Agenda for Later Life 2011 - Andrew Dilnot


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Keynote speech from Andrew Dilnot, Chair of the Commission on Funding of Care and Support - 'Searching for Social Care Solutions'

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  • Slide 2 - The Age UK Group   As an organisation, Age UK is still in its infancy.   It has been less than 12 months since the launch of Age UK and only two years since the merger of Help the Aged and Age Concern into a single-minded organisation.   We have successfully merged several charities, 40 subsidiary trading companies, and 2,500 staff into one single-minded organisation.   With our local partners, Age UK now covers two-thirds of the country   Diverse portfolio: we offer information and advice; campaign for change; provide practical services; conduct and support research on age-related conditions; develop and offer market leading commercial products; run health, social and retail training; and work with international partners in emergency response and aged focussed programmes.   The core focus of our organisation centres on five pillars that have been identified as areas where we can support and improve conditions for those in later life:   Money Matters Health and Wellbeing Work and Learning Home and Care Travel and Lifestyle   This is where we think we can make the most difference for those in later life
  • Slide 3 – Scene setting   No-one in this room needs to be told that our population is ageing.   We recognise it is real, and for a long time have been calling for a cohesive approach to deliver an appropriate and joined-up strategy to respond.   As the aged and late-aged population increases, we expect spending for health, care and pensions to increase as a percentage of GDP.   The long-term funding challenges to sustain an ageing population are acute and highlight why a policy stock take such as this is vital in guiding responses and solutions.   This time last year, we were only a few weeks away from the General election and Age UK was heavily involved in working to improve the manifestos of each party.   12 months on, we are seeing some of our key demands for change – including equalities legislation and the abolition of the default retirement - finally coming to fruition.   These are two significant steps in outlawing discrimination against those in later life – a clear sign that moods are finally starting to change.   Challenging negative attitudes to ageing is a paramount public policy goal   We are also now looking closely at how a number of policy reforms being formulated and implemented - particularly in health, pension reform and social care- will affect those in later life.
  • Slide 4 – Indicators Comparative   Whilst we have touched on where we have seen improvements, there are a number of areas where we are yet to see any tangible benefits for those in later life.   Agenda for Later Life 2011 points to 13 key indicators that have trended backwards since last year - including in health and income inequality.   The policy setting has altered significantly in 12 months as a result of a change of government and the magnitude of spending cuts in an economy whose growth remains uncertain. We are also now starting to see the practical fall-out of the comprehensive spending review which means many prospects for improved indicators over the next twelve months look bleak in some areas. However, there are a number of areas where we have seen improvements over the last 12 months. Overall, 17 indicators have improved since last year – a clear sign that things are heading in the right direction. In addition to listing the key indicators and their tracking over the past 12 months, the Report also includes a traffic light summary of our general election priorities and the progress made. I will now outline some of the key indicators in each of our five pillars of focus. I will go into more detail about one or two of these indicators per pillar to highlight our views on a way forward.
