The recent WRVS report “Gold Age Power List” asked what David Attenborough, Delia Smith, Michael Palin and a diverse range of other well known individuals have in common. Few would have said the fact that they are all over 66 years old. The perception of age is changing and “grey power” is beginning to come to the fore. As the number of those over 80 is set to double in the next two decades we can expect increasing pressure from a generation of older people that are not content to put up with poor quality care services. This is going to make the job of figuring out how to pay for more and better services for an aging population even harder.
In the aftermath of the Southern Cross experience the cost of provision by the private sector is set to be increased by the need for bonds to underwrite the continuity of service. The current regulatory frame work is about the quality of care as opposed to the financial viability of the provider. It has been suggested that care providers will need to be licensed by Monitor the NHS regulator.
The demographic time bomb is creating a rapidly increasing demand for services but the changing nature of what it means to be old is creating other demands for increases in quality and continuity of service. The report of the Dilnott Commission next week has a series of dilemmas to resolve that would challenge Job himself.
Southern Cross and Winterbourne View have changed the policy context for support and care in the United Kingdom. They pull out of the shadows an issue which any government, but particularly one attempting to implement public sector spending cuts, would have difficulty dealing with. Whilst the two events are superficially very different, one about a broken business model another about brutal assault, at bottom they both spell one thing, increased cost.
Over time the cost of care and support has been increasing and it has mainly been driven by quantum as more and more people need it. This quantum trajectory is set to continue for the long term. As society’s get wealthier they get healthier and certainly get cleverer at prolonging life. To date the pressures of quantum have been dealt with by reducing costs.
One strategy to achieve this has been the outsourcing of the provision of the service to the private sector. The theory being that productivity is better in the private sector. Some investment in IT has happened that can genuinely help to increase worker productivity however care and support is essentially a people service. The principle cost is staffing so to reduce cost you either have to reduce the number or the pay of the staff you employ. Both of these have been happening over recent years. The problem with this strategy however is that you start to impact the quality of the service or you get into financial difficulty.
This brings us to what is likely to become another significant driver of cost, a demand for better quality. Southern Cross and Winterburne View have started to raise questions about the level of quality that needs to be provided. Each successive generation of older people since the War has been one of increasing expectations. Now the baby boomers are starting to focus their minds on the issue of care in their old age. The days of the characterless lounge with the chairs around the walls have, in the main, gone. However, people of the generation of Mick Jagger are likely to far more demanding if they feel they can’t get no satisfaction.
Expectations are rising and the strength of the grey vote is increasing. Governments of all colours will struggle to square the circle on this. When the homes of older people are put at risk by “clever” financial engineering making some people multi millionaires; when people are cruelly assaulted in the very places they should be safe, ignored by under resourced regulators, the instant response of ministers is “something must be done!” Over the coming months what that something is going to be will start to become clear. Whatever it is it is likely to cost more money. The Dilnot Commission, which is due to report soon, will be read with a new sense of concern in the light of recent events.