SUMMARY

  The NHS can contribute both directly and indirectly to reducing health inequalities by increasing staff awareness and knowledge of the issues. There are practical steps the NHS can take in tackling health inequalities, often by working more closely with other organisations. A key aspect of health inequalities for older people remains age discrimination in service provison. Age equality must become a cornerstone of the planning and provision of services, and there must be equity of access to information and support.

1.  INTRODUCTION

  1.1  Age Concern welcomes the opportunity to submit evidence to the House of Commons Health Committee Inquiry into the contribution of the NHS to reducing health inequalities.

  1.2  Age Concern England (the National Council on Ageing) brings together Age Concern organisations working at a local level and 100 national bodies, including charities, professional bodies and representational groups with an interest in older people and ageing issues. Through our national information line, which receives 170,000 telephone and postal enquiries a year, and the information services offered by local Age Concern organisations, we are in day to day contact with older people and their concerns.

2.  ADDRESSING SOCIAL DETERMINANTS OF HEALTH

  2.1  NHS practice can contribute directly to preventing disadvantage. For example, worklessness is a major risk factor for social disadvantage. Older workers who are absent from work for health reasons for even a relatively short time risk never working again. Active treatment with rehabilitation in mind can reduce the risk of social—and, in the longer term, health—disadvantage.

  2.2  As poverty is associated with poorer health, the NHS can play a very important role in promoting full take-up of benefit entitlements, particularly among older and disabled people and their carers. The most recent Department for Work and Pensions estimates indicate that up to £4.6 billion of means-tested benefits go unclaimed by older people each year and many more miss out on vital help towards disability costs such as Attendance Allowance and Disability Living Allowance. Those who miss out on these benefits are often older and frailer members of society. They are however more likely to be in contact with NHS services, particularly in primary care, which provides an ideal opportunity to provide information and advice about benefits.

  There are existing examples of good co-operative working in this area:

—  The Health Advice Benefit Initiative Team (HABIT) is a service provided by Age Concern Liverpool in collaboration with primary health care teams and other agencies. A letter from their GP and Age Concern Liverpool is sent to patients, encouraging them to contact HABIT. They can then be seen in their own home, at their health centre or doctor's surgery, at Age Concern Liverpool's city centre offices or at one of the local outreach sessions.[80]

—  The Newham GP Advice Project, managed by Newham Council Social Regeneration Unit, bases welfare advisers in GP practices. An evaluation of the service in 2006 concluded that it freed up GP's time to concentrate on medical matters and improved people's health and well-being through addressing poverty and social welfare issues.[81]

  2.3  Wider adoption of good practice in this area would result in older people receiving an increased income which is likely to have a positive impact on their quality of life, health and wellbeing.

  2.4  Age Concern recommends that NHS staff are made aware of the social determinants of health and how their practice can contribute to reducing health disadvantage. They do not need to be experts in the benefits system but they should have an awareness of potential entitlements and links to advice agencies to which they can refer patients. The Department of Health and Primary Care Trusts should encourage the provision of benefits advice sessions in GP practices and other primary care settings, working with other agencies.

  2.5  Age Concern recommends that the Department of Health and the Department for Work and Pensions should work together to identify best practice and disseminate findings widely.

3.  GP SERVICES

  3.1  Some groups of older people with particularly significant health needs currently receive insufficient support from GP services:

3.1.1  Older carers often experience poorer health than their peers.[82] Due to the pressure of caring responsibilities, they may neglect their own health needs, and it may be difficult for them to come to a surgery for an appointement as they may be unable to leave the person they are caring for. Organising a visit to the surgery for the person they are caring for can be equally difficult and stressful. Carers should be able to have a home visit if required. GP practices should take into consideration the social circumstances of carings in deciding whether to undertake a home visit.

3.1.2  While people living in care home are entitled to register with a GP practice and therefore receive core general medical services, there has been a failure to address nationally the need for a system to provide clinical leadership and support for care homes from the NHS. A variety of systems is in place with some homes paying a "retainer" fee to GPs for additional services, the cost of which is sometimes passed on to residents in care home fees. People living in care homes by definition have greater health needs than other members of the community and the coordination and planning of their health care needs to be led by the NHS.

