Intended for healthcare professionals


Focus on physical activity can help avoid unnecessary social care

BMJ 2017; 359 doi: (Published 17 October 2017) Cite this as: BMJ 2017;359:j4609
  1. Scarlett McNally, consultant orthopaedic surgeon1,
  2. David Nunan, senior researcher2,
  3. Anna Dixon, chief executive3,
  4. Mahiben Maruthappu, health executive4,
  5. Kenny Butler, health and wellbeing lead5,
  6. Muir Gray, public health doctor6
  1. 1Eastbourne District General Hospital, Eastbourne BN21 2UD, UK
  2. 2Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  3. 3Centre for Ageing Better, London, UK
  4. 4Cera, London, UK
  5. 5UKactive, London, UK
  6. 6Oxford University Hospitals NHS Trust, Oxford, UK
  1. Correspondence to: S McNally scarlett.mcnally{at}

A concerted effort to provide support and opportunities for physical activity can help older adults maintain independence and lessen the costly burden of social care, argue Scarlett McNally and colleagues

Social care has received substantial media coverage in recent months. There is now acknowledgment of the direct link between the parlous state of the NHS and the social care crisis.1 Most social and political commentators focus on cuts in public funding of social care, shortages of staff, the increasingly fragile financial state of care home providers, and knock-on consequences for the NHS. The blame is usually placed on the rising numbers of older people, as if the requirement for social care was an unavoidable consequence of ageing. Thankfully, the need for social care is not inevitable. The UK National Institute for Health and Care Excellence made it clear in 2015 that “disability, dementia and frailty can be prevented or delayed.”2 This remarkable statement received little publicity at the time.

A person’s need for care and support, whether provided by unpaid family carers or professional carers paid for personally or by the local authority, arises when someone is no longer able to manage vital activities of daily living such as washing, dressing, and feeding themselves. For illustration, for some people, the ability to get to the toilet in time is a threshold marking the difference between having carers visit twice a day and requiring live-in or residential care. The cost of care increases fivefold as this threshold is crossed.3 A residential care placement costs an average of £32 600 a year3 and may be required for months, years, or decades.

Ensuring that as many people as possible maintain the ability to manage vital activities of daily living requires a cultural change so that it becomes normal to expect …

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