This article forms part of the LGA think piece series 'Towards a sustainable adult social care and support system'.
We are all aware of the increasing pressure local social care provision is facing. This is partly a consequence of England’s success in significantly increasing life expectancy, compounded by the truth that these increased years of life are not always healthy years of life. While healthy life expectancy in England is currently 63 years for males and 64 for females, this average masks significant local variations. A female born in Richmond upon Thames will spend 17.8 more years in good health than a female born in Manchester (72.2 years and 54.4 years respectively).
Inequalities in healthy life expectancy mean that over four million (or 40 per cent) of people in the UK over the age of 65 have a limiting long-term health condition, such as diabetes, heart disease, and dementia. For many people with long term conditions, this means experiencing challenges in carrying out simple activities such as washing and dressing, which has an impact on their independence and ability to spend time doing what’s important to them. At the same time, the impact of such conditions on social care is significant. Alzheimer’s UK estimates that local authorities spend £4.5 billion on social care services associated with dementia. This is in addition to the £5.8 billion people with dementia and their families pay out annually for help with everyday tasks that are provided by professional care workers, such as washing, dressing and eating.
Yet, these years spent in ill health are not inevitable. As the regional variation shows us, good health and wellbeing is not defined by age and many older people across England enjoy an excellent quality of life remaining both physically active and in work or volunteering. Many of the factors that cause people to age differently are amenable to public health interventions. A recent Lancet Commission report found that more than a third (35 per cent) of dementia cases are a result of just nine modifiable risk factors such as smoking, obesity and social isolation.
The benefits of prevention go beyond savings to health and care budgets, important though they are, and can be felt throughout a community. Age UK estimates that 40 per cent of people over the age of 50 provide regular childcare for their grandchildren, enabling their children to remain in the workforce and in turn benefiting the local economy. Others want to remain in the workforce in their later years and it’s estimated that if everyone worked for a year longer, GDP would rise by 1 per cent. Our vision for a sustainable social care system must therefore go beyond an ambition of simply reducing costs and instead shift our culture to one that supports and values people living longer, healthier lives.
Local authorities have now been responsible for commissioning public health services for five years and the benefits realised through this delivery are certainly being felt. There are countless examples of local areas taking bold steps to address risk factors associated with ill health and the need for social care.
In Dorset for example, prevention at scale is the foundation for the sustainability and transformation partnership, recognising the role of prevention in significantly improving health outcomes, and rising service costs. Dorset’s prevention programme works across the life course, helping people to start well, live well, age well and live in healthy places. Practically, this means that local people are benefitting from integrated healthy lifestyle support and helped to manage long term conditions - maximising independence and reducing hospital admissions. People are also actively engaged in the delivery of their services with an asset based approach that uses the experiences and expertise of local people as volunteers and peer supporters.
The results in Dorset are clear to see – the Live Well Programme for example has seen 75 per cent of the people taking part reduce their alcohol consumption and 69 per cent increase their physical activity. This is all the more impressive when regular physical activity reduces the risk of more than 20 chronic conditions yet by the age of 65 only half of adults are doing the recommended amount of physical activity and by 75 that drops to a third.
Many local authorities are maximising their uniquely placed position to influence the wider determinants of health such as housing, education, the environment and economic growth in order to improve the health of their communities. Southwark for example is embedding public health into the planning process, creating healthy communities that encourage active travel and connectedness. While in Bristol, the Ageing Better partnership brings together a range of local services and partners to champion Bristol as an age-friendly city – increasing connectedness, reducing social isolation and using an asset based approach to utilise the skills and expertise of the local community.
Local government has many responsibilities but none more core than creating places that are inspiring of good health, leading improvements for local people, encouraging businesses to grow and creating jobs that local people can get. By being ambitious for the health of local people they can create years full of life as well as life full of years.
Duncan Selbie
Chief Executive, Public Health England