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Royal Voluntary Service blog
Find out about the people behind Royal Voluntary Service in our series of guest stories from our volunteers, staff and partners.

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Unmet needs of older people being met by informal helpers

On Monday the Care Bill reached report stage. To coincide with this research commissioned by the Care and Support Alliance, of which Royal Voluntary Service is a member, highlighted that in the period 2005/06 to 2012/13, the number of people receiving formal packages of care from their council fell by 320,000. Researchers at the LSE calculated that, given the rising numbers of older and disabled people in the population over that time, 453,000 fewer people were receiving care in 2012/13 than would have done in 2005/06 given a consistent level of eligibility. You can read the full report here.

Today the vast majority of councils are supporting individuals with substantial and critical needs only (86%) meaning that many people are not having everyday personal care and mobility needs met. These needs fall into activities of daily living (ADL) and instrumental activities of daily living (IADL). As the terms suggest ASL is about very basic tasks such as washing, dressing, eating and using the toilet. In contrast IADL are activities although not fundamental to functioning, are important aspects of living independently with some degree of dignity like shopping and leaving the house.

Today’s results from the 2012 Health Survey for England highlight the crucial role that informal help plays in supporting older people. ( The ADL for which help was needed most often by men and women aged 65 and over was using the stairs (21% and 29% respectively). Help was relatively frequently needed in other activities, including having a bath or shower (reported by 15% of men and 19% of women), dressing or undressing (14% of both sexes), getting in and out of bed (10% and 13% respectively) and getting around indoors (9% and 12% respectively).

Among the IADLs, more people said that they needed help with shopping for food (20% of men, 31% of women) or routine housework (20% and 27% respectively) than with getting out of the house or (16% of men and 24% of women).

The shocking finding is that fewer than one in ten reported that they had received help with any of the ADLs in the last month. The proportions who received help with IADLs were higher than for ADLs, but not much. 26% of women received help with shopping for food compared with 14% of men and 19% of women received help to get out the house compared with just 11% of men.

Not surprisingly the need for help and the proportions receiving help increase with age. However, for most activities there was a gap, with more people reporting needing help than reported receiving help. Among those aged 85 and over, 42% of men and 67% of women needed help with shopping for food, while 34% and 57% respectively received help with that activity.

Overall, 44% of men and 55% of women aged 85 and over had some unmet need with at least one ADL, compared with 15% of men and women aged 65-69. Results were similar for IADLs: 26% of men and 28% of women in the oldest age group had unmet need for at least one IADL, compared with 10% of men and 8% of women aged 65-69.

If you believe that the bulk of help is provided for by the authorities then think again. The survey finds that majority of people aged 65 and over that received help in the last month got that from an informal helper, rather than a formal one. For ADLs, 75% of men and 71% of women had informal helpers only, 8% and 13% respectively had formal helpers only. Most informal help is provided by family and close friends to whom no payment is made.

In the survey volunteers are categorised as formal help which shows just how much the state relies on the role of informal help overwhelmingly from families. It is entirely understandable that most families will want to help close relatives where they can but in a significant number of cases that is not possible. With funding under increasing pressure, there is an opportunity for the government to turn to the voluntary sector to support older people with low level care needs. Often something as simple as a weekly visit from a volunteer, a lift to a doctor’s appointment or help with basic tasks such as shopping for food can make a huge difference to that older person and reduce that unmet need.

So as 2013 disappears over the horizon make that New Year’s resolution to join the 15 million people who volunteer regularly to help others live a better life.

Posted by Steve Smith Public Affairs Manager (England) at 00:00 Friday, 20 December 2013.

Increase in Excess Winter Deaths among over 75s is unacceptable

The Office for National Statistics has today released its Excess Winter Deaths stats for 2012/13, which show an astonishing 31% increase in deaths among the over 75s.

One older person dying unnecessarily is a tragedy but 25,600 older people dying every year is unacceptable. Many older people face a winter of chronic loneliness, cold homes and severe isolation. More needs to be done to ensure that older people living alone get the help and support they need in winter to make sure they remain safe, warm and well and the solution is not complex. Government and local authorities are in a strong place to work with, signpost, acknowledge the work of the trained volunteers who exist in every community but their contribution must be better understood and utilised. Quite often, something as simple as a visit from a neighbour can mean the difference between life and death for an older person in winter.

Through our army of 40,000 volunteers who donate their time to help older people stay independent and happy in their own homes, we are making a real difference to older people’s lives. It is vital that we pull together as a society to share our time and help stop the scandal of older people dying unnecessarily.

