The government must make a ‘big shift’ towards joined up care in the community to meet the needs of an ageing population, leading charity Age UK has warned.
In 2019/20 alone, 855,000 emergency hospital admissions of older people in England could have been avoided with the right care at the right time, according to a report released by the charity this week.
The report called on the government to ‘reverse the decline of primary and community health services and social care’ to ensure more older people can receive the help they need before health issues escalate to hospitalisation.
Amid a decline in the community nursing workforce, the report noted that older people are accessing hospital and emergency services in increasing numbers.
For example, there were 4.8 million emergency department attendances by older people in 2021/22, with the rate of attendance increasing by 40% since 2012/13.
Once admitted, older people have longer hospital stays and are more likely to be readmitted after discharge, noted the charity.
And over winter 2022/23, around 14,000 patients were in hospital on any given day, up from around 4,500 in the same period in 2018/19. One in six patients over the age of 75 were readmitted within 30 days during 2022/23, noted the report.
Age UK’s report claimed that establishing a ‘fundamental principle’ of ‘home first’ treatment would help reduce the burden on hospitals, with hospital at home and virtual ward teams able to care for older patients within their own home.
However, the report added that this must be underpinned through investment in primary and community health staffing, by improving pay and increasing the attractiveness of the profession.
Between 2015 and 2020, the number of nursing posts in social care fell by 24% and the number of district nursing posts by 12%, according to data analysed by Age UK.
‘District nurses play an essential role in not only acute, complex and end-of-life care, but also in preventative care that supports older people to maintain independence and manage long-term conditions,’ said the report.
‘If there are insufficient numbers of district and community nurses, then hospitals may not only need to delay discharging patients but will also see increases in admissions and readmissions.’
Age UK chief executive Paul Farmer said that the report was, in many ways, ‘deeply depressing’ but added that there was now an opportunity to ‘switch to a much more effective approach to providing health and social care services for older people in their own homes and in care homes’.
‘We must do better by our older population and I’m sure we can,’ he said.
But Caroline Abrahams, charity director of Age UK, said the UK would not see the benefits of bringing care closer to home unless ‘we also get a government prepared to grasp the nettle of rescuing and restoring social care’.
Ms Abrahams added: ‘We urgently need an ambitious social care workforce plan, one that recognises the fantastic contributions of our care staff and rewards them fairly.’
Responding to the report, Dr Crystal Oldman, chief executive of the Queen’s Nursing Institute, told Nursing in Practice that policy makers ‘tend to focus on hospitals when talking about investment in healthcare’, often overlooking community services.
However, she added: ‘As health services are all in some way interdependent, investing in community services would reduce the strain on hospitals.
‘District nurses are ideally placed to lead, manage and deliver planned and urgent care when needed, in people’s homes, avoiding unnecessary and unplanned hospital admissions.’
A Department of Health and Social Care spokesperson noted that the government had invested £250m in the social care workforce, among other investments.
‘We are also investing a record £1.6bn over the same period to support timely and safe discharge from hospitals into the community, giving people access to rehabilitation and prevention initiatives, including local falls services,’ the spokesperson added.