Report reveals more than one in four older people have some unmet need for social care

A new report by Age UK finds older people are often struggling due to insufficient access to high-quality NHS treatment, as well as social care, and that the system is currently under-prepared for population ageing.

Age UK strongly supports Lord Darzi’s conclusion that the answer lies in focusing more on prevention and early intervention, supporting older people at home or in a care home to stay fit and well.

The ‘The State of Health and Care of Older People in 2024’ report has found that two million older people in England are now living with some unmet need for social care.

Drawing on the latest available data, the report concludes that England’s health and care services continue to be under enormous pressure so that, despite the best efforts of many dedicated staff, they are currently unable to meet the needs of all the older people presenting who require treatment, care and, support.

Long-standing problems were greatly exacerbated during the pandemic years, and, despite some recovery since then in some areas, in others it has not yet proved possible to arrest a decline in capacity, service availability, and performance, with extremely worrying implications for older people and their families and unpaid carers.

This is all the more concerning in light of a rising older population, says Age UK, the growth of which will accelerate still further over the next decade, increasing by a projected 4.3 million by 2044.

However, more optimistically, the new report shows that significant numbers of emergency hospital admissions could be avoided if the right kind of help was provided earlier on, before relatively minor health problems develop into full-scale crises.

The inability of services to intervene quickly or effectively enough to support older people at home leads to many waiting for very long periods in A&E and then becoming stuck in a hospital bed because of a lack of community-based care, creating huge problems for hospital managers and undermining their own chances of making a good recovery, according to the report.

Age UK finds that in particular, people aged over 80 are often not getting the good and timely NHS treatment, care, and support they need and ought to be able to expect. It also finds more than one in four have some unmet need for social care, and people in this age group are also the most likely to experience long waits in A&E, having arrived there by ambulance.

Many have complex health and care needs, and, at the moment, the system is often insufficiently geared up to meeting them, though there are some isolated, excellent examples of good practice. The charity says they urgently need to be scaled up and that the forthcoming NHS Ten Year Plan is well-placed to be the vehicle for driving this through.

The data shows that of older people aged 65, 1.1 million older people have difficulty dressing, 500,000 older people have difficulty walking across a room, and 640,000 older people have difficulty bathing.

It also found that one percent of older people have difficulty eating, six percent of older people have difficulty getting in and out of bed, and four percent of older people have difficulty going to the toilet.

Other key findings include the number of people over 75 has grown by 18 percent since 2017. Growth in the number of GPs is not keeping pace with the population growth of older people aged 75 and above, and the social care sector is struggling to fill vacancies in almost every key adult social care role.

Additionally, fewer older people are receiving local authority long term-care, from 542,420 in 2022/23, compared to 565,240 in 2017/18.

Finally, the risk of needing to attend A&E increases as people get older: per 100,000 population, there are 49,917 attendances for the 75-79 age group, rising to 93,931 for those aged over 90.

The numbers of district nurses reduced by 17.5 percent between 2014 and 2023, a trend in completely the wrong direction, Age UK emphasises, given how central their role is in treating older people at home for problems like pressure sores, which can develop into serious health problems requiring acute care.

Similarly, the NHS workforce is not growing fast enough to meet increasing needs and acuity, but to the extent that it has been growing, hospitals, rather than community settings, have generally been the beneficiaries.

The report finds that primary and community health services, and social care, are either inadequate in terms of availability or are insufficiently joined up and planned.

The charity says services must work better together in ways that enable older people in declining health to be identified and assessed, and the provision then has to be in place so they can benefit from early intervention and proactive support. This is likely to require a shift of resources out of hospitals and into the community.

Caroline Abrahams, Charity Director at Age UK, said: “It’s deeply worrying that the numbers of older people living with some unmet need for social care have now reached two million, out of a total older population in England of about 11 million.

“Some of these older people may be just about managing, but others will undoubtedly be struggling badly with everyday tasks like getting out of bed and washing, increasing their risk of problems like falls which could cause them serious injury, or worse.”

“The Government has not yet said what it intends to do in terms of reforming and refinancing social care, though it has made it clear that it sees social care playing a crucial role in the more joined up, community-based Health and Care approach it wants to see supporting older people to stay fit and well at home.”

Age UK recommends the body responsible for health and care services in each area puts in place an Ageing Well Strategy, including how they will invest in public health over the life course and into older age.

Also, investment in GP practices, primary care, and community services to offer coordinated support for people living with long-term conditions and/or frailty is recommended. The charity also suggests the introduction of an ambitious preventative public health strategy that encourages and enables physical activity among older people and those with long-term health conditions, building on Sport England’s ‘We are Undefeatable’ programme.

Significantly expanding the number of ‘integrated neighbourhood teams’ bringing together health and social care professionals with a range of other support workers to help older people with complex needs to maximise their health and independence is suggested.

Another recommendation involves implementing a strategy to clear waiting lists, including a return to the 18-week standard and support for people while they are waiting.

The charity also recommends the implementation the NHS Workforce Plan and make sure that all healthcare professionals have the skills they need to support an ageing population, alongside stabilising the social care sector and act quickly to consult on putting funding on a sustainable footing.

Within 18 months, Age UK urges that a comprehensive plan to reform social care and commit to implementing it during this Parliament is published.

The charity also asks for an immediate pay rise for care professionals. Within two years, the government should publish a comprehensive social care workforce plan, joined up with the NHS Workforce Plan, and the introduction of a right to at least five days of paid Carer’s Leave, plus a longer period of unpaid leave.

Finally, Age UK advises significantly increasing access to respite services and practical support for carers that recognises the specific needs of older carers.

Caroline added: “We completely agree with Ministers and with Lord Darzi that this is the right direction of travel, but the question we would ask is whether it will prove possible to achieve this without the comprehensive social care reform which Ministers suggest it will be impossible to achieve during this Parliament.

“Our fear is that unless this Government grasps the nettle of social care reform firmly and quickly, they will find it impossible to stabilise and strengthen the NHS either, to the enormous detriment of all of us but of older people, its principal client group, most of all.

“Some of the findings in our new report are frightening, in that they show how badly our Health and Care system is currently failing some older people, the oldest old especially, despite the professionalism and commitment of many kind and dedicated staff.

“These older people do not have time on their side and it is above all for their sake that we would urge the Government to work with the NHS, local government and charities like Age UK too, to chart a path to a better future for Health and equally for Social Care.”

Recent analysis shows that removing the most serious fall hazards in homes lived in by at least one person aged 55 or over would also bring broader annual savings to society of £1.4 billion.