Care Services: Elderly People

Baroness Jolly Excerpts

Wednesday 6th March 2013 Grand Committee

[Baroness Jolly]

My Lords, I start by thanking the noble Lord, Lord Turnberg, for bringing this important issue to the attention of this Committee. He has adequately covered areas of the economy, so I shall leave that. Care in the community is a critical component of our current health system and an even more critical component of our future health system, and we must ensure continued support for those who require and provide this vital service.

Today I wish to touch on a few distinct aspects of this issue. First, I want to highlight the growing demand for care in the community for the elderly population. As we are all certainly aware, the elderly population are particularly vulnerable to conditions that require long-term care which, if left untreated, can lead to a revolving door of hospital care for the elderly, which is both unhealthy and costly. Building on this, I want to draw attention to the ways in which the newly established clinical commissioning groups can work to improve the quality of care in the community as well as to encourage the use of this type of care. Finally, I will pose three questions to the Minister that reflect my concerns and hopes for the future of care in the community for elderly individuals.

Older people already represent the largest cohort of patients in the NHS, accounting for 60% of hospital admissions. Hospital days are dangerous for elderly people and expensive. Patients are susceptible to infections in the ward and often fail to eat properly while staying in the hospital. Moreover, these stays can encourage a loss of independence, which leads to added problems on discharge. Home healthcare is proven to deliver better outcomes for patients. There is evidence that it can lead to lower costs and reduce admissions to hospital. Home-based models of care have proven to be effective for patients with multiple diagnoses and comorbidities with a high risk of hospitalisation. According to Department of Health statistics, during September and October 2011 some 128,517 hospital bed days were lost as the result of the delayed discharge of people who could have been cared for in the community had the right support had been available.

In order to provide care in the community that is of the same quality as a hospital environment, CCGs must ensure collaboration between acute care, community care and social care. This was clearly called for in the Health and Social Care Act 2012, and we expect CCGs and local authorities to be actively pursuing this practice. It is particularly important for elderly patients as long-term conditions associated with old age are particularly complex to treat and often involve several different types of health and social care intervention. These services are provided over months and years by a range of organisations in the public, private and voluntary sectors, and it is hard to split them into single episodes. Pathway design is a critical and urgent task for CCGs to engage in.

In order to delay acute care for our elderly citizens, we must also refocus our energy on prevention. Joint strategic needs assessments must emphasise the value of preventive care for the elderly, including simple things: measures to decrease falls, improve nutrition to prevent diabetes and encourage community-based programmes such as Dementia Friends. Here the involvement of the voluntary sector can often be critical.

Part of the prevention agenda is about combating loneliness. Isolation is associated with poor physical and mental health in older people, both conditions that undermine the health we seek to provide our citizens. Local providers work together to address this issue and must not fall short in this critical area of care, because it is care. Social isolation affects about 1 million older people and has a severe impact on people’s quality of life in old age. Mentoring projects, befriending schemes and computer classes form part of a solution built to engage an elderly population in their community.

The patient must be at the centre of every health and care system we create. The location and community in which we choose to spend our later years deeply affects our quality of life. By supporting people to remain in their homes for as long as they wish, we provide an invaluable service to those patients we serve. In light of these remarks, I ask the Minister to confirm the following three expectations that relate to CCGs. CCGs will be expected to work alongside local authorities on integrated care pathways for the older population in the community, which might or might not involve shared budgets. CCGs will be expected to enhance preventive services in the community to reduce unnecessary hospitalisations. They will also be expected to embrace a campaign against isolation in the community, working with local authorities, especially among the elderly who wish to stay in their homes.