Prevent a crisis with a fundamental rethink of informal care

We are living through a huge demographic shift in the UK, one that is set to cause fundamental changes in the way we do things.

The population of the UK is getting older. Statisticians now tell us that life expectancy is rising by about five hours a day. Already there are more pensioners in the UK than there are young people, and the older population is set to double over the next 25 years. By 2025 half of the adult population will be over 50.  

‘By 2017 the number of older people in need of care will outstrip the number of family members able to provide it’

This is a startling achievement – the result of better healthcare, better environments.

However, this demographic shift is placing unprecedented demands on society and is set to transform everything from welfare to employment and even family norms.

The House of Lord’s committee on public service and demographic change concluded that “the government and our society are woefully unprepared” for our rapidly ageing population, and “without urgent action this great boon could turn into a series of crisis”. 

• HSJ commission scoping report: Pave the way for better elderly care
• Japan’s integrated total care vision for an ageing population
• Activate the next level of patient engagement

Ageing is often talked about as a burden, a crisis waiting to happen. However, this ignores the huge opportunity and value this population can bring. 

What it does mean is that we need to prepare for what lies ahead, identify areas of need and respond accordingly. One of the biggest challenges on the horizon will be how we ensure this growing older population gets access to the support and care they need to live a good quality of life.

Preparing for how to support people to live a good life means fundamentally rethinking how we care.

What do we mean by care?

A lot of different needs and tasks are bundled into the word “care”.

Care will meet a huge spectrum of needs from quasi-clinical care addressing high needs and intimate support to addressing more practical and emotional needs, such as being socially connected and help with shopping and getting around.

Care can also be self-care, self-assessment and monitoring of complex long term health conditions.    

The current situation

If we accept that in our later years there is a spectrum of decline, dependency and care needs, our priority has to be to slow it down. Theoretically, improving quality of life and addressing low level care needs before a time of crisis will improve health outcomes and delay the need for more expensive professional care. 

Public resources are under huge strain; already two-thirds of all health resources are devoted to older people. The result of this is that understandably the provision of public sector support is targeted at those with high care needs; more than 80 per cent of councils have had to restrict access to state funded care to only those with “substantial” or “critical” needs. 

There is a need for new and more proactive models of care that improve and maintain quality of life at an early stage.

‘More than 80 per cent of councils have had to restrict access to state funded care to only those with “substantial” or “critical” needs’

For many older people leading a good quality of life is about being socially connected and having a sense of purpose, about having support to live well and independently despite declining health and mobility.

This “informal care” will need to be met by family, friends and the community. In our recent report, Who Cares?, we estimate that there are currently 6.5 million people in the UK in need of some kind of informal care, and in the next 10 years there could be as many as 9.3 million. 

As well as putting a strain on public resources, the looming demographic shift will reduce the relative supply of informal carers available to supply care. The Institute for Public Policy Research estimates that by 2017 the number of older people in need of care will outstrip the number of family members able to provide it. 

The challenge is to find new ways of caring and providing “more for less”. 

The role of technology

At Nesta Impact Investment we are seeing a rise in the number of entrepreneurs developing technology solutions, which have the potential to radically transform informal care for our older population; solutions that can help to increase the supply of care, can make care easier and more effective, and can help to manage complex conditions and improve how care is delivered.

And the increased adoption and reduced cost of technology has opened up the opportunity to deliver these digital solutions at low cost and at scale. 

‘The community is a relatively untapped supply of support’

Casserole Club is a great example of technology enabling informal care from the community. It links people online who are willing to share a plate of food with neighbours less able to cook for themselves.

The community is a relatively untapped supply of support, and platforms such as Casserole help to unlock this supply by making it easy and accessible for people to get involved. Creating these community networks is so important, especially for those living without the support of family. 

Shifting demand for care

If we are going to address the issue of care, we not only need to improve the supply of care but there is a need to shift the demand for care. 

Tools such as Hometouch are helping people to manage their own health conditions and coordinate a network of support around them.

Simple functions such as video messaging and photo sharing can increase meaningful connections between families living apart, providing emotional support and reducing loneliness. Its medication reminders, well being tracking, specialist advice and emergency nurse call enable people to feel confident and safe living independently with declining health or a long term condition.

‘Linking data with personalised care plans and health tools means patients can understand and self-manage conditions’

As people’s care needs become greater, they require the support of multiple specialist providers.

Technology is being used to enable better integration. For example, Patients Know Best has developed electronic personal health records, linking patients and informal carers with specialist health providers to improve communication, coordination and continuity of care. 

Linking this data with personalised care plans and health tools means patients can understand and self-manage their conditions better reducing the demand on clinicians.   

Realising the potential of technology

It is clear that the current system of care is unsustainable. The provision of publically funded support will simply not be able to increase in line with demand. Tools such as these have huge potential to radically transform the way we provide care and the need for them has never been greater. 

However, technology is only part of the solution. So much more needs to happen if we are to realise the potential these tools offer and have a real impact on how we care, and ultimately on people’s lives.

These technologies need investment to enable them to develop and launch in what is a difficult and fragmented marketplace.

‘Individuals and the community need to be open to creating and engaging with new models of care’

Local authorities and commissioners need to engage with entrepreneurs to ensure innovations get into the hands of the professionals on the front line so that they can really make a difference. 

Importantly, individuals and the community need to be open to creating and engaging with new models of care.

Better awareness and education is needed to encourage and support self- and community care, to showcase new technology; a campaign with national charities and healthcare providers could provide the lead on this. 

If we respond now, and prepare for what is on the horizon with coordinated and systemic action, hopefully the landscape will look much different in 10 years’ time and we will avoid the threat of a care crisis.   

Katie Mountain is impact investment analyst for Nesta Impact Investments