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Fragmented system is failing older people, say experts

Investment and training needed in general practice

Adrian O'Dowd

Monday, 26 September 2016

Older people are being let down by the current health and social care system, which is “inadequate” and “fragmented”, according to a report published today by the BMA.

Additional resources for general practice and more training in geriatrics for GPs will be vital to help improve the care being provided for this part of the population, says the Growing older in the UK report – a series of expert-authored briefing papers on ageing and health.

The report’s authors concluded that increasing demand from an ageing population that was living longer with more complex needs, and inadequate resources meant the UK’s health and social care system was increasingly unable to cope.

It is estimated that four in 10 people aged over 65 years old and seven in 10 over 85 years olds have a long-term illness. Out of 16 million adults admitted to hospital in England in 2014-2015, almost half (47%) were aged over 65.

The report calls for more to be done to support and improve people’s health and wellbeing as they grow older in the UK, including:

  • a focus on tackling the under-diagnosis and under-treatment of mental health conditions in older adults, to help ensure that parity of esteem between older people’s physical and mental health becomes a reality
  • action to tackle the social isolation of older people through a focus on ‘social prescribing’ – connecting people to non-medical and community support services
  • a focus on developing a ‘carer friendly health service’, in which carers are identified, provided with adequate information and advice, and their expertise listened to and respected.

Developing primary care would be central to efforts to improve the situation, said the authors.

The report says: “GPs have a unique role in coordinating the care of older adults with physical and mental health problems: continuity of care and advance care planning are two areas that are key to providing better care.

“Resources and investment will need to reflect the key roles of general practice, the need for rapid supported discharge from hospital, and for responsive integrated community services.”

If there was a real desire to move care of long-term conditions more into the community away from hospital, they argued, then this had large implications for clinical staff.

“Moving care into the community does not equate to moving the skill set into primary care,” says the report. “Undergraduate training in geriatric medicine is presently inadequate for modern day needs.

“Few GPs have developed a specialist interest in elderly care. GP trainees should be encouraged to train in geriatrics and complete the Diploma in Geriatric Medicine qualification.”

The report follows warnings from think tanks The King’s Fund and Nuffield Trust in their recent report that vulnerable, older people in England were having to fend for themselves because government-funded care was being scaled back.

Professor Parveen Kumar, BMA board of science chair, said: “The UK’s ageing population is being failed by a fragmented and over-stretched health and social care system. Far more needs to be done by the government to support greater co-ordination and integration of health and social care services and ensure that these services can cope with the growing needs of older patients.

“In particular, we must tackle the under-diagnosis and under-treatment of mental health conditions in older adults, to make sure that their mental health is treated as importantly as their physical health.”

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