Elderly

UK health inequalities made worse by Covid crisis, study suggests

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I am not surprised by this story. The concentration on the elderly as a key component of those most disadvantaged should maintain our focus on rural England as a series of places disproportionately challenged by the impact of the pandemic. It tells us:

The coronavirus crisis has disrupted routine healthcare disproportionately across society with women, older people and minority ethnic groups most likely to report cancelled or delayed appointments, prescriptions and procedures, researchers say.

Public health experts trawled through data from nearly 70,000 people enrolled in 12 major UK studies that surveyed the population before and during the epidemic. They found evidence for widespread inequalities, with disadvantaged groups often facing the greatest disruption to their medical care.

“Many of the people who report experiencing the greatest healthcare disruption often had poorer health prior to the pandemic,” said Vittal Katikireddi, a senior author on the study and a professor of public health at the University of Glasgow. “While experiencing healthcare disruption is common across all social groups, our study raises the possibility that the health of the most disadvantaged in society might actually be more impacted by the disruption to the health system.”

Elderly vital to revival of towns

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Does this article represent an increasingly new approach to the future of our smaller rural towns?

“Ageist and insulting” was the verdict of one resident when Elmbridge Borough Council in Surrey turned down a 220-home retirement village proposal last autumn.

But elsewhere, new partnerships are being formed between local groups and a new breed of more socially conscious developer set on building communities for older people that support positive ageing and reanimate the towns and neighbourhoods they call home. A confluence of factors means these partnerships are very likely, in the next decade, to draw billions of pounds of baby-boomer and pension fund money into towns and cities.

The first driving factor is growing concern about the future of towns. Council leaders are concerned that the damage to retail from online shopping and Covid is irreversible. Plus no one knows by how much town-centre office space will shrink.

Local politicians understand the vital role of town centres as social hubs and meeting places at the centre of how society functions. So, they are urgently looking to attract investment and find a sustainable future for the burgeoning stock of empty commercial space.

At the same time, major investors are looking for ways to have a greater social impact. For some, such as AXA Real Estate-owned Retirement Villages Group, the idea of investing patient capital or pension fund money to build high-quality housing for older people, while contributing to the post-Covid renewal of towns and cities, is exciting.

Last, but not least, is the demand factor. Baby boomers have more wealth than any previous generation of over-65s, a greater desire to stay connected, and a preference to be closer to town centres and play an active role in communities.

England’s ‘fragile’ care sector needs immediate reform, says regulator

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We’ve known for a long time that social care is a badly dysfunctional area of policy, one which impacts disproportionately in rural areas with a higher proportion of rural dwellers. This article charts the corrosive impact on coronavirus on it, telling us:

The government must immediately deliver a new deal for social care with major investment and better terms for workers, the Care Quality Commission has said, as it warned that the sector is “fragile” heading into a second wave of coronavirus infections.

In a challenge to ministers, the regulator’s chief executive, Ian Trenholm, said overdue reform of the care sector “needs to happen now – not at some point in the future”.

Boris Johnson said in his first speech as prime minister, in July 2019: “We will fix the crisis in social care once and for all.” But no reform has yet been proposed, and more than 15,000 people have died from Covid-19 in England’s care homes.

Trenholm said Covid risked turning inequalities in England’s health services from “faultlines into chasms” as the CQC published its annual State of Care report on hospitals, GPs and care services.

The report reveals serious problems with mental health, maternity services and emergency care before the pandemic, and says these areas must not be allowed to fall further behind.

In routine inspections carried out before March, 41% of maternity services were found to require improvement for safety – for example, because a baby’s heart rate was being monitored in labour by staff who lacked training.

More than half of urgent and emergency care services were also rated as requiring improvement or inadequate. Thirteen per cent of wards for people with learning disabilities and/or autism were rated inadequate, a sharp increase from 4% the previous year.

Half a million over-75s with dementia will have to pay for TV licences – study

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This is bad news in rural England, where we have both a higher proportion of old people than the national average and where social isolation often contributes to loneliness. This story tells us:

More than half a million older people with dementia could be forced to pay for their TV licences from next year, according to research commissioned by Labour, findings the party said were “a national scandal”.

Tom Watson, the shadow culture secretary, who has pushed for the government to maintain funding for free TV licences for those aged 75 or over, said the process of applying for a licence could be particularly difficult for those with dementia.

