Attendance Allowance as key to early intervention?

I’m grateful to Simon Bottery from Independent Age for a reminder of a suggestion which was being made in the run up to the last Green Paper (or was it the one before?!) that the key to targeting early intervention effectively for older people is simple. There are 1.3m older people receiving £5bn of Attendance Allowance. They have been assessed as needing low level support and their AA is intended to be a bit like a small personal budget for prevention. Once they receive the money, that’s it. No link from the DWP’s assessment processes to their local council of voluntary sector, let alone a linked offer of support to plan for crises, strengthen families, or build resilience. AA is cheap for DWP to run and it’s non-intrusive for recipients. But whilst recipients may choose to buy support of some kind with their AA and almost certainly appreciate getting it, it’s hard to find evidence that AA as currently delivered makes a significant positive difference to their resilience or the risk of loss of independence.

So it would be wrong to introduce new bureaucracy or even worse, labyrinthine shared IT systems. But is it inconceivable that the AA process could involve an invitation to give permission to share contact details with agencies able to help, with the DWP and councils working together to offer people in that group who wanted it access to a little support? With some of our partner agencies we’ve argued for some time for a more open-door approach to the ‘front end’ of social care, with people able to get support which doesn’t speed them into ‘service land’ but does help them to plan and lower their risk of increasing dependence. Amongst older people, many of the people for whom that kind of support would be most relevant will be AA recipients.

Ditch ‘prevention’!

This is the last blog in a series inspired by a seminar with social care leaders which looked at the question of citizen and community-led change.

It became clear early on in the discussion that some people had arrived expecting a debate about ‘social capital’ and community development, whilst others had been expecting a debate about early intervention and prevention. Personally, I believe that both of those concepts do, or should, mean much the same thing. Put another way, soon after I agreed to become the ‘co-lead’ on prevention and early intervention for the social care White Paper, I decided that given the choice, I’d drop the language of prevention and early intervention entirely and replace it with the language of well-being, empowerment and citizen-leadership.

Sue Bott of Disability Rights UK reacted to talk of prevention like this: “People who use services don’t want to be divided into the fixable and the not-fixable”. The problem is that prevention is all about people’s problems (will you be a drain on resources?) whereas the things ‘preventative services’ wish to achieve, are best achieved by focusing on people’s gifts, skills and assets.

‘Early intervention’ is just as bad: if the territory of ‘prevention’ is all about tackling isolation, helping people to connect and empowerment, those are outcomes which are just as relevant to the person who has just started to become less mobile in later life, the person with a life-long physical impairment or the person at the end of their life. No one wants to be lonely: whatever else is going on in your life, being lonely is miserable and worse for you than smoking.

So I think it’s time to move on from thinking about how to save money through reducing NHS admissions, which might involve coming up with wheezes which simply transfer the cost to social care, and instead think whole-person and whole-community. People will always need specialist responses and hopefully those responses will continue to become more coordinated, skilled and efficient. But the real gains will come when all services, whether they are used by people with ‘low level’ or ‘high level’ needs, think beyond meeting the present need and towards increasing the likelihood that the individual – and often their community – will be more knowledgeable, networked and confident in future.

If we can get that right, not only will more people be able to live a good life, with fewer trapped in a cycle of dependence and ‘revolving door’ use of crisis services, but savings generated will be more likely to be real, and to the public purse as a whole, not just to one sector or another.