The Institute of Ageing and Health works alongside other organisations to raise issues facing older people in our society.
This year we are supporting the Royal College of Nursing’s Local Learning Event Programme in the West Midlands to help educate nursing staff around this important agenda. Click here for the programme of events.
We are sorry to announce that this conference has been postponed.
Given the importance and current national focus on good discharge arrangement for older people we would still like to run the event in March 2018. We will update you as soon as a date has been agreed.
Half day events for 2018
In addition to the conference next year, we are planning to run a further two half day events:
Please save these dates in your diaries and we will post further details as and when they are confirmed.
The Institute of Ageing and Health are delighted that Theresa May appointed Tracey Crouch as the UK’s first minister for loneliness, recognising the importance of this issue. Last year I wrote a blog on the effects of feeling lonely, alone or isolated. Loneliness is associated with increased health risks and can be as bad for you as smoking 15 cigarettes a day or as dangerous as obesity and it can increase the chances of early death by as much as 26%. Recent publications suggest that more than nine million adults across all age ranges in the UK are either always or often lonely with 35% of men feeling lonely at least once a week. People living with dementia are at risk of loneliness in fact, people living with dementia tend to be lonelier than the population as a whole and a survey by the Alzheimer’s Society found 62% of people living with dementia who live alone feel lonely and 38% of all people with dementia felt lonely.
The Jo Cox Commission on loneliness was created as a response to the MP's own experience of isolation. "This is an issue that Jo cared passionately about and we will honour her memory by tackling it, helping the millions of people across the UK who suffer from loneliness," Crouch said in a statement. We will watch with interest the developments from Tracey Crouch going forward.
Dr Ruth Pearce (Deputy Chair IAH)
The IAH invites papers for its journal 'Ageing & Health'. Contributions to Ageing & Health enable us to share research, reflections and stories to help improve ageing and health in the West Midlands; we are looking for articles that present views and perspectives from a wide variety of disciplines related to health and ageing.
Re-inventing a Long Term Dream: Do we need new systems to deliver “working together” We run a huge risk of repeating the mistakes of the policy 10 (PPM ?70) years ago, thinking that integration is solved just by fiddling with organizational form options” M. Winn 21.5.2018 I have had a career long passion in delivering services across sector boundaries as geriatric service lead of hospital and community health facilities, running the Institute’s Excellent Care Award, participating in the development of Stroke Illness pathways , and as a former chair of joint planning in Birmingham. My purpose with this publication is to seek examples of Good Practice, building on our experience from the “Excellent Care Award” to inform the work now being done under the new national drive to promote integration in commissioning and in delivering health and social care. The driver for this strategy is the long-standing perception that underfunded fragmented poorly delivered services can be reorganized to provide cost effective services with the person in need at the centre of the change required. The World Health Organisation (WHO) and NHS England (NHSE) see the patient/citizen as the pivot round which service configuration should be structured. But most service planning is initiated centrally and in the recent Sustainability Transformation Partnerships (STPs now becoming Integrated Care Systems (ICS)) the service user seems the last group involved in planning and driving service change. NHS clinical commissioning groups (CCGs) do have a requirement to consult their populations and some are doing this well but many are too small and lack the skills to deliver. Mergers to bigger commissioning organisations, as recently agreed in Birmingham and Solihull, may help address this? Mental Health services may, more frequently, have developed successful models of population involvement in service development and I would argue that the research community has also developed robust models of public involvement in priority setting, design and delivery of research outcomes. What is integration and is the present focus on health and social care the correct focus. There seems little emphasis on implementing health promotion and disease and disability prevention in reducing long term systems overload. Public Health interventions remain an essential driver for improving long term outcomes and should be in all integration contracts. The WHO definition states: “Integrated Care is a concept bringing together inputs, delivery management, and organisation of services related to diagnosis, treatment, care rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality user satisfaction, and efficiency” NHSE have adopted a definition co-developed with National Voices: “I can plan my care with people who work together to understand me and my carers allowing