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Counsel & Care – Graham Lecture

I never knew Bob Graham but I do know that he was one of that rare breed of people who actually go out and make a difference.
Bob founded the Elderly Invalid Fund in 1954. Its aim was simple – to provide comfort and support for older people. Since then it has helped hundreds of thousands of people.
In 1974 its name was changed to Counsel & Care and Bob Graham retired as General Secretary in 1978. This work is as important today as it was when Bob first identified the need for such a service.
So it is a personal privilege to have been invited to deliver this year’s Graham Lecture.

Older people – the new frontier of a reformed welfare state

If we are to meet our responsibilities to older people in our society then we will have to open up a new frontier in the welfare state and establish the elderly as a key political priority in the years ahead.
The figures that show the dramatic demographic changes taking place make a powerful case for a fresh approach. More people aged over 80 than over 5. More over 60 than under 16.
The government estimates that by the middle of the century the average life expectancy for men will be 87 and for women 90. The other big shift is in the numbers actually reaching an older age. Due to long term improvements in the health of the nation 80% of men and 90% of women are now surviving to the age of 65.
But important as it is it would be a mistake to simply play the numbers game. We also need to consider the expectations of those entering old age. The first of the baby boomers born after the Second World War are now reaching 60. They are from a generation which is far less deferential to those in authority. They will make greater demands and expect to have their voice heard.
If we are to get our response right then we will need to change the way in which we model provision in order to meet the requirements of these new consumers of services for older people. The implications are far reaching. It would mean not just a new frontier being opened up but also raises questions as to what we expect from the welfare state and how we believe it should respond to the quite different demands that will be made on it when the post war generation get into their 60s.
The Beveridge report had at its heart the need to provide protection against sickness, unemployment, want and to provide for retirement. It is really no surprise that in order to meet these massive challenges a rather paternalistic, top down and uniform approach was adopted.
The new Welfare State must be more about offering choice, moving away from a ‘one size fits all’ approach to one which is personalised; being a facilitator rather than just a provider; engaging and empowering individuals and the communities in which they live and giving people control over the options available to them and the services they receive.
In some parts of the Welfare State this more responsive approach is already taking place but it needs to go further and become the norm. It has to be regarded by the government as a fundamental part of its modernisation and reform agenda for our public services.

Comprehensive Spending Review
The outcome of the Comprehensive Spending Review will be a key factor in determining the new offer that can be made to older people. This is only the second time since Labour was elected into office in 1997 that such a fundamental reconsideration of Labour’s political priorities and spending allocations has taken place.
This is said to be a ‘zero-based’ review which means starting from scratch without any preconceptions or budgets already set.
It will not be an easy exercise. The overall amount available for public spending will be tight and there will be many competing demands.
But because of the comprehensive nature of the review it is of far greater significance than just the normal three year term of spending allocations. Its outcome will determine priorities for the next ten years.
It is a positive sign that the demographic changes taking place in our country will be a major consideration of the review. It is crucial that as the work goes on there is agreement about the choices available to society in terms of what we can offer older people.
Over the past year we have seen reports from a number of Government departments and charities which have highlighted the importance of a new approach to satisfy the legitimate expectations of a growing elderly population.
The spending review is the opportunity to bring this thinking together in a strategic way. In this area, as in many others, there has been a demand for joined-up government. Here is the chance to do exactly that by linking major political objectives with the finance and the structures that will deliver them.
The danger is that providing a new deal for older people will just appear too difficult and not be regarded as a political priority. This would be a terrible mistake. Doing nothing and simply leaving things as they are must not be regarded as an option.
I say this not to ignore the very real achievements that there have been and improvements made in the lives of many pensioners. A million pensioners have been lifted out of relative poverty since 1997, with a 15 per cent fall in pensioner poverty in the last year alone. Absolute pensioner poverty has been cut by two-thirds; compared to 1997, pensioner households are on average £1,350 a year better off in real terms, with the poorest third of pensioner households £1,750 a year better off.
• £200 winter fuel payment to pensioners and an extra £100 for over-80s.
• Over 11 million people will benefit from a winter fuel payment this winter
• We have introduced free TV-licenses for those over 75
• Free eye tests
• Free local bus travel for over-60s
• As of October 2006 discrimination in employment and vocational training on the grounds of age is illegal.
But there has to be a recognition that more needs to be done and in a different way than has been the case in the past. So what are the issues that could form part of a new offer to older people?

Funding of Care for Older People
How we can have a sustainable system of funding for top quality care for the elderly is both a political and social challenge.
There is a growing feeling of injustice about the way the present system works. The Wanless review of social care and the Joseph Rowntree Foundations’ final report on funding long-term care have provided the analysis and the background to the situation we now face.
In this area, perhaps more than any other, waiting for years to pass without taking a decision will simply not be acceptable. This is one of the major issues that will need to be determined by the Comprehensive Spending Review. We should have a debate as to how we might achieve a consensus as to the way forward.
To my mind such a debate must have at its focus a number of key elements. They should include:

• A new system of funding which is affordable, sustainable over the long term and which can provide good quality care.
• How to provide a personalised service which enhances an older person’s dignity by providing choice and empowerment.
• Greater use of preventative services which would help now when needed but which might save on the cost of care at a later date.
• A more joined up approach to the provision of services to overcome any gaps in care for older people.

We should be in no doubt that failure to set out a new vision for social care and how it could be funded in next year’s spending review would be seen as a huge missed opportunity and we need to make sure that this doesn’t happen.

