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BGS Commissioning Workshop London, 25 th November 2008 Better can be cheaper: from postcode lottery to cost-effective, system-wide care?. Colin Currie Consultant Geriatrician, NHS Lothian Special Adviser on Health and Social Care, Policy Unit, Prime Minister’s Office. Outline .
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Consultant Geriatrician, NHS Lothian
Special Adviser on Health and Social Care,
Policy Unit, Prime Minister’s Office
Multi-Agency Inspection of Services for Older People (MAISOP): Tayside 2006
Probability of multiple admissions (>2 p.a.) of >85’s per 1000 population?
*>75s – 7.7% of population – account for c. 29% of HCHS costs
Multi-Agency Inspection of services for Older People (Scotland):
‘.. a striking inverse correlation… between the observed volume and quality of collaborative health and social care provision in localities and the use of acute sector care – in the form of multiple admissions and delayed discharge – by older people from those localities’.
Care Quality Commission (England):
‘Initial impressions from high- and low-performing PCTs appear to confirm the inverse correlation identified by the MAISOP inspection process in Scotland.’
Adult social care as % of total LA budget varies from:
Proportion spent on care home care for older people varies
Proportion of gross expenditure derived from client contributions varies from 29% to 5% (average 14%)
A culture of separatism between health and social care: a legacy of ‘the fault-line of 1948’ with:
organisational, political, financial, cultural and professional divisions:
Separatism entrenches demographic denial
Result: no ownership of the main challenge for both sectors: the care of older, frailer people
Isle of Wight
Establish for older people – nation-wide – services that:
‘We will bring together the National Health Service and local care provision into a new National Care Service….’
The Prime Minister: 29th Sept 2009
A debate dominated by provider interests:
Strong local community teams combining front-line health and social care staff?