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Governance and autonomy in alternatives to hospital care.

Older people with complex illness and disability should have the same equitable opportunities and safeguards for treatment and care as do younger people. These should be based on needs, likely health gain and personal preference. Comprehensive assessment and goal setting, with monitoring of progress and outcomes, should be an integral feature of alternatives to hospital care, wherever they are provided. To satisfy the principles of clinical governance the development of innovative intermediate rehabilitative and long-term care programmes may require more time and expertise than small purchasing groups can reasonably provide. Pooled health and care budgets managed in partnership by larger providers may offer a solution. There is an urgent need for pilot projects to inform development.