Straight Talk
Professor Martin Green OBE • Chief Executive • Care England

The Equality and Human Rights Act was supposed to enshrine in law the concept of equal treatment across a range of different and protected characteristics. These included gender, race, sexuality and age.

As I look across the care sector, I am conscious that some characteristics are more protected than others, and it is my view that older people are getting a very poor deal from health and social care services.

This poor deal is not only measured in the amounts of money that are put into different client groups, but there is also an inequality of access and a paucity of ambition in the way in which older people’s care services are commissioned compared to other client groups.

Let’s start by looking at the money. Despite the fact that older people represent the largest cohort of people using services within local authorities, the spending on younger adults is outstripping the spend on older people in a great number of local areas. This is a tangible way to show that there is an inequality in the way in which resources are allocated across different age groups.

When you look at the unit cost of delivering care for an older person compared to that of delivering care for a younger person, sometimes the disparity can be as much as 20 times. Those who want to defend this inequality often point to the fact that younger people have greater needs. I would be very happy with the system that allocated resources on the basis of the need, but quite clearly the current system does not do this. An older person living with advanced dementia may have the same needs as a younger person with autism or a learning disability, but the system treats them quite differently.

Firstly, older people’s services are usually commissioned on block basis. Each local authority allocates a woefully inadequate amount of money for residential care and nobody is allowed to go above that ceiling figure, no matter how complex their needs might be. In contrast, younger adult services are usually commissioned on an individual and bespoke basis, and I have seen in some areas people having services commissioned at several thousand pounds a week; this is simply not done for older people living with dementia.

Not only is there the challenge of the funding, but there is also a paucity of ambition in some of the care plans, particularly those which are community-based. I recently saw a care plan for a younger person, which talked about maintaining family relationships, ensuring they have access to leisure and cultural activities, and the plan included taking the person 40 miles once a fortnight in a taxi, with a chaperone, to ensure that they spent the afternoon with their sister. I have never seen a care plan like this for an older person living with dementia, though I have known many older people who would have loved to spend the afternoon with their sister. Older people’s care plans tend to be based on functions rather than outcomes and I have never yet seen a community plan that enables the older person to stay in their own home with 24-hour round-the-clock care, yet I have seen a number of such plans for younger people.

I am also conscious of the way in which the Care Quality Commission is advancing the notion that learning disability services should be small, and they have mistakenly, I believe, linked the size of the service to the quality and outcomes it provides. If the size of service is the definer of quality, I question why the Care Quality Commission, and indeed, local authorities, are not advocating for much smaller residential units for older people, which would be more akin to a family situation, but which of course would cost huge amounts more money than the current miserly allowance given by local authorities for older people’s residential care.

It is clear that social care is institutionally ageist and all the institutions of Government, such as the NHS, local authority commissioners and the Care Quality Commission, work on a totally different premise when they address older people’s issues than they do when they are advocating for children or younger people.

Older people are being failed by the Equality and Human Rights Commission and I believe we need to have a Commissioner for Older People, just as they do in Wales, to ensure that older people are not left off the equality and human rights agenda when it comes to their care and support needs.

Professor Martin Green OBE is Chief Executive of Care England. Twitter: @ProfMartinGreen

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