Age UK: Fixing the Foundations (17 February 2023)

Summary

A new in-depth report from the Charity Age UK, ‘Fixing the Foundations’, reveals how our under-funded and overstretched NHS and social care system is struggling and sometimes failing to cope with the needs of older people. 

The report provides a first-hand account of older people’s difficulties in getting the good, joined up health and social care they need to manage at home, leaving them at risk of crisis which often results in being admitted to hospital. Yet the evidence is clear that with the right care at the right time many of these admissions could have been avoided.

The report also includes perspectives from professionals and unpaid carers. It also shows how living with multiple long-term health conditions, as a significant proportion of older people do, including more than two-thirds of those aged over 85, makes it especially hard to navigate health services which are still usually organised around individual illnesses and diseases. Meanwhile social care was often inadequate or absent in these older people’s lives. Age UK estimates that astonishingly, over 1.6 million older people have some level of fundamental care and support need, such as help to get dressed, washed or getting out of bed, that is not being fully addressed.

Content

Key findings

• Half (49%) of all the people arriving in A&E by ambulance are over 65.
• A third (36%) of all the people arriving in A&E by ambulance are over 75.
• Unplanned hospital admissions have been rising and have become more frequent, particularly for the oldest old.
• The proportion of older people feeling supported to manage their condition has been falling consistently, almost 20% in relative terms since 2016/17.
• 2.6 million people over 50 have unmet social care needs increasing to 15% of people in their 70s, and 21% of people in their 80s.
• In 2022, there were 165,000 vacant posts in social care- an increase of 50% and the highest rate on record.

Call for action

• Integrated Care Systems (ICS) to develop comprehensive strategies for meeting the health and social care needs of older people at home, and in care homes, living in their areas. This must include major efforts to embed prevention in their work so older people can avoid the need for crisis care and maintain their independence.
• Social care reform and a major and sustained increase in funding. The NHS cannot deliver these improvements alone. The lack of adequate social care for basic daily needs simply stores up problems, leaving older people less able to care for themselves and arriving in hospital with serious health problems that could have been avoided.
• Multidisciplinary working to become the default method of delivering health and care services to older people. Older people are too often left to fall between the cracks of disjointed services and professionals who don’t communicate well with each other. For ICSs, this means making sure that social care services – and by extension the local authorities that are responsible for them - are central to their leadership and decision-making.
• A better paid health and social care workforce, with the skills and competencies to properly support older people would make a huge difference to the quality and availability of care.
• A step change in the recognition of and financial and practical support on offer to unpaid carers, who are holding up many parts of the health and care system.