Independent report. Chief Medical Officer’s annual report 2023: health in an ageing society (10 November 2023)

Summary

Chief Medical Officer Professor Chris Whitty's annual report recommends actions to improve quality of life for older adults and prioritise areas with the fastest growth in older people.

Content

Chris Whitty's recommendations

• a) Older age is becoming increasingly geographically concentrated in England, and services to prevent disease, treat disease and provide infrastructure need to plan on that basis. This should be seen as a national problem and resources should be directed towards areas of greatest need, which include peripheral, rural and coastal regions of the country. The NHS, social care, central and local government must start planning more systematically on the basis of where the population will age in the future, rather than where demand was 10 years ago. This includes building or adapting housing and transport to be appropriate for an older population.
• b) Central and local government (the State) have the principal responsibility for environmental factors which can delay or prevent the probability of early ageing (primary prevention). Making it easy and attractive for people to exercise throughout their lives is one of the most effective ways of maintaining independence into older age. Reducing smoking, air pollution and exposure to environments that promote obesity are other examples where the State has a major role to play in delaying or preventing ill health and disability over a lifetime and into older age.
• c) Delaying disease to the greatest possible extent, to delay the period of disability in older age, should be the aim of public health and medicine. Science is continuously developing new tools to help do this, but we are often extremely poor at maximising the use of the tools we have. The longer people live with risk factors such as hypertension or high cholesterol, the earlier the start of their disabilities will be. Secondary prevention is predominantly the responsibility of the NHS but is currently under-prioritised. Screening programmes help to delay or stop the onset of serious disease and therefore prevent ill health in later life. It is essential that we prioritise secondary prevention and screening services, and do more to extend these services to groups with reduced access and historically low uptake.
• d) The medical profession needs to respond to the inexorable rise of multimorbidity. The single most important way to achieve this is to recommit to maintaining generalist skills as doctors specialise. NHS organisations also need to minimise the probability that the same person has to attend multiple clinics for a predictable cluster of diseases.
• e) The health and care needs of older adults are often not recognised because the relevant data are not systematically collected or aggregated in one place. For example, epidemiological data on health conditions contributing to disability such as hearing loss and mental health is not routinely available for older adults. To plan appropriately, organisations including the NHS, Office for National Statistics (ONS), and central and local government need systematically to collect and share data on the health and care needs of older adults, including by ethnicity, sex and other protected characteristics.
• f) I have put a number of recommendations around research into the chapter on research for scientists and research funders. Three in particular are worth highlighting. The first is that it should be unacceptable to have exclusion criteria based on older age or common comorbidities. The second is that research into multimorbidity, frailty and mental health needs to be accelerated. Thirdly, social care research needs to be a core component of health research programmes. The lack of inclusion of social care in health research is a significant gap.