A new in-depth report from the Charity Age UK, ‘Fixing the Foundations’, reveals how our under-funded and overstretched NHS and social care system is struggling and sometimes failing to cope with the needs of older people. Longstanding problems, predating the pandemic but exacerbated by it too, are piling pressure on families and carers and leaving the NHS in constant crisis mode, contributing massively to ambulances being stacked up outside hospital emergency departments at the moment, and long waits for people of all ages to access urgent care.
• Half (49%) of all people arriving in A&E by ambulance are over 65 and a third (35%) over 75
• The proportion of older people feeling supported to manage their health condition has fallen by a fifth (almost 20%) in relative terms since 2016/17
• One in five (21%) over 80s have some unmet need for social care
‘Fixing the Foundations’ provides a first-hand account of older people’s difficulties in getting the good, joined up health and social care they need to manage at home, leaving them at risk of crisis which often results in being admitted to hospital. Yet the evidence is clear that with the right care at the right time many of these admissions could have been avoided.
The report also includes perspectives from professionals and unpaid carers. It also shows how living with multiple long term health conditions, as a significant proportion of older people do, including more than two thirds of those aged over 85, makes it especially hard to navigate health services which are still usually organised around individual illnesses and diseases. Meanwhile social care was often inadequate or absent in these older people’s lives. Age UK estimates that astonishingly, over 1.6 million older people have some level of fundamental care and support need, such as help to get dressed, washed or getting out of bed, that is not being fully addressed.
For those older people who do receive care and support it is often coming from unpaid family carers, who provide a far greater volume of care in our country than formal services. However, the latest figures from 2019 estimate that 3.3 million older people now live alone[iv], up from 2.8 million a decade earlier. 1.5 million older people are ageing without children in our society and their numbers are expected to rise significantly in the coming years as our population ages. This trend is certain to increase the demand for formal social care services, so we need to plan for this by expanding their availability now – yet sadly the trend has been going in the wrong direction.
Between 2016/17 and 2021/22 the proportion of older people receiving long term support from their local authority went down by 13.5%, We know from our many conversations with older people that accessing support is harder than ever. When care is rationed for older people, those pressures will ultimately bear down on the NHS, and particularly our hospitals as we have seen this winter. This is therefore a terrible false economy in the charity’s view, reflecting how thresholds for support have risen as a result of council budget shortfalls.
The Charity reveals that:
• Half (49%) of all the people arriving in A&E by ambulance are over 65.
• A third (36%) of all the people arriving in A&E by ambulance are over 75.
• Unplanned hospital admissions have been rising and have become more frequent, particularly for the oldest old.
• The proportion of older people feeling supported to manage their condition has been falling consistently, almost 20% in relative terms since 2016/17.
• 2.6 million people over 50 have unmet social care needs increasing to 15% of people in their 70s, and 21% of people in their 80s.
• In 2022, there were 165,000 vacant posts in social care- an increase of 50% and the highest rate on record.
On the back of its new report Age UK calls for:
Integrated Care Systems (ICS) to develop comprehensive strategies for meeting the health and social care needs of older people at home, and in care homes, living in their areas. This must include major efforts to embed prevention in their work so older people can avoid the need for crisis care and maintain their independence. We know from the pandemic that when local services are freed up to work across health and care boundaries the experience and outcomes for people are much better. One example was the discharge support fund that supported people out of hospital with packages of care in the community. The Government’s decision to stop the fund in March 2022 certainly contributed to the challenges this winter. ICSs must expand examples like this but start to think much bigger, supported by Government.
Social care reform and a major and sustained increase in funding. The NHS cannot deliver these improvements alone. The lack of adequate social care for basic daily needs simply stores up problems, leaving older people less able to care for themselves and arriving in hospital with serious health problems that could have been avoided.
Multidisciplinary working to become the default method of delivering health and care services to older people. Older people are too often left to fall between the cracks of disjointed services and professionals who don’t communicate well with each other. For ICSs, this means making sure that social care services – and by extension the local authorities that are responsible for them – are central to their leadership and decision-making.
A better paid health and social care workforce, with the skills and competencies to properly support older people would make a huge difference to the quality and availability of care.
A step change in the recognition of and financial and practical support on offer to unpaid carers, who are holding up many parts of the health and care system.
Caroline Abrahams, Age UK Charity Director, said:
“As our new report shows, we need to turbocharge our efforts to recruit, retain and support all the brilliant professionals that older people depend on to help them stay well at home, especially if they are struggling to manage several serious health conditions, like heart disease and diabetes, as many are. We need lots more social care staff, and hugely important community health professionals like District Nurses and Occupational Therapists, as well as GPs. Then we need to get them working effectively together – not only at the point when an older person is at immediate risk of needing a hospital bed, as with urgent response teams and virtual wards, but well before they reach that point too.
“Although this winter is not yet over it won’t be long before next winter is upon us, and it’s imperative we start work now to make sure it’s a much better one for the NHS and social care, and for older people too. At Age UK we are committed to doing everything we can to support a major national effort to this end – the voluntary sector, including our wonderful local Age UKs, has a big potential role to play. As we have learned this year, and as our new report shows, if we can get it right for older people in the NHS and social care then we’ll go a long way towards making the whole health and care system work more smoothly for people of all ages.
“It would be terrible if Age UK had to publish another report in five years’ time that once again found these same problems were still to be addressed. The fact is we know what has to happen to unblock our jammed-up hospitals and give older people the dignified health and social care support they need and deserve, and it’s down to the Government above all, to provide the leadership and resources to make it happen.”
The Fixing the Foundations report can be downloaded here