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Social Inclusion

My Lords, I start by congratulating the noble Baroness, Lady Morgan, on securing this very important debate and on the hugely comprehensive and interesting introduction to it that she has given us. I was very moved by many of the points she made. I want to concentrate on one of the groups identified in the social exclusion report—disadvantaged older people. The report contained very clear recommendations. We live in a diverse society. The older population is no exception to that diversity because among our older population are what are known as the ““golden age of older people””. They have much more wealth than the next generation is probably going to accumulate, and they live very good lives. But there is a great deal of social exclusion among the older population. It is often unintentional and sometimes heavily disguised, sometimes through ignorance and often through patronising attitudes. It is recognised very rarely and often not by older people themselves. So it is quite hard to get things right. The Government have made valiant efforts to tackle this sort of social exclusion caused by poverty among many older people, through measures such as the national service framework in health and the credits and particular benefits that have gone to older people in the past few years. Notwithstanding that, many people are suffering from many disadvantages. Following the introduction by the noble Baroness, Lady Morgan, I would agree that from some of the work that has been done, particularly by Professor Sir Michael Marmot, on social inequalities leading to huge inequalities in health and, indeed, in life expectancy—I am very honoured to chair his advisory group on the longitudinal study of 50-plus adults—it is very telling that if you do not have autonomy and respect in your working life you will die several years earlier than people who do. With that autonomy and respect usually goes a higher standard of living. There are other, purely physical, attributes to the social disadvantaged that many older people endure. We know that many live in old houses. Old people living in old houses suffer the disadvantages of dampness and of poor design. Despite the many programmes that try to do something about this, it is difficult. I do not think that, as a society, we have really got our act together on joined-up thinking. We are always trying, but we are not there yet. People, because of family change or because of societal change, now tend to be rather isolated and sometimes incredibly lonely. We have to think about how we can get a good joined-up approach together and make it work for this growing section of our population, most of whom are basically well. They are not suffering from ill-health, but sometimes their social circumstances—this could be as simple as not being near to decent transport or not having access to a chiropodist or a dentist—means that, in the case of the chiropodist, people become bedridden for no reason really, and in the case of the dentist they will not go out and undertake social activities. That could be righted, and it must be if we are to change the situation of that vulnerable group. The group itself is diverse. If you happen to be female and old ,or from an ethnic minority group and old, if you happen to have an acquired disability, which many older people have—it may be no worse than my visible disability; I need glasses, but it may be deafness or many more serious disabilities—those things build up and people have a difficult life. We need concerted action to address that. Women live longer and therefore live longer with chronic disease and in poverty, if they are poor. Much has been done for carers, but we sometimes forget that a huge number of those carers are older women. Often, they are still unaware of their rights and are isolated. From a recent report, we know that males of 45 to 54—lots of people think that they are older—suffer multiple disadvantages. We need both national action and, what affects most people in their daily lives: local action. I end by mentioning a couple of things that need to be done. We must not pre-empt what we think older people want. Sometimes it is not a great range of social services, it is someone to patch up the garden and clean the windows. Sometimes it is a befriending service. Mostly, it is one point of advice, advocacy and help. If you are old and frail, you cannot traipse around offices if you need help. As we know from our debate yesterday, it is far too complex to claim the money to which we are entitled if it is means-tested benefits or pension of some sort. Transport may not be suited to the population that we are discussing. Also, many older people live in rather unjustified fear of going out late. We know that they are not the victims of crime nearly as often as younger people, but we do not know whether that is a chicken and egg situation, because perhaps they just do not go out in the evenings and therefore have a narrowed social life because they are too scared. We need some new models of community planned care. We have one model that we all know is very successful: Sure Start for children. There is no reason why a similar model could not be introduced that focuses on older people. We can also use specialist housing for older people as the basis of peripatetic and community-based services, which will also serve to bring other people from the community into the homes of older people, so that they are not isolated. We have models, such as Better Government for Older People, in which older people are carefully consulted and involved in the planning of services. That is essential if the service provider is to get the respect and help to get the service right. Community services have shrunk as the population of older people has grown and there is a real crisis in community nursing services. Health visitors, who work with the entire vulnerable population, have now disappeared entirely. I have come to the end—I hope, in time—but universal design and planning of services must be the long-term aim, so that people are not labelled as old, frail, ethnic minority, or whatever, but universally designed services can meet the needs of all of our population and we will not isolate one group as a special case for special needs.