Age UK issues clarion call for a big shift towards joined up home and community based health and social care services for older people

1 in 6 emergency admissions of people over 75 occur within 30 days of last being discharged from hospital’.[i]

36,000 fewer older people a year are receiving long term care[ii].

A major new report from Age UK, ‘The State of Health and Care of Older People in England 2023’, documents how our health and care system is struggling, and too often failing, to meet the needs of our growing older population.  The Charity says this shows that as a nation we need to switch away from our current over-reliance on acute hospital based care, towards a laser focus on prevention and early intervention to enable older people to stay fit and well in their own homes, and in care homes. This would be far better for older people and would also alleviate pressures on hospitals.

The new report shows how significant numbers of hospital admissions of older people could be avoided if they received help earlier on, before small health problems mushroom into crises requiring urgent clinical support. But this will only happen if there is a strong political leadership from the Government and a drive right across the NHS and local authorities to make it happen.

However, it’s not all doom and gloom as Age UK says there are glimmers of hope in some places and the beginnings of the shift it wants to see, with the development of community Falls Services, Hospital at Home services, Virtual Wards and Integrated Frailty Services. At present though these new approaches are only patchily available, whereas they need to be on offer to every older person, wherever they happen to live.

The Charity also points out that there will be no lasting solutions in this area until politicians grip the problems in social care, support it’s under-paid and under-appreciated workforce, and expand social care services to tackle the enormous scale of unmet care need among older people.  

The report shows:

• In 2021/22 there were 4.8 million A&E attendances by older people.
• The rate of A&E attendances amongst over 80s went up by 40% between 2012/13 and 2021/22.
• In 2019/20 alone there were 855,000 emergency admissions to hospital of older people which could have been avoided with the right care at the right time.

Once admitted, older people have longer hospital stays and are more likely to experience delayed discharge. Over winter 2022/23, between 13,000 and 14,000 patients were stranded in hospital on any given day, up from around 4,500 in the same period in 2018/19[iii]. 1 In 6 patients over the age of 75 is then readmitted within 30 days of being discharged – a terrible vicious circle.

In many areas at present there are too few effective, joined up health and care services capable of identifying older people at risk of a health emergency and intervening to help them avoid it. The statistics picked out below tell a clear story: significant numbers of older people are finding it difficult to access the support they need from their GP, and we know there aren’t enough nurses working in the community in either the NHS or social care. In addition, rather than expanding to meet the needs of growing numbers of older people, State funded social care has gone backwards in terms of the numbers being helped. This in turn is placing more burden and responsibility on unpaid carers – usually families – to fill the gap, and leaving large numbers of older people struggling to cope alone. Inevitably in this situation their health often declines, and sometimes this leads to a hospital stay that might have been avoided.

• Between 2015 and 2020 there was a 24% reduction in the number of nursing posts in social care and 12% reduction in the number of district nursing posts.
• Since 2017/18, 36,000 fewer older people are getting long-term care from their local authority.
• An estimated 1.6 million people aged 65+ have unmet needs for care and support[iv].
• 45% of older people were concerned about their ability to access their GP[v] and 40% of older people did not feel they had enough support to manage their health conditions[vi]
• One in five (20%) unpaid carers are aged 65 plus and many are having to pick up many hours of support[vii]
• 85% of older carers are worried about whether they would be able to keep caring or providing support.[viii]

The report draws on many more official statistics and Age UK analyses to provide a comprehensive and authoritative picture of how services are functioning today for older people across the NHS and social care. Even before the pandemic, growing numbers of older people were experiencing avoidable emergency admissions to hospital, being delayed at discharge, often because of waits for social care, and not receiving essential assistance with daily living. Then, the pandemic struck and made things considerably worse, leaving many older people today with poor mental or physical health, hospitals and care services under immense pressure and struggling to retain staff who are very tired, altogether leading to fewer older people receiving the help they need.

With 10.5 million people aged over 65 in England [ix]- and rising - the Charity says it’s imperative we change tack now, to serve older people better and to make better use of the resources within Health and Social Care. Given that only 26% of people aged 65-74 do not live with at least one long term health condition, falling to just 14% of those aged over 85 in England[x], the Charity says that ensuring people have the support to stay well and manage their health at home is essential to the future sustainability of the NHS.

