Care for elderly 'let down by fragmented system'

Old person's hands MPs want a single body for social care

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Older people are being let down by a social care system in which they are "passed like a parcel" between services, a committee of MPs has said.

The Commons health select committee wants local areas in England to deliver "joined-up" care, health and housing.

Funding pressures were reducing older people's quality of life, MPs added.

The government said "urgent reform of the care and support system is needed", and that it was creating the conditions for more integration.

The committee's report said that the Health and Social Care Bill - currently making its way through Parliament - would not simplify a fragmented system in England.

Rather than the current system of multiple funding sources, the MPs are calling for a single local body with the power to commission health, support services and housing.

The precise model would depend on local circumstances, they suggest.

The committee says in its report: "Despite repeated attempts to 'bridge' the gap between the NHS and social care... little by way of integration has been achieved over a 40-year period.

"These separate systems are inefficient and lead to poorer outcomes for older people."

Funding gap denied

Evidence was cited in the report that services which worked together to help keep older people well could potentially save the NHS £2.65 for every £1 spent by, for example, avoiding emergency admissions to hospital.

Start Quote

Growing demand makes it more urgent than ever before to convert fine words into fine deeds”

End Quote Stephen Dorrell MP Health committee chairman

The committee visited projects which had successfully integrated care in Torbay, Devon, and Blackburn, Lancashire.

However, the report points out that the care trusts that had pioneered integration in these areas are due to lose their commissioning functions under the controversial Health and Social Care Bill.

The MPs acknowledged that the government was putting extra money into social care in England - but said they had still received a "weight of evidence" which pointed to funding pressures and service cuts.

The government's commitment of an extra £2bn a year for social care by 2014/15 was "not sufficient to maintain adequate levels of service quality and efficiency", the report claimed.

In a hearing with the committee, Health Minister Paul Burstow denied there was any gap in social care funding.

'Efficiency challenge'

The Conservative MP and former Health Secretary, Stephen Dorrell, who chairs the committee, said: "This government, like its predecessors going back to the 1960s, has stressed the importance it attaches to joined-up services.

"Growing demand, coupled with an unprecedented efficiency challenge, makes it more urgent than ever before to convert these fine words into fine deeds.

"It is impossible to deliver high quality or efficient services when the patient is passed like a parcel from one part of the system to another.

"We recommend that the government should place a duty on the new clinical commissioning groups and local councils to create a single commissioning process for older people's services."

Ministers in England are due to publish a White Paper on social care in the coming months.

The committee is calling on the government to implement the findings of the independent Dilnot Commission, which last year recommended a system in which the costs of care for individuals were capped.

MPs warned though that the future of social care should not be "dominated by a debate about the technical details of funding".

They said carers needed more support - but this was too often not identified by staff such as GPs and social workers.


The King's Fund think tank estimates that 890,000 people are not receiving the care services they need - a figure which is disputed by ministers.

A senior fellow at the King's Fund, Richard Humphries, said: "Delivering integrated care must assume the same priority over the next decade as reducing waiting times was given over the last.

"The committee is right to stress that a more ambitious approach is needed to achieve this based on co-ordinated commissioning and pooled budgets.

"We think this could go a stage further by moving towards a single assessment of the funding needs of the NHS and social care in future spending reviews."

The shadow care minister, Liz Kendall, said: "Far from focusing on what older people and their families really need, the government has instead wasted 18 months on its disastrous NHS reorganisation.

"As the committee points out, some of the best examples of integrated care have been achieved by Care Trusts, which will be swept away by the government's own Health and Social Care Bill."

Mr Burstow said: "Integrated care should be the norm. That's why we asked the NHS Future Forum to specifically work on this issue. They told us there is no single silver bullet when it comes to integration.

"What we have already done and continue to do is create the legal and financial conditions for more integration."


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  • rate this

    Comment number 158.

    I work in social care with the elderly. The system where I live already has integrated health and social services working for the NHS not councils. The combination of cuts and rising demand from those living longer and with dementia means that care is increasingly rationed to only those in most urgent need and at most risk. The time bomb of need outstripping supply is exploding.

  • rate this

    Comment number 157.

    The money would be spent much more efficiently if the social care services were staffed with people who believed their job was to care for people, rather than meet targets, tick boxes, and deal with units of care requirement (aka people)

  • rate this

    Comment number 156.

    So an update on possible money savings to put towards social care for the eldery:

    No more 'illegal' wars: ~10bn (3.3%)
    Rolling Council Tax/National Insurance into Income Tax without increasing total tax take: ~4bn (1.3%) [admin savings alone]

    With everything I've mentioned so far (and most of it with -ve comments) it still barely hits 50% of what's necessary.

    Who's for more tax?

  • rate this

    Comment number 155.

    151 Fk
    In my profession (which is science based) 12% is considered a step change, how much do you need before you consider it worthwhile?....either way it makes a big dent.

  • rate this

    Comment number 154.

    The sad thing is that 'joined up thinking' is just one of those buzzwords (or buzzphrase) that's wheeled out whenever something goes wrong, along with 'lessons will be learned' and a whole raft of others. Just note how many times the word 'robust' is used in conjunction with government policy (or how often 'proactive' is used in your place of work).

