Older people are the biggest users of the health service. With services being reconfigured, their need for participation and independence must not be forgotten.

Older people are the largest user group of the NHS and of social care. Apart from paediatrics and obstetrics, they use all parts of the system.

At any one time, about 65 per cent of people occupying acute hospital beds are over the age of 65. People over 75 represent more than three-quarters of all people whose discharge from hospital is delayed.

The white paper Our Health, Our Care, Our Sayplaces great emphasis on the shift of resources from the acute sector to community settings. Recent reports have indicated a need to rationalise emergency and specialist trauma facilities into a smaller number of hospital sites. These changes have major implications for older people.

CSIP (Care Services Improvement Partnership)'s older people's programme is well placed to assist. Drawing on our experience of tackling delayed transfers of care, we bring a whole-systems approach to the work. This draws together acute and primary care, social care, the voluntary and community sector and private providers. Examples of our work include:

  • practical help to identify causes of blockages in the system and to use resources better to improve care pathways for patients;
  • advice on developing data sets across health and social care to inform service planning and commissioning;
  • help with getting the right partnership arrangements in place so that difficult conversations about resources and service changes can take place co-operatively and constructively;
  • evaluation of service changes to measure their impact.

In a system under financial strain, it is all too tempting to take short-term measures to solve a budget problem, without considering the longer-term consequences.

Acting unilaterally without consultation with, and involvement of, key partners will only store up problems for the future - no single agency can solve the complexities of resource management, commissioning for a local population and patient choice all by itself.

What older people want
Closing an acute ward or a community hospital will place undue pressure on primary and community care services, unless all parties are actively involved in planning and managing the change. Most importantly, local communities and organisations representing users and carers must be involved from the beginning. People's needs do not just disappear because a facility has been removed.

In planning service changes, we know that the following are relevant to older people:

  • Most people want to live at home. This means they should have access to responsive, flexible services, such as intermediate care and community rehabilitation, that can either help them avoid an unnecessary hospital admission, or get them out of hospital as soon as they are well enough to leave the acute bed.
  • Sixty per cent of admissions to residential and nursing homes are direct from hospital. Yet we know from Audit Commission and National Audit Office reports that, given time to recuperate and the opportunity to benefit from rehabilitation, older people are likely to regain enough of their mobility and daily living skills to return to live at home. Assessing older people's needs for long-term care in acute wards is completely inappropriate.
  • Investing in services that promote health and well-being, and encourage active participation by older people as citizens, can delay the need for more intensive support.
  • Many older people in acute hospitals have some degree of mental illness, often undiagnosed. Liaison and in-reach services can provide a rapid assessment service that enables people to move quickly through the system to more appropriate settings, often their own homes.
  • Social care and the NHS need to commission services together. Practice-based commissioning offers huge opportunities to develop different sorts of services for local populations, starting to move resources out of the acute sector and closer to home.

Reconfiguration presents us with the opportunity to make changes that use resources more effectively, and produce more responsive and accessible services for everyone's benefit. Let's make sure older people do not lose out.

Ruth Eley is the CSIP national programme leader for older and disabled people.