A presentation on policy, demographic and fiscal challenges through the lens of Catholic Social Teaching

1. Health and Care of Older People
and the Post Covid World
Association of Provincial Bursars, 5th October 2022
Jim McManus, D.Sc, FBPsS, CPsychol, CSci, FFPH
President, Association of Directors of Public Health
Executive Director of Public Health, Hertfordshire County Council

2. • Microbial uncertainty – viral volatility
• Living with Covid
• Cost of living squeeze for many
• Tough choices
• Social Un-safety
• A false choice between “woke supremacy” on one hand and aggressive populism
harnessing “othering” as a tool for culture war on the other
• Economic challenges – impact on investments and pension funds
• An atmosphere of vulnerability, threat and uncertainty
• Long Covid impacts - enduring for some
• Readjustment
• The social gradient to most of these
The next two years or so?

3. Post WWII
‘baby boom’
Narrowing in
teenage years
corresponds
with particularly
low birth rates
around the turn
of millennium
Source: Office for National Statistics
While the UK’s population is
growing, improvements in
healthcare and lifestyles
means it is also getting older.
In the UK, the number of
people aged 85 is projected to
double to 3.2 million in the
next 23 years.
The shape of the
UK population is
changing

4. Life expectancy at Birth, England 2000-21

5. Thanks to life expectancy gains, the number of
people living with complex needs is rising
Source: Kasteridis, 2014

6. Have we learned that Covid, HIV, many other diseases are Syndemics not pandemics?
• Singer, 2009
• 1st Wave: Immediate mortality and
morbidity of COVID-19.
• 1st Wave Tail: Post-ICU and
admission recovery for many
patients.
• 2nd Wave: Impact of resource
restrictions on non-COVID conditions
– all the usual urgent things that
people need immediate treatment
for – acute.
• 3rd Wave: The impact of interrupted
care of chronic conditions (people
stayed home).
• 4th Wave: Psychic trauma, mental
illness, PTSD, economic injury,
burnout, and more.
• LONG COVID

7. Multiple impacts
• La Pandémie…a surprisé,
desorienté et desorganisé dans
toutes leurs structures tous les
pays du monde” (Larchet,
2022)
• shattered assumptions about
certainties especially science
• Shattered reality
• Psychological
Petite théologie pour les temps de pandémie (editions-
syrtes.com)

8. Epidemiological Trends
• More people ageing, more complex needs
• Greater preventable frailty
• Life expectancy has stalled
• Demographic change
• Extreme weather killing more people
• Severe winter
• Covid and Flu and other pathogens
www.adph.org.uk

9. BUT ….Stop
blaming the
pandemic as
the root of all
evil – that’s
ideological, not
evidential
• Mental health need was rising before the pandemic, it has
accelerated
• Suicides have not risen – the main risk for suicides is
economic difficulties we are now entering
• inequalities that existed before Covid worsened during it
• Obesity was rising, it has accelerated
• Social divisiveness was increasing due to cultural and political
factors
• The Americanisation of Catholic culture wars
• THE NHS
• waiting list was 4.4m in December 2019, it grew worse
during the pandemic but was already a record
• NHS Vacancies were running at 100,000 before Covid
• Public Health had been cut by 25% before Covid

10. Source: NAO analysis of ONS 2011 census data
And the proportion of
adults with major
limitations on their
day-to-day activities
varies by region
Need is highest in the North East and North West

11. Changes in life expectancy by deprivation decile, 2015-2017 and 2018-2020
Source: ONS

13. Excess deaths and Heatwaves

14. The System
NHS
• Went into covid with 100,000 short
workforce, and 4 m waiting list
• Now 6 million waiting list
• Resignation continues , last quarter
saw highest ever NHS resignation
figures
• Continuing Healthcare increasingly
difficult to get
• Funded nursing care difficult to get
• Health Budgets
Social Care
• Workforce haemorrhaging because
supermarkets pay more than frontline
care
• Social care underfunded
• Gap in Local Authority funding getting
worse
• Politics is about NHS and not seeing
the detail in social care
• Care rationing by eligibility criteria
• Means Testing
• Direct Payments
www.adph.org.uk

15. www.adph.org.uk

16. Source: ING

17. Multiple causes: This is NOT about the NHS
alone

20. The means-tested social care system has suffered a
sustained funding squeeze
Source: NAO analysis of local authority revenue expenditure and financing

21. Many care homes, particularly
those that are most reliant on
LA-funded residents, are not
currently in a sustainable
position….. while they might be
able to stay in business in the
near term, they will not be able
to maintain and modernise
facilities, and eventually will find
themselves having to close, or
move away from the LA-funded
segment of the market.
”
“

