Crisis in health and social care for older people

'A destructive vicious circle': Damning Age UK report highlights crisis in health and social care for older people

A damning report by charity Age UK finds that the health and care system for older people in England is under severe stress and is underperforming, leading to higher costs, poorer health outcomes and worse patient and service user experience.

The disturbing findings presented in this comprehensive report suggest 'a destructive vicious circle' according to charity director Caroline Abrahams, as inadequate access to high quality social care is progressively sapping the resilience both of NHS services and of older people who are at risk of poor health.

The numbers of older people in England are steadily growing, and those with long term conditions growing faster still, but overall, investment in healthcare is failing to keep pace and funding for social care has very significantly declined.

Between 2005 and 2016 the number of people aged 65 or over in England increased by 18.8 per cent (or by 1.5million people) with the biggest growth amongst the over 85s (up by 29.3 per cent). Community based services on which many older people depend in order to sustain their independence have seen the sharpest falls and elsewhere supply is often failing to meet rising demand.

In light of this, the report 'The health and care of older people 2015' builds on Age UK's earlier work, presenting an updated analysis of the state of social care as well as examining key trends across the NHS and presenting the latest insights into the health and care needs of an ageing population.

The report looks at the:

• growing need for health and social care services
• the rising numbers of people living with complex needs
• trends in funding, activity and the workforce across the health and social care system
• evidence of growing pressure and stress across the health and social care system
• the degree to which health and social care services are effectively supporting people to stay well and independent

Taken as a whole, the report paints a sobering picture of two systems under great stress.

Caroline Abrahams, Charity Director at Age UK said:

'All the data in this report points in the same direction. The numbers of older people in England are steadily growing, and the proportion with long term conditions is growing faster still, but investment in health care overall is failing to keep pace and spending on social care has fallen quite spectacularly over the last five years.

'On the whole it is the community based services which help older people to sustain their independence which have seen the sharpest falls, or where supply is most obviously failing to meet rising demand. So, for example, GPs numbers are not keeping up with a growing older population and meals-on-wheels provision, once a mainstay of community care, is rapidly falling away.

'Our health and social care system is designed so that social care and the NHS interact and support each other to help keep older people fit and well, but starving social care of resources is seriously undermining the NHS - our hospitals especially. This can be seen in the latest worrying figures for delayed discharges from hospital and emergency readmissions.

'Hospitals and other services are forced to ‘run hot' due to the extra pressure, increasing stress on the staff and making it ever harder to recruit and retain them. This is a destructive vicious circle and we are really worried that it seems to be getting worse.

'There is a lot of ingenuity and commitment within our health and care system but even so, it is hard to see it being a match for the consequences of a steadily rising older population, combined with health spending failing to keep pace and social care spending significantly declining.

'Looking at all the trends in this report, if an older person asked us today how confident we were that their health and care needs will be met well in the future we would be whistling in the dark if we gave a wholly reassuring answer.

'The Government has the power to change this through its forthcoming spending review and we sincerely hope they will.'

Some key findings and facts from the report:

1. Between 2005/6 and 2014/15 the numbers aged 65+ in England increased by almost a fifth and the numbers aged 85+ rose by approaching a third. The increase in the older population is projected to accelerate over the next 20 years.[i]

2. Disability free life expectancy is rising more slowly than life expectancy.[ii] Most people aged 75 and over have one or more health conditions[iii], though 50 per cent of them do not consider it ‘life limiting'[iv]; 1 in 4 of those aged 85 and over are frail[v].

3. Most long term conditions are more prevalent among older age groups[vi]; for example, 0.3% people aged 60-64 and 4% 75-79 year olds have dementia but this rises to more than one in four 95-99 year old women and one in five men[vii].

4. £1.85 billion has come out of social care over the last 10 years[viii]; Government budget allocations for 2015/16 imply social care budgets will fall by a further £470 million, even after accounting for the transfer from the NHS to the Better Care Fund[ix][x].

5. Government spending on home care for older people fell by a fifth between 2010/11 and 2013/14, with 15% fewer older people getting support. State spending on meals on wheels has halved in the last 3 years and approaching two thirds fewer older people now receive them[xi].

6. More than a million older people in England now have at least one unmet social care need[xii], up from 800,000 in 2010; this means they receive no help from their local authority or from family, neighbours or friends. The risk of having an unmet care need is greatest for the oldest and those who live alone. Around half of those older people with difficulty bathing or getting dressed without help, and around a third with difficulty going to the toilet unaided, receive no support[xiii].