  • Slide 5 - Money Matters   Agenda for Later Life highlights that 62% of cheque users say they would have problems if they couldn’t write a cheque.   Given this, we remain concerned about plans to abolish cheques by 2018   We are pragmatic – we know that cheque usage continues to fall across the country and therefore challenges their viability as a payment form   However we do believe that alternatives to the cheque need to be implemented before cheques are excluded from the payment system   Characteristics of ageing may change in the future particularly attitudes to technology - and the solution in short term may not be best solution in longer term.   But cannot phase out cheques without alternative   Older people are not an homogenous group – interaction with and needs from financial services vary greatly based on individual situation and location   Many firms continue to deny essential financial services including insurance to people over an arbitrary age limit which is why Age UK offers travel and car insurance with no upper age limit.   More to be done on financial inclusion for those in later life and more to be done on preventing increased financial exclusion as payment forms change
  • Slide 6- Health and Wellbeing   Looking at these indicators – easy to see why health for those in later life is a huge concern   Britain’s health outcomes still lag behind other comparable countries in successful treatment of cancer, stroke and heart disease. Older people already represent the largest cohort of patients in the NHS, accounting for over three quarters of NHS patients and 60% of hospital admissions.   We are seeing a continued increase in the number of people aged 75 or over who are readmitted to hospital as an emergency within one month of discharge. The Government also recognise this as a major issue and have introduced commissioning levers to ensure that this does not happen – local health and social care communities will especially need to focus on this challenge.   And while we are seeing positive signs in terms of health expectancy we are seeing a bigger gap in health inequalities across England for men, and still an 8.3 year gap in life expectancy for women in the best and worse local authorities. This is clearly unacceptable and sets a clear improvement area for local health and wellbeing boards   Age UK believes in the importance of holistic approaches to health care – looking at how investment in healthy lifestyles such as programmes to increase fitness and falls prevention can keep older people out of hospitals.   As the Health Service Ombudsman report ‘Care and Compassion’ has also highlighted ageist attitudes prevail in our health care system. We are not seeing in the health care of older people any incremental service improvements or changing attitudes.   It requires a real step-change in the way the way our health care system views and treats older people and it is important that reform of the NHS addresses these underlying challenges.
  • Slide 7 - Home and Care   In Age UK’s view the share of GDP spent on older people’s care may need to double over 15 years, which is why we are intently interested in how social care indicators will be affected by local authority budget constraints and the longer term proposals of the Dilnot commission. Whilst we cautiously welcomed the £2 billion in funding for social care as announced as part of the comprehensive spending review, we are concerned that social care funding to local authorities has not been ringfenced and merely plugs a gap in an area of funding that has not kept pace with an ageing population.   We have given a green light to the establishment of the Dilnot commission as we have been calling for radical reform to our care and support system.   But to see improvement in social care we need considered recommendations and rapid implementation of change.   More cooperation is also required between local authorities, and the emerging GP commissioning consortia around the country to ensure that there aren’t as many gaps between health and social care services.   For Age UK and its partners social care is front of mind as we start to get a greater picture of how local authorities will pass on budget cuts in their communities   We expect the cuts to care services on the ground to affect those later life almost immediately
  • Slide 8 - Work and Learning   Last year at this Conference, we highlighted why the default retirement age needed to be abolished and are pleased this has been achieved.   However, proposals to speed up increases in State Pension age to 66 by 2020 will affect nearly 5 million people and is likely to hit women and the poorest hardest.   There has been a fall in the number of full-time employees saving for retirement through membership of a pension scheme   Only 62 % of men and women are members of a pensions scheme, a drop of 1% in the case of men and 2% for women.   We would hope that the new system of pension auto-enrolment from 2012 will improve this indicator   We are pleased this year to see some positive trends in digital inclusion and learning.   However, these positive trends still show that 60% of people over the age of 65 remain digitally excluded and unable to access the benefits of the internet.   Age UK is working to encourage older people to get online with a number of awareness and training programmes across the country including our Digital Champion of the year.
