Joining up services: better care for older people

Our increasing life expectancy, thanks to improved public health and medical advances, is leading to an ageing population that presents new challenges for our health and social care system. Work led by Professor David Oliver at The King’s Fund aims to develop a new comprehensive and practical resource for local leaders wanting to transform their services for older people from public health through to end-of-life care.

A model fit for the future

‘The fact that we are likely to live longer than our parents’ and grandparents’ generation is a cause for celebration. It is a success story for society driven by advances in medicine and public health. We also recognise that an ageing population is putting increasing demands on health and social care services that are already struggling to cope with the needs of this group,’ says Professor David Oliver, Visiting Fellow at The King’s Fund. ‘For example, people with life-limiting long-term conditions – the majority aged over 65 – account for the highest proportion of GP consultations, practice nurse visits, and hospital outpatient activity, and acute inpatient bed days; and people over 65 account for 60 per cent of social care spend and three-quarters of home care packages. With increasing pressure on budgets, we must get care for older people right; the current model just won’t deliver what’s needed.’

A practising hospital doctor for 25 years, David has specialised in geriatric medicine for 16 years. Alongside his clinical experience, David has held a variety of national leadership roles: until recently he was the National Clinical Director for Older People at the Department of Health; he is president-elect of the British Geriatrics Society; and chair of the Royal College of Physicians Speciality Committee for Geriatric Medicine. At The King’s Fund, David is bringing both his clinical and policy expertise to a range of projects that focus on integrated services for older people.

Priorities for change

Working with colleagues, Catherine Foot and Richard Humphries, David is co-authoring a paper that explores priorities for change based on an older patient’s care pathway. These include helping older people to age well and stay well, accessible support in times of crisis, person-centred acute care, good rehabilitation and reablement, and effective end-of-life care.

The paper, due to be published next year, aims to facilitate change: ‘It’s targeted at people who are leading services locally and who want to redesign services for older people in their area,’ explains David. ‘It’s a practical tool to develop ideas and inform discussions locally; people can use it to walk through the care pathway, look at how well they are doing at each stage, and identify where there are opportunities to improve.’

Learning from what works

For each of the priority areas in the paper, there will be good practice examples to help others learn from what works. For example, the Age UK programme ‘Fit as a Fiddle’ supports healthy active ageing with a diverse range of initiatives including activity participation, telephone peer support and networks for older men facing social isolation. Looking at a later stage in the pathway, providing effective and accessible support in a crisis close to home, there is the example of a falls prevention programme run by Nottinghamshire Ambulance Trust. Working with local partners, the trust developed a pathway for referral when responding to a call from a person over the age of 65 who had fallen. Patients who did not need to go to hospital were referred to the community falls assessment and treatment team rather than being sent to A&E. The community falls team experienced a 55 per cent reduction in falls in the following year, a 60 per cent reduction in ambulance call-outs for falls, and measurable improvements in physical function among patients.

‘There are lots of fantastic examples out there and the paper will highlight many more,’ says David. ‘The paper will also pull in learning gathered from one of the Fund’s integrated care learning networks, where we are supporting senior NHS, local authority, and voluntary sector leaders from ten communities to implement integrated care across their local populations.‘

Joining care up

Although each component of the pathway outlined in the paper is important, ‘integration is the glue that binds the principles together,’ explains David. ‘It’s the interdependency of the different stages of the pathway, and the knock-on effect each can have, which is crucial. For example, if we focus more on healthy active ageing, people are less likely to end up with debilitating long-term conditions. For people who do have one or more long-term condition, if we manage them proactively, they are less likely to need acute care. If patients do go to hospital, and are given effective post-acute rehabilitation, they will be less likely to need to rely on long-term care. Focusing on these interdependencies is how we can transform services for older people.’

Find out more

 Catch up with the highlights from our recent event, Making health and care services fit for an ageing population.

View our resources on integrated care, including an animation on what joined-up care really means for patients, and an interactive map with more than 20 examples of integrated care.