The time has come to make health and care services work for our ageing population

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In the past few years, we've witnessed more policy initiatives, reviews and reports designed to improve the health and care of older people than at any time since the foundation of the NHS: the Equality Act; the Dilnot Commission; The Patients Association CARE campaign, the Francis reports, and the government’s response; the Dementia Strategy; the concerted focus on integrated services and the Better Care Fund; the Royal College of Physicians’ Future Hospitals Commission; the Lords’ Ready for Ageing report and the Age UK/NHS Confederation Delivering Dignity commission. And in April, we can expect the announcement of the Department of Health's No-one left alone policy for primary care for older people.

The demographics make clear the need for these policies: a 50 per cent increase in the numbers of over 65s by 2030 and a 100 per cent increase in those over 80. Life expectancy at 65 is already nearly 20 years, and by 2030 it will be 23 for men and 26 for women. This represents a victory for wider public health and for modern medicine, with many older people reporting high levels of happiness, health and wellbeing. Older people continue to contribute to society as spenders, in paid work, as volunteers, carers or grandparents. It’s definitely time to shift from the tired, ageist narrative of 'burden', 'time bomb' and 'tsunami'.

But at the same time we have to be realistic about the implications of ageing on our health and care services. The biggest spend across primary, secondary, community and social care and prescribing is on older people. There are major variations in activity (eg, rates of hospital admission or care home placement) and inefficiencies in transferring older people between services. In this time of austerity, it is imperative for the whole system that we get care right for older people with complex needs.

Local service leaders are fully aware of this, and various plans, programmes and pathways for older frail people and those with complex co-morbidities are in development. But these plans are often focused on only one group of service users or one or two parts of the pathway. They have also been developed by serial 'pilotitis', fostered by short-term initiatives and leading to duplication.

So what is required to deliver the right kind of care for our growing older population? Our new report aims to equip leaders with evidence and practical guidance for whole systems, end-to-end redesign across all services and all stages of health for their local older population. The components of care can be seen in the following diagram:

Ten components of care for older people graphic

We do, however, emphasise that these interventions shouldn't just be parachuted in without considering the local context and a range of related services being conducive to change. This won't work. On the other hand, the practical examples in the report illustrate that, even in the face of austerity and upheaval, improvements can be and have been made. We are currently just too slow to adopt proven service improvements or innovations.

For change to happen, we need to end the silos that place prevention and public health, long-term conditions, acute care, intermediate care, long-term care and end-of-life care in separate plans and pathways. We must realise the fundamental interdependency of each component of care. For instance, if we focus on healthy active ageing, we may reduce progression to dependency and high service use; if we can assess and treat older people properly when they present to acute hospitals, they are more likely to be alive and at home up to one year later.

It's also important to move away from a constant focus on organisations and who is providing care, and look instead at components of care – older, frail people or those with multiple complex co-morbidities, including dementia, will not have the same needs as younger or less medically complex patients. People should not be denied adequate investigation, assessment or support merely because of ageist assumptions. Often someone who is falling; becoming immobile, confused or incontinent; or is struggling to manage at home can have underlying medical causes that should be investigated and treated. At the very least, rehabilitation, equipment or support can help them to retain or regain their independence. We should never assume that 'it's just their age', or that the only thing that counts is compassionate care. Older people deserve access to the same range of services as younger people, and we should still be trying to help them to get better.


Cynthia Godfrey

complementary practitioner,
Comment date
06 May 2014
From my own personal experience, especially with my late elderly mother, I found when she was in a Home from her late 80s until she died at 101, that some of the staff were wonderful and others should never have been caring for the elderly. The patronisation of the elderly is particularly infuriating, calling them by their first name, seems a small issue but to me it is disrespectful. This situation is endemic in the NHS hospitals, and when we talk about the NHS, whose staff invariably do not speak good English, who come from abroad, it is a cheaper option for the over-paid Management, who constantly treat their staff very badly with their idiotic 'targets'. andI understand approx. 20 to 25,000 have left the NHS. Does not surprise me, if there is no incentive and staff are treated badly, how can they tend the sick, and especially the elderly.
The elderly in the UK have been treated shamefully for years, being old in the UK has become a crime, dosed with medication to keep you quiet so that the staff in the old age homes have a more peaceful life. That used to be the situation even 6 years ago and I don't suppose much has changed.
Then you have the cases where carers will quite openly treat the elderly appallingly, and one incident I recall was in the media, where a camera had been installed, and the carer could not have cared less and mooned to the camera.
There is something in the UK culture, whereby unless you have a caring relative, you become invisible, someone to be made fun of, your own personal wishes are ignored. Youngsters will torment you and heaven help you live on a council estate, your life can become a misery.
All this talk and reports by the Kings Fund, is all very well, but there is an urgent need for more action. No, sadly, I am afraid, the elderly, the disabled and the mentally ill are not treated well in the UK. The actual UK pension is an insult, and the increases annually a further insult and why should any elderly person have to choose between food and heating every winter? The incidents of elderly people being found dead, who have no relatives who care, has become daily news, again during the winter.
I know the welfare bill is very high, but maybe part of the reason is the administration costs. Far far too many staff, with layers upon layers, especially within the NHS, the wages bill at present must be colossal. So that the men and women who need the money are not receiving it, and those at the top, who make the decisions about their welfare, earn a nice salary thank you, and then retire with a much better pension than those they are supposed to be caring for or making decisions about.
Instead of the Kings Fund reiterating that improvements have to be made, and I am wondering if those behind this Report, have actually spoken to those who actually work with the elderly, disabled and mentally ill.
It is good to read from 'Dan' that Weymouth care for their elderly, maybe instead of emigrating abroad my husband and I should have moved to Weymouth. In fact, the only men and women who I came across in the last say 15 years who showed any respect and seemed to care were those from the Far East, especially the Phillipines. However, now with the new rulings there are not that many coming to the UK, mostly carers are coming from Eastern Europe, whose level of the English language is again a lot to be desired. Their traditions caring for the elderly especially is not so the 'sea change' has to be carried out within the next year or so, and with an ageing population, why not employ those in their late 50s and 60s, pay them much better wages, than the appalling minimum wage most carers receive at the moment. Bringing to mind, if you pay peanuts you get monkeys!


Comment date
08 April 2014
Weymouth community is really taking care of the elderly. I find this very encouraging and I believe that more can be done for the elderly and for people with disabilities. I found an article that shows how the service to access the ocean for disabled individuals is being implemented>>

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