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Continuity of care failing frail older people in hospitals

Two reports published recently by The King’s Fund highlight how frail older people are being exposed to unacceptable standards of care and moved around from pillar to post in hospital because of a lack of continuity of care.

The first report draws attention to breakdowns in continuity of care inside hospitals. Analysis of inpatient surveys cited in the report shows that measures of continuity of care – that is, the effective planning, communication and co-ordination of care have remained static or slightly worsened between 2005 and 2010:

  • nearly half of all patients thought they were not at all involved or only to some extent involved in the decisions that affected their care
  • one in five said they could not find a member of staff to talk to about their worries and fears
  • two-fifths said that their discharge was delayed. (1)

Older people make up the majority of hospital patients, accounting for 70 per cent of occupied beds. They often have multiple health needs, which make continuity of care especially important. The report shows how pressure to maintain high bed occupancy, reduce lengths of stay and meet access targets in hospitals leads to patients being assigned the first free bed, often in the wrong ward, before being transferred again. Transfers of the same patient can happen more than once and often occur late at night.

Researchers found that the most distressing failures of continuity of care for patients and carers is the breakdown of communication and relationships with frontline staff. Failing to communicate can leave patients and carers feeling isolated and frustrated. Terms such as ‘bed blocker’ are often used to describe older patients, highlighting a more entrenched problem where specialising in the care of older people is perceived as unattractive. This is often accompanied by a sense of ‘therapeutic nihilism’ whereby staff, unable to see beyond the age of the patient, leave treatable conditions undiagnosed.

The report finds that the barriers to improving continuity of care in hospitals are deep rooted and systemic. The physical environment and daily routines are unsuitable for many older patients who need supportive care and rehabilitation, and who may spend a period of weeks as an inpatient. It calls for a revolution in the way that older people experience care in hospital. For example, there needs to be a named key worker available 24/7, complete medical records should be held electronically and all staff should be trained in the care of older patients.

Alongside this report, the Fund has also published the conclusions of a two-day summit (2) attended by senior figures from the NHS and social care, academics and organisations representing patients and older people. This specifically addresses how to improve care for frail older people with complex needs, making five key recommendations:

  1. Ward leaders should be identified to take responsibility for standards of care and must be given the authority to ensure that patient care is always put first.
  2. Hospital boards must ensure that frail older people are recognised as their organisation’s core service users and hold managers to account for meeting their needs.
  3. The government should set the framework for delivering care, then reduce the number of central directives and make hospital leaders responsible for ensuring standards of care are met.
  4. Professional bodies should mount a concerted campaign to change professional attitudes through education and training and to raise the status of caring for older people among the health care workforce.
  5. Policy-makers, commentators and society must challenge negative stereotyping of older people and change social attitudes towards ageing.

Jocelyn Cornwell, Director of The Point of Care Programme at The King’s Fund and lead author of both reports, said:

A health care system should be designed with its principal users centre stage, but this isn’t currently the case for frail older people with multiple conditions, particularly in relation to hospital. The health and social care system has failed to keep pace with changing health needs. It needs a radical rethink from top to bottom, a new definition of excellence in care and a realisation that quality depends entirely on relationships between patients and people who look after them. It is time to turn the rhetoric of personalised care into the reality of everyday care and practice.’

Notes to editors

For further information, or to request an interview, please contact:

Cara Phillips, Senior Press and Public Affairs Officer, at The King’s Fund on 020 7307 2632 or email

Main Press Office number: 020 7307 2585

For out of hours assistance: 07584 146 035

Continuity of care for older hospital patients: a call for action by Jocelyn Cornwell, Ros Levenson, Lara Sonola and Emmi Poteliakhoff. The report is available free to download or can be purchased for £5.

The care of frail older people with complex needs: time for a revolution by Jocelyn Cornwell (lead author) was the output of a two-day summit (see appendices for attendees). The report is available free to download.

(1) Statistics from the national inpatient surveys 2005-10

(2) The care of frail older people with complex needs: time for a revolution? Was the output from The Sir Roger Bannister Health Summit, a two-day summit at Leeds Castle in November 2011.


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