What are the key inequalities?

Factors identified by the Institute of Public Policy Research as shaping wellbeing in older people include:

• Poverty - financial security
• Physical / mental health - ill health / lack of mobility
• Marital status - divorce or separation
• Living alone - 80 per cent of those classifying themselves as 'often lonely' live alone. Women over 75 are almost twice as likely to be living alone as men.
• Social isolation - Community participation - family life, an active social life and support from partners, friends, family and religion is important in promoting well being and a sense of value. Transport and access to important social networks
• Gender - women are more prone to some mental health problems than men particularly depression
• Ethnicity

What are the key gaps in knowledge/services?

• Given future resource constraints, there is a need to focus on the potential for reducing need for intensive support by investing in low-intensity, preventative interventions. (Personal Social Services Research Unit)
• More needs to be done to ensure that those most at risk of depression are made the focus of community initiatives and policy priorities.
• As the number and frailty of black and minority ethnic residents increases over the next ten years there will be a need to commission more services that are culturally and religiously appropriate.

As the number of people with dementia increases, in line with a growing older population, there will be a need for staff to be able to communicate with people and deliver care appropriately.

What are the risks of not delivering our targets?

• Older people in poor health - particular risk of dementia, stroke, musculo-skeletal disorders, cardiovascular disease and cancer
• Unnecessary hospital admissions: older people's health neglected until they become ill and require treatment
• Older people unable to participate in neighbourhood, family life and social life
• Carers not adequately supported to enable them to continue their caring role

Is what we are doing working?

Many initiatives in place, but Health and social care services face a particular challenge in meeting the expectations of a growing and changing older population.

What is coming on the horizon?

In 2008/09 and 2009/10 older people's services is likely to face significant base budget pressures in Social Services. It is unlikely that older people's net expenditure budget will increase significantly above inflation and there will therefore be greater demand to realise efficiency savings so that resource levels can finance most of the growing demand for services.

Care needs in people aged 65 and over are estimated to rise by 87 per cent by 2051 from 2002 levels and by 2041 the number of disabled people is expected to double compared with 2002 (Moullin 2008). In 2008 the Government launched a national debate, leading to a Green Paper in 2009, about the future care system. These debates and strategies show recognition that the current care system is in need of a major redrawing in terms of funding, types of care support offered and where and how care should be delivered.

What should we be doing next?

1. Provide a package of support to enable older people to retain independence in their own home e.g. direct payments and individual budgets, supported housing schemes, domiciliary services, invest in new technologies such as tele-health, tele-care and tele-medicine, equipment and adaptations, better access to GPs and work with the voluntary sector to encourage the development of preventative services e.g. handyperson, trade register, information bank.

2. Ensure that rehabilitation and intermediate care services are in place which avoid unnecessary admission to hospital and facilitate timely discharge back to a person's own home. PCT community staff are enabled to maintain contact with people during hospital admissions including systems to track people during their hospital admission to ensure continuity of care.

3. Provide information, advice and support to older people and their carers so that they can make more informed choices about options available to them, thereby empowering people to have more control. E.g. review of first contact/referral systems in social services, consider self assessment process, patient information centre at Newcastle General Hospital and written information, Information NOW website and NHS Life Check

4. Support welfare rights to maximise the income of older people to enable to them make choices and participate fully in society. E.g. benefit checks for people using day and domiciliary services and for carers and Pension Credit 'take up' service.

5. Safeguarding and dignity Maintain and continually improve standards in the social and health care workforce through investing in staff training and development. Develop a portfolio of joint training and inter-agency development opportunities in partnership with the independent sector. Carry out Safeguarding Adults and Mental Capacity Act.