The dramatic increase in life expectancy over the past 50 years is one of the greatest achievements of our times. The number of centenarians has quadrupled over the last 20 years to 12,000 living in the UK today and this number is predicted to rise to 87,900 by 2034. This advance has not only transformed individual lives, but brings a whole new demographic dimension to our society.
Yet while we are living in a new era of longer life, in many ways our health service is woefully ill-prepared for people living into late old age. The treatment this growing group of people receive in hospitals and GP surgeries can often lag behind other age groups. The medical advances we have made don't always benefit older people and, in comparison to other Western countries, our older population is still dying prematurely of preventable diseases.
So where does the NHS need to improve to meet our ageing population's health needs? Firstly people in late old age have not fully shared in improved health outcomes with respect to the main 'killer' diseases of cancer, heart disease and stroke. Our death rates for younger ages now fare reasonably well compared to other developed nations, but fall behind for people aged over 75. This indicates a system with in-built age discrimination.
It is imperative that structures within the NHS are changed to ensure the same importance is placed on health outcomes for older people as other age groups. Changing deeply ingrained ageist attitudes is harder to fix, but must be tackled throughout the organisation.
Older people are also losing out when it comes to commissioning vital community and preventative healthcare used mainly in later life. There are big gaps in the provision of audiology, chiropody, ophthalmology and falls prevention services, as well as care and support for people with incontinence, depression, osteoporosis and arthritis. None of these are glamorous 'life or death' services but together they have a huge impact on keeping people well, in their own homes and avoiding the need for expensive, acute care. The move towards GP commissioning offers a golden opportunity to end this practice and ensure that services provided actually reflect the needs of the population it is serving.
We need to ensure our workforce is trained to care for older people with complex, overlapping health needs, acute frailty and cognitive impairment. But we still organise too much of our healthcare, and train our workforce, on a condition specific basis, rather than expecting that everyone is able to adopt a geriatric care perspective, focused on the whole person not the health need. Recent strategies on end of life and dementia are only starting to scrape the surface.
We need a fundamental change in the patient journey, so that people receive a range of care and support, closer to home, with help to manage their own health conditions and retain as much control as possible over their own lives.
Finally, the NHS can often still fail to put dignity and patient experience at the heart of all it does. People using services and their families still too often encounter poor communication, lack of involvement in decisions, and inadequate support for basics such as eating, drinking and using the toilet. Much of this is down to attitude, often as a result of frontline staffing pressure. Without a strong steer from commissioners that the patient experience really matters, dignity will always be an afterthought in the patient experience.
Some of the solutions are fairly obvious; we need to ensure that results relating to older people are made to count when rating the NHS's performance and we need structural change to achieve this. The Equality Act to be introduced to health and social care next year will go some way towards challenging ageist clinical decisions, but the damaging attitudes embedded across the NHS need to be tackled. Sustained professional collaboration, national and local leadership, and a greater role for experts in older people's care at both levels is required. A good place to start would be an inquiry into the NHS's response to ageing.
The scope of the government's reforms for the NHS have been described as ambitious and wide-ranging, but their success depends in part on the organisation's ability to respond to the complex needs of our ageing population. We cannot afford to stand still or let ourselves be distracted by re-organisation of the NHS; unless this issue is tackled urgently, any efficiency measures will be undermined by this single issue. Medicine has extended our lives, but we now need a health and care structure to support later life which treats older people with dignity and respect and allows them to flourish.
Article from The Guardian