The report calls for:  

• A strong strategic push, nationally and locally, to reverse the decline of primary and community health services and social care, so many more older people get more help, earlier, enabling them to stay well for longer at home and reducing their reliance on crisis health care in hospitals.  
• More community-based services to be developed and joined up in local areas so they include doctors, nurses, physiotherapists, social care staff, among others, and the voluntary sector too, working closely with GPs and their practice teams. These services also need to be able to flex to respond to older people’s and their unpaid carers’ needs, especially where the latter are themselves older people, as in the case of older couples.  
• The principle of ‘home first’ as the foundation of our approach to health and social care for older people now and into the future.

Paul Farmer CBE, Chief Executive of Age UK said, “In many ways the picture painted by our new report is deeply depressing, but what strikes me the most is the wonderful opportunity we have now to switch to a much more effective approach to providing health and social care services for older people in their own homes and in care homes. After all, if we don’t do it on the back of findings like these, when will we? It’s clear that we need services to reach out to older people much sooner, particularly those living at home, quite often alone, whose health is fragile or declining. This would not only be great news for older people, and their families, providing much needed reassurance, it would be cost-effective too. And it would go a long way to relieving the enormous pressure on hospitals as well.

“Sometimes older people do need to go to hospital of course, but at the moment too many are doing so for want of the help they need at home. Then if they are admitted they are at risk of getting stuck in a hospital bed once medically fit to leave. That’s incredibly miserable for them and also jeopardises their recovery.

“We must do better by our older population and I’m sure we can. For example, some of the new Hospital at Home services and Virtual Wards are great – we just need a lot more of them, everywhere – with voluntary organisations like Age UK playing a full part alongside others.”

Caroline Abrahams CBE, Charity Director of Age UK said: “At Age UK we are convinced the future lies in bringing health and social care services together locally, to provide better, earlier support for older people at home – but we won’t reap the rewards of this change of approach unless and until we also get a government prepared to grasp the nettle of rescuing and restoring social care – which is such a crucial component.

“Recently we have rightly welcomed a Workforce Plan for the NHS, and celebrated its 75^th anniversary, but many Health leaders have observed that the comparison with social care is stark, and that the lack of determined action on care is holding progress back right across the system. I’m sure that if Nye Bevan was alive today he would recognise that too.

“We urgently need an ambitious Social Care Workforce Plan, one that recognises the fantastic contributions of our care staff and rewards them fairly. The drive to recruit more care workers from abroad has been pretty successful, at least for some care providers, more so than many of us had expected, but meanwhile we know we are haemorrhaging more experienced care workers, including registered managers in care homes. Many of these people are worn out and fed up, and are quitting for better terms and conditions in hospitality, retail or indeed the NHS. They are the backbone of the social care workforce and they play a crucial role in setting and maintaining good standards of care. We must do more to give them hope for the future and a well thought through, funded Social Care Workforce Plan would really help.”   

[i] NHS Digital (2022), Emergency readmissions to hospital within 30 days of discharge : indirectly standardised percent trends broken down by age bands and sex, https://digital.nhs.uk/data-and-information/publications/statistical/compendium-emergency-readmissions/current/emergency-readmissions-to-hospital-within-30-days-of-discharge

[ii] Figure 2.7 Number of people aged 65+ receiving long-term care, by support setting, 2017/18 to 2021/22, England, Age UK 2023: Analysis using: NHS Digital (2022). Adult Social Care Activity and Finance Report, England, 2021/22, based on these numbers:

[iii] NHS England (2022). Urgent and Emergency Care Daily Situation Reports 2022-23

[iv] Source: Age UK 2023: Analysis using waves 3 to 9. English Longitudinal Study of Ageing (ELSA), 2018/19  & ONS 2022: Mid-Year Estimates 2021.

[v] Age UK (2022). Age UK polling and insight, undertaken with Kantar – unpublished

[vi] Age UK 2023 analysis of NHS Outcomes Framework: Proportion of people feeling supported to manage their long-term condition (2022). GP Patient Survey 2022.

[vii] ONS (2023). Unpaid care, England and Wales: Census 2021

[viii] Age UK (2022). Age UK polling and insight, undertaken with Kantar – unpublished.

[ix] Number of older people in England is estimated to be 10,468,000 ONS (2022). National population projections: 2020-based interim

[x] Age UK 2023: Analysis using waves 3 to 9. English Longitudinal Study of Ageing (ELSA), 2018/19.