Policies For Peace of Mind? Devolution and Older Age in The UK

WWW.IPPR.
ORG
PoliciesforPeace
ofMind?
DevolutionandolderageintheUK
ByJamesMcCormick,EleanorMcDowellandAndrewHarris
PoliticsofAgeingWorkingPaperno.2
October2009
©ippr2009
InstituteforPublicPolicyResearch
Challengingideas– Changingpolicy
2 ippr|PoliciesforPeaceofMind?DevolutionandolderageintheUK
Contents
Aboutippr ............................................................................................................................. 3
Abouttheauthors ................................................................................................................. 3
Acknowledgements ............................................................................................................... 3
Abbreviations......................................................................................................................... 4
1.Introduction....................................................................................................................... 5
2.Measuringprogress .......................................................................................................... 7
UKGovernment................................................................................................................. 7
IndependentmeasuresattheUKlevel ............................................................................. 8
Thedevolvedgovernments............................................................................................... 9
Keytrends ....................................................................................................................... 10
3.Olderpeople’spolicyintheUKandEngland................................................................. 12
Well-beingthroughactiveageing................................................................................... 13
Familyandcareroles....................................................................................................... 14
Alocalfocusonprevention ............................................................................................ 14
Advocacy,scrutinyandinvolvement............................................................................... 18
Summingup .................................................................................................................... 18
4.Devolutionandolderpeople’spolicy:Scotland.............................................................. 19
Freepersonalandnursingcare ...................................................................................... 20
Warmhousingandsupportedliving .............................................................................. 20
Concessionarytravel........................................................................................................ 21
Scrutinyandadvocacy .................................................................................................... 21
Summingup .................................................................................................................... 22
5.Devolutionandolderpeople’spolicy:Wales .................................................................. 23
FirstphaseoftheStrategyforOlderPeople (2003–08) ................................................ 23
SecondphaseoftheStrategyforOlderPeople (2008–13) ........................................... 24
Scrutinyrole:TheCommissionerforOlderPeople ......................................................... 25
Summingup .................................................................................................................... 26
6.Devolutionandolderpeople’spolicy:NorthernIreland................................................. 27
AimsandactionsofNorthernIreland’sageingstrategy ................................................ 27
FromAdvocatetoCommissioner .................................................................................... 28
Anti-povertyandsocialinclusionstrategy:oldercitizens .............................................. 29
Summingup .................................................................................................................... 30
7.Conclusion....................................................................................................................... 31
Whatdifferencehasdevolutionmade? .......................................................................... 31
References ........................................................................................................................... 33
Annex:
1.GovernmentOfficeRegionsinEngland:Populationprojectionsage65-plus............ 35
2.StrategiesforageingandolderpeopleacrosstheUK ............................................... 36
3.LinkAgePlus(LAP)casestudy:LinkUpinGateshead............................................... 37
Aboutippr
TheInstituteforPublicPolicyResearch(ippr)istheUK’sleadingprogressivethinktank,
producingcutting-edgeresearchandinnovativepolicyideasforajust,democraticand
sustainableworld.
Since1988,wehavebeenattheforefrontofprogressivedebateandpolicymakinginthe
UK.Throughourindependentresearchandanalysiswedefinenewagendasforchangeand
providepracticalsolutionstochallengesacrossthefullrangeofpublicpolicyissues.
WithofficesinbothLondonandNewcastle,weensureouroutlookisasbroad-basedas
possible,whileourGlobalChangeprogrammeextendsourpartnershipsandinfluence
beyondtheUK,givingusatrulyworld-classreputationforhighqualityresearch.
ippr,30-32SouthamptonStreet,LondonWC2E7RA.Tel:+44(0)2074706100E:info@ippr.org
www.ippr.org.RegisteredCharityNo.800065
ThispaperwasfirstpublishedinOctober2009.©ippr2009
Abouttheauthors
JamesMcCormickisanipprResearchAssociateandaco-founderofMcCormick-McDowell
ResearchPartnership.HeisScotlandadvisertotheJosephRowntreeFoundationandwas
previouslyDirectoroftheScottishCouncilFoundationthink-tank(2002–07).Hisresearch
interestsincludewelfarereform,thefutureofsecondaryschoolsandapproachestopublic
involvement.
EleanorMcDowell isco-founderofMcCormick-McDowellresearchpartnerhship.Shewas
previouslyalecturer(1995-2008)intheSchoolofLawandSocialSciencesatGlasgow
CalendonianUniversity,specialisinginEnvironmentalSociology.Sheistheauthorofanew
EnvironmentchapterinSociology:MakingSenseofSociety(2009)andco-authorof
SustainableWorkingLives,acomparativestudyofflexibleworkinginEurope(2008).
AndrewHarrisisanexperiencedpolicyanalyst,havingworkedinpublicpolicyinScotland
since1998.InitiallyasacivilservantwiththeScottishExecutive(1998-2004)andthenasa
memberoftheindependentthink-tanktheScottishCouncilFoundation(2004-09),Andrew
hasproducedanalysisandadviceonawiderangeoftopics,withastrongemphasison
devolvedpolicies,inparticularhealthandwellbeing.
Acknowledgements
ipprwouldliketoacknowledgethegeneroussupportoffundingpartnersinthePoliticsof
Ageingproject:CalousteGulbenkianFoundation,IntelHealthandtheNorthernRock
Foundation.Theauthorsthankcolleaguesatipprforhelpfulcommentsonadraftofthis
paper.
Abbreviations
CSR ComprehensiveSpendingReview
CHCP CommunityHealth&CarePartnerships
DH DepartmentofHealth
DWP DepartmentforWorkandPensions
CLG DepartmentforCommunitiesandLocalGovernment
ELSA EnglishLongitudinalStudyofAgeing
GDP Grossdomesticproduct
GHQ GeneralHealthQuestionnaire
IBSEN IndividualBudgetsEvaluationNetwork
LAA LocalAreaAgreement
LAP LinkAgePlus
NICVA NorthernIrelandCouncilforVoluntaryAction
NHS NationalHealthService
OFMDFM OfficeoftheFirstMinisterandDeputyFirstMinister
POPP PartnershipforOlderPeople’sProjects
PSA PublicServiceAgreement
PSSRU PersonalSocialServicesResearchUnit
SNP ScottishNationalParty
WAG WelshGovernmentAssembly
1.Introduction
Thispaperconsidersthechanginglandscapeofpolicyandpracticeforolderpeoplesince
2000andhowthisvariesacrossthefourcountriesoftheUnitedKingdom.WereflectonUK
Governmentreformsoverthisperiodaswellastheearlychoicesmadebythedevolved
administrations,whichhavevaryingpowers.
Thereisnoconsistentdefinitionofwho‘olderpeople’are.Somestrategiesapplytoallaged
over50,whilespecificpoliciesareaimedattheover-60s,arebasedonstatepensionageor
targetthe‘olderold’,agedover75or80.
Weknowmuchmoreaboutpolicyinputs–programmesdesignedtoimproveolderpeople’s
qualityoflife–thanabouttheirimpact.Evaluationofpoliciesforolderpeopleispatchy,but
variouspatternsarerevealed,nonetheless.Asaresultofdevolutiontothethreesmaller
countriesoftheUK,wecanidentifytheintendedpolicyaimsforolderpeople,aswellasthe
roleofpoliciesreservedtoWestminster.Inparticular,weareinterestedinhowfarpolicies
havesoughttoimprovewell-beingforallolderpeopleorforsome,forexampletargetedon
need,resourcesorstagewithinolderage.
Forsomepolicies,itispossibletocomparepolicyaims,objectivesandapproachesfortwoor
threecountries,butrarelyfour.Forthatreason,weincludeshortcountry-specificsectionsin
thepaperinvolvingaselectivereviewofkeypolicyinitiatives.
Thepaperdrawsmainlyonadeskreviewofpublisheddocuments,supplementedbyasmall
numberofinterviewswithpolicymakersineachofthefourcountriesoftheUK.ippr’s
DevolutioninPracticepublication(forthcoming2009)willofferafreshassessmentofhow
thethirdtermofdevolutionisaffectingkeypolicyareas.1
Populationprojections
In2007theshareofpopulationofstatepensionagehasgrowninthefourcountriesofthe
UKstoodatabout16percentinEngland,19percentinScotlandand21percentinWales
(Table1.1).NorthernIrelandstandsoutforhavingasignificantlyyoungerpopulation:fewer
thanoneinsevenofthepopulationwasofstatepensionagein2007,one-thirdlessthanin
Wales.
Table1.1.Shareofpeopleofstatepensionageintotalpopulation(projected)
Year England Scotland Wales NorthernIreland
2007 16.0% 19.2% 21.0% 13.7%
2011 16.6% 20.1% 21.9% 14.7%
2021 18.9% 20.9% 22.2% 17.6%
2031 21.7% 24.0% 24.4% 21.6%
Change +35.6% +25.0% +16.2% +57.6%
Source:StatsWales(www.statswales.wales.gov.uk),UKNationalStatistics(www.statistics.gov.uk),General
RegisterOfficeforScotland(www.gros-scotland.gov.uk)andNorthernIrelandStatisticsandResearchAgency
(NISRA–www.nisra.gov.uk)
1.SeealsoJosephRowntreeFoundation’sseriesofpapersaskingwhatdifferencedevolutionhasmade
forpoorerpeopleandplaces,includingBell(2009)whotakesacross-countryapproachtosocialcarefor
olderpeopleoverthelastdecade.ippralsohasaseparateprogrammeofresearchonattitudesto
receivingandpayingforsocialcare.Forthesereasons,wedonotlookatsocialcareinmuchdepthhere,
althoughwedrawoutsomerelevantpointstodemonstratehowsocialcarepolicyhasdivergedacrossthe
UKasaresultofdevolution.
Lookingahead,demographicprojectionsindicateanincreasedrateofageing.By2031all
fourcountriesareprojectedtohavemorethan21percentofthepopulationabovethestate
pensionagethreshold:therankorderisexpectedtoremainthesamebutconvergenceis
likelytooccurasNorthernIrelandissettoagefastest.Inallcases,therateofincrease
amongtheolderold(aged80-plus)ismostmarked.Acorrespondingincreaseinthenumber
ofpeoplewithdementiaisanticipatedthroughouttheUK;forexample,ariseof30percent
isprojectedinWalesby2021(WelshAssemblyGovernment2008a).
IntheEnglishregions(Annex,Table1),theSouthWesthasthelargestproportionofpeople
aged65andover(18.8percent)whileLondonhasthesmallest(11.6percent)(figures
fromtheOfficeforNationalStatistics).By2031,allregionsexceptLondonareprojectedto
havemorethan21percentinthiscategorywiththelargestincreasesexpectedintheNorth
East,EastMidlandsandSouthEast.
Thelimitsofdevolutionintheareaofolderpeople’spolicy
Table2intheAnnexshowskeypointsfromthemostrecentstrategiesonageingandolder
peopleforeachcountry.Thesimilaritiesarestriking.Itisprobablynotsurprisingthatfew
majordifferencesinvisionandobjectiveshaveemergedoverwhatisarelativelyshortspan
ofdevolvedpolicymaking.Nonetheless,someintriguingvariationsinpolicyandpractice
haveemerged.
ThemainpowerstopromoteageequalityandtacklepovertyarereservedtoWestminster.
TherearedevolvedgovernmentprogrammestoimplementUK-widepolicyobjectives,for
exampletorecruitandretainmoreolderworkers,engagewithemployersonflexible
retirementandincreasetake-upofPensionCredit.Thesevaryinscopeandeffectiveness.
Governmentsineachofthefourcountriesaretakingforwardstrategiesforcarers,mental
health,palliativecare,supportingvulnerablepeopletoliveindependentlyandinter-
generationalaction,allofwhichaffectolderpeoplesubstantially.Wefocusondistinctive
policytrendsinthethreesmallercountriesoftheUKinSections4–6.
Beforeconcentratingonthepoliciesofthedevolvedadministrations,inSection2welookat
theoutcomes,targetsandmeasuresinplacetotracktheprogressofpoliciesforolder
people,andinSection3wereviewtheUKGovernment’sageingstrategy.
2.Measuringprogress
Theoutcomes,targetsandmeasuresinplaceindicatetheintendedpurposeofvarious
policiesforolderpeopleandhowwearetoassesstheirimpact.Wereviewtheminthis
sectionandalsoconsiderprogressoverthedecadeto2007fortwokeytrends–poverty
amongolderpeopleandearlymortality.
UKGovernmentmeasures
ThekeystatementofoutcomesforolderpeopleisPublicServiceAgreement(PSA)17.Its
aimisto‘tacklepovertyandpromotegreaterindependenceandwell-beinginlaterlife’.Like
otherPSAs,thissetsthepriorityoutcometheUKGovernmentwantstoachieveinthe
currentComprehensiveSpendingReview(CSR)periodof2008–2011.TheDepartmentfor
WorkandPensions(DWP)leadsonPSA17withmajorcontributionsfromtheDepartment
ofHealth(DH)andDepartmentforCommunitiesandLocalGovernment(CLG).Spanning
health,care,employmentandequalities,itcoversbothreservedpowersfortheUKand
policiesapplyingtoEngland.LocalauthoritiesinEnglandcontributethroughLocalArea
Agreements(LAAs)inpartnershipwithvoluntaryandcommunitygroups.Others,suchas
PrimaryCareTrusts,alsohaveasignificantcontributiontomake.
PSA17includesfivekeyindicatorstoassessprogressupto2011:
•Theemploymentrateofthoseaged50–69andthedifferencebetweenthisandthe
overallemploymentrate
•Thepercentageofpensionersonlowincomes
•Healthylifeexpectancy–theexpectedyearsoflifeingoodorfairlygoodhealth–at
age65
•Satisfactionwithhomeandneighbourhoodamongtheover-65s 2
•Theextenttowhicholderpeoplereceivethesupporttheyneedtoliveindependently
athome.
Threeindicatorson‘improvingwell-beinginlaterlife’areincludedinalistof200possible
indicatorsforselectionbyLocalStrategicPartnershipsinEngland.Veryfewhavechosen
theseastargetsintheirlocalauthorityarea(AgeConcernandHelpTheAged2009).
