Success treating, managing and preventing disease has led to increased longevity and a relatively active and prosperous older generation who provide an invaluable economic and social contribution to society. However, it has also contributed to what is arguably the most daunting challenge facing the UK health and social care system today – the need to care for and support growing numbers of medically complex, frailer older people with increasingly limited resources. As a result the current model of care for our most vulnerable members of society is at a tipping point and no longer fit for purpose.
Since 2010-11, real-term funding for healthcare in England has been almost flat against a background of increasing demand for services, driven largely by an ageing population who are also experiencing reduced access to social care support. As a result, spend on frail older people is largely on expensive acute intervention and residential care rather than on prevention, self-management, early intervention, and helping people live well and independently for longer. The numbers of people failed by the current system stands to increase considerably unless we act fast and adopt new models of care which address the current physical, mental and social care needs of our valuable, yet increasingly vulnerable, older generation.
Delivering the much needed change is challenging due to a number of entrenched barriers to better care, including:
- separate funding models for health and social care despite the fact that older people’s needs are increasingly interdependent
- fragmented care delivery with multiple groups of health and social care staff treating individual aspects of need in an un- coordinated manner
- limited supply of adequately trained and remunerated home care and care home staff who have the most contact hours but the least education and training
- capacity constraints in primary care with increasing demand for GP and practice nurse consultations
- health conditions exacerbated by unsuitable living conditions, low availability and affordability of extra care housing and care home places and chronic loneliness, which is as bad for health as smoking 15 cigarettes a day.
The need to act to improve quality of care in all care settings is well publicised however, exactly how to do this is not yet clear.
Improving the experience and outcomes for frail older people requires improvements on three fronts, physical and mental healthcare, social care and place of care. It also requires the redesign of services around the individual to enable them to live independently for as long as possible. This includes support in the community to allow prompt return home should admission to hospital or residential care be necessary. Deloitte’s report ‘better care for frail older people’ outlines ways in which to achieve this goal, including new funding models which shift resources to primary, community and home care; supported by the wider adoption of technology; and access to better information, including patients medical records, for all those providing care. It also requires staff to work differently to forge sustainable partnerships and provide consistent coordinated services, 24/7.
None of this is revolutionary, and indeed we are already seeing new models of care implemented in pockets of the UK. However, the sheer scale of the challenge requires more immediate and widespread action to address the needs of increasing numbers of frail older people who aren’t in a position to wait for policy makers to take 5-10 years to develop the more integrated health and social care system that successive governments have agreed is the desired model of care.
Research Director, Deloitte UK Centre for Health Solutions