Older people are bearing the brunt of a rundown Health and Care system

Older people are bearing the brunt of a rundown Health and Care system that must change more quickly to meet the needs of an ageing population.

Age UK’s  10^th anniversary report reveals stark and growing inequalities in older people’s health and access to services. 

Age UK today launches the tenth anniversary of its State of Health and Care of Older People report, revealing a troubling picture of declining health among an ageing population, unequal access to services, and growing pressures on unpaid carers and frontline staff. 

The report shows that while the number of older people in the UK continues to rise, healthy life expectancy at age 65 has dropped to 11.2 years for females and 10.1 years for males [[i]]. However, these declines are not shared equally: the more deprived an area, the shorter the period of life spent in good health, on average. Older people with more advantages often age well, while others face worsening health, limited support and fewer opportunities to live independently.  

As the largest group of users of the NHS and social care older people are bearing the brunt of a struggling Health and Care system. In the face of a rapidly ageing population, the growth in the number of full-time equivalent GPs has not been keeping pace and there are fewer older people receiving social care support compared to a decade ago. Most services are over-stretched and unpaid carers and staff alike are under intense pressure. Many older people who need help from the NHS or social care cannot access it quickly – and sometimes not at all.

The report shows that the percentage of people aged 65+ with common mental health problems who are receiving no treatment is higher than for every other age group. One in seven (14%) people aged 65-74 have a common mental health condition, including generalised anxiety disorder, depressive episodes and panic disorders [[ii]]. Two-thirds (67%) of people in this age group with clinically significant symptoms did not receive any treatment, with this proportion rising to 78% for the 75+ group [[iii]]. 

Some of our most vulnerable older people are unable to access NHS dental treatment, with the ‘oldest old’ (aged 85+) seen least by dental services.[[iv]] In 2025, 16% of respondents to the GP Patient Survey aged 65+ said they had been unable to get a dentist appointment in the last two years [[v]]. 

Satisfaction levels are falling. In 2025, 28% of people aged 65+ felt the length of time they waited for a GP appointment was too long ^[[vi]]. Respondents to the British Social Attitudes Survey conducted between September and October 2024 felt the most important priority for the NHS should be making it easier to get a GP appointment (51%) [[vii]], reflecting what we hear directly from older people at Age UK too.  

Key findings in the report include: 

• Growing inequality in access to some NHS services: Those who can afford it are increasingly turning to private healthcare for procedures with long waiting lists such as cataract and knee operations, widening the gap between rich and poor.
• Social care under strain and tightly rationed: State-funded support is now largely the preserve of the poorest older people with the most severe social care needs, leaving others to rely on family and friends or struggle without help if they are of modest means. 

• Lasting pandemic effects: COVID-19 accelerated health decline in older people and worsened NHS waiting times, which remain at record highs. 

• A legacy of chronic long-term underinvestment: More than a decade of insufficient funding and workforce planning has left the UK short of GPs, hospital beds, and social care professionals, among many others. 

Within social care, Age UK welcomes the establishment of an independent Commission led by Baroness Louise Casey but laments the fact that the Government has set a deadline as late as 2028 for the Commission to report – beyond the current Spending Review period. It has also recently become clear that the Fair Pay Agreement for care professionals will not now crystallise into concrete action until a similar date, after it had originally been implied that this welcome initiative would improve pay for care workers much sooner. Now that the Government has changed the migration rules to curtail the numbers of care workers coming here from abroad there’s a big risk of growing staffing gaps over the next few years.    

Problems in accessing formal care services are placing greater pressures on unpaid carers: 

• 76% of Directors of Adult Social Services reported an increase in the number of unpaid carers requiring support in 2024/25, according to ADASS.  For the third year in a row, Directors ranked burnout as the number one contributing factor to increases in carer breakdown over the past 12 months [[viii]]. 

• Around 16% of people aged 65+ in England are unpaid carers, (equivalent to 1.8 million), as are one in five (20%) people aged 50+ (equivalent to 4.3 million) [[ix]]. 

• Age UK research found that 74% of older carers (aged 65+ in the UK) felt under strain; 66% had lost sleep due to worry; and 62% felt unhappy or depressed. More than half (55%) were living with a long-term illness or disability themselves [[x]]. 

The Charity has warmly welcomed the Government’s 10 Year Health Plan and was pleased to help contribute to its development. Central to the Plan is the aim of shifting the focus from hospital to community-based care by developing a new Neighbourhood Health Service.

Caroline Abrahams, Charity Director at Age UK, said: “This 10^th anniversary report, Age UK has produced, paints the picture of a Health and Care system under unprecedented pressure – in some places, at times virtually under siege. We want to recognise the enormous efforts being made by staff from top to bottom to turn this situation around and we thank everyone who is working so hard to that end.

“The uncomfortable truth though is that at present, many older people are not able to get the high-quality healthcare and social care support they need - and they do not have time on their side. Against this context it’s not surprising that satisfaction levels are sharply down and there’s a trend towards more ‘going private’ if they can afford it. Sadly, the result is that inequalities are growing and those who are least advantaged are being left further behind. The starkest evidence of this are gaps in healthy life expectancy the scale of which shame us as a nation.

