Ageing: Prepare for self-funding

Filed under: Policy,Social Care — lenand @ 9:04 am
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One of the biggest sources of health care costs is dementia, £23 billion according to Age UK.  Falls currently cost £1 billion for health and social care, rising to £2.2 billion in 2050 (AKTIVE).  Adult social care costs for the Elderly are £8.9 billion (HSCIC).  The nation cannot afford to increase funding to meet these levels of growth.

Budgets will be capped in 2016, without annual increases.  It is inevitable that more social care costs will be paid by private individuals – self-funders in the jargon.  The Dilnot Commission “Fairer Care Funding“, provides much evidence for changes in policy.

  • The current system is confusing, unfair and unsustainable. People are unable to plan ahead to meet their future care needs. Assessment processes are complex and opaque. Eligibility varies depending on where you live and there is no portability if you move between local authorities. Provision of information and advice is poor, and services often fail to join up.

To protect people from extreme care costs, Dilnot recommended capping the lifetime contribution to adult social care at £35,000, increased by the Government to £72,000.  Thereafter, people should be eligible for full support from the state.   In practice, it means that self-funding will increase and that many people will not get any state contribution to care costs.  As has been observed – there is a risk of smart people ‘gaming’ the rules to obtain earlier access to state funding.

Dilnot also recommended a statutory duty placed on local authorities to provide information, advice and assistance to all people, irrespective of how their care is funded or provided.  This must include local knowledge about care homes and care services.  In addition, people should be made aware of assisted living technology that is emerging from innovations in the Internet of Things.  Older people living independently and their distant relatives can obtain better outcomes by embracing new concepts of care.



Co-production: Agree Local Policy First

Filed under: Local Government,Policy — lenand @ 10:37 am
Transforming local public services through co-production is a recent mantra.  Birmingham University has reviewed the evidence and produced one unsurprising finding.

“The case for co-production is often made in terms of its potential relationship to efficiencies and cost-savings. But, the evidence base on co-production is limited and suggests that efficiency savings are not simple to achieve in the short-term.

‘it’s becoming a byword for passing responsibilities onto the communities and that’s leading to cynicism and anxiety’”

But there are also many positive messages and grounds for giving advice on how to move co-production forward.

  • Delivering co-production is less about ‘scaling up’, than taking a localist approach: ‘scaling out’ through sharing practice and spreading innovation between organisations.

They also list implications for policy makers:

  • Neighbourhood community budgets, neighbourhood plans and community rights all offer a potentially significant shift of power to communities providing grounding for transformative co-production of local public services.
  • But how the ambition of transformative co-production is communicated is crucial.  The message needs to engage with values and aspirations in order to motivate and mobilise people to work differently and take action.
  • Communication will need to be different within and across communities, localities and professional groups.
  • Transformative co-production depends on working with communities to bring together existing assets and resources in new and creative ways.
  • Local public delivery partners (as broadly defined, including voluntary, social enterprise, co-operative and mutual models) may be best able to understand and engage with such priorities and values ensuring that opportunities are communicated in credible and locally appropriate ways.
  • Community rights–particularly the ‘right to challenge’–have been communicated as an opportunity for the community to ‘take over’. This message has been interpreted on the ground as exacerbating an adversarial relationship between existing service providers and communities, rather than encouraging collaboration and synergy, and so may be counter-productive.
  • In commissioning services, the Public Services (Social Value) Act 2012, which requires public authorities to have regard to economic, social and environmental well-being in connection with public service contracts, can help to ensure that small, local public and community organisations are able to compete fairly.
  • Incentivising and inspiring, through peer-to-peer learning which feels ‘real and relevant’ is crucial to spreading co- production.
  • Neighbourhood community budget pilots have demonstrated that flexible, innovative approaches are important to initiating and continuing the dialogue between professionals and communities. Co-design and creative practice offer ways to build a credible commitment and incentivise different stakeholders.
  • For neighbourhood planning, spatial and visualisation tools (such as digital maps, computer games and touch- tables) seem particularly appropriate way of engaging the community in problem-solving.


