Why are we needlessly admitting so many to hospital?

Whilst everyone with an interest in the crises faced by the NHS is fully aware that the situation is exacerbated by bed blocking caused through delays in discharging patients from hospital. What is not so widely known is that almost 1,000 elderly people a day are being admitted to hospital needlessly amid a crisis in social care, according to Age UK.

Analysis of NHS figures by the charity found that there were 341,074 avoidable emergency admissions for people aged 65 and over during the year to April 2017.

The number has risen by 107 per cent since 2003 for those aged 65 to 69, and by 119 per cent for older people aged 75-79.

Among the general population of England, the number has risen by 63 per cent.

Reason for admissions

The figures relate to admissions because of conditions such as ear, nose or throat infections, kidney and urinary tract infections, and angina, for which hospitalisation could potentially have been avoided had the person been better looked after.

Many older people rely on family and friends to help them in the absence of reliable social care, the charity warned.

One in three over-65s live alone, and one in ten have no children, and these figures are expected to rise as younger generations, who are less likely to have married or had children, reach retirement age.

Many of those who do have loved ones to care for them rely on elderly relatives who may have health problems of their own.

One case study highlighted by the charity involved a 67-year-old woman who has been a carer for 40 years, first for her parents and more recently for a younger sister who has Alzheimer’s disease.

In another case a 73-year-old woman has been the sole carer for her 75-year-old husband since he had a stroke and brain hemorrhage four years earlier. She cancelled previous at-home care because it was “unreliable and lacking in continuity”.

Its report also highlights the problem of older people stuck in hospital and unable to go home, putting more strain on the healthcare system.

Unavailability of care

Care not being in place was the main reason there were delays for older people leaving hospital in England last year, according to figures released by the NHS.

A social care green paper, set to be released this autumn, is due to set out the Government’s plan for reforming the sector. It was originally supposed to be released before the summer recess.

Caroline Abrahams, charity director of Age UK, said: “The safety net for older people living at home has worn dangerously thin after years of underfunding and an absence of workforce planning across both health and care – this is why the numbers of older people whose emergency admissions to hospital could have been avoided are rising so fast.”

Councils warned of a “crisis in adult social care”. Cllr Ian Hudspeth, chairman of the Local Government Association’s community wellbeing board, said: “With people living longer, increases in costs and decreases in funding, the system is at breaking point and is ramping up pressures on unpaid carers who the backbone of the care system.

A department of health and social care spokesman said: “Patients should only be admitted to hospital when absolutely necessary, and we expect the NHS to work closely with local authorities and ensure people have a care plan in place when they are discharged.

“The Government has committed to a long-term plan with a sustainable multi-year settlement for the NHS to help manage growing patient demand.

“Health and social care are two sides of the same coin and reforms must be aligned – that’s why our forthcoming Green Paper will be published in the autumn alongside the NHS plan.”


This report by Age UK into avoidable emergency admissions for people aged 65, brings to light that bed blocking is not the only contributor to the crises that besets the NHS. Unavoidable admissions can also be a preventable cause, if sufficient resources were made available to community social care services. Central government continues to exacerbate the problem, by continuing to take advantage of unpaid carers who form the backbone of the care system, rather than properly funding the social care service.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

New policy for payment of social care

At long last a realistic means of paying for social care is appearing to gain some traction.  A recent report from the Health Secretary Matt Hancock confirms that he has endorsed proposals for every adult in England to pay into a second ‘pension’ that will be used for funding their old age care.

Mr Hancock said he wants people take more ‘personal responsibility’ for their health and care by regularly saving from their salary.

He said people could be automatically enrolled – in a system similar to workplace pensions – but those who did not wish to contribute would be able to opt out, but Mr Hancock doubts many would choose to do so.

Those who opt-out would have to fund their own social care. He said: “I’m attracted to the model of auto-enrolment, which has been so successful in pensions.

“If you make it the norm, tell people what it is they have to do to look after themselves, it’s often the case that very few people will opt out.”

The idea is the first from a major policy paper on overhauling social care that is due to be finally published within weeks. The so-called ‘green paper’ will include a range of options for consultation and may not make a specific recommendation.

The intervention comes as new figures reveal the number of pensioners who will be looked after is to rise from 657,000 in 2015 to 1.2 million by 2040 and the bill by 159 per cent, from £7.2 billion to £18.7 billion.

Mr Hancock claimed he wants to end the situation where people can lose almost all their money paying for social care.

‘It takes away the injustice of people losing all that they have saved for.’

