Health and Social Care of Older People: Could Policy Generalise Good Practice?

Current provision of health and social care for older people reflects a dysfunctional historic legacy of separatism, one with increasingly unacceptable consequences for the quality and cost-effectiveness of the care provided. However, there is now detailed and encouraging comparative evidence to support the view that more integrated care - delivered jointly, promptly and flexibly to meet the changing clinical and dependency needs of frailer older people at home - can minimise unnecessary use of more costly and less preferable care elsewhere, and thus reduce the overall costs of late-life care while improving its quality. This paper considers the background to the widely prevailing culture of separatism, presents quantitative evidence of the current postcode lottery in care, describes examples of current good practice, considers some options on functional and structural integration, and speculates on policy that might deliver better and more cost- effective care for an ageing population at a time of impending stringency in the funding of public services.