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Writing online ahead of the publication of Next steps on the NHS Five Year Forward View, Caroline Abrahams, Age UK’s Charity Director, said:
Flicking through the TV listings last weekend I noticed ‘Carry on Matron’ was on – again. Have you noticed how in British films from the 1960s and 1970s the hospital patients are almost exclusively young and improbably healthy-looking?!
Of course, this image of the archetypal hospital patient was never realistic, but it is less realistic than ever now. For while people of all ages receive help from our hospitals, older groups predominate. We have an ageing population because longevity is increasing; for example, a child born today in our country has a one in three chance of living to 100. This trend is a great boon, but unfortunately the extra years we are gaining are often lived with ill-health: in other words, as life expectancy rises it is outstripping disability-free life expectancy and intensifying demands on the NHS.
If one of the NHS’s organising principles really was to meet the needs of its majority users – older people – as effectively as possible, local health economies would look rather different to what we often see today. The balance would shift more towards community health and primary care, joined up with social care and lower level support – with much of the latter often provided by the voluntary and community sector. Help would ‘wrap around’ older people and would mostly be close to home. In addition, co-production would be the norm and there would be a lot more support for self-care. Oh yes, and social care would not be at risk of collapse; let’s hope the Government’s forthcoming Green Paper will chart the path to a better future for this essential service.
Hospitals would continue to be utterly crucial but their role would become more strategic; for example, the services they provide would owe less to history and geography, as is sometimes the case today, and more to a shared analysis across a sub-region of the needs of the population living and working there, and how these can best be met when all the available health and care assets are taken into account.
In an upgraded system of this kind there would also be more of a focus on sustaining older people’s resilience, helping them to retain their independence at home for as long as possible. Achieving this would not only be down to the NHS, indeed much of the responsibility would lie elsewhere; for example, with a more comprehensive system of housing with care and support designed to adapt to older people’s changing needs as they age. This illustrates a broader requirement: aligning other areas of public policy and service delivery more closely with the NHS, to maximise impact and make progress on shared priorities.
Certainly, there would be huge benefits to the public, older people especially, if the NHS and other services were organised more along these lines; indeed, in areas where aspects of this kind of approach are already in place evidence of gains in terms of health and wellbeing are coming through.
We hope and expect this will be acknowledged in the NHS’s Delivery Plan document which is published next week.
Is it fanciful to think of progressive practice like this becoming less the exception, more the rule? It is ambitious, for sure, but from our perspective at Age UK it is the right thing to do if we are serious about helping older people to get the most out of their later lives, and serious about arranging our health, care and other services to facilitate this.
Which is why Age UK supports the idea behind the Sustainability and Transformation Plans (STPs) that are currently being developed across England and which are widely anticipated to be the centrepiece of the Delivery Plan document coming out soon. We sincerely hope that STPs will challenge and support system leaders in health and care to come together with their staff, the local population and others such as ourselves in the voluntary and community sector, to design and put in place a better sub-regional approach to meeting needs, those of older people especially.
For the reasons I have explained we do need some ‘transformation’, both within the NHS and in the relationship between health and other public services too. But of course, major change of this kind takes time, or it can end up being botched or proceeding in a top-down fashion that risks leaving staff and the public far behind. It also takes money in the form of up-front investment – the ‘sustainability’ side of the equation – because without some initial ‘double-running’ there’s a risk that people in need will be very badly let down.
Both these risks need to be carefully managed because STPs are too big an idea to fail and the best chance we currently have of updating services so they are a better fit with today’s population, rather than yesterday’s – as in those Carry On romps of forty or more years ago. These films were the stuff of fantasy, but today’s reality is of a growing older population and they – we – really do need the STP programme to land well and we hope that the NHS’s Delivery Plan will confirm they are here to stay AND that they will receive the challenge and support they need to succeed.