National director calls for five point plan on care of older people

BMJ 2007; 334 doi: (Published 01 February 2007) Cite this as: BMJ 2007;334:229
  1. Lynn Eaton
  1. 1London

    The Department of Health needs a five point plan to improve healthcare services for older people, says England's national clinical director for older people, Ian Philp.

    Early intervention, management of long term conditions, early supported discharge, acute care in hospital when needed, and health and social care agencies working in partnership are all keys to the success of caring for an ageing population, he said.

    “This is already happening in some areas,” said Professor Philps, “but it needs to happen across the country.”

    His report cites examples of delivering care in innovative ways that he believes should be developed countrywide.

    One example is where ambulance trusts work in partnership with NHS and social care colleagues to prevent falls and manage patients better after they have had a fall, he says.

    “Early intervention is vital. For example, more investment on falls and bone health could prevent 4000 hip fractures and save 800 lives every year. If every strategic health authority spent £2m (€3m; $4m) on this, they could each save £5m every year.”

    People aged over 65 years make up 10% of the population, but more than 40% of the NHS's budget is spent on caring for them, said Professor Philp.

    “By 2025 the number of people in the UK aged over 85 will have increased by two thirds. Older people are the main users of health and social care services and are three times more likely to be admitted to hospital after coming into A&E [accident and emergency departments].

    “On any given day 65% of hospital beds are occupied by the over 65s. Our existing services were not designed with older people's needs in mind, so we need to improve and reorganise services to better meet their needs.”

    The health secretary, Patricia Hewitt, welcomed the report: “Older people have told us loud and clear that they want the NHS to do more to prevent illness and more to keep them living independently in their own homes,” she said. “Professor Philp has made it clear that early intervention and more and better services in the community will give older people what they need and want.”

    However, the British Geriatrics Society, which represents doctors and others who specialise in the medical care of older people, gave the report a guarded welcome.

    “Broadly speaking we welcome the idea of a five point plan,” said its chief executive, Alex Mair. “But I have to say that there is no reference in the report at all about additional funding.”

    He said the society hoped that sensible and adequate new investment will be provided “to ensure that health and social practitioners are adequately provided and trained to meet the challenge and make the plan a reality.” Although partnership working was beginning, the picture was very patchy, he said.


    • A Recipe for Care—Not a Single Ingredient is available at

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