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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




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