Public services often fail to consider the special needs of older people, according to a new report by three independent watchdogs published recently.

It suggests that "deep-rooted cultural attitudes to ageing" in local public services are hampering wider Government plans to improve health, social care and local council services for older people. The report has been produced jointly by the Healthcare Commission, the Audit Commission and the Commission for Social Care Inspection.

Called Living well in later life, it assesses progress five years into a 10 year Government plan to improve services for people over the age of 50.

The three inspectorates joined forces to provide a comprehensive assessment of services for older people, the biggest users of health and social care, and services that contribute towards older people's wellbeing and quality of life.

The report found that services have improved since the March 2001 publication of the Government's 10 year National Service Framework for Older People. But this progress was not evident consistently across the country and improvement in some areas has been slow.

At this halfway stage, none of the communities inspected had reached all Government-set milestones to enable them to meet the standards in the national service framework.

The report found:

• Improvements in how most public services are addressing age discrimination. All communities inspected had taken steps to ensure that policies and eligibility criteria for access to services did not discriminate against older people.
• More people, who have had a stroke, than ever before have access to good quality hospital care. But more still needs to be done to improve rehabilitation outside hospital and access to specialist units.
• More people are supported to live at home. There is a reduction in the number of older people admitted to care homes, with health and social care services supporting more frail older people to live independently.

Despite this the report found a number of areas of concern:

• Evidence of a lack of priority being given to the needs of older people when planning and commissioning services. For example, local authorities were not considering the needs of older people in planning public transport, when a high proportion of older people do not drive. And podiatry and foot care services were given a very low priority from primary care trusts, resulting in older people losing mobility and becoming socially isolated.
• Evidence of a lack of dignity and respect in the way older people are treated when in hospital. Many older people experienced poorly managed discharge after being rushed through the system, repetitive moving from one ward to another to free up surgical beds, and having meals taken away before they can eat them due to a lack of support at meal times.
• A lack of consultation by service providers with older people to find out exactly what they want. Ninety five per cent of older people surveyed had not been asked their views on NHS or council services in the last year, and 80 per cent did not think that they influenced the planning of services.
• Mental health services for older people were particularly poor. Older people reported a noticeable difference in their experiences of accessing services as they reached and passed 65. Out-of-hours services for psychiatric advice and crisis management are much less developed than for working age adults and older people with dementia experience unacceptably long waits for specialist care.
• Some examples of excellent partnership working were found between different public service providers. However, a lack of shared direction and desired outcomes between partner organisations in most communities have resulted in services that are fragmented and confusing.

Anna Walker, Chief Executive of the Healthcare Commission, said:

"Older people are the biggest users of healthcare, occupying almost two thirds of our hospital beds. Yet they continue to be a low priority in both the planning and development of our health service. The challenge now is to provide much better care for older people closer to home. Health and social care organisations and local authorities need to work better together on behalf of older people. We will be monitoring the health service's progress against national targets, and in working with partners as part of our new annual health check, to make sure improvements in the care of older people continue."

Steve Bundred, Chief Executive of the Audit Commission, said:

"This report provides a snapshot of the national state of services for older people. It confirms that councils and their partners are increasingly aware of their responsibility to support the wellbeing and independence of older people, who now comprise over a quarter of the population. But our findings show that progress has been patchy and services are not as well coordinated as they should be. Additionally, older people do not feel they are given a voice in shaping the way services are delivered. The Audit Commission will continue to focus and report on this area in our assessment of councils."

David Behan, Chief Inspector of the Commission for Social Care Inspection, said:

"The best services involve the people they are there to serve. They must be responsive to their needs and assist them to lead independent, fulfilling lives. The evidence from this study is that older people are not involved in the design of services and consequently services are not tailored to their needs and aspirations. It is vital to understand and respond to the specific needs of older people."

The three inspectorates assessed 10 communities across England. They inspected each local authority and 40 NHS trusts across Brent, Buckinghamshire, Dorset, Greenwich, Leicester, Liverpool, Medway, Portsmouth, Wiltshire, and Redcar and Cleveland.

In order to tackle the issues highlighted in this report, the three commissions have made the following recommendations:

• Managers from all organisations must make sure that older people are treated with dignity and respect and that their basic human rights are upheld at all times;
• NHS trusts and local authorities must take action to ensure that the standards set out in the national service framework for older people are met;
• Partner organisations involved in providing health and local government services need to work together to develop a joint strategy for the promotion of good health and wellbeing for older people; and
• Partner organisations need to work together to ensure that there is a systematic and coordinated approach to engagement that recognises the diversity of the population served.

Unless these overarching issues are tackled as a priority, older people's experience of public services is unlikely to improve significantly.

The three commissions, as regulatory bodies with responsibilities across healthcare, social care and local government, have committed to take action to ensure that there is continuous improvement of services for older people.

The Audit Commission will monitor progress through the older people's theme within the corporate assessment, part of the Commission's Comprehensive Performance Assessment (CPA) of local authorities.

The Commission for Social Care Inspection will monitor organisations' progress through the annual assessment of councils and inspections of social services for older people.

The Healthcare Commission, as part of the new annual health check, will continue to monitor progress against national targets, including supporting older people to live independently at home and treating patients with dignity and respect.