Person-centred care in a sustainable system

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.

Hospital discharge – everyone loses when its handled poorly

Dr Tom Nutt is Chief Executive of Healthwatch Essex and Dr Oonagh Corrigan led the hospital discharge research as Commissioning and Research Manager. Dr Alex Georgiadis is currently Acting Research and Commissioning Manager at Healthwatch Essex and co-authored the study. Healthwatch Essex tweets at @HWEssex

A major two-year research study undertaken by Healthwatch Essex into the experiences of patients discharged from three hospitals in the county has provided a comprehensive picture of this thorny issue. The report encourages local health and social care commissioners to overcome artificial boundaries and develop a unifying vision of care to provide high quality care.

The report, published at the end of last year, marks the organisation’s most ambitious project to date, involving almost 200 hours of observation and over 200 interviews with patients, staff, and family carers.

Working as an Extensivist GP

Dr Margaret Lupton is a GP in North West England with over 20 years’ experience in General Practice. She joined the Blackpool, Fylde and Wyre Extensive Care Team in January 2016. She is one of the key speakers at the BGS Autumn Meeting during the Community Geriatrics Afternoon on Wednesday 23 November. She tweets as @magsielodge

I have been a GP for 20 years and over this time I have witnessed the patient population becoming gradually older with increasingly complex problems. Also, GPs have become more and more involved in their patients’ chronic disease management. The standard 10 minute GP appointment just isn’t long enough anymore to deal with these older patients who have complex needs. For a long time I have been interested in exploring new ways of working and new models of care and so when I got the chance to join the Blackpool, Fylde & Wyre Extensive Care Service, I jumped at the chance.

‘Help yourself’; Supporting older people towards independence

Rudi GJ Westendorp, is Professor of Medicine at Old Age at the Department of Public Health and Centre for Healthy Ageing, University of Copenhagen. In this blog he discusses his recent Age and Ageing paper New horizons: Reablement – supporting older people towards independence.

The majority of older people wish to remain independent and live in their own homes for as long as possible. Instead maintaining a cruising altitude however, the process of ageing forces many to descend towards dependency and long-term care.

It’s never too late to learn new ways for coping by yourself and to make preparations for independent living in older age. But it is a shame that too often these good intentions are superseded by doubts and avoidance.

Book Review: Being Mortal by Atul Gawande

Shane O’Hanlon is a Consultant Geriatrician (Surgical Liaison and Cancer Care), Royal Berkshire Foundation Trust and Macmillan Cancer Support. 

As a geriatrician who works with surgeons every day, I was intrigued to see what Atul Gawande’s latest book had to say – apparently it was all about what happens in later life. But was it just a misguided attempt by a surgeon to write a book on geriatric medicine?

Gawande has been a general surgeon and a professor at Harvard for over a decade. During that time he began writing for the New Yorker, and is now well known in patient safety circles for his successful books “Complications” and “The Checklist Manifesto”. He is seen as a sensible writer who doesn’t shy away from talking about his own mistakes. This humble approach also pervades “Being Mortal”, which considers how healthcare treats the old and dying, and asks “What really matters in the end?”

The NHS England Five Year Forward View: A crucial document for our speciality, for the care of older people and for Health and Care Services in England.

David Oliver is President of the BGS, Visiting Fellow at the King’s Fund and Consultant Geriatrician at the Royal Berkshire Hospital, Reading. In part 1 of a 2-part blog, he discusses how the NHS “Five Year Forward View” is important for people involved in the care of older people.

October 23^rd 2014 is memorable to me, as it’s my 23^rd wedding anniversary. It’s also now of significance to the rest of us, as the date that NHS England’s “Five Year Forward View” plan was published. I realise not many of you will have had the time or necessarily inclination to read it, though at only 39 pages it’s an easy canter.

I also know it hasn’t attracted much Twitter activity from fellow BGS members. But it’s a document which I suspect will have far reaching influence and implications for the services we all work in. These implications seem largely positive. Let me explain why.

Year of Care Explained

By Eileen Burns and Amit Arora

Payment by results (PbR) never fully addressed the management of long term conditions, and the importance of timely and seamless transition to and from the community for patients who live with them.

Year of Care (YoC) was suggested as a possible solution in 2011 by Richard Murray, Chief Economist at the Department of Health in his document, “Payment reform in the NHS”. The long-term conditions YoC tariff is designed to allow health and social care to be provided based on a person’s overall needs as opposed to what specific diseases they have. It fits with the work being undertaken across the NHS to make care better integrated. If it works as intended, it will allow funding to be moved around as needed to provide the most effective ‘package’ of care for the person over a 12-month period. The underpinning philosophy is that money should be present in the parts of the healthcare system best-suited to provide patient care. The financial model is based upon an annual risk-adjusted ‘capitation’ budget, based on levels of health care need.

Who will care for the carers?

Sharon Xiaorong Wang is a  nurse researcher at the Center of Research on Aging, Jinan, Shandong, China and is the lead investigator for the Chronic Disease Self-Management Program at the Department of Gerontology, Jinan Central Hospital.

The association between chronic disease and carers of patients with dementia has been well described in the literature. Caring for patients with memory impairment can put a strain on the health [both physical and mental] of the care-giver. Up till now, the demographics and scale of chronic disease afflicting care providers have not been well explored. We have conducted a study to examine the prevalence of chronic disease in carers of patients with dementia.

Our results indicate that more than four-fifths of care-givers reported having at least one chronic disease, and nearly two-thirds reported multiple.

EASYCare Project: A new world for older people

 

Judith Long is a Project Officer in Research and Development at Hull and East Yorkshire Hospitals NHS Trust. Here she introduces a new collaborative project to promote independence  in older age.

EASYCare is a collaborative project involving a large network of researchers, service providers, practitioners, volunteers and age advocacy partners throughout the world. Our mission is to extend healthy active life and maximise independence in old age using the EASYCare targeted approach to early identification of needs, and by providing a response according to the priorities of the older person.

Third sector organisations – the forgotten dimension of integrated care?

By Robin Miller, Senior Fellow at the University of Birmingham and Co-Editor of the Journal of Integrated Care

The need for better integrated working between health and social care and acute and community services has been recognised for many years in policy and practice. However, despite this emphasis, many older people and their families continue to experience services that do not communicate effectively, are far from seamless, and require considerable persistence to successfully navigate. The increasing challenge of responding to our changing demography with limited resources means that it is more important than ever that we avoid wasteful duplication or gaps that result in older people being unnecessarily admitted to residential care or hospital.