GO’D: We are in a bad place, but it is a stable bad place

Filed under: Governance,Policy,Politics — lenand @ 4:46 pm

Gus O’Donnell, a former Cabinet Secretary, has proposed key reforms that he believes would lead to better government in an article in the Political Quarterly.

On the social side, he recognises problem of a rapidly ageing population, with increasing pressure on health and social care budgets.  He notes the rising trend in obesity, the growth of dementia and Alzheimer’s and mental health issues in general, making it hard to see how the state can afford to help all who need it.

In his solutions, he proposes policy changes for enhancing wellbeing, and constitutional changes would deliver such policies.  He asserts a fairly broad consensus on the following:

  • our planning laws are too rigid and slow;
  • our infrastructure is outdated and in need of urgent attention;
  • our education system is not producing the skills that our businesses need;
  • our health system is expensive and inefficient, with too little spent on prevention and mental health resulting in too much being needed for drugs and hospitals.

He questions whether money spent wisely, with UK public spending (Total Managed Expenditure) accounting for round 45 per cent of GDP.  The implication is that is unwise and he postulates three reasons for poor levels of public sector productivity: policy hysteresis, short-termism and vested interests.

On politicians and policy, he has lots to say, which includes a desire for pre-qualification criteria for candidates. He questions the sense of free travel for Londoners over 60, free prescriptions and “winter fuel allowances to millionaire pensioners on the Costa Brava”.  He sees it as “all part of the ludicrous bias whereby the old are subsidised by the young. It is bad economics and bad social policy.”  Which politicians would wish to reverse these policies?

On short-termism, he sees the overwhelming priority in health is to focus more on prevention and to rebalance resources in favour of mental health.  He would like to use wellbeing as a success measure.  “All hospital staff from the cleaners to the consultants should be absolutely clear that their objective is to improve the wellbeing of patients. Subject to that, they may well have intermediate targets, like reducing waiting times and cleaner wards, but the main goal should be clear.”

On public sector Governance, he suggests a body with strong professional integrity. An Office for Taxpayer Responsibility (OTR) with its own professional staff.  Yet he proposes staffing that would only seem to continue organisational hysteresis: “secondments from the Big 4 accountancy firms, some former civil servants, particularly those with Treasury experience, some ex-ministers and private sector members, particularly those with experience of working with the public sector.”  Each of these are at risk of having vested interests.

His conclusion is:

Unfortunately, we suffer from strong policy and constitutional hysteresis. We are in a bad place, but it is a stable bad place.


KISS: The NHS explained

Filed under: Policy — lenand @ 12:07 pm

The NHS explained in one short animation.


Get all the URLs into a room!

Filed under: Innovation,Policy — lenand @ 6:39 am

The Internet of Things may eventually enter the vocabulary of Members of Parliament (MPs).  But as Dr Julian Huppert, MP, pointed out, the eyes of MPs glaze over at the mention of digital technology.  He was not joking when he said that in the debate about child protection, there was a call to get all the URLs into a room for a meeting.

The use of acronyms adds to the confusion when they could have alternative meanings.  When discussing the protection of IP addresses, an MP can be forgiven for thinking it is about the protection of Intellectual Property addresses.

The point was well made at the beginning of yesterday’s meeting of the Digital Policy Alliance (the DPA, not to be confused with the Data Protection Act).  If digital technology terminology is to permeate policy, then DPA publications must be clear and have value to MPs in their constituencies.  This enabled the meeting to massage the message into five topics on the Internet of Things (IOT), not to be confused with the Internet:

  • Business
  • People
  • Government
  • Privacy
  • Infrastructure


Ageing: Digital Half-Life Policy

Filed under: Innovation,People,Policy,Technology — lenand @ 7:53 am
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Digital technology will impact everybody in the second half of their lives.  The age from 50 to 100, for the vast majority of people, will be a decline of most faculties until death do them claim.  Now is the time to think of the technology implications and develop a policy for public debate.

