Chapter 2 - What Are The Symptoms? Or What Are The Problems Facing
Older People In Health And Social Care?
Chapter 2 - What Are
The Symptoms? Or What
Are The Problems Facing
Older People In Health
And Social Care?
We have set the scene, describing a population which is both increasing and ageing,
and the pressures that that population places on an already overburdened health
and care system. In this chapter we outline the main problems that flow from this
confluence of drivers.
2.1 Over occupation of hospital beds and delayed transfers of
When asking about the key solutions that the health and social care system isn't
delivering as it could, the top answer, cited in every case, is the vast number of
(mainly older) people in hospital who simply do not need to be there, due to either
unnecessary admission and/or being left in hospital when they should be either
discharged or moved for treatment elsewhere. 'Bed blocking' - the unfortunate
term used in the media that suggests those stranded in hospital are in some way
culpable - puts a very significant strain on health services.
Avoidable admissions are not specific to older people alone, with a recent study
revealing that 87 per cent of children and young people attending accident and
emergency could be better treated in primary and community care.15 There are
also systematic problems. Dr Clifford Mann, president of the College of Emergency
Medicine pointed blame towards the '111' NHS phone line. The '111' phone line
was designed to relieve pressure on hospitals but he claims it has had the opposite
effect. He said that the number of visits to accident and emergency departments
rose 446,000 last year. Of these, 221,000 involved people being told to attend by
the 111 service, and 222,000 cases were brought in by ambulances dispatched
by the service.16
However the Care Quality Commission (CQC) found the number of people aged
over 65 admitted as an emergency with 'avoidable' conditions had seen a substantial
increase in five years to 530,000 in 2012/13- up from 374,000 in 2007/8.
During 2012/13 one in 10 of those aged 75 or over was admitted to hospital with
potentially avoidable conditions.17 The picture is even worse for those over 90 with
five admitted to hospital at least once as an emergency with 'avoidable' conditions.
The CQC go on to say: "These conditions are potentially avoidable because they
are manageable, treatable or preventable in the community or could be caused by
poor care or neglect, such as pressure sores, bone fractures or dehydration. This
suggests GPs and social care services could be working together better."
Another reason for avoidable admissions is a lack of focus on prevention-
particularly with regard to falls. The King's Fund found: "Falls are a leading cause
15 Reform, Fewer hospitals, more
competition (March 2010)
16 Neville, S, "Top doctor links
A&E chaos to NHS advice line"
Financial Times (14 January
17 Care Quality Commission, The
state of health care and adult
social care in England 2012/13