  • Slide 9 - Travel and Lifestyle   The size of the so called ‘grey market’ is increasing with households with a 65 and above year old now spending over £100 billion annually. According to Age UK’s report ‘The Golden Economy’ which was published in autumn, the older consumer market is forecast to grow by 81 percent from 2005 to 2030, but the 18-59 year old market only by 7%   And there are some positive signs that business is at last starting to recognise the value of providing age-friendly products and services be it through inclusive design and packaging or attitude and customer service across the retail, marketing and media environments.   Last year, 46% of people over 65 thought businesses had little interest in their consumer needs. This year we welcome a fall of some 7% which indicates that businesses are finally starting to appreciate the importance of understanding the needs of older consumers.   This benefits the private sector, but it also and more importantly benefits older people by making it easier for them to participate in activities that improve their lifestyle in old age
  • Slide 10 - Where to from here, 12 challenges   It is against the backdrop of an ageing population that we work to improve later life – recognising the challenges and working to offer solutions   These are Age UK’s 12 challenges for government, the private and public sectors and individuals to overcome.   And the indicators which I have highlighted underpin why it is important to meet these 12 challenges   In conclusion – there is still a long way to go, particularly in addressing the indicators that are going backwards, to ensure we encourage everyone to celebrate later life and an ageing population   To do this all stakeholders need to work together on a coordinated strategy for our ageing population   We are realistic about the challenges, but optimistic about the outcomes if the correct long-term framework is established now.   There is a role for all of us as we go forward as we continue to change attitudes towards ageing and improve overall outcomes
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  • Agenda for Later Life 2011 - Andrew Dilnot

    1. 1. Follow the conference on twitter #afll Free wi-fi access code: 7348449353
    2. 2. Chair’s welcome <ul><li>John Stapleton </li></ul><ul><li>Broadcaster and journalist </li></ul>
    3. 3. Our agenda for later life <ul><li>Tom Wright CBE </li></ul><ul><li>Chief Executive, Age UK </li></ul>
    4. 4. The Age UK Group <ul><li>Combined several charities and 40 subsidiaries companies to improve later life </li></ul><ul><li>Providing information & advice to over 5m people </li></ul><ul><li>Wide range of charitable services working with 150 Age UK partners </li></ul><ul><li>International work in 40 countries and active DEC member </li></ul><ul><li>Leading research into conditions of ageing </li></ul><ul><li>Financial services to over 1m customers </li></ul><ul><li>470 shops covering UK's high streets </li></ul>Money Matters Money Matters Health & Wellbeing Home & Care Work & Learning Travel & Lifestyle
    5. 5. Agenda for Later Life 2011 Today 2020 2050 Aged over 60 (UK) 14m 16.4m 23.4m Aged over 85 (UK) 1.4m 1.9m 5m State pensions (% GDP) 5.5% 5.3% 6.5% NHS (% GDP) 8% 8.5% 10.3% Care (% GDP) 1.2% 1.4% 2.1%
    6. 6. Agenda for Later Life 2011 Going backward Going forward Income inequality Health inequality (men) Loneliness Cheques Attitudes of health professionals Hospital readmission Support for carers Early intervention Saving for retirement Volunteering Fear of crime Infantilisation Over 60 population Over 85 population Health inequality (women) Size of the grey market Business interest in older consumers Digital inclusion Age discrimination Health expectancy Exercise Direct payments Over 50s learning Over 75s learning
    7. 7. Money Matters <ul><li>5% of households include someone aged 85+ without a bank account </li></ul><ul><li>Only 62-73% of people eligible for pension credit receive the benefit </li></ul><ul><li>Between £3.2 and £5.4 bn of income related benefits unclaimed by pensioners every year </li></ul><ul><li>1.8 million older people living in poverty </li></ul><ul><li>62% of cheque users who say they would have problems if they could not write cheques </li></ul>