    Trouble is, this works on us every time.

  • rate this

    Comment number 153.

    This is what happens when you hand over parts of a public service to the private sector whose motives are profit and more profit. It also illustrates how short sighted this govt are in attacking people on benefits who are caring for both old and young in their homes.Benefits which pale into insignificance in cost terms compared to care home costs.

  • rate this

    Comment number 152.

    @145 Sheila Coleman: I don't agree if you said" In these homes of course are people who have never paid tax/NI"
    I am planning to put my husband in care home during my holiday as I didn't see my dad for over 5 yrs. My husband taking early retirement & have to pay 20%tax of his income(what ever you get still 20%tax), the same with my parents in law as they paid 20%of their retirement.

  • rate this

    Comment number 151.

    :138.sheila coleman
    "Why not tax the bankers bonuses at 100%"
    Erm. If you did this, they wouldn't take bonuses, so you wouldn't get any revenue from it. Duh?

    "I think I'd prefer that they consider wasting less of it on pointless wars"
    Total defence budget was 43.6bn. This would make a dent (~12%) but on it's own wouldn't solve the social care problem, and would lose jobs.

  • rate this

    Comment number 150.

    Unfortunately in this country, we have always been well-intentioned with our care ideaology, but the implementation is always sadly lacking. Senior citizens are often cared for out of a grudging obligation, rather than any real commitment. And private enterprise, the government's panacea to every problem, runs every home, but they are in it for PROFIT not altruism, which says everything.

  • rate this

    Comment number 149.

    Thanks for putting me straight Polly, sorry my mind was wandering :-)
    I'm feeling all patriotic again now LOL
    I believe that Simon Cowell is holding auditions for Iran 2014 as we speak, it's going to be the best yet, wait and see.
    "Iran's got Oil" or maybe "Strictly come fighting"

  • rate this

    Comment number 148.

    Lets cut to the chase. We are talking about folks who for decades have paid their way, often paying MORE than the minimum - I've paid NI for 38 yrs so far, but officially told I only need pay 30 years for my pension (I've got yet another 7 years before I can collect). The present elderly have often sacrificed lots for this generation. The way they are treated now is a national disgrace!

  • rate this

    Comment number 147.


    "I think I'd prefer that they consider wasting less of it on pointless wars"

    Wars aren't pointless, they benefit arms companies and unite the nation so we forget our problems and anyone who criticises the state on stuff like this can be painted as the enemy. And it helps a govt get re-elected.

    Iran 2014 anyone?

  • rate this

    Comment number 146.

    The gov should have a pot of money to support elderly based on their needs. It won't be fare if some one who works on their entire life& reject the financial assessment& can't get access. My mother in law has to pay for their care as she got stroke few years ago, I can't help as my husband suffered from MS and getting down hill. The gov cuts shouldn't have impact.

  • rate this

    Comment number 145.

    Why are nursing homes so expensive even several yrs ago they were over £600 per wk, surely there ought to be some sort of regulation. I know nurses/heating cost money but people at that age eat little, do not go out binge drinking, sit all day etc. In these homes of course are people who have never paid tax/NI so think Ive answered my own question

  • rate this

    Comment number 144.

    If we stopped giving money to so-called developing countries that already have space and nuclear programmes, such as India and China which don't require our money anyway, we might be able to afford to look after our own people. The elderly are fast becoming a forgotten generation with little or no voice to express their concerns about care.

  • rate this

    Comment number 143.

    132.Billy The Bull
    yes it's extremely perverse that a low life like Abu Nomark gets millions spent on his rights but a lifelong hardworking, law abiding pensioner is treated like dirt. It's a bit odd isn't it - human rights " some are more right than others "

  • rate this

    Comment number 142.

    MPs want a single body for care...well I'll tell you a single body. It is called the FAMILY UNIT. We should take a leaf out of our middle eastern neighbours and have all the family living together and they can all help to look after the eldery of the family. The way the elderly are treated in Britain is shocking. In other cultures they are highly respected for their wisdom.

  • rate this

    Comment number 141.

    It is a general problem with the public sector. Nothing seems really joined up. No one, ever, takes responsibility.

    There was a recent report in our local press about the local NHS in effect killing a baby. The NHS response? A mumbled 'lessons will be learned' from the management, and a sizeable payout - with OUR money!! to the parents.

  • rate this

    Comment number 140.

    Yes, of course care for the elderly should be joined up. But let`s not ignore the reality here, this is all about money. Providing individualised services to an elderly person costs, if they have dementia, it costs a lot more. Both health and social care have less money to spend in this area and will try to pass the responsibility and the cost to each other. Dreadful

  • rate this

    Comment number 139.


    A baby receives care and has money spent on them to turn them
    into a healthy adult and future worker, to ensure profit creation carries on to benefit the few.

    Once retired, the system views you as a burden with little reason to spend money to keep you going.

    It will never be any different under a system that views people as parts of a profit/loss sheet. Civilised society?


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