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Last Updated: Wednesday, 11 July 2007, 11:09 GMT 12:09 UK
Who'll look after me when I'm old?
Young people relax in a park

By Geoff Adams-Spink
Age & disability correspondent, BBC News website

It's a question that rarely troubles the young - but by the time they need help with daily living, our stretched social care system will struggle to cope. What's it like to be on the receiving end?

In her small retirement bungalow in Maldon, Essex, Valerie Tugwell talks animatedly about her dogs.

In her time she has bred, shown and raced whippets but today all that remains are her photographs and her memories. The 72-year-old has given all of her dogs away because her arthritis means she is no longer able to exercise them.

Valerie Tugwell
I could eat what I wanted to, I could have fresh vegetables and fresh fruit which I can't do now
Valerie Tugwell on the difference extra care would make
Because she is estranged from her family, the loss of her dogs has been a body blow. Her cat, Twinkle, is now her only companion.

Mrs Tugwell is bright and articulate; she just needs some help around the house in order to stay independent.

Social services provide an hour's help in the morning - extended by 15 minutes once a week to allow for a change of bed linen and a bath - and 45 minutes in the evening. At lunchtime she takes meals on wheels but would prefer not to, as the limited choice of dishes often conflicts with her food allergies.

Often she will have to make the choice between going without a hot meal or risking a stomach upset, on top of which she already experiences bouts of incontinence.

Ideally, she would like someone to come in for half an hour in the middle of the day to cook a meal that will suit her needs. That one extra task would make an enormous difference to her life, she says.

"I could eat what I wanted to - I could have fresh vegetables and fresh fruit which I can't do now because they're not available."

Extra assistance would also mean that Mrs Tugwell would be able to go out and about on her mobility scooter, which she needs help to use. Currently her only activity outside the home is a weekly visit to a day centre. Her requests for additional support have, she says, been turned down flat.

"There's no money and there are no staff available - they just reiterate that over and over again."

Institutionalised

Mrs Tugwell is on the receiving end of a system of social care experiencing unprecedented levels of demand - demand that will only increase as the population ages. The number of people aged over 65 in the UK is projected to increase from 16% in 2004 to 23% by 2031.

Elderly man in a care home
Improved health care means more of us live longer
As more people seek help with daily living, the budget for this help is being driven down by local authorities on the lookout for efficiencies. And because resources are being rationed, help is targeted - not surprisingly - at those in most need.

Campaigners say that in the long run this is not a sustainable way to deal with the needs of older and disabled people.

"People with anything less than the most severe levels of need get turned away altogether and are left to fend for themselves," says Mervyn Kohler, of Help the Aged.

"This has got to be a very short-sighted strategy; people presenting with low-level needs are likely - if unattended to - to turn into people with high level needs and then those will have to be met at a fairly large level of public cost."

Now, the concerns of those who rely on home help are being addressed in a private member's bill which is now before the House of Commons, sponsored by Labour MP Roger Berry. He says the problem with the current system is that it is incredibly wasteful and horrendously bureaucratic.

What is more, the lack of support for people like Ms Tugwell often leads to residential care being the only option - and an expensive option at that.

"I have lots of constituents who are older people, who are getting a bit infirm and who - with the right kind of support - want to live in their own homes."

Stay at home

So if providing a little support with daily chores has so many benefits, why don't social services cough up? The answer seems to be that there is very little slack in the system.

"We all, I think, want to develop far more and early intervention services, lower levels of support and delay people's need for intensive care," says Anne Williams, president of the Association of Directors of Adult Social Services.

I don't believe any politician - being straight with people - can look them in the eye and say that social care will be free
Ivan Lewis MP
"But we are having to spend the money we've got on smaller numbers of people with very intensive needs and that's the opposite of what we'd actually like to be doing."

The social care system is universally disliked by those on the receiving end and those administering it, who agree that it needs an overhaul to avoid the risk of collapsing under pressure from our ageing population.

The minister with responsibility for social care, Ivan Lewis, believes the system was never designed to help the increasing numbers of people with complex or multiple conditions who are now making it into old age. And before politicians start proposing alternatives, we need to redraw the map of collective and individual responsibilities, he says.

"We need a new consensus, a new settlement in terms of the funding of social care between the state, the family and individuals. That settlement needs to be fair, it needs to be sustainable and it needs to reflect changing expectations."

There can be no question, says Mr Lewis, that a free and universal service is in the offing.

"I don't believe any politician - being straight with people - can look them in the eye and say, going forward, that social care will be free."

As more of us age, acquire disabilities or dependents who need looking after, this is set to be an increasingly hot political potato.


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