    8. 8. Health & Wellbeing <ul><li>9% of over-65s are often or always lonely </li></ul><ul><li>8 year gap in life expectancy between the best and worst local authorities in England </li></ul><ul><li>32% of people aged 65+ who agree that health professionals consider older patients a nuisance </li></ul><ul><li>176,601 people aged 75+ readmitted to hospital emergency within one month of discharge </li></ul><ul><li>Only 19% of 65-74 year olds and 7% aged 75+ meet national guidelines for physical activity </li></ul>
    9. 9. Home & Care <ul><li>93,000 carers aged 65+ receiving a carer specific payment </li></ul><ul><li>2.8 million people over 50 providing unpaid care </li></ul><ul><li>55,000 households receiving low-level home help or home care </li></ul><ul><li>473,000 people aged 65+ receiving care or support a home </li></ul><ul><li>Social care – growing demand, no net spending increase, costs risen by 4% per year over past four years </li></ul>
    10. 10. Work & Learning <ul><li>Removal of forced retirement </li></ul><ul><li>32% of 50-74 year olds and 14% of those aged 75+ are taking part, or have recently taken part, in learning activities </li></ul><ul><li>64.6% of those aged 50-64 are employed </li></ul><ul><li>60% of those aged 65+ have never used the internet (down from 64%) </li></ul>
    11. 11. Travel & Lifestyle <ul><li>Grey market now exceeds £100 billion </li></ul><ul><li>39% of people aged 65+ think businesses have little interest in the consumer needs of older people </li></ul><ul><li>6% of people aged 65+ leave their home once a week or less </li></ul><ul><li>51% of people aged 65+ who believe age discrimination exists in older peoples’ everyday lives </li></ul><ul><li>Discrimination legislation </li></ul>
    12. 12. 12 Challenges <ul><li>Create a savings and pensions culture </li></ul><ul><li>Extend working lives </li></ul><ul><li>Prevent longer periods of illness in later life </li></ul><ul><li>Reduce levels of inequality </li></ul><ul><li>Deliver care and support </li></ul><ul><li>Change attitudes to later life and ageing </li></ul><ul><li>Build communities that can tackle severe isolation </li></ul><ul><li>‘ Age proof’ services and environment </li></ul><ul><li>Engage older people with successive waves of new technology </li></ul><ul><li>Re-imagine and redesign every stage of life </li></ul><ul><li>Support strong families </li></ul><ul><li>Consider the case for the growing share of GDP </li></ul>
    13. 13. <ul><li> </li></ul>
    14. 14. Changing attitudes to later life: winning hearts and minds <ul><li>John Stapleton </li></ul><ul><li>Broadcaster and journalist </li></ul>
    15. 15. Changing attitudes to later life: winning hearts and minds <ul><li>Camilla Palmer </li></ul><ul><li>Partner, Leigh Day & Co </li></ul><ul><li>Ben Summerskill OBE </li></ul><ul><li>Chief Executive, Stonewall </li></ul><ul><li>Kate Waters </li></ul><ul><li>Director, Blue Rubicon </li></ul><ul><li>Jacki Connor </li></ul><ul><li>Director of Colleague Engagement, Sainsbury’s </li></ul>
    16. 16. Parallel conference sessions <ul><li>Integrating health and social care: </li></ul><ul><li>mission impossible? </li></ul><ul><li>Location: Victoria Suite, Basement Level 1 </li></ul><ul><li>  </li></ul><ul><li>Older consumers: out of sight, out of mind? </li></ul><ul><li>Location: Albert Suite, Basement Level 2 </li></ul><ul><li>  </li></ul><ul><li>Reducing poverty and deprivation in later life </li></ul><ul><li>Location: Edward Suite, Basement Level 2 </li></ul>
    17. 17. Integrating health and social care: mission impossible? <ul><li>Chair: </li></ul><ul><li>Andrew Harrop </li></ul><ul><li>Director of Policy and Public Affairs, Age UK </li></ul>
    18. 18. Integrating health and social care: mission impossible? <ul><li>Jo Webber </li></ul><ul><li>Deputy Policy Director, NHS Confederation </li></ul>
    19. 19. Integrating health and social care: mission impossible? <ul><li>Dame Jo Williams </li></ul><ul><li>Chair, Care Quality Commission </li></ul>
