Ex-older people's tsar criticises out of hospital obsession

David Oliver stood down at the end of last year after three years as a Department of Health national clinical director.

In an interview with HSJ he challenged what he described as a “holy grail” belief that the majority of admissions of older people to hospital were preventable. He said that view was a “denial” of the reality in hospitals, where the majority of people admitted as emergencies are older people.

“The [commonly stated view] about hospital care is it should be acute, episodic and specialised. But it is absolute la la land to think we’re going to be in a situation any time soon where older people don’t still keep piling through the doors of general hospitals.

“The lived reality on the ground is that hospitals are daily on black alert opening any flat surface they can to put beds in, turning ambulances away,” he said.

“I’m not saying it’s the wrong thing to try and [reduce admissions]… but we have to translate that aspiration to reality and there’s not a load of convincing evidence yet of anywhere where focusing on prevention has actually led to reducing overall costs in the health and social care economy.”

He challenged the belief – expressed by NHS chief executive Sir David Nicholson last year – that “hospitals were bad places for older people to be and they should go through the same revolution as the old mental asylums”.

Professor Oliver, a consultant geriatrician, said more focus was needed on improving hospitals care for older people with multiple conditions, for example by reducing the number of times they were moved, which often led to deterioration, and recognising that nursing older patients was a “highly skilled job”.

He said: “If your local comprehensive’s no good you don’t solve the problem by home schooling all the children. “

Professor Oliver told HSJ he decided to stand down as national clinical director for older people at the end of last year because he was not interested by the equivalent role in the reformed commissioning system.

From April national clinical directors will be based in the NHS Commissioning Board, with a focus on commissioning rather than policy advice and service improvement in providers.