This document discusses challenges and opportunities for local governments in caring for an aging population. Key points include: 1) The population aged 80+ is projected to double in 20 years, increasing demands on health and social care. 2) Government policy aims to personalize care and shift local authorities from direct provision to ensuring supply. 3) There is a need to better understand demand drivers, target interventions like fall prevention, and use funding to support individuals and communities rather than replace them. 4) A holistic approach is needed across local authorities to address aging as a whole system issue.

1. All Change - New Horizons for Local
Government
The Future of Care for Older People
December 2011

2. National demographics
 Numbers of people aged 80 and over will
increase from 2.3 million to 4.4 million by
twenty years time.
 Nationally, big differences between rural
and urban populations, eg, by 2030 the
population aged 75 and over will have
increased on average by 47% in urban
areas and by 90% in rural areas.
 Already 60% of all hospital beds are
occupied by people aged 65 and over, 40%
of whom have a dementia.
 The rate of admissions of older people to
hospital in the last ten years has grown at
nearly double the rate for the whole
population. 2

3. National wealth
 Average pensioner incomes have risen
faster than average earnings since the mid-
1990s, increasing by 44 per cent in real
terms between 1994/95 and 2008/09.
 Occupational pensions are increasingly
significant, accounting for over a fifth of
average gross income for single pensioners
and over a quarter of average gross income
for pensioner couples.
 Nearly 50% of all housing equity is held by
people aged 65 and over some £3 trillion
worth of property assets.
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4. Regional demographics
 In the West Midlands the population aged
80 and over will grow from just over a
quarter of a million to just under half a
million, in the next 20 years.
 By 2030 over a 100,000 older people it is
estimated will have a dementia with some
30,000 people per annum being admitted to
hospital after a fall.
 In Shropshire and Herefordshire by 2030
nearly a third of the population will be aged
65 and over.
 However, 76% of the older peoples
population across the region are home
owners.
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5. Government policy
 To increase the personalisation of care
through giving care users the funding to
purchase in the care market.
 To shift LAs from being providers and
purchasers of care to being ensurers of
care supply for all.
 To reduce regulation through reducing the
inspection regime and promoting the
growth of personal assistants.
 To increase diversity in the market place
through encouraging different forms of
enterprise.
 To resolve the future funding of care.
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6. The care market
 Residential care – Private, fragmented and
diminishing.
 Home care – Private, fragmented and
growing.
 Specialist housing – Public, still
represented by sheltered housing, extra
care still small.
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7. Care market questions
 Who is residential care for?
 DO we need to tackle perverse incentives in
home care?
 Will personalisation increase costs?
 How do we make sure voluntary
organisations deliver independence rather
than provide a step up onto the care
pathway.
 If there is less regulation who determines
and measures quality.
 How do we fund and support capital
investment?
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8. Potential impact of government policy
 Could bring more people into some element
of state funding depending on the threshold
levels.
 In the short term we could see more care
organisations fail.
 In the longer term could increase the use of
residential care.
 Does little to reduce demand or promote
efficiencies.
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9. What needs to happen – seven pillars
of wisdom?
1. Understand demand for high intensity
care.
2. Target interventions.
3. LA funding to support individual and
community endeavour rather than replace
it.
4. See older age as an issue for the whole
local authority not just social care.
5. Integrate at the point of delivery not just
strategic management.
6. Stop seeing providers of care as the
enemy.
7. Stimulate private housing with care for
older people. 9

10. 1. Demand for care
 Failure to deal with or plan for
bereavement.
 Extreme old age.
 Social isolation / living alone.
 Poor health service performance.
− dementia,
− falls,
− stroke,
− continence
 Ageism
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11. 2. Target interventions – falls as an
example
 Patients with first fractures are not flagged
up for secondary prevention. Only around
half of A&E and MIU routinely screen
people who have had a fall for risk of future
falls.
 Many of the exercise programmes being
provided are not evidence based.
 Less than half of falls admissions are
screened for osteoporosis risk.
 Care homes were the usual place of
residence in 10% of non-hip fractures and
22% of hip fractures. Although they only
make up 4.5% of the population.
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12. 3. Using funding like gold dust
 Need to move population from seeing care
as an acquisition to a service available as
and when needed.
 Testing the value added benefits the
voluntary sector brings.
 Focussing funding for carers.
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13. 4. A holistic LA approach
 Is strategic planning old age focussed and
tested?
 What does business support offer the care
sector?
 Start focussing on outcomes rather than
cost and volume.
 Make sure Public Health delivers VFM.
 Recognise that better health in the
community means hospital closures.
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14. 5. Integration
 Start to integrate services at the front end.
 Persuade clinical commissioning groups of
the financial gain.
 Stop signposting.
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15. 6. Work with providers
 Framework agreements often not worth the
effort.
 Set standard terms and conditions for
contracting.
 Be clear about price v quality.
 Better understand business and recognise
vulnerability not always good for
consumers.
 Incentivise good performance that reduces
demand.
 Incentivise diversity, recognise the kinds of
choice people really want.
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16. 7. Stimulate private sector specialist
housing development
 Health and care will not sustain people in
the community on their own.
 Using housing equity to fund housing that
reduces demand is better than using
housing equity to fund care.
 Understand local market issues and how
the LA can help to overcome them.
 Help to support housing that offers ‘Wow’
rather than ‘has it come to this’ design and
development.
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17. Delivering the future
“"We can't solve
problems by using the
same kind of thinking
we used when we
created them." Albert
Einstein