7.In 2014 about 1 in 6 of the population were caring for an older person, a third of them for more than 20 hours a week[xiv]; I in 5 people aged over 65 was caring for another older person, a quarter of them for more than 50 hours a week[xv]

8.The Kings Fund says NHS spending must rise 3-6% a year to keep up with growing demand and the cost of new technology[xvi]; in fact, in real terms since 2010/11 NHS funding has risen by an average 0.8% a year[xvii]. NHS England says the NHS funding gap will reach £30 billion by 2021[xviii]. The Government has said it will increase NHS funding by up to about £10 billion, leaving a £20 billion gap, to be bridged it is hoped through increased productivity and efficiencies[xix] - which is ambitious

9. Between 2005/6 and 2012/13 emergency hospital admissions of people aged 65 or older rose by a fifth, a steeper increase than is explained by demographic change[xx].

10. Between 2011/12 and 2014/15 the annual numbers of delayed discharges for acute patients in hospitals increased by 40 per cent; between 2013/14 and 2014/15 delays due to social care increased by 15.5 per cent[xxi].

>Read the full report

ENDS

Notes to editors:

[i] [i]Office for National Statistics; "Population estimates for UK, England and Wales, Northern Ireland, mid-2014," Office for National Statistics (2015) - http://www.ons.gov.uk/ons/rel/pop-estimate/population-estimates-for-uk--england-and-wales--scotland-and-northern-ireland/mid-2014/rft---mid-2014-uk-population-estimates.zip

[i]Office for National Statistics; "Revised population estimates for UK, England and Wales Scotland and Northern Ireland, mid-2013," Office for National Statistics (2015a) - http://www.ons.gov.uk/ons/rel/pop-estimate/population-estimates-for-uk--england-and-wales--scotland-and-northern-ireland/mid-2014/rft---mid-2013-uk-population-estimates.zip

[i] Office for National Statistics; "Population Estimates Total Persons for England and Wales and Regions, Mid-1971 to Mid-2012," Office for National Statistics (2013) - http://www.ons.gov.uk/ons/rel/pop-estimate/population-estimates-for-uk--england-and-wales--scotland-and-northern-ireland/mid-2001-to-mid-2010-revised/rft---mid-2001-to-mid-2010-population-estimates-analysis-tool.zip

[i] Office for National Statistics; "Principal projection - England population single year of age, 2012-based," Office for National Statistics (2013a) - http://www.ons.gov.uk/ons/rel/npp/national-population-projections/2012-based-projections/rft-table-a3-4-principal-projection---england-population-single-year-of-age.xls

[ii] Office for National Statistics; "Life expectancy at birth and at age 65 by local areas in England and Wales, 1991-93 to 2011-13," Office for National Statistics (2014) - http://www.ons.gov.uk/ons/rel/subnational-health4/life-expectancy-at-birth-and-at-age-65-by-local-areas-in-england-and-wales/2011-13/rfd-1.xls

Office for National Statistics; "Disability-free life expectancy and life expectancy at birth by region, England: 2006-08, 2007-09, 2008-10 and 2009-11," Office for National Statistics (2014a) - http://www.ons.gov.uk/ons/rel/disability-and-health-measurement/sub-national-health-expectancies/disability-free-life-expectancy-by-upper-tier-local-authority--england-2009-11/rft-table-5.xls

[iii]Age UK and University of Exeter Medical School; "The Age UK almanac of disease patterns in later life," Age UK and University of Exeter Medical School - http://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Research/Age_UK_almanac_FINAL_9Oct15.pdf?dtrk=true

[iv] "Health care quality for an active later life," Age UK/University of Exeter, 2013 - http://www.exeter.ac.uk/media/universityofexeter/medicalschool/pdfs/
Health_Care_Quality_for_an_Active_Later_Life_2012.pdf

[v] Frailty in elderly people, Clegg, A., et al, Lancet 2013

[vi] Age UK and University of Exeter Medical School; "The Age UK almanac of disease patterns in later life," Age UK and University of Exeter Medical School - http://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Research/Age_UK_almanac_FINAL_9Oct15.pdf?dtrk=true

[vii] Age UK and University of Exeter Medical School; "The Age UK almanac of disease patterns in later life," Age UK and University of Exeter Medical School - http://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Research/Age_UK_almanac_FINAL_9Oct15.pdf?dtrk=true

[viii] Health and Social Care Information Centre; "Personal social services: expenditure and unit costs, England - 2013-14, Final release: national expenditure," Health and Social Care Information Centre (2014) - http://www.hscic.gov.uk/catalogue/PUB16111/pss-exp-eng-13-14-fin-nat-exp.xlsx

