Exclusive: NHSE’s defunding of older people’s programme ‘a source of national shame’

One former NHSE clinical director said the fact the Ageing Well plans, set out under the NHS long term plan, “were largely defunded and badly implemented must now be a source of national shame”.

NHSE originally announced back in 2019 that it would spend £647m between 2020 and 2024 on a big expansion of community-based services for older and frail people. This included faster access to rehab care on discharge, personalised care and support at home, and urgent crisis response.

Funding for the Ageing Well programme, under the NHS long-term plan, was set to be targeted by NHSE for local providers to hire staff and create infrastructure. Its LTP allocations were back-loaded, with £204m in 2022-23 and £343m in 2023-24.

But now, figures released to HSJ under the Freedom of Information Act show the final amounts allocated in those two years were just £77m and £79m respectively — a cut across the two years of £391m (72 per cent).

On paper, more than planned was allocated to Ageing Well before this, in 2021-22 (£291m rather than £70m planned) – but documents seen by HSJ show the vast majority of this was not targeted, and instead put down to local decision making in “fair shares” allocations.

The funding cuts meant NHS long-term plan proposals for a “two day response standard” to speed up discharge, and “proactive care” to prevent admissions among frail and older people, were never rolled out.

NHSE did spend a dedicated £200m a year from 2022 on “virtual wards”, which are often run by community services and can also speed up discharge, and it said planned “urgent community response” and “enhanced health support in care homes” had been widely delivered.

But leaders involved with Ageing Well at the time told HSJ the work could have been maintained properly after covid, at a time when NHS spending and hospital staffing grew steeply, and would have put the NHS and care in a better position.

Lord Darzi’s NHS review last month found: “Since at least 2006, and arguably for much longer, successive governments have promised to shift care away from hospitals and into the community. In practice, the reverse has happened… The NHS has implemented the inverse of its stated strategy.”

An NHS England spokesperson said: “While some funding originally due to be part of the Ageing Well programme instead went to [integrated care boards] directly, allowing them to continue providing a range of support for older people according to local needs, there is much more to do to improve older people’s care and reduce long stays.

“The NHS has rolled out two-hour [UCR] services and specialised support for people in care homes, virtual wards – with over 12,000 beds helping patients avoid stays in hospital – frailty and falls services and care transfer hubs.”

A warning for new reforms

Geriatrician Professor Martin Vernon, who developed the long-term plan proposals as NHSE national clinical director from 2016 to 2019, told HSJ they should “have assumed even greater priority” after covid; and would have put the NHS “in a much better place”.

But he said: “The fact that these plans were largely defunded and badly implemented must now be a source of national shame. The opportunities have been largely squandered and rather than world-leading on ageing health we are now in many ways trailing…

“This regrettable situation must be rescued urgently with renewed commitment, the right national leadership and laser-sharp focus, to avoid yet more people facing a truly dismal future as they get older.”

Adrian Hayter, a GP and national clinical director for older people’s care from 2019 until last year, said: “What integrated care systems need to action is there in black and white [in published frameworks] but implementation requires the money to follow the patients, or populations living with frailty, otherwise delivery is fragmented…

“It’s clear that NHS funding needs to support general practice and community services to deliver for older people, as well as more funding for social care and voluntary services if we wish to meet our ambition for integrated care. Greater transparency around where the money gets spent at both a local and national level is needed.”

Age UK charity director Caroline Abrahams, who was involved in developing the work, said although the pandemic was “clearly a major reason” for the cuts, “I can’t help wondering how much stronger a position we would be in now in terms of tackling knotty problems like delayed discharges if it had been rolled out as originally intended”.

She added: “It’s notable one of the three big shifts to which this government is committed is ‘from hospital to home’. From this perspective the failure of Ageing Well to take root is something of a warning: engineering a transition of this kind – which is exactly the right thing to do – is really challenging and requires sustained political support and adequate funding, as well as delivery skill and commitment at all levels.”