Conference: The Welfare State and Long Term Care in Europe


I recently spoke at a conference held in the European Parliament addressing the challenges of long term care in Europe.

The event was organised by Mr Pier Antonio Panzeri, S&D MEP from Italy and featured a number of experts and MEPs of different countries debating about the issue.  You can find the programme of the event here.

The debate was intended to compare LTC systems in 4 different EU countries (Italy, UK, France and Germany) and discuss the best way forward to support inclusive growth and ensure decent living for people of all ages.  Please see my contribution to the debate below:

Life Expectancy

Although the the whole debate around age and long term care  has been taking place since after World War 2, it has recently become a topic of increased focus and interest .

In today’s world, people are living longer than ever before.  Whilst 100 years ago, people were lucky if they lived up to 50 years of age, the average life expectancy today is about 76 for men and 81 for women.

According to the Office of National Statistics, 1/3 of babies born in the UK will live for over 100 years.  Soon, being a centenarian will not be unique.

The main change came in the 20th Century when world life expectancy rose substantially from about 30 years of age in 1900 to about 62 years of age in 1985.

This significant demographic shift is one of humanity’s greatest achievements which can be put down to a number of things:

The first is better food Supply and Nutrition:  With the advance of technology and general overall wealth, we now have both widespread availability and access to a much higher quality and diversity of foods.

Then there are improvements in medicine. The advent of vaccinations and antibiotics has drastically reduced the number of childhood deaths and improved diagnostics means that disease can be identified and treated earlier on.  Surgical procedures have also advanced enormously so that they are now much safer and more effective.

Public health has drastically improved such that we now have better sanitation and significantly improved health and safety conditions at work.

And general public awareness has increased so that people are now far more conscious of health factors such as diet and lifestyle.  Nutritional information is also more widely available for example labelling on food packages which allow us to evaluate how balanced our diets are.

The Challenge

This may all be fantastic news and an ageing population brings a number of benefits and opportunities, particularly for economic growth in the form of new markets for goods, services and knowledge. But it also has its risks and challenges.

The greatest social risk that has posed a significant challenge is the increase in the numbers of care-dependent people .

The increase in life expectancy, coupled with reduced rates of fertility and people generally having fewer children has resulted in a squeeze in the younger strata of society and a significant expansion of older people..

The UK is now carrying out a 3 year review of the population and it is predicted that in about 10 – 15 years, half of the population will be over 50 years of age.

Bear in mind that a longer life does not necessarily mean a healthier life either – just recently, on World Cancer Day, it was announced that 1 in 2 people will contract cancer at some point in their lives.

Processed foods, sugary diets, the prevalence of chemicals in our foods and in the air and a general lack of exercise means that our bodies are ever more prone to disease and illness.

The increased stresses of today’s fast pace life have also taken their toll – the ‘Rush Hour’ effect, meaning that people are always on the go and hardly have a chance to rest, has in itself contributed to a number of debilitating diseases – heart disease being amongst the foremost.

Social structures have also significantly changed which means that more and more older people are living without relatives, whether it be because relatives have moved out, or because of break ups, or because relatives have died or simply because they don’t have children.   According to a BBC report, 53% of older people in the UK will live alone.

All of this has led to more and more people in need of formal support and care and the increased demands this has posed on the public expenditure has been quite heavy, such that many authorities are struggling to provide quality long term care.

The Situation So Far

Out of 2 million older people living in England with care-related needs, approximately 50%  receive no formal support from the public or private sector.

Due to a serious lack of funding, the care system has gone from bad to worse despite the dedication, professionalism and innovation of thousands of people working in social care.

In the 6 years before the financial crisis, public spending on LTC went up by only 0.1% per year whilst the number of people aged 85 or over increased by 23%.

Couple this with the fact that further spending cuts are now projected to reduce spending by millions of pounds.

The huge pressures this has placed on the publicly supported LTC system has resulted in a number of measures intended  to drive down costs such as tighter eligibility requirements, a rigid means-testing, inadequate help for people living in their own homes, under-funded care homes, discrepancies in support levels across the country and more.

Due to tougher eligibility requirements, there has been a significant decline in the number of older people receiving local authority funded care at home -A report last year from the Nuffield Trust and Health Foundation revealed that approximately 250,000 fewer individuals aged 65 or over were getting free social care in the community in 2012/13 compared with  in 2009/10 – a fall of 26%.

For those that are deemed eligible, support is still inadequate to maintain a good quality of life.  Normally only the most essential services are provided, e.g. help getting out of bed, wash and eating a meal.  Home visits frequently only last a short time and wider support services are generally unavailable such as domestic cleaning, help with tasks at home and the chance to go out to socialise.

In fact, A recent report by BBC 5 Live Investigates suggested that one in five care homes for older people in England fail to meet set national standards for safety and care

The report found cases of residents being washed in cold water or left with scabies. Homes were found dirty, unhygienic and smelling of urine. There were cases where the wrong drugs were being given out and residents were cared for by poorly trained staff and whose criminal records had not been checked.