OpportunityAgeindicators
OnthebackoftheGovernment’sOpportunityAgereportof2005,DWPpublisheda
‘balancedscorecard’across33indicators(DWP2009).Theseshowhowolderpeopleare
faringinEnglandorBritainacrosssixbroadthemes:
•Overallsubjectivewell-being
•Havingindependencewithinsupportivecommunities
•Healthyactiveliving
•Fairnessinworkandlaterlife
•Materialwell-being
•Supportandcare.
Trendsbetweenthebaselinedate(inmostcases2005)andthemostrecentreportin2008
show12indicatorsimprovingandthreeworsening,withsevenbroadlyconstant.Broadly,this
pointstoanetbetter/worsebalanceofplus9.
2.Mainlycoveringhousingandcrime
Thethreeindicatorsthataremovinginthewrongdirectionandthuspossibleareasof
concernforpolicymakersare:
•Olderpeople’sperceptionoftheavailabilityofwork
•Relativeandabsolutelowincomes(thoughimprovementisseenoveralonger
period)
•Accesstoacaranduseofpublictransport:peopleagedover80areninetimesmore
likelythanthoseaged50–64andfourtimesmorelikelythanthoseaged65–79to
havenoaccesstoacarortorarelyusepublictransport.
TheEnglishLongitudinalStudyofAgeing(ELSA)offersrichinsightintothechanginglives
ofpeopleastheygetolderandreportsanoverallmeasureofwell-being(DWP2009).The
medianscoreforrespondentsaged65–79wasonepointlowerthanamongthoseaged
50–64.However,thescorewasfourpointsloweramongpeopleaged80andover.Although
thevariationsarenotmarked,itappearsthatthoseinthemiddlestageoflaterlife(65–79)
aremorelikepeoplewhoareyoungerthanolderintermsofwell-being.
ELSA’sassessmentofmentalhealthisbasedona12-pointmeasureusedintheHealth
SurveyforEngland(GeneralHealthQuestionnaire[GHQ]12).Peoplescoringzeroare
consideredtobefreeofmentalillhealth.Expressedasathree-yearaverage(2004–06),68
percentofwomenand71percentofmenaged65–79hadascoreofzero(Table2.1).
Amongpeopleagedover80,thisdropsto56percentforboth.Thosescoring4ormoreon
thismeasureareregardedashavingsomeformofmentalillhealth.Amongpeopledaged
65–79,10percentofwomenand9percentofmenreachedthisthreshold,risingto15per
centofwomenaged80andoverand18percentofmen.
Table2.1.Averagementalhealth(GHQ12)scoresinEngland,byageandsex(2004–06)
Women Men
Age 16–49 50–64 65–79 80-plus 16–49 50–64 65–79 80-plus
Score0 60% 64% 68% 56% 69% 68% 71% 56%
Score1–3 25% 20% 21% 29% 21% 20% 20% 26%
Score4+ 15% 16% 10% 15% 10% 12% 9% 18%
Source:AdaptedfromOpportunityAgeIndicators:2008update (DWP2009:56-50),Indicator12
Womenandmenaged65–79hadthelowestriskofmentalillhealthofanyagegroup,older
oryounger,whilepeopledaged80andoverhadthehighestriskofall.Therearesignsthat
mentalhealthdeterioratesfasteramongmenthanwomenaftertheageof80.However,
althoughmentalhealthappearstodeclineaftertheageof80,amajorityappeartostayfree
ofmentalillhealth.Aswellasdoingabetterjobofsupportingthosewhoarevulnerableto
depression,weshouldfocusontheprotectivefactorsthatenablemanytoreachthisagein
goodmentalhealth.
Nosinglemeasurecanofferaroundedpictureofpeople’sexperiencesandsomesources
suggestthattheburdenofmentalillhealthinolderagehasbeensignificantlyunder-
reported,under-diagnosedandthusnottreatedappropriately.Forexample,thesecond
reportfromtheUKInquiryintoMentalHealthandWell-beinginLaterLife(2007)revealed
thatmentalhealthproblemsaffectmanymorepeopleinlaterlifethanpreviouslythought
andpredictedthatthenumberswillincreaseinthefuture.
IndependentmeasuresattheUKlevel
AgeConcernandHelpTheAged(2009)publishedtheirown‘stateofthenation’indicators,
servingasanindependentcheckonhowolderpeoplearefaring.Asetof35indicatorswas
includedintheOneVoicereport,whichalsocontainsa‘devolutionwatch’commentafter
eachsetofindicators,explainingclearlywhichpartsoftheUKarecovered.Thereportpaints
quiteadifferentpicturefromOpportunityAge,withonlyfiveindicatorsimprovingand14
worsening,12showingnochange.3 Onthesamebasisasbefore,thisgivesanetscoreof
minus9,explainedbydifferentindicatorsbeingusedratherthanalternativemeasuresofthe
sametrendordifferentreportingdates.
Whatdoesthistellus?Someofthetrendsgettingworseinvolvematerialwell-being:
notably,forexample,therateofpensionerpovertyisprojectedtoremainatoneinfive
peopleinthenextdecade.MuchdependsonhowPensionCreditGuaranteeoritsequivalent
isupratedovertime,aswellastheBasicStatePensionrisinginlinewithearningsfrom
2012.Othersrefertoattitudes,forexamplemorepeopleaged65-plusthinkthereisage
discriminationineverydaylifeandsaytheirqualityoflifehasdeterioratedinthepastyear.
Accesstosomeservicessuchashomecareisworse.Otherindicatorsrefertoolderpeople’s
contributiontosociety,forexamplewhilethenumbersvolunteeringatleastonceamonth
peakamong45–64yearolds,theyhavebeenfallingamongtheover-65s.
Overall,thepictureisquitecomplex.Governmentstendtohighlightindicatorsshowing
progresswhilethevoluntarysectorpointstoareasinneedofattention.Differentindicator
setsgiveadifferentimpressionofhowolderpeoplearefaring.Ratherthandebatingwhich
givesthemoreaccurateaccount,aconsensusisneededontacklingthetrendsgoinginthe
wrongdirection,orprojectedtodosoinfuture.
Thedevolvedgovernments
Waystotrackprogressforolderpeopleinthedevolvedcountriesvary.InScotland,the
nationalperformanceframework ScotlandPerforms4 wasintroducedin2007bytheminority
ScottishNationalPartyGovernment.Thiscovers45targets,twoofwhicharedirectly
relevanttoolderpeople:
•Increasetheproportionofpeopleaged65-pluswithhighlevelsofcareneedwhoare
caredforathome
•Reducetheproportionofpeopleaged65-plusadmittedasemergencyinpatients
twiceormoreinasingleyear.
In2004/05,fourinten(41percent)ofallemergencyhospitaladmissionsinScotlandwere
amongpeopleaged65andover.Bycomparison,one-thirdofelectivehospitaladmissions
andofallcontactswithprimarycarewerefromthesameagegroup.Thetargetaround
emergencyadmissionsisheadinginthewrongdirectionandhasbeenforsometime.For
examplethenumberofsuchadmissionsforpeopleaged85andoverincreasedfourfoldfrom
1981–1999andhascontinuedrisingsince.
IncontrasttotheraftofOpportunityAge indicators,noothermeasurestowardsstated
outcomesforolderpeoplearecurrentlyinplaceinScotland.
InWales,theWelshAssemblyGovernment’sStrategyforOlderPeople isinitssecondphase
(2008–13).Thisincludes12indicatorsacrosssixthemesspecificallyaboutolderpeople(see
Section5onWalesbelow).
InNorthernIreland,separatestrategiesonageingandanti-poverty/socialinclusionwere
preparedduringthelastperiodofdirectrule(2005–06).Theseincludeseparateobjectivesfor
olderpeople,althoughprogresshasbeenmuchmorelimitedthaninBritainasaresultof
devolution‘proper’onlyresumingin2007.Themostspecifictargetintheanti-poverty
strategyapplyingtooldercitizenswasimprovingthequalityoflifeandindependenceof
peopleinneedsothat45percentofallwhorequirecommunityservicesaresupportedas
requiredintheirownhomebyMarch2010.
3.Afurtherfourindicatorshavenotimeseriesdatayet.
4.www.scotland.gov.uk/About/scotPerforms
Keytrends
Povertyamongolderpeople
Untilrecently,oldagewasstronglyassociatedwithpoverty.ThedecliningvalueoftheBasic
StatePensionoverdecadesalliedwithlimitedsecondpensioncoverageforolderpensioners
(especiallywomen),benefitpaymentsfailingtokeeppacewithlivingcostsandahigherrate
ofconsumerpriceinflationforolderpeopleledtoaroundone-thirdofolderpeoplelivingin
povertybythemid-1990s.Since1997,variouschangestomeans-testedbenefitshavebeen
made.Forexample,PensionCreditreplacedtheearlierMinimumIncomeGuarantee.
ReducingpovertyinolderageisconsideredtobetheclearsuccessstorywithinLabour’s
agendatotacklepoverty.Theratehasfallensteadilyformuchofthelastdecade,althoughit
hasstalledinrecentyears,inlinewithtrendsinchildpoverty.
PovertyinolderagefellineverypartoftheUKbetween1997–98and2007–08(measured
afterhousingcosts)(Palmer2009).ThereductionwaslargestinScotland,wherethe
proportiononalowincomefellfrom31percentintheperiod1995–98to16percentin
2005–08.ThenextlargestfallswereintheNorthEastandYorkshire&Humberside,twoof
thethreeEnglishregionsthatstartedwiththehighestpovertyrates.Thesmallestreductions
wereintheEastMidlandsandWales.
ThePensionCreditwasintroducedtocutpovertyamongolderpeople.TheGuaranteed
elementofPensionCreditisintendedtoserveasaminimumincomebelowwhichnoone
shouldfall.Thus,thebulkofpovertyamongolderpeoplereflectsentitlementsnotbeing
claimed.Forpeopleofworkingage(especiallythosewithoutchildren)povertyismainlyan
issueofbothout-of-workbenefitsandwageratesfailingtokeeppacewithcosts.Child
povertyhasbeenprojectedtoincreaseoverthenext20yearsunlessbenefitsandtaxcredits
areupratedinlinewithearningsratherthanpricesortheadhocapproachesusedby
governmentsinthepast.Maintainingprogressincuttingpovertyamongolderpeople
dependsoncontinuingtoupratePensionCreditGuarantee(oranysuccessor)andtheBasic
StatePension(from2012)inlinewithaverageearnings.
Take-upofPensionCreditin2006–07acrosstheUKasawholebyolderpeoplewhoare
eligiblewasestimatedtobebetween59and67percent5.Thereforebetweenone-thirdand
two-fifthsofpeoplewhowereentitledwerenotclaiming–thisrepresentsupto1.8million
households.
InNorthernIreland,however,theSocialDevelopmentMinisterreportedasurvey-based
estimatefromFebruary2008of83percentofpeopleeligibleforPensionCreditreceivingit,
upfrom67percentin2003–05.Thisrate,equatingtooneinthreepeopleofstatepension
ageinNorthernIreland,issignificantlyhigherthaninBritainwheretheratevariedfromjust
over12percentinSouthEastEnglandtoalmost23percentintheNorthEastofEngland
(Table2.2).
Atthelocallevel,atleasthalfofpeopleaged60-pluswereclaimingPensionCreditin25
wards(nineofthoseintheNorthWestofEngland).Attheotherendofthescaletherewere
31wardsinwhichfewerthan2percentofpeopleaged60-pluswereclaiming(12ofthose
intheSouthEast).ComparingPensionCreditreceiptwithpovertyfiguresisnot
straightforward;lookingatuptakefiguresasaproportionofthoseeligiblewouldinfact
provideabettermeasureofneed.Nevertheless,itappearsthatahigherrateofreceiptin
NorthEastEnglandandScotlandmaybeassociatedwithquickeningreductioninpensioner
poverty,whilethelowerrateofreceiptintheEastMidlandshaslefttheregionwithoneof
thehighestpovertyratesforthatgroup.
5.Seewww.poverty.org.ukfordataontake-upofPensionCredit.
Table2.2.ProportionsofolderpeoplereceivingPensionCreditandthoselivinginpoverty
Region Proportionofpeopleaged60-plusin Proportionofpensionersinlow-income,
receiptofPensionCredit,Feb2008 2005–07*
NorthernIreland 33.5% 20%
NorthEast 22.9% 19%
Wales 22.2% 19%
Scotland 20.8% 16%
NorthWest 20.4% 18%
London 18.7% 22%
Yorkshire&TheHumber 18.1% 18%
WestMidlands 17.0% 18%
EastMidlands 15.9% 21%
SouthWest 14.7% 18%
EastofEngland 14.2% 16%
SouthEast 12.6% 16%
Total 17.6% 18%
*Measuredafterhousingcosts
Source:DWPdata(February2008)accessedviawww.npi.org.uk
Theinfluenceofdevolution,atleastonthispovertymeasure,isunclearjudgingbythe
variableratesofprogressseeninScotlandandWales,aswellasthelargedifferences
betweenratesofreductionintheEnglishregions.Thisdoesnotnecessarilymeanthat
devolutionhasnotmadeadifferencetotheolderpoor.Itmightsimplybethat,sincethe
majorpolicypowersremainreservedtoWestminster,thedevolvedadministrationshavenot
forgeddistinctiveprogrammesonascalethatisbigenoughtoshowupatthenationallevel.
However,theapparentsuccessoftheBenefitUptakeProgramme(2007–08)runby
NorthernIreland’sSocialSecurityAgency,whichcontactedmorethanhalfoftheprovince’s
olderpeople,showsthatimpactcanbefeltbymoreeffectivelyadministratingtheexisting
systemevenwithoutformalpowersbeingdevolved(NICVA2009).
Earlymortality
Aslifeexpectancyafter65hasincreasedsteadily,keyindicatorsnowusetwomeasures:
healthylifeexpectancy–thenumberofyearsafter65livedfreeofalimitinglong-term
illnessand/ordisability,andlifeexpectancyafter75.Thepolicypriorityistoimprovequality
oflifetokeepupwiththeincreaseinlifespan.
