20 June 2017
We need to talk about funding social care
Each week Inside Housing publishes the thoughts of industry leaders around the big issues that matter most to the housing world. In its blog today, regular contributor Dame Clare Tickell looks at the need for a joined-up approach to social care. The full text of the blog is below.
We need to talk about funding social care
By Dame Clare Tickell, Chief Executive, Hanover Housing Association
It is nothing new for those of us providing services of any kind to older people to be highlighting the urgent need for grown up conversations about longevity, demographics and the implications that these have on NHS and Social Care planning and budgets.
Nor is it new for those of us in housing to lament the fact that the centrality of decent housing as a positive factor in improving well-being and health for people as they age is repeatedly overlooked by policy makers. It is important to remember that the NHS was conceived in 1948 when life expectancy for men was 66 and for women 71.
By 2030 it is anticipated that men will live to nearly 86 and women to 88. Social care in 1948 operated in an entirely different context; families were expected to care for ageing relatives unless they were very ill and needed to be looked after in residential institutions and the time between retirement and death were far shorter. Whiile political attention on the issues facing people living longer have evolved, this has not been joined up with policy led debates on the social and financial consequences of increased longevity.
While a number of reports have been commissioned and published, most notably Andrew Dilnot’s in 2011, analysing the issues and making recommendations on what a realistic and affordable approach to funding health and social care might look like, the brutal truth is that there has not been the political will to demand that policy makers and then citizens engage with the complexity of these issues and consider the provision of future services and how they are paid for.
The 2017 election was an opportunity to put this issue firmly into the spotlight. Its timing could not have been better given the increasingly visible pressures on health and social care and emerging consensus that “something needs to be done about housing”. Instead the manifestos of the main political parties missed this open goal. Not only that, it was spectacularly done.
“There has not been the political will to demand that policy makers and then citizens engage with the complexity of these issues.”
Bravely, and surprisingly given the age profile of their core vote, the Conservative party manifesto highlighted the issue of inequality and suggested that better off older people might be expected to contribute more to their care.
However, not only did this come as a bit of a shock to members and prospective MPs as they knocked on doors, it turned out that the manifesto commitment was insufficiently thought through.
Gifts such as these don’t often come as easily as this one during general election campaigns and the other parties piled in to pour scorn on this suggestion and the Conservatives were vilified for suggesting a “tax on dementia” by all political parties. So the debate that we really need to have may have been closed down again as a difficult issue became a political football.
And yet, the issue has not gone away and the absence of debate means that the difficulties will escalate. In human terms, this means increasing numbers of less well off older people not getting access to services, living with chronic pain as they wait for operations and staying in hospital for longer than is necessary. This is also very expensive.
The manifestos also missed their chances to link health and social care with housing despite the obvious wins across a number of policy areas.
So, what role must housing associations play to encourage these discussions and what solutions might we offer? The increase in the number of older people is a fact that affects all housing providers and needs to be reflected not only in what we build and provide but also how we talk about responding to the need for more housing when policy makers and funders come knocking.
“The increase in the number of older people is a fact that affects all housing providers.”
Where we are not doing it already, we should be placing ourselves assertively at the heart of discussions about health and social care, pointing out the positive impact on communities that well designed housing has in improving wellbeing and supporting people to live independently and well in later life.
A number of parliamentarians from across the political spectrum have called for a cross party approach to be taken to solving the health and social care crisis. One which can draw in other stakeholders, including housing, so that a sensible national debate can take place which comes up with solutions based on consensus. These solutions have to have housing at their heart so the sector has a key role to play and must demand its place there. Even more, we must insist that the debacle of the general election and the politicisation of this complex social policy issue does not close down a conversation that needs to happen now.