UK: Better Care For Frail Older People: A Right That Needs To Become A Reality

Last Updated: 13 March 2014
Article by Karen Taylor

Advances in science and technology and year on year increases in funding have made a significant contribution to our ability to treat, manage and prevent disease. This success has led to increased longevity and a relatively active and prosperous older generation who provide an invaluable economic and social contribution to society. It has also contributed to what is arguably the most daunting challenge facing the UK health and social care system today - the need to care for and support growing numbers of medically complex, frailer older people with increasingly limited resources. As a result the current model of care for our most vulnerable members of society is at a tipping point and no longer fit for purpose.

Deloitte's report titled 'Better care for frail older people' outlines the need to change the current health and social care delivery model to improve care for frail older people and explores how providers and commissioners can work differently to drive quality and efficiency and improve people's experience in each place of care that they encounter.

The scale of the problem

Since 2010-11, real-term funding for healthcare in England has been almost flat against a background of increasing demand for services of around four per cent per annum, driven largely by an ageing population, whose number and prevalence of chronic disease is growing. At the same time social care support is reducing, restricted to those with substantial or critical needs. We estimate that current NHS and social care spend on the over 65s living with at least one long term condition is at least £30 billion a year. However this is spent largely on expensive acute intervention and residential care rather than on prevention, self-management, early intervention, and helping people live well and independently for longer. The number of people failed by the current system stands to increase considerably unless we act fast and adopt, as a matter of urgency, new models of care which address the current physical, mental and social care needs of our valuable, yet increasingly vulnerable, older generation.

Barriers to better services for frail elderly

Delivering the much needed change is challenging due to a number of entrenched barriers to better care, including:

  • separate funding models for health and social care despite the fact that older people's needs are increasingly interdependent, with significant cultural and behavioural tensions undermining efforts to integrate and improve care
  • fragmented care delivery with multiple groups of health and social care staff treating individual aspects of need in an un- coordinated manner when what is required is a shift towards treating the 'whole patient', facilitated by shared access to information at each place of care
  • Limited supply of adequately trained and remunerated home care and care home staff who have the most contact hours but the least education and training – with almost 40 per cent of the 1.56 million social care staff having no relevant qualification
  • capacity constraints in primary care with increasing demand for GP and practice nurse consultations and a workload in caring for the over 75s three times that of caring for the 45-64 age group
  • health conditions exacerbated by unsuitable living conditions, with a third of people over 75 living in housing that has failed the decent homes standard, and low availability and affordability of extra care housing and care home places. This is compounded by the fact that half of all people over 75 live alone and are often socially isolated leading to chronic loneliness which is as bad for health as smoking 15 cigarettes a day. 

The need to act to improve quality of care in all care settings is well publicised thanks to the many high profile national reviews and reports published over the last couple of years. However, exactly how the wheels of change will be set in motion is not yet clear especially given the difficulties prioritising, funding and implementing the long list of recommendations in these reports.

Solutions

Improving the experience and outcomes for frail older people requires improvements on three fronts, physical and mental healthcare, social care and place of care. It also requires the redesign of services around the individual to enable them to live independently for as long as possible. This includes support in the community to allow prompt return home should admission to hospital or residential care be necessary. Our report outlines ways in which to achieve this goal, including new funding models which shift resources to primary, community and home care; supported by the wider adoption of technology; and access to better information, including patients medical records, for all those providing care. It also requires staff to work differently to forge sustainable partnerships and provide consistent coordinated services, 24/7.

None of this is rocket science, and indeed we are already seeing new models of care implemented in pockets of the UK which are revolutionising care for frail older people. However, the sheer scale of the challenge requires more immediate and widespread action to address the needs of increasing numbers of frail older people who aren't in a position to wait for policy makers to take 5-10 years to develop the more integrated health and social care system that successive governments have agreed is the desired model of care.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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