Intended for healthcare professionals

Education And Debate

Geriatric care in the United Kingdom: aligning services to needsCommentary: current system could be made to work

BMJ 1999; 319 doi: (Published 23 October 1999) Cite this as: BMJ 1999;319:1119

Geriatric care in the United Kingdom: aligning services to needs

  1. Clive Bowman, associate director (,
  2. Malcolm Johnson, directora,
  3. David Venables, chief executiveb,
  4. Chris Foote, consultant physicianc,
  5. Robert L Kane, Minnesota chair in long term care and ageingd
  1. a International Institute on Health and Ageing, University of Bristol, Bristol BS8 1TX
  2. b Brunelcare, 3 Redcliffe Parade West, Bristol BS1 6SL
  3. c Amersham Hospital, Amersham, Buckinghamshire HP7 0JD
  4. d Division of Health Services Research and Policy, School of Public Health University of Minnesota, Box 197 420, Minneapolis, MN 55455, USA
  5. Department of Health Care for the Elderly, Bancroft Unit, Mile End Hospital, Tower Hamlets Healthcare Trust, London E1 4DG
  1. Correspondence to: C Bowman
  • Accepted 20 April 1999

Current provision and funding of health and social care for older people in the United Kingdom are undermined by a structural and operational misalignment of primary healthcare teams, acute hospital trusts, community trusts, and social services. The problem has been compounded by the fact that funding originates from at least three sources: the NHS, local social services departments, and personal or insured means. The inevitable result is obfuscation of responsibilities.

The recent report from the Royal Commission on Long Term Care, With Respect To Old Age,1 recommends the establishment of a national care commission to monitor trends, costs, accountability, and the interests of the consumer and to set national benchmarks. This builds logically on policy trends signalled in the government discussion paper Partnership in Action and Modernising Social Services, which suggest a national regulatory system and standards.2 3 In this article we outline a possible solution that integrates and aligns health and personal care for elderly people in a practical and incremental manner. To put our strategic proposals in a contemporary perspective we briefly outline some present issues.

Summary points

Health care tends to focus on acute problems at the expense of managing and preventing exacerbations of chronic illness.

Long term care of elderly people has been shifted from hospital to residential homes.

A partnership is proposed including general practitioners, geriatricians, and social support staff for care of frail elderly people.

Partnership would be encouraged to and responsible for maintaining and improving the health of frail people rather than fire fight acute illness.

Planned, supported, and funded care by general practitioners may improve the health of care home residents and avoid episodes of expensive care.

Shift to residential care

The locus of long term care has shifted from hospital long stay wards directed by geriatricians to privately operated community nursing and residential …

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