    20. 20. Breaking down the barriers Can it be done? <ul><li>YES….But </li></ul><ul><li>Government aim to drive transformation </li></ul><ul><li>and integration </li></ul><ul><li>Everyone’s public duty to pull together </li></ul><ul><li>Shared, agreed vision for the locality </li></ul><ul><li>Requires strong local leadership and real champions </li></ul>
    21. 21. CQC’s contribution (i) <ul><ul><li>Oversight of health, mental health and adult social care </li></ul></ul><ul><ul><li>Focus on quality and safety </li></ul></ul><ul><ul><li>We see, speak, listen and act eg. dignity and nutrition inspections </li></ul></ul><ul><ul><li>Intelligent data analysis and risk assessment </li></ul></ul>
    22. 22. CQC’s contribution (ii) <ul><ul><li>Involve people who use services; actively seek people’s voices </li></ul></ul><ul><ul><li>User Groups & Regulated bodies </li></ul></ul><ul><ul><li>Provide information to inform and support choice </li></ul></ul>
    23. 23. CQC’s contribution (iii) <ul><li>Specifically Outcome 6: Cooperating with other providers </li></ul><ul><li>When care & treatment of service users is shared with, or transferred to, others we will expect to see evidence of – </li></ul><ul><li>appropriate care planning through the cooperation of those relevant </li></ul><ul><li>appropriate information sharing, particularly around admission, </li></ul><ul><li>discharge and transfer, and coordination of emergency procedures </li></ul><ul><li>supporting individuals to access the right health & social care support to meet their needs </li></ul>
    24. 24. Our strategic objectives <ul><li>Focus on quality and acting swiftly to eliminate poor quality care </li></ul><ul><li>Ensuring that care is centred on people’s needs and protects their rights </li></ul><ul><li>Acting Together – </li></ul><ul><li>LINKs (Health Watch) </li></ul><ul><li>Experts by Experience programme </li></ul><ul><li>Speak Out Network </li></ul><ul><li>SOFI 2 </li></ul>
    25. 25. New opportunities from system reform <ul><li>Health and wellbeing boards </li></ul><ul><li>Healthwatch and user “voice” </li></ul><ul><li>New commissioning arrangements </li></ul><ul><li>Reform – Commission on the Funding of Care and Support </li></ul>
    26. 26. Care Quality Commission <ul><li>CQC website: National Contact Centre: Telephone: 03000 616161 Fax: 03000 616171 CQC National Correspondence Citygate Gallowgate Newcastle upon Tyne NE1 4PA </li></ul>
    27. 27. Integrating health and social care: mission impossible? <ul><li>Dr Petra Wilson </li></ul><ul><li>Senior Director, Public Sector Healthcare Europe, </li></ul><ul><li>Internet Business Solutions Group, </li></ul><ul><li>Cisco Systems </li></ul>
    28. 28. Integrating health and social care: mission impossible? <ul><li>Questions and discussion </li></ul>
    29. 29. Follow the conference on twitter #afll Free wi-fi access code: 7348449353
    30. 30. Afternoon plenary <ul><li>Dianne Jeffrey DL </li></ul><ul><li>Chairman, Age UK </li></ul>
    31. 31. Solutions for our ageing nation <ul><li>Rt Hon Iain Duncan Smith MP </li></ul><ul><li>Secretary of State for Work and Pensions </li></ul>
    32. 32. Searching for social care solutions <ul><li>Andrew Dilnot CBE </li></ul><ul><li>Chair, </li></ul><ul><li>Commission on Funding of Care and Support </li></ul>
    33. 33. Over 65 in UK
    34. 34. Over 65 in UK
    35. 35. GDP
    36. 36. Progress so far <ul><li>Inputted into the Spending Review </li></ul><ul><li>Agreed Criteria with Government and developed two underlying principles </li></ul><ul><li>Established our definition of the problem and characteristics of an ideal system </li></ul><ul><li>Lots of evidence gathering and engagement – including devolved administrations </li></ul><ul><li>Launched the Call for Evidence </li></ul><ul><li>Now entering new phase of narrowing down options and working up proposals </li></ul><ul><li>Report in July 2011 </li></ul>
    37. 37. Publicly funded social care Net expenditure 2008-9 (millions) Older people, £7,250, 54% Physically disabled adults, £1,470, 11% Adults with learning disability, £3,570, 27% Adults with mental health needs, £1,100, 8%
