Make hospitals good for older people

David Nicholson, chief executive of the NHS Commissioning Board, asserts that “Hospitals are very bad places for old, frail people” and suggests alternatives must be found.1 Perhaps then the solution to nurses’ lack of compassion might be to admit to hospital only patients who do not need compassion.

Here is a radical suggestion—make hospitals good places for older people. Few national providers would make such a blatantly ageist inference that its “core business”2 was too tricky to manage and propose solving “the problem” by ceasing to attempt to deal with it. The greatest burden of ill health falls on older people, the group most commonly encountered in clinical practice. But it seems that the impertinence of our older population in becoming unwell and needing care will no longer be tolerated in hospitals. The acute care of older people has progressed from being an inconvenience to being an anathema.

Hospitals are still organised around the care of younger fit adults presenting with a single acute medical problem. Yet this is no longer the population needing care. Around 23% of patients in general practice have two or more chronic conditions, and this rises steeply with age.3 The problem is not with our patients but with our health systems. Let’s fix our healthcare system to make it responsive to the needs of those who need it. Let’s change training and education to ensure that workers possess the skills to manage people with multimorbidity, including older people. Let’s enable prompt diagnosis and invest more in downstream systems designed to allow older people to leave hospital when ready. Let’s have equity of access for all patients who need it and make the NHS fit for the 21st century.