In the face of an ongoing health and social care crisis, experts at the British Geriatrics Society (BSG) are calling for immediate action to safeguard the rights of older people in the United Kingdom. With individuals aged 65 and above accounting for over 40% of hospital admissions and occupying a significant portion of inpatient beds, it is clear that this demographic is most severely impacted by the crisis.
The current state of affairs has resulted in unprecedented waiting times for ambulances, prolonged stays on trolleys in emergency departments, frequent relocations within hospitals, and lengthy delays in accessing community services and social care upon discharge. These conditions have created a cumulative effect, increasing the risk of older patients dying in hospitals or leaving with diminished mobility, confusion, and greater dependency.
The lack of adequate rehabilitation and support for older individuals upon leaving hospitals further exacerbates their health conditions. Shockingly, statistics reveal that an average of 15% of older patients discharged from hospitals are readmitted within just 28 days. Each subsequent readmission increases their level of frailty and care needs, placing even greater strain on home-based or care home health and social care services.
Frailty is particularly prevalent among those aged over 85, with up to 50% living with this condition. It poses a significant risk, as minor illnesses and events can lead to rapid deterioration. The cost to UK healthcare systems for managing frailty amounts to £5.8 billion annually. However, evidence suggests that appropriate prevention and care measures can slow down or reverse this decline. Investing in community services tailored to older people can significantly reduce emergency hospital admissions. Unfortunately, primary care is overwhelmed, community nursing teams are understaffed, rehabilitation services are operating at maximum capacity, and care homes and domiciliary care providers are struggling to recruit and retain sufficient staff.
The crisis at hand has been brewing for a considerable period, and quick fixes are not feasible. It is imperative that the government and Integrated Care Systems across the country make informed decisions to address the situation in the short term. These decisions should optimize available funding and workforce and invest in strategies that mitigate harm and improve outcomes for older individuals. The aim should be to solve problems rather than shift them, while avoiding the generation of additional demand and costs for the health and care system.
To this end, the British Geriatrics Society (BGS) has put forward seven evidence-based short-term actions that should be undertaken:
- All older people with frailty should receive comprehensive multidisciplinary assessments as soon as possible after their arrival in hospitals. This can be facilitated through specialized services such as acute frailty units or frailty assessment teams.
- Hospitals must focus on preventing, identifying, and managing both deconditioning and delirium, which are avoidable conditions associated with extended hospital stays and increased dependency upon discharge.
- The government and health and social care providers should ensure the protection and preservation of the right to rehabilitation for all older people who require it. This includes early mobilization in hospitals, establishing rehabilitation goals promptly, and providing continued therapy until their condition stabilizes. Rehabilitation multidisciplinary teams should support older people in all care settings.
- There should be ongoing investment in a multi-professional urgent community response that provides intensive short-term hospital-level care at home through Virtual Wards and Hospital at Home programs. This network should work closely with ambulance services, ambulatory care, and same day emergency care services.
- Enhanced Health in Care Home models, aimed at minimizing avoidable hospital admissions, should be implemented consistently. These initiatives should prioritize reducing inappropriate polypharmacy and include discussions with residents and their families about preferences during acute healthcare crises.
- Services for older people with multiple long-term conditions should adopt a coordinated and person-centered approach, involving geriatric medical teams as appropriate. This approach can minimize unnecessary investigations and medications while empowering older individuals to make informed decisions about their future care, treatment, and place of care.
- Experts in older people’s care must be included in government and NHS policy planning. Given that older people represent 40% of hospital admissions and the fastest-growing age group, their specific needs and perspectives must be considered in healthcare planning.
Addressing these urgent actions necessitates innovative and integrated workforce solutions, including leveraging technology for professional decision-making support, expanding the scope of practice, and reevaluating roles within healthcare. In the short term, this may involve specialists in care of older people dedicating their efforts exclusively to frailty-specific initiatives during critical periods.
Long-term solutions require a comprehensive workforce strategy that acknowledges the shortage of healthcare professionals across various disciplines and the complex needs of an aging population. Proactive and personalized anticipatory care, enabling older people to maintain independence and good health for as long as possible, should be a core focus. The contributions of nurses and therapists in leading such services must be recognized, and a more integrated approach across home-based and community healthcare roles should be explored urgently.
The challenges faced by health and social care providers in recruiting the necessary expertise to deliver existing services are well-documented. To address this issue, it is crucial to ensure that healthcare professionals feel valued. The British Geriatrics Society expresses its gratitude to its members for their unwavering dedication to the NHS, urging them to be compassionate toward themselves and their colleagues during these trying circumstances.
In response to the concerns raised by unions and professional bodies representing healthcare workers, including nurses, ambulance staff, allied health professionals, and doctors, the government must engage in urgent dialogue to devise strategies that facilitate the recruitment, training, and retention of professionals necessary to provide the best care for older people.
Professor Adam Gordon, President of the British Geriatrics Society, emphasized the urgency of the situation, stating, “While the current crisis in the NHS affects us all, it is older people who are bearing the brunt of it. We need the Government to act urgently to implement both short- and long-term changes to ensure that the NHS is there for older people when they need it most.”
Dr. Sarah Clarke, President of the Royal College of Physicians London, pointed out that the crisis results from long-standing neglect of health and social care funding, emphasizing the need for an honest appraisal of the situation and prioritizing appropriate solutions.
Professor Andrew Elder, President of the Royal College of Physicians Edinburgh, stressed the importance of investing in training for healthcare professionals across multiple disciplines to provide high-quality care for the aging population.
With the UK’s older population projected to continue growing, it is imperative to act decisively to secure the health and well-being of this demographic. Only through concerted efforts and comprehensive reforms can the NHS and social care services effectively support older people, helping them lead healthier lives and ensuring their needs are met with compassion and dignity.
Resources
BGS Article: Protecting the rights of older people to health and social care
