Older people in England should have ‘rapid access’ to physiotherapy and other community-based services when needed, according to a report published last week (26 September) by Age UK.

The charity’s State of Health and Care of Older People report – the tenth in a series released annually – paints a picture of declining health among an ageing population, unequal access to services and growing pressures on unpaid carers and frontline staff. 

It urges the government to make older people an ‘explicit priority cohort’ in its neighbourhood health reforms ‘right from the start and throughout’.

By the end of this Parliament – which is October 2029 at the latest – the number of emergency admissions for acute and chronic conditions that could and should be managed in the community should fall to less than 100,000 a year, the reports stresses.

Falls risk assessments

Every older people who is diagnosed with severe frailty in the community should be guaranteed to receive a structured medication review and a falls risk assessment, as a minimum.

Meanwhile, the number of people who are delayed in hospital when fit for discharge should be brought back to pre-pandemic levels (some 4,500 on a typical day compared to the current figure of more than 12,000).

To achieve this, NHS and social care services should offer shared community assessments as a minimum service requirement, according to the report’s authors: Chloe Reeves, Aisha Isla and Tom Gentry.

These assessments would ensure older people have ‘rapid access’ to care such as physiotherapy and occupational therapy, community mental health and ‘other rehabilitation services’ when needed.

The Age UK report also urges the government to assess and standardise maximum GP list sizes, taking into account the size of the older population as part of its upcoming NHS workforce strategy. It also calls for funded commitments to increase the community workforce, including district nurses, while improve and standardise core skills and capabilities across the workforce relating to older people’s care and frailty.

‘We have to go as fast as we possibly can now in achieving transformational change in community-based health and care services, as the NHS will never run optimally until this task is complete’ [Caroline Abrahams, Age UK]

Another key recommendation is that a funded strategy should be developed to increase the proportion of unpaid carers who are able to take a break for 24 hours to at least one in four by the end of this Parliament.

Services ‘under siege’

Caroline Abrahams, Charity Director at Age UK, said the health and care system faced ‘unprecedented pressure’ and was ‘virtually under siege’ at times. ‘We want to recognise the enormous efforts being made by staff from top to bottom to turn this situation around and we thank everyone who is working so hard to that end,’ she noted.

’The uncomfortable truth though is that at present, many older people are not able to get the high-quality healthcare and social care support they need – and they do not have time on their side. Against this context it’s not surprising that satisfaction levels are sharply down and there’s a trend towards more “going private” if they can afford it.

‘Sadly, the result is that inequalities are growing and those who are least advantaged are being left further behind. The starkest evidence of this are gaps in healthy life expectancy the scale of which shame us as a nation.’

Ms Abrahams added: ‘If we’re to transform the NHS and make it more effective then older people must be an explicit priority for the new Neighbourhood Health Service, because they are occupying the great majority of hospital beds when in many cases it would be better for them to stay at home with good treatment and support. This must include the right social care as well as health support, so ensuring social care is fully part of Neighbourhood Health is crucial.

‘With the 10 Year Health Plan we’re now finally trying to do the right things but much later than we should be and at a time when there’s less public money available to invest compared to 10 years ago. That’s why we have to go as fast as we possibly can now in achieving transformational change in community-based health and care services, as the NHS will never run optimally until this task is complete. ‘

Backing from British Geriatrics Society

British Geriatrics Society president Jugdeep Dhesi welcomed  the Age UK report. ‘These practical recommendations, if enacted, will make a noticeable and much needed difference to the experiences of older people seeking health and care,’ he said.

Professor Dhesi added: ‘We urge the Government to act upon these recommendations to improve services for older people across England. We know that if health and care services work for older people, they are more likely to work for everyone else.’

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