Making Health and Care Fit for an Ageing Population.

Kings Fund and BGS Conference: BGS President Elect, David Oliver, describes how this conference ties in to the work of the BGS and the Department of Health’s new proposals to improve care for vulnerable older people.

On 22 October, the Kings Fund is hosting a one day event on making health and care services fit for an ageing population. This event is supported by the BGS and several of our members are speaking. I am fortunate to have a foot in both camps as BGS president-elect but also as a Kings Fund Visiting Fellow. We have timed the event to coincide with the planned autumn announcement by Rt Hon Jeremy Hunt MP – Secretary of State for Health – of the Vulnerable Older Peoples Plan. Mr Hunt is due to speak at our event and announce some further details.

Both the BGS and the Kings Fund have responded to the consultation regarding the plan and the consultation can be found here. Key elements of the plan (my paraphrasing) include:

• Helping people to age well and maintain health and independence
• Giving them more choice and control over decisions affecting their health and care
• Improving access to services – including out of hours services
•  Making care more “joined –up” and “co-ordinated”, with better information-sharing (the manifestation to older people and their carers of the current focus on “integration”)
• As part of this, the need for vulnerable older people to have named clinicians accountable for co-ordinating their care

Despite some reservations over the use of the world “vulnerable” and about what doesn’t feature highly in the consultation (e.g. what happens within hospital – with Comprehensive Geriatric Assessment and good discharge planning critical to their  long term health after discharge or healthcare in nursing and residential homes – both  key priorities  for the BGS as set out in our recent publications – The Silver Book and Quest for Quality), a spotlight on improved care for older people is welcome and overdue.  It feels like care for older people is now a higher priority than at any stage since the NHS was founded. And the BGS can play a crucial role in the social movement and public conversation.

We also have a “perfect storm” momentum in the wake of several high profile reports culminating in the Lords Report Ready for Ageing, the NHS Confed and Age UK Dignity Commission, The Kings Fund Report on the care of frail older people with complex needs (with BGS members contributing to all) and the Francis Inquiry (a focus for a recent Kings Fund event still available on the site  and the Twin Challenges set of population demographics (with older people accounting for a high proportion of spend and activity) and financial challenges to services.  We cannot get health and care systems right without addressing the needs of older people.

A number of problems have bedevilled thinking in this area. These include:

• An excessive focus on single diseases rather than the modern reality of older people with multiple morbidity often compounded by dementia, functional impairment or frailty.
• Systematic ageism and age discrimination throughout services, leaving older people and their carers disadvantaged
• Older people often use multiple services and see multiple professionals. We know that to them, care often seems disjointed and care transitions bewildering. Increasingly, politicians, service leaders and clinicians “get” this – hence the focus on integration. However, we have falsely “silo’d local plans and national strategies into “acute care” “long term conditions” and “public health” (with the latter often focussing little on prevention within the ageing life course)

The Kings Fund Conference, together with a paper due for publication in the months afterwards aims to highlight; first the fundamental interdependence of each part of the “pathway” for older people – quality and access in each having “knock on effects” on the rest and on the lives of people as they age; second  fact that many agencies,  not just the NHS, but  Social Care, Local Government and the Voluntary Sector all have a key stake in getting this right; third that to meet the challenges facing services, we need to shift the curve of care to the left to increase the focus on prevention.

Both the conference and the paper are organised to address 10 key priorities for action.

• 1. Healthy active ageing, wellbeing, independence ageing in place
• 2. Living well with single or stable Long Term Conditions
• 3. Living well with complex co-morbidities, frailty 
• 4. Rapid support in crisis as  close to home as possible
• 5. Good acute care from front to back door
• 6. Good discharge planning and early post –discharge support
• 7. Re-enablement after acute illness or injury and loss of function
• 8. Minimising long-term care use. Providing high quality healthcare inputs and compassionate personalised care in care homes
• 9. Planning for end of life care with adequate, choice, control, palliation and ability to die at home at the end
• 10. Continuity, co-ordination and integration

We have speakers from many sectors and disciplines. But among the prominent BGS members to speak will be Steve Iliffe (on innovative primary care approaches), Tom Downes and Simon Conroy (on acute care) John Young (on intermediate care),  Louise Robinson (on Dementia in primary care), Finbarr Martin (on nursing home medicine and Martin Vernon (on end of life care).

Please come along – it should be a fascinating day. And you will find much of the conference content on the Kings Fund website in due course.