comment: Lack of cohesion in older people's services needs swift action

Published: 15/07/2004, Volume II4, No. 5914 Page 13

The welcome decision announced in the government's comprehensive spending review to increase the number of Sure Start schemes by 50 per cent is further confirmation that the initiative is proving one of the most successful interventions of recent times.

However, it serves to flag up the often confused state of older people's services. This area lacks a vanguard policy like Sure Start or an overarching vision, like the one contained in the children's green paper, Every Child Matters.

There is much talk about the transfer of adult social services to primary care trusts or, at the very least, for health to take a stronger lead in this area, in the way that education is currently driving the children's agenda. If this produces closer working and better outcomes it is to be applauded, but too often re-organisation seems to be a substitute for clear strategic direction.

What is more, social services are realising that they are sitting on a potentially valuable asset. Providing almost any health service to older people is bound to involve an element of social care. The more forward-thinking social services departments are realising that using the choice agenda to reconfigure and develop the range of services for elderly people may give them a new lease of life. Traditionally conceived joint working solutions may no longer be relevant. Now may not be the time to let health take over.

The government is not blind to the lack of cohesion in older people's services. The comprehensive spending review declares the Department of Health's intention to spend£60m on 20 joint projects between councils 'and their NHS partners' to provide 'seamless integrated care for older people'. Then there is the£80m to install 'smart alarms' in the homes of the vulnerable elderly.

Finally, of course, there is the DoH's parallel commitment to 'case manage' many of the same people, albeit if the government now seems to be less confident about its ability to reduce hospital admissions (news, pages 4-5).

But despite all this good work, the feeling persists that elderly people's services in many areas would not stand up to the kind of scrutiny of children's services provided by the Climbié inquiry. Making sure that they can must be a priority at all levels.

Cradle to grave, a Sure Start and a good end. That must remain the promise of health and social services in this country.