BGS issues stark warning to the new government ahead of winter

The BGS, supported by 22 organisations including four medical Royal Colleges, has expressed grave concerns about the impact of the winter months on the health and wellbeing of older people.   

BGS members say that services are already critically overloaded in many parts of the country and have been so throughout the summer.

The government has pledged to transform health and social care but none of these promised improvements will be in place before winter. 

The BGS is calling on the new government to act for the long term rather than with quick fixes that do not address root causes. 

The BGS proposes seven evidence-based actions that will make a sustainable difference to older people’s care across the UK. These aim to ensure that older people with frailty and multimorbidity are able to access the care they need over the winter months:

1. Services for older people living with multiple long-term conditions should take a coordinated and person-centred approach including the involvement of experts in older people’s healthcare as appropriate. BGS’s Joining the Dots Blueprint sets out what coordinated and person-centred care should look like for older people. This can reduce unnecessary investigations and medications, and support older people to make informed decisions about their future care, treatment and place of care. Effective implementation of proactive care to identify those in the community at risk of deterioration and early intervention can prevent ill health occurring or worsening. The BGS will shortly be publishing the evidence base to support NHS England’s Proactive Care Framework and also a guide about the delivery of proactive care in primary and community care settings.
    
2. Investment in good quality healthcare support for care homes reduces avoidable hospital admissions. There should be continued efforts to implement Enhanced Health in Care Home models where it is possible to do so. These initiatives should focus on minimising inappropriate polypharmacy and discussing resident and family preferences about what should happen in the event of an acute healthcare crisis. The BGS has published guidance on the provision of healthcare in care homes in our Ambitions for change report.
    
3. Experts in older people’s care must be included in Government and NHS policy planning. Older people are the largest group of people who use NHS services, accounting for 40% of hospital admissions and 62% of hospital bed days. Older people are also the fastest growing age group, with the number of people aged over 85 projected to double by 2045. The BGS has supported calls for the establishment of an Older People’s Commissioner in both England and Scotland to advocate for the rights of older people. These roles already exist in Wales and Northern Ireland and have had a positive impact on older people’s advocacy in those nations.
    
4. All older people with frailty should receive comprehensive multidisciplinary assessment as soon as possible after they arrive in hospital. This is often best achieved by dedicated services such as acute frailty units, or frailty assessment teams. Such teams can initiate early treatment to prevent deterioration and enable timely discharge to community services at home. We outline more about how to deliver such approaches in our guide to Front door frailty services.
    
5. There must be a focus on preventing, identifying and managing both deconditioning and delirium in hospital. Both are avoidable and are associated with increased length of stay in hospital and increased dependency on discharge. All hospitals should have a delirium policy in place as described in our Delirium Hub. Information on preventing deconditioning is available from the ‘Sit up, Get dressed, Keep moving’ campaign and the Reconditioning Games.
    
6. The government, and health and social care providers, must protect and preserve the right to rehabilitation for all older people who need it. Effective care for older people with frailty requires early mobilisation in hospital, rapid establishment of rehabilitation goals, and continued therapy input until their condition has stabilised. The right to rehabilitation means that older people must be supported by rehabilitation multidisciplinary teams wherever they receive care. Where delayed transfers of care to community rehabilitation services are unavoidable, rehabilitation should commence in hospital. Older people with rehabilitation goals should not be transferred to a care home or community bed without assurance of appropriate rehabilitation being available. BGS’s Reablement, Rehabilitation, Recovery: Everyone’s business report outlines what good quality rehabilitation looks like for older people.
    
7. There should be continued investment in a multi-professional urgent community response that provides both intensive short-term hospital level care at home through Hospital at Home and access to goal-oriented home-based and bed-based reablement and intermediate care services. These must work closely with ambulance, ambulatory care and same day emergency care services as an integrated local network. We have written more about this in Right Time, Right Place, our guide to urgent  community-based care for older people and Bringing hospital care home, which outlines how virtual wards and Hospital at Home services can support older people.

The BGS and its partners will continue to campaign for transformation of the health and care services used by older people. Solutions such as spot purchasing beds or time-limited funding perpetuate a short-termist approach which is not sustained beyond a few months, after which the same challenges resurface. 

A joined-up integrated system of care would deliver better health outcomes for older people. It would also unblock some of the ongoing systems problems the NHS faces, such as long waiting lists for elective care, delayed transfers of care and avoidable hospital readmissions. Now is the time to undertake systems transformation in readiness for the increased demands of an ageing population.   

Professor Adam Gordon MBE, President of the BGS, said:

Yet again, we are approaching another winter season that promises to be just as challenging as previous years for both older people and those working in health and social care.   

The only way to break the recurring cycle of crisis is to invest sustainably in the systems change that will deliver high-quality integrated care for those who use the health service the most.  This paper outlines those priorities but also highlights immediate steps that we can take as winter approaches.  

The evidence and the solutions are well-known. Now what is required is leadership and investment in a strategy that will be fit for the future and for an ageing population. We urge the new government to act swiftly."

Dr Mumtaz Patel, acting as president of the Royal College of Physicians, said:

The BGS is right to call for urgent action ahead of the coming winter. As the report highlights, older patients living with frailty and multiple long-term conditions use health and social care services more than any other population group. The need for system transformation to meet the needs of this growing ageing population is clear, and the NHS Ten Year plan presents an opportunity to do that.

‘We endorse the immediate actions proposed by the BGS, which will not only improve the health of older people but also alleviate wider system pressures such as avoidable hospital admissions and discharge delays. Central to this is the need to address workforce shortages—ensuring that we have the right professionals in place, at the right time, to deliver high-quality care."

Professor Andrew Elder, President of the Royal College of Physicians of Edinburgh, said:

As another NHS winter approaches it is deeply concerning that so little has changed within our health and social care systems that might make the coming months easier for older people, their families and staff.

We ask our new government in Westminster, in their first winter, to heed the clear calls we again make in this document. Each and all of our requests can lead to improvements in the care of older people if they are heard and acted upon. The ageing of our population is a societal triumph, yet we risk turning it into a disaster if we do not act to improve our services in the near future."

Mike McKirdy, President of the Royal College of Physicians and Surgeons of Glasgow, said:

Year on year, our NHS faces increasing pressure. Where we were once preparing for a tough winter, we now see similar levels of need as early as the summer months. These pressures often affect older adults at a time when they are most vulnerable and in need of our care.

As we all know well, the solutions are grounded in a well-funded, well-functioning, and properly integrated health and social care service. This begins with caring for our workforce and addressing the ongoing challenges they still face.

As a College, we support the recommendations outlined by the BGS. We will continue to work with them and other organisations to ensure health professionals are supported to deliver the best possible care."