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Executive Summary

It's almost three years since major reform of the health and social care system

in the UK. With the NHS facing crisis it's clear there is more to do - this

report this report addresses some of the issues that have recently witnessed in

the health service, explores the reasons behind them and argues that recent

changes need to go further.

It is older people who are suffering the most from the lack of health and

social care integration. They are more likely than any other age group to

face unnecessary admissions to hospital, and to experience lengthy discharge

delays and poor standards of care - problems that are only likely to be

compounded by shrinking health and social care budgets. And these vital

issues will become ever more critical as the population of England ages


Sadly, this level of poor care for older people is not surprising. The need for

integration is well documented and the current model of delivery and service

is not fit for the future. If we cannot effect change, the failure to prepare for

our ageing population will undermine the many great benefits that longer

lives bring to the country. This report looks in detail at the key barriers to

change and draws on extensive interviews with health and social care experts

from across the country and a survey of more than one hundred local health

leaders. Our key findings were:

• The health and social care system still rewards activity - not outcomes, so

undermining attempts to focus on the successful management of long-term

health conditions.

• In fact, we financially incentivise disjointed care with short-term budgets that

inevitably end up being concentrated on short-term pressures in the system,

rather than thinking afresh about how to prevent illness in the first place.

• UK healthcare does not do enough to prevent avoidable injuries for older

people and is conditioned to keep older people in hospital longer then they

need to be there.

• Relationships between partners delivering care remain poor.

• The current government has acknowledged some of these problems and we

have identified some glimmers of hope with positive examples of health and

social care working together.

• It was revealing, however, that we found many on the ground believing that

Westminster and Whitehall do not understand care for older people.

Breaking the logjam and making widespread change happen can be done but

it's the biggest public service challenge facing the next government. Our key

recommendations are:

1. To shift the blame away from blameless patients by encouraging

the media to stop using the phrase 'bed blocking' and use 'preventable bed

occupation' instead.

2. To better co-ordinate care for the elderly by introducing single, placebased commissioning budgets for 40-55 year olds (who gain the most from

prevention) and care provision of those over 85 (who are the most likely to have

complex medical conditions). The introduction of a Minister for Older People will

ensure that care for the elderly is better coordinated at Whitehall.


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