It seems fitting on Older People’s Day that, as a partnership across health and social care, we should pause and reflect on the services we provide. We have a growing, ageing population across the country that are living longer with more complex care needs. Coupled with the £22 billion efficiency gap the NHS needs to close by 2020, the current delivery of health and social care in England is unsustainable. Now more than ever we need to look to others to be inspired and encouraged to radically reform our models of care, to make them person-centred, efficient and effective and in so doing maximise the value of services delivered for the benefit of the populations they serve.
On Wednesday 23 September, UCLPartners co-hosted (alongside the NHS European Office, HSRUK, Universities UK and LSE Health) the second in the current series of Lessons from Europe seminars, which are exploring how good practice from Europe can be applied to shape health policy, research and leadership. The focus was on active and healthy ageing, drawing on examples from Ireland and Catalunya, two of the 32 European Reference Sites.
The session opened with insights from the I’m still me: a narrative for older people programme. A reminder that we should start with the people we want to support, find out what matters most to them, and shape care and support to fit in the context of their lives and preferences. It sounds obvious but how often do we really do it? Older people told us their independence matters the most, being able to “do what I want when I want to do it”, regardless of the level of physical support required to enable them do so. This was a very different from the definition implied in our services, where ‘activities of daily living’ and physical immobility mark people as dependent rather than recognising what they can do and building from there.
The Ireland site have been creating a new tool to enable service providers to better shape services around people preferences; called the community assessment of risk and treatment strategies (CARTS) and the risk instrument for screening in the community (RISC). This is a screen for frailty to triage those at medium to high risk of adverse healthcare outcomes and perform comprehensive assessments with person-centered treatment strategies. Their greatest contribution has been to acknowledge the importance of the caregiver network; which is the biggest risk indicator. Creating a mechanism to highlight gaps in the caregiver network, coupled with appropriate responses, can reduce the risk of adverse healthcare outcomes such as hospitalization or premature transfer to residential or nursing homes.
A further insight from the Ireland work, comes from their approach to end-of-life decision making. Through their research, they’ve highlighted that for a particular scenario, the decisions we would make for different people varied greatly. The example they give is of an 82-year-old man with dementia is suffering from life-threatening Gastrointestinal (GI) bleeding. They found that:
- If this man was your patient and you were making the decision on treatment approach, up to 20 percent would choose palliative treatment
- If the man was your father this increased to 35 percent
- If it was you that was suffering, up to 60 percent would choose palliative care.
It reminds us of the need to understand, discuss and document individual’s preferences so we can start by stopping providing those things that people don’t want, and release capacity to focus on things they do.
Catalunya gave a wide ranging description on how technology is helping. The landscape is changing and with it bringing opportunities to further improve how we connect across settings of care to unify access to information and more importantly the consistency of the care we deliver. Progress is being made across four digital domains, information integration (sharing information across service settings), medical devices, wearable devices and health and social interfaces for patients. Combined, these four domains have accelerated the ability to better integrate health and social care support around the individual.
While these insights are progressive, the discussion digressed from the initial discussion topic of active and healthy ageing. These interventions are important, but so too is the broader frame of intervention to promote healthy ageing, and to respect and reflect the positive contribution older people make to society. Rather than see older people as a burden, consuming health and social care resource and presenting dilemmas for future service design and delivery, let’s move to a positive dialogue. Let’s start reflecting on the contribution they make to communities and society, to build support networks that start with what matters most to them and recognises what they can do rather than what they cannot. On the horizon we have some exciting organisations that are building exactly this opportunity – through Care City, a new health innovation and research hub in east London, and through the Centre for Ageing Better. We are excited about the solutions that lie ahead and are look forward to participating as we celebrate Older People’s Day and learn from others about activities and examples that inspire a new approach.