Recent reports show that deficiencies in elderly healthcare remain. A national survey of 1,600 health service managers rated older people (along with those with mental health needs) as the “most neglected groups in the service, who had seen the least benefit from NHS reforms.”
A paper in the Royal Medical Society’s official journal followed the publication of these results – stating that the care of older people is too often “marginalised, neglected and plays second fiddle to initiatives or targets designed to appeal to younger voters.”
The author Dr David Oliver, a senior lecturer and consultant physician in geriatric medicine, argued that most NHS staff spend the majority of their careers working with older people and most health resource is expended on this group. However, he pointed out that the current emphasis in education, training, research funding and government policy is skewed towards “sexier” areas of care.
“Older people are the main users of the NHS: around 60% of admissions and nearly 70% of hospital bed days are devoted to people over sixty five. They are not a minority. Improving the care of older people is the key to transforming the whole system. We need to start providing public services based on need rather than on political demand.”
The author noted how labels such as “bed blocker”, “social admission” or “acopia” are still being used in many NHS general hospitals and argued that these attitudes are affecting diagnosis and treatment of older people. Conditions such as falls, poor mobility, confusion or incontinence are labelled as “social”, when they are usually perfectly treatable conditions.
Even when the patient has a more complicated condition or incurable illness, there is plenty more that could be done to enhance their dignity and choice, argued Dr Oliver. He described a case where a physician clinical director said “he was spending too much time ‘market gardening’ (i.e. caring for old patients who were ‘cabbages’).”
Dr Oliver argued that because “geriatric medicine does not feature prominently in the curricula of many medical schools, nor sufficiently highly in the core curricula for post medical training some attitudes might be rooted in ignorance rather than malice or indifference.”
This lack of focus on training in geriatric medicine is reflected in the fact that most students and recent graduates in medicine and allied professions state that they do not wish to pursue a career working with older people.
Dr Oliver suggests some possible solutions:
• Re-balance medical education and training to give staff the right skills to care for the patients they will actually see.
• Shift the emphasis in research funding and governance a little more towards clinical and health services research on frail people.
• Produce performance and inspection targets frameworks which place high quality assessment and care for older people at the centre of service delivery.
Figures obtained by Age Concern, also revealed that many older people who need care because of chronic health problems are being let down by the NHS. Fewer people are now getting “continuing NHS healthcare” overall, despite the introduction of new Government guidelines to make entitlement fairer. The charity described the failings as further evidence of how the entire care system is routinely failing older people and their families.
Gloucestershire PCT reported the lowest level of continuing care in England at only 5.65 people per 50,000 population, despite the high number of people over 85 years old living in the area. The PCT that reported the second lowest level – East Riding of Yorkshire PCT – cut its numbers in half by the end of the year. But these were not the biggest cut backs. Mid Essex, Sandwell and Wandsworth PCTs all reported staggering reductions in excess of 80%.
Gordon Lishman, Director General of Age Concern, said: “Some areas of the country seem to be black spots for older people needing continuing care. Frail older people should not be denied the care they are entitled to because of where they happen to live.”