3.1.3  Depression in later life is very common with about a quarter of people over 65 showing signs of this condition.[83] However, depression is not an inevitable aspect of ageing and can be treated. The UK Inquiry into Mental Health and Wellbeing in Later Life highlighted that this condition is under-diagnosed and under-treated. It is estimated that only about 15% of all older people with depression are diagnosed and receive treatment.[84]

  3.2  Age Concern recommends that Department of Health supports and incentivises GP services to:

—  Improve access to carers;

—  provide a clinical lead for care homes; and

—  diagnose and treat depression in older people when warranted.

4.  PUBLIC HEALTH SERVICES

  4.1  The majority of chronic illnesses affecting the lives of older people can be either prevented or postponed, mainly through the adoption of healthy lifestyles. Yet public health initiatives are often designed to exclude older people, in spite of strong evidence that they people could benefit.

  4.2  Older people stand to benefit greatly from healthy eating, keeping physically active, and sensible drinking, not just to extend life expectancy but to increase wellbeing and independence.

  4.3  The promotion of physical activity is often linked with sports, for example with the 2012 London Olympics, rather than incorporating activity into people's daily lives. Such association does not necessarily motivate older people.

  4.4  The fact that an estimated 10% of people over the age of 65 living in the community suffer from malnutrition[85] is often overshadowed by the efforts to combat the obesity epidemic.

  4.5  The current national alcohol strategy does not mention drinking in later life.[86]

  4.6  Programmes to promoted good mental health rarely include older people and are separate from programmes to improve good physical health, in spite of the interplay between the two.

  4.7  The demand to demonstrate cost-effectiveness mitigates against investing in initiatives to improve health of older people as they by definition will have fewer years of benefit.

  4.8  Age Concern recommends that all mental and physical health promotion strategies should be desinged to include older people while acknowledging that different initiatives are likely to be effective for different age groups.

5.  AGE EQUALITY

  5.1  There are still areas in which the organisation of health services directly discriminates against people on the grounds of age, resulting in health inequalities.

  5.2  Mental health services continue to be planned and provided separately for "adults of working age" and for "older people".[87] The consequence is that some services are not accessible to older people and that people can be required to leave a service on reaching the age of 65. As an example, in spite of evidence from NICE that there is benefit at any age, the programme to improve access to psychological therapies has been focused on "adults of working age".

  5.3  Breast and bowel cancer screening programmes are still not extended upwards to the maximum ages at which people can achieve health gains.

  5.4  In other respects NHS service priorities discriminate indirectly against older people by not providing services that are important to maintain health and independence. Chiropody services are essential in helping to maintain mobility as almost a third of older people are unable to cut their own toe nails. Yet NHS foot care services have been scaled back, forcing many older people to pay privately or go without a service.

  5.5  Age Concern recommends that the NHS takes effective action to promote age equality in service provision.

6.  HEALTH LITERACY

  6.1  The trend for increased choice and a greater emphasis on self-management of long-term conditions puts at a disadvantage people who are less "health literate", unless they are offered additional support. The emphasis on electronic information disadvantages people—including many older people—who have not got access to the internet or the skills to use it. There is a risk that those in greatest need will have least access to support.

  6.2  Age Concern recommends that additional methods of health communication are made available to those who cannot use mainstream sources of information.

January 2008

81   Newham GP Advice Project: http://sru.newham.gov.uk/PDFs/GP%20Project%20ImpAss.pdf Back

82   Social Policy Research Unit, Univ. of York, Hearts and Minds. The health effects of caring, 2004. Back

83   Age Concern, Improving services and support older people with mental health problems: Second report from the UK Inquiry into Mental Health and Wellbeing in Later Life, 2007: www.mhilli.org Back

84   Ibid. Back

85   European Nutrition for Health Alliance, Malnutrition among older people in the community. 2006. Back

86   HM Government, Safe.Sensible.Social.The next steps in the National Alcohol Strategy, 2007. Back

87   Department of Health, National Service Framework for Mental Health: modern standards and service models, 1999. Back