Why isn’t there an older peoples service in every GP surgery and A&E dept?

I think we’re all familiar with the figures by now but they don’t get any less worrying

  • over-75s account for one-third of the 5m emergency admissions each year
  • 60% of hospital beds are occupied by people over 65
  • 40% of those people have dementia
  • 66% increase in inpatient episodes for people aged over 75
  • A two thirds increase in the number of people aged over 90 attending A&E
  • LTC cost the NHS 77 billion pounds a year: One in three people currently have a LTC rising to half of all people aged over 60 and people with LTC also more likely to have corresponding mental health problems
  • Campaign to end loneliness research with GPs identified that three quarters of family doctors reported that between one and five patients a day attend their surgery primarily because they are lonely, 11 per cent of family doctors reported up to 10 patients a day who they think are lonely, and four per cent of doctors saw more than 10 lonely patients on an average day.
  • The Campaign to End loneliness research also found that (49 per cent) of the doctors questioned said they were not confident they had the tools necessary to help their lonely patients

I spent 10 years in the 1990s/early 2000s working as an advice worker and then a manager for Age Uk (Age Concern as it was then), and I went on to run a healthy living centre for older people in Camden. Since then as a consultant I’ve worked with organisations all over the country that provide services to older people. Out there are organisations providing advice on benefits, housing options, care services and a whole range of disparate topics. They provide visiting services, shopping, housework, gardening, handyperson services, social groups, holidays, falls prevention programmes, exercise classes, healthy living projects footcare, and home from hospital schemes.

The thing is, in all that time, I can count on the fingers of one hand the voluntary organisations providing these services who received significant referrals from GPs. I never got that many when I ran front line services for older people and other than in isolated pockets, it still doesn’t happen now.

I’m amazed that even now I can talk to a GP or a CCG commissioner about what services voluntary organisations provide and still be met with an incredulous “really? I had no idea!” It baffles me it really does! (I do of course accept that some of the blame lies with us for not being better promoters of our work).

Older people  are heavy users of the NHS; they go to their GPs a lot, a lot of the time with issues related more to poverty and isolation than a pressing medical problem. They can end up in A&E because there’s no support and get admitted to hospital because there’s no one to help them at home. Often they don’t need high end personal care, they just need someone to help them get home, make sure the house is clean and warm, that there’s food and to reassure them someone will be round to check on them tomorrow and the day after and for as long as is necessary.

It seems to me basic common sense that having a service for older people located in a GP surgery and A&E  (or if there isn’t room, something that can be accessed through the web or skype) that can deal with the issues around poverty, isolation and practical support would be a good thing. It would help lessen some of the GP workload, not just the physical workload but the mental frustration of wanting to help and not being able to.

It really doesn’t seem that difficult to to do either. Out there are organisations who are already running the services the NHS needs to help alleviate the issues around older people. Is it really so hard to get together to make it happen?

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