Posted by at 00:00 Tuesday, 26 November 2013.

Our response to dedicated GPs for frailest patients announcement

It was announced today that patients in England over the age of 75 will be allocated a named GP who will know their medical history. This is good news for the millions of older people who find the current system both confusing and distressing. Having a named GP will ensure that care is joined up and that older people have a familiar face who knows their personal medical history inside out. This will go a long way towards easing the increasing pressure on A&E, which unfortunately is where a lot of older people end up because they feel they have no other option. Royal Voluntary Service is urging the Government to take this a step further by recognising the crucial role volunteers can play in further reducing the mounting pressure on GPs. Preventative care such as that delivered by Royal Voluntary Service’s Good Neighbours volunteers, who provides frequent contact with vulnerable, lonely and isolated older people, can remove the need for unnecessary trips to the GP’s surgery or A&E.

Posted by David McCullough, chief executive of Royal Voluntary Service at 00:00 Friday, 15 November 2013.

Voluntary sector can help ease A&E crisis

Sir Bruce Keogh has today published the first stage of his review into urgent and emergency care in England, setting out proposals for the future of urgent and emergency care services in England.

The report highlights key factors that are contributing to an A&E service that is critically over stretched and we hope this will be a catalyst for change. It’s shocking that 40 per cent of patients attending A&E are discharged requiring no treatment at all. With emergency care at breaking point, there’s a great chance for the government to speed up the prevention agenda and turn to the voluntary sector to support older people with low level care needs. Often something as simple as a weekly visit from a volunteer, a lift to a doctor’s appointment or help with basic tasks such as shopping for food can reduce the number of older people ending up in A&E unnecessarily.

Posted by David McCullough, chief executive of Royal Voluntary Service at 00:00 Wednesday, 13 November 2013.

NACC National Community Meals Week - raising awareness of a vital service

11-15 November is NACC National Community Meals Week, an annual event to raise the profile and highlight the importance of a vital service that improves the lives of so many people.

Community meals services, such as our own Meals on Wheels not only provides essential nutritious meals but also vital human contact to older people across the country. Last year alone Royal Voluntary Service delivered more than 2 million meals to older people. Many older people go days, weeks, even months without seeing or speaking to another person, leaving them chronically isolated and lonely.

Royal Voluntary Service Meals on Wheels drivers and volunteers are an essential point of contact for older people, not only through delivering much-needed meals but also by conducting Safe and Well checks to ensure that the people they visit have all of the help they need. Without these vital services older people are at risk of malnourishment, dehydration and acute loneliness.

Posted by John Pearson, Royal Voluntary Service executive director of operations at 00:00 Tuesday, 12 November 2013.

More needs to be done to support older people living alone

The Office For National Statistics have today released stats which reveal that  3.6 million people over 65 live alone, up 8% since 2003 and the highest it's ever been.

For many older people, living alone leads to chronic loneliness and isolation, with many older people not seeing a friendly face for weeks and sometimes months. Solitary confinement is regarded in the Western world as a punishment and yet we are allowing many members of our older generations to face a similar experience. More needs to be done to ensure that older people living alone are supported by their community and know where to go to seek help for what can often be a debilitating issue. Something as simple as a weekly visit from a friendly face, a lift to the shops or a chat over a cup of tea can mean the difference between an older person living a happy life or a lonely one.

Through our army of 40,000 volunteers who donate their time to help older people stay independent and happy in their own homes, we are making a real difference to older people’s lives. It is vital that we pull together as a society to share our time and help stop the scandal of older people feeling forgotten and rejected by the communities they live in.

Posted by Verity Haines, Royal Voluntary Service Executive Director of Marketing and Development at 00:00 Thursday, 31 October 2013.

Loneliness takes centre stage

Steve SmithFriday was shaping up to be like any other Friday. But the breaking news story that Health Secretary, Jeremy Hunt, was to highlight the “national shame” of 800,000 older people suffering from loneliness in his speech to NCAS later that day, was about to change that.

It didn’t take long for the phone to begin ringing as requests for media interviews began to flood in. From Cornwall to Manchester and from Solent to Humberside everyone wanted to get a reaction to what he was saying.

The Minister spoke of the 5 million who’s main company is the TV and the serious health implications – worse than smoking or obesity. He recognised that Government could not tackle this issue alone and called for a social solution. He cited Chinese and other Asian cultures where older people had closer bonds to family and where residential care was a last option. He said that a social contract needed rekindling between the generations.

Not surprisingly radio commentators picked up on this last point. I said that Royal Voluntary Service had undertaken a survey around a year ago and had found that the majority of families try and do the right thing, but many family members work unsociable or long hours, have relocated away from their close relatives to seek affordable housing or to find employment. We found that in 10% of cases that the nearest child of an older person lived more than 40 miles away and that would have an impact in the amount of contact they will have.

Many commentators asked what could be done to ease the problem. I explained that approximately 15 million people volunteer at least once a month. Organisations such as Royal Voluntary Service had a 40,000 strong army of fantastic volunteers who’s role it was to make those social connections and provide that companionship where it was lacking. The age of our volunteers ranged from 14 to 104 with an average age of 64. So in effect older people are supporting older people. Royal Voluntary Service knows from its own research that those older people who give up their time to volunteer are happier and experience improved well-being. So it is a win-win situation.

We all needed to step up to the plate and encourage more older people to volunteer. We know from other Royal Voluntary Service survey that one in five older people have skills and talents that they don’t use. We need to encourage and make better use of this resource.

I added that Government and its agencies needed to work hand in hand with the voluntary sector. We know from a survey carried out by the Campaign to End loneliness that of the Health and Well-being Boards that had submitted strategies for care, only half had included tackling loneliness as a priority for the coming year. I said that it was a “wake up call” for those HWBs that had omitted to prioritise loneliness as it is surely a false economy in the long term.

Whilst volunteering doesn’t come for free it does offer effective low cost solutions and can get involved where formal health and social care can’t or won’t get involved.

So at the end of the day although the Minister didn’t offer any concrete policy solutions to help tackle the problem of loneliness in older people, he did put the issue centre stage and for that we are grateful.

Listen to Steve on Radio London with Vanessa Phelps, scroll forward 35 minutes (Available until 25 October)

Listen to 78 year old Caroline as describes being lonely to Shelagh Fogarty on Radio 5 Live

Read Friday's blog from David McCullough as he urges the government and thirs sector to work together to end loneliness in older people

Posted by Steve Smith, Public Affairs Officer at 12:10 Tuesday, 22 October 2013.

Labels: Loneliness, Older people

Government and Third Sector work together to end loneliness in older people

Loneliness is a reality for too many older people in the UK who live alone and rarely see friends, family or neighbours, sometimes going months without having a conversation with another person. Loneliness and isolation can affect older people regardless of their geographical location – people can feel lonely when living in the centre of a city – it is real relationships and human contact that can make someone feel less lonely.

In light of the Health secretary Jeremy Hunt's anticipated speech at the National Children and Adults Services (NCAS) conference today, it is vital that Government and Third Sector organisations work hand-in-hand and that Government acknowledges and supports the role that volunteers could and do play in helping older people with low level care needs. For many older people, the everyday issues they face can be as simple as having a friend to talk to, having healthy food in the cupboards and having support when they leave hospital, all of which can be roles carried out by caring volunteers. 15.1 million people in the UK volunteer at least once a month** and these numbers could be increased substantially. It is time for the wasted skills and compassion of many members of our communities to be utilised if we are to meet the growing needs of older people in the UK.

Posted by David McCullough, chief executive of Royal Voluntary Service at 00:00 Friday, 18 October 2013.

Royal Voluntary Service response to cap on costs for care for older people

More older people may have to sell home after all

Royal Voluntary Service supports the long overdue reform of social care. However, the government needs to be clearer about what this policy will mean in practice for older people. At a time when more older people are entering the care system and this number will increase in the coming years it is essential that the reforms now being consulted on are as clear as possible.

A cap of £72,000 on eligible costs is a very welcome step, but it is important to realise only eligible needs will count towards this, so the cap won’t be applied to everyone. Some people will still pay indefinitely for care, if their needs are assessed to be below the level the local authority contributes to, which due to cost cuts over several years, is currently set at the high level of ‘substantial’ or above for 87 per cent of local authorities in England. The Government has proposed a national eligibility threshold equivalent to substantial needs for care costs across authorities in England, but this would still mean many thousands of people with low or moderate needs will not benefit from the cap at all.

"A cap on costs is a very welcome step, but there is a big hole in the proposed policy, in addition to the discovery that the deferred payments loan won’t be universal. Everyone assumes all care costs will be covered by a cap, but only care needs at the ‘right’ level will be included. Many thousands of people will be entirely unaffected by the cap if their needs are assessed to fall below this level. The government needs to be clearer about what this policy will mean in practice for older people."

David McCullough, Royal Voluntary Service chief executive
Last night at report stage of the Care Bill the Lords revealed that the proposed deferred payments loan is not universal as had been assumed, but will only apply if a person’s other assets in total come to less than £23,250. This demonstrates very clearly that more clarity and better understanding of the Coalition’s proposals are required. The main thrust of the reform is welcome but the devil is in the detail and in the small print.

