Better care for older people ‘could avoid pressure on hospital admissions’

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Another “chaotic” winter in the NHS could be avoided in part by renewed efforts to support older people with health problems to stay well at home, Age UK has said.

The charity described the health and care system for older people as “clunky and under-resourced”, especially when it comes to community and social care.

Better care and support “delivered proactively” in the community before an older person’s health deteriorates can avoid the need to go to hospital and therefore help alleviate pressures on the NHS, Age UK said.

It has previously estimated that more than 1.6 million older people have some level of care and support need, such as help to get dressed or washed.

Age UK said the latest NHS Digital data has shown that avoidable hospital admissions for conditions that should be managed in the community, such as diabetes and high blood pressure, have risen for older people in the five years up to 2019/20 “particularly for the oldest old” who are 90 and over.

The charity said the latest data from NHS England for the 2021/2022 financial year showed almost half (49%) of all people arriving in A&E by ambulance are over 65, and a third (35%) are over 75.

The proportion of older people feeling supported to manage their health condition has fallen by around a fifth in relative terms since 2016/17, they added.

The charity’s report, which applies to England only, also included in-depth interviews with 14 people aged between 57 and 92, many of whom were carers but often living with their own long-term health challenges, which they had to juggle with caring responsibilities.

Avoidable hospital admissions for conditions that should be managed in the community have risen for older people in the five years up to 2019/20 (Jeff Moore/PA)
Avoidable hospital admissions for conditions that should be managed in the community have risen for older people in the five years up to 2019/20 (Jeff Moore/PA)

“Care that can support and sustain older people to stay well at home can be the foundations of an effective and sustainable health and care system. At the moment, these foundations are often broken or simply not there at all.”

The charity said shortages of home care staff are having a “devastating effect” leaving “many older people stuck in hospital who could be at home with the right support”.

Age UK’s head of health and social care influencing Ruthe Isden said: “We know what happens when we don’t support this group of people. We see that very clearly. We see that in how people are kind of falling chaotically into the acute system.

“It’s very difficult to support them in that environment. It’s very difficult to support them to move back out.”

A growing older population living longer with increasingly complex needs and many without children to provide informal care means there is not a “safety net in quite the same way” as there has been in the past, she added.

She said there is “broad agreement across the NHS, we cannot go through another winter like the one that we’ve just been through”.

Report co-author Tom Gentry said there have been some positives such as integrated care systems which mean there is a “skeleton of a system that can integrate better” but lamented the “lack of political will” which he described as “one of the biggest barriers” to change in health and social care.

David Fothergill, chairman of the Local Government Association community well-being board, described preventative care and support as “an absolutely crucial part of our social care system” but said “sufficient funding” was key.

He said: “We have consistently said that £13 billion is needed for social care so that its many pressures can be addressed and councils can deliver on all of their statutory duties including those related to preventing or delaying the onset of conditions which, if left unsupported, can lead to hospital admissions.

“This is the level of investment needed to ensure people of all ages can live an equal life and reduce the need for hospital treatment.”

A spokesperson for the Department of Health and Social Care said it had committed up to £7.5 billion for adult social care over the next two years.

They said: “We’re improving care for elderly and frail patients through our urgent and emergency care plan, which will expand community teams and virtual wards – allowing the most vulnerable patients to continue living independently or recover at home.

“We’re also investing an additional £200 million to free up hospital beds and reduce pressures on A&E and £50 million to expand hospital capacity, on top of our £500 million discharge fund, and £3.8 billion made available in long-term grants last year to help local authorities meet their social care needs.”

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