The report showed a concern that the poor standards in residential homes were linked to the ‘auctioning’ of care services.  Around a dozen councils were found to use a web-based commissioning system which invites care homes to bid to provide an individual’s care package

Jane Vass, Head of Public Policy of the Charity, Age UK, stated that: ‘It’s one thing for them to be, for example buying computer supplies, quite another when they are organising the future living arrangements for a frail older person. “No one would want their ageing mum or dad to be ‘auctioned’.

Another problem is that public sector Commissioners  are forced to under-pay for older people’s care homes due to funding reductions.  Numerous stories are told of fees being frozen or even cut despite the fact that public sector costs continue to rise.  Residents are significantly affected by putting quality service at risk as operators seek to cut costs or by demanding residents pay ‘top up’ fees, a severe injustice.  It also puts older people at risk of losing their homes if operators go out of business.

Much of this has led to significant discrepancies in local quantity and quality of care. Tower Hamlets, for example, the highest spending local authority in the UK, spends five times as much on LTC as Cornwall, the lowest spending.

On top of this, an independent review found that younger service users are allocated more than older users.

Lower income groups have been hit hardest by all of this but higher income groups have also been affected. There is a rigorous means –test for eligibility which means that people with higher incomes often have to pay substantial fees for care.  In 2012, many councils increased charges or abolished maximum caps leaving many people who received large amounts of care facing huge increases in costs.

The result is a lottery: some people never need to use care services and pay nothing, whilst others lose almost all their entire life saving. And in between, too many people are put off using support they clearly need.

All this, whilst most councils are making genuine efforts to transform the services they deliver.  For years, local authorities have been taking steps to reduce the number of people living in care homes by providing better support for those living in their own homes.

But with insufficient funding, results have been patchy, with many authorities simply lacking the funds they need to provide adequate services.

Principles for Reform

Ultimately, we need a new ‘architecture’ to transform the care system.  A new arcitechture that firstly guarantees the quality and quantity of care for low income older people as a high priority. People who can’t pay for care by themselves should become eligible for support earlier on and services should provide a good quality of life.

It should also provide a non-means tested entitlement for everyone with care needs regardless of income.  This would help to reduce extreme costs for those with the highest needs.

It should bring an end to the current post-code lottery  through a national legal entitlement to support and information and assessment services should be funded so that they are available to everyone.

It should end the age discrimination in provision of care and support so that there is complete age equality and it should supports rather than penalise families and carers.  A reformed system should be carer-neutral such that those who want to provide informal care should be supported to do so through benefits and services.

The new architecture should be in alignment with the NHS and other local government services such as housing support

And it should provide a flexible system of care that promotes diversity of types of services available and gives users greater choice and control.  This should include neutrality between those that opt for cash payments or commissioned services and the different types of tenure– whichever is more appropriate.

Some Approaches:

Responses to the dilemma have been varied.

A National Care Service

One is to replace the National Health Service with a ‘A National Care Service’, something the UK’s Shadow Minister Andy Burnham is calling for.

A National Care Service would provide a wholistic approach to health by integrating social care needs and more in the public health service.

An incoming Labour Government would ask hospitals and other NHS institutions to evolve into integrated care organisations, working from home to hospital to cater for  physical, mental and social care needs.

People caring for others would be recognised and  would get “carer’s breaks”, the right to an annual health check and help with hospital car parking charges.

As Andy Burnham said ‘Bringing social care in to the NHS wouldn’t add to the financial burden. It would be the key to unlocking the money.”

A National Care Service would end the “shameful scenes” of older people being mistreated in care homes and would prevent privately run homes to “make profits off the backs of the most vulnerable.” Labour would also ensure that private health providers contribute a fair share towards the cost of training.

Age Friendly Cities

Another approach has been to create something called ‘Age Friendly Cities’, a policy response led by the World Health Organisation.

The idea is to get cities to adapt their structures and services to be more accessible and inclusive of older people and their varying needs so that people of all ages can actively participate in community activities and so that everyone is treated with respect, regardless of their age.

Older people would be able to stay better connected to people that are important to them, would be able to stay healthy and active even at the oldest ages, and would be given the appropriate support if they can no longer look after themselves.

I am proud to say that my City, Manchester, is a founding city of this work and is well respected internationally for its progress on this front.

EU Policy

Age Platform, the EU wide NGO on ageing, is also working towards an EU declaration on population ageing.  Representing over 40 million older people in Europe their work focuses on a range of policy areas that impact older people such as anti-discrimination, social protection, pension reforms, engaging older people in economic recovery, ensuring access to quality long term care and more in the hope of finding long term solutions.

Alternative Models

There are also a number of interesting Models for long term living such as naturally occurring retirement communities (NORC) and Co-housing, which is popular in Scandanvia. In the Asian- Muslim community, a more integrated family system means that elderly people are generally looked after by quite a large family until they die.

I would like to thank Paul McGarry, Senior Strategy Manage of the Age-Friendly Manchester Team at Manchester City Council for his advice and council.