More, Different and Better

On 4 July the independent review of the funding of social care, chaired by Andrew Dilnott, published its report. It reported that current arrangements for paying for social care (both for people in later life and younger disabled people) are confusing, unfair and not understood. It points out that there s no way of predicting whether an individual is likely to need social care or not, and for how long. For one in ten the costs will exceed £100,000, while a quarter will incur no costs at all. Under the current system some will lose 90% of their assets.

The report proposes a complete overhaul of the system, based on a Government guarantee of support for care (residential or domiciliary) once an individual has contributed a threshold payment of between £25,000 and £50,000. It also proposes that the threshold for refusing means tested benefits should be raised from the current £23,250 to £100,000. These changes would remove the current uncertainty, anxiety and distress, where people do not know what support they can expect, and will receive different decisions in different places. The cost to the public purse would be around £2B (which represents an increase in Government spending of less than 0.3% and compares with the current cost of all social care and disability benefits of £27B).

As an organisation committed to social equity and wellbeing, NIACE welcomes the report, and hopes that, unlike previous attempts at reform, it will be implemented.  The uncertainty and unpredictability of the current system is a cause of great distress and anxiety to older people. However, NIACE’s concerns are with the implications for the education of adults, which are smaller in financial terms, but significant in the quality of later life.

There are four ways in which education can help:

- by enabling individuals to stay longer in their own homes;
- by improving the quality of life (and the cost) for those who are in residential care;
- by helping the army of voluntary carers to play their part more effectively,  and with less stress; and
- by helping people to anticipate and prepare for the final phase of life, particularly, though not only, as part of pre-retirement education programmes (although the time gap between retirement and needing residential care can be, for some, twenty or thirty years).

Staying in one’s own home

Most people prefer to stay in their own homes as long as possible, and most want to die there. Domiciliary care is usually a cheaper option, but often becomes impossible, for practical, though sometimes avoidable reasons. Education about how to manage and avoid risks in the home, to manage health conditions and to maintain self sufficiency, can all make a significant difference. Teaching cookery to a man who has lost the wife who did the cooking for all his married life can make him more independent and better nourished for years, at a trivial cost compared to the costs of residential care. Physical education of various kinds can maintain strength and resilience, reducing the chances of falls – a major source of expenditure for the Health Service and a major cause of moving to residential care.

Improving life in care

For understandable operational reasons, the first priority of residential homes is the physical welfare of residents. Despite the commitment of staff, this can often leave little time or resource to consider quality of life. As a result, many people who enter care mentally active, but with a physical need, deteriorate quickly. This is a moral challenge to society, but projects which introduced adult education classes into homes have produced a very significant reduction in the costs of medication and incontinence aids, as people find a new sense of structure and purpose to their lives.

Improving the life of carers

Very large numbers of people take on caring responsibilities for one or more older relatives at some stage. Sometimes this lasts for many years and it sometimes combines with parallel caring responsibilities for grandchildren. Although this may be undertaken willingly, it can be very stressful, for the carer and their family. Relatively little support is available to assist such carers in their role and Dilnott recognises the need to provide education for carers, both to help them cope with stress and the demands of particular kinds of dependency, but also to maintain a broader range of interests outside the home, including maintaining skills against the day when the caring responsibilities end (as they inevitably do).

Preparing for the future

Managing the finances of retirement faces most people with new challenges, whether they are living primarily on the State Pension or large occupational pensions.  For many this is the first time they have had to manage such large funds, and many lack understanding and relevant numeracy skills. Although pre-retirement education has existed for decades, it is still only accessible to a minority of people, mainly in professional and managerial jobs and in large organisations. As a result, many people make unwise, but irrevocable, decisions about their lives and finances. There is a strong case for expanding pre-retirement education to a much larger population.

Four proposals for action

Although NIACE recognises that educational issues are on the margins of the debate about the future of social care, the social and financial benefits of investing in education for older people are out of all proportion to the very small sums involved. NIACE therefore recommends:

1. Funding. The role of educational activities in reducing costs and raising the quality of life of older people should be factored into the design of any future system for funding care. The costs are tiny by comparison with the costs of more intensive care and the benefits disproportionately high.

2. Partnership. One barrier to more creative policy is the institutional boundaries and funding systems. The Partnerships for Older People Programme dramatically demonstrated the savings which could be achieved by pooling resources between health and local government. We hope these lessons can be built on and that education providers (formal and informal) can be built into such partnerships.

3. Education for carers. The Dilnott report recognises the educational need of carers, both to improve their ability to undertake the caring role and to maintain an independent life in the outside world. NIACE recommends that education providers and funders should recognise both these needs and that a ‘carers entitlement’, perhaps in the form of fee concessions for adult education, should be available to carers.

4. Pre-retirement education. Some of the risks and costs of social care in later life can be reduced if people are well prepared, informed about choices, and provided with the tools to manage health and lifestyle.  Employers should be encouraged to support pre-retirement education for their employees, and education providers should be encouraged to expand provision.