Meet Milly, she is 86 years young and has lived on her own since her husband died three years ago in north London. She has no family nearby.
Milly is highly independent and was remarkably well until last year when she had a fall. Fortunately nothing was broken but it knocked her confidence and she didn't feel as strong or mobile afterwards. Shopping is becoming tiring and she finds she is awfully stiff when she wakes up in the morning and so it takes her time to get going.
Worried about being caught short at night or falling if she has to get up in a hurry - her blood pressure tablets make her want to pee a lot - she cut down on how much she was drinking. However, unfortunately this led to a urinary tract infection.
The infection got worse and made her delirious, which is quite common among older people. So when a neighbour popped round to collect a parcel they were so concerned - as she seemed incoherent and close to collapse - that they called an ambulance. Milly was admitted to hospital. While her infection was being treated it became clear that Milly had become quite run down because she wasn't eating or drinking properly, and needed some support with everyday things around the house. As well as her high blood pressure the doctors also found that Milly was suffering from mild memory loss, which might be the start of some form of dementia.
After a week Milly is medically fit enough to go home, but she needs a package of care to support her in settling in and thereafter and there is none available in her local authority. So Milly ends up staying a further week in hospital, becoming depressed and physically weaker from being largely immobile. Meanwhile, a number of people due into the hospital for elective surgery that week find their operations are postponed because there is no bed for them.
This situation is playing out every day, right across the country. There are growing numbers of people like Milly, because we are an ageing population; in fact, over the last ten years the numbers of over-85s have increased by almost a third and looking ahead the pace of increase is projected to accelerate. The fact we are living longer is terrific but, of course, it brings challenges as well as great gains. Nowhere is this more obvious than in health and care.
Older people, the over-85s especially, are understandably its primary users and more of them are living with one or more long term conditions such as diabetes, hypertension or indeed dementia, for which they need on-going medical help. If they are unwell and becoming increasingly frail they may also need social care: practical help with the essentials of daily life, like getting up, going to the toilet and making meals. Sometimes families and friends can step in but quite often they aren't around to do so: a million older people in England have at least one unmet social care need and are struggling alone.
Against this context you would expect public spending on both the NHS and social care to be rising, in line with our ageing population. However, as a report Age UK published this week shows, spending on the NHS is failing to keep pace and investment in social care is tumbling. Between 2010/11 and 2013/14 Government spending on social care reduced by a fifth, with 15% fewer older people getting support.
The social care funding left is being directed to help those in the greatest need. This is rational but it is storing up big problems for the future. For example, State spending on meals on wheels has halved in the last three years and approaching two thirds fewer older people now receive them. Yet they used to be a mainstay of community care and helped many older people like Milly to be reasonably well nourished, supporting them to stay fit and well.
Unless the social care funding position improves the future looks bleak for older people like Milly and hundreds of thousands like her. It also threatens to bring our hospitals to a grinding halt, because every day many older people are in hospital beds when really they are medically fit to go home, owing simply to a shortage of social care.
This is why we hope the Chancellor will recognise the need for urgent action to support social care in his Spending Review. Older people would benefit hugely and so too would the NHS.
You can read Age UK's new report here.