Ambitious, welcome and absolutely necessary: words that could fairly sum up the content of the NHS long-term plan. Who could argue with a programme for the NHS that focuses on prevention, and seeks to radically change the way it delivers healthcare to meet the changing health needs of the nation?
While there will always be arguments about the right level of financial investment in our health system, the recipe for change identified in the NHS long-term plan is spot on. Reversing the cuts to primary care; addressing traditionally neglected needs such as mental health; bringing health care closer to home and to the community; and embracing changes in medicine, innovation and technology are all essential ingredients. But now the plans need to deliver what they promise.
The NHS must focus the success and effectiveness of the initiatives set out in the plan on how well they improve the health of our ageing population. No one can deny that the health needs of the nation have changed dramatically since the creation of the NHS, and the health service needs to reflect this.
Improving the interactions older people have with the NHS is critical to realising the ambitions of the plan. Last year 1 in 4 over 65s had to wait more than a week to see their GP; hospital waiting times for older people increased significantly; 41% of adult admissions to hospital, around 7.6 million in 2017, were people over 65; and 85% of older people with depression receive no help at all from the NHS. Without change, many more older people will increasingly rely on high-cost, already stretched, NHS services.
As the Nuffield Trust has shown, two-fifths of the NHS budget is spent on over 65s. This group uses the NHS more than any other age group, so shifting this spend away from keeping people in hospital and towards providing health care closer to home, as well as prioritising mental health needs alongside physical health, will be key.
Publishing the NHS reform and social care reforms as two separate documents is a huge missed opportunity. Why is there no parallel commitment to a long-term plan or a sustainable funding model for social care? Until the government seriously starts to address the crisis in social care, any prevention strategy or attempts to free up resources within the NHS will be almost impossible. Indeed, the plan itself recognises that both the wellbeing of older people and the pressures on the NHS are intrinsically tied to how well social care is functioning.
We are concerned that the government’s funding settlement does not address the savage cuts to public health in recent years. This has contributed to increased ill-health of older people and must be reversed.
We know that public health interventions are often low-cost and highly effective. There is significant potential to improve the health of older people through public health investment, reducing unnecessary pressures on the NHS. For example, when comparing alcohol consumption and its implications on NHS resources, in 2017, 17% of those over 65 drank on 5 days or more in the week, compared to 10% for all ages. 25% of those aged between 65 and 74 reported drinking more than 14 units a week. Yet little support is available targeted at older people. When it comes to physical activity, only 15% of 65-75 year olds and 6% of over 75s meet the current physical activity recommendation. Failure to address the public health needs of older people now will only store up problems for the future.
The government must take more responsibility. Their job is not done, and handing over the money alone is not sufficient. One option available would be a commitment to introduce free personal care for the over-65s as part of their forthcoming social care reforms. Free personal care is consistent with the direction and approach set out in the long-term plan. Furthermore, our research has found that this policy is not only popular with the public, but would also be affordable and would enhance the integration of health and social care. In doing so, it would provide vital support to enhance independence for older people, allowing them to stay in their own home for longer. This would reduce pressure on hospitals and the high costs that local authorities pay for care home placements.
In addition, no one can ignore the significant staff shortages and high turnover of staff in some parts of the NHS. The government needs to urgently address the staffing shortages across the NHS, as well as scrapping the salary threshold proposed by the Migration Advisory Committee of £30,000, which is much higher than many jobs in the NHS. Joined-up action in wider areas of public policy, such as the industrial strategy’s ageing grand challenge, housing, transport and leisure services are all essential to improve the health and increase the number of years older people can spend in good health.
By 2039, people aged 65 and over are estimated to represent nearly a quarter of the population. If the NHS does not succeed in changing the way it supports the health needs of an ageing nation through the delivery of the long term plan, we may risk losing the NHS itself.