A 26-year veteran of the charity, current Age Concern England director general Gordon Lishman is not as cynical about political attitudes to the elderly as you might expect. He believes the government’s much-maligned response to the Royal Commission on long term care (LTC) for the elderly, never far from his thoughts since becoming director general this July, was more mistake than conspiracy.
“Rather than economic and funding experts, the government chose intelligent laypeople for the Royal Commission,” he says. “When this body failed to come up with the answers ministers expected, they didn’t know how to cope, and I heard stories of proposals being bounced between the Department of Health, the Treasury, and Number 10 for some time.”
Age Concern never expected a particularly satisfying set of LTC policies from the government, but Lishman says he was surprised at how badly the government presented its proposals, even the few that met with charity approval.
“For me, that’s why this government, supposedly so good at ‘spin’, is always under attack,” he says. “Take the £900m investment in intermediate care for example, which will help elderly people return to their home, rather than have to sell it, after illness. That’s the sort of expenditure Age Concern welcomes – but, as it was hidden within the wider response to the Royal Commission, with its refusal to fund personal care, there was little press coverage of the bit the government actually got right.”
Like most LTC commentators, Lishman is positive about some aspects of the government proposals but concerned that the whole strategy lacks coherence and detail.
He gives the government’s definition of nursing care – nursing time spent on providing, delegating or supervising care in any setting – as an example of this ambiguity.
“It’s difficult to decipher what that means,” he says. “From what we understand, part of the ‘free’ nursing care will be the time a nurse spends delegating, rather than the delegated person spends working – which will be a negligible amount. To balance figures, organisations will have little choice but to maximise the time they say they are spending on care and minimise the time they actually spend, and the government is actually building this kind of financial logic into the system.”
Age Concern has a unique position in the LTC arena, both as a charity and, through its partnership with CGNU to form Age Concern Financial Partnerships (ACFP), a LTC insurance provider. Lishman is one of the few people in the organisation to have responsibilities on both sides of the divide. He says ACFP has improved LTC insurance but is quick to point out that, despite interests in a provider, Age Concern will retain its integrity to comment on the insurance market.
He sees LTC as a difficult market as insurers are faced with incorporating people’s difficult-to-predict long-term needs into products without raising premiums. But he is positive about the current state of the industry and believes none of the providers are setting out to profiteer.
“Although failing most of Age Concern’s ‘clarity, choice and security’ criteria, the government’s response to the Royal Commission does at least allow people to plan for old age,” he says. “People now know what they will get from the state and can calculate if they want to use some of their capital to buy LTC insurance. Bearing this in mind, I’m surprised we haven’t seen more in the way of new products since the announcement.”
As LTC insurance is only viable for around the wealthiest 10 per cent of elderly people, Lishman believes the industry will have to develop some sort of bulk purchasing scheme to open the product to a wider audience. He ventures that it might work as an employee benefit, through which people could join forces with their employers over the course of their working life to create the security of eventual LTC accessibility.
Considering the obvious complexity of LTC insurance, Lishman is very much in favour of regulation of the market.
As part of this regulation, Lishman suggests that IFAs who want to sell LTC insurance should have to undergo specialist training. “Advising on LTC is something that professional care advisers find hard enough,” he says, “so IFAs certainly need training to help them understand the patterns of care needs. Recent government announcements will have major implications for the products people need to buy, and this is just too specialist an area for people without special training and qualities.”
And with more LTC announcements on regulation and further definitions imminent, cynical or not, Lishman and Age Concern England are poised to jump on anything that fails the elderly population.