    38. 38. Estimated public spend on older people in England (2010/11) £bn Personal social services for over 65s NHS expenditure on over 65s Social security benefits for those over state pension age 6% 35% 59%
    39. 39. Call for Evidence <ul><li>Closed at end of January with nearly 250 responses. </li></ul><ul><li>We asked: </li></ul><ul><ul><li>What are the challenges and opportunities? </li></ul></ul><ul><ul><li>What are the strengths and weaknesses of the current system? </li></ul></ul><ul><ul><li>How should the funding system be reformed? </li></ul></ul><ul><li>Received lots of useful data on unmet need (which needs further work) and length of stay </li></ul><ul><li>Interesting evidence on possible role of financial services sector </li></ul>
    40. 40. Direction of Reform <ul><li>Clear direction – a new funding system needs to include the following elements: </li></ul><ul><ul><li>Increased resources </li></ul></ul><ul><ul><li>Opportunity for people to be protected against costs </li></ul></ul><ul><ul><li>Enable people to plan and prepare </li></ul></ul><ul><ul><li>Be aligned with the wider public funding system </li></ul></ul>
    41. 41. Projections for age related budget expenditure 2009-2010 2019-2020 2029-2030 Health 8.0 8.5 9.3 Long term care 1.2 1.4 1.7 Public service pensions 1.8 1.9 1.9 State pensions 5.5 5.3 5.9 Education 6.0 5.9 6.0 Total 22.5 23.0 24.8
    42. 42. Future lifetime costs Total costs (care plus hotel) at 65 (in 2009/10), all care types <ul><ul><li>around a third of people age 65 would not expect to spend much at all on care </li></ul></ul><ul><ul><li>half face lifetime costs of over £20,000 </li></ul></ul><ul><ul><li>one in ten aged 65 can expect costs of more than £150,000 </li></ul></ul>
    43. 43. Opportunity to be protected against care costs <ul><li>Working out the form of this partnership is going to require weighing up some difficult trade-offs… </li></ul><ul><ul><li>Which type of risk is it best for the state to take? </li></ul></ul><ul><ul><li>Should there be a universal element or means-testing? </li></ul></ul><ul><ul><li>What is the balance between early intervention and helping </li></ul></ul><ul><ul><li>those with the highest needs? </li></ul></ul><ul><ul><li>What role could the financial services sector play in the future? </li></ul></ul>
    44. 44. Source: Banks, Crawford and Tetlow 2010 using Wealth and Assets Survey 2006/8 Distribution of net household wealth per adult, by age (net financial, property and private pension wealth) Household wealth
    45. 45. People need to be able to plan and prepare 50% of those with experience of elderly relatives or friends receiving care are ‘concerned’ vs. 38% of those with no experience 47% ABC1s are concerned vs. 39% of C2DEs How concerned are you about covering the costs of care in your old age should you require it in future? 46% women are concerned vs. 41% of men Source: TNS Omnibus, 2011, Base: All respondents, (921)
    46. 46. Public Funding needs to be clear, coherent and aligned <ul><li>We know that from the individual's perspective the care and support system can often look disjointed and uncoordinated – and that it can fail to deliver the best outcomes </li></ul><ul><li>Boundaries with housing, NHS, benefits etc can be unclear </li></ul><ul><li>No simple solutions here – there are different structures, agencies, funding systems involved – but it makes sense that in tackling the funding of social care we also look at how these fit together. </li></ul>
    47. 47. Looking forward <ul><li>A lot of modelling work still to be done </li></ul><ul><li>Narrowed down our options now and are testing them </li></ul><ul><li>We’ll be undertaking further deliberative work </li></ul><ul><li>Further engagement with academics, key stakeholders and the financial services sector </li></ul><ul><li>Publish in July 2011 </li></ul>
    48. 48. Searching for social care solutions <ul><li>Andrew Dilnot CBE </li></ul><ul><li>Chair, </li></ul><ul><li>Commission on Funding of Care and Support </li></ul>
    49. 49. Closing remarks <ul><li>Dianne Jeffrey DL </li></ul><ul><li>Chairman, Age UK </li></ul>
    50. 50. <ul><li> </li></ul>