Breakfast Seminar

“We celebrate later life, we celebrate the fact that girls born today could live to be 105,” Tom Wright told Care Conversation delegates. His organisation was not only a large charity delivering healthcare services but a social enterprise with more than 500 shops and a member of DEC (Disasters Emergency Committee), supporting relief efforts around the world, he said.

Fundamentally, it was a ‘great progression’ that people were living longer, and his organisation actively campaigned to support ambition for a better later life. There had, however, been a collective failure to address the implications of an ageing population, he stressed. 

Over-85s were now the fastest growing part of the population and by 2020 there would be 2.7m people aged 75 or above, he said. “Increasingly, we’ll see multi-generational families with people in their 70s who have parents alive.” One of the issues that came with an ageing society was preparedness for later life, but the majority of people were failing to make pension contributions and many saw their home as their pension. “That’s not a good place to be.”

Another crucial issue was wellbeing, he told the seminar. “Around 3m people in this country will have malnutrition at some stage in their lives, something that’s difficult to believe in a society as sophisticated as ours.” Other key issues were alcohol – with many older people using it to self-medicate – and the very real problems of loneliness and isolation.

In terms of health, meanwhile, the key challenge was non-communicable diseases, with more than three quarters of the population likely to develop at least one – but probably more – condition such as raised blood pressure, type 2 diabetes or COPD. “Our hospitals are not designed around this,” he stated. “Our healthcare system is totally inappropriate for the nature of our society.”

The social care system in England was also finding it difficult to cope with the changing society, he stressed, with informal carers now providing the majority of care for older people. As traditional family models continued to break down, the situation would be exacerbated, with the net result a care system “fundamentally in crisis”.

The total amount of funding going towards care had fallen by around 10% over the last few years, he said, partly as a result of cuts to local authority budgets. While around half of the people with moderate care needs were receiving that care from the local council in 2005, the figure was now 13%. “We’re failing at a community level,” he said.

More people were ending up in residential care or hospital, with A&E departments increasingly full of older people who were “being failed upstream”, he told the seminar. “It doesn’t take a genius to work out that this can’t go on. We haven’t remotely got our heads around this as a healthcare system.”

The good news was that the Care Bill aimed to address some of these issues, he said, alongside the postcode lottery of quality of care. “But the devil really is in the detail. The Bill is phenomenally complicated.” What was really needed was for healthcare systems to be fundamentally re-designed, he stressed. “Hospitals are not system-efficient. Massive, acute hospitals are the dominant force – they account for three quarters of NHS spend, with only 15% going to preventative measures.” All of this would also be exacerbated by the £20bn of savings the NHS needed to find, he said. “None of this is unique to us. They have the same challenges in the US. We just need to re-engineer the system.”

There were initiatives to reconfigure the model in the UK, he pointed out, such as Age UK’s own integrated care pathway in Newquay. This had demonstrated how it was possible to re-model healthcare in order to dramatically improve outcomes, including reductions in hospital re-admissions. “A pound spent upstream saves more than £4 downstream,” he told delegates. Age UK’s ‘care navigators’ helped to keep people out of hospital and design services around the individual, with shared records, early identification of problems and a whole range of interventions.

“By also looking at the social aspect – loneliness, housing, diet – you can transform the health of many people who are otherwise falling over and ending up in hospital.” It was an approach that delivered support not possible in a health-only structure, restored people’s dignity and independence and saw many of them even go on to volunteer themselves, he said.

However the power in the NHS remained at the acute end, with foundation trusts semi-independent, resource-hungry organisations that tended to attract much of the top talent. Making an integrated system work depended on good commissioning and a change in GP delivery, he said, as well as convincingly presenting the public with a different model.

“The £20bn NHS saving will, in a way, have to force change,” he said. “Otherwise I can’t quite see where all of this will end up.”