Health and Housing

A series of posts exploring the links between health and housing.

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Corona Virus

To date the Prime Minister has struck what feels like a sensible balance between recognising the seriousness of Covd-19 and reassuring people that the UK is in the best possible position to deal with the problem. Certainly he is a shining example of leadership when compared with his opposite number in the United States. It is interesting, in a year when health care was already a major election issue in the US, how the benefits of a free-at-the-point-of-use National Health Service are thrown in to sharp relief when a public health emergency occurs. 

One has to have sympathy with political leaders at the moment. We are all beginning to learn about the complexity of responding to a pandemic which seems to be highly contagious. Just adapting to the speed of change is itself a challenge with the infection rate roughly doubling every 6 days.

At the moment much is made by the PM about how the government is following the advice of the experts.  whenever he makes a statement to the nation about the disease he is flanked by the Chief Medical Officer and Chief Scientific Advisor. He is always careful to preface his words with a statement about how the government is being guided by the science.

Clearly the government must take account of the science. As so often President Trump is helpfully providing an excellent object lesson in what happens when you develop policy in a science free zone.

Having said this however, the policy response has to balance a whole host of factors which do not simply drop out of the epidemiological science. There are alternative strategies which might be adopted which all come with their own risks. Ultimately it is the politicians who decide what the policy response is and whilst I have real sympathy for them they cannot hide behind their advisors. It may be that the PM speaks so frequently about following the science because he thinks it will be reassuring to the public. And it is, however he should not think it is a get out of jail free card if the strategy, which seems markedly different to that being adopted in other places, proves to be wrong.

The government Corona Virus Action Plan seems all very sensible with a reassuring institutional infrastructure to provide guidance and leadership in managing the national response. There is also clear advice about what infected individuals need to do, how the virus is spreading and how the government is responding. Transparency and consistent messaging is vital in maintaining public confidence.

There is a growing chorus of concern however that the government are not taking drastic enough action quickly enough. It has been suggested that part of the strategy is to try to secure herd immunity as soon as possible. Without a vaccine this is likely to result in a  high level of mortality amongst older people. The pressure, from dissenting voices, or the rational tipping point for some version of lock down seems to be approaching fast. This weekend there are announcements about new legislation early next week that will impact everyone. 

One of the voices calling for early and drastic action is Tomas Pueyo. He has produced an article, “Corona virus: Why you must act now“, illustrated with a series of graphs showing the progression of the disease in different countries and what appear to be the most effective strategies to contain or delay the spread of the virus. Chart 7 is probably the most shocking giving some indication of the scale of the actual incidence of the virus as opposed to just the numbers of those who have died or tested positive. It shows that the scale of infection is quickly many times greater than the latter two figures might suggest.

I have never heard of this person, but he has been referenced quite widely including by Edward Luce, an excellent opinion writer in the Financial Times. I have checked some of the numbers he quotes with other reputable sources and they seem to be consistent. It is a sobering read. I suspect its urgent tone is about to be reflected in a gear change in the UK’s response. I suspect we are all about to lose a month or more of our social lives. Given the mortality rate amongst older people it is a small price to pay to keep our grand parents and older parents alive.

Finally, I have read a fair amount about this virus and as yet have heard no mention of raging diarrhea  as being one of the symptoms or outcomes. Of course the sale of toilet rolls may actually be a good proxy measure for the level of fear the virus is generating.

 

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Care of the Elderly: Changing terms of debate

The recent WRVS report “Gold Age Power List” asked what David Attenborough, Delia Smith, Michael Palin and a diverse range of other well known individuals have in common. Few would have said the fact that they are all over 66 years old. The perception of age is changing and “grey power” is beginning to come to the fore. As the number of those over 80 is set to double in the next two decades we can expect increasing pressure from a generation of older people that are not content to put up with poor quality care services. This is going to make the job of figuring out how to pay for more and better services for an aging population even harder.

In the aftermath of the Southern Cross experience the cost of provision by the private sector is set to be increased by the need for bonds to underwrite the continuity of service. The current regulatory frame work is about the quality of care as opposed to the financial viability of the provider. It has been suggested that care providers will need to be licensed by Monitor the NHS regulator.

The demographic time bomb is creating a rapidly increasing demand for services but the changing nature of what it means to be old is creating other demands for increases in quality and continuity of service. The report of the Dilnott Commission next week has a series of dilemmas to resolve that would challenge Job himself.

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The Cost of Care

Southern Cross and Winterbourne View have changed the policy context for support and care in the United Kingdom. They pull out of the shadows an issue which any government, but particularly one attempting to implement public sector spending cuts, would have difficulty dealing with. Whilst the two events are superficially very different, one about a broken business model another about brutal assault, at bottom they both spell one thing, increased cost.

Over time the cost of care and support has been increasing and it has mainly been driven by quantum as more and more people need it. This quantum trajectory is set to continue for the long term. As society’s get wealthier they get healthier and certainly get cleverer at prolonging life. To date the pressures of quantum have been dealt with by reducing costs.

One strategy to achieve this has been the outsourcing of the provision of the service to the private sector. The theory being that productivity is better in the private sector.  Some investment in IT has happened that can genuinely help to increase worker productivity however care and support is essentially a people service. The principle cost is staffing so to reduce cost you either have to reduce the number or the pay of the staff you employ. Both of these have been happening over recent years. The problem with this strategy however is that you start to impact the quality of the service or you get into financial difficulty.

This brings us to what is likely to become another significant driver of cost, a demand for better quality. Southern Cross and Winterburne View have started to raise questions about the level of quality that needs to be provided. Each successive generation of older people since the War has been one of increasing expectations. Now the baby boomers are starting to focus their minds on the issue of care in their old age. The days of the characterless lounge with the chairs around the walls have, in the main, gone. However, people of the generation of Mick Jagger are likely to far more demanding if they feel they can’t get no satisfaction.

Expectations are rising and the strength of the grey vote is increasing. Governments of all colours will struggle to square the circle on this.  When the homes of older people are put at risk by “clever” financial engineering making some people multi millionaires; when people are cruelly assaulted in the very places they should be safe, ignored by under resourced regulators, the instant response of ministers is “something must be done!” Over the coming months what that something is going to be will start to become clear. Whatever it is it is likely to cost more money. The Dilnot Commission, which is due to report soon, will be read with a new sense of concern in the light of recent events.