Remember ME - You Me and Dementia

February 14, 2012

UK: We need a commissioner for old people

LONDON, England / The Guardian / Culture / February 14, 2012

Comment is free
Older people need a sympathetic individual to speak up for them, and help them navigate the complexities of social care

By Joan Bakewell
 A commissioner for older people 'would ideally have a background in caring, and be
conspicuously on the side of the old.' Photograph: Siewert Falko/Corbis
I am proposing an amendment to the health and social care bill this week in the House of Lords calling for the appointment of a commissioner for older people. I am increasingly convinced we need a commissioner as story after story recounts failure to offer care for the helpless old.
Every day, headlines tell of new disasters. Most recently, as a result of a high court ruling, it has emerged that a care home in Sefton, Merseyside has been spending as little as £2.27 a day on food for its elderly residents. Council spending across the UK is being massively cut and the danger is that the true cost of care for needy older people is not being met.
Ros Altmann, director general of the over-50s group Saga, calls it a "national disgrace". Other voices are expressing increasing concern from many directions. On Monday, the archbishop of Canterbury convened a meeting at Lambeth Palace to consider the plight of the old. Meanwhile, we still await a government white paper in response to the Dilnot recommendations for a cap on what individuals should have to pay. The whole field of social care is confused and confusing.
The story is not a new one. In November the Patients Association called on the NHS to take action to improve quality of care for the elderly, and last month Age UK launched its campaign, Care in Crisis. The crisis has been a long time coming and should take no one by surprise. The statistics of our ageing population are all too familiar: 10 million people in Britain aged 65 and over; by 2034, 3.5 million of them will be over 85. Older people are by far the heaviest users of the NHS, and it comes as a huge shock when they realise that social care – such as provision for daily needs such as washing and dressing – does not come free.
Social care was never within the NHS. When someone is discharged from hospital and well enough to live at home or in a care home, the provision of their care passes from the (free) NHS to a system of payment, from the person's own savings, the sale of their home, or, for those with few resources, by local councils. Councils are cutting their support systems and increasingly providing carers only for the very needy. Those same carers have increasingly heavy caseloads, too little training, low pay and low status. Consequently there's a heavy turnover and often inadequate care.
We simple can't go on like this. That is why I proposed a commissioner for older people – a single, sympathetic individual to speak up directly for the old themselves. This person would ideally have a background in caring, and be conspicuously on the side of the old, speaking up "for us" to those with the power and money to do something to improve the situation for millions of older people.
This is not a new idea: in 2006 the Welsh assembly appointed a brisk and effective commissioner in Ruth Marks. She has already had 12 recommendations on dignity and respect accepted by the NHS in Wales, and is currently setting up advocacy arrangements in care homes. Similarly, the Northern Ireland assembly has an advocate for older people, Dame Joan Harbison. Each of the four nations has a children's commission to stand up for the rights of children. The pressure is growing for the old to be as well-served as the young.
I know from my personal experience just how important this would work be. During the last 18 months of the Labour government I acted as avoice for older people – a part-time, voluntary post that in an instant revealed the scale of the need. I was deluged with calls and correspondence, many appeals of the most poignant nature, expressing every kind of suffering – distress, neglect, depression, physical pain, and often rage at the sheer helplessness and dependency of being old. I did what I could to publicise the problems, but it was not enough. This calls for a full-time professional in the job – and, no, that isn't me.
The legislation now going through parliament aims to smooth out the clumsy relationship between health and social care. The new commissioner would be part of the system set up to monitor that change and keep the plans on course. That's why the time is right; the time is now.
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