However,therehasbeenanotabletrendoverthelastdecadeinearlymortalityforadults
beforetheageof65.Onthismeasure,therewasprogressineverypartoftheUKfrom
1997–2007(Palmer2009)butgeographicalinequalitiesintheriskofdyingbefore65remain
strikingandthegapbetweenlowestandhighestriskisgrowing.In2007,theratein
Scotlandwas1.5timeshigherthanintheEastofEngland,andhigherthantheraterecorded
inallbuttwopartsoftheUKtenyearspreviously.TherankorderofsomepartsoftheUK
haschangedaswell,withtheNorthEastnowrankedeighthbest(fromeleventhin1997)
andLondonimprovingtofifth(fromninthin1997).Eventheregionswiththelowest
mortalityratesadecadeagosawamarkedfall–down18percentintheSouthEastand15
percentintheEastofEngland.TheseregionsfaredbetterthanScotlandandWales(both
down13percent)whichhadamongtheworstfiguresin1997(ibid).Sotheyearsof
devolutionsofarhaveseenimprovementonthismeasure,butthisimprovementhasnot
beenquickerthanincomparableregionsinnorthernEngland.
3.Olderpeople’spolicyintheUKandEngland
ThissectiondiscussestheUKGovernment’sageingstrategy,BuildingaSocietyforAllAges,
whichwaspublishedinJuly2009(HMGovernment2009).ThestrategyfollowsOpportunity
Age,whichinformedacomprehensivesetofindicatorsformeasuringolderpeople’sprogress
andaraftofpolicyreformsthathavebeenmadesince1997.Themainreformsareshownin
Box3.1below.Broadly,policiesinvolvingcashpayments,employmentandequalities
legislationapplyacrosstheUKwhileotherpublicservices(forexample,concessionarytravel,
warmhousing,healthandcare)applytoEngland,withseparatedevolvedpoliciesinthe
othercountries.
Box3.1.Keypolicyreformsonageingsince1997
• PensionCreditincludingGuaranteeintroduced
• BasicStatePensionincreasedby7percentoverinflation,pluschangesmadeto
eligibility(totakeeffectfrom2010),creditsforcarersofchildrenuptoage12(2011)
andTurnerrecommendationsincludingauto-enrolmentinpensionschemesand
linkingofBasicStatePensiontoearnings(from2012)
• Freeprescriptions,sighttestsandoff-peakbustravelinstatedthroughoutEnglandfor
over-60s
• Helpwithcentralheating/insulationtargetedtoPensionCreditrecipientsandfree
energyefficiencymeasures/insulationintroducedforover-70s
• FreeTVlicencesprovidedforover-75s
• WinterFuelPaymentsmadetoallhouseholdsthathavesomeoneaged60-plus
(higherratefor80-plus)
• Agediscriminationandharassmentatworkoutlawed(2006).IntegratedEqualityBill
toincludenewprotectionagainstharmfulagediscriminationingoodsandservices,
andadutyonpublicsectoragenciesto‘age-proof’theirpolicies.
Source:GovernmentEqualitiesOffice(2009)
InadditiontoreformsidentifiedassignificantbytheGovernmentEqualitiesOffice,shownin
Box3.1,thegoalofpersonalisationinsocialcareserviceshasbecomemoreimportant.
Legislationpassedin1996authorisedlocalauthoritiesthroughouttheUKtomakedirect
paymentstocareusersinplaceofprovidingservicesdirectly.In2003,newregulations
requiredEnglishcouncilstoofferdirectpaymentstoalladultsusingcommunitycare
services,whilesimilarguidancecameintoforceinScotlandandNorthernIrelandaroundthe
sametimeandlaterinWales.Therehasbeenamarkedgrowthinthenumberofclients
receivingdirectpaymentsinEnglandinthelastdecade.Despitegrowingsupportinthe
devolvedcountries,take-uphasbeenslower,atabouthalftherateinEngland(Riddelletal
2006).
TheEnglishframeworkforadultsocialcareservices,PuttingPeopleFirst (Departmentof
Health2007),gavefreshimpetustothedebate,introducingtheideaofpersonalbudgets
whichcanbetakenasadirectpayment,bythelocalcouncilcommissioningtheservicein
agreementwiththeserviceuserandcarer,oramixofboth.Italsointroducedindividual
budgetscoveringalargergroupoffundingsourcesincludingSupportingPeople6.Pilotingin
13Englishcouncilsin2006–07gainedagenerallypositiveresponse,butolderpeople
supportedbyadultservicesweremorelikelytoreportnotwantingwhatmanydescribedas
6.Aworkingpartnershipoflocalgovernmentserviceusersandsupportagencies.
the‘additionalburden’ofplanningandmanagingtheirowncare(IndividualBudgets
EvaluationNetwork[IBSEN]2008).Ofcourse,olderpeopleareahighlydiversegroupand
thereforefurtherevaluationwillbeneededtoimproveourunderstandingofforwhom,and
inwhatcircumstances,theseapproachescanworkbest.
Wheretonext?TheUKGovernment’sageingstrategyreviewsvariouspolicyreforms
introducedinrecentyearsaswellassettingoutafuturevisionfora‘societyforallages’.The
strategyseekstochallenge‘out-datedstereotypesaboutlaterlifeasatimeofdependency
anddecline’andcreateasocietywhere‘peoplearenolongerdefinedbyage’(HM
Government2009).TheEqualityBill,tobeintroducedinApril2012,willextendlegal
protectionagainstnegativeandunreasonablediscriminationinconsumerservices,following
equalitieslegislationcoveringemploymentin2006.
Butthereisunfinishedbusinessintermsofthe‘default’retirementage.TheUKGovernment
recognisesconcernaboutenforcedretirementatthestatepensionageandhaspledgeda
reviewfor2010(earlierthanoriginallyplanned).Andwearealsoleftwiththetougher
culturalchallengeofchangingattitudesandexpectationsaboutlaterlife.Whilethisis
recognisedingovernment,thebulkofthe2009strategyfocusesonearlyinterventionto
enablemorepeopletostaywellforlonger,andisdividedintothethemesof:
•Well-beingthroughactiveageing
•Familyandcareroles
•Alocalfocusonprevention
•Advocacy,scrutinyandinvolvement.
Wereviewthesebelow.
Well-beingthroughactiveageing
Well-beingisenhancedanderodedineverydaylife.BuildingaSocietyforAllAges
recognisesthis,notingthatitisreducedbyinactivityandlonelinesswhichinturnresultfrom
‘nottakingadvantageofopportunitiesavailable’.Policymakershavegraspedtheneedto
reduce‘cliff-edge’effectsassociatedwithageing,wherepeoplelapsefromactivityasthey
growolderwhentheywouldprefertocombinesomepaidandunpaidworkwithsocial
activity.Thereisalsoarecognitionofthescaleofuntappedmarketopportunities
representedbyconsumersagedover50,forexampleinleisureandlearning.
However,aswellasexpandingtherangeofopportunitiesforolderpeopleandpromoting
theirinvolvement,asharperanalysisisneededofthebarriersthatreduceinvolvementfor
peopleindifferentstagesoflaterlife.Weneedabettergraspofthedynamicsofageing,to
improveourunderstandingofwhatiseffectiveatreducingbarriersovertime.Forexample,
weknowthatratesofinvolvementinvolunteering,leisureandlearningdeclinesignificantly
withage.Thisreflectsamixofchoiceandconstraints.Thereisasizeableminorityofpeople
whowouldliketocontinueorreturntoparticipationbutlacktheinformationorsupportto
doso.
WhatstepsinthisdirectionareprovidedforintheGovernment’sstrategy?Itproposesan
Activeat60programmefrom2010,bringingtogethernationalinformationonpensions,
benefitsandotherentitlementswhiletestingoutwaysofmakinglocalinformationavailable
throughcouncils.Informationwillbeprovidedtoallpeopleapproachingstatepensionage
bythePensionService.Pre-retirementcoursestoimproveawarenessoffinancialeducation,
adultlearningandvolunteeringopportunitieswillbeexpandedthroughCitizensAdviceand
thirdsectorpartners.Othersourcesofinformation,adviceandguidancewillbeexpandedas
well,coveringmoneyguidance,housingandcare.
Allofthisraisesthequestionofhowtodeliverinformationinaformatandatatimewhenit
islikelytohavemostimpact.ipprrecommendsfurtherresearchtoexplorethebestmixof
face-to-faceandalternativeapproaches(writteninformation,telephoneadvicelinesand
websites)forolderpeopleaccordingtotheirindividualcircumstances.Oneofthemost
promisingdevelopmentsappearstobethepotentialofall-in-onesmartcards.Concessionary
buspassesinEnglandtypicallyusesmart-cardtechnologywhichcouldbeadaptedforother
purposes.ThisisbeingconsideredbytheWelshAssemblyGovernmentforolderpeoplein
Wales.TheBuildingaSocietyforAllAges strategynotesthatinEnglandthishasalready
beenextendedinDerbyshire,wheresmartcardsareusedforlibraryregistrationandtogive
accesstobothcentralandlocalgovernmentservicesaswellasdiscountswithvarious
businesses.
Thesewaystosupportparticipationineverydayactivitywillsupportmanyolderpeople.But
theymaybeoflittlehelptothosewhoarehousebound,frail,inlong-stayhospitalsorin
residentialcare.Anystrategymustbenefitolderpeoplewhoarenotabletolive
independently.BuildingaSocietyforAllAgesmakesanodinthisdirectionwithits
referencestoinformallearninganddigitalinclusionopportunitiesforpeopleincareand
opportunitiestosharelifeexperienceandknowledgewithyoungerpeoplethroughschool-
agementoring.Butoverallitseemsthatmorecreativethinkingandactionareneededifthe
strategyistogettogripswiththediversecircumstancesoftheolderoldinparticular.
Familyandcareroles
Manyunpaidcarerstakeontheroleofprimarycaregiver,commonlytoaparentorspouse.
Otherscontinueascarertoadisabledchildwellintotheiradulthood.Thehealthandwell-
beingofcarershasslowlyachievedahigherprofile,reflectedintheNationalCarersStrategy
(DepartmentofHealth2008),whichrecognisestheroleofcarersas‘expertpartnersincare’.
Thisagendaisdevelopingfurtherwiththebelatedrecognitionoftheneedforaframework
toincludeextendedfamilies–particularlygrandparents–whotakeonthecareofchildren
whenparentscannot.
TheBuildingaSocietyforAllAgesstrategyproposesthedevelopmentofacarers’helpline,
websiteandtrainingprogrammeandthecreationofaDignityinCareChampionsNetwork7
inEngland.Whilethesearewelcome,manypeopleinlaterlifestillfindthemselvesin
financialhardshipasaresultoftheirunpaidcarerole.Extendingstatepensionprotectionto
carersofchildrenupto12willhelpsomegrandparents.Ifthesupplyofunpaidcareistobe
sustainableinthefaceofvariouspressures–manycarersgettingolder,whileothers
expectingtoremaininemployment–abolderpackagewillberequiredstartingwiththe
rightforcarerstoreceivethesupporttheyhavebeenassessedasneeding.
Alocalfocusonprevention
BuildingaSocietyforAllAges aimstopromotehealth,well-beingandindependenceinlater
life.Apackageof‘healthprevention’measureswillbedevelopedforolderpeople.However,
weconsiderthetitletorevealsomeconfusionoverterminologyandthatitwouldbebetter
referredtoashealthpromotion orsimilar.Nonetheless,thedirectionofchangeisclearly
helpfulinbringingtogetherexistingservices(forexample,preventingfallsandhelpwithfoot
care)andtobeexpandedtoincludeotherconditionsthatmayimpactonthequalityof
people’slaterlivessuchasarthritis,continencecareanddepression.
Strategiespublishedin2009fordementiaandstrokewillbefollowedbyanewserviceguide
andstrategy(NewHorizons),outliningapproachesforimprovingthementalhealthofolder
peopleandtheircarers.TheGovernmentisproposingtoidentifyin2010thehelpthatneeds
tobeavailabletoimprovecarefortheseconditions.Thisisgoodasfarasitgoes,butdoes
notemphasisetheneedtoimproveservicequalityorimproveunderstandingamongservice
plannersandprovidersabouttargetingandachievingbetteroutcomes.
7.TheNetwork‘supportspeopletoshareviews,resources,knowledgeandbestpracticeonissuesrelating
todignityinhealthandsocialcaresettings’(www.networks.nhs.uk/networks/page/909)
Bydefault,Englandhasbecomedevolvedinsubstantialareasofpolicy.Health,socialcare
andeducationpoliciespassedatWestminsternowapplyonlytoEnglandinmostcases.
Pensions,benefits,employmentandequalitylawsarereservedtoWestminsterandapply
throughouttheUK.Here,wenarrowourfocustotwosignificantlocalinitiatives,both
designedtotakeapreventativefocusathomeandinthecommunity,thathavebeenpiloted
recentlyinpartsofEngland:LinkAgePlusandPartnershipforOlderPeople’sProjects.
Mindfulofthegapbetweennationalstrategiesanddelivery,ourfocushereisonlocal
partnership-workingtoshinealightonhowprogressismadeorfrustrated.Suchapproaches
areattheforefrontoftheTreasury’sthinkingaboutmakingsavingsaswellasincreased
healthandwell-beinginlaterlife.
LinkAgePlus(LAP)
LinkAgePlus(LAP)isledbytheDepartmentforWorkandPensionsinEngland.LAP
projectsaredescribedasprovidingthat‘littlebitofhelp’onaday-to-daybasistopromote
well-beingandindependenceandreducetheneedformoreintensivesupport.LAPhasbeen
adaptedbymostlocalauthoritiesinWalesbutnotinScotland.
LAPaimstohelporganisationsworkonpartnerships,capacity-buildingandtheinvolvement
ofolderpeopleinservices,toreduceduplication,achievedeliveryofmorerelevant,tailored
andpreventativeservices,increasesatisfactionandeventuallycosteffectiveness.Amongthe
desiredoutcomesofvariousLAPinitiativesineightpilotareasinEnglandwere:amore
positiveviewofageinginsociety;greaterconfidenceamongolderpeople;increasedquality
oflife;andfinancialbenefitsforindividualsandsociety.AnexamplefromtheNorth-Eastof
EnglandisdescribedintheAnnex(Part2).
Anevaluationpublishedin2007(Wattetal 2007)lookedatthecostsandbenefitsofthe
LAPinitiativesinthepilotareas.Itestimatedthebenefitsintermsofpreventativesavings
fromupstreamactivity,notablyfromdelayedprogressiontomorecostlyresidentialcareand
reducedemergencyadmissionstohospital.TheauthorsnotedthatifLAPinitiativesachieved
thisin5percentofcontacts,majorsavingscouldbeachieved:forexample,theunitcostof
treatingahipfractureismorethan£25,000whileunitcostsofLAPcontactsaresmall.
