HEALTH AND SOCIAL CARE SERVICES FOR OLDER PEOPLE

1. HEALTH AND SOCIAL CARE SERVICES FOR OLDER PEOPLE Roger Beech Institute of Primary Care and Health Sciences Keele University

2. ACKNOWLEDGEMENTS Keele University: • Sue Ashby, Faye Foster, Rosie Piggott, Alison Pooler. London School of Economics: • Cate Henderson, Martin Knapp, Gerald Wistow. University of Hertfordshire: • Angie Dickinson. Lincoln University: • Karen Windle. University of Plymouth: • Rod Sheaff.

3. PLAN OF THE SESSION Health and Social Care Services for Older People: • Challenges for service commissioners and providers. • Challenges for researchers.

4. CONTEXT • Ageing population. • Focus on providing care “closer to home”. • Growth of service options to: • Prevent acute events; • Provide alternatives to hospital admission; • Reduce hospital lengths of stay.

5. ORGANISATIONS INVOLVED These include: • Primary care practices. • Community Trusts. • Third sector organisations. • Secondary Care Trusts. • Patient groups.

6. A JOINED-UP PATIENT JOURNEY? • Findings from study that: • Focused on patients (18 in total) eligible for care “closer to home” services in three health and social care settings in England. • Used interviews with patients (46), carers (14) and health and social care staff (52) to map “patient journeys” from pre-crisis to recovery.

7. PREVENTING ACUTE EVENTS • There are quite a lot of people referred because of falling, but unfortunately a lot of them don’t get referred at the time of the fall – they get referred for physio as an afterthought by the GP. You wish sometimes that they’d referred them at the time for a more immediate response (Provider).

8. PREVENTING ACUTE EVENTS (2) • If you want a home visit, you have to let them know between 8 and 8.30 in the morning, which defeats a lot of our patients. Because they think they’re not so good and by lunch time they think ‘I’m definitely not so good here’. Well, if they then ring up for a home visit, they can’t have one ... So then they’ve got to wait ‘til the next day – often then it’s too late. (Provider)

9. PREVENTING ACUTE ADMISSIONS • If I press that [alarm], then it answers in the hall there. That’s how I got the paramedics you see, because – not being unkind – you can be on the phone for hours trying to ring a doctor and you don’t get anywhere. So I ring now for the paramedics. (Patient)

10. PREVENTING ACUTE ADMISSIONS (2) • I had to go to hospital, really... they took details in the ambulance and passed me over (laughter), as a parcel … I went to the hospital and they x-rayed the hips and my elbow, because I made a mess of the elbow. I had to stay overnight because I couldn’t walk. And then they brought me home, because the care team were willing to look after me and see that everything went OK. (Patient)

11. REDUCING ACUTE LENGTHS OF STAY • I just couldn’t believe it. It all sort of clicked into place. I thought this is actually going to happen… I came home and I just couldn’t believe it, the phone rang and [they] said ‘We’ll be here in half an hour’ – and they were. (Patient)

12. REDUCING ACUTE LENGTHS OF STAY (2) • It’s difficult to say what prevented her from coming to us earlier. One of the issues for us is the communication between the acute hospital and here. We have information on the computer system, but there isn’t any actual verbal communication. ... I think there are probably bed pressures from their side and that determines when people get moved on. There isn’t any real joint working to say that we’re picking people up at the right time. (Provider)

13. MAIN FINDINGS • Under-use of services for preventing acute events/ providing alternatives to acute care. • Lack of patient and staff awareness about available care options. • Communication difficulties between staff (in particular across organisations) and between staff and patients/ carers.

14. INTEGRATION, INTEGRATION, INTEGRATION

15. EMERGING EVIDENCE ABOUT IMPACTS OF INCREASED INTEGRATION • Organisational integration alone does not impact on care at the patient/ practitioner interface. • Can improve patient, carer and staff experience. • May improve health outcomes. • Impacts on costs of patient care and their use of services currently unclear

16. EVALUATING INTEGRATED CARE INITIATIVES: A WAY FORWARD? • Pulmonary rehabilitation services for patients with COPD. • Effective and cost-effective. • Available. BUT • Under-used (16 out 168 eligible patients in one Stoke practice).

17. INTEGRATING PULMONARY REHABILITATION SERVICES Pulmonary Rehabilitation Monitor Eligible Patients Re-Design Re-Design Current Practice Patients Staff Academics

18. IMPLICATIONS • Increased service uptake and improved patient and staff experience are key measures of success. • The economic impacts of increased service integration can be projected.

19. CONCLUSIONS • For service providers and commissioners. • Efforts to improve service integration are needed. • Service re-design needs to be driven by the care needs of key patient groups. • For researchers. • Integrated care is enabler. • A focus away from “what works” to ensuring timely patient access to “what works”.