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Planning to keep elderly out of hospitals is 'la la land'

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Planning for large reductions in older people in acute hospitals is “absolute la la land”, the government’s former older people’s tsar has told LGC’s sister title Health Service Journal.

Health reporting HSJ and LGC logo

David Oliver stood down at the end of last year after three years as a Department of Health national clinical director.

In an interview with HSJ he challenged what he described as a “holy grail” belief that the majority of admissions of older people to hospital were preventable. He said that view was a “denial” of the reality in hospitals, where the majority of people admitted as emergencies were older people.

“The [commonly stated view] about hospital care is it should be acute, episodic and specialised. But it is absolute la la land to think we’re going to be in a situation any time soon where older people don’t still keep piling through the doors of general hospitals.

“The lived reality on the ground is that hospitals are daily on black alert opening any flat surface they can to put beds in, turning ambulances away,” he said.

Professor Oliver also questioned the view that preventative services would reduce costs for the NHS and local government.

“I’m not saying it’s the wrong thing to try and [reduce admissions]… but we have to translate that aspiration to reality and there’s not a load of convincing evidence yet of anywhere where focusing on prevention has actually led to reducing overall costs in the health and social care economy.”

He challenged the belief – expressed by NHS chief executive Sir David Nicholson last year – that “hospitals were bad places for older people to be and they should go through the same revolution as the old mental asylums”.

Professor Oliver, a consultant geriatrician, said more focus was needed on improving hospitals’ care for older people with multiple conditions, for example by reducing the number of times they were moved, which often led to deterioration, and recognising that nursing older patients was a “highly skilled job”.

He said: “If your local comprehensive’s no good you don’t solve the problem by home schooling all the children”.

His comments are a challenge to measures in the government’s draft care and support bill, published last year and due to be put before Parliament this spring. Under the new social care regime set to be ushered in by the bill, councils will be expected to extend support for carers and instigate a shift towards preventative, community services rather than institutionalised care.

Professor Oliver told HSJ he decided to stand down as national clinical director for older people at the end of last year because he was not interested by the equivalent role in the reformed commissioning system.

From April national clinical directors will be based in the NHS Commissioning Board, with a focus on commissioning rather than policy advice and service improvement in providers.

Professor Oliver has also been appointed president elect of the British Geriatric Society.

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Readers' comments (1)

  • It is not surprising that a consultant geriatrician is expressing the view that hospitals are the answer to the so called "problems" of dealing with older peole.This is equally la la and merely confirms a deep seated addiction to hospitals and hospital based responses bordering on the absurd but pandering to perceived public opinions but then alcholics would never support the closure of breweries .To suggest that many of the conditions coming through A&E could not be better dealt with through appropriate community based services flies in the face of the experiences of people working in A&Es and many patients themselves .Cost is not the only criteria we should apply ,the quality and effectiveness of the intervention is equally important ,in other words what is the best value for money Nobody is suggesting the older people will not continue to be the largest user group in NHS including hospitals But we actually need less hospitals (and politician and senior managers who have the courage and conviction to say so and pursue it)and a much wider and better range of preventative and early intervention services at local level centered on "hubs" where the distinction between health and socail care does not exist .Yes we need to build up the evidence especially over the long term but this will emerge as and when such a policy is seriously pursued over time

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