ThefocusofLAPactivityhasvaried,fromlinkingupservicesandsignpostingtowardsother
existing–sometimesmainstream–servicesaswellasextraprovision,forexampleofnew
benefittake-upactivity,homesecurityandinstallationofsmokealarms,andopportunitiesto
socialisemore.Inmanycasesitwasfoundthatextrasupportinthecommunitywasavailable
butnotaccessed,reflectingpatchylevelsofawarenessamongserviceprovidersaswellas
olderpeople.Fundingwasusedtohelpthirdsectorpartnersattractextrafundingand
volunteerworkers.
Amongthebenefitsforolderpeoplehighlightedinafurtherinterimreport(Daly2009)were
enhancedsafetyandpeaceofmind(achieved,forexample,throughhandymanservices);
physicalandmentalhealthbenefitsarisingfromschemestoaddresstheinactivity/isolation
thataccelerateprematureandpreventableillhealthanddependency(forexample,walking
groups,befriending,peervolunteering);financialsecuritythroughincreasedbenefituptake;
andmobility,throughcommunitytransportinitiativeswhichrecogniseolderwomenare
muchmorereliantonpublictransportandmorelikelytoreportdifficultiesaccessinglocal
services.Initiativesusuallyconcentratedonthoseatlowormoderaterisk.Supportwasalso
focusedonsomeminorityethnicgroups,oldermenaswellaswomen,andruralcommunities
aswellasinner-cityneighbourhoods.
OtherpositivefindingsfromDaly(2009)includebetterinter-agencyworkingwhichhasled
tosingleaccesspointsforservices,servicegapsbeingfilledandsomeworkingwithprivate
carehomes(forexampletoinstallexerciseequipment).Thesefindingsfocusmoreupon
inputsthanevidenceofoutcomes,oraclearviewofthepathwaysthatmightlinkthem.We
areleftwiththeimpressionofmuchgood,innovativeworktakingplace,butitremains
unclearwhysomeapproachesweremoreeffectivethanothers.
Abusiness-caseassessmentoftheLAPpilots(citedinHMGovernment2009)showed
substantialaddedvalueusingreturnoninvestmentmeasuresforspecificelementsincluding
homeadaptationsandhomesecurityimprovements.Theseservicesmorethancoveredtheir
costs.Afurtherreport(WillisandDalziel2009)analysedhowtherangeofLAPinitiatives
contributetoaframeworkforcapacity-building.Itconsideredtheevidencefrompilotsites
acrosstendimensions,includingenhancedstaffskillsresultinginbetterwaysofworking
withinexistingservices;efficiencygainsthroughreducedduplication;holisticviewsofolder
people’squalityoflifeleadingtoperson-centredapproachestocommissioning;and
multipliereffectswhereolderpeoplehavebeenengagedinpolicydevelopmentandservice
design.Theauthorsconclude:
ThereisemergingevidencethattheworkofLAPpilotsisfosteringa
radicalchangeawayfromtraditionalneedsorservice-centred
approachestowardsstrategiccommissioningfoundedonapeople-
centredapproach.Thefocusofsuchworkisonimproving
outcomes...andnotsimplyensuringimprovedaccess,integrationor
partnershipworking. (WillisandDalziel2009)
Thisisahopefulassessment.Althoughtheremaybeadegreeofover-claimingthesuccess
oftheLAPprogramme,itappearstohaveaddedmuchtoourknowledgeofpreventative
workforolderpeoplelivingatlowtomoderateriskandshowsthatlocalpartnershipworking
canshiftthefocusofservicecommissionersandprovidersontobetteroutcomes.
PartnershipforOlderPeople’sProjects(POPP)
LedbytheDepartmentofHealth(DH)inEngland,thePartnershipsforOlderPeople’s
Projects(POPP)bringsafocusonearlyinterventiontohealthandcareinthecommunity.
TheunderlyingaimofPOPPis:
Tocreateasustainableshiftinresourcesandcultureawayfromthe
focusoninstitutionalandhospital-basedcrisiscare,towardsearlierand
bettertargetedinterventionsforolderpeoplewithincommunity
settings. (PSSRU2008)
Thefindingsdiscussedherearedrawnfromaninterimevaluationoftheperiod2006–08
(PSSRU2008;afinalreportofthenationalevaluationisduethisautumn).Itfoundthat
almost100,000peoplehadreceivedaservicevia470projectsin29locationsacross
England.8
•Sevenoutoftenprojects(71percent)werefoundtoofferuniversalservicesaimedat
allolderpeopleandtheircarers.Theseincludedhandymanschemes,gardening,
shopping,leisureandsignposting–suggestingoverlapwithLAPthoughindifferent
locations.
•Aboutoneinsevenprojects(14percent)offeredadditionalsupporttoolderpeople
atriskofhospitaladmission(forexample,medicinesmanagement,fallsprevention
andtelecareservices).
•Asmallernumber(8percent)providedspecialistsupporttothoseatseriousriskof
imminenthospitaladmission,including‘hospitalathome’andintensivesupport
teams.
•Afurther7percentofprojectswerefocusedoncapacity-buildingratherthanservice
delivery,coveringstafftrainingandneedsmapping.
POPPappearstohavebeensuccessfulinreachingtheolderold:almosttwo-thirdsofservice
userswereagedover75andalmostone-thirdwereagedover85.Preventativeandearly
8.MostwereduetocompletepilotworkbyMarch2009.
interventionworkcanoccuratvariousstagesofolderagesincethetriggerpointsfor
escalatingneed,illhealthorfrailtyoccuratvaryingtimes.Successseemstohavebeenmixed
intermsofengagingolderpeople:almosthalfthepeopleinvolvedinservicedeliverywere
themselvesoldervolunteers,andinaquarterofcasesolderpeopleweretrainedto
undertakeresearch,thoughmorecommonlyforvoluntaryorganisationsspeakingonbehalf
ofolderpeopleratherthanengagingwithotherswhodonotusuallygetinvolved.
TheimpactofPOPPwasassessedagainstfivecriteria(PSSRU2008).Keyfindingswere:
•Cost-effectiveness:Pilotsiteshadacleareffectonreducinghospitalemergency
admissionscomparedwith‘control’locations.Forevery£1spent,anaverageof73p
wassavedonthemonthlycostofemergencyhospitalbed-days.9 Onthismeasure,
POPPinitiativescameclosetopayingforthemselves.Theauthorsnotethatthistype
ofcost-effectivenessneedstobecomparedwithbeneficialoutcomestoolderpeople.
Therewouldbelittlepointinreducingtheuseofacutehealthcareifcaseswere
merelydeferredandpresentedtohospitalsinamoreseverestate.
•Serviceusechange:Savingsfromtherebeingfewerovernightstaysinhospitalwere
foundtosignificantlyoutweighthecostofgreateruseofprimarycareandhome
servicessuchasmealsonwheels,socialworkandcommunitynurses.Anetaverage
savingof£410perpersonwasestimated.
• Qualityoflife:Projectsappearedtohaveapositiveeffectonqualityoflife
perceptions,includinghealth-relatedqualityoflife(forexample,bettermobility,less
anxietyandpain).Evenontheleastfavourableassumptions,costsrelatedtothese
benefitswereestimatedtobeone-thirdbelowtherecognisedthreshold.
• Culturalchange:Projectsaimedtochangeworkingculturesinhealthandcareaswell
asshiftingresourcesintothecommunity.Theevaluationauthorsnotedthatgreater
localfocusonpreventativeservicestoimprovewell-beinghas‘reinvigoratedlocality
workingwitholderpeopletoidentifyneedsandinformcommissioningprocesses’.
Projectswerethoughttohaveacceleratedjointcommissioninginhealthandsocial
care,especiallypartnershipsbetweencouncilsandthevoluntarysector.Butreformsto
PrimaryCareTrustsandthelackoffullinvolvementofGPsremainedobstacles.
•Sustainability:Long-termservicereformwillrelyontherebeingsavingsfrom
acute/residentialcareandmainstreamingsuccessfulPOPPapproaches.Itispromising
thatjust4percentofprojectssaidtheydidnotintendtocontinuetheservice
followingtheendofDHfunding.However,themainbarrierwasprojectsbeingunable
tocapturesavingsfromacuteservices.Onthismeasure,POPPwasnomore
successfulthanearlierapproaches.11
Inspiteofthegoodpracticeandsavingsidentified,itappearsthatthepainstakingworkof
partnershiponlygetsussofarbeforefailingtomoveresourcesintopreventioninthe
community.Abolderconclusionisthatintegrationofhealthandcareservicesintoasingle
agencyisrequiredifresourcedecision-makingistobecometrulyresponsiveinanageing
society.
Lookingahead,theauthorsconcludethatcommissioningshouldfocusonvalueformoney
andreturnoninvestment.Someinterventionswillproducenetsavingsandotherswill
improvequalityoflifeatanetcost.Whileitishardtomeasuretheimpactoflow-level
preventativeservices,betterestimatescanbemadeusingmoreappropriatesurveyand
interviewmethodswithpeopleatdifferentstagesofoldage.
9.Theassumedcostwas£120perday.
10.Thisfindingistrueattheinterimstage.Findingsfromthefinalevaluationmaydiffer.
Advocacy,scrutinyandinvolvement
TheestablishmentofaUKAdvisoryForumonAgeingwasannouncedbyDWPinFebruary
2009(HMGovernment2009).ItwillworkwiththeUKGovernmenttoidentifyadditional
stepstoimprovewell-beingandindependenceinlaterlife.TheForumwillincludeMinisters
fromthedevolvednationsandofficialsfromtheEnglishregionsaswellasthirdsector
stakeholders.TheUKGovernmentwillreportonprogresstowardsachievingthevisionset
outinitsrecentageingstrategy(HMGovernment2009)toaCabinetCommitteeonAgeing
andtothisnewForum.AtthisstageitisnotclearhowfarthenewForumwillplayascrutiny
oraccountabilityroleasdistinctfromanadvisoryrole.Itdoes,however,havethepotential
toserveasavaluablemeansoflearningpolicyandpracticelessonsbetweenthefour
countriesoftheUK.
Intermsofadvocacy,theUKGovernmentappointedaVoiceofOlderPeople,DameJoan
Bakewell,inNovember2008.TheVoiceofOlderPeopleisindependentfromgovernment,
servingasaninformedadvocateonissuesthataffectolderpeople’slivesacrosstheUK.One
aimistoraisetheprofileofageequalityissuesandencouragepublicdebate,particularlyas
theEqualityBillprogressesthroughParliament,aswellasgivingviewsonotherkeypolicies.
TheroleisdescribedasuniquewithinGovernment.Itmaybeusefulintermsofraising
awarenessandinfluencingdebate,butrepresentsadifferentapproachfromthe
CommissionerandAdvocaterolesestablishedinWalesandNorthernIrelandrespectively
(discussedlater).TheWelshrole,inparticular,appearstooffermorescopetohold
governmentandpublicserviceproviderstoaccount.
Summingup
Theapproachestopreventativeworkingdiscussedherearerelativelymodestinscopeyet
interimevaluationspointtotherebeingsomeveryeffectivepracticethatcannowbe
consolidated.Someoftheinitiativeshavebrokennewgroundincommissioning,
engagementwitholderpeopleandcapacity-building.Theyaregood,andsometimesbetter
thanthat,asfarastheygo.TheTreasuryaswellastheDWPandDHwillwanttoretaina
long-terminterestinsuchapproaches.Butitislessclearhowtomakethedocumented
positivechangesstickinthelongerterm–notably,howtocapturebudgetsavingsinthe
NHSforinvestmentincommunityservices.TheCommunityHealth&CarePartnerships
(CHCP)modelinScotlandincorporatestwoorganisationalcultureswithinstatutory
partnerships,buteventhisissomewayremovedfromhavingasinglesetofobjectivesand
resourcestodeployforolderpeople’shealthandsocialcare.
Justlikechangingoutdatedattitudesinsocietyasawhole,thechallengehereisoneof
culturalproportions– itinvolveschangingtheworkingcultureofhealthandcareservices,
theassumptionsandworkingpracticesapplyiedacrosswholesystems.Noamountofgood
partnershipworklookslikelytodeliverthekindofintegratedplanningandresource
flexibilityneeded.Itishardtoescapetheconclusionthatasingleagencyspanninghealth
andcareservicesisthemodelmostlikelytoachievethis.
Inthesectionsthatfollowwegoontolookatdevolutionandolderpeople’spolicy.Weask:
tenyearsafterthebeginningofdevolution,whatdifferencehastheprocessmadeto
policymakingforolderpeople?
4.Devolutionandolderpeople’spolicy:Scotland
Since1999ScottishadministrationshavedivergedfromtheUKgovernmentonarangeof
policies,aswasanticipatedwhenthedevolutionprocessbegan.Atthesametime,therehas
beenahighdegreeofcontinuitybetweenEnglishandScottishpoliciesonhealth,andon
welfareduetobenefitsandemploymentpolicybeingreservedtotheUKlevel.Itisnotable,
therefore,thattheclearestpointofdivergenceinthefirstdecadeofdevolutionlayatthe
intersectionofhealthandwelfarepolicy:freepersonalandnursingcareforolderpeople.
ItappearsthatScotlandhasmadesignificantprogressinaddressingsomeofthekeyissues
facingolderpeople.AmongthefinalactsoftheLabour-LiberalDemocratcoalitionwasthe
publicationinMarch2007ofAllOurFutures:PlanningforaScotlandwithanAgeing
Population (ScottishExecutive2007).ThisstrategyhasbeencontinuedbytheSNP
Government.WhileithasbeenplacedfirmlywithintheSNP’sframeworkobjectives12,thisis
mainlyapresentationalshift:inpractice,theactionsoutlinedintheoriginaldocument
remainlargelyunchanged.So,attentionhasfocusedoncreatingthegovernanceand
consultativearchitecture.
