Fighting pensioner poverty… what’s the score?

Last week I opened the Inside Government conference on the future of UK pensions, with a presentation on tackling pensioner poverty. With Steve Webb as a fellow panellist I described  the human impact for the poorest of our inadequate pension system; ‘scored’ current public policy; and set out Age UK’s policy ‘wish list’.

Older person - Photo: Hoveringdog via Flickr
Photo: Hoveringdog via Flickr

Pensioner poverty remains a massive issue across the UK. The stereotype of the rich ‘baby boomer’ means that we often think of older people as wealthy homeowners with significant disposable income. For some, this is true, but income inequality within the older cohort is rising steadily.

Over 1.8 million people over 65 live below the poverty line of just £119 per week for a single person. Those most likely to be poor in later life include single women, people from black and minority ethnic communities and the ‘oldest old’ – people currently in their late 70s and upwards. The poverty among many older people is too often exacerbated by benefits being left unclaimed. Somewhere between £3.6bn and £5.4bn in means-tested benefits for pensioners goes unclaimed every year.  Continue reading “Fighting pensioner poverty… what’s the score?”

NHS Reform: Challenge and opportunity

BBC Four’s new sitcom, Getting On, takes a bleakly comic look at life on an NHS geriatric ward. But a new report this week shows that NHS hospital treatment of many older people is no laughing matter.

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) launched its new report this week; ‘An Age Old Problem’. Its findings were disturbing, demonstrating that the NHS at present is just not equipped to deal with an ageing population. The report looked at the care given to 820 people aged over 80 from across England, Wales and Northern Ireland, all of whom died within 30 days of having surgery. It highlighted that pain management, malnutrition and delays in receiving care were all common problems. Only 38% of the patients analysed received care that could be classed as ‘good’.  Continue reading “NHS Reform: Challenge and opportunity”

Human rights in small places, close to home

As Eleanor Roosevelt so famously remarked “Where, after all, do universal human rights begin? In small places, close to home so close and so small that they cannot be seen on any map of the world. … Unless these rights have meaning there, they have little meaning anywhere.”

Because home care services are operating in such ‘small places’, out of sight and often out of mind, evidence about how human rights are promoted and protected or otherwise by them can be hard to come by. Shockingly, a previous estimate from the UK Study of Abuse and Neglect of Older People published in 2007 by NatCen and King’s College London, found that 350,000 older people are abused in their own homes (although this figure does not focus solely on abuse carried out by paid carers). Home care services provided by the state are regulated by the Care Quality Commission but it can be difficult for a regulator to shine enough light into these ‘small places’ to illuminate them properly. Earlier this week the Equality and Human Rights Commission (EHRC), issued a call for evidence directly to older people and their carers, which it hopes will build up a much clearer picture of how home care services are impacting on older people’s human rights.  Continue reading “Human rights in small places, close to home”

Future of cities: you’re in control

When we think about the future of our cities we often imagine a dystopian, dysfunctional Bladerunner scene. With this in mind it’s not surprising that many plan for the idyll of escaping to the countryside. But shouldn’t our cities be as relevant and pleasurable to older people, as they are to the young professionals drawn there? This morning at the Future of Cities debate, speakers challenged the audience to be more optimistic: cities can change for the better if they put people in charge.

Echoing the government’s proposals for decentralisation and a Big Society, Doug Saunders (author of Arrival Cities) set out his vision for regenerating cities based on autonomous, self-governing neighbourhoods. Based on his research into immigrant neighbourhoods in cities around the world, he believes that, rather than regulation and grand plans for our cities, the people that live there should be freed to create their own social and economic paths.

Put simply, it’s the people and their networks, rather than big business and big government, that should shape cities. If you want to open a shop in your front room you can, you shouldn’t have to battle the planning and trading regulations to do so. The messages seem to point in the same direction – if you want your community, city even, to change then it’s over to you.

At the moment older people are less likely than younger people to feel they can influence local and national decision-making. But there are already ways you can take control. Our new Change One Thing campaign for instance can help you make your neighbourhood better. Take a look, we’re going to be supporting local groups of people in later life to campaign to make their neighbourhoods better.

But there was still a word of caution. An audience member at the debate reminded us that one man’s heaven is another man’s hell. The question still remains: can we all have what we want?

What’s wrong with money?

Caring and carers - Flickr user: Kai Hendry
Photo: Kai Hendry via Flickr

Care Services  Minister Paul Burstow’s latest idea for alleviating the deepening social care crisis is Hureai Kippu , or ‘caring relationship tickets’. This is a scheme which originated in Japan, whereby people volunteer to help older people who require care and support . In return they receive a credit which they can bank in anticipation of the day that they need care themselves, or they can transfer their credit to a relative so that they can obtain care.  In the UK we have for many years had a not dissimilar system of exchange called ‘money’. People make a contribution to society and in return receive ‘money’ which they can then put aside to buy care.

So what’s wrong with money? Well for a start local authorities don’t have much of it. The monetarisation of relationships can also be criticised for de-humanising relationships, and it can be seen as a sad condemnation of society that many people who need care never see anyone who is not paid to be there. On the other hand, cash payments that are supposed to turn people into empowered consumers of care services, are seen by many disabled people as the key to independence and choice.

In fact evidence from Japan indicates that Hureai Kippu works. Older people prefer to receive care from someone who is being paid with ‘care relationship tickets’ rather than someone who is being paid cash. And there is a growing body of literature on the benefits of alternative systems of exchange, such as time banking and Local Exchange Trading Systems. These alternative currencies can foster local relationships and, since everyone’s contribution is valued equally, promote equality.

