Politics is all about priorities. So here are my top 10 priorities for the new prime minister and his team beyond June 27.
My focus is on older people, who after all are the biggest group of users of care and health services. Our ageing population demands a new approach to create a care system that is fit for the future, tackling the current inconsistencies and failures, unfairness and injustice. I should say from the outset that I am optimistic about the next few months and the prospect for change. So without further delay:
Priority one: Listen to older people, their families and carers. If Gordon Brown’s ‘listening and learning’ initiative is to be meaningful, then the voices of older people, their families and carers must be heard and acted on. Their private struggles must become the subject of greater public debate.
Priority two: Ask the right questions and don’t reinvent the answers. The Caring Choices coalition is currently raising the debate through regional events to explore how we reach a fairer system of paying for care. The Wanless review and the Joseph Rowntree Foundation have already provided solutions on paying for care, many of which could be implemented swiftly.
Priority three: Integrating health and care to make the system work better for older people. The new commissioning framework for health and wellbeing jointly introduced by the Secretaries of State for Health and for Communities and Local Government is a step in the right direction. Local area agreements provide a powerful vehicle to move this agenda forward and enable the involvement of a range of partners in delivering health and wellbeing. Dare I say it, local area agreements could also be the first step to introducing much needed greater accountability to local health services.
Priority four: Housing is key. The focus must be much wider than purely health and care if we are to create places that are good to grow old in. The commissioning of a range of local services such as housing, transport, community safety and leisure is therefore critical in moving from community care to caring neighbourhoods. The importance of appropriate, safe and affordable housing in reducing the need for health and social care services is often underestimated. The development of a housing strategy for an ageing population is a key 100 days priority.
Priority five: the creation of one stop shops – the Sure Start for older people or LinkAge Plus approach – providing access to services through a single gateway as well as reaching out to where older people live. These could build on existing community hubs. The 3500 children’s centres currently being created give us the chance to develop intergenerational centres serving all ages.
Priority six: Making ‘power to all the people’ a reality requires investment in information, advice and independent advocacy services, particularly for those who are isolated, disadvantaged and without a voice. A national one stop care advice service together with local information and advice services and independent advocacy services in every community would help give older people control over care and other services. Information and advice are also key to boosting public confidence in the quality of care, particularly care homes. Star ratings for care homes next year will make it easier for people choosing care homes. The new regulator Ofcare needs to become as widely recognized and well known as Ofsted.
Priority seven: More support for carers. The consultation on the new national carers strategy is a major opportunity to ensure that the growing number of carers get the time, money and support they need to fulfil their caring role and have a life too. More could be done by employers and the government to help carers who work – from extending tax exemptions to care vouchers to providing emergency care and signposting advice. Particular attention must be paid to carers who are older people themselves. Making carer’s allowance available to pensioners and providing more respite care and practical support would help.
Priority eight: We need new levers or incentives to encourage health and local government spending to move away from expensive acute or residential services to community-based support that helps people stay in their own homes. Investment in early intervention, falls prevention, telecare, home repairs and adaptations, and other community services could be encouraged by incentivising the reduction of hospital admission rates for older people. Local authorities should also be incentivised to increase the take-up rate of direct payments, which for older people is still very low.
Priority nine: Tackling underfunding requires greater investment from the 2007 spending review and beyond. The reality is that again this year local authorities have tightened their eligibility criteria, restricting the number of people who get care services. The funding gap now is estimated to be £1.7bn and it will grow as our population ages. As already suggested, some of that money could be redirected from health spending, starting perhaps with last year’s £500m underspend.
But we also need to examine some radical solutions for funding care for our ageing population – for example, from inheritance tax. It has been estimated that a 2.5% ‘care duty’ would raise around £1.5bn. The framework for collection is already in place and such a care duty would provide instant funding, keeping up with increases in the older population. It offers a fair and just way of delivering the funding needed to provide long-term care.
Priority 10: Be bold. Making the changes required and delivering what older people want requires boldness and a leap of faith. That is what political vision and leadership are all about. Given the fact that half the people who will actually vote at the next general election will be aged 60 or over, there is a huge political prize at stake.
This is a version of a speech given at a Progress debate on First 100 Days: Labour’s priorities for health and social care on Tuesday June 12.