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The timebomb is ticking for elderly care

http://www.pulsetoday.co.uk/practical-commissioningl

Recently, I attended a seminar organized by Saga about funding the care of the elderly. It was led by Andrew Dilnot, whose recent report on the subject ‘Fairer Care Funding' published last summer has given considerable food for thought.

The main recommendation of the report, co-authored with Norman Warner, was that the injection of the ‘relatively small' sum of £1.7 billion would defuse many of the problems that have been headlined about the ‘time bomb' of elderly care services; there was much agreement and nodding of heads among the politicians and opinion formers who were at the meeting.

Three thoughts came to me in response: the first, slightly perverse one was that none of us actually grows old.  I don't know about you, but inside I'm still in my twenties.  Old age is something that happens to other people, and by the time it becomes something we acknowledge to ourselves, it's too late. It's only when hips/heart/waterworks/mentation start really failing that I'll begin to recognize that the geezer in the mirror that looks like my father is actually me.

Thus, public perception of old age care as a ‘now' problem is a real issue; as long as it's happening to others, our interest may be altruistic, academic, or familial, but it won't be urgent, and so it's unlikely to take priority over more pressing aspects of our lives. 

So how can we raise the profile of old age care? At the meeting, there was a remarkable degree of consensus among the politicians: they wanted ‘noise' in the media about the problem, but felt that it should be handled in a non-partisan, apolitical way.  This led me to my second contrary thought. Noise happens with friction; when any mechanism is moving in a smooth, well oiled way, then there is little or no noise.  Political consensus, without any of the friction of argument, produces no noise. Our daily papers don't publish political stories without friction, and what we would actually get if those at the meeting had their way would be a conspiracy of silence, with no discussion, and no progress.

This becomes even more likely in our current political context where the main preoccupation is saving money.  In fact, in a tight political environment, with a governing coalition and an opposition vying for power at the next election, the only way to get elected is to create ‘clear blue water' in policy terms between your party and the others; the last thing you want is consensus, which becomes a way of keeping issues off the table.  I think we should be creating noise by suggesting radical change, by having a real political debate, and making sure that the daily papers have some real contradictions to discuss. 

My final observation, and one that is more optimistic, is that we may be getting older, but we are different from our forebears. The next generation to retire will be the ‘baby boomers', who have grown up in the climate of entitlement and privilege that has typified the last 50 or 60 years. We are used to getting our own way, and there is little sign of that changing, whatever the economic climate. Somehow, I can't see us going from paragliding to old age homes, can you? We will need pressure groups, something on the lines of our own Saga, or the American Association of Retired Persons, whose ‘Grey Power' has become an influential and effective force for change.

So roll on the noise, and the debate so that when it's our turn, to paraphrase Dylan Thomas

‘We will not go gentle into that good night,

Old age should burn and rage at close of day;

Rage, rage against the dying of the light.'

Dr Jonathan Shapiro is a former GP and senior lecturer in health services research at the University of Birmingham

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