Health and social care services must adapt to meet the urgent care needs of older people

Association of Directors of Adult Social Services
Date: Tuesday 19th June 2012
Embargo: 00.01 hrs, Wednesday 20th June 2012

ADASS has welcomed a report* published today which urges social care and health services to adapt themselves to the needs of older people in urgent need of care.

More older people than ever before are attending emergency departments and accessing urgent care services; there is a pressing need to address how they are cared for over the first 24 hours of an urgent care episode, while attending an Emergency Department can too often be associated with a high risk of admission to hospital for older people. 

The report warns that not only are older people admitted to hospital more frequently,  but they stay in hospital longer than other patient groups.  

The Silver Book recommends ways in which emergency admissions can be reduced and the experience of those admitted improved. It considers all the clinical contacts which a patient might have during an emergency and suggests minimum standards and responses for each service including: primary care in and out of hours; ambulance services; emergency departments; urgent care units including minor injury units and walk-in-centres; acute medical units and community hospitals.

A core focus of the Silver Book is the skills and competencies needed by healthcare staff to ensure they are better able to assess and manage frail older people.   This includes appropriate communication skills both with patients and other health and social care professionals. It suggests that in acute medical units, greater use of geriatric liaison services should increase the proportion of older people able to be managed in community settings.  It also encourages greater use of the voluntary sector.

Jay Banerjee, lead author of the Silver Book said: We need to change how we care for older people in an emergency.  At the moment services are too fragmented and poor communication between different clinical settings and professionals is affecting the quality of care older people receive. The Silver Book explains what services and skills are needed to ensure high quality care for older people in an emergency, leading to better outcomes for patients and a more efficient health and social care service.

According to ADASS President Sarah Pickup, the report is a timely injection of sound advice and excellent good practice ideas into an arena where older people are frequently at their most exposed and vulnerable. She praised the wide range of professionals whose contributions have so enriched the scope and quality of the report. In  particular she thanked ADASS associate member Julia Ross, Chief Operating Officer of Care and Healthtrak, for the amount of hard work and sound advice she had given the project.


*The Silver Book  is a set of quality standards for the emergency care of older people. The launch today coincides with the first ever Acute Medicine Awareness Day.

For further information and interviews with the authors of the Silver Book please contact
Iona-Jane Harris, 07807 231432
Tom Thorpe , 07766 227724 or email

Notes to Editors

The Silver Book has been developed by a multidisciplinary group of stakeholders including:
Age UK
Association of Directors of Adult Social Services
British Geriatrics Society
Chartered Society of Physiotherapy
College of Emergency Medicine
College of Occupational Therapists
Community Hospitals Association
National Ambulance Services Medical Directors
Royal College of General Practitioners
Royal College of Nursing
Royal College of Physicians
Royal College of Psychiatrists
Society for Acute Medicine

Specialist Advisors:
Matthew Cooke, National Clinical Director for Urgent & Emergency Care
David Oliver, National Clinical Director for Older People
Alistair Burns, National Clinical Director for Dementia

The lead authors are Jay Banerjee, College of Emergency Medicine, University Hospitals of Leicester NHS Trust and Dr Simon Conroy, British Geriatrics Society, University of Leicester.

All the stakeholders involved will be promoting the quality standards and building on The recommendations of the Silver Book to improve urgent care for older people. The Silver Book is available to download from the British Geriatrics Societys website: and is also available via other stakeholders websites.

The Association of Directors of Adult Social Services (ADASS) represents directors of adult social services in local authorities in England. DASSs have statutory responsibilities for the social care of older people and adults with disabilities, while over 50 per cent also run social housing departments. ADASS members might also share a number of responsibilities for the provision and/or commissioning of housing, leisure, library, culture and arts services within their councils.