United Kingdom

Demographic information

• Total population: 61,113,205
• No. of citizens 65+: 9,779,100
• No. of citizens 75+: 4,721,400
• No. of people with long-term care needs: 3,094,000

Characteristics of health, social and long-term care delivery

Currently, older people’s services are commissioned by local authority adult social services and by Primary Care Trusts (PCTs). The latter are local NHS bodies tasked with commissioning acute care (from a range of local/regional acute hospital trusts), mental health care (from large mental health trusts), community health services (from an increasingly mixed economy of providers) and primary care (from local general practitioners). In the past, PCTs both commissioned and provided services. More recently, their role has focused primarily on commissioning (and many have either divested themselves of their provider services or developed a clear organisational separation between their commissioning and providing functions). Over significant time, both local authorities and PCTs have been increasingly working together to commission joint services from a range of public, private and voluntary providers. In the future PCTs are to be abolished and local authorities and  GP consortia will commission older people’s services.

Background information on key-issues

Prevention and rehabilitation in LTC

(...) In English health and social care, there is growing recognition of the need to more fully embed prevention and rehabilitation in services for older people.  Historically, many current services were established following the Second World War with a particular focus on providing a basic safety net for those in severe need.  In the words of William Beveridge, one of the key architects of the post-war welfare state, the aim of services was to tackle “five giants” (or serious social problems).  His language would not be used today, but the concepts and responses which Beveridge outlined remain as relevant now as they were then.  From the beginning, therefore, the health care system in particular was focused on meeting the needs of people with an immediate crisis in their health. While the English NHS has often been criticised for being a ‘sickness service’ rather than a more positive and proactive ‘health service’, its origins in the 1940s desire to tackle the ‘giant’ of ‘disease’ make this more understandable (more ...)

Quality assurance and quality management in LTC

(...) In the UK each of the devolved governments of Scotland, Northern Ireland and Wales have control over their health and social care systems which operate independently and under different policies. This report focuses on how quality policy and delivery is organised in England only. It is important to recognise that policy and systems in England are currently changing as a result of both organisational restructuring implemented under the previous Labour Government and alterations to the functioning of those new organisations made by the current Coalition Government. The Healthcare Commission, Commission for Social Care Inspection and the Mental Health Act Commission were merged in April 2009 into the Care Quality Commission (CQC). The merging of these three inspectorates better reflects the overlaps between these sectors and is intended to help reduce problems of incompatibility in the quality criteria that apply to integrated services. The establishment of the CQC brings regulation of health and social care together under one regulatory body. Regulation is moving away from national minimum standards towards outcomes based assessments. This transition began in April 2009; we present what is currently happening and what is known at this time about the future of quality assurance and management (more ...)

Governance and financing of LTC

(...) Summarising a complex history, the governance and financing of services for older people in England are influenced by three main factors:

• Since the creation of the British welfare state in the late 1940s, there has been a strong commitment to the principle of a publicly funded National Health Service (NHS), available on the basis of need and free at the point of delivery. This remains a central feature of British society, and all major governments have continued to support this concept (often competing to portray themselves as a champion of the values which the NHS embodies). For historical reasons, adult social care is subject to a means-test, and older people often have to contribute financially towards the cost of their care.
• Adult social care emerged out of the poor law and the workhouse of the nineteenth century, so remains more of a targeted and (to some extent) stigmatised service than the NHS. For historical reasons, adult social care is subject to a means-test, and older people often have to contribute financially towards the cost of their care. It is to rectify some of these historical influences that a current Adult Social Care Green Paper is debating the future principles and funding of adult social care and care home provision (HM Government, 2009).
• From the early 1980s, English health and social care have increasingly adopted market-based approaches to reform, with a growing emphasis on choice and competition as a means of improving standards and value for money. Thus, while there remains a strong commitment to publicly funded, comprehensive and universal services in many areas of the welfare state, such support is often provided in practice by a much more mixed economy of public, private and voluntary sector providers (more ...)