Independence Daze – Why we must value prevention over cure to promote independence for our ageing population

IOOP_screen_itWith an ageing population in Wales and increasing strain on our public services, Nick Selwyn looks at how we public services can act on the lessons from the Wales Audit Office report and look again at the value we place on preventative services.

The period of austerity has seen unprecedented reductions in public spending. Councils, health bodies and their partners are struggling to make ends meet, address increasing demand for assistance, especially for health and social services, and have to continue to provide the help many of the most vulnerable in society rely on.

This situation is set to get worse. By 2035, the Office of National Statistics project that those aged 65 and over will account for 23 per cent of the total population, and the numbers of ‘the oldest old’ (over 85 years) are projected to grow faster than any other age. And with the Chancellor completing his next spending review in November 2015 there is a universal expectation that further cuts are on the way.

One significant implication of an ageing population is the challenge of promoting independence and preventing or delaying deterioration in the health and quality of life of older citizens. The ageing population and growing number of people with long-term chronic conditions is placing considerable strain on health and social care services and the current focus of Welsh Government policy is to seek to reduce this demand and shift services out of expensive acute hospitals and nursing homes and into the community.

Whilst health and social care are important, services such as education, leisure, housing, transport, community facilities and support to remain in employment all play an essential part in the wellbeing of older people. There are some services that are specifically focussed on independence and prevention of ill health, whilst others are services that are not provided with prevention as their specific aim, but are of great benefit to older people in maintaining their quality of life.

There are obvious benefits to allowing older people to live independently in their community: it may provide the best possible life for older people, they remain in their homes, close to their friends and families, they can continue to contribute to society and the impact on expensive health and social care services is minimised.

Our study on the how councils support older people to live independently shows that rather than supporting autonomy for older people, services are reducing and being withdrawn in many key areas. This highlights a risk that the Welsh public sector is not supporting the independence of older people and consequently not making the best use of public money.

For example, many of the preventative services that support older people to live independently have experienced cuts in their budgets and overall finances. Our research found that preventative services have experienced a 16.8 per cent cut with budgets falling from £147.3 million in 2013-14 to £122.5 million in 2014-15. We found that seven of the ten services rated as most important by older people and four of the top five services that support them to live independently have been reduced – community halls (-41 per cent), public toilets (-26.8 per cent), libraries (-18.7 per cent) and public transport (-5.7 per cent).

In addition, leadership on older people’s issues is not consistent or well embedded in councils and partner organisations are not always positive about the delivery of that leadership role. We found that there is a surfeit of often disconnected plans and strategies in councils that set priorities and actions aimed at maintaining or improving the independence of older people, but the contribution of low level preventative services in supporting delivery of this ambition is often overlooked.

We know the challenge councils face in having to reduce expenditure to balance budgets, but the effect of these cuts is going to impact adversely on older people and may prove to be a false economy for the taxpayer as cuts to preventative services can often result in more demand for more costly acute health and social services in the medium term.

In addition, older people make an enormous contribution as carers, workers, consumers, volunteers, taxpayers and as members of communities across Wales. This is often overlooked and they are too frequently treated as recipients of social care services and viewed as a “resource problem”.

This is why now, more than ever, we all need –  the government, public, private, and voluntary sectors and individuals – to work together to meet the challenges and maximise the opportunities our growing ageing population presents. After all we are all going to get old.

If you would like to find out more about the report ‘Supporting the Independence of Older People: Are Councils Doing Enough?’ the report can be downloaded from the
Wales Audit Office website.

Nick SelwynAbout the Author

Nick Selwyn is a Local Government Manager at the Wales Audit Office, with responsibilities for our programme of all-Wales studies. He has worked for the WAO for eight years in a variety of roles and is a Fellow of the Chartered Institute of Housing.

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