TheAllOurFutures strategyseekstoaddresstheroleofolderpeopleinpolicyformation,
faceuptocontinuingageismanddevelopagovernancestructuretoensureolderpeople’s
viewsarecentraltofuturedecisionmaking.Thedocumentprovidesaclear,evidence-based
statementoftheissues,andhighlightssixkeythemesforthefuture:
•Improvingopportunitiesandremovingbarriers
•Forgingbetterlinksbetweenthegenerations
•Improvingandmaintaininghealthandwell-being
•Improvingcare,supportandprotectionforolderpeople
•Developinghousing,transportandplanningservices
•Offeringlearningopportunitiesthroughoutlife.
(SeeAnnex,Table2)
ResearchintoageismresultedinamajormediacampaigncalledSeetheperson,nottheage
beingruninScotlandfromJulytoSeptember2008.Buildingonpositiveresponsestothat
campaign,follow-upactivityisplannedinrecognitionofthetimerequiredtochangecultural
viewsofolderpeopleandageing.The£750,000campaignhasbeensupplementedbya
programmeofregionaleventsinplaceoftheone-offnationaleventthatwasoriginally
envisaged.Inthatsense,therhetoricofinclusionandequalityspokenbyadministrations
since1999hasbeenatleastpartlyreflectedinpractice.
Actionhasfocusedonqualityoflifeforolderpeople,throughanewentitlementtofree
personalandnursingcareforeveryoneassessedasbeinginneed,improvedcentralheating
andinsulationpackages,andreducedisolationwithfreebustravelforover-60sthroughout
Scotlandwithoutrouteortimerestrictions.Wediscussthesemeasuresbelow.
Freepersonalandnursingcare
Asusual,somedevilsaretobefoundinthedetail.Thedecisiontoproceedwiththefree
personalandnursingcarepolicywasimportantinthatitcreatedasignificantandongoing
commitmenttothewell-beingofolderpeople,regardlessoftheirabilitytopay(andwas
seeninthatlightatthetime).WiththissinglesteptheScottishParliamentdemonstratedits
willingnesstodivergefromEnglandonpolicyforolderpeople.Therelativelyswiftmove
12.ThestrategicobjectivesforScotlandare:wealthierandfairer;saferandstronger;smarter;healthier;
andgreener.
frompoliticaldebatetoimplementationledtodifficultnegotiationsbetweencentraland
localgovernmentaroundtheanticipatedcostsofcare.Localvariationsinthe
implementationofthispolicymaybeservingtomaintainoropenupnewinequalities
betweendifferentpartsofScotland.Forexample,somelocalauthoritiesusehigherneed
thresholdstomanagedemandforservices,whileothersmakeuseofwaitinglistsbothfor
assessmentofneedandtoaccessthefullrangeofservices.
Nevertheless,reviewsbyLordSutherland(ScottishGovernment2008b)andAuditScotland
(2008)foundthatoverallthepolicyhasbeenimplementedsuccessfully.Costsremain
relativelystableataround0.2percentofScottishGDP,althoughthisisexpectedtorise
from2013duetohigherratesofageing.Currentlythepolicybenefitsaround50,000people
peryearwhilethenumberofresidentsincarehomesfellby2percentfrom2000–2005,
despitetheincreasingolderpopulation.However,thereviewsalsoidentifiedafundinggap
whichresultedinanadditional£40millionbeingallocatedbytheScottishGovernmentin
2008.Inaddition,theSutherlandReviewrecommendedthataround£30millionperyearof
AttendanceAllowancewithdrawnbytheDWPfromScottishclaimantslivingincarehomes
andinreceiptofpersonalcarefundingshouldberestored.Thisisnotanissueonwhich
HolyroodandWestminsterarelikelytoagree.
TheindependentSutherlandReviewhighlightedanumberofoutcomesassociatedwiththe
policy:
•Reducedprovisionofotherhomecareservicesbylocalauthorities,suchashelpwith
cleaningorshopping,asresourcesweredivertedtonewpersonalcareobligations
•Risingcostsofresidentialcareprovision,althoughitwasnotclearifthispriceinflation
wasduetotheincreaseinrevenuesfromfreepersonalandnursingcarefundingor
otherfactors
•Anincreasedproportionofcarepackagesdeliveredathomeratherthanthroughcare
facilities;thishashelpedtokeepthetotalcostsofcaredownashomecareischeaper
thaninstitutionalcare
•Littleornoeffectonratesofinformalunpaidcarebyfamilymembers,relativesand
friends;infactthereviewsuggestedsomebenefitswerebeingseeninthe‘quality’of
informalcarewhichcannowfocusonqualityoflifeandsocialfactors,ratherthan
servicessuchasassistancewithbathingandfeeding,whicharenowcoveredinthe
statutoryservice.
Warmhousingandsupportedliving
Thefocusonwarmhousingseemstobehavingsignificantandtangibleresults.Thefirstkey
housingmeasureaimedatolderpeopleafterdevolution,theCentralHeatingProgramme
(2001),wasaimedspecificallyathouseholdswithonememberagedover60andwithnoor
brokencentralheating.Areviewin2004foundthattheprogrammehastakenthree-quarters
ofclientsoutoffuelpovertyandreducedhouseholdspendingtoachieveanacceptable
heatingstandardbyalmosthalf.ThiswasreplacedinApril2009byanEnergyAssistance
Package,includingthesamebenefitsbuttakingamoreholisticapproachintendedtoend
fuelpovertyby2016andensurewarm,dryhousingforolderpeople.
DespitetheCentralHeatingProgramme’sachievements,oneinthreehouseholds(32per
cent)headedbyapersonover75remainedinfuelpovertyin2007.Agreaterproportionof
olderowner-occupiersexperiencefuelpovertythantheirpeersinotherformsoftenancy,a
causeforconcernasowner-occupationamongolderpeopleroseby11percentbetween
1999and2005.Forthefuture,theScottishGovernmentplanstoprioritisebetteruptakeof
existingassistancepackagesandbenefitsforolderpeopleandtoofferadvicetoensureolder
people’smoneygoesfurther.Itisalsoconsideringprovisionofaloansscheme,basedon
partialequityrelease,toenableolderpeopletofundhomerepairsandadaptationstoallow
themtoremainathome.
Whenitcomestosupportedliving,therearefairlystrongindicatorstosuggestthereisgood
socialcohesionforolderpeopleinScotlandandsoneighbourhoodinitiativesarebeing
implementedinarelativelybenigncontext.Forexample,over-75saremostlikelytoregard
theirneighbourhoodasa‘verygoodplacetolive’,andtheyarealsothemostlikelyto
believethattheycancallonaneighbourforhelpifneeded(ScottishGovernment2008c).
Inthisarea,theSupportingPeopleFund,aUK-widepolicy,implementedindifferentways
bydevolvedandlocalgovernments,supportedvulnerablepeopletoremainathome,
includingolderpeopleasakeyclientgroup(representingjustunderhalfofthoseassistedin
2007–08).Overall,5percentoftheadultpopulationinScotlandreceivedsupport,risingto
14percentofpeopleaged75–84andreaching30percentforthoseaged85andover
(ScottishGovernment2008c).However,undertheconcordatbetweenlocalauthoritiesand
theScottishGovernment,thefundisnolongerring-fenced;itisnowuptolocalauthorities
todecidehowmuchtospendandhowtodeployresources.Giventheseverefinancial
pressuresnowfacingcouncils,thereisaclearriskthatthelevelofsupportpreviously
providedtovulnerableolderpeoplebythefundmaybeeroded.
Newinvestmentwasalsopledgedfor‘telecare’servicestoenableolderpeopletoremainat
homeforlonger,extendedonthebasisofasuccessfulsmall-scalepilotinWestLothian.
Theseservicesinvolvehousesbeingfittedwithavarietyofremotesensors,monitorsand
otherequipmenttoensurethatolderpeoplewerefitandwell,andtoeasetheirmovement
aroundthehouse.
Concessionarytravel
Theotherkeypublicservicepolicyspecificallyfortheover-60swastheintroductionofa
nationalconcessionaryfaresschemeonallbusservicesinScotlandatanytimeofday,
introducedin2006.Thisreplacedaraftoflocalarrangements.Thepolicywasintendedto
promoteinclusionandactivelifestyles,reduceisolation,encouragemodalshiftintransport
choicesandensureequalityofaccesstobusservicesforallolderpeople.
AreportbyTransportScotland(2009)suggestedthattheseaimshadbeenbroadlymet.It
highlightedsomemixedresultsintermsofuptake,suggestingthatthemostdeprivedmay
nothavebenefitedasmuchasotherolderpeopleonlowincomes,butoverallthescheme
appearstobenefittheleastaffluentmorethanthemostaffluent,anduseincreaseswith
age.Forexample,5percentofthoseintheirfiftieshaveaconcessionarypasscompared
with70percentofthoseaged60–64,and85percentofthoseaged65andover.Over
four-fifthsofthoseaged60-plusinhouseholdswithanannualnetincomeofunder£15,000
haveabuspass,comparedto68percentofthoseinhouseholdswithover£20,000.The
reportdidhighlight,however,thathighuptakeandthesteadygrowthoftheolder
populationmeansthatthecurrentbudgetofaround£160millionperyearislikelytorise.
Scrutinyandadvocacy
ThefailuretoestablishanindependentchampionforolderpeopleinScotlandsendsanodd
signal,particularlywhensuchaposthasbeenestablishedintheotherdevolved
administrations.Elsewhere,aCommissionerorAdvocaterolehasbeenestablishedoutside
government.InScotland,responsibilityfortheseissuesissplitbetweentheCommunities
MinisterandtheMinisterforPublicHealth(who‘owns’AllOurFutures-associatedwork).A
NationalForumonAgeing(AllOurFutures ImplementationGroup)andanOlderPeople’s
ConsultativeForumweresetuptoensurestakeholderinvolvement.Aprogressreporton
implementationwasprovidedtotheScottishParliamentinDecember2008,meetinga
commitmenttoreportannually.
Theoutcomecouldhavebeendifferent.APrivateMembersBilltocreateanew
CommissionerforOlderPeoplewasfirstintroducedtotheScottishParliamentin2004(Neil
2004)butencounteredamoodinfavourofstreamliningthenumberofCommissioners,
OmbudsmenandscrutinybodiesatworkinScotland.Thecreationofanew‘umbrella’
CommissionerforEqualitiesandHumanRightsmeansthiswillbethemostlikelyhomefor
olderpeople’sissuesinfuture.
Ultimately,itmakessenseforequalitiesissuestobe‘mainstreamed’–inthiscase,forthe
diversityofolderpeople’sexperiencestobewrittenintothedesignanddeliveryofpolicies
infuture.AnintegratedEqualities&HumanRightsCommissionmarksastepinthat
direction,butageremainssomedistancefrombeingamainstreamconsideration.So,while
thecaseforseparatestrategiesforageingandolderpeopleoughttodiminishovertime,to
reduceourfocusnowrisksneglectinganumberofcriticallyimportantissues.Wecannot
assumewearereadyyet,asasociety,tomakeagea‘normal’elementofourpolicyand
practice.Forthatreason,theremaystillbeacaseforestablishingindependentrolesto
scrutinisepolicymakersandserviceproviders,holdthemtoaccountandmaintainpressure
forimprovement.
Summingup
TheScottishExecutivewas,arguably,braverthantheotherUKadministrationsinits
introductionoffreepersonalandnursingcareandarelativelymoregenerousnational
concessionarytransportfaresscheme.ButitremainstobeseenhowfutureScottish
administrationswillcopewiththeseopen-endedcommitmentsandimplementtheAllOur
Futuresstrategyaspublicspendingisreducedandtheproportionofolderpeoplecontinues
torise,alongwithservicedemands.ItisquitepossiblethattheScottishGovernmentwill
comeunderpressuretotargettheseandotherentitlementsinfuture,andthatthe
concordatwithlocalgovernmentwillseewideningvariationsinsupportservicesforolder
people.ThedraftScottishBudgetfor2010–11signalsthestartofaprocessofcuttingpublic
expenditurewhichisexpectedtolastforyears.Noneoftheolderpeoplepoliciesistargeted
atthisstagebutitishardtoseehowtheGovernmentwillmanagetoavoidhavingto
changethebasisofeligibilityforfuturerecipients.
Whileitishardtoseeanysignificantexpansionofservices,oneexceptionisanewfocuson
improvingthepositionofkinshipcarers–typicallythosewhotakeonthemaincarerrolefor
grandchildren–toensuretheyreceiveaweeklyincomeequivalenttothatreceivedbyfoster
carers.Thisputsthefocusbackonthesplitbetweenreservedanddevolvedpowerssince
directcashpaymentswouldcurrentlytriggerareductioninother(UK)means-tested
benefits.
5.Devolutionandolderpeople’spolicy:Wales
TheWelshGovernmentAssembly(WAG)’sStrategyforOlderPeopleinWalesprovidesa10-
yearcommitmenttoimprovingthepositionofolderpeople,inwhatappearstobethemost
cohesiveapproachtoolderpeopleintheUK.TheWAGisdistinctforbuildingtheMadrid
Declarationintonationalpolicy,bydrawingontheUnitedNations’PrinciplesforOlder
People:independence,participation,care,self-fulfilmentanddignity.Assumingthetaskis
complexandlong-term,toaddressdiscriminatoryattitudesaswellasbarriersarisingfrom
servicedesignanddelivery,theWelshstrategyispositiveintoneandcomprehensivein
scope,seekingtointegratemanyareasofdevolvedpolicyaswellastakingapragmatic
approachtoworkingwiththeUKGovernmentonreservedmatters.
FirstphaseoftheStrategyforOlderPeople (2003–08)
Initsfirstphase,thestrategyaimedprimarilytoincreaseawarenessofolderpeople’s
concernsandestablishprocessestosustainlong-termaction.Theapproachcentredon
engagementandparticipationofolderpeople,coupledwithpromotionofvariouspoliciesto
improvehealthandwell-being,independenceandrecognitionofolderpeople’seconomic
contribution.Italsosoughttochallengenegativeviewsassociatedwithageing.The
objectivesofthestrategywereunderpinnedbyaclearexpressionofcitizenship,withaview
totacklingdiscrimination,socialexclusion,isolationandpoverty(WelshAssembly
Government2003).
TheWAGappointedaMinisterforOlderPeopleandaNationalPartnershipForumforOlder
Peopletoadviseonpolicyandactasacommunicationchannelwitholderpeopleandtheir
representatives.Italsosupporteddevelopmentofintergenerationalpracticeresultinginthe
WelshCentreforIntergenerationalPracticeattheUniversityofGlamorganandlaunchofthe
firstaccreditedintergenerationalcourseinEuropeattheUniversityofLampeter.Butthefirst
phaseofthestrategywasmostnoteworthyforthepassageoflegislationatWestminsterand
theWelshAssemblytoappointanindependentCommissionerforOlderPeople(seebelow)–
thoughttobethefirstofitskindinEurope.
