Care in our communities

LesleyTurnberg4x3.jpgLeslie Turnberg on the measures necessary to bridge the gap between the needs and funding of adult social care

As social care budgets are left behind, it is becoming clear that the UK is ill-equipped to deal with the increasing demand for care of the elderly. The statistics are disturbing. The total number of people in our country aged 65 or over will reach 5 million by 2020, with those over 85 doubling from 1.3 to 2.6 million. Although we are also extending the length of our lives before we become dependent, the numbers with multiple long-term chronic diseases is increasing markedly. 

The most striking example is in dementia, where it is calculated that one in three over 85 year olds will develop the disease. A huge number of the elderly end up lingering in an acute hospital – a place least suited to their needs. Around 30% of hospital beds are currently occupied by patients who should not be there; but there is often nowhere else for them to go. 

Care in the community, where they should be, is sadly lacking. Social service departments are sorely stretched, with about 80% now restricting adult social care for those whose needs are graded as substantial or critical. Care needs have changed, but provision and resources have yet to catch up – and this gap between need and funding is set to grow. We need a long term plan and can’t go on as we are, simply patching up the current system of an NHS designed for acute hospital care.

Some measures can and should be taken now. 

Improving the co-ordination between hospital and community staff so that patients are discharged in a timely way, as is being done successfully in some places, would help. Merging NHS and social service budgets for elderly care – as posed by Andy Burnham recently – would be helpful too. Although simply merging two cash-strapped funding streams will not solve the problem alone. 

Nor will the government’s recent initiative, following the Dilnot Report, ease the burden on social service departments, since it is designed to help the elderly themselves part fund their care. But this may in fact increase local authority problems as they will have to find more money to fill the gap.

It is often said that closing hospitals might release sufficient funds for care in the community, where 30% of occupants would be better off. But the NHS is itself under severe constraints as it struggles to meet the Nicholson Challenge (of saving 4% per annum). 

Current trends suggest that the NHS will have a shortfall of £30bn each year by 2020. It also ignores the fact that the workload of hospitals is rising constantly, with clinical staff increasingly having to deal with acutely ill patients. It is this acute load rather than the number of beds that determines the need for hospitals. Closing beds would simply increase the intensity of work in a smaller number of beds. And all of this may account for the surprising observation that we save only a third of a £ in hospital costs for every £ spent in the community. Care in the community is not a cheap option.

We can hope that exciting health research currently going on will find cures for chronic diseases. Past evidence however suggests that, as new treatments come along, costs increase and future plans have to be more realistically based. The focus therefore must be on the priority that all governments give to care for the elderly. 

Is it wishful thinking to believe that a majority of the population would favour a diversion of resources to areas they think are of high priority? I can think of few higher priorities than the way we care for our elderly. 

Lord Leslie Turnberg is a former President of the Royal College of Physicians and a backbench Labour Peer in the Lords

Published 6th March 2013

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