By IGHI guest blogger, Chris Bird, PG student in the Centre for Health Policy and Project Manager in the System Engagement Programme at the National Institute for Health and Care Excellence (NICE)
In today’s fast moving world, we need to constantly adapt to keep up. But what about those people in later life who might struggle to do so?
We live in a world where society is ageing. Falling mortality rates, particularly in the over 65-year age group coupled with low fertility rates in the younger population are leading to a society which is growing older[i].It is also true that conventional care delivery is often based around admittance to institutionalised hospital care which is both costly and can be inefficient as professionals, bound by silo working, fail to achieve either best value or best care for patients[ii].
The National Institute for Health and Care Excellence (NICE) has developed a quality standard which addresses the need for the National Health Service (NHS) and other sectors to work together to identify mental health and independence issues in older people. This an important step for those who would benefit from a helping hand but can’t find it themselves.
Working with Age UK’s Integrated Care Team to evaluate their personalised integrated care programme, I have seen first-hand how the essence of this standard can be put into practice locally and improve older people’s wellbeing for the better. Age UK delivers an integrated holistic service for older people. It’s aimed at those with complex and long-term health problems.
Working with GPs to identify those who are eligible for the programme, (typically those who have had 2 or more unplanned hospital admissions and have 2 or more long-term conditions), Age UK is able to set individual’s up with their own “independence coordinator”.
After a series of home visits to get to know the person better, the coordinator helps create some personal goals. These can range from visiting a coffee mornings, to arts and crafts lessons, to a day out at the seaside – it depends on the person and what is important to them.
Over the course of this three-month personal intervention programme, independence coordinators monitor changes in their clients’ wellbeing through use of the Warwick and Edinburgh Mental Wellbeing Scale (WEMBWS).
There’s no ‘one size fits all’ approach to improving mental wellbeing, but services like this are a positive step in the right direction. And in the course of my evaluation I have observed the positive improvement made in the mental wellbeing of those who use the service as demonstrated by improvements in the WEMBWS scores.
During the course of my evaluation I spoke to dozens of frontline professionals both in the NHS and Age UK working collaboratively to deliver the Integrated Care Programme to clients. Of all their comments and feedback, it was the observations of GPs that I found particularly striking, in that they emphasised the complimentary nature of this form of holistic programme alongside healthcare:
“They’re a great asset to us locally, they offer a really complimentary dimension that we can’t offer in primary care. Giving more time and more holistic assessments and being able to get into people’s homes and get on a level with them and that is of huge value to us”.
Another GP commented to me that the independence coordinators’ specialist knowledge of the range of local voluntary care sector (VCS) services when applied to the patient’s needs offered something unique:
“She has vast knowledge of what other VCS services can provide. She facilitates getting what that patient needs elsewhere and that was an absolute gap”.
Reflecting back, I’m led to wonder how many patients slip through the net in the absence of a service like this and subsequently end up in institutional care. This when their needs might have been better met, and scarce hospital resources saved, by having a joined up local approach to identifying those people most at risk of an unplanned admission and stepping in proactively to prevent it.
Age UK has shown that working together with the NHS can have positive benefits to people’s experience and mental wellbeing, something that NICE encourages in its quality standard.
This programme can demonstrate that the collaborative approach really works, and I hope it will inspire others delivering health and care services locally to follow suit.
Chris Bird is a postgraduate student in the Centre for Health Policy and Project Manager in the System Engagement Programme at NICE.
He was supervised in researching and writing a dissertation for the MSc in Health Policy on this topic by Phil Hope, Visiting Professor at the Centre for Health Policy and former Minister of State for Care Services at the UK’s Department of Health.
[i] Government Office for Science. Future of an ageing population. 2016. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/535187/gs-16-10-future-of-an-ageing-population.pdf
[ii] Hope P, Bamford SM, Beales S, Brett K, Kneale D, Macdonnell M, McKeon A. Creating sustainable health and care systems in ageing societies. 2012. The Global Health Policy Summit. Available at: http://www.cpahq.org/cpahq/cpadocs/Creating%20Sustainable%20Health%20and%20Care%20Systems%20in%20Ageing%20Societies.pdf