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Finding novel ways to keep the fast-growing elderly population in good health are essential, says Sara Wajid...
Finding novel ways to keep the fast-growing elderly population in good health are essential, says Sara Wajid

With over-65s outnumbering under-16s, the UK population is quickly

ageing. This makes long-term funding of council-provided health and social

services a real problem.

Most resources for the elderly are spent on so-called fire-fighting, rather than illness prevention. But a Department of Health white paper last year marked an important shift of resources from in-hospital care to community-based services.

Via campaign 'Fair care', the Local Government Association stresses the need for a timetable to bring about this shift, arguing local authorities are instrumental in delivering a more holistic approach to caring for the elderly.

Councils have been working for some time to promote preventative care services at a local level. Here are five examples.

1 Land-swap with local PCTS

By 2010 there will be 80,368 people aged over 75 in Hertfordshire.

A solution to the county council's potential care home problem is 'land-swapping' with the local primary care trust. Three years ago, a deal was struck for a purpose-built nursing home in Ware - built on land owned by the PCT (at the time, South East Herts Primary Care Trust).

Denise Radley, Hertfordshire's assistant director of performance and commissioning, estimates Westgate House will save the council£10m over the 25 years of the contract, because 'we are buying care at our [rather than market] rates'.

The PCT let the council build the home on the site of a run-down Victorian hospital, in return for land elsewhere in the borough.

A private care provider was attracted to the Westgate Health Care project because the old hospital site was offered for less than its market value.

Securing premises in the right locality was key to the project's success, according to Ms Radley. 'It's a difficult area in which to secure supply and we've got a great deal of flexibility in how we use the site.'

Keeping the care home in the locality meant it was easier to retain staff, and gave elderly people the chance to stay in familiar surroundings and within reach of their families.

2 Involve older people in planning

Highcliff ward in Christchurch, Dorset, has the highest concentration of elderly people in Europe, with 69% of residents aged over 65.

So it makes sense that Dorset CC is hiring older people to advise on service provision, as part of a DH-funded 'Partnerships for Older People' project.

Andrew Archibald, the council's head of community care, older people's strategy, says: 'Older people are a very rich resource; they have so much experience.'

Mr Archibald believes the improvement in quality of life for participants and service users alike is a key benefit: 'Conversations inform the design of community projects at early stages, and are better than consultations, which imply you're looking for approval of something already decided.'

3 Use voluntary sector networks

By 2020, it is predicted that 23% of eastern and coastal Kent's population will be aged over 65. The Independence through Voluntary Action for Kent's Elders scheme aims to make life easier for those dealing with long-term health problems in order to minimise hospital admissions and GP visits.

The DH-funded pilot scheme is a partnership between Kent CC, the local PCT and voluntary groups such as Age Concern, and sees carers regularly meeting individuals to advise them on self-support, such as the availability of exercise classes.

'The voluntary sector brings a wider sense of community services and is able to reach into local communities,' explains Anne Tidmarsh, head of adult services, east Kent. 'Voluntary sector carers know how to use the statutory sector; these workers will be based in the parish council, for example, or places where groups meet socially.'

She says Age Concern's perspective was vital in shaping the project, but that the charity will have to compete with other voluntary sector organisations for the delivery contract at the end of the pilot.

4 Set up dedicated teams

Cornwall had a 9% growth in emergency hospital admissions in 2003, but has reversed the trend, particularly among the over-75s, by establishing rapid assessment and integrated discharge teams.

'Between 20% and 30% of emergency admissions of older people are unnecessary,' says Andrew Rust, Cornwall CC's assistant director, community care (commissioning and partnership).

Mr Rust describes the rapid assessment teams as single access points for the entire

social care and health systems. But is this not what GPs should be?

'GPs don't have all the information or much time so there's a tendency for them to [just call an ambulance],' he explains. The integrated discharge teams comprise PCT nurses and social workers who are better able to manage complex discharges.

5 Provide a single point of access

'Older people say they only want to tell their story once,' says Marian Harrington, assistant director of older people with disabilities at Westminster City Council. Its Senior Passport Scheme, a council service hotline for older people, was launched in 2005, and now receives an average of 277 calls a year.

'It's for people finding it difficult to manage things like getting out of bed. We can provide physiotherapists, occupational therapists, and so on. We're hoping to expand it to give advice on any service,' says Ms Harrington.

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