State of Health and Care of Older People in England 2024

The ageing population

In 2024, there are now 22 million people aged over 50 in England, equivalent to two in five of the total population and this is rapidly increasing: the population of people aged 50+ in England is projected to increase by 19.3% between 2024 and 2044 (an increase of 4.3 million people). The population aged 85+ is growing the fastest.

Unmet need

Age UK estimates that 2 million people aged 65+ have unmet needs for care and support.

• 10% (1.1 million) of older people have difficulty dressing
• 5% (500,000) of older people have difficulty walking across a room
• 6% (640,000) of older people have difficulty bathing
• 1% (140,000) of older people have difficulty eating
• 6% (600,000) of older people have difficulty getting in and out of bed
• 4% (440,000) of older people have difficulty going to the toilet

The number of people over 75 has grown by almost 21% since 2013. Despite this, fewer older people are receiving local authority long term care (542,420 2022/23 compared to 565,240 in 2017/18).

This unmet need is also reflected in the number of GPs, where the number of full-time equivalent GPs (including trainees) increased by just 2.5% between March 2023 and March 2024 which is not keeping pace with the population growth of older people aged 75+.

Accident and Emergency is feeling the pressure

This unmet need in the community is resulting in far too many older people experiencing a vicious cycle where they end up in hospital for something that is often avoidable, and then get stuck waiting for care packages while their health declines and their needs increase.

Accident and Emergency attendances offer insight into the effectiveness of primary and community care and the likelihood of attending A&E rises significantly with age. There are 49,917 attendances for every 100,000 people aged 75-79, rising through the age bands to 93,931 attendances per 100,000 amongst those aged over 90.

As the biggest users of NHS and social care services older people are experiencing the brunt of the pressure and problems in the system. There are other distinct inequalities at play too, particularly geographical, with those in the most deprived areas experiencing poorer health earlier in their life, which leads to greater demand on A&E in those areas.

The social care system is under significant pressure

The health and social care systems are intrinsically linked to one another and yet are often not working together in a way that supports older people. The long-standing issues of the social care sector need addressing if any changes are to be successful in the health care system.

One key area of concern is the number of vacancies and staff retention in the adult social care system. There are simply not enough people working in adult social care. While the vacancy rate reduced from 10.6% in 2021/22 to 9.9% in 2023/24, there were still an average of 152,000 vacant posts a day. As reported in 2022/23 one third of social care staff left the sector completely.

Recommendations

While these challenges feel immense, there are solutions. There must be a shift of resources, treatment and focus from hospitals and acute care to the community. Identifying older people in declining health earlier and providing effective interventions and proactive support will reduce the pressure on A&Es and other services.

This shift has to go hand in hand with a fundamental reform of the social care system – without this vital integration between health and social care, the vicious cycles will continue.

The NHS

• Ensure every Integrated Care System – the body responsible for health and care services in each area puts in place an Ageing Well Strategy, including how they will invest in public health over the life course and into older age.
• Invest in GP practices, primary care and community services to offer coordinated support for people living with long-term conditions and/or frailty. Investment is needed in the workforce, premises and technology.
• Introduce an ambitious preventative public health strategy which encourages and enables physical activity among older people and those with long-term health conditions, building on Sport England’s ‘We are Undefeatable’ programme.
• Significantly expand the number of ‘integrated neighbourhood teams’, bringing together health and social care professionals with a range of other support workers to help older people with complex needs to maximise their health and independence.
• Implement a strategy to clear waiting lists, including a return to the 18-week standard and support for people while they are waiting.
• Implement the NHS Workforce Plan, and make sure that all healthcare professionals have the skills they need to support an ageing population.

Social care

• Stabilise the social care sector and act quickly to consult on putting funding on a sustainable footing.
• Within 18 months, publish a comprehensive plan to reform social care and commit to implementing it during this Parliament.
• Fund an immediate pay rise for care professionals, and within two years publish a comprehensive social care workforce plan, joined up with the NHS Workforce Plan.
• Introduce a right to at least five days of paid Carer’s Leave, plus a longer period of unpaid leave.
• Significantly increase access to respite services and practical support for carers that recognises the specific needs of older carers.