Ageing: Public Services and Demographic Change Committee Report

Baroness Thomas of Winchester Excerpts

Thursday 17th October 2013 Lords Chamber

[Baroness Thomas of Winchester (LD)]

My Lords, I cannot remember when I last enjoyed two maiden speeches so much as those which we have heard today.

I, too, congratulate the committee on what must be one of the most important reports ever produced by a Select Committee of this House. Why has this whole question of our ageing population not been at the top of the agenda for successive Governments in the recent past? After all, we have known about the figures for many years. I am glad that at last we are having a proper debate about the whole subject of our ageing society. This report gives us a most welcome route map, and must be seen in conjunction with some of the health reforms and, of course, the Care Bill which simply would not have happened without the former Minister, Paul Burstow, whom I salute today.

Paragraphs 37 and 54 of the report both state:

“Central and local government, housing associations and house builders need urgently to plan how to ensure that the housing needs of the older population are better addressed”,

because the housing market is delivering much less specialist housing for older people than is needed. The Government’s response is encouraging. They acknowledge that more designated specialised housing for older people and disabled adults is needed, and highlight the capital grant of up to £300 million for the care and support specialised housing fund. Perhaps my noble friend could tell us more about how that money is being allocated.

However, many older people want to keep their independence by staying in their own home. Although I acknowledge that the Government have increased their funding of the disabled facilities grant over the past two years, I worry about the bureaucracy involved. In his oral evidence, the managing director of Care and Repair Cymru in Wales says that the first thing they try to do is to make sure that people do not have to use that system for smaller things such as handrails, grab rails or even a stairlift. That plea is echoed by occupational therapists because, they say, the DFG process is long and bureaucratic. That sounds ridiculous. Is my noble friend convinced that the DFG process is working as well as it should? Surely it should be simplified because a long bureaucratic process must cost a lot of money to administer—if for no other reason.

This brings me to the role of the social services departments of local authorities. The spotlight is often thrown on to social workers when tragedies occur involving the death of young children, but the other vital professional group we hardly ever hear about are the occupational therapists, who are the first port of call when an elderly person rings their local authority to say that they can no longer get out of their bath safely or climb the stairs. What may not be so well known is that local authority OTs advise people in all forms of housing on how to stay independent as they age. They manage the long waiting lists of assessments and are the key workers in providing early interventions, preventive approaches and reablement. That assesses what people can do for themselves with their existing support, helping them to set weekly goals, and reablement workers support the person in meeting those goals.

However, the occupational therapists’ workload grows ever heavier, while local authority budgets are shrinking. OTs deal with between 35% and 45% of local authority referrals yet make up only 2% of the workforce. The importance of their intervention is illustrated if one looks at what happens when an elderly person has a fall which leads to a hip fracture. That costs the public purse around £28,665, which is more than four and a half times the average cost of a major housing adaptation and more than 100 times the cost of fitting hand and grab rails to prevent falls. There are many other savings to be made when OTs become involved at an early stage, and I urge the Government to do all they can to make sure that guidance is given to the relevant authorities to involve occupational therapists in designing and commissioning services.

The two other functions these invaluable people undertake are also getting busier. These are advice for people with dementia on strategies and techniques for managing problems, and in the public health field, advising people with long-term conditions on how to manage their health and well-being. The more OTs are employed in the public service, the more money will be saved.