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Caring for older people with frailty: despite the challenges we do have some reasons to be cheerful


I’ve been an NHS doctor since 1989 and have devoted my career to the care of older people with frailty and long-term conditions – generally those presenting with acute illness or injury who require not just an immediate response but ongoing, proactive and joined-up care that crosses professional and organisational boundaries.

In that time I’ve led local services and had the privilege of being involved with and having advised on national clinical leadership, policy development and health system re-design. I have co-authored, with colleagues from The King’s Fund, a report that sets out some of the key evidence and lessons in ‘end-to-end’ care for older people. And I am currently leading a series of related workshops and conferences which culminates with the upcoming event ‘Delivering integrated care for older people with frailty’.

This has given me a broad perspective on developments in health and care services for our oldest citizens. Older people account for an ever-increasing amount of activity and spend in our health and care system. They are the largest group to use multiple services and see multiple professionals, and are therefore most likely to be affected by poorly integrated care. The factors that shape the system ultimately have an impact on them and their carers.

No one on the front line of the NHS in England could be in denial about our current challenges. The King’s Fund has repeatedly highlighted these challenges and not held back from giving a full and thorough insight into the reality of the situation. Issues include NHS funding deficits and workforce shortages, culture and morale, cuts in social care funding and provision, a rise in delayed transfers of care, increasing pressure on emergency departments and hospital beds, and serious concerns about the quality and safety of care – especially for older people.

Unfortunately, there is no quick fix. My experience in acute hospitals short of beds, funds and staff keeps me more grounded than some of those involved in health policy and leadership. Nevertheless, despite all the gloom I do think we have – in the words of the late singer Ian Dury – some ‘reasons to be cheerful’.

First, our ageing demographic and the increasing number of older people living with frailty, dementia or complex co-morbidities means that getting their care right, age-proofing and specifically tailoring services to fit them and their families is now key to the future of our health and social care system. And with so many baby-boomers now considering their own older age or becoming carers for their parents, this issue is unlikely to diminish. Previously services for older people were in the shadows, but now we are seeing major policy drives from government, regulators and NHS leaders. These include NHS England’s initiatives on community and primary care for older people with frailty; the Care Quality Commission’s new focus on moving from ‘regulating in silos’ to assessing integrated care for older people; quality improvement initiatives from clinical bodies (such as NHS Benchmarking’s detailed national audit on acute care for frail older people); and new care guidelines and standards – all helping to put the care of older people in the spotlight.

Second, despite the current pressures, constant re-organisations and uncertainty, staff leading and working in local services continue to innovate and drive quality improvement and put older people and their families at the heart of what they are doing. There will be presentations on more than a dozen projects at our conference, and details of all 80 projects submitted for consideration will be posted online.

Finally, there is a growing consensus on good practice in services for older people, and a lively and interactive community where people share ideas, examples and resources. And this sharing of good practice goes beyond organisational boundaries, or even national borders. While political systems, management structures and funding models vary across the world, the challenges of helping people to age well, helping them to live with long-term conditions, and providing more integrated, person-centred care when they need it are genuinely international.

Despite the current challenges, those working in the field of health and care for older people remain passionate about improving services, and I remain optimistic that there are positive developments under way that could make a real difference to service users.