Those who opt out would still face care bills in the future meaning they would face the same choices over selling their home, as today.

Previous proposals for an overhaul of care funding as part of Theresa May’s ill-fated 2017 general election manifesto – which proposed taking money retrospectively from people’s assets to fund home care – was nicknamed a ‘dementia tax’.

Since auto-enrolment was introduced for workplace pensions in 2012, the number of workers with a pension has almost doubled to 93 per cent.

Under the current Care England system, those in residential care can end up losing all their savings except for the final £23,500, at which point the state steps in.

This includes any property you may own.

While the average cost of care is £25,000 per year, one in ten people can end up paying more than £100,000.

Full details of the proposed social care funding scheme have not been drawn up, but ministers claim it could mean the end to crippling care costs.

This new social initiative is not without its problems however. Should this scheme be implemented it would have an impact on people in their 50s, who would have to contribute more than people in their 20s. Nor does the proposal address the care needs of those who are past retirement.

Former pensions minister Baroness Altmann said “This could be part of a long-term solution for younger generations. Older people who are now retired will need social care soonest, so there is no silver bullet.


Payment for social care has posed a challenge to all political parties over many years because it is recognized as a high octane political issue. Mr Hancocks plan should be considered on merit as there does not appear to be any other proposals on the table. The proposal to pay into a second pension may well be of benefit to younger people, but for those who are retired it says little about how their care needs are to be met.

The Government is expected to publish a Green Paper, a preliminary report, on social care shortly. This should show whether Mr Hancock’s plan is being further developed.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

People over the age of 85 needing 24-hour care is set to double

The number of people aged 85 and over needing 24-hour care is set to double, says a new study, as an expert warns the care system is “at breaking point”.

The study, published in the Lancet Public Health journal, analysed the projected health needs of the elderly in England between 2015 and 2035.

It found that the number of 65-year-olds and over needing round-the-clock care is also set to rise by a third.

The government says adult social care reforms will be set out in the autumn.

The modelling study, carried out by Newcastle University and the London School of Economics and Political Science, highlighted the fact that the fastest growing demographic in the UK is elderly people over 85, whose numbers are projected to more than double by 2035, increasing by 1.5 million.

Many of these elderly will develop multiple long-term health conditions, such as dementia and diabetes, leading to increasingly complex care needs.

The number of over-85s requiring help throughout the day with tasks such as dressing, bathing and going to the toilet is estimated to almost double to 446,000 by 2035.

By the same time, the experts predict that a million over-65s will need similar 24-hour care.

Prof Carol Jagger, from the Newcastle University Institute for Ageing and senior author of the study, said the number of unpaid carers is in decline. She warned that relying on unpaid family carers was not sustainable and said: “The challenge is considerable.

“Our study suggests that older spouse carers are increasingly likely to be living with disabilities themselves. “On top of that, extending the retirement age of the UK population is likely to further reduce the informal carer pool, who have traditionally provided for older family members.”


Nick Forbes, senior vice-chair of the Local Government Association, warned that more investment was needed to avoid a crisis. “Adult social care services face a £3.5bn funding gap by 2025, just to maintain existing standards of care,” he said.

“The system is at breaking point, ramping up pressures on unpaid carers. “There is an urgent need to plug the immediate funding gap and find a long-term solution to how we pay for adult social care.”

The study also noted that there were increasing numbers of adults aged over 65 living independently, with a rise of 60% forecast by 2035.

However, as they got older men were more likely to remain independent, whereas women will spend almost half of their remaining life with low dependency needs and more years needing intensive 24-hour care.

The researchers categorised elderly people’s care needs as high dependency if they need round-the-clock care, medium dependency if they need help at regular times daily, or low-dependency if they require support less than daily and are generally looked after in the community.

Focus on disabling conditions

Prof Jagger said this highlighted the importance of focusing on disabling long-term conditions, such as arthritis, that were more common in women than men.

“The rise in obesity is hitting women harder than men, and men have probably benefitted more from the reductions in cardiovascular disease.

“Women also suffer from a decline in muscle mass, and so I am stressing the importance of physical activity and maintaining strength and balance.”

She added: “This expanding group will have more complex care needs that are unlikely to be met adequately without improved co-ordination between different specialties.”

The report also predicts that the number of people aged over 65 with dementia and at least two other diseases will double by 2025 and treble by 2035.