“If we’re to transform the NHS and make it more effective then older people must be an explicit priority for the new Neighbourhood Health Service, because they are occupying the great majority of hospital beds when in many cases it would be better for them to stay at home with good treatment and support. This must include the right social care as well as health support, so ensuring social care is fully part of Neighbourhood Health is crucial. Local voluntary organisations such as our local Age UKs must be fully brought in too; they are invaluable local assets that do important things the NHS and social care can’t, like help people who are lonely or who have housing issues – problems that when unaddressed accelerate health and care needs.

“The decade that has passed since we first started producing these reports has been largely wasted as regards the need to adapt Health and Care for a growing older population, even though the trend in population ageing has been so obvious it should have been visible from outer space. With the 10 Year Health Plan we’re now finally trying to do the right things but much later than we should be and at a time when there’s less public money available to invest compared to ten years ago. That’s why we have to go as fast as we possibly can now in achieving transformational change in community-based health and care services, as the NHS will never run optimally until this task is complete. From this point of view we think that the Government needs to accelerate its timetable for social care reform and in our report we call on them to do so.”

To make our Health and Care system more responsive to the needs of our ageing population – essential if the NHS is to be more effective and efficient - Age UK is calling for the Government to:

1. Make older people an explicit priority cohort for Neighbourhood Health right from the start and throughout.  
2. By the end of this Parliament:  
3. Reduce the number of emergency admissions for acute and chronic conditions that could and should be managed in the community to under 100,000 a year.  
4. Guarantee that all older people diagnosed with severe frailty in the community receive a structured medication review and falls risk assessment, as a minimum. 
5. Bring down the numbers of people delayed in hospital when fit for discharge back to pre-pandemic levels (approx. 4,500 on a typical day vs 12,000+ now) [[xi]]. 
6. In order to achieve the above, develop and put in place in every area shared community assessments involving NHS and social care services and minimum service requirements for rapid access to care such as physio and occupational therapy, community mental health and other rehabilitation services where needed.  
7. As part of the upcoming NHS workforce strategy, the Government must:  
8. Assess and standardise maximum GP list size, taking into account the size of the older population.  
9. Make funded commitments to grow the community workforce, including District Nurses.  
10. Increase and standardise core skills and capabilities across the workforce relating to older people’s care and frailty.  
11. Request the Casey Commission produces its final report in 2027 at the latest, rather than 2028.  
    
    6. Develop measures to support the care workforce and mitigate the impact of the new Immigration Rules, including bringing the Fair Pay Agreement into force sooner than 2028 if at all possible.  
12. Develop a funded strategy to increase the proportion of unpaid carers who are able to take a break for 24 hours to at least 1 in 4 by the end of this Parliament.  

– ENDS – 

 
Notes to editors: 

• For interviews, case studies, or further information, please contact Liz Fairweather, Robert Ince or Nikki Lennox. 

For information, older people are defined as having an unmet need for social care if: 

• They have difficulty with one or more of six activities of daily living (dressing, walking across a room, bathing, eating, getting in and out of bed, going to the toilet). 

• And for any activities with which they have difficulty, they haven’t received help in the past month. 

Additional data:  

• Around one in three people aged 65+ and half of people aged 80+ will have at least one fall a year [[xii]]. In 2023/24, 220,000 people aged 65+ in England had an emergency hospital admission due to a fall [[xiii]]. 

• Multimorbidity increases with age. almost one in five (17%) people in their 50s have multiple long-term conditions. By 80+, this rises to two in three (68%) people [[xiv]].   
• At age 50, healthy life expectancy has fallen to 20.6 years for females and 19.4 years for males. [[xv]].  

• Over 3.3 million people aged 60+ need help with essential everyday tasks [[xvi]].
•  1.4 million new requests for support from older people to English local authorities, the highest on record [[xvii]].

  References

Age UK’s State of health and social care of older people: 

[i]. ONS (2024). Healthy life expectancy in England and Wales: between 2011 to 2013 and 2021 to 2023.

[ii] NHS England (2025). Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/24

[iii] NHS England (2025). Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/24

[iv] The Dentist (2023). Annual NHS dental statistics for England report released

[v] NHS England (2025). GP Patient Survey 2025

[vi] NHS England (2025). GP Patient Survey 2025.

[vii] The King’s Fund (2025). Public satisfaction with the NHS and social care in 2024 (BSA)

[viii]  ADASS (2025). 2025 Spring Survey.

[ix] Age UK analysis of data from wave 14 of: University of Essex, Institute for Social and Economic Research (2025). Understanding Society: Waves 1-14, 2009-2023, 19th Edition. UK Data Service. SN: 6614.

[x]  Age UK (2025). 1.6 million carers worry whether they’ll be able to keep caring or providing support to their loved ones.

[xi] ONS (2024). Healthy life expectancy in England and Wales: between 2011 to 2013 and 2021 to 2023.

[xii] Office for Health Improvement & Disparities (2022). Falls: applying All Our Health

[xiii] OHID (2025). Public health profiles. 2025: Emergency hospital admissions due to falls in people aged 65 and over.

[xiv] Valabhji J. et al. (2023). Prevalence of multiple long-term conditions (multimorbidity) in England: a whole population study of over 60 million people. 

[xv] ONS (2024). Healthy life expectancy in England and Wales: between 2011 to 2013 and 2021 to 2023.

[xvi] Age UK analysis of data from wave 10 of the English Longitudinal Study of Ageing (ELSA) (2021-23), scaled up to the English population using ONS mid-year population estimates for 2023

[xvii] NHS England (2024). Adult Social Care Activity and Finance Report, England, 2023/24