Providing quality care for the growing older population is often portrayed as a burden on the NHS, but with central support we can spread best practice across the country to care for them
Our ageing population is often catastrophised with language like “burden”, “time bomb” or “tsunami”. This must stop.
‘Worryingly, there is substantial evidence of ageism and age discrimination in health and care services’
It represents a victory for modern medical and public health advances, and for improved societal conditions. It gives most of us the chance to live a longer life in better health. Most people report high levels of happiness, health and wellbeing well into old age. Older people also make a valuable contribution to society and the economy; in paid work and volunteering, by spending, and as unpaid carers or grandparents.
- King’s Fund calls for ‘urgent shift’ in elderly care
- Get involved with HSJ’s Commission on Hospital Care for Frail Older People
- Find out more about David Oliver and the other commissioners
Despite these benefits, we must be realistic about the inevitable health and care implications of a higher proportion of older people. As people age, they are progressively more likely to experience multiple long term conditions, with most over-75s having at least three, and disability also becomes more common. With age, we are more likely to require formal or informal personal home care, long term nursing or residential home care, hospitalisation and rehabilitation treatment, and to rely on multiple services and professionals, increasing the risk of receiving disjointed care.
Yet health and care services have failed to keep up with the dramatic demographic shift. Our system is too focused on single diseases, failing to meet the needs of patients with multiple and complex conditions.
Common age related conditions receive less investment, fewer incentives, and lower quality care than general medical conditions. Worryingly, there is substantial evidence of ageism and age discrimination in health and care services. And capacity for intermediate care and support is variable and generally insufficient to meet demand.
Given that healthcare spending increases with age, there is also a financial imperative to act. Costly inefficiencies include large variations in admission rates and bed occupancy, and the number of people being in high cost, bed based services when they could be at home. It is essential to address these issues.
This will require a fundamental shift towards care coordinated around the needs of the individual, not single diseases, and a model that prioritises prevention and support for maintaining independence. Incremental change is not sufficient – change is needed at scale and pace.
What good care looks like
Increasingly, local commissioners and providers are grasping the nettle, transforming older people’s services by engineering a radical shift towards prevention, anticipatory care and care closer to home. This provides a rich source of good practice and local service innovations the King’s Fund has drawn on in a new report, Making our health and care systems fit for an ageing population, which aims to provide a single resource for local service leaders in different settings, considering the whole “end to end” pathway of care.
‘There is a risk of continuing to make the mistake of relying on short term initiatives with non-recurring money’
The report considers 10 key components of care. Instead of overspecifying who or where they are provided, it identifies what good care looks like, examining the current state of play and where we need to get to. It includes evidence, resources and practical examples of where local service innovations are being delivered right now.
We hope this will be a useful tool for leaders to redesign services ensuring that each is delivered to the highest quality and that these services work better together. We need to acknowledge that every component of care is interdependent on every other.
Better support outside hospital can prevent admission; high quality care within hospital can improve long term outcomes and reduce disability or readmission. We also know that better post-acute rehabilitation can reduce placement in care homes.
We know what works
Thankfully, the care of older people is on the national policy radar as never before. Commendable work has included the Francis reports, and the government’s response; the dementia strategy and challenge; the Equality Act; and the establishment of integrated care pioneers.
But there is a risk of continuing to make the mistake of relying on short term initiatives with non-recurring money. And silo thinking continues, with public health, primary care, long term conditions management, urgent care and social care all hived off into separate strategies, national policy initiatives or local programmes.
The Department of Health will soon publish its paper No One Left Alone, which is expected to focus on the role of GPs in providing continuity of care for people over 75. But more is needed. In 2014, the DH and NHS England must offer a shared vision for older people across all care settings. This vision should go beyond the short term electoral cycle, eye-catching pilots and projects.
There is plenty of excellent practice ready to adopt. National policymakers need to throw their weight behind this by supporting innovative, joined up thinking. We know what works, but only with steady support from the centre will it become the norm.
David Oliver is a visiting fellow at the King’s Fund, president-elect of the British Geriatrics Society and a commissioner for HSJ’s Commission on Hospital Care for Frail Older People