This study published in the Lancet Public Health journal highlights the challenge faced by governments regardless of their political persuasion in meeting the future care needs of people in England. The study found that the fastest growing demographic in the UK is elderly people over 85, whose numbers are projected to more than double by 2035, increasing by 1.5 million. Many of these people will develop multiple long-term health conditions such as dementia and diabetes, leading to increasingly complex care needs.

Despite government platitudes claiming additional funding has been made to the social care sector, those who work in the industry know that this level of investment is no more than a sticking plaster measure. What is needed is real investment now and, in the future, along with a strategy that addresses the complex care needs of people who are living longer. To rely on the valuable contribution made by carers is unsustainable.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

England left behind in funding of Social care services

A new report commissioned by Age UK highlights the different approaches to long-term care across a group of countries in the developed world, and how they compare to the system in England.

The Incisive Health report ‘An international comparison of long-term care funding and outcomes: insights for the social care green paper’ set out to explore key characteristics and outcomes of the social care systems operating in some other advanced nations, with a view to seeing what lessons could be learned and potentially applied here in England. The other countries were Italy, Spain, France, Germany and Japan.

Challenges to the social care system

The findings suggest that creating a sustainable social care system fit for a rapidly ageing population is a challenge in every one of these countries, which none has completely overcome. However, most of the countries featured in the report have grasped the nettle and implemented significant reforms during the last 25 years. For example, Germany began to modify its system in 1995 and Japan in 2000. Over the same period, despite two Government consultations, two official Commissions, five Green or White Papers and one Act of Parliament, England’s system of means tested care funding is broadly unchanged.

Means Testing

It is notable that England has a stricter means test than the other countries examined in the report. England has a fixed means test limit for all long-term care services, meaning anyone with savings or assets above £23,250 has to pay all the costs of their long-term care (with tapered means tested support available to those with savings and assets between £23,250 and £14,250). Even those with savings and assets below the £14,250 threshold will still be expected to pay a contribution towards the costs of their care through a deduction from their State Pension. Other countries have more progressive systems, either providing a non-means tested basic level of support (Germany), capping the level of co-payment for all (at 10% in Japan), or using a more generous and gradual means test (France). Furthermore, in recent years England’s harsh means test has become increasingly less generous:

  • Capital thresholds (£14,250 to £23,250) have not changed in nearly a decade: if the value of the means test had merely risen in line with inflation the upper level would be £25,559 today. This is effectively a 9 per cent stealth cut over the last ten years.
  • Charges for care have increased as local authorities have come under growing financial pressure. In 2010/11 the average charge was £2016.49 a year. By 2013/14 (the last comparable year) this had risen by over £500 to £2563.90 (2015/16 prices).
  • Since 2010 the Personal Expenses Allowance in a care home (i.e. the amount someone can keep out of their income for themselves) has risen by a miserly £2.60 to £24.30 a week.

Out-of-pocket payments to fund their own care

England and Germany both rely on citizens making high levels of out-of-pocket payments to fund their own care. In the UK, this amounts to 33% of the overall spend on long-term care. In Germany, mandatory social care insurance covers the costs of basic care with out-of-pocket expenditure only expected to pay for anything additional.

England also has a system with noticeably less risk pooling than other countries for the non-health aspects of the whole person care that people often require. In addition, in England long-term care needs which are paid for by the NHS are covered totally with risk completely pooled through the Continuing Health Care scheme, whereas needs that fall under the social care system have very limited coverage, with all the risk borne by the individual. This stands in contrast to the other countries included in the report where health and long-term care systems are more similar to each other, and this in turn means that people with dementia, for example, get a much better and fairer deal than they do here, where public outrage erupted last year over the so-called ‘Dementia Tax’ – something that would not have been possible in these other nations.

Quality based on standards

The report found that in in financially distressed social care markets, quality is better ensured by a system based solely on service standards, rather than price competition. For example, in Japan, the price of services is set nationally with recipients able to choose provider. This is said to keep quality high, with providers unable to undercut each other as happens here. A damaging ‘race to the bottom’ is therefore avoided.


The report commissioned by Age UK highlights the failure of successive governments to find a solution for to payment of social care. There is a drain in the confidence of people who work in the social care industry that the green paper, which has been put back and delayed now on a number of occasions, will provide a credible and acceptable solution.

While the other counties in this report continue to face challenges in the payment of social care, they have still accepted and implemented reform over the past 25 years. In England, successive governments have failed to agree reform, and have been left behind in the race. Resulting in an entire generation of elderly people who have “lost out” after various proposed care reforms have been left to “gather dust”.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy