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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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Winter can be an especially hard time for older people. For someone with mobility problems, rain, snow and ice mean it's difficult to get out and about and this can lead to social isolation during the colder months. Feeling isolated and lonely can have a major impact on the physical and mental health of many older people. Keeping in touch with friends and family helps keep older people emotionally well but bad weather can put a stop to social activities.
Royal Voluntary Service volunteers can help people keep doing the things they want to do all year round, whatever the weather. We can provide transport to get out and about, help with shopping or with a trip to the hairdresser. Above all, we can provide a friendly face and much-needed companionship, perhaps over a cup of tea. The older people we work with tell us a visit from one of our volunteers can make their day. These are all little things, but together they can make a big difference to an older person's quality of life.
Former social worker Vanessa Bishop is one of our volunteer Good Neighbours. She's been visiting 90 year old Sheila Hunter for several months and the pair have become firm friends. Sheila was suffering from depression after a fall resulted in an eight-week hospital stay but with Vanessa's help she's starting to feel much more positive again.
"Vanessa's such a cheerful person and we have such fun together. She helps sort out my paperwork, she posts things for me, she takes my library books back and picks up my prescriptions. She's not a carer, she does what a friend or sister would do."
Vanessa hopes that when Sheila is fully recovered they'll be able to resume their trips out to the local garden centre and cafe, but in the meantime she's happy to provide companionship and a listening ear. She encourages Sheila to have hot drinks and warm food especially when it's cold outside, they do the crossword together, watch favourite shows on TV and they both love to talk.
"We describe ourselves as friends now because it's a very easy relationship... we have a lot in common and get on very well. It's just a lovely interlude in the week when I go and see her."
Vanessa would like to encourage other people with a bit of spare time to get involved too:
"It does make you feel more connected and useful. You're very directly involved in making a difference to someone else's life."
Take a look at our Get Ready for Winter tips on staying healthy and connected whatever the temperature as well as finding out what your local Royal Voluntary Service can offer. And if you have a few hours to spare, why not join us as a volunteer? Be one of our 35,000 volunteers who are committed to helping older people live independent and fulfilling lives. We have opportunities across the UK and would love to hear from you.
This blog was originally published on the Met Office website.
Tuesday’s report from the National Audit Office on Planning for the Better Care Fund painted a disappointing picture of plans containing misplaced assumptions not backed up with evidence through a lack of engagement with important stakeholders.
As a result, during the summer the process was placed on hold and targets and incentives were redesigned. Plans were not put to Ministers in April as intended because the financial risk to the NHS was regarded as far too great.
Plans have been reworked and last month we learned that 146 of the plans, the vast majority, have been approved, including those requiring further support (91) and some with certain conditions attached (49).
The Better Care Fund now contains some £5.3 billion in funding and exceeds the minimum contribution by £1.5 billion. The amount of credible savings has been adjusted down from £1billion to £532 million made up of reduced emergency admissions (£283 million), reduced delayed transfers of care (£31 million) and increased effectiveness of reablement (£30 million). The vast majority of savings appear to accrue to the NHS.
The main change was to the framework for the £1 billion payment-for-performance part of the Fund. The proportion of the £1 billion linked to performance now depends on the level of the local target for reducing total emergency admissions to hospitals.
We know all too well that there are far too many people being admitted and readmitted into hospital unnecessarily. Over 200,000 older people are readmitted into hospital within a month of discharge. Together the plans aim to deliver over one year an overall reduction in non-elective activity (general and acute) of 163,162 stays. In addition over 2 years the Fund aims to deliver 100,962 fewer unnecessary days spent in hospital, 11,860 older people remaining at home 3 months after discharge and 1,948 more people supported to live independently.
This process has been tough on local authorities. In the past few months local areas would have been preparing to implement the Fund. Instead they were reviewing and resubmitting their plans. This may impact on their performance and therefore ability to hit targets in the early stages of the Better Care Fund which may have a knock on effect on resources.
Joined up health and social care is a laudable and necessary ambition given tight funding and an increasingly ageing population. With the emphasis so strong on reducing hospital admissions, local government believes that the resources to support wider local initiatives to promote integration and prevention will be reduced. Reducing admissions by over 3% when they have risen by 47% over the past 15 years is a very ambitious target.
Providing a degree of focus and direction is a good thing and is an improvement on a vague call to pool budgets. But we must not lose the good initiatives that already exist. The dust is now settling and it is hoped that lessons have been learned and that that the Fund can deliver on its core undertaking “to give elderly and vulnerable an improved health and social system and to join up health and care services around the needs of patients, so that people can stay at home more and be in hospital less”.
On Thursday 13 March the National Audit Office (NAO) published its Adult Social Care in England report.
Much of the content of the report will come as no surprise to many who follow the health and social care agenda. It includes much talk about integration and social care being 'joined up'. In particular the finding the older people have experienced the greatest spending reduction in their care, down 12% between 2010/11 and 2012/13, is a stark one. Over the last four years, the number of adults receiving individual packages of state-funded services has fallen. But with 87% of local authorities having set their eligibility threshold to only provide support to those with substantial or critical needs paints a consistent and disappointing picture, especially with a growing government focus on prevention being the best and cheapest way to look after older people. Around a third of adults aged 65 and over report a need for help with at least one activity of daily living. Without this help they are at further risk of having a poor quality of life and becoming socially isolated with all of the negative health implications that brings.
The NAO indicates that greater spending on social care is related to lower delayed hospital discharge rates and fewer emergency admissions. At a time when A&E and other services are under severe pressure the continuing cuts in funding of front line support services does seem counter-productive. We know from Royal Voluntary Service research that a Home from Hospital scheme can reduce hospital readmissions by 50%.
Indeed, voluntary organisations are filling a much needed gap. In 2010-11 the NAO showed that the voluntary sector spent £2.9 billion from its own fundraising on care and provided a further £6.2 billion of care commissioned mainly by local authorities. This represents nearly a quarter of voluntary sector activity.
Self funders of care contribute 13% towards a total adult social care budget of £19 billion. There are fears expressed by the NAO that Councils know little about this group of service users and will struggle to plan for them. There are also criticisms that the commissioning and providing services which are the most cost-effective is based on weak evidence. The NAO concludes that national and local government do not know whether the care and health systems can continue to absorb the cumulative pressures, which includes increased demands of an ageing population, and how long they can carry on doing so.
The Public Accounts Committee chair Margaret Hodge MP, has been swift to swoop on the report findings. "The result is unnecessary stress and an unfair financial burden on those who need care and the 5.4m unofficial carers who already contribute £55bn worth of care every year.
"The fact the departments do not know how much longer the entire care system can cope under the mounting pressure makes for a worrying picture.” The MP meets with Government departments on 26 March when this will be discussed.
Friday 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.
More and more evidence suggests that keeping occupied and undertaking activities that give an older person a sense of achievement and purpose is good for their health and wellbeing.
Previous research on whether retirement is bad for health has produced mixed results. New research presented by the Institute of Economic Affairs this summer indicates that being retired may decrease physical, mental and self-assessed health and these adverse effects increase as the number of years spent in retirement rises. The results obtained showed that clinical depression increased in retirement by around 40% and the probability of having at least one diagnosed physical condition by around 60%. Equally, while retirement in itself is a stressful event it can decrease work related pressures which can also be harmful to health. So much will depend on the type of work that the individual is exiting from.
Earlier this month a survey undertaken on behalf of the Royal Voluntary Service showed that more than two million retirees over the age of 60 spend their time volunteering for at least two charities. The research also provides an insight into why older people choose to volunteer. Although 83% of those aged 60 and over volunteer because they believe the work of the charity is very important, 39% follow in the footsteps of a relation and say they volunteer because their family have always done so.
Furthermore, 46% of older people admit they chose to volunteer because they need to feel they have a purpose. Our previous research also found that older people who volunteer are less depressed, have a better quality of life and are happier.
And a few days ago a study led by the University of Exeter showed that people who volunteer benefit from various improvements in mental health. Those who gave up their time to help others were less likely to suffer from depression, plus they had higher levels of life satisfaction and wellbeing. However, if volunteering gives nothing back to the volunteer its positive effect is limited or negated.
But the message seems to be clear, keeping active and busy for as long as possible in roles that “give back” is an important factor in maintaining health and wellbeing in older age, whether that is through a choice of formal paid work or through volunteering.
One way of ensuring that volunteers receive acknowledgement for the contribution that they make is by nominating for this year's Diamond Champions awards. Nominations can be made up until 15 September. More information can be found here.
Posted by Steve Smith, Royal Voluntary Service Public Affairs Manager (England) at 00:00
Wednesday, 28 August 2013.
The new ONS statistics on loneliness in older people, published today, paint a stark picture of growing old in Britain today, with almost half of those over the age of 80 feeling lonely. These feelings of loneliness are exacerbated by poor health and living alone, both of which we know increase as the nation ages. Those that feel lonely do fewer day to day activities creating a vicious circle of isolation with older people feeling trapped in their own homes. WRVS comes into contact with older people day in day out whose main company is the TV, and without our volunteers may not see another person from day to day. It doesn't have to be like this. Simple and cost effective solutions, such as befriending, can help tackle loneliness, help older people to stay connected to their communities and prevent unnecessary hospital stays.
The ONS have also today release a report on older people's wellbeing, leisure time and volunteering. With WRVS’ army of 40,000 volunteers, we know well the benefit of volunteering, as do the older people that our volunteers provide a lifeline for. The new ONS data shows that one in five of the over 50s volunteer and links volunteering with higher satisfaction in life. We know through our own research that older volunteers live happier and healthier lives and we see this every day, as over half of our volunteers are in this age group with some still volunteering into their 90s and over the age of 100. However, with an ageing population, this country needs more people to step up and volunteer to make life better for others. So we would encourage anyone thinking of volunteering to take the plunge and get involved!
The delivery of health and social care has undergone major change to its core structures. Many of the changes have already taken place, but most took effect on 1 April 2013. These changes will have an impact on who makes decisions about NHS services, how these services are commissioned, and the way money is spent.
Primary care trusts and strategic health authorities have been abolished, and other new organisations such as clinical commissioning groups (CCGs) have taken their place. As of this week a total of 211 CCGs are responsible for £65 billion of the £95 billion NHS commissioning budget. All 8,000-plus GP practices in England are members of a CCG, putting the majority of the NHS budget in the control of frontline clinicians for the first time. The groups will include other health professionals, such as nurses.
CCGs will commission most services, including, planned hospital care, rehabilitative care, urgent and emergency care, most community health services and mental health and learning disability services. CCGs can commission any service provider that meets NHS standards and costs. These can be NHS hospitals, social enterprises, charities, or private sector providers.
To add to the mix are health and wellbeing boards; a new forum where leaders from the health and care system work together to improve the health and wellbeing of their local population and reduce health inequalities. Each top tier and unitary authority has its own health and wellbeing board. Board members will work together to understand their local community’s needs, agree priorities and encourage commissioners to work in an integrated way. The intention is that as a result, patients and the public should experience more joined-up services from the NHS and local councils in the future. Local boards are free to expand their membership to include a wide range of perspectives and expertise, such as representatives from the charity or voluntary sectors.
In addition each local authority will have a local Healthwatch organisation in their area. The aim of local Healthwatch will be to give citizens and communities a stronger voice to influence and challenge how health and social care services are provided within their locality. Local Healthwatch will also provide or signpost people to information to help them make choices about health and care services.
Add to this other bodies such as the NHS Commissioning Board, Public Health England and Healthwatch England to name but a few, and it becomes a complex maze to work oneself through. The intention is the make health and social care more integrated and responsive to the needs of the local community. Support for older people such as that provided by organisations like WRVS has never been more necessary given the constraints on central and local Government spending. It is in everyone’s interest to work towards making sure this new system delivers. Time will tell whether the changes bring about the transformation that is urgently required.
We all know how frustrating it is to be left marooned when the car is off the road for repairs, or the buses are unreliable in bad weather – but for over 18,000 older people in Wales, this isolation through lack of decent transport is a daily reality. New WRVS research released today has found that 17% of older people in Wales have been hit by a reduction in public transport services, with many being left trapped at home through poor access to public or community transport.
Whilst the narrative of cuts in transport services is not new, it is about to get a whole lot more severe. The recent Welsh Government announcement of the merging of different funding streams for transport services has signalled a massive 26% reduction in subsidies for local transport services – and across Wales, the impact is already being felt as vital local services are withdrawn or cut to the bone.
Frustratingly, this is happening at exactly the time when those services are needed the most. Figures indicate that 66% of Welsh single pensioners do not have a car, and it has also been shown that 40% of households without a car feel that local bus services fail to meet their travelling needs to the local town or shops, and 65% believe services are inadequate for travel to their local hospital. Further cutbacks will make a bad situation worse, especially for older people – reliable local transport networks become increasingly significant as people get older, with journeys for essential items and social activities sometimes becoming more of a challenge.
At the heart of this is the extent to which transport planning takes account of the voices of older people. Today’s WRVS research indicates that older people feel dis-empowered and disenfranchised; 23% of respondents did not feel able to make comments or complaints about local transport services, and this clearly has an impact when services fail to meet their needs. It should shame us as a nation that nearly 20% of older people are unable manage the walk to/from their nearest public transport, and that many of that same group feel unable to do anything to challenge the system.
This is not, however, simply another request for more money. What today’s research underlines is that we can spend existing resources more shrewdly on services which protect the most vulnerable. Community transport (such as Bwcabus or WRVS services) is a great example, with schemes being viewed much more positively than regular public transport, and rural areas in particular benefiting from such services. Community transport is also rated extremely highly by users in terms of its social impact and for its social return on investment.
We need to help promote community transport, and ensure that funding is there for schemes to become sustainable in the longer-term. We should start by increasing the proportion of transport funding which has to be spent on community transport – realigning spending priorities to ensure that we keep vulnerable older people connected and independent. We also need to ensure that older people have an outlet to express formally their concerns about transport, so that their voice is not marginalised or ignored. Without these sorts of fundamental changes, we may find ourselves waiting for a bus that simply never comes.
A year ago the House of Lords decided that the social changes that were being experienced with many more people living longer needed investigating as they couldn’t find evidence that it had been looked at comprehensively by Government before. Today the Lords Select Committee on Public Service and Demographic Change published its highly anticipated report. The key message is that are as a nation we are “woefully underprepared for ageing”.
Many of us will be living 10 years longer than we were expected to when we were born. Whilst there is a very real issue now, we don't have to look that far forward to the change accelerates. For example, by 2030 the number of people aged over 85 will have doubled.
The key message from
the report is that are
as a nation we are
We know that this creates opportunities. WRVS' own research shows that older people generate some £40billion to the UK economy, and this will rise
. But at the same time this brings about its own challenges.
The Committee is concerned about how older people will support themselves and has highlighted three key areas that need addressing. The first is around pensions and encouraging saving, the second around working past traditional retirement age and lastly around unlocking assets within their own homes.
On health and social care the Committee believes that the system is not designed to deal with long term chronic conditions, but more acute conditions and therefore it will need radical change. It argues that there needs to be a shift in focus and vision in England to improve integration and prevention, with an aim of keeping older people safe in their own homes rather than in hospitals. It suggests looking at merging health and social care budgets and providing care 24hours a day, 7 days a week for 365 days of the year. The Committee recognises the valuable contribution that voluntary organisations such as WRVS already make, but recommends that central and local government work with the third sector to increase volunteering especially by older people to support older people.
Ageing is a huge social change that will impact on everyone. Government therefore needs to have a firm understanding of what this means in terms of the UK’s population, society and public policies and develop a coherent strategy going forward. The Committee is critical of the current and previous Governments over many years that have failed the grasp the enormity and urgency of the situation. The Committee calls for the issuing of a White Paper before the next general election setting out the issues and how we should prepare for longer life. All parties should consider an ageing society in their manifestos for the next election.
The Committee also recommends that whoever is successful after the election should establish two cross party commissions to respond to the ageing society; one would look at finance and the other health and social care.
This report offers a unique opportunity to tackle some difficult issues and to bring about real change. Let us hope that this opportunity is grasped by all parties as we head towards the next election. Read the full Ready for Ageing report.
Yesterday’s confirmation by the Health Secretary revealed that the cap on social care will be set at £75,000 in England. This headline has received a cautious welcome from most quarters. However, the cap cannot be looked at in isolation and at the moment it is still difficult to see how many older people and those entering old age in the coming years will be affected as there are still a number of unknown factors. In addition, boarding and food costs are not included in the cap. The objective is to try and ensure that people living in their own home are not penalised unfairly as they are still responsible for paying their housing costs. These so called “hotel” costs will be capped at £12,000 a year.
The cap won’t take effect until April 2017 and the Government has stated that £75,000 in 2017 is in effect worth the equivalent of £61,000 in today’s prices. The current threshold over which support is not provided is rising from £23,250 to £123,000, a rise of nearly £100,000. This means that more people will be entitled to receive some support for their care albeit on a sliding scale.
The big element missing in all of this is at what level the national “eligibility criteria” will be established. At the moment councils are free to set the criteria at low, moderate, substantial or critical. This perpetuates something of a postcode lottery. As funding has become tighter, an increasing number of local authorities have set their criteria at substantial. At the last count well cover 82% of England’s local authorities were at a substantial level or higher. The level at which this is set will be important calculating how many people will be supported. The higher the eligibility criteria bar is set means that those with lower needs which may prevent or delay more intensive and expensive interventions may miss out.
But the response to Dilnot is not the full answer. Implementation of these changes and those proposed in the Care and Support Bill won’t take effect for over 5 year’s and there is already a shortfall in the funding of adult social care that will increase during this time as local authorities make further savings.
All of this goes to demonstrate that volunteers working within organisations such as WRVS are key in delivering the practical support that older people want, but without the huge bills attached, not just for now, but for the long term.