Delivering innovations in the care of older people: an opportunity to brag, steal, learn and deliver?

Older people, especially those who are frail or live with dementia or complex chronic conditions, are becoming the ‘core business’ of health and social care. This trend will only increase: by 2030, one in five people in England will be over 65, and those over 80 are the fastest growing demographic. Living longer is a cause for celebration, but it can present challenges for the health and social care system.

Our recent paper, Making our health and care systems fit for an ageing population, set out a framework and tools to help local service leaders improve the care they provide for older people across nine key components.

Building on this research, we are hosting a one-day event next week on Innovations in the delivery of care for older people. In the lead-up to the event we invited people to send us examples of innovative projects that are improving care for older people. We were delighted to receive 70 diverse submissions – all interesting in their own way, from a variety of sectors and from all four UK nations.

Just to pick out a few: North Staffordshire Clinical Commissioning Group offers a range of enhanced clinical services to local care home residents; Aneurin Bevan University Health Board has been working hard to improve advance care planning and end-of-life care in their local nursing homes; and East of England Ambulance Service in Cambridgeshire has been delivering rapid response services for frail older people at home who are at risk of imminent crisis, avoiding inappropriate hospital admissions. There are many more examples, from acute hospitals and primary and community care to the third sector and private sector organisations collaborating in service innovations.

We have ample evidence of what good care for older people looks like and numerous service models delivering it, yet we aren’t very good at disseminating good practice, and worse still at adopting and implementing improvements at scale and pace. Given our ageing demographic, financial pressures, and the concerns about quality and safety thrown up by reports such as the Francis Inquiry, we need ‘the rest as good as the best’ pronto.

There are recent examples of social movements and initiatives, including the Dementia Action Alliance and the National Hip Fracture Database, that have involved staff from a wide range of services working together to drive quality and service transformation and to share learning from initiatives. This prevents the need to ‘reinvent the wheel’ in every organisation. Now the time is right for similar concerted action around care for older people.

There are several national-level initiatives that aim to improve care for older people, including the Health Service Journal Commission on Hospital Care for Frail Older People, NHS England’s work on safe compassionate care and various campaigns and resources from the British Geriatrics Society. The governments in Scotland, Northern Ireland and Wales all have programmes of activity focused on joined-up and preventive care for older people.

Events on improving older people’s care can be inspiring. But when the party’s over and the delegates have gone home and returned to the reality of hard-pressed local services and their day job a sense of deflation can kick in. This time let’s create some real momentum – by sharing best practice, learning from others and helping to make change happen on the ground. Together, we can make a real difference to the lives of older people and their families, so that NHS staff like me can feel proud of the services they work in.

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#42216 Dr L Anderson

We have a way of involving more families in social care. it's a continuous wellbeing monitor.

#42218 George Coxon
Various H&SC roles

I'm amongst the presenters at the kings fund conference this week sharing the model we have developed in Devon promoting positive efforts to have care homes seen as part of the solution rather than the problem. It's a shame that the Better Care Fund is as much about keeping the frail elderly older person with dementia out of good appropriate residential care as it is to keep them out of hospital.

Our dementia kite mark has generated much momentum for a credible (provider led) 'share to learn' approach that headlines likemindedness and reputation management through energy and commitment to continuous quality improvement using monthly peer reviews - the question 'what does good care for older people in care homes look like?' Can be near enough answered in a 3 letter word...... FUN. Let's see more of this for all those receiving 24/7 care especially I'm very happy to enter into more debate on this and hope to do so still further on Wednesday in London

#42220 Angela M Cavill...
Carer of Older person

Oh dear if Cambridgeshire is being mentioned as a beacon of hope for older peoples services, god help us all. Http:// our local NHS can not even make sure those covered by continuing health care get supplied with appropriate care workers leaving family members to take up the impossible strain. Until some one tackles the role of NHS complex case managers who hold the purse strings for CHC patients, they will be continued to be left to vagaries of the care agencies leaving no one with a welfare or integrated care component to their care.

#42221 Geoffrey Cox
MD Care Provider Group
Southern Healthcare

I am about positive innovation although it is true that 'the reality of hard-pressed local services and the challenges of the day job' can bring a sense of deflation.

I am not sure that it so much about the job, as the tangled web of external populist demands for better, in a cash reducing environment (a paradox), with some confusion between self interest and what is in the common interest (another paradox).

My suggestion is that we might move forward more quickly if we were (i) more open and transparent in our approaches (politicians) (ii) a little more respectful to those who need our health and social care services (commissioners) and (iii) put the common interest before self / organisational interest (more widely).

By (i) I mean that if the Care Act is to help us build a world class Health and Social Care system, then as Dilnot said, we need to fund it, not knowingly throw more responsibility onto Local Authorities whilst the cash is already inadequate, as for (ii) rather than demean 'service users' for needing support e.g. 'ending up in a Care Home' (dreadfully insulting) should we not commit to improve the quality of people lives with appropriate services rightfully needed wherever is appropriate rather than tell everyone, they will want to stay in their own home irrespective of loneliness, helplessness and deterioration because it is cheaper and as for (iii) the rather patchy picture of effective Provider / Health / Social Services collaborative working eg with North Staffordshire CCG enhanced clinical services to care home residents; Aneurin Bevan University Health Board working hard to improve advance care planning and end-of-life care in their local nursing homes; and East of England Ambulance Service rapid response for older people at home at risk of imminent crisis, avoiding inappropriate hospital admissions etc should be main stream not just rare beacons of good practice from a minority of people with a wider lens than most seem to have.

Forever optimistic though,

Geoffrey Cox MSc. Dementia studies, LLb.

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