Here’s a table that shows the decreasing personal digital needs of people over 50 and the increasing needs of their family, friends and service agencies.  There’s an shift from being active and independent to moribund and entirely dependent and others. There a wide range of intermediate states of health and vigour, and digital needs should be individually tailored for the best outcomes.

Digital half life - Needs

Digital half life – Needs

The active, social person with no major health problems has lots of choice with the faculties to manage digital technology with ease.  For many this can last into their nineties.  However, the vast majority steadily need more external support. They wish to live independently, and this becomes easier and more economical if they accept external monitoring services. Currently these are expensive, using old technology in the home.  There are gaps in the market for home monitoring services – some idea is given in the table below:

Digital half life - Gaps

Digital half life – Gaps

The Internet of Things will lead the revolution.  Low cost home networked sensors are critical to the way forward.  It also needs good communications to data centres and analytical software as part of an affordable infrastructure.  Automatic sensing of changes to normal behaviour are necessary, in addition to the commonplace detector alarms.  With intelligent investment, the UK could develop a World leading technology industry.


Sustaining digital engagement by older people

Filed under: Governance,People,Policy,Technology — lenand @ 6:57 am

Not many people realise that elderly people become more disengaged with ICT as they become older.  They ‘fall off the bandwagon’.  There is plenty evidence and the relevance is summarised in this St George’s House Consultation.

“It has been shown that ICTs can help the fifty-plus population to live independently, access government and commercial services, and engage socially. However, very many older people remain offline and unconnected. Even more worryingly, some of the older people who may at some point have gone online may subsequently disengage, i.e. they do not stay online. They face particular, age-related barriers including physical and cognitive changes, transformation of social and family environment, as well as fast-altering technology. More general barriers include distrust lest they be exploited by commercial providers, and incomprehension of ICT terminology and jargon. Meanwhile, technologies continue to evolve at a bewildering rate. The challenge is not just to help (older) people to get online in the first place, but to provide a context which will help them to overcome challenges posed to their on-going digital engagement (whether by changes in capability, social support or technology) and to develop their own skills and competencies as far as they wish to do so.”

This theme will be followed in subsequent postings.


Who should trust “Trusted Computing”?

Most PC devices can connect to network resources, either on a public (Internet) or private network.  The Trusted Computing Group has developed standards for “Trusted Computing”, which has a specialised meaning.  With “Trusted Computing”, PC behaviour is enforced by standards and technologies that shift the root of trust from software to hardware embedded in the device.  For example, PCs with a TPM (Trusted Platform Module) could have hardware preset by the supplier:

  • to restrict the operating system versions;
  • to restrict software to specific versions;
  • to provide encrypted access to data stores;
  • to measure and report on the integrity of platform, including the BIOS, disk MBR, boot sector, operating system and application software.

In a corporate environment with a private network, it increases confidence in the integrity of the system.  Hardware identification of the end-points increases levels of information assurance is a benefit and could justify the complex processes of TPM deployment.  There is a case for extending the use of TPMs into more mobile devices.  Such reasons have led to mandation for business communications with the US DoD.

However, before anybody thinks of mandating “Trusted Computing” for the general public, let’s look at some of the implications.  Depending on how the standards are deployed, both PCs and mobile devices could lose flexibility, freedoms and privacy.  The superficial attraction of improved security on private networks could constrain the use of public networks and deter innovation.

