Commission calls for radical rethink of care for older people

Care must be driven by the needs of individuals rather than rigid institutions and structures. That is the main message from an independent report published today.

The Commission on Improving Urgent Care for Older people is calling for a fundamental change to the way care for older people is designed and delivered. Experts, drawn from across the health and care sector, have called for a radical new approach to urgent care for older people.

People aged over 85 are the fastest growing age group in England, while the population of those aged over 65 is expected to increase by 50 per cent by 2030. It is critical that the health and care system adapts to meet the needs of today’s population. Growing Old Together, published today, sets out key principles for revolutionising the way that urgent care for older people is delivered, focusing on how people receive the right care based on their needs and wishes. By changing the way services to older people are organised, we can improve their care and relieve the growing pressure on acute hospitals, so that they can focus on providing timely, high quality care for those who really need it. This means addressing issues across the system.

Eight key principles for improving urgent care for older people are identified in the report.  These principles have been influenced by innovative care models across the country, and conversations with senior leaders across the care system, clinical experts and carers.

Together the principles set out a vision for joined up, personalised and proactive care. This includes:

  • Always starting with care driven by the person’s needs and personal goals.
  • Care co-ordination that offers older people a single point of contact to guide them through an often complex system.
    Prioritising proactive and preventive care so that the health and care system is not structured around “short-term” reactive fixes but instead long-term solutions for helping people to maintain their independence where possible. This includes encouraging social interaction to help people to stay well, and out of hospital.

Dr Mark Newbold, chair, Commission on Improving Urgent Care for Older People said:

“We have talked too much in the past about integrating the providers of services and not enough about integrating care around people. It is the coordination of personal care for individuals that really matters. It is unacceptable to expect older people and carers to navigate a very complex system.

“Older people do need to access A&E at times, and the best hospitals tailor their service to meet their needs. But all too often, older people are forced to go to A&E because the alternative services that would help them be cared for at home are not available at the time they need them.

“We want to help people to stay well both mentally and physically and receive care that responds to care needs and personal wishes. Achieving this is better for both the individual and the wider care system.”

The report includes compelling evidence of the success of initiatives across the country that have improved care and reduced pressure on the health service but says this needs to happen nationally. Changing the health service from delivering short-term fixes for older people to helping them to keep well demands strong local leadership. We should back dynamic leaders to join up care while ensuring that outcome and performance measures allow local leaders to focus on individual needs, delivered by the whole health and care system.

The following innovative examples of integrated care were examined as part of the report:

  • By using a geriatric assessment team, Sheffield Teaching Hospital has cut down hospital stay days from 5.5 days to 1.1 days.
    Introducing a care co-ordinator function commissioned by Age UK in Cornwall has resulted in a 31 per cent reduction in all hospital admissions and a 26 per cent reduction in non-elective admissions.
  • By providing a home based emergency assessment and treatment service, North East London Foundation Trust and London ambulance service have saved around £108,000 by avoiding ambulance trips and reducing the need for A&E admission and assessment.

You can download the full report here.

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