within local authorities is for older people’s strategies that concentrate on prevention and rehabilitation, information and advice, and support for people with complex needs.
There is also a need for health and social care to be able to work effectively together. Promoting independence straddles both sectors: better management of conditions such as diabetes, heart disease and dementia, for example, would help people to live independently. In many areas, integration projects are shifting services from the acute sector towards community-based care, but managers need statutory support to ensure that they can work easily across the traditional boundaries.
All three directors believe that the scale of the challenge is not fully understood by the public, and that ministers must urgently address the long-term funding issues. As Ruth Lake says: “Social care pressures can be a vague concept to people, until they need that support for themselves or a family member and experience just how tight the belt is being pulled on this.”
Managing staff and services under pressure is not easy, so what motivates these directors to do the job? Lake particularly enjoys helping staff to recognise the positive impact of the work they do. “Everyone needs to feel they are making a difference, and every day that’s what our staff in Leicester are doing.”
Dawn Warwick agrees. “Every day something absolutely wonderful happens in our service, and we do a lot of work with our front-line staff and managers to recognise this.” The current challenges present opportunities to work in different ways, she adds, such as mobile working and IT-based solutions that ensure front-line staff spend more time in the community.
Andrew Ireland also sees a silver lining in the cloud of resource constraints. “In times like these, well-commissioned services that do meet people’s needs are cheaper. The expensive decisions are the rushed emergencies. I find it very motivating to get out and about across the county and see good practice and the difference it makes to people’s lives.”