Localgovernmenthasplayedakeyroleintakingthestrategyforwardinpartnershipwith
theNHS,voluntaryandcommunitysectorsandwitholderpeople.Duringthisphase,local
authorityStrategyCoordinatorsfundedbytheWelshAssemblypromotedengagementwith
olderpeoplethroughtheestablishmentofLocal50+Forums.Eachauthoritywasexpected
toappointaChampionforOlderPeoplefromamongitscouncillors–oftenacabinet
member–topromoteolderpeople’sconcernsacrossarangeofissues.
OnestrengthoftheWelshStrategyhasbeenacommitmenttoevaluatethefirstphase,
coordinatedindependentlybytheNationalPartnershipForum,workingwithacademic
partners.Thestrategywasdescribedas‘exceptionallyimportant’andnotableforbeing
basedexplicitlyontheprincipleofequalcitizenship(citedinWelshAssemblyGovernment
2008a).Researchintothefirstphaseoffersareviewofinputs–extendedpolicyinitiatives
(forexample,freeaccesstoservices),betterintegrationofservicesandenhancedknowledge
–ratherthananyclearsenseofoutcomesyetachieved.
Thekeystrengthswereidentifiedasbeing:
•EstablishmentoftheLinkAgeWalesprogramme(workingwiththeDWP)innearlyall
partsofWales,givingolderpeopleaccesstoawiderrangeofgovernmentand
voluntaryservicesatsingleaccesspoints.ThisbuildsontheDWP’sLinkAgeprojectsin
England.Ithasplayedanimportantroleinencouragingdevelopmentofjoined-up
servicesandpromotingthetake-upofolderpeople’sentitlements
•Theprovisionoffreeswimminginlocalauthoritypoolsandleisurefacilitiesforthe
over-60s
•Supporttolocalauthoritiestodeveloptelecareservices,withconsiderablepotential
benefitstomanyolderanddisabledpeople
•Directsupporttoagencies/servicesofparticularbenefittoolderpeople,forexample,
Care&RepairCymru
•Continuedsupportforagenciesthatnurturelocalnetworksofolderpeopleand
provideavenuesfortwo-waycommunicationontheissuesaffectingthem,leadingto
adistinctincreaseinawarenessofthestrategy,characterisedbyolderpeopleasbeing
preparedtochallengethe‘oldorder’.
Theevaluationteamconsideredthatcertainissuesshouldbegivenmoreemphasisor
approachestodeliveryrevised.Threepriorityareasforfurtheractionwereidentified:
•Negativeimagesofolderpeople:TheScottishGovernment’scampaigntocombat
ageismandpromotemorepositiveimagesofolderpeoplewasconsideredauseful
precedentthatWalescouldfollow,althoughweshouldnotethatlittleisknownabout
theeffectivenessoftheScottishapproachtodate.Theevaluationalsorecommended
commissioningnewresearchonWelshattitudestowardsolderpeople.
•Socialexclusionandpoverty:Despitelevelsofpovertyinolderagefallinguntil
recently,theissueremainsacentralconcern.About115,000olderpeopleare‘very
poor’andamuchhigherrateofpovertyisexperiencedbyolderpeoplewithblackand
minorityethnicbackgroundsinWalesthanbytheirwhitecounterparts.
•Fundingofcare:TheNationalPartnershipForumexpressedconcernthatolderpeople
inWalesmustpayforawiderangeofpersonalcareservicesandrecommendedthat
theWAGsetupaninquirytogatherfurtherevidenceonthewayforwardforfunding
ofsocialcare.
Overall,theForumconcludedthattheWelshStrategyoffersacaseforchangefoundedona
moralpositionthatseesolderpeopleasequalcitizensinasocietythatfrequentlyleadsto
thembeingoverlookedandthat–becauseofageistattitudesorthewaysthatservicesare
configured–ispronetobringabouttheexclusionofmany.Withtheappointmentofa
CommissionerforOlderPeopleinWalesandnewsupportivelegislationinplace,theForum
wasoptimisticthatthepaceofchangewouldincrease.
SecondphaseoftheStrategyforOlderPeople (2008–13)
Thestrategy’ssecondphasewaspublishedinMarch2008andfocusesonaddressingolder
people’sneedsacrossallpolicyareas–so-called‘mainstreaming’(WelshAssembly
Government2008).Ithasfourcorethemes:
•Valuingolderpeople:counteringdiscrimination,developingengagementandsocial
inclusion
•Changingsociety:enhancingtheeconomicstatusandcontributionofolderpeople
•Well-beingandindependence:enhancingparticipationofolderpeopleinsocietyand
alllevelsofgovernment
•Makingithappen:implementationofthesecondphase.
(SeeAnnex,Table2)
Thebudgetis£12millionuptoApril2011,whichmarkstheendofthecurrentAssembly.A
dozenindicatorsofchangewerechoseninsixpolicyareas.Thesedonotmapneatlyonto
thestrategy’sthemes,butareclearlyrelated.Theyare:
•Socialinclusion:fearofcrime;contactwithfamilyandfriends;accesstotransport
•Materialwell-being:employmentratesuptoage65;work-relatededucation/training
forover-50s
•Activeageing:participationinanysportorleisureactivity
• Socialcare:thoseaged65-plusreceivinghelptoliveathome;thoselivinginunfitor
defectivehousing
• Healthcare:accesstohipsurgery;accesstokneesurgery
•Healthandwell-being:healthylifeexpectancyatage65-plus;disability-freeyearsat
age65-plus.
ThisrepresentsabroadersetofindicatorsthanPSA17inEnglandandtherelevantScotland
Performstargetshave.Itisnotablethatthematerialwell-beingindicatoremphasises
employmentandtrainingratherthanincreasingratesofbenefitandPensionCredittake-up
forexample,asitishardertoinfluenceemployment(areservedarea)thantraining
(devolved).ThenumbersbenefitingfromthehelpandadviceserviceNewDeal50Plusin
Waleswererelativelysmallevenduringtheyearsofeconomicgrowth.Incontrast,thereis
significantscopetoincreasetake-upofwelfarebenefitsthroughsmarteradministrationof
theUKsystem.ThespreadofLinkAgetomostifnotallauthoritiesinWalesoughtto
provideamajoropportunitytomakeabiggerdentinpovertylevelsamongolderpeople,
whichhavebeenslowertofallinWalesthanintherestofBritain.Evaluationofthesecond
phasewillneedtoidentifyoutcomesmoreclearly:tenyearsis,inanycase,afairertestof
whatdifferenceithasmade.
Improvingaccesstopublicservicesisseenasaroutetoensuringparticipationforallolder
people.Asinglesmartcardforolderpeopletocoveruseofservicessuchaslibraries,leisure
centresandlocalbusesisbeingconsideredandabusinesscasereviewofthecostsand
benefitsisunderway.AnothercommitmentintheOneWales:Aprogressiveagendaforthe
governmentofWalescoalitionagreement (WelshAssemblyGovernment2007)istoextend
freeentrytonationalmuseumsandgalleriesandgiveWelshpensionersfreeentryto
AssemblyGovernment-fundedheritagesites.
ThedevolvedTransportStrategy,OneWales:ConnectingWales (WelshAssembly
Government2008b),recognisesthataccessibilityisaboutmorethanmakingsuretransportis
availableandfreeforolderpeople.Itisalsoaboutthetiming,reliabilityandconvenienceof
publictransport,thelocationofkeyfacilities,whetherpeopleliveclosetothem,wherethey
needtotravel,andwhetherafacilitycanbeaccessedbythosewithmobilityrestrictions.It
includesmeasurestoremoveregulationsthathaveslowedthegrowthofthecommunity
transportsector.
InMay2007apilotschemewasintroducedofferingafirstforBritain:freeconcessionaryrail
travelforover-60sontworoutesinWales(ConwyValleyandHeartofWales).Passholders
livinginthefivelocalauthoritiesofConwy,Gwynedd,Carmarthenshire,PowysandSwansea
becameeligiblefortravelunderthepilotschemes.Areviewin2008extendedtheschemeto
twootherlines,butidentifiedsomeproblemsarisingfromsubsidisingtheselessbusyroutes
insummerwhileurbancommuterrouteswereinneedofgreatercapacity.Theschemewas
restrictedonsomeroutestojourneysinautumnandwinter(WelshAssemblyGovernment
2008c).
Scrutinyrole:TheCommissionerforOlderPeople
ThefirstCommissionerforOlderPeopleinWales,RuthMarks,wasappointedafteraprocess
thatinvolvedolderpeople.TheCommissioner,whoisindependent,seeksto:
•PromoteawarenessoftheinterestsofolderpeopleinWales
•Promoteprovisionofopportunitiesfor,andtheeliminationofdiscriminationagainst,
olderpeopleinWales
•EncouragegoodpracticeinthetreatmentofolderpeopleinWales
•Keepunderreviewtheadequacyandeffectivenessofthelawaffectingtheinterests
ofolderpeopleinWales.
Thisisregardedbymanyasa‘headline’commitmentwithinthe StrategyforOlderPeople.
TheCommissionerrolewillaccountfor40percentofthetotalstrategybudgetto2011(£5
million)anditwillbeimportanttoestablishaclearanddistinctsetofresponsibilities(for
example,toavoidduplicationwiththePublicServicesOmbudsmanandothercomplaints
procedures).In2009–10,theCommissioner’sofficeispreparingtoundertakethematic
reviewsofpolicyareasbasedonextensiveconsultationwitholderpeopleacrossWalesthat
hastakenplaceinthelastyear(seewww.olderpeoplewales.com).TheWelshAssembly
GovernmentsupportstheCommissionerbeingwhollyindependentfromgovernmentand
holdingit,localgovernmentandtheNHStoaccount.
ByappointinganindependentCommissionerforOlderPeopleandaDeputyMinisterfor
SocialServiceswithspecificresponsibilityintheCabinetfortheOlderPeople’sStrategy,the
Welshapproachcouldbeviewedasworkingagainsttheaimoffurtherintegrationofolder
people(EuropeanPoliciesResearchCentre2006).However,itwasfeltthatanational
championwouldbeanappropriateresponsetonegativeperceptionsofageingthatarestill
consideredprevalent.Initssecondphase,theWelshmodelseekstoachievegradual
mainstreamingviaadedicatedfocusratherthanassumingahighdegreeofreadinessto
embedolderpeople’sissuesinotherareaspolicyandpracticewhichisnotyetthere.It
standsincontrasttotheScottishapproach.
Summingup
TheWelshapproachseekstoextendsometypesofuniversalprovisionforolderpeople
furtherthantherestofBritaindoes;forexampleviaapilotconcessionaryrailfaresscheme
andextendedfreeaccesstocultureandleisurefacilities.Overall,theWelshstrategylooks
distinctlysocial-democraticandhassecuredcross-partyconsensusbeyondtheLabour-Plaid
Cymrucoalition.Itscoreshighlyintermsofremovingsomebarrierstoinclusionandmobility.
However,withamodestbudgetupto2011setagainstverytightpublicspending,question
marksareboundtoberaisedabouttheprioritythatshouldbegiventomorecostlyuniversal
approaches.
Itisunclearhowtheparticipationagendaistobewidened,toensuretheinclusionofolder
peoplewhosevoicesarelessoftenheard–thefrail,theolderold,peoplewithdementiaand
theircarers,vulnerableresidentsofcarehomes,thosewithoutadvocates.Therearelimitsto
bothrepresentativeandparticipativemodels.However,thesecondphaseofWales’sstrategy
makesacommitmenttowiderinvolvementandincreasedengagement,usingvariedwaysof
reachingtheover-50sincludinggroupsthatareseldomheard.TheWelshapproachto
advocacyandscrutiny,withtheappointmentofafully-fledgedCommissionerforOlder
People,isthemostpromisingintheUK.
Certainlytherearerisksassociatedwithmovingfromring-fencedfunding,overwhichlocal
authoritieshavesomediscretion,tofoldingresourcesintotheoverallgrantallocationfrom
2010.Doingsoraisesquestionsofwhetherlocalauthoritieswillcontinuetochampion
improvementsforolderpeople,andhowwilltheWelshAssemblyGovernmentwishto
addresslocalperformancethatlagsfarbehindthemostinnovativeauthorities.Buttheseare
questionsforgovernanceintheUKasawhole,notjustforolderpeopleinWales.
Thebigissueofwhoshouldpayforsocialcareremainstobeaddressed.Thedevolved
governmenthascommitteditselftoacomprehensivereviewoffundingrequiredforsocial
caretobecompletedbytheautumnof2009.AsstatedinOneWales,theWelshAssembly
GovernmenthasappliedforaLegislativeCompetenceOrderwhichspecifiesthemeasuresit
wishestointroducetoachievegreaterconsistencyinchargingforhomecareservices.
TheWelshapproachseemstobethemostcoherentlong-termcommitmenttoimprovingthe
positionofolderpeopleofanyadministrationintheUKinthelastdecade.Abolderpolicy
onsocialcaremayhavebeenenactedinScotland,reflectingitsgreaterlegislativepowers,
buttheWelshStrategyappearsthemostlikelyofanytoensureacontinuinghighprofilefor
olderpeople’sissuesacrossmanypolicyareasandatalocallevel.
6.Devolutionandolderpeople’spolicy:NorthernIreland
ItwouldbeunfairtojudgeprogressinNorthernIrelandagainsttheadministrationsin
mainlandBritainduetothestop-startnatureofdevolutionthere.Duringtheyearsofdirect
ruleintheprovince,UKMinisterspublishedtwostrategiesofdirectrelevancetoolder
people,AgeinginanInclusiveSociety (OfficeoftheFirstMinisterandDeputyFirstMinister
2005)andLifetimeOpportunities,theanti-povertyandsocialinclusionstrategy(ibid2006a).