The problem with the latter argument is that not everyone will be able to accumulate credits, or has children to do it for them. The success of such local schemes is likely to be based on the characteristics of the community – for example whether people have free time, whether they have strong roots in the area or are transient.

Hureai Kippu seems distinctive in that, in order to work, it has to be rolled out on a large scale, and people have to trust that their credits will still be valued by future generations. In a climate where people don’t trust the state to care for them in their old age, don’t trust insurance companies and don’t trust banks why should they trust in the value of ‘caring relationship tickets?’. It might also be the case that the success of timebanking schemes and LETS derives from the fact that they are usually small and that their character would change if they were developed on a much larger scale.

So Hureai Kippu might be worth trying out, but  as with the ‘Big Society’ the trouble is not so much the idea itself but the ambitious  claims being made for what it can achieve.

‘Caring Relationship tickets’ along with other big society ideas for encouraging small scale, neighbourhood and mutual support can make a significant contribution to changing people’s lives. But replacing social care services, or even mitigating the impact of cuts to services is another matter altogether. Social care services for older people are now concentrated on those with the greatest need. Family carers often have to develop skills comparable to those of specialised nurses in order to provide such care – it’s not a role for untrained volunteers.

Invisible but Invaluable

Christine and her mother Margaret. Photo: Sam MellishThis is Christine and her mother Margaret. Christine has been her mother’s carer for the past 14 years. She is one of nearly a million people in England over the age of 65 who provide unpaid care to a husband, wife or partner, an adult child with disabilities or even a parent.

Christine and Margaret’s story is a powerful one. It’s a story about huge responsibilities, emotions and life-changes. Margaret moved in with Christine when her husband died. Christine continued to work, but after Margaret contracted an infection and needed a leg amputation, life changed ‘dramatically’. Christine was ‘forced’ into early retirement and full-time caring. Ending work meant that the family’s finances ‘nosedived’ and Christine’s pride was dented when they had to claim benefits. Christine said she then ‘understood what a carer is’ and recognised that carers ‘are entitled to a life of their own’. She now gets 4 hours a week support. It took Christine hitting crisis point to get that support.

Age UK has listened to the experiences of hundreds of older carers like Christine, and despite the fact that many of them find caring rewarding, and an expression of their relationship with the cared-for person, they also talk about how they feel invisible and undervalued. Many are stressed and exhausted.

This week a new exhibition opens at St Martin-in-the-Fields church on Trafalgar Square. It’s called Invisible but Invaluable.  Working with photographer Sam Mellish the exhibition aims to make the invaluable work of older carers visible.

The stories illustrated in the exhibition are personal and deeply moving. Every situation is different. But there are common threads. Many people become carers in later life almost without realising it. At a time when their own health may be deteriorating, they find they are having to prioritise the needs of someone else. Then they must navigate their way around the ‘system’ to get the support and help that they need.

Age UK’s call to policy makers is to prioritise the needs of older carers, and to ensure that they receive the financial, practical and emotional help they need. In the current financial environment, the Government needs to be thankful for the unpaid care which older carers contribute – a whopping £15billion in care each year.

A new report by Age UK, Invisible but Invaluable, tells the experiences of hundreds of older carers. It outlines measures which the Government, local authorities and health providers could take to improve the lives of older carers. Simplifying the application for Carer’s Allowance and other benefits, for example, could have a massive impact. As would a drive targeting carers to register as carers with their GPs and receive regular health checks.

If you are in London, go and have a look at the exhibition – it’s open daily from 10am to 5pm, until Saturday 20 November. If you can’t make it, you can view the photographs on the Age UK website

Real terms growth in older people’s needs

Following the intense interest in the Comprehensive Spending Review, we can be forgiven for thinking that the only figures that matter are the ones with pound signs in front of them. However, the Hospital Episode Statistics (HES) released last week come as a timely reminder of how important the NHS is for many older people.

The headline figures showed that average hospital stays for people over 75 years have grown by 66% since 1999. For people between 60 and 74 years, this number has grown by 48%. By comparison, people between 15 and 59 years saw growth in hospital says of 28% in the same period.

Further detail reveals how much longer older people need to stay in hospital compared with other groups. Observing average length of stay, we can see that people over 75 years are in hospital for almost three times as long as people between 15 and 59. However, people over 75 years have also seen the biggest drop in average length of stay since 1999, a decrease of almost four and a half days.

So apart from reflecting the growing numbers of our older population, what do these figures tell us? The growth in NHS funding since 1999 could explain the extra numbers of people being treated – we are spending around three times as much today then we were in 1999. People are also living longer and therefore could return to hospital on more occasions later on in their lives.

What of the decrease in the days spent in hospital? Reducing bed days has been a significant focus of the NHS for the past ten years and this clearly shows it has paid off. Certainly, getting people home, in appropriate circumstances and with the right level of support, should always be a priority. Advances in medical practice and the opportunity to treat more people as day cases have also paid dividends.

However, the numbers presented in the statistics relate to episodes of care, not individuals. We also know that emergency readmissions have gone up significantly since 1999. It could be that as the number of bed days go down, people have become more likely to return to hospital, thus generating a new episode of care. The Nuffield Trust recently made an assessment of rises in emergency admissions and highlighted the need for better care outside of hospital and prevention services. Whatever the figures show, it is important to remember that achieving more episodes of care is only one part of the picture.

The figures need further analysis to draw any firm conclusions, though it is immediately welcome that more older people are receiving care (though obviously less welcome that they need it in the first place). As we concentrate on the figures in the CSR going down, we must not forget those critical figures that continue to go up.