The unequal outcomes experienced by older users of the NHS points to a lack of vision rather than a lack of funding, writes Michelle Mitchell.
In early May, the health secretary Andrew Lansley made a seemingly benign statement about funding allocation. Money, he stated, should follow the “respective burden of disease” and therefore areas with a higher proportion of older people should get more.
This argument means less money for areas with a lower proportion of older people, since there is no immediate prospect of funding growth in the system.
The challenge to this proposal is that the highest incidence of disease tends to be in areas of socio-economic deprivation, where there is usually a lower proportion of older people. This is partly because if you live in a poorer area, you are less likely to live as long. However, on average an older person will live with a disability or a long-term condition for longer in a poorer area than a wealthier one.
Areas with larger numbers of older people also tend to be wealthier and healthier, because they tend to be a destination for relatively affluent pensioners living mortgage free. On this basis, it may seem unwise to suggest higher funding should automatically flow to areas with larger numbers of older people. This misses two key points.
Historically, spending on older people’s services has been proportionately low. One estimate suggests that although two thirds of NHS “clients” are aged 65 and over, they get only two fifths of total expenditure.
There continues to be under-investment in preventative services and a lack of targeted large-scale action to address older people’s needs. For example, Age UK commissioned research in 2010 interviewing national and local NHS workforce leads. It was universally accepted that older people were the main group they were caring for, yet they were rarely the target of strategic planning.
This could help explain why a lack of integrated NHS services remains a major issue and why we still have unacceptable levels of avoidable admissions due, for example, to poor care after discharge or patchy access to falls prevention.
Older people are also experiencing unequal access to services, which we hope will be redressed when the Equality Act comes into force in October.
If you are over 65 and suffering from cancer, your chances are less than in other developed countries due to a combination of ageist attitudes and a paucity of research into the care of over 65s.
Mental health treatments are currently inequitably skewed away from talking therapies for older people, often replaced by tranquilisers and other cheaper pharmaceutical alternatives.
However, these issues point to a lack of vision rather than a lack of funding. As much focus is needed on changing the whole system to meet older people’s needs as on recalibrating the funding formula.
The fact that the formula already takes into account the age of the local population yet does not deliver even equal outcomes for older people shows this is only part of the picture.
Proximity to death is a far more useful marker than simply overall age of the community. Wouldn’t it be perverse to send less money to an area because people happen to die 10 years earlier than the healthiest areas?
Some people have interpreted Lansley’s comments as suggesting a simple swap in the funding formula away from deprived communities to older ones and from north to south. I doubt that is the reality; it certainly wouldn’t be desirable.
Older people are the largest users of the NHS and must be recognised as such. The Commissioning Board must prioritise addressing health inequalities and distribute funding to where it will have the greatest impact. It means being more intelligent and long-term with funding, with decisions based on a predictive assessment of local needs, setting out to improve prevention and the care of long term conditions. This will ultimately deliver better outcomes for patients and better value for the NHS.
The Commissioning Board must ensure the NHS is delivering for older people. This means better joined-up services; eradicating ageist attitudes and practices; and fully realising the aspiration of person-centred care. Older people must be part of the health secretary’s first mandate to the board, and at the top of its strategic priorities. Do this right, and the NHS will deliver better care for everyone.