Choosing a Care Home
Moving into a care home is a major decision that will have a significant impact upon an older person’s quality of life. Most older people finding themselves in this position will be in poor mental or physical health at the time, with many having just left hospital. With no experience of having to make such decision, it is imperative that they are given help, advice and support to lead them through the decision-making process and ensure that they make the best possible decision for their personal circumstances.
Last year the Office of Fair Trading (OFT) carried out a market review of the care homes market. One of they key areas they looked at was the information provided to individuals choosing a care home and the support and advice available to them in this difficult period.
In its market study the OFT found that the information provided by some Authorities is “unclear or incomplete, particularly with regard to the availability of care homes in their areas that do not usually require a ‘top up’ to be paid by Authority funded resident”. It also found that the information provided to those who were going to have to fund their own care was particularly scant – “only 27% of self funders had received information about care homes in their Authority”.

So how can the necessary advice and guidance be provided?
A first step would be the establishment of a network of care advisers. Under the new patient choice system in the NHS many patients are now able to make use of the services of a patient care adviser who has the task of helping the individual make a decision about where to get treatment.
It would be possible to establish a similar network of people to give advice about the choice of care home.
Information would also be provided through up to date guides and a website with details of local provision.

Support for Carers
We owe a great debt to those that provide care and should do more to support them.

1. Tax breaks on care vouchers
The latest census showed that there are six million adult carers in the UK and half of these juggle their care responsibilities with holding down a job.
We owe a great debt to those who take on these obligations and we can and should do more to assist them.
At present a scheme exists to help working parents with childcare costs through tax breaks on childcare vouchers.
We should extend this scheme to those in work who have care responsibilities say for an elderly mother or father.
Tax breaks on care vouchers would help employees with care responsibilities to pay for additional care and support services for their older relatives.
Under the scheme the employer would provide care vouchers. The cost of the value of the voucher would be exempt form both national insurance and income tax. An employee would then select the most appropriate support they require from a range of accredited and approved services. The sorts of services that would be purchased with a voucher could include:
Informal support and assistance with services such as cleaning and home maintenance; domiciliary services such as help with getting up; getting dressed; personal hygiene; shopping and walking. Right up to residential care, either full time or as a respite.
As for the cost of such a scheme a group pf organisations included in the childcare voucher scheme calculate that if 150,000 people took advantage of such as scheme with £50 a week being the level of support available to purchase care services then the approximate cost to the Government would be £195 million a year.

2. Carer’s Allowance for Pensioners
There is a further unfairness that works against pensioners who have a caring responsibility. At present when someone who is receiving a carer’s allowance reaches the age at which they begin to receive a state pension they lose their carer’s allowance. The explanation given over many years is that a carer’s allowance is paid to replace income for a person who is unable to work because of their caring responsibilities. As the state pension replaces income then the carer’s allowance stops.
In my view this is a flawed argument. We should see the carer’s allowance as a tangible form of recognition for the important work carried out and it should continue to be paid for as long as the individual concerned continues to perform such an important role.
In June 2004 the government estimated that the net cost of providing carer’s allowance to pensioners would be £145 million.
Taken alongside the introduction of care vouchers the total cost to the government would be around £340 million. A sum which could easily be funded from the amount unclaimed by pensioners for council tax rebate and pension credit which amounted to £2.5 billion in the latest year for which figures are available.

3. Flexible Working
The new Work and Families Act which comes into force in April 2007 will give carers the right to ask for flexible working just as parents of children can do at the moment. This has proved to be a great success for parents and I have no doubt that this can be the same for some carers – although it will be important for the availability of this new right to be extensively advocated.

In addition to providing greater support for carers we also need to find a mechanism to ensure that government the needs of older people are kept to the fore and treated in a comprehensive and coherent manner.
In Wales the decision has been taken to appoint a Commissioner for Older people. We should do the same in England. Their role would be to oversee provision for older people, would speak on their behalf and be their champion. I would also propose that the Commission should be under a duty to present an annual report to Parliament.
Such a publication would guarantee a focus on the needs and demands of older people.
The government can be proud of its record in lifting pensioners out of poverty.
The level of pensioner poverty that existed when Labour came to office in 1997 was nothing short of a national scandal. We need to build on the good progress made in this area. The government has established a clear timetable for the eradication of child poverty. There is a strong case that can be made for a similar poverty reduction target to be put in place for pensioners.
There is one final specific proposal that I want to make today. Parliament has legislated to create a single equality body to replace the Equal Opportunities Commission, the Commission for Racial Equality and the Disability Rights Commission.
The Commission for Equality and Human Rights is in the process of being set up and we expect an announcement about who will chair this new body in the very near future.
Now from October it will be unlawful for discriminate against someone on the grounds of age in fields of employment and vocational training. This means that older people will come within the remit of the new equality body.
It is crucial that they recognise the importance of their work in this area and make it a priority. Giving one of the individual Commissioners lead responsibility for older people would be a demonstration that the needs to older people are being taken seriously.
Today I have sought to set out a range of proposals that could form the basis of a new offer that can be made to older people.
In doing so I am acutely aware that there will be a range of issues, also of importance, that in the time available to me I have not been able to address.
The important point is that we use the period ahead to debate the priorities and identify the way forward for older people.
Our population is ageing. There can be no doubt that this will present significant challenges for politicians and population as a whole. Important decision will nee to be taken in the next few months. We cannot ignore the difficult issues involved but need to respond in a positive way to ensure that older people can be active, independent and secure.