26. English Reform of Social Care
www.adph.org.uk

27. System Change yet again
• England – Integrated Care Boards and Integrated
Care Partnerships. But social care and Health
separate
• Scotland, Wales – Social Care and NHS Separate
• N Ireland – Social Care and NHS Amalgamated

28. www.adph.org.uk

29. Cap on care costs from October 2023 £86,000
• limit on costs that people will need to spend to meet their eligible care and
support needs.
• ‘personal care costs’ refers only to components of care not hotel and
accommodation costs. This will be based on what the cost of that package
is or, in the case of self-funders, would be to the local authority if it were
to meet the person’s eligible care and support needs (see the ‘How people
progress towards the cap’ section below).
• From October 2023 the cap will be set at £86,000. This means the
maximum amount anyone will have to pay for personal care to meet their
eligible care and support needs from October 2023 onwards will be
£86,000. The cap will be implemented for adults of all ages, without
exemption.
POTENTIAL ISSUES IF YOU ARE A PROVIDER

30. www.adph.org.uk
Assets What do you pay from October 2023?
Above the upper
capital limit
(£100,000 from
October 2023)
Full cost – you are a self-funder.
Between the
capital limits
What you can afford from income plus a means-tested
‘tariff’ contribution from assets. The tariff is calculated as
follows: for every £250 of capital between the lower and
upper limit, an income of £1 a week is assumed, and this
will be payable towards the cost of your care.
Below the lower
capital limit
(£20,000 from
October 2023)
You no longer contribute from your assets and only what
you can afford from your income.

31. Three big sets of issues
• Your members and future care needs
• You are a provider of care
• Mission to an ageing and ill society with unequal
burdens

32. Your Members
1. Funding going to get tighter
2. Need to understand significant proposed changes in social
care funding Eng, Wales
3. Need to understand NHS continuing healthcare changes
4. What can you do to prevent frailty and cognitive
impairment in your communities
5. Information requirements and other changes
www.adph.org.uk

33. What can we do?
• A Social Care “commission” to
• identify issues for religious,
• do some actuarial modelling
• campaign for fair funding
• Identify models
• Get involved in local VCSF Alliance in England
• Similar fora in other nations
www.adph.org.uk

34. Wider Society - Mission
• Warm banks
• Food
• Prevention of Frailty
• Argue for public policy which enables secure,
safe, healthy ageing
www.adph.org.uk

35. Tools the
Church has
for Recovery
Discerning God
in circumstance
and change
Social Ministry,
Social Teaching
The Saints
Liturgy and
sacramental
theology
(Reconciliation;
Grace)
The Psalms
Trust and
Perseverance
Theological
tools for
resilience
Charisms
Plant,
Skills,
Resources
Lament Solidarity
Care for
Others
Lament

36. Example: key psychological skills for
addressing poverty (work with Health
Visitors)
• Stigma – using the “social cure” insights from trauma psychology in
communities – need to widen and nuance our understanding of
trauma
• Psychological Flexibility – getting people into employment
• The mindset to access help
• The mindset to think widely about what people need
• The mindset to think systems
• The mindset to naturally collaborate

37. Leadership in and beyond the Pandemic
Leadership Tasks for tough times
1. Identify the absolute core must do’s and work with others in the system
to identify who can do what, at national, regional and local levels
2. Articulate the harm with evidence and articulate what can be done
about it -be as constructive as you can be and as challenging as you
need to be
3. Get engaged with ICSs and make sure they understand this is “not all
about the NHS” it’s about the system
4. Get engaged with other system key players
www.adph.org.uk

38. Centre for Ageing Well Recommendations
• Prevention of frailty and avoidable disability
• Strength training
• Reablement
• Assistive technology

39. Key Trends in ageing
• Population Trends
• Covid and its impact
• Financial Trends
• Policy Trends
• Climate Change and impact on excess death
• Policy trends
www.adph.org.uk

40. Useful background read
www.adph.org.uk

41. Functional ability has had less
attention in public policy.
Loss of function is a big driver of
public spending and poor
outcomes.
Shifting this line would have a
significant impact on quality of
life.
What matters to
you not what is the
matter with you.
Existing life science,
health research and
public health
programmes tend to
address improving
intrinsic capacity.
Work on public health is focused on
reducing health inequalities, which will
be critical to achieve the goal.
Healthy Ageing Framework

42. Pillars for
Leadership
Care for Self as part of care for others – Kenotic
leadership requires this – Apostolicam Actuositatem
Rediscover the Purpose – Gaudium et Spes, Lumen
Gentium, Apostolicam Actuositatem
Use all the talents – build up all the vulnerabilities, make
the Church safe – Fratelli Tutti
Articulate Hope – Spe Salvi
Liturgy, Spirituality, Worship – Desiderio Desideravi
Listen, Dialogue - Ecclesiam Suam

43. Thank you!
www.adph.org.uk
Jim.mcmanus@hertfordshire.gov.uk