‘A destructive vicious circle’: what does the future hold for health and social care?

age-ukJill Mortimer is Age UK’s Health and Care Policy Adviser and tweets at @Age_UK.

What’s really happening in health and social care services? Over the last few years, we used in Age UK’s Care in Crisis campaign to document the devastating budget cuts that meant fewer and fewer people were getting public support for help with their day to day activities.

But what about the NHS? Hasn’t it been protected through the last five years of cuts in public services? If so, what lay behind last year’s winter crisis? And why is Monitor, the health services financial regulator, now talking about the ‘worst financial crisis in a generation’?

These are the kinds of questions people are now asking and in our new report, ‘The Health and Care of Older People in England 2015’ we try to answer them. We have updated our usual annual analysis of trends in social care, and added analysis of trends in the NHS. We present the most authoritative and up to date facts and figures to understand older people’s health and care needs, and the extent to which these are being met by our health and care systems.

Taken as a whole, the results are very worrying. The disturbing findings suggest “a destructive vicious circle” according to Age UK’s Charity Director Caroline Abrahams, as inadequate access to high quality social care is progressively sapping the resilience of both NHS services and older people who are at risk of poor health

Although the NHS budget has been protected, it has only increased by 0.8 per cent a year over the last five years. Most experts believe it needs to increase by 3 to 4 per cent to keep up with new technologies and treatments as well as increases in the numbers of older people with multiple health conditions. Spending on social care has continued to fall, and as a result even fewer people now receive publicly funded support. The rate has dropped from 15 per cent of people aged 65 and over in 2005/06 to 9 per cent in 2013/14 – this at a time when the numbers of older people in our population are growing.

It is the primary and community based services where supply is most obviously failing to meet rising demand. Unfortunately, these are the services on which many older people depend in order to sustain their independence.

For example: demands on GP practices have increased steadily whilst the budget has remained static. It’s not surprising therefore that in a BMA survey in 2015, 74 per cent of GPs agreed that their workload was unmanageable and unsustainable compared to 67 per cent in 2014.

In another 2013 survey, 20 per cent of district nurses said they provided only a poor or fair service, which was linked to increases in the number of people they saw each day: dispiriting for them and not in the best interests of older people.

Public funding for care services in the home has decreased by 20 per cent since 2010/11. Fewer people, with higher needs, now receive them. More than one million older people facing difficulties with everyday tasks (like washing, getting to the toilet, getting out of bed, eating) receive no help of any kind at all, whether from neighbours, family or friends or help that they have paid for themselves.

The result of all this is much more intense pressure on hospitals: the number of A&E attendances by people aged 60 and over increased by two thirds between 2007/8 and 2013/14.

There has also been an increase of 48 per cent between 2001 and 2013 in hospital admissions of people aged 75 years and over for conditions such as pneumonia and urinary tract infections, many of which could have been avoidable if there had been earlier access to good primary and community health and care services.

In addition, loss of hospital capacity because patients are waiting for a suitable place to go to before they can be discharged is increasing alarmingly. The number of bed days lost has rocketed by 40 per cent between 2011/12 and 2014/15.

There are some positive developments going on in many local areas as professionals try to join up health and care services around the needs of individual older people. The voluntary sector can make a very significant contribution. But we fear these developments will not be enough. Unless there is significant change to the funding for our health and care services in the Spending Review in November we look to the future with considerable foreboding.

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