Innovating the Delivery of Care for Older People – My Thoughts

Daniel Sommer is a Foundation Year 2 Doctor at Charing Cross Hospital in London. He is an aspiring Geriatrician. He tweets at @danielf90 Web

Another Monday morning at work, and I was looking forward to another week of inspiration with my fantastic boss in interface geriatrics as part of my hospital’s OPAL (Older Peoples’ Assessment & Liaison) team and in our Older Peoples Rapid Access Clinic. Before I got going, I undertook a cursory check of my e-mails and I saw something slightly out of the ordinary – an e-mail from Professor David Oliver (of British-Geriatrics-Society-President-elect fame). “What are you doing Wednesday?” he asks. “Come to my conference at The King’s Fund!” he beckons. My consultant’s response when I asked her permission was “You’d better have already said yes!”. Off I went.

The King’s Fund is an organisation that I’ve been aware of for a long time and whose influential work I have admired greatly. It turns out that their headquarters in Cavendish Square are also rather shiny. I turned up really quite nervous, feeling like a child dressed up in his dad’s suit. A lanyard with a shiny, personalized name badge awaited, as did a plethora of caffeine options that put the hospital vending machine to shame.

I had perused the programme beforehand and it looked like a pretty exciting day. An early morning seminar on Good Dementia Care, followed by sessions about how to design services that are right for older people, policy implications and how to pull the right levers to make it all work. We then split up into 3 groups, and I chose to follow a stream about good discharge planning and providing post-discharge support because I felt this was most relevant to my working life. We had a lovely hot lunch and then started the afternoon with inspiration from around the country hearing about real-life, working examples of schemes and initiatives that already work. We ended the day with some interesting words from Professor John Young (The National Clinical Director for Integration and Frail & Elderly Care – the shortest job title in NHS England, apparently) about what’s happening at a national level to improve the way we look after older people. I was inspired and, at times, overwhelmed by the scale and scope of the conference but I don’t want to spend my entire blog post talking you through the day. I’d much rather spend my remaining 500 words drawing together some key ideas that I felt resonated throughout the event.

There were some common themes that I heard repeated throughout the day that I think are important when considering how to create a healthcare service that is fit for older people.

  1. Clinical Credibility – To lead an innovation, you need people to trust you and to know that you know what you’re doing. The easiest way to do this is to do your “day job” well. David Oliver referenced himself being a “jobbing clinician” several times throughout the day and it resonated.
  2. Patient Satisfaction – The patient is at the centre of what you’re doing and their experience when accessing “the system” has to be a positive one. Tracey Taylor (CEO of Birmingham Community Healthcare NHS Trust) made this point very effectively when talking about good post-discharge care in Birmingham.
  3. Single Point of Access – No clinician (no matter how clued up) is going to know about every service out there, nor are they going to know how to refer to them all individually. Throughout the day, I could see peoples’ faces light up with envy every time a single point of access was mentioned.
  4. No duplication – Why does every team have to repeat an assessment? Surely one should stick. Everybody seemed keen on this (not least the patients).
  5. Involve the Third sector – Not every aspect of care can be met by “social services”, “Primary Care” or “Secondary Care”. I was reminded throughout the day, especially by David McCulloch from the Royal Voluntary Services (who described his “Hospital 2 Home Scheme”), that some things can’t be provided in a traditional “package of care”.
  6. Involve the Carers – Time and time again we heard stories that carers (the people who know our patients better than anyone) are left out of discussions and decision-making. We need to make sure that stops happening.
  7. Just Say Yes – Older people are disadvantaged in an ageist healthcare system that is not designed around their needs. If you’re developing a service, you should try not to exclude people. Having broad criteria was a key message from Leicestershire’s HART (Homecare Assessment and Re-ablement Team).

One of the best parts of the day was listening to the intelligent questions and comments that members of the audience had. One in particular struck me, as it was something I’d never really thought about before: Why can’t GPs diagnose dementia? A GP in the audience made a very astute point that many of the frail elderly with cognitive impairment may not want (or be able) to go to hospital, or may lack insight and feel that they do not need help. If a GP can flag this up, why can’t they continue on and diagnose dementia – especially given how prevalent the disease is? Are we being too rigid and thus not meeting the needs of our population by insisting that they attend hospital outpatient memory clinics?

Overall, the day left me feeling very hopeful. It was encouraging to see invited speakers and audience members alike asking each other for advice on how to improve the way we deliver care for our target population. As a junior doctor (and aspiring geriatrician), the event has opened my eyes to the vast scope of work that lies ahead of me. I went back to work with increased determination to know more about the extended “care system” that my patients can access. The future is bright and I’m looking forward to playing an active role.

Highlights from the conference can be found here.

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