Ageing and disability: the role of financial and regulatory incentives in facilitating intersectoral collaboration
By David McDaid and A-La Park
David McDaid is Associate Professorial Research Fellow and A-La Park is Assistant Professorial Research Fellow, Personal Social Services Research Unit, London School of Economics and Political Science.
The deaf-blind author and pioneering advocate for people with disabilities, Helen Keller, once said “alone we can do so little. Together we can do so much”. Too often organisations can be isolated within castles in their own fiefdoms when in fact there are opportunities to put down the drawbridge and collaborate with others including the public, policy makers, practitioners, and yes, even researchers, to address issues of mutual interest.
The issues of ageing and disability present one area where the castle walls could be torn down, as there are so many common concerns and opportunities. As individuals age they may acquire the sudden onset of a disability or just experience symptoms of gradual functional decline. At the same time more and more people with disabilities acquired earlier in life are reaching older age. The ageing and disability communities can learn from each other.
These challenges are be celebrated as they mean that we are all living longer; but more efforts are needed to protect and promote quality of life and wellbeing for people ageing with disability. Governments will be mindful of the future costs of long term care due to increased longevity. Yet there are also opportunities; even slight improvements in health and/or in ability to maintain independent living, as well as achieving synergies in the provision of services, eliminating duplication of effort, are likely to have positive downward impacts on these future costs. It should not be forgotten that this population group are also consumers helping to stimulate the economy. In 2014 the UK Department of Work and Pensions estimated that all households with a disability had combined income of £212 billion after housing costs. Another analysis suggested a positive net contribution from older people to the UK economy of £40 billion in 2010 rising to £77 billion by 2030. There is thus a business and economic case to foster better outcomes in this population; but how can things be made to happen?
Recognising the importance of this issue, in 2012 a group of researchers and practitioners in the fields of ageing and disability drafted the Toronto Declaration on Bridging Knowledge, Policy, and Practice in Ageing and Disability. It stated that “bridging encompasses a range of concepts, tasks, technologies and practices aimed at improving knowledge sharing and collaboration across stakeholders, organisations, and fields in care and support for persons with disabilities, their families and the ageing population”. 
One way in which collaboration between different sectors can be encouraged is through the use of financial and regulatory incentives. There is for instance a significant literature on how financial incentives have helped facilitate joint actions between the health and social care sectors. We undertook a systematic review of literature over the last decade to find out whether there were examples of effective practice were to be found re ageing and disability..
The results were disappointing. The literature tends to focus on barriers to collaboration between these sectors rather than discussing solutions. In short we only found a handful of relevant examples. These include the use of incentives to encourage continued participation in work by older people with disabilities, incentives for stimulation of the market for assisted living arrangements and technologies as well as the benefits of rolling out personalised budgets and other forms of consumer directed payments.
So there is a real opportunity to address this deficit evaluate the use of financial mechanisms to stimulate interaction and bridge ageing and disability sectors. Encouraging lessons might be learnt from elsewhere. For instance in a recent review for the WHO Health Evidence Network on collaboration across sectors for health promotion, mechanism identified included the use of earmarked funding conditional on collaborative activity (usually from a ministry of health or local government, recurring delegated financing allocated to an independent body that works across sectors, mandatory or voluntary pooling of budgets between different organisations, tax incentives and specialist contracting arrangements.
There is also an opportunity to look at other factors that can influence the implementation process, such as assessing the impact of communicating all the costs and benefits relevant to each stakeholder of collaborative action, or looking at different ways of build cross-sectoral working relationships, especially where there is no past history of collaboration. What impact, for instance, does the co-location of ageing and disability organisation personnel have in establishing trust. The recent creation of BADIN may also provide a forum for stakeholder to share examples of experience in the real world where the drawbridges have been lowered and the castle walls torn down.
 Royal Voluntary Service. Gold Age Pensioners. Valuing the Socio-Economic Contribution of Older People in the UK. Cardiff: WVRS, 2011.
 Bickenbach J, Bigby C, Salvadaor-Carulla et al. The Toronto Declaration on bridging knowledge, policy and practice in aging and disability. International Journal of Integrated Care 2012; Oct-Dec; 12: e205.7
 McDaid D, Park A-L. Evidence on financing and budgeting mechanisms to support intersectoral actions between health, education, social welfare and labour sectors Copenhagen, World Health Organisation Health Evidence Network Synthesis Reports, 2016.