Last week we held our third roundtable discussion on the Deloitte Centre for Health Solution's report on better care for frail older people.
The first roundtable focused on how to deliver improvements in each place of care that frail older people find themselves; the second focused on how collaboration, integration and a better understanding of frailty might improve patient outcomes and deliver higher quality, more cost effective, services; and the third looked at the challenges from a whole health economy perspective and how best to harness the different parts of the system to become more than the sum of the parts1.
All three discussions highlighted the challenge presented by the rising demand and cost of care for frail older people but also provided ideas and suggestions as to how the statutory health and social care sector might work more effectively. This article focusses on the suggestion that resonated strongly with all three discussion groups: the need to work more collaboratively with the charitable and voluntary sectors and harness the valuable contribution that informal carers and frail older people themselves can contribute.
There was agreement on the need for commissioners and providers to recognise and acknowledge the wealth of 'informal' community care that's available, for example through community volunteers and the voluntary sector. There was also a view that the people who are more likely to notice a change in circumstances or deterioration in an older person's health are those who have more frequent contact, such as the local pharmacy or grocery store. Harnessing the social capital2 in these organisations could prove much more effective in supporting older people to live well in their communities than is currently the case.
The need to forge sustainable partnerships with multiple parties across the local health economy was seen as especially important given that the statutory health and social care providers are unlikely to be able to meet the demand challenges on their own. The prevailing view was that individual provider organisations tended to focus on a "set menu of options", leading to overlap and gaps in provision, while failing to see the system from the patient's perspective. Yet most people do not understand or care about artificial organisational boundaries but want a single point of contact and a personalised solution. This was something that needed to be tackled urgently, requiring all stakeholders to subjugate their vested interests and move away from the current system of silo based, fragmented care.
There were concerns that the Better Care Fund had missed a trick by not engaging sufficiently with the voluntary sector. However, examples were discussed of commissioners and providers starting to grasp the nettle and transform older people's services by engineering a shift towards prevention, anticipatory care and care closer to home. These examples were seen as too few and far between and required a leap of faith to enable the adoption of more effective partnership working at pace and scale.
There was concern over the increase in evidence of loneliness in old age and recognition that loneliness can often be worse for health than smoking, drinking or obesity. Tackling social isolation and loneliness was not seen as something that would necessarily cost a lot to improve; rather that harnessing the social capital available in every health economy could help restore a sense of purpose and connection to society for older people.
Older people are often assumed to be less capable and dependent than is actually the case. What is needed is the right environment and circumstances for this independence to flourish. Institutionalisation, no matter how good the quality of care, inevitably promotes loss of independence and can induce increased disability in older people. In seeking to empower older people, one size won't fit all. It is not about stigmatising residential care but identifying options for older people; moving away from the current linear models of care to provide more choice in terms of types of accommodation and types of support and care.
Older people could themselves be supported to act as role models or ambassadors and help other older people navigate the complex health and social care sector. They might also be encouraged to befriend the young to help bridge the generation gaps and tackle ageism from the bottom up.
In future, the catalyst for adopting new models of care is likely to be the 'voice' of the empowered and knowledgeable older person within an environment that encourages this voice. This involves addressing how society views older people and creating a vision of life beyond adulthood by adding the concept of a rewarding and fulfilling "elderhood" into our current lexicon. Incremental change is no longer sufficient, what is needed is a commitment to change at scale and pace. Overall the need is for policy makers, commissioners and providers to walk in the shoes of frail older people and deliver services accordingly.
Footnotes
1 Further details of the discussions and the ideas and insights that came out of the roundtables are available for download on our website.
2 Social capital is a term used to define social resources which can facilitate positive outcomes with respect to a broad range of phenomena. It refers to the individual and communal time, energy and resources available for such things as community improvement, social networking, civic engagement, personal recreation, and other activities that create social bonds between individuals and contributes towards their health and well-being.
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