Dr Eileen Burns has been a geriatrician in Leeds since 1992 and is President of the BGS. She is currently Clinical Lead for integration in Leeds. She tweets @EileenBurns13 This blog originally appeared as part of Independent Age’s Doing Care Differently series. You can join the debate here.
We warmly welcome Independent Age’s new project, Doing care differently. Our members are passionate advocates for person-centred care. The role of geriatricians and specialist health care professionals starts with identifying the care and treatment that best suits an older person’s individual needs and wishes, and those of their families and carers. Delays in access to social care, and also in intermediate care, for example, occupational and physio therapy, create unnecessary barriers to person centred care, leading to poorer health outcomes, an increased likelihood of presenting at A&E, and people having to stay on acute hospital wards for longer than necessary. For older people with frailty the negative impact when this occurs is significant, and their health deteriorates with every additional day spent on an acute hospital ward.
The need for a clear vision of what sustainable social care for older people would look like is high on the political agenda yet still a long way from being realised and translated into tangible service delivery.
How can we do care differently?
Our top three priorities for all older people who need social care are:
1. all older people can access person-centred care services when they need them, so that:
- Timely access to person-centred care services becomes the norm – older people don’t have to wait, exposed to increased risks of falls and other health crises, dependent on the goodwill of friends, neighbours and family members, or have no-one to call on for help with getting in and out of bed, washing, dressing, eating and going to the toilet.
2. funding is structured on a basis which equitably shares risks and costs, so that:
- Older people and their families understand, and can plan for and not fear, the costs. They understand what they are entitled to free of charge and what they will need to pay for, and the funding framework does not unnecessarily penalise older people if they have a long term condition, for example, people living with dementia and needing long term social care.
3. social care is fully integrated with other health and care provision
- older people and their families don’t have to try and negotiated a hugely complex web of health and care services as they do at the moment.
- the transition from hospital to home or care home is smooth and minimises the likelihood of re-admittance to hospital.
How can we get there?
This isn’t some sort of utopian vision – it is about meeting basic needs and it is within the gift of our society. In our BGS election manifesto we called on the incoming government to better recognise the commitment and expertise of the current workforce across health and social care. This includes recognising that effective multi-disciplinary working requires adequate levels of staffing. It also means that all who care for older people have the right skills, training and specialist knowledge to meet the needs of the rapidly increasing numbers of older people with frailty, dementia and long-term conditions.
We know that Sustainability and Transformation Plans have shortcomings but we support the vision and intention behind them, in particular the concept of needs-based and place-based planning being used to inform service design. We would like to see much greater investment from central government to enable this to be genuinely transformative, and call for better recognition of the time and cost involved in overcoming cultural as well as financial barriers in the journey towards integration.
Earlier this year we welcomed and supported the call for cross-party talks made by the chairs of the Health Committee, the Public Accounts Committee and the Communities and Local Government Committee. We believe that fresh and creative thinking is urgently needed, and we would like to bring the expertise and experience of our members to that. We look forward to working with Independent Age as it works to ensure that as a society we really are doing care for our older people differently, and can be confident it is sustainable in the long term.