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City academics contribute to report on the frail elderly

Professors Julienne Meyer and David Oliver consult on HSJ/Serco Commission on care for the elderly
by George

Two academics from City University London have been directly involved in a new report published today by the Health Service Journal/Serco Commission.

nullThe report, titled Hospital Care for Frail Older People, says that hospital providers and commissioners must act now to tackle the problem of a frail, ageing population instead of relying on government plans for greater integration between health and social care as a solution. It was produced in collaboration with representatives from the NHS, King's Fund, and MacMillan.

Analysing the previous main reports on hospital care for frail older people, as well as all the material submitted from the original call for evidence, the Commission mainly addresses the problem of how the NHS should care for the country's increasing number of frail older people. The five key findings of the commission are as follows:

  1. There is a myth that providing more and better care for frail older people in the community, increasing integration between health and social care services and pooling health and social care budgets will lead to significant, cashable financial savings in the acute hospital sector and across health economies. The commission found no evidence that these assumptions are true.
  2. The commonly made assertion that better community and social care will lead to a reduced need for acute hospital beds is probably wrong. A short term reduction in acute sector demand may follow as a consequence of community-based demand reduction initiatives, although this is unproven. Improving community care may postpone the need for hospital care, but it will make frail older people neither invincible nor immortal: mostly, they will simply need the care later.
  3. We need more realism in the debate about the quality and quantity of care that can be provided in an environment of funding that is declining relative to demand. The pursuit of current NHS funding policies looks likely to lead to a funding gap.
  4. Hospitals should not be used to provide care that should more appropriately be provided elsewhere. Commissioners must improve community care to meet future demand, but the required investment must be based on evidence.
  5. While acute hospital admission is often the right thing to do for frail older people, being in hospital also creates risks for older people. Hospitals need to gear up to provide the very best care for frail older people, who are now their most frequent users, involving geriatricians from the start of the admission together with the other appropriate specialists.

Julienne Meyer, Professor of Nursing: Care for Older People at City University London says: "We need to make hospitals better places for old people. While caring for frail older people is now the core business of most hospitals, many have come to view their 'customers' as too tricky to manage. This must change, and we can no longer have a system whose flaws punish older people for their frailty, nor blame staff for problems in the system beyond their control. It is time that hospitals recognise the specific needs of frail older people, as a failure to do so will lead to even more problems and longer stays in the future."

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