Two of the great achievements of last century were that life expectancy was practically doubled and terminal illnesses became chronic conditions. But the challenge these achievements leaves us with is the number of elderly people for whom we need to provide care. The fastest growing age group in the UK is those aged over 80 years, now constituting 4.5% of the population. One in five of these will develop dementia. The average cost of care that a 65-year-old will require during their retirement is £30,000 and the average annual cost of a care home place is £24,000.
Today is World Alzheimer’s Day and the desire is to see better provision for people with dementia. There hasn’t yet been an evaluation of the English Dementia Strategy (although undertaking this is mentioned in the White Paper) but what we know already is that investment in Alzheimer’s research is inadequate. In 2007, public funding of dementia was £7 per head pf population in the UK – in the USA it was £52. In 2007-8 the Medical Research Council and Department of Health gave cancer research £248.2m while dementia research received £32.43m. Yet the cost of supporting people with dementia in the UK is estimated to be £17Bn, more than the cost of cancer and heart disease combined, not least because of the additional ‘social’ care that those with dementia require. The division between health and social care is a confusing one for families and an unhelpful one for designing efficient integrated care services.
Section 5 of the Structural Reform Plan (SRP) that accompanied the White Paper stated that its purpose was to: reform the system of social care to provide much more control to individuals and their carers, easing the cost burden that they and their families face. Subsequent to this the ‘The Commission on the Funding of Care and Support’ was announced with the remit of reviewing the funding of social care. Derek Wanless writing in response said it had the difficult task of : defuse some explosive issues including ensuring fairness between the generations, how risk should be pooled, the degree of choice and compulsion in the funding arrangements, the role of wider tax and benefit systems, and the balance between universality and means-testing.
There are two messages here. We need to up our investment in research into conditions like Alzheimer’s which are placing increasing pressures on our economy. Secondly we need to identify the advantages and achievements of integrated (health and social) care organisations so we can move beyond the pilots. Clarifying funding streams, integrating IT, reviewing domiciliary care all are vital to avoid wasteful duplication and achieve the joined-up, improved care that our elderly relatives deserve.