Adult social care needs reform - and the third sector
Older and vulnerable people at risk of becoming isolated from their community and its services can see improved provision.
This week the Older People’s Commissioner called for mandatory health inspection visits for people as they turn 75.
The Commissioner’s suggestion is sound, and would be a purposeful aspect of the sweeping changes required in adult social care. Whatever direction of change is taken, the third sector is going to find its own role growing in importance.
Health reform continues to splutter along, at best, but a key facet of any reconfiguration will be more prevention, with greater focus on the community and at home – and this means more, and more wide ranging, social care for older and vulnerable adults.
And that is just on a per capita basis; consider further the immense demographic changes Northern Ireland is undergoing and how this will compound that spike in demand.
Reconfiguration of services will allow the Department of Health to direct more support to domiciliary and other community healthcare but the sheer enormity of what is required means there will be plenty of gaps.
Private and non-profit organisations already comprise much of this sector in Northern Ireland, where it is run using statutory funds. Providers are extremely stretched but any growth in coverage (or towards a more realistic remuneration) would probably see a similar mix of for-profit and not-for-profit organisations delivering on commissions from central funds.
But the gaps in this web of provision will have to be filled by the third sector; by definition, we are talking about the places statutory support does not reach, and those most in need will not be able to pay private firms.
The solutions will need to be found in social innovation and enterprise.
COPNI’s recommendation for a visit to all people on or around their 75th birthday is something the statutory sector could well fulfil itself.
However, what comes afterwards? Such a visit should be a proper health check that leads to a suite of tailored recommendations for the individual in question. Identifying new health problems, structured management of any chronic issues, delivering proper nutrition, combating social isolation, ensuring access to services, and so on – there is a long check list that such a visit would need to handle.
Delivering all the necessary services after such a visit is something the state is unlikely to be able to do itself. It will need good partnerships with community and voluntary organisations.
COPNI made this call at the same time as it presented research to policy people at Stormont – the age-75 visit being one of the recommendations from their report.
Their paper Prepared to Care? Modernising Adult Social Care in Northern Ireland dates back to 2015 but is just as relevant today and is well worth a read. It looks at various issues with the current system, such as a lack of awareness about entitlements, to the fact that most people’s first contact with social care is at the point of crisis (i.e. the system, as it stands, is not preventative).
Eddie Lynch, Commissioner for Older People for Northern Ireland, said: "Adult Social Care enables thousands of older people to live independent lives within the community every year but many older people have told my office that the current system is too complex and it's unclear what help they are entitled to. Often older people's first interaction with these services is at the point of a crisis or sudden illness, leading to important decisions being made at short notice and with little information.
"Modernisation and reform of Adult Social Care legislation is urgently needed in Northern Ireland if we are to better support the changing needs of an ageing population. The introduction of a preventative support visit for everyone upon turning 75 would help older people to have more choice and control. They would be able to influence the type of help and support that would assist them to continue living independently in the community, rather than making life changing decisions at a point of urgency. Additionally, a support visit would assist Government with future planning as they could better predict the levels of social care and support that would be required by older people over the next number of years."
The idea that many older people already find the system too complex is a warning sign for future provision. Given that the high-level strategic aims are for a significant expansion of services, it is natural to worry that this may only get worse.
Simplification must to be built into health reform at the same time as producing a system that is tailored to the needs of individuals. This is not an easy thing to do.
The third sector already provides plenty of examples of how social innovation can and does make a huge difference to the lives of older and vulnerable people who are at risk of isolation, both in terms of social interactions and also access to services.
The health trusts have squeezed domiciliary care rates so that provision has been pared back to the barest essentials – such as a sub-15-minute call out which maybe sees the delivery of a meal, and that’s about it.
Calling this “essential” is a bit of a misnomer downgrading, as it does, vital considerations such as loneliness and isolation.
Thankfully, charities and community and voluntary organisations are pushing back against concerns in many different ways.
Age NI is one of the largest and most prominent support organisations for older people in Northern Ireland and they both improve communications and access through their 11 age-sector networks as well as delivering a large care service themselves.
On a more local level, groups are using people within communities to provide support and companionship to older and vulnerable people.
Examples include CLARE-CIC, which is looking to roll out beyond North Belfast with its model that boosts local employability at the same time as working against isolation, and Engage With Age, which is a network of organisations in South and East Belfast and Castelreagh aiming to maximise older people’s participation in local communities.
The third sector is already doing great work. It will almost certainly have to do more.
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