GovernmentobjectivesforolderpeopleinNorthernIrelandcanbeinterpretedwithreference
toboththesedocuments.Inevitably,theyreflectamixoftheprevailingviewsinWhitehall
andconventionsamongNorthernIrelandOfficecivilservantsusedtogettingonwith
policymakingwithoutasetoflocallegislatorsandscrutineers.Theconsultationprocesses
underpinningthedocuments,aswellassomeoftheproposals,wereconsidered
unsatisfactorybyasizeableproportionofvoluntarysectorstakeholderswhoresponded.In
retrospect,thestrategiescanbeseenasdraftstatementsofintent.Theydidinformaction,
buttheywerealwaysgoingtobedependentontheviewsofincomingMinisterswhen
devolutionresumed.
AimsandactionsofNorthernIreland’sageingstrategy
Thecoreaimoftheageingstrategyis:
Toensurethatagerelatedpoliciesandpracticescreateanenabling
environment,whichofferseveryonetheopportunitytomakeinformed
choicessothattheymaypursuehealthy,activeandpositiveageing.
(OFMDFM2005)
AnAnnualReportonprogresswithimplementingthestrategywaspublishedforthefirst
yearinMarch2006,butnotsince(OFMDFM2006b)andisamorehelpfulstatementof
intentthanthestrategyitself,sinceitoffersamoredetailedaccountofobjectivesandpolicy
approaches.Sixpriorityobjectiveswereset:
•Ensureolderpeoplehaveaccesstofinancialandeconomicresourcestoliftthemout
ofexclusionandisolation
•Deliverintegratedservicestoimprovethehealthandqualityoflifeofolderpeople
•Ensureolderpeoplehaveaccesstotheservicesandfacilitiesthatmeettheirneeds
andpriorities
•Ensureolderpeoplehaveadecentandsecurelifeintheirhomeandcommunity
•Promoteequalityofopportunityforolderpeopleandtheirfullparticipationincivic
life,andchallengeageismwhereveritisfound
•Ensurethatgovernmentworksinacoordinatedwaybetweendepartmentsandwith
socialpartnerstodelivereffectiveservicesforolderpeople.
(SeeAnnex,Table2)
Proposedactionsinclude:
•Addressingisolationamongolderpeoplelivinginremoteandruralareas,whofacethe
highestratesofpovertyamongolderpeopleinNorthernIreland,2.5timesthelevelin
Belfast.‘Sociallynecessarytransportservices’wouldbeprovidedthroughrural
communitytransportpartnerships
•Preventingunnecessaryhospitaladmissions,promotingtimelydischargeand
independentlivingandincreasingtheproportionofpeoplewhohavetheircaremetin
theirownhomes
•ContinuingtheNorthernIrelandConcessionaryFaresSchemewhichprovidesfree
publictransportservicestothoseaged65andover13,expandingthedoor-to-door
transportprogrammeforpeoplewithdisabilitiesinurbanareasandaddressingbarriers
thatdiscourageolderpeoplefromusingtransportservicesavailabletothem
•Supportingregularvisits,bookexchangesandamobilelibraryserviceinresidential
andnursinghomesandhospitals.(Thisseeminglymodestproposalisasignof
innovativethinking:suchactivitytakesplaceinsomehealthandcaresettings,butis
oftenanafter-thought)
•CitizenshipeducationintheNorthernIrelandcurriculumincludingafocusoninter-
generationallearning.14
SincetheNorthernIrelandAssemblywaselectedin2007,thevoluntarysectorhasexpressed
frustrationattheslowrateofprogressontacklingpovertycomparedwithotherareasof
policy.Itappearsthisisnowbeingaddressed.However,asignificantopportunitycostmay
havebeenpaid,sincetheprospectsfortacklingpovertyamongolderpeopleappearmuch
tougherforthenextfiveyearsthantheywereinthelast.Ontheotherhand,Northern
Irelandmayhaveconsiderablepotentialformakingprogressonpolicyforolderpeople.
BecauselocalgovernmenttherehastraditionallybeenweakerthaninGreatBritain,a
thrivingvoluntaryandcommunitysectorcouldmakeabigimpactinNorthernIrelandifthe
devolvedgovernmentmadeacommitmenttoimplementAgeinginanInclusiveSociety.The
riskisthatengagementaroundthestrategygetsstuckatthelevelofrepresentative
involvement,ratherthan‘drillingdown’toreacholderpeoplewhosediverseexperiences
mightotherwisebelost.
Fromadvocatetocommissioner
NorthernIrelandhasfollowedWalesinestablishinganindependentchampionforolder
people’sissues.InNovember2007,theOfficeoftheFirstMinisterandDeputyFirstMinister
(OFMDFM)commissionedareviewofthecaseforaCommissionerforOlderPeoplein
NorthernIreland.Thiswasfollowedbyconsultationonproposalsforlegislation.Anew
interimroleofOlderPeople’sAdvocatewasappointedinDecember2008,currentlyfilledby
DameJoanHarbison,sponsoredbytheOFMDFMEquality,RightsandSocialNeedDivision.
TheAdvocate’sobjectivesareto:
•Facilitatepublicconsultationeventsonherrole,remitandpowers
•Provideafocusforindividualolderpeopleandrepresentativegroupsfromthe
voluntaryandcommunitysectortohighlightissuesthatareofconcernforolder
people
•BringtheseissuesandconcernstotheattentionoftheJuniorMinistersinthe
OFMDFM
•ProvideMinisterswithanalysisbasedontheviewsofthevoluntaryandcommunity
sectoroftheimpactandpracticalworkingsofpoliciesandstrategiesaimedatolder
people.
TheOlderPeople’sAdvocatehasnostatutorypowerstohelpsupportandfulfilthecurrent
role.Rather,itoffersafeedbackandtransmissionrouteintogovernmentforolderpeople’s
concerns.Thisinterimmeasure,inplaceuntilthelegislationtoestablishaCommissionerfor
13.Itisestimatedthat44percentofallpeopleaged65-plususedtheirSeniorSmartPassesatleastonce
in2005–06.
14.ThestrategydocumentnotedthataNorthernIrelandIntergenerationalSteeringGrouphadbeen
establishedwithAgeConcernandYouthCouncilinNorthernIrelandasleadpartners.Itsremitwasto
promotepositivelinksbetweenschoolsandolderpeoplebydevelopingprogrammesinmuseumsand
schools.
olderpeoplecomesintoplay,focusesonadvocacyratherthanscrutinyandisclosertothe
EnglishandUK‘VoiceforOlderPeople’thantheWelshCommissioner.However,theOlder
People’sAdvocatehasestablishedanumberofthematicworkinggroupsbringingtogether
publicandvoluntarysectoragencies,aswellasengagingwithprovidersofessentialservices
regardingthebarriersfacedbyolderpeople.EvenwiththismorelimitedrolethaninWales,
anindependentfocusaddssignificantvaluetotheolderpeople’sagendabeyondgiving
responsibilitysolelytoaNorthernIrelandExecutiveMinister–orthestatusquoante ofaUK
Ministerandseniorcivilservantasin-house‘champions’.
AdraftbillandconsultationpaperwaspublishedinOctober2009,ontheroleandremitofa
CommissionerforOlderPeopleinNorthernIrelandwitharangeofstatutorypowers
includinginvestigation.TheprocessofconsultationwillbecompletedbyDecember2009
andtheconsequentlegislativeprocessisduetocompletebeforethenextNorthernIreland
electionsin2011.ThiswillbringNorthernIrelandcloselyintolinewithWales,leaving
ScotlandastheonlypartoftheUKwithoutadedicatedroleforolderpeople’sissues.
Anti-povertyandsocialinclusionstrategy:oldercitizens
NofurtherAnnualReportsonAgeinginanInclusiveSocietyhavebeenpublishedsince
devolutionresumedin2007,givingtheimpressionthatprogresshasstalled.However,in
2006ananti-povertyandsocialinclusionstrategywaspublishedbytheUKSecretaryof
State,LifetimeOpportunities.TheNorthernIrelandExecutiveagreedtoadoptthisaspolicy
inNovember2008,althoughitremainstooearlytogaugewhichpolicyprioritieswillemerge.
Thestrategytakesalife-courseapproachfamiliarinUKGovernmentsocialinclusionreports
inthelastdecade,includingasectiononoldercitizens.Theprimarygoalofthestrategyasit
affectsolderpeopleis:
Toensureolderpeoplearevaluedandrespected,remainindependent,
participateasactivecitizensandenjoyagoodqualityoflifeinasafe
andsharedcommunity. (OFMDFM2006a)
WhiletherateofpovertyamongolderpeoplehasfalleninNorthernIreland,thestrategyis
clearthatprogresshasnotbeensufficient.ACentralAnti-PovertyUnitbriefingnoteon
indicatorsofsocialchangeinNorthernIreland(OFMDFM2006c)notedthatoneinfive
pensioners(21percent)livedinpovertyin2004–05.Theratevariedbetween12percentin
BelfastMetropolitanUrbanAreaand33percentinruralareas.
Theanti-povertystrategysetsevenobjectives(mostlyto2020–25)towardsthisgoalfor
olderpeople,including:reducingthelifeexpectancygapbetweentheone-fifthmost
deprivedareasandtheaverage;maximumuptakeofeligibilitytopensionsandbenefits;
decent,warmandsecurehousingforallpensioners;accesstoarangeofsupportservices,
socialnetworks,culturalandsportingactivities;andimprovedaccesstoruraltransport.
Amongtheactionsapplyingtoolderpeopleinparticularwere:
•AbenefituptakeprogrammeledbytheSocialSecurityAgencyinpartnershipwiththe
independentadvicesector:fourbenefituptakeexerciseswereprimarilyaimedat
around20,000olderpeople(two-thirdsofthemwomen)targetedforassessmentand
helpwithclaiming
•Anenablingpowerinstatedinlegislationtoallowpensionerstochoosetodeferrate
paymentsovertheirlifetime.ThestrategystateditislefttoafutureExecutivetouse
thepoweriftheywish
•PlansforanAllIrelandFreeTravelSchemeextendingeligibilitytotravelinthe
RepublicofIreland.
ThisaddsuptoanagendathatwouldbefamiliarelsewhereintheUK,notsurprisingsinceit
waspreparedbeforethedevolvedExecutiveandAssemblywererestored.However,itis
worthnotingthatNorthernIrelandhasamodestpowertovarysocialsecuritylawspriorto
devolution,whichallowsforsomedivergencefromGreatBritain.Noplanshavebeenput
forwardbyMinisterstousethemtodate.
TheNorthernIrelandExecutiveagreedtoadoptLifetimeOpportunitiesaspolicyin
November2008,althoughitremainstooearlytogaugewhichpolicyprioritieswillemerge.
JuniorMinisterJeffreyDonaldsonannouncedinJanuary2009thataMinister-ledAnti
Poverty&SocialInclusionForumwouldbeestablishedtooverseetheprocessandmonitor
progresswithstakeholders(NICVA2009).
Summingup
ProgressindevelopingdistinctivepoliciesforolderpeoplehasbeenlessclearinNorthern
Ireland.Thisreflectsthefalteringstarttodevolution.Strategiesonageingandtackling
povertyamongolderpeopleweredevelopedbyUKMinistersduringperiodsofdirectrule.
ThesewereclearlyconsistentwithUKGovernmentapproaches,spanningincome
maximisation,transportaccessibilityandindependentlivinginthecommunity,aswellas
reflectingtheneedtoaddresshigherlevelsofpovertyamongolderpeopleinruralareas.Itis
onlysincetheelectionoftheNorthernIrelandAssemblyin2007thattrendsindevolved
policycanbemeasured.Sincethen,takingforwardthetwostrategiesconsideredhere
appearstohavebeenalowpriority.However,ministerialcommitmenttothestrategiesrose
during2009andafairertestofNorthernIreland’sapproachtoolderpeoplecanbemadeby
theendoftheAssembly’scurrenttermin2011.
Limitedprogressatastrategicleveldoesnotmeanearlyobjectivesweresetaside.An
interimOlderPeople’sAdvocatewasestablished,tobefollowedbyafully-fledged
Commissionerroleby2011.Onthismeasure,NorthernIrelandwilljoinWalesashavingthe
mostadvancedpowersofinquiryandscrutinyonbehalfofolderpeopleintheUK,and
perhapstheEU.Inaddition,adeterminedfocusonraisingthetake-upofolderpeople’s
entitlementshasledtoasignificantlyhigherrateofPensionCreditclaimsthaninBritain.
7.Conclusion
Inthelastdecadesustainedprogresshasbeenmadeinreducingpovertyinolderage,
althoughthishasstalledsince2005andhasevenreversedinsomepartsoftheUK.Policies
totacklepovertyhavebeenledprimarilybytheUKGovernment,spanningtargeted
measurestoboostlowincomessuchasPensionCreditaswellasuniversalpaymentsto
addresstheimpactofhigherfuelcostsanduniversalmeasuresfortheolderold(for
example,freeTVlicencesfortheover-75sandahigherWinterFuelAllowancefortheover-
80s).Thedevolvedadministrationshavefewpowerstoactdirectlyinthisarea,butthey
havetakenstepstoreducecostsassociatedwithpublictransportandwarmhousing.
OnesignificantdevelopmentistheentitlementtofreepersonalandnursingcareinScotland.
Apartfromthis,variationsinpolicieshavebeenmodest:theageofentitlementtoafreebus
passis65inNorthernIrelandbut60intherestoftheUK.Travelonanyrouteatanytimeis
permittedinScotland,butrestrictedtooff-peakjourneyselsewhere.Concessionaryrailtravel
hasbeenpilotedinpartsofWalesandconcessionarytravelintotheRepublicofIrelandhas
beenproposedinNorthernIreland.Freeswimmingfortheover-60s(EnglandandWales)
andaccesstoculturalfacilities(Wales)havebeenintroducedmorerecently.Localauthorities
mayalsodecidetoreduceorremovecostsforolderpeople.Finally,despitespeculation
abouttightereligibilityruleswithincentralheatingprogrammes,thebasisofentitlementhas
remainedthesameorbecomerelativelymoregenerousinthecaseofScotland.
Whatdifferencehasdevolutionmade?
Itisimportanttonotethatalthoughpolicyvariationsaremostlymodest,implementation
mayvarysubstantiallyespeciallygiventhedifferentstrategiesandmethodsforscrutiny.This
meansthatitisstilltooearlytoassesswhatdifferencedevolutionhasmadetooutcomesfor
olderpeopleasawhole.Weknowquitealotabouttheobjectivesofvariouspoliciesbutnot
enoughabouttheirimpact.
