Fundamental flaws in Dilnot – recommendations demand an alternative for funding better care and health for our ageing population

Citation

(2013), "Fundamental flaws in Dilnot – recommendations demand an alternative for funding better care and health for our ageing population", Quality in Ageing and Older Adults, Vol. 14 No. 1. https://doi.org/10.1108/qaoa.2013.55914aaa.008

Fundamental flaws in Dilnot – recommendations demand an alternative for funding better care and health for our ageing population

Article Type: News and events From: Quality in Ageing and Older Adults, Volume 14, Issue 1

The Dilnot proposals for reforming care funding are so flawed that the government should look at alternatives to fund better care for our ageing population, according to a paper published by social enterprise United for All Ages. The coalition government appears to have stalled on reforming care funding following resistance from the Treasury.

The “Ten Dilnot Flaws” paper calls for a national health and care system funded by taxation. Integrating health and care would deliver better care for older and disabled people, while saving resources by using more appropriate care in or near the home rather than expensive hospital or residential care. A new health and care system could be funded from these savings; by diverting spending from other areas; by taxing universal benefits for older people; or by a new care duty on estates of wealthier older people.

Ten Dilnot Flaws warns against the country “sleep-walking” into accepting Dilnot for lack of an alternative, despite multiple problems with its recommendations. Dilnot:

1. 1.

   …makes the current complex care system even more complicated.

2. 2.

   …care cap is a misnomer – costs would be higher for many people.

3. 3.

   …does not bring much extra cash into the care system.

4. 4.

   …would not meet current unmet needs let alone growing demands in the future.

5. 5.

   …would create a new financial industry with millions more insurance transactions.

6. 6.

   …does not promote prevention.

7. 7.

   …does not promote integration of care and health.

8. 8.

   …is about protecting the assets of wealthier families.

9. 9.

   …doesn’t explain how its reforms should be paid for.

10. 10.

    …is bad enough; a voluntary Dilnot-lite reform would be even worse.

The paper suggests some immediate steps to address the care crisis. These include raising the assets threshold for paying for care to £250,000; introducing universal deferred payments; making specialist financial advice easy to access; and extra support for carers.

Stephen Burke, director of United for All Ages and the Good Care Guide, said: “It shouldn’t be surprising that the coalition government has not committed funding to implement the Dilnot recommendations given that they are fundamentally flawed. Why would the Treasury in austere times agree to protect wealthier families’ inheritances when we need more funding for growing unmet care needs?”

For a copy of Ten Dilnot Flaws – time for an alternative for funding better care, visit web site: www.unitedforallages.com

Sheltered and retirement housing

The Age UK report “Making it Work for Us” (PDF 1094 KB) gives a residents’ perspective on sheltered and retirement housing. Age UK set up a panel of residents, from both the social and private sectors, to review a wide range of issues affecting residents. Recommendations include:

• •

  There should be a comprehensive policy review of future models and funding of sheltered and retirement housing.

• •

  More must be done to promote the benefits of retirement housing to future generations, by offering well-designed and affordable housing options.

• •

  Policy-makers and planners should facilitate the provision of additional retirement housing, to meet the growing need for this type of accommodation.

• •

  Residents need much greater transparency in the delivery of retirement housing and associated services, to prevent them being exploited and to protect their rights.

• •

  Residents need a more robust regulatory framework in the private leasehold sector, to ensure fair and honest competition between providers.

• •

  Older people need greater equality of rights between those living in the social and leasehold sectors, especially on the issue of consultation.

• •

  More support should be given to initiatives that give residents greater control over their housing, such as the “Right to Manage”, co-operative and co-housing solutions.

• •

  Scheme managers are an essential feature of sheltered housing and panel members believe they need to be retained, to promote the health and safety of residents.

Providers must make it easier for older people to obtain accurate and reliable housing advice, so that they can make informed decisions about their housing.

New films highlight the ability of people with dementia to influence attitudes, services and policies affecting their lives

The Mental Health Foundation launched two films showing people with a dementia diagnosis who are involved in activities and groups aimed at influencing the attitudes, services and policies that affect their lives.

The films come at the end of the first year of the Dementia Engagement & Empowerment Project (DEEP). The project aims to support the collective voice of people with dementia and to begin developing a UK-wide network of initiatives and groups of people with dementia. These groups are already involved in campaigning, media work, training and advising on policies and the DEEP project aims to support and promote this work by empowering people with dementia to share their experiences, ideas and resources, and support one another.

DEEP has been led by the Mental Health Foundation, with support from Innovations in Dementia (who will be leading the next phase) and the Alzheimer’s Society, and is funded by the Joseph Rowntree Foundation. It investigates the ways that people with dementia are currently engaged with groups and activities that influence attitudes, policy and services and will explore how they would like these initiatives to operate in the future.

The Mental Health Foundation is a UK-wide charity that carries out research, campaigns for better mental health services: www.mentalhealth.org.uk

Innovations in Dementia (Community Interest Company) is a national organisation that tests opportunities that enable people with dementia to live life to the fullest, promoting a more positive view of dementia.

For further details visit web site:www.innovationsindementia.org.uk

Achieving age equality

The Access all Ages? Report by the Royal College of Surgeons on the challenges older people and their families face in accessing surgery on the grounds of age only serves to further highlight the inherent age discrimination that persists in the NHS. Given that older people are the its largest “user group”, it is hoped that this report will provide a wake-up call and encourage all public bodies to look at ways in which they can ensure that both treatment and support can be both accessed and shaped by the people that wish to participate in them. The October 1 ban on age discrimination in goods and services as part of the Equality Act 2010 means that the NHS and others are obliged to review and change the way that they work with older people. An evidence based online toolkit developed by NDTi with the Department of Health and the Social Care Institute for Excellence, “Achieving Age Equality”, is available to help local authorities and NHS organisations work together to audit their services and target resources on banning age discrimination in health and social care and ensuring that people of all ages can access the treatment and subsequent support that they need.

The Achieving Age Equality toolkit can be found at: http://age-equality.southwest.nhs.uk/

The Access all Ages? Report by the RCS can be found at: www.rcseng.ac.uk/publications/docs/access-all-ages

Culture shift needed to improve the hospital care for elderly people with mental health problems

A new report by The University of Nottingham says there has to be nothing less than a culture shift to improve the hospital care of older people admitted with delirium and dementia. Failure to do so, the report says, will lead to poor outcomes and negative experiences of hospital care for patients and carers, delivered by a de-motivated workforce with inadequate skills for the job.

The report entitled: Better Mental Health: Care for Older People with Cognitive Impairment in General Hospitals was commissioned by the National Institute for Health Research Health Service and Delivery Research (NIHR HS&DR) Programme.

John Gladman, Professor of the Medicine of Older People, said: “Providing care for older people with cognitive impairment is complex, difficult, time consuming and emotionally draining. Staff need to be trained appropriately and wards resourced accordingly. A cultural shift is necessary to recognise that care of older people with mental health problems is core business of general hospitals. Understanding what the patients, their carers and the staff experience is helpful. Concerted efforts are required to interrupt what may become a vicious spiral of poor care and instead provide a virtuous cycle of high quality patient-centred care, with well-trained staff, good communication, an adapted environment and a proactive organisation at its core”.

In a typical 500 bed general hospital 330 beds will be occupied by older people. Half of these older people have confusion: up to 40 per cent have dementia, nearly 30 per cent have delirium and about 20 per cent have both.

More information is available from Professor John Gladman, at The University of Nottingham, on john.gladman@nottingham.ac.uk; Tel.: +44 (0)115 823 0239.