Department for Communities and Local Government; "Revenue account (RA) budget 2014 to 2015," Department for Communities and Local Government (2014) - https://www.gov.uk/government/uploads/system/uploads/attachment_data
/file/365591/RA_2014-15_data_by_LA_-_Nat_Stats_Release_-_Revised_22-Oct-2014.xls

Department for Communities and Local Government; "Revenue account (RA) budget 2015 to 2016," Department for Communities and Local Government (2015)

[ix] Prior to 2014/15 revenue expenditure and financing data, a large part of the budget used to be disaggregated into two components: spend for younger adults (18 to 64) and spend for people aged 65 and over. Since 2014/15 this is no longer the case. Therefore for this part of the budget in 2014/15 and 2015/16 we have used the balance of spending between younger adults (18 to 64) and older adults in the personal social services expenditure and unit cost data to apportion the amounts that are likely to be spent on older people. In 2015/16 this entailed apportioning £1.4 billion to older people's services as 44.8 per cent of £3.1 billion.

The figures for social care expenditure from 2005/06 to 2013/14 are final figures reporting actual spend as reported by HSCIC. The amounts for 2014/15 and 2015/16 are based upon DCLG allocations, pre-spend

[x] We assume that income from the NHS (including transfers from the NHS in 2014/15 and the portion of the Better Care Fund that will be available for social care services) is included in the DCLG figures cited above because it was included in the years up to 2013/14.

[xi] Health and Social Care Information Centre; "Community care statistics, social services activity, England - 2013-14, final release," Health and Social Care Information Centre (2014) - http://www.hscic.gov.uk/catalogue/PUB16133/comm-care-stat-act-eng-2013-14-fin-anxe.xls

Health and Social Care Information Centre; "Community care statistics, social services activity, England - 2010-11, final release," Health and Social Care Information Centre (2012) - http://www.hscic.gov.uk/catalogue/PUB05264/comm-care-soci-serv-act-eng-10-11-fin-anx.xls

Health and Social Care Information Centre; "Community care statistics, social services activity, England - 2005-06, final release," Health and Social Care Information Centre (2007) - http://www.hscic.gov.uk/catalogue/PUB01561/comm-care-ref-eng-06-asse-pack-tab.xls

[xii] Age UK Research analysis using Marmot, M. et al. , English Longitudinal Study of Ageing: Waves 0-6, 1998-2013 [computer file]. 21st Edition. Colchester, Essex: UK Data Archive [distributor], July 2014. SN: 5050 , http://dx.doi.org/10.5255/UKDA-SN-5050-8

[xiii] Age UK Research analysis using Marmot, M. et al. , English Longitudinal Study of Ageing: Waves 0-6, 1998-2013 [computer file]. 21st Edition. Colchester, Essex: UK Data Archive [distributor], July 2014. SN: 5050 , http://dx.doi.org/10.5255/UKDA-SN-5050-8

[xiv] University of Essex. Institute for Social and Economic Research and NatCen Social Research, Understanding Society: Waves 1-4, 2009-2013 [computer file]. 6th Edition. Colchester, Essex: UK Data Archive [distributor], November 2014. SN: 6614 , http://dx.doi.org/10.5255/UKDA-SN-6614-6

[xv] University of Essex. Institute for Social and Economic Research and NatCen Social Research, Understanding Society: Waves 1-4, 2009-2013 [computer file]. 6th Edition. Colchester, Essex: UK Data Archive [distributor], November 2014. SN: 6614 , http://dx.doi.org/10.5255/UKDA-SN-6614-6

[xvi] The King's Fund; "The NHS productivity challenge: experience from the front line," The King's Fund (2014) - http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/the-nhs-productivity-challenge-kingsfund-may14.pdf

[xvii] HM Treasury; "Summer Budget 2015," HM Treasury (2015) - https://www.gov.uk/government/uploads/system/uploads/attachment_data
/file/443232/50325_Summer_Budget_15_Web_Accessible.pdf

[xviii] NHS England Five Year Forward View 2014

[xix] HM Treasury; "Summer Budget 2015," HM Treasury (2015) - https://www.gov.uk/government/uploads/system/uploads/attachment_data
/file/443232/50325_Summer_Budget_15_Web_Accessible.pdf

[xx] Health and Social Care Information Centre; "Emergency admissions to hospital, April 2004 to March 2013," Health and Social Care Information Centre (2015)

[xxi] Delayed Transfers of Care 2014-15 http://www.england.nhs.uk/statistics/statistical-work-areas/delayed-transfers-of-care/delayed-transfers-of-care-data-2014-15/

NHS England Delayed Transfers of Care 2015 http://www.england.nhs.uk/statistics/statistical-work-areas/delayed-transfers-of-care/