Download HSJ’s landmark report

The main report from the landmark HSJ/Serco Commission on Hospital Care for Frail Older People is available to download.

The commission addressed the problem of how the NHS should care for the country’s increasing number of frail older people.

The commission’s central conclusion is that hospital providers and commissioners should not rely on government plans for greater integration between health and social care as a solution – they must and can take action now themselves to tackle the problem.

The commissioners had five key findings:

  • There is a myth that providing more and better care for frail older people in the community, increasing integration between health and social care services and pooling health and social care budgets will lead to significant, cashable financial savings in the acute hospital sector and across health economies. The commission found no evidence that these assumptions are true. 
  • The commonly made assertion that better community and social care will lead to less need for acute hospital beds is probably wrong. A short term reduction in acute sector demand may follow as a consequence of community-based demand reduction initiatives, although this is unproven. Improving community care may postpone the need for hospital care, but it will make frail older people neither invincible nor immortal: mostly, they will simply need the care later.
  • We need more realism in the debate about the quality and quantity of care that can be provided in an environment of funding that is declining relative to demand. The pursuit of current NHS funding policies looks likely to lead to a funding gap.
  • Hospitals should not be used to provide care that should more appropriately be provided elsewhere. Commissioners must improve community care to meet future demand, but the required investment must be based on evidence.
  • While acute hospital admission is often the right thing to do for frail older people, being in hospital also creates risks for older people. Hospitals need to gear up to provide the very best care for frail older people, who are now their most frequent users, involving geriatricians from the start of the admission together with the other appropriate specialists.

Alongside the report HSJ has published a series of case studies showing good practice from around the NHS. Also available at is further evidence that led to the commissioners’ conclusions and a full bibliography.

The report in full