The journey to age equality

To mark the International Day of Older Persons, the National Clinical Director for Older People and Person-Centred Integrated Care looks at the need to reduce inequalities for the frail and elderly:

International Day of Older Persons 2019 focuses on the Journey to Age Equality, drawing on the UN Sustainable Development Goals which are a blue print for a better future.

Reducing inequalities means ensuring policies pay attention to the needs of disadvantaged and marginalised populations. This will only be achieved with full age inclusivity.

To do this all older people must be empowered to promote their active participation where possible in social, economic and political life. Getting this right means we achieve an active reduction in inequalities of both opportunity and outcome for everyone as we age.

Reflecting on my time as National Clinical Director (NCD) the NHS has palpably realigned health policy and investment to begin to do this. These are significant steps in the right direction. Yet progress is not without challenge and the values underpinning the Day of Older Persons are a timely reminder to avoid complacency in assuming we have already completed the job. We are still at the start of the most important journey the NHS has yet undertaken.

Not long after becoming NCD I began to doubt that I would ever achieve anything of value in such a formidable role.  The more I pondered the task of tackling the health needs of an ageing population, the more I worried.

By 2050 one in four people will be over 65, at which age both men and women can expect to spend around half of their remaining life expectancy in good health. However, the likelihood of losing functional ability and living with complex health conditions increases as we age. As life expectancy increases, so too does the amount of time many spend in poor health.

In consequence, the impact on the social care system supporting people who are not ageing well is substantial and will increase, creating significant economic pressure. Gross current expenditure on adult social care by local authorities was £17.9 billion in 2017-18 and most agree this is inadequate. As a compassionate society we must all consider how we address these issues both now and longer term. Tackling this successfully is both urgent and important but will continue to be very difficult, and as NCD I have been very clear on both the strategy and the tactics I believe are required.

Fortunately, I have benefitted significantly from my network of colleagues across all sectors who coalesced around a clear campaign plan. This began with re-characterising ‘problematic ageing’ as the long-term condition of frailty requiring routine identification nationally.  Despite rather difficult terminology, frailty is something most parts of the country have quickly understood and focused on. A lot of hard work and complex projects lay ahead however.

The first major success was to secure national frailty identification requirements in the general practice GMS contract in 2017-18. By the end of 2018 this had led to over 2.5 million older people being assessed for frailty and nearly one million diagnoses documented in general practice records. Of these over a fifth had undergone medication and falls risk assessments prompted by evidence-based guidance. Not a bad start and big numbers, but more importantly the frailty genie was out of the bottle and ageing well was becoming everyone’s business.

More complex challenges lay ahead with the opportunity to lead on a major workstream in developing the NHS Long Term Plan (LTP). Nonetheless I believe the rewards reaped more than justify the ordeal many of us endured in crafting a credible and funded plan to address key areas of need for older people.

The LTP creates fresh focus on primary and community health services backed by new government investment. The Ageing Well programme is a blueprint for attenuating rising health service demand to support older people with frailty in their communities. It promotes healthier ageing and begins to address inequalities through population health management. In providing fuel for the journey to age equality, successful implementation will make better use of public and local community assets. This means better use of health services including hospitals and better outcomes for older people.

The plan comprises three key policy areas:

  • Urgent Community Response increases the capacity of intermediate care services to deliver a 2-hour response to those in crisis at home and 2-day response for those needing rehabilitation to avoid or following a hospital admission
  • The Anticipatory Care model implements a proactive population health approach for people with complex needs
  • Enhanced Health in Care Homes (EHCH) rolls out a tested approach to improve the provision and quality of NHS healthcare across all care home beds.

Like any venture into new territory, it remains to be seen what precisely happens next. But whatever emerges, I am confident that for many older people across England, things will never be the same again as we make our way towards national age equality.

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Martin Vernon

Professor Martin Vernon was appointed National Clinical Director for Older People and Person Centred Integrated Care at NHS England in 2016.

He qualified in 1988 in Manchester and following training in the North West he moved to East London to train in Geriatric Medicine where he also acquired an MA in Medical Ethics and Law from King’s College. He returned to Manchester in 1999 to take up post as Consultant Geriatrician building community geriatrics services in South Manchester.

Martin was Associate Medical Director for NHS Manchester in 2010 and more recently Clinical Champion for frail older people and integrated care In Greater Manchester. He has been the British Geriatrics Society Champion for End of Life Care for five years and was a standing member of the NICE Indicators Committee.

In 2015 Martin moved to Central Manchester where he is Consultant Geriatrician and Associate Head of Division for Medicine and Community Services. He also holds Honorary Academic Posts at Manchester and Salford Universities and was appointed as Visiting Professor at the University of Chester in 2016.

In 2017 he became Chair of the NHS England Hospital to Home Programme Board and is working on National Frailty Care with NHS Improvement.