No One Left Alone

By Karen Noakes, ACEVO Head of Health Policy

In the last year the Government have stepped up significantly their work with older people. Their plans are now almost ready. But like many other policy areas that ACEVO works on, older people’s care will not succeed unless the voluntary sector is an integral part of the government’s plans. Here’s why. 

Last July the Department of Health (DH) launched a consultation on their Vulnerable Older People Plan (VOPP), a plan for personalised, proactive care for vulnerable older people.

At ACEVO the members of our Health and Social Care Special Interest Group (SIG) directly discussed the plans with the DH official leading the work, Eleanor Knights.

In April the latest plan appeared under the title ‘No One Left Alone, a plan for more personalised, proactive and joined up care’. It widened the plans to include not just people over the age of 75 but people of all ages living with complex health needs.

It’s a credit to our charities’ advocacy and campaigning role that the Government is taking this issue so seriously in the first place. Charities such as Age UK and National Voices have made a significant contribution to the strategic development of the Department of Health’s plan.

But any progress will be seriously jeopardised unless GPs, charged with turning this plan into a reality, make the connection between what is currently missing from the care delivered by the NHS and the obvious partner to fill that gap – the voluntary sector.

So what is the problem in hand? We are all living longer but we are not necessarily all living well. Two out of three people over the age of 75 cope with one or more long-term conditions. One in three will suffer from dementia in old age and many have to cope with these conditions alone. Half of over-75s in England live alone and, while past generations might have lived and worked where they were born, we are increasingly mobile. So we are now more likely to live alone with no immediate family surrounding us to provide extra social support as we get older. You can start to see how the gap in our health and care needs has been created and where the solution lies.

This gap will be best filled not by traditional NHS providers, housed in hospitals or GP practices, but by organisations used to working across and in between health and social care, in the community and in people’s own homes. Organisations that have traditionally been set up to address an unmet need, offering expertise and services across a wide range of conditions; there to offer people advice, peer support and advocacy. In short, it will be filled by charities.

The Department of Health states in the plan that its initial focus is the expanded role for primary care in improving the care of those with the most complex health and care needs. GPs will have greater responsibilities and a larger work load unless we start delivering care differently. The solution? The title of the publication itself sets the scene for a report that looks beyond medical care and acknowledges that some of the solutions lie in addressing the wider determinants of good health such as housing, malnutrition and social isolation. The voluntary sector is well positioned to support GPs in delivering services that reach beyond traditional health care and address these wider determinants of good health.

The report itself is clear that this plan cannot be implemented by GPs alone and will require a wide range of people, inside and outside the NHS. Old professional boundaries will need to be broken down in favour of more team relationships and greater flexibility around roles.

On the ground, GP consultations with older people and people with complex health needs should ensure that they are linked to the relevant charities who can provide the additional care and support they need. GP practices should offer to make those links for patients or carers who are unsure what help they need. It will save them time in the long run.

The voluntary sector is eager to play an increasing role as an enabler of better care that starts in the community or in the home. There are many charities out there already providing care alongside hospitals and GPs, as the case studies in No One Left Alone highlight. But there is not always awareness by the NHS and among the public of what is on offer.

The voluntary sector is so diverse that NHS commissioners and providers have told us that it’s difficult to engage with. They must if we want no one to be left alone.

At next month’s ACEVO Health and Social Care SIG, on 17th June in Manchester, we will hear from the team at NHS England in charge of rolling out personal health budgets this year. We will discuss what this means for people wishing to access services through a personal health budget and for the charities planning to provide these services. All ACEVO members are welcome to attend, so please do join us for another topical discussion.

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