The Alzheimer’s Society called for more work to communicate the changes, saying television could be “a lifeline” for isolated older people.

The free licences were introduced by Labour in 1999, with the cost funded by government. In 2015, the Conservatives said they would phase this out by 2020, and that the BBC should take on the financial burden of £745m a year.

But the corporation argued this sum, a fifth of its annual budget, would require wholesale channel closures to reduce costs. Instead, from next June, it will make all those aged 75 or over pay the £154.50 annual fee, apart from those who can show they claim the means-tested pension credit.

Research commissioned by Labour from the House of Commons library estimated that more than 552,000 older people with dementia could thus lose their free TV licences, including more than 140,000 aged 90 or over.

The total of those living with dementia affected by the change was reached by combining official population estimates with the prevalence of dementia by age group, reaching a total of 682,000. Of these, 19% on average received pension credit and are thus still eligible for a free licence.

84% of care home beds in England owned by private firms

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Very thought provoking article in relation to an issue of great significance for rural settings. It tells us:

More than eight out of 10 care home beds are provided by profit-driven companies, including more than 50,000 by large operators owned by private equity firms, research reveals.

Private companies now own and run 84% of beds in care homes in England used by older people, as local councils have almost totally withdrawn from a key area of social care they used to dominate.

The disclosure of the private sector’s huge market share has raised concerns because some of the biggest operators have large debts, are alleged to use tax avoidance schemes and drive down staff pay. The Care Quality Commission (CQC) watchdog has said inadequate staffing levels at care homes can lead to elderly residents receiving poor-quality care.

For-profit companies own 381,524 (83.6%) of England’s 456,545 care home beds, research by the IPPR thinktank (in partnership with Future Care Capital) has found, based on analysis of data from the CQC and Companies House, an increase on the 82% in 2015.

“The state has abdicated its responsibility for providing care over recent decades. The private sector may have filled this gap but it consistently puts profits before people,” said Harry Quilter-Pinner, a senior research fellow at the IPPR and co-author of the report.

Councils in country have far less to spend on elderly than those in cities

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Anecdotally I thought this was the case but this article demonstrates the funding bias against rural settings in the way local government is funded. It tells us:

Councils in rural areas like Dorset have five times less than to spend on care of the elderly than those in cities, new analysis reveals. 

The study by the Salvation Army warns that areas with lower house prices are unable to properly fund social care, because they cannot raise enough from council tax and business rates. 

Experts said the findings were evidence of a “dementia lottery” which meant the chance of receiving help were a matter of geography. 

The analysis suggests that typically councils in Dorset would have around £5,762 a head to spend on elderly care – while those in Lambeth in London could have more than £31,000 at their disposal. 

Leicestershire, Derbyshire, Somerset, East Sussex, Staffordshire, Lincolnshire and North Yorkshire were among other areas with the most limited resources, according to the analysis. All the councils which fared best were in London. 

The trends also show an increasing gulf, with  “spending power” in rural councils falling, while it is rising in urban areas. 

The organisation said it was now having to subsidise places in its own care homes, to the tune of an average £302 per person were week. 

Lieut-Colonel Dean Pallant, of The Salvation Army, said: “Rural local authorities have been set up to fail with this flawed formula and it urgently needs revision. 

“People are living longer and the population is ageing, the adult social care bill is rising but the local authority funding streams aren’t enough to cover the demand, especially in areas where there are not many businesses or people to tax.”

“The Government must prioritise its spending and properly fund adult social care.”

Personal care should be free for over-65s, says thinktank

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I think this is a really interesting proposal. Many people who have made provision for their old age, many in rural areas, feel very challenged by the need for their modest savings to disproportionately support the cost of their care, just because they fall the wrong side of what can be seen to be an arbitrary line. This would address that challenge to a degree at least. Putting the cost of such an innovation on National Insurance however would have the unintended consequence of disincentivising small rural businesses to employ people. In this case, as with a number of others I am led to ponder why never raising income tax (which is the other option posited here) should be such a sacred cow? 

Older people should receive free help to eat, wash and get dressed in a move which would improve their health but need to be funded by a 2p tax rise, a thinktank has said.

The proposal, by the left-of-centre Institute for Public Policy Research (IPPR), highlights the growing political consensus that personal care should become free for over-65s. If implemented, it would bring England into line with Scotland, where such care has been free since 2002.

The IPPR argues that the key principle underlying access to the NHS – free care at the point of need – should be extended to this element of social care services in England.

