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The Failing Safety Net

Not unreasonably, we expect the health and care system to be there to support us as we age, ‘keeping an eye’ and making sure we are safe and well. Those living alone at home, without family or friends to help, are arguably especially in need of this benign oversight. Unfortunately however, despite much well intentioned policy and the best efforts of many who work in health and care, this ideal remains a long way from the reality for many older people. Instead, from what Age UK sees and hears, significant and growing numbers of older people are living precariously, trying to traverse a complex health and care system while managing the day to day demands of living with ill health and disability.

The stories in this report show how easy it is for older people to ‘fall off the health and care radar’ or not get on it in the first place, so they only receive help at crisis point. It highlights the cliff edges and gaps between services for older people living in their own homes and the hard work and emotional energy it takes for loved ones to ‘hold the ring’ in a fragmented and under-resourced system, one which often seems to assume they are available to ‘paper over the cracks’. It also reflects the sadness, stress and frustration experienced by committed health and care professionals who lack the time or support to do the job they want to do.

The bottom line is simply that far too many older people still do not receive the coordinated, wrap-around support at home that they need. And the problem is becoming more pressing by the day. Over 65s accounted for more than half the increase in emergency hospital admissions in the last two years. According to NHS England, around a quarter of emergency admissions in 2016/17 could have been avoided had effective community care and case management been in place and multiple experts agree.

Our older population is growing rapidly, meaning there are increasing numbers of older people living with multiple long term conditions, frailty and significant care needs. Age UK estimates there are now more than 465,000 people aged over 65 living with three or more health conditions who are also in need of help with three or more activities of daily living (i.e. care needs), such as getting out of bed, going to the toilet or getting dressed. Of these individuals, only about one in three receives care at home with the remainder relying on family - or managing without. Yet among those with family support, nearly two in three depend on a partner who is often an older person with their own increasing health needs.

More broadly, of all those aged over 65 in the UK, nearly a third – more than 3.6 million people - live alone8, while around 1 in 10 (1.2 million people) are ageing without children, and these numbers are expected to keep rising over the coming years.

Ever since the NHS first opened its doors in 1948 clinicians and policy makers have been talking about the need to expand services in the community, rebalance care away from hospitals and integrate support across health and social care to better support older people living with frailty at home. From the 1960s onwards concerns about fragmentation have been echoed by successive reviews and Government papers. Most recently The NHS Forward View rightly recognised that: “The traditional divide between primary care, community services, and hospitals - largely unaltered since the birth of the NHS - is increasingly a barrier to the personalised and coordinated health services patients need…..”

It's time to move from rhetoric to reality and the NHS Long Term Plan now in development offers us an opportunity to do so but, for now, this report suggests, the safety net that should be there for older people is not always in place, and the consequences for those who fall between the cracks can be devastating. In particular, the prospects for older people who are on their own and in declining health at home are increasingly worrying. For these people the health and care safety net can be dangerously thin.