Making the care system fit for an ageing population

Richard Humphries of The King's Fund looks at how social care can meet one of this generation's biggest policy challenges

By Richard Humphries

Making our care and health systems fit for an ageing population – the title of our recent report – is one of the biggest public policy challenges of our generation.

How well we rise to it may well hinge on the contribution of local government across a range of functions – especially social care.

The report aims to be a single, accessible reference guide to help local leaders improve services for older people and much of it is directly relevant to practitioners.

In it we set out nine components of high-quality, person-centred care, ranging from promoting independence through to long-term residential and nursing home care and care at the end of life. The evidence for what ‘good’ looks like is summarised, with examples of good practice and innovation.

Transforming services for older people means a shift from a system that all too often is crisis-driven and focuses on single diseases towards care that is coordinated around the full range of individual needs and gives priority to supporting independence and reducing the need for formal services.

When asked what they value in terms of wellbeing and quality of life, older people say that access to health and care services when they are ill is only part of the story.

Local authorities can do much to support healthy ageing, for example by addressing the wider determinants of health (as shown in another recent report by the King’s Fund), preventing social isolation, promoting age-friendly communities and getting housing right for older people. Well-designed, appropriately located, affordable and warm housing is crucial in enabling people to remain in their own homes.

But as older people develop health and care needs, the value of the social care contribution comes into its own.

Care coordination is one area where social work has demonstrated its value in engaging older people and their families in planning and coordinating their own care. Social workers are well-placed to take a lead in future ‘named person’ arrangements – although it would be unwise for any single profession to become too proprietorial about this role.

Social work expertise and social care capacity are vital elements in multi-disciplinary efforts in urgent and emergency care, such as rapid response teams, crisis response and care at home. The requirement that the Better Care Fund should be used to introduce 7-day working underlines the need to extend the availability of these kinds of services.

Good hospital discharge planning and post-discharge support is another component where social care has a generally positive track record – the proportion of people delayed in hospital because of social care reasons has steadily fallen in recent years. Local authority-led reablement services are demonstrating increasing success not just in facilitating timely discharge but reducing the need for social care later on.

The report also emphasises the value of ensuring residential and nursing home residents have access to good health care, improving health care support to reduce the need for hospital admission and providing much better support and training for care home staff.

Times are tough in adult social care. Spending is falling, fewer people are getting help and maintaining quality whilst balancing the books is becoming a nightmare.

Yet the importance of good social work and social care has never been greater, not in isolation but in concert with other professions and parts of the health and housing systems.

Already examples of good practice and innovation abound. There is no single new ‘big idea’ that will transforming health and care for older people – to borrow the words of William Gibson, the future is already here, it is just unevenly distributed.

Richard Humphries is assistant director of policy at The King’s Fund.

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