Doing so would remove what critics say is a deeply unfair system in which more and more people of pensionable age are having to use their savings to pay for care received at home that is vital to their independence.

The switch would cost an extra £8bn a year by 2030 but could be paid for by raising income tax by 2p or National Insurance by 1.3p, according to calculations in a new IPPR report.

The NHS would save £4.5bn a year by 2030 because older people would be in better health as a result of improved support at home and so would end up in hospital less, it says. Cuts to local council budgets since 2010 have contributed to hospitals becoming routinely full all year round.

One in four English postcode areas have no care provision – study

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I suspect many of these areas in rural settings in England. We still appear (in these Brexit fixated times) to have no real sense of how to deal with the huge challenge presented by Adult Social Care.

A study commissioned by Age UK found that large swathes of the country were “care deserts” lacking residential care or nursing homes.

Caroline Abrahams, the charity’s director, said the research showed how “chaotic and broken” the market for care had become after years of underfunding. “If the awful situation set out in this report does not persuade our government to finally get a grip and take action, I don’t know what will,” Abrahams said.

The study, conducted by Incisive Health, an independent health consultancy firm, found that more than one in four postcode areas in England – 2,200 out of around 7,500 – had no residential care provision. Two-thirds (5,300) had no nursing homes, for people with more acute problems.

The report said more than 1.3 million over-65s lived in these areas and risked being unable to get support if they needed it.

The study found that a big driver of the problem was a lack of staff. Vacancy rates for nurses in social care rose to 12.3% in 2017/18. The report said staffing was a particular problem in the south-east, and that high numbers of EU staff in the sector, many of whom have left or are planning to leave, could mean extra disruption from Brexit.

More than 1m childless people over 65 are ‘dangerously unsupported’

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We know all about the challenges facing vulnerable older people in rural England. This particular category of the over 65 population is worthy of particular attention and one we seldom think of as a discrete group. This story tells us:

More than 1m childless people over 65 are ‘dangerously unsupported’

More than 1 million people aged over 65 without children are “dangerously unsupported”, and at acute risk of isolation, loneliness, poor health, poverty and being unable to access formal care, according to a report.

The number of childless older people in the UK is expected to double by 2030, putting huge pressure on a health and social care system that is already struggling to support the vulnerable, warned Kirsty Woodard, founder of the organisation, Ageing Well Without Children (AWwoC).

“Read any report on inequalities on ageing and you’ll see the adverse impact of being isolated with poor support networks, loneliness, poor health and a low income,” said Woodard. “Certain groups will be highlighted as being particularly at risk, carers for example, people from the LGBT communities, people with disabilities.

“However, one group you will hardly ever see mentioned despite being overrepresented in many of the above at risk categories is people ageing without children – even though they are disproportionately represented in every one of those categories.”

According to Woodard’s analysis, individuals ageing without children have worse health, worse health behaviours and higher mortality rates than parents. Those who are not childless through choice have higher levels of depression and anxiety as they age.

Thousands of poorest pensioners will lose out, government reveals

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Astounding, ostensibly callous and likely to have a massive impact on a number of rural pensioners. This story tells us:

The government has revealed that 60,000 of the least well-off pensioners with partners of working age are set to lose thousands of pounds a year as a result of benefit changes designed to save £1bn over the next five years.

A rule change coming into force on 15 May means that pensioners who have partners under the state retirement age of 65 will no longer be able to claim for pension credit, a means-tested top-up for older people on very low incomes.

The change means pensioners claiming after that date must sign up to the much less generous universal credit, a move which will leave the couple potentially £7,000 a year worse off.

Caroline Abrahams, charity director at Age UK, called the move an “ill thought-out decision” that would potentially devastate the incomes of poorer older people.

Analysts say the scale of the losses faced by couples could put pressure on relationships, and may persuade them that they cannot afford to marry or move in together. Some may consider splitting up to try to avoid the loss.

The change, which was slipped out in January on the evening of a Brexit vote, was condemned by charities as a stealth cut which would drive up pensioner poverty, although at the time there were no details of how many people would be affected.

The Department for Work and Pensions (DWP) revealed in an analysis published on Thursday that the rule change will affect 15,000 couples this year, rising to 60,000 in 2023-24. Estimated savings will be £45m this year, rising to £385m by 2023-24, amounting to cumulative savings of £1.1bn.

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