Why our ageing population requires a little extra care
Increased pressure on public finance makes reform of the social services a priority, says Colum Conway
Much has been written and said in recent weeks about the forthcoming Budget cuts and how we will all have to ensure that Government gets value for money from the provision of services.
From my point of view, this isn’t just an issue in the short term.
As chief executive of Northern Ireland’s largest domiciliary care charity, I know that how we manage, and pay for, the care of the elderly will become an ever more pressing issue in the decades to come.
If the resources in health and social care in Northern Ireland are already stretched — and due to be stretched even further — how will we meet and fund the rising care expectations of an increasing older population?
How will we provide for a fair |and affordable system for some |of the most vulnerable people in our society?
Rising demand and increasing pressure on finances make reform of our health and social care system essential — and it has to begin now.
The population is, on average, getting older: look at the numbers:
l By 2026, one-in-five people will be aged 65 or over;
l Between 2008 and 2020, the number of people in Northern Ireland aged over 75 will have increased by 40%;
l One-in-14 people over 65 has a form of dementia, rising to one-in-six people over 80 and one-in-three over 85. Almost 10,000 people over 65 are cared for in residential or nursing homes and, of the 21,000 people who receive care at home, 70% are over 75.
Reform requires more than tinkering around the edges of existing services, or salami-slicing services so that everyone gets a little less of what is often not enough: it requires a fundamental look at how we provide care for older people.
One example could be the way we currently provide for care at home. Caring for people in their own homes is the most cost-effective way of providing care and it responds to what people clearly say they want.
There are a number of organisations in Northern Ireland which provide care at home for older people. Together, they employ approximately 12,000 care workers.
By far the largest provider is the health and social services trusts, which provide almost 50% of an annual total of more than 12 million care-hours. The other 50% is provided by the voluntary and independent sector. The cost of providing the care services is higher in the health and social care trusts.
Unlike many other services, there is no real underlying reason why so much of our home care service is provided directly by the health and social services trust.
Could the health and social care resources be put to better use? In most other UK areas, the local authorities account for less than 20% of direct-service provision.
If we begin now, over time we can significantly reduce the cost of caring for older people at home without reducing the level of service.
At Extra Care, we have been concerned for some time about cost. So, over the last 18 months, we have systematically dismantled and rebuilt the structure of our organisation so that we can provide the same high-quality services for less cost. We now care for more people every week, provide more jobs and use resources more effectively.
As a voluntary organisation, we can also provide additional services from our own funds, such as benefits advice to very sick or very frail people, and provide additional respite-care for carers.
No change or reform is easy and hard decisions need to be made. But I believe no one can argue with ensuring that our focus is always entirely upon the needs of our oldest and most vulnerable citizens.
Colum Conway is chief executive of Extra Care Northern Ireland