Nonetheless,strengthscanbeidentifiedineachcountryoftheUK.Somegenuinely
innovativepartnershipsaroundpreventativeworkatthehealth/careinterfaceinthe
communityhavedevelopedinvariouspilotlocationsacrossEngland.Waleshasdevelopeda
comprehensiveStrategyforOlderPeople spanningtenyears,rootedinaclearstatementof
citizenship.Itsstrengthliesinitsfuturepotentialratherthanhavingdeliveredclear
outcomestodate,butWalesappearstobeparticularlywellplacedtomakethemostofits
devolvedpowers.
Scotlandhasmoreextensivepowerstolegislateandmadetheboldestmoveofallin
extendingfreepersonalandnursingcaretoallolderpeopleassessedasbeinginneed–
removingproblemssometimesassociatedwithmeans-testinglikeinefficiency,lowuptake,
perverseincentivesand,forsome,indignity,whileextendingbenefitstothosewhowould
previouslyhavebeenrequiredtopay.Yetthereisnowlesssenseofmomentumforolder
people’sissuesinScotland.NorthernIrelandis,inmanyways,justgettingstartedbuteven
hereaclearfocusonincreasingtheuptakeofPensionCredithasledtoimpressiveresults.
Moresignificantly,therapidlychangingenvironmentforpublicfinancescreatesconsiderable
uncertaintyaboutfuturepledges.ThedraftScottishBudgetfor2010–11signalsthestartof
aprocessofcuttingpublicexpenditurewhichisexpectedtolastforyears.Policiesforolder
peoplearenottargetedexplicitlyatthisstage,butitishardtoseehowgovernmentswill
managetoavoidchangingthebasisofentitlementforfuturerecipients.
Differentapproachestoadvocacyandscrutinyonbehalfofolderpeoplehavebeentaken.
TheCommissionerforOlderPeopleinWalesappearstorepresentthemostadvanced
‘independentchampion’modelintheUK.NorthernIrelandhasestablishedaninterimOlder
People’sAdvocatewhichcurrentlyhasnostatutorypowers,tobefollowedbyafully-fledged
Commissionerroleby2011.TheUKGovernmenthasappointedanindependentVoiceof
OlderPeoplewhowillraiseissuesofconcernforEnglandaswellasUK-wideissues.Scotland
isaloneinhavingnosuchdedicatedrole.
Intermsofstructuresforparticipation,variousconsultativeforumsandadvisorypanelshave
beenestablished,usuallyinvolvingolderpeople’srepresentativesalongsidestatutoryand
voluntaryserviceproviders.Theemphasisisonstakeholderinclusionanddialogue.However,
withoutgreaterclarityontheirscrutinyandaccountabilityroles,itishardertoseehowtheir
impactwillbedemonstrated.
Overall,thebulkofpolicieshaseitherputmoremoneyintothepocketsofolderpeopleor
reducedthecostofusingservices.Thisislikelytohavesomeclearbenefitsintermsof
inclusion,independenceandwell-being.Butitisdoubtfulthatwewillseemuchmorealong
theselinesinthenextdecade,andquitepossiblethatcurrenteligibilitywillcomeunder
scrutinywithinanultra-tightpublicspendingenvironment.Ifagesofentitlementareto
change,orsomeelementofco-paymentintroducedinplaceoffreeaccess,itisessential
thatthisisdoneonthebasisofrigorousimpactassessment.Thefirstpriorityshouldbeto
ensurethattheoldest,poorestandmostvulnerableolderpeoplearenotdisadvantaged.
Athoroughreformagendaforolderpeoplehasbeenmappedoutbythirdsector
organisationsinrecentyears,mostrecentlyintheOneVoice reportfromAgeConcernand
HelpTheAged(2009).Thesinglemostsignificantissueisreformingthecostsandqualityof
socialcare,thesubjectofvariousinquiriesandreviewsbutoneinwhichtherehasbeenlittle
progressinEnglandsince1997.InsteadofrestatingtheconclusionsinOneVoice,whichwe
largelysupport,thefinalreportinippr’sPoliticsofAgeingproject(forthcoming2009)will
identifycross-cuttingthemeswhichwebelieveshouldbeaddressedurgentlyandcreatively
inordertoachieveabreakthroughinolderpeople’swell-being.Thesewillhighlight
challengescommontoallpartsoftheUK.Devolutionoffersscopetotakedifferent
approachestothesechallenges.
Lookingahead,comparativeanalysiscouldbehelpedbygreatercollaborationbetweenthe
fourgovernmentsoftheUKandbetweenresearcherswhomoreoftenlookinternationally
ratherthancross-countrywithintheUK.TheestablishmentofaUKAdvisoryForumon
Ageing,involvingthedevolvedadministrationsaswellastheEnglishRegions,presentsan
opportunitytoimproveourknowledge.Furtherdivergenceinpoliciesforolderpeopleis
likely,butifmorecross-countrysharingofpolicyandpracticeoccurswemightalsofind
examplesofre-convergenceasonecountry’sexperienceinfluencesanother.
References
AgeConcernandHelpTheAged(2009)OneVoice:Shapingourageingsociety London:AgeConcern
andHelpTheAged
AllenJ(2008) OlderPeopleandWellbeing,London:ippr,availableat
www.ippr.org.uk/publicationsandreports/publication.asp?id=620
AuditScotland(2008)Areviewoffreepersonalandnursingcare,Edinburgh:AuditScotland
BellD(2009,forthcoming)Howhasdevolutionaffectedtheprovisionoflong-termcareintheUK?
York:JosephRowntreeFoundation
DalyG(2009)LinkAgePlus:Benefitsforolderpeople,ResearchReport554,London:Departmentfor
WorkandPensions
DepartmentofHealth(DH)(2007)PuttingPeopleFirst:Asharedvisionandcommitmenttothe
transformationofadultsocialcare, London:DepartmentofHealth
DepartmentofHealth(2008)Carersattheheartof21stcenturyfamiliesandcommunities:Acaring
systemonyourside.Alifeofyourown, London:DepartmentofHealth
DepartmentforWorkandPensions(DWP)(2009)OpportunityAgeIndicators:2008update,London:
DepartmentforWorkandPensions,OlderPeopleandAgeingSocietyDivision.
EuropeanPoliciesResearchCentre(EPRC)(2006)RegionsforAllAges:Theimplicationsof
demographicageingforregionalpolicy,FinalReport Glasgow:UniversityofStrathclyde
GovernmentEqualitiesOffice(2009)Creatinganage-friendlysociety(Factsheet),London:
GovernmentEqualitiesOffice,availableatwww.equalities.gov.uk/pdf/age%20fact%20sheet.pdf
HMGovernment(2009) Buildingasocietyforallages,DepartmentforWorkandPensions,London:
TheStationeryOffice
HMGovernment(2009)Buildingasocietyforallages,Cm7655,DepartmentforWorkandPensions,
London:TheStationeryOffice
IndividualBudgetsEvaluationNetwork(2008)EvaluationoftheIndividualBudgetsPilotProgramme:
SummaryReport,York:SocialPolicyResearchUnit,UniversityofYork
MoullinS(2008)JustCare?Afreshapproachtoadultservices,London:ippr,availableat
www.ippr.org.uk/publicationsandreports/publication.asp?id=605
NeilA(2004)CommissionerforOlderPeople(Scotland)BillConsultationPaper,Edinburgh:Scottish
Parliament
NorthernIrelandCouncilforVoluntaryAction(2009)‘Anti-Povertystrategyadopted’,newsrelease,
29January,availableatwww.nicva.org/index.cfm/section/News/key/290109-anti-poverty-
strategy
NorthernIrelandExecutive(2008)‘PensioncredituptakeatalltimehighsaysMargaretRitchie’,
DepartmentforSocialDevelopmentNewsRelease,25February
OfficeoftheFirstMinisterandDeputyFirstMinister(OFMDFM)(2005)AgeinginanInclusive
Society:Promotingtheinclusionofolderpeoplestrategy,Belfast:OFMDFM
OfficeoftheFirstMinisterandDeputyFirstMinister(OFMDFM)(2006a)LifetimeOpportunities:
Government’santi-povertyandsocialinclusionstrategyforNorthernIreland, Belfast:OFMDFM
OfficeoftheFirstMinisterandDeputyFirstMinister(OFMDFM)(2006b)AgeinginanInclusive
Society:2005-06AnnualReport atMarch2006,Belfast:OFMDFM
OfficeoftheFirstMinisterandDeputyFirstMinister(OFMDFM)(2006c)IndicatorsofSocialChange,
CentralAnti-PovertyUnit,Belfast:OFMDFM
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JosephRowntreeFoundation(unpublished)
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People’sProjects:InterimReportofProgress, Canterbury:PSSRU,UniversityofKent
RiddellS,PriestlyM,PearsonC,MercerG,BarnesC,JollyDandWilliamsV(2006)DisabledPeople
andDirectPayments:AUKComparativeStudy, Leeds:ESRC/LeedsUniversity
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Edinburgh:ScottishExecutive
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Framework,Edinburgh:ScottishGovernment
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reportbyLordSutherland, Edinburgh:ScottishGovernment
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HouseholdSurvey,Edinburgh:ScottishGovernment
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Annex
1.GovernmentOfficeRegionsinEngland:Populationprojectionsage65-plus
Year North North Yorks East West East London South South
East West &Humber Midlands Midlands East West
2007 16.9% 16.2% 16.0% 16.2% 16.4% 16.8% 11.6% 16.5% 18.8%
2011 17.5% 16.8% 16.5% 17.2% 17.3% 17.7% 11.4% 17.4% 19.8%
2021 20.6% 19.3% 18.6% 19.9% 19.7% 20.3% 12.1% 20.1% 22.6%
2031 24.1%
2.StrategiesforageingandolderpeopleacrosstheUK
22.3% 21.1% 23.0% 22.4% 23.2% 14.1% 23.2% 25.7%
Change +42.6% +37.6% +31.9% +42.0% +36.6% +38.1% +21.5% +40.6% +36.7%
Source:OfficeforNationalStatisticsEnglandprojectionsGovernmentOfficeRegions2006,basedfromUKNationalStatistics
36
England/UK Scotland Wales NorthernIreland

Nameof BuildingaSocietyForAllAges AllOurFutures(2007) StrategyforOlderPeople:Phase2 AgeinginanInclusiveSociety(2005)
strategy (2009) (2008–13)
•Improvinglaterlifetoday •Improvingopportunitiesand •Valuingolderpeople:countering •Ensureolderpeoplehaveaccessto
Keythemes
•Thechallengeaheadandavision removingbarriers discrimination,developing financialandeconomicresourcesto
forthefuture •Forgingbetterlinksbetweenthe engagementandsocialinclusion liftthemoutofexclusionand
•Havingthelaterlifeyouwant generations •Changingsociety:enhancingthe isolation
•Olderpeopleattheheartof •Improvingandmaintaining economicstatusandcontribution •Deliverintegratedservicesto
families healthandwell-being ofolderpeople improvethehealthandqualityof
•Engagingwithworkandthe •Improvingcare,supportand •Well-beingandindependence: lifeofolderpeople
economy protectionforolderpeople enhancingparticipationofolder •Ensureolderpeoplehaveaccessto
•Improvingfinancialsupport •Developinghousing,transport peopleinsocietyandalllevelsof theservicesandfacilitiesthatmeet
•Betterpublicservicesforlaterlife andplanningservices government theirneedsandpriorities
•Buildingcommunitiesforallages •Offeringlearningopportunities •Makingithappen:implementation •Ensureolderpeoplehaveadecent
•Workingtogethertobuilda throughoutlife ofthesecondphase andsecurelifeintheirhomeand
societyforallages community
•Promoteequalityofopportunityfor
olderpeopleandtheirfull
participationinciviclife,and
challengeageismwhereverfound
•Ensurethatgovernmentworksina
coordinatedwaybetween
2.StrategiesforageingandolderpeopleacrosstheUK
departmentsandwithsocial
partnerstodelivereffectiveservices
ippr|PoliciesforPeaceofMind?DevolutionandolderageintheUK
forolderpeople
Governance, •MinisterforPensionsandthe •DeputyHealthMinister •MinisterforOlderPeople •TwoJuniorMinisters(OfficeofFirst
advocacy AgeingSociety •NationalForumonAgeing •NationalPartnershipForumfor Minister&DeputyFirstMinister)
andscrutiny •UKAdvisoryForumonAgeing ImplementationGroup(AllOur OlderPeople •OlderPeople’sAdvocate(interim)
roles •IndependentVoiceofOlder Futures Group) •LocalGovernmentChampions
•CommissionerforOlderPeople
People •OlderPeople’sConsultative (electedmembers)andStrategy
(proposed)
Forum Coordinators
•NoCommissionerorAdvocate •CommissionerforOlderPeople
specificallyforolderpeople
3.LinkAgePlus(LAP)casestudy:LinkUpinGateshead
LinkUpinGatesheadwasdevelopedasaLAPinitiativeinthepilotphase.Itwasbasedon
aforumforolderpeople,anetworkofpreventativeservicesandarangeofactivitiesthat
peopleagedover50couldtakepartin.Forexample,handymanserviceswereprovided
forsmalltasksaroundthehomeand‘safetyworks’topromotesafecommunityliving.
LinkUpalsoidentifiedtheneedtoraiseawarenessamongsocialcarestaffaboutthe
availabilityofnon-assessed(i.e.universal)servicestomeetlow-levelneeds.Ithighlighted
theneedforcoordinatedandaccessibleinformation,especiallyfairaccesstocareandto
supportnewinitiativessuchasindividualisedbudgetsandpersonalisedsupportplanning.
KeyelementsofLinkUp’sworkfocusedonhealthandwell-being,through,forexample,a
majorbefriendingprojectsetupinisolatedcommunities,whichachievedover1,000
contactsinthreeisolatedareasoftheauthoritywithinsixmonths;aGoodCompanions
project;communityhealthchecksandsignpostingtoGPs.
Over17,000contactshadbeenmadewiththeseservicesatthetimeofreportingata
costof£4.45percontact.Costsoftheinitiativewerekeptlowthroughpartnership
working.Localevaluatorsbelievedthatthebenefitswouldexceedthesecosts,although
nofirmerdatawereavailableatthisinterimstage.
Source:Wattetal 2007

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