Many areas of concern are reviewed in Wikipedia:

  • In order to trust anything that is authenticated by or encrypted by a TPM … , one has to trust the company that made that chip, the company that designed the chip, those companies allowed to make software for the chip, and the ability and interest of those companies to not compromise the process;
  • “Trusted Computing” (TC) would have an anti-competitive effect in the IT market;
  • TC can support remote censorship;
  • Software suppliers can make it much harder for to switch to competitors’ products;
  • TC-protected documents may be unreadable by competitive software;
  • Digital rights management technology could prevent users from freely sharing and using potentially copyrighted files without explicit permission;
  • A user who wanted to switch to a competing program might find that it would be impossible for that new program to read old data;
  • With remote attestation, a website could check the Internet browser being used and refuse to display on any browser other than the specified one;
  • The migration section of the TPM specification requires that it be impossible to move certain kinds of files except to a computer with the identical make and model of security chip;
  • Users unable to exercise legal rights, under headings such as fair use, public interest or whistle-blowing;
  • Users vulnerable to vendor withdrawal of service;
  • Users unable to override restrictions even if confirmed to be physically present to allow the computer to use a secure I/O path to another user;
  • Loss of anonymity could have a chilling effect on political free speech, the ability of journalists to use anonymous sources, whistle blowing, political blogging and other areas where the public needs protection from retaliation through anonymity;
  • TPM hardware failure creates the possibility of a user being irrevocably cut-off from access to private information.

The risk is that “Trusted Computing” becomes mandated without a full debate of these concerns before incorporation into government policy.  When you look at the list of financial supporters of “Trusted Computing”, many have a lot to gain from anti-competitive application of the standards.  Arguments for policies and regulations that might curtail current liberties should be balanced against those from less well-financed champions of Open Source, Open Rights, Open Internet and Civil Liberties.  We must avoid the scenario where honest citizens, without TPMs installed in their communications devices, could be locked out of using digital public services.


Compulsory Voter Registration: Yes, No or Maybe

Filed under: Electoral,Policy — lenand @ 9:36 am
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The question is simple.  Will electoral registration become compulsory? An answer in June 2012 from the Cabinet Office is not the ‘Yes’ or ‘No’ we might have expected:

The Electoral Registration and Administration Bill provides that Electoral Registration Officers (EROs) will be able to issue a civil penalty to individuals who, when required to make an application, fail to do so. There will be safeguards in place to ensure that only those who refuse repeated invitations can be fined, and registration officers will have to take specific steps to encourage an application before they can issue a fine. We expect the number of fines levied to be similar to the number of prosecutions for failing to respond to the canvass under the current system, of which there are approximately 150 per year. This will provide strong encouragement for people to do their civic duty and register to vote. It is not the Government’s intention to allow people to opt-out of registering to vote, or to opt-out of jury service. Equally there is no provision in the Bill to allow people to remove themselves from the register should they so wish. EROs will however be able to remove entries from the register where they have evidence that the application submitted was fraudulent, or is no longer accurate.

Maybe, or don’t panic, seems to be the response from the Electoral Registration Transformation Programme (ERTP).  Central policy is yet again, leave it to harassed local government EROs to decide on how to implement the Law.

LAs frozen out of IdAP

Filed under: Local Government,Policy — lenand @ 12:04 am
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Quarkside has heard that the Cabinet Office do not want Local Authorities (LAs) to compete in the Identity Assurance market against the private sector. This is strange because LAs could be more cost effective, given access to standardised private sector products or services.  Assuming that DWP will pay for Id Assurance, couldn’t any of the seven companies on the Id Assurance Programme (IdAP) framework ask LAs to front enrollment for their products?

LAs probably have the most capable local enrollment infrastructure – with the possible exception of Job Centres or some Post Offices.  Many towns with over 100,000 population, no longer have a General Post Office.  For example, Woking residents now have to dive down to a basement of WH Smiths.  What the policy makers have not accepted is that certain levels of trust should have face to face enrollment.  If somebody is receiving benefits of tens of £ thousands each year, wouldn’t eyeballing the person increase the level of trust in credentials presented at later stages?

Quarkside’s suggestion for a process that sets financial trust levels based on the transaction values may not be all that crazy.  Could it have a significant impact on fraud reduction?

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