me control and bring services tog In a Grant Thornton (GT) workshop on Integrated Care Systems 11.6.2018 Presented by Prof Andy Hardy (CEO NHS Trust and STP lead Coventry) and Peter Saunders (GT) emphasized the difficulties but described positive indicators arising from STP discussions and GT support in contracting. Difficulties included: - lack of skilled leads in e.g. integration of back office functions and workforce management - Lack of meaningful public engagement - Major difficulty in delivering local change with very slow progress - increasing block contracting reducing drive for innovation and transparency Positive indicators included: - Increased communication between organisations and their officers - Support for modernization - New models described: included Royal Wolverhampton NHS FT directly employing GPS and financing their service improvements, South Yorkshire 12 organisations serving 2.5 million populations close to agreeing new integrating contracts. They suggest that 30% of outcome is due to systems change but 70% is due to public and staff engagement. - That the new contracts based on driving quality and outcomes. . NHSI states that successful models are based on all people in the system having a shared philosophy and core values, mutual trust, mutual gain, good process leadership, a focus on the priorities that matter and an avoidance of power dominating discussion ” NHS Providers 11.6.2018 suggest that “NHSE and NHSI should make clear that they actively support local areas in communicating and co- designing service changes with local communities and elected representatives. This parliamentary select committee report(7th Report - Integrated care: organisations, partnerships and systems | House of Commons | Health and Social Care | HC 650 | Published 11 June 2018) found that more integrated care will improve patient experience, particularly for those with long-term conditions. However, while it may reduce demand on hospital services, the Committee concluded there is a lack of evidence that integration, at least in the short term, saves money. Useful local evidence from Healthwatch Birmingham is published in the report. (11.10.2017.) ” We are yet to see a clear process of seeking patient and public insight, experience and involvement within our local STP nor is there a consistent strategy developed for each stage of the plan. Having an engagement strategy would ensure that patients, the public, service users and carers understand the implications of changes to their health and social care services. Equally, it would ensure that they feel engaged and informed throughout the process and that their thoughts, ideas and comments are taken into account to develop these plans further.” Read NHS Providers “On the day Briefing” if you read nothing else: Read this summary of the main findings and recommendations in this report. HSC OTDB 11 June 2018.pdf I would totally concur with Roy Lilley (NHS Managers.net) that an essential outcome is a library of successful models and, let us, by collecting these from the West Midlands play a small part in the education of those trying to implement integration and avoid the obsession with only funding something NEW. PPM 25.6.2018
Due to the delay in publication the reader might wish and should consult the "hot off the press' government response to consultation:
Government response to the recommendations of the Health and Social Care Committee's inquiry into 'Integrated care: organisations, partnerships and systems'
Seventh report of session 2017-19Presented to Parliament by the Secretary of State for Health and Social Care by Command of Her Majesty August 2018 Cm 9695
This is the response to the Health and Social care paper of June 11th:
To quote a few paragraphs in full from its executive summary:
"Integrated care is centred around a person's needs; proactive in supporting wellbeing and identifying risks of health deteriorating; and coordinated so that it feels like it's provided by one service, even if it isn't. It should improve health and wellbeing for the population, enhance the quality of care from providers, and improve financial sustainability. Integrated care also involves a greater focus on population health. This will need the NHS, local authorities and the third sector to work together to enable the development of new models of care that focus on populations and their needs and, prevent ill health and unnecessary hospitalisation."
"-a 2014 meta-review of integration found beneficial effects of integration of care on several outcomes, including reduced mortality, reduced hospital admissions and re-admissions, improved adherence to treatment guidelines and better quality of life."
So a very much in favour report which talks about ring fenced transformation funding but suggests this may already be from the 3.4% 10 year plan increase announced. They see STPs as the basis and from 10 existing ICS and suggest a "joint national transformation strategy" including the DoH, NHS England, NHS Improvement, Health Education England, Public Health England and CQC.
And a conclusion which I suspect will not be accepted by many:
"We also welcome the Committee's recognition that integration will not lead to privatisation nor will it threaten the founding principles of the NHS – which will always remain free at the point of use."
