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The NHS and social services should work together to improve care for older people, says an Audit Commission report ...
The NHS and social services should work together to improve care for older people, says an Audit Commission report published today. Changing the emphasis away from hospitals, residential and nursing homes to helping people cope at home is the way to escape the cycle of pressures on the NHS each winter.

People aged over 65 use around half of health and social services resources, and yet the basic building blocks for putting their care in place do not always fit together. Key problems identified by The Coming of Age included:

-- All too often the NHS and social services fail to agree responsibilities and deadlines, or to co-ordinate their assessments of what needs to be done and who should do it. Older people can be caught in the confusion.

-- Older people and their carers are often not kept informed about what is going on or what choices of services are available. Social services staff have limited flexibility to tailor care to older people's needs. * Hospital admission rates have been rising rapidly: they are equivalent to nearly one in five people over 75 every year compared with one in eight fifteen years ago. This rise, combined with a doubling of the number of older people over the same period, is putting severe pressures on hospitals.

-- The time older people spend in hospital has been halved in order to cope. This allows less scope for recovery and rehabilitation and some older people, who with proper preparation could have returned home, are instead going on to residential and nursing homes at higher cost.

-- Social services departments in England alone spent£2.6 bn. (gross) in 1995/6 on residential and nursing care for older people - some two thirds of their budget. This reduces the amount of money left to support people in their own home, who therefore need to be admitted to hospitals in increasing numbers.

What needs to be done:

If this vicious circle is to be broken, people must feel confident that they will get the services they need if they stay at home. Instead of focusing on hospitals and residential and nursing homes, ways of supporting people at home or of getting them back home from hospital must be developed. A review in one city estimated that nearly half of all admissions to acute hospital of people aged over 75 years could have been avoided if safe, reliable alternatives had been available.

Health and social services must get together urgently to review existing needs and services for older people, and agree what they will do and when this winter. But short-term actions will not change services overnight. The NHS and Social Services need to start working now with public, private and voluntary sector providers to develop alternative forms of care for older people, such as better rehabilitation and support at home.

Andrew Foster, controller of the Audit Commission, commented:

'It will not be easy to develop solutions to the problem of health and social provision for the growing older population, and pressures are already building for the winter ahead.

'This report identifies the actions the NHS and Social Services should be taking this winter to make the most effective use of the£300 million extra funds provided for the NHS this year.

'In the short-term health and social services need to work together to make sure they have good arrangements for making sure that elderly people receive the care they need. But, in the medium-term, unless both agencies shift the emphasis of services towards prevention and rehabilitation, winter pressures will become a recurring problem, lengthening waiting lists and causing funding problems.

'The refocusing of services will need to be accompanied by a review of the roles of the NHS and Social Services and a fresh look at the funding of care for older people. Any review by the Government of long term care should encompass both.'

-- in a separate announcement - available on LGCnet - health minister Paul Boateng sets out a package of measures designed to target new money on better care for elderly people, counter winter pressures, and encourage more co-operation between health and social services.

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