After months of political wrangling, the Health and Social Care Bill has finally made it to parliament. There has rightly been fierce scrutiny of this important piece of legislation – its implications will affect all of us at some time in our lives. For older people it is particularly important because they’re already the largest cohort of patients in the NHS and with the number of people aged 65 and over set to rise by 65 per cent in the next 25 years to almost 16.4 million, there will be a higher prevalence of people living with multiple long-term conditions and physical frailty. So, will the reforms deliver better healthcare for older people?
The overall vision for healthcare reform set out in the Health and Social Care Bill is one Age UK supports. Developing a much clearer focus on the outcomes the NHS achieves in terms of treatment and patient experience is a positive step. Increased emphasis on public health and prevention is equally welcome.
However, we are concerned that the strategy the Government is pursuing may not deliver the step-change in the NHS’ treatment of older people that is needed. To be successful, the Bill needs to deliver better patient care for the whole population including for people with complex medical conditions or in need of preventative services. At the moment the NHS continues to under-commission vital community and preventative healthcare used mainly in later life: audiology, chiropody, ophthalmology, falls prevention services; and care and support for people with incontinence, depression, osteoporosis and arthritis. None of these are glamorous ‘life or death’ services but together they have a huge impact on keeping people well, in their own homes and avoiding the need for expensive, acute care. Unless the Bill can be changed to ensure that commissioners from the NHS Board to individual commissioning consortia have to deliver services for the whole population we believe these services will again be ignored by the NHS’ measurement of patient outcomes.
The reforms must improve integration between health and social care services and, make sure that all levels of the NHS are properly accountable to patients and transparent in their decision making. Ministers have made much of the phrase, ‘Nothing about us, without us’ to show they intend to put patients at the heart of decision-making, but there are no mandatory seats for patient representatives on the NHS Commissioning Board or at a local level so this aspect of the Bill must be strengthened.
In addition, the Government must successfully support and engage NHS staff throughout the programme of reforms – without this, current services could be disrupted and the patients who depend on them cannot afford to be let down.
Older people are the largest users of NHS services. Poor communication, a lack of joined up care and inappropriate services have a high impact on older people as frequent service users. Everyone suffers when poor practice goes unchallenged so getting health care right for older people is fundamentally about getting it right for everyone.