Dr P P Mayer
Hello from the new Chair
As the newly elected Chair, I thought this may be an opportune moment to introduce myself and lay out a little of my vision for the Institute, given all that is happening within the West Midlands.
So, Hello! My name is Dr Andrew Dayani. I am Executive Medical Director at Birmingham Community Healthcare NHS FT and was a GP for 21 years before moving into an Executive Director role. That gives you a flavour, but doesn’t tell the whole story, as I have also been an Occupational Physician, Community Hospital doctor and trained in Dermatology and Cardiology, whilst being involved in commissioning and medical politics. I like to keep busy! Until last year I lived and worked in Somerset.
The most frequent question I get asked is ‘why have you moved?’ and answering that may allow me to start to tell you about what makes me tick and consequently the vision for the IAH. The answer is that I was born and grew up in the West Midlands. The further one gets from direct, patient facing care, the more important it is to have a strong link to the population served. For me that link is about feeling part of the community and the imperative to address health inequalities and consequently improve health outcomes. The changing demographic means that older persons care is a vital part of the puzzle to make the system work.
It is a sad reflection that across the West Midlands, there are many areas in which life expectancy remains well below national average. Of course length of life in itself is nothing without there being quality and enjoyment to be experienced. The statistics for many older persons shows that coming into contact with Health services is a life limiting event. Attendance at A&E results in admission to hospital. Emergency admission to hospital leads to dependency, core muscle wastage, loss of mobility and increasingly failure to return home.
The 1 year mortality rate in Care homes is 26 per cent (Age and Ageing, Volume 42, Issue 2, 1 March 2013, Pages 209–215)
Within the Sustainability and Transformation Boards there is recognition that admission to hospital is not the answer. We need to be more agile and pro-active rather than waiting for a crisis to intervene. Partly, this results from the inevitable stretch on primary care and community services, where funding has been largely static with consequent impact on staff recruitment and retention. But that isn’t the whole story. There has been a lack of change in the way care is delivered, failing to truly recognise the potential of multidisciplinary working or to recognise fully the expertise that exists.
So, how do I want to see the Institute develop? I feel that this is an opportunity to bring together all parts of the multidisciplinary system to demonstrate positive leadership and publish what works well. We should be supporting small quality improvement projects as well as large scale research. I also feel that we shouldn’t be afraid of holding the system to account. The Institute was formed by a group of geriatricians in the 1970s. Times may have changed, we have learnt a lot and treatments certainly have improved in the last 40 years, but sadly there remains a lot to be done to improve outcomes.
The Birmingham and Solihull STP are developing models of care based upon localities and neighbourhoods. As part of this work there will be a pilot to change the way in which older people are assessed and treated to make home the first choice for treatment. This requires a major change in the way in which organisations and teams work, across both health and social care. Fortunately, there is recognition that we cannot continue as we have been and collaboration and co-operation finally seem to be winning.
In the 18th Century the Lunar Society brought about the Midlands Enlightenment. Perhaps the time has come for a similar movement in older persons health care.
More Information, Less Accessibility
Mike Marshall MIHM, DHSM – IAH Trustee
I have probably driven my Trustee colleagues to distraction over completing my first ever blog for the West Midlands Institute of Ageing and Health. It was due in January 2018 and I was ill at the time. Since then holidays, retired life and procrastination seem to have got in the way. It’s always been the same: as a Health and Social Care practitioner / Manager/ Commissioner - reports finished at the deadline and funding bids submitted on the day (the last of which gained £2.3 million from the Government!).
Well, here I am finally at the keyboard, relatively fit and able, unlike many of the older people we seek to support through the Institute’s work.
I can travel to my GP, access hospital appointments (unfortunately not in my home town of Bromsgrove in the actual community hospital I commissioned) but in Redditch (or Kidderminster) some 7 miles away.
Should I have experienced a stroke the journey would be to Evesham, 48 miles round-trip with no direct bus route. Trains? Forget it. Older relative, no car? – no chance.