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British plans break new ground

Proposed overseas reforms include some good ideas that could work in Australia. By Sandra Hills and Alan Gruner

While debate over the Australian government’s Living Longer Living Better aged care reforms continue, the British government released a report, Caring for our future, on social care reform that could provide some lessons for us here in Australia.

At the outset it is important to recognise there are real differences between the UK and Australian aged care systems.

Significantly the British paper covers only low-level community care and support (user pay conditions) and does not mention the higher level community nursing care, which comes under the National Health Scheme (free of charge).

It also provides very little information on how proposed initiatives will be funded and gives only a small mention to residential aged care.

Despite the differences in the proposed reforms the UK paper, released in July, does present initiatives which should be of interest to the Australian government and community.

Isolation and loneliness

The UK paper suggests that in the future care planning will need to look beyond healthcare and disability, and ensure that areas such as emotional and psychological wellbeing, loneliness and isolation of older people are addressed.

Service providers will need to work in partnership with community organisations to connect people to peer and social support networks.

This approach is being picked up in Australia through person-centred care, but unlike the UK initiative, it is piecemeal and in many ways agency dependent. The integration of community care and support services through the proposed Home Support Program is an opportunity for the Australian government to work with community organisations to ensure care planning covers all aspects of a person’s wellbeing.

Integration of care, health and housing

Funding is being made available in the UK to support the development of innovative services that join up health, housing, care and support. UK local authorities (which cover care and housing) will work with health boards to implement local strategies to promote innovation and integrated working between health, care and housing.

This is potentially a role that Medicare Locals could undertake in Australia. Given that housing is a key health determinant, it would make sense for Medicare Locals to include housing support services in its discussions involving health and aged care services.

Interestingly, the UK Government has committed £200 million ($313 million) over five years to build an estimated 6000 new units for older people. This brings into focus the future commitment by the Australian government to the building programs that include older people, such as the National Rental Affordable Scheme.

Social Impact Bonds (SIB)

A SIB is when a government creates a contract for a bond-issuing organisation, such as an aged care facility, to raise funds from investors. These funds are then used to provide improved services to the community. Once improved services are achieved based on agreed KPIs, the government then provides the investors a reward in addition to the repayment of the principal. The benefit of this for the government is improved social services, which also generate future government costs savings.

There is a great deal of interest in SIBs in Australia and they are currently being trialled in NSW in foster care and in preventing young offenders from returning to prison. SIBs could be investigated by the federal government, as they have by the NSW government, as a means of raising funds for aged care.

Community connections

My Home Life is a national program in the UK that publicises best practice and runs programs to connect residents in aged care facilities with local communities.

The program uses a website (www.myhomelife.org.uk) and other various publications to promote quality of life for those living, dying, visiting and working in care homes.

There are clear benefits in establishing a similar program in Australia given the demonstrated benefits of residents engaging with their local communities. It may be possible for the government to widen the scope of its proposed My Aged Care website to include an initiative similar to My Home Life.

Timebank is a proposal to establish a program for volunteers in the UK so they can provide assistance to aged care recipients and bank these hours, which can be then drawn down if the volunteer needs care sometime in the future.

The Timebank program would also be worth investigating in Australia, although the obvious administrative costs to operate such a program would need to be taken into account. Perhaps this could set up as a trial as part of an existing volunteer program.

Despite the difference between the UK and Australian aged care systems, there are definitely some worthwhile proposals in the Caring for our future paper which could add to and complement our community care services in Australia and ultimately lead to a better quality of life for older people into the future.

Sandra Hills is the chief executive and Alan Gruner the research manager at Benetas.

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