Editorial: A dilemma that won't go away

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As we live longer, the pressure on the health service mounts. The number of hospital stays by elderly patients, by over-75s in particular, has soared by about a third since 2000. It makes for a lopsided use of resources, not just because other people are prevented from using these beds but also because, as Sir David Nicholson, the new head of the NHS Commissioning Board, says in this newspaper, prolonged hospital stays are bad for old people, too.

Sir David points out that some 40 per cent of all patients in the average general hospital now have dementia. Yet, this growing body of often confused people find themselves all but abandoned in the alien environment of modern hospitals that "are fast moving and organised round getting a diagnosis". These are "bad places for old, frail people," he says.

A wealth of evidence backs up his belief that protracted hospital stays lead to poor outcomes, as well as being very expensive. While all patients are exposed to infection in hospital, the elderly especially risk losing their independence and eating and drinking poorly.

A 2011 report by the care sector watchdog, the Quality Care Commission, said more than half of hospitals in England were failing key standards in care for the elderly in terms of nutrition and dignity. Some did not just have problem with resources, they also had a bad attitude.

What to do? Last year, the King's Fund said that if all primary care trusts followed the practice of the best, and reduced the admission levels for chronically ill elderly patients, the NHS could free up more than 7,000 beds. That is a laudable goal, but if beds for the elderly are cut without the development of more integrated after-hospital care services, they will be even worse off. Sir David promises more community-based treatment centres for elderly patients, which sounds right.

The problem is not going to go away. By 2032, the over-75s are expected to comprise 22 per cent of the population, up from 17 per cent now, so we need to act fast.

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