What is the challenge?
We want to eliminate institutional long-term care through business-led projects with the potential for real commercial value in the UK. The aim is to harness creativity and innovative capabilities across a wide range of sectors in order to provide more options in future - options that will enable people to live with more dignity and autonomy, as well as help decrease the financial pressure that the Government and individuals will face if they eventually need high levels of care.
The rapid growth in the number of older adults through population ageing and increasing longevity, and the growing concerns to deliver a dignified later life, have triggered substantial debates on reforming long-term care provision over the last three decades. Despite numerous initiatives, the UK still grapples with affordable long-term care that delivers quality of life for older adults and their families.
Demographic concerns and the scale and nature of likely demand
More important than the growth in numbers of older adults, is that of the very advanced in age. The numbers of those 90+ were 13,000 in 1911, 340,000 in 2001 and 430,000 in 2011. The key trend is that the demand for long-term care will continue to increase because of increasing life expectancy and ageing.
There is a particular challenge with dementia. The total number of people with dementia in the UK is forecast to increase by approximately 40% in the next 15 years and by 150% in the next 45 years (Frost & Sullivan (2013). Market Analysis of Long Term Care in the UK. A report commissioned by the Technology Strategy Boar) . In care homes in the 1980s, about 20-25% of people had dementia. Ten years ago it was 65% and now it is probably greater than 80%.
The shortcomings of institutional care
These have been documented and deplored since the early twentieth century. This scenario continues today with a steady stream of high profile media reports of appalling practice and unwarranted deaths. Despite some of the best intentions by various groups across the UK, many people continue to live as objects of ‘care'.
About 6.5m people, 13% of the adult population, provide informal care in the UK - a resource estimated as worth £119bn per year, more than the entire spending on the NHS (Department of Health. (2006). Our health, our care, our say: a new direction for community services: A brief guide. London: HMSO).
Caring peaks at age 50-59 but over 12% of those aged over 65 provide informal care for older adults. There are over 2m family members providing over 20 hours of care per week. They themselves risk impoverishment in midlife, finding they cannot juggle paid employment with caring and must reduce working hours or (for one in five carers) give up their job (Pavolini, E., & Ranci, C. (20 08). Restructuring the welfare state: reforms in long-term care in Western European countries. Journal of European Social Policy, 18(3), 246-259).
Numbers in institutions and costs
One study showed that, where appropriate, postponing entry into residential care for one year saves an average of £28k a year. There is evidence that some people are in institutions, for example in hospitals and in care homes, unnecessarily. Hip fractures are the event that prompts entry to residential care in up to 10% of cases (Stirling, T. ( 2011). Pathways to prevention: ma ximising the oppor tunities of the integration of health and social care and housing for the benefit of low income, older home owners: HACT).
Poor care in institutional settings and at home
Institutional care is expensive yet the major challenge remains the poor standard of care provided both in institutions and at home. Numerous reports have identified the lack of dignity and care, which have been found in both situations.
For institutions the challenges are not just the poor standard, including lack of adequate medical care, but the fact many older adults enter them in a crisis without proper planning, many do not need to be there and some could be moved out if there were adequate alternatives. It is deemed that currently there are no adequate alternatives.
There is reduction in expenditure for long-term care across Europe. As well as reductions in the public sector, there are also less people employed in the voluntary sector. A recent Local Government Association estimate was that spending on adult social care will exceed 45% of council budgets by 2019-20 (HM Treasury and Department of Communities and Local Government, 2010, p. 17).
Complexity of funding
The Dilnot Commission
claimed that the current system of institutional long-term care was hard to understand, often unfair and unsustainable. Lessons from 13 pilot projects in 2010 on the delivery and funding of public services showed the complexity of attempting to integrate each user's diverse funding streams into a single Individual Budget. From a citizen viewpoint, public services were often impersonal, fragmented and unnecessarily complex.
The UK remains a global leader in innovation and should remain so. The aim therefore is to:
identify new and innovative approaches with the greatest potential for new markets, business development opportunities and improved quality of life for people requiring long-term care
bring together technology providers with the owners of the commercial and technical challenges
engage innovators in new and unusual areas with the capacity to understand the opportunities presented by population ageing and new models of long-term care.