Posted by Steve Smith Public Affairs Manager (England) at 16:00 Tuesday, 15 October 2013.

A different take on health and social care integration.

Much of the health and social care debate currently centres around “integration”. Everyone is in favour of it. But what does this mean in practice? The political party conferences gave some indication in the way in which each has a different twist of what is meant by the term.

The Lib Dems opened the conference season with Norman lamb stating that: ‘We have created a £3.8bn transition fund for 2015/16 as part of the spending review to join up health and social care. You may think that is a long way off, but we are expecting every area of the country to start their planning now. Some areas are well on the road, but others are simply not making the progress that is necessary, still working in silos, allowing people to fall through the gaps in an unacceptable way.’

He said: ‘It is not acceptable for an older person to be shunted from one institution to another, with no one ultimately taking overall responsibility for their care. So about one million older people, with the most complex health needs will get a personalised, proactive GP service which will include first of all a GP overseeing all aspects of their care. That doesn’t mean doing everything but overseeing, ensuring that they are treated as a person and not just a set of conditions, and looking to see where improvements can be made and that these are properly followed up. Secondly, a separate care coordinator who will work with a range of experts to ensure that the plan is delivered.’

In Balls speech at Brighton on the economy he was clear that an incoming Labour Government would have to govern with less money and that they would have to make cuts too. He suggested that Labour could improve care and save money by pooling health and social care as a single service, with a single budget and joint management.

Labour wants hospitals to take overall responsibility for integrated care. This requires structural change which might not be welcomed, especially when the most recent changes are bedding down. However, Labour claim that this would not be on the on the scale of that initiated by the coalition government. Labour recognised that there is a shift in the burden of disease towards chronic illness and an aging population which needs to be addressed involving more community care.

During conference fringes shadow health secretary Andy Burnham set out his vision for whole-person care to delegates and announced that 25 councils had already agreed to be whole-person care 'innovation areas' (not all were Labour councils). He argued that the NHS had never been set up to deliver on social wellbeing and if things remained unchanged, he felt a sixth social ill would develop, a fear of old age. He asked whether social care could be paid for on NHS terms, free at the point of use, although not completely free as people would still need to make a fair contribution.

In Burnham’s keynote speech he set out that in the last two years, there had been a 66% increase in the number of people aged 90 and over coming in to A&E via ambulance. “And when they arrive, hospitals unable meet all the needs of people at that age. So they go downhill and we hear those stories of older people lost on the acute ward, disorientated and dehydrated. Our new mission - to care for everyone's mum and dad in the way we wish for our own. By uniting social care with the NHS, we take the first meaningful step on the road to good care for all people in the 21st century. Labour taking away the fear of old age.”

Burnham went on to add that the competition aspect of the Health and Social Care Act through requiring competition was driving services down. Rather than promoting integration this was causing fragmentation. He confirmed that in the first Queen's Speech of the next Labour Government, the Health & Social Care Act would be repealed. He has stressed however that he wants to retain Health and Wellbeing Boards, something that ex health minister Stephen Dorrell is very supportive of too.

During a fringe event, Dorrell, current Chair of the Health Select Committee, said that fragmentation of commissioning was more of a worry than fragmentation of providers. He believed that siloed budgeting was the big problem and better budgeting could deliver better health outcomes. When asked if he supported joint health and social care commissioning as proposed by Burnham, he said it had been his idea first. Dorrell also sees social housing as a key issue that needs adding to the mix.

At a fringe Health Secretary Hunt made clear that his immediate priory was to help support the frail elderly. “One big change we need more than anything, it's to transform the care older people receive outside hospital. It's true for all of us, but especially true for older people that prevention is better than cure. Avoiding that fall down the stairs, stopping an infection going septic, halting the onset of dementia - these are things that give people happy, healthy last years to spend at home surrounded by family and friends. They also save the NHS money.”

Hunt’s key commitment was that patients will be able to see their GP seven days a week and out of office hours under new proposals for a first wave of GP groups offering extended opening hours across the country. Also from next April the Government will introduce plans for a named GP to be responsible for proactive care for all vulnerable older people to act as a champion in the integrated health and social care system already announced (the government's announcement that it is investing £3.8 billion in a pooled health and social care budget).

So there we have it. All favour integration, but have different interpretations on how far it goes and how it can be achieved.

Posted by Steve Smith Public Affairs Manager (England) at 00:00 Tuesday, 15 October 2013.