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Rodd Bond
Rodd Bond
Rodd Bond
Rodd Bond
Rodd Bond
Rodd Bond
Rodd Bond
Rodd Bond
Rodd Bond
Rodd Bond
Rodd Bond
Rodd Bond
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Rodd Bond

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What is the system in Ireland for Providing Community

What is the system in Ireland for Providing Community

Published in: Health & Medicine
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  • Benefits and outcomes of ANP in care of the Older Person Reduce hospital admissions and reduce acute bed occupancy Empowerment of the older person to manage illness and disability with support mechanisms in place Provision of Integrated and more connected service to promote quality of life for older persons. Promote healthy Ageing Educate staff, families and Older Persons in preventative healthcare and health promotion strategies. The ANP caring for Older Persons will address the Older Persons changing needs on their life journey, through Community, respite, rehabilitation and continuing care settings. Appropriate care and treatment intervention by an Appropriate practition in the most Appropriate setting.
  • Transcript

    • 1. Innovation Symposium Collaborative Networks in AAL and Connected Health Fairways Hotel, Dundalk - Ireland 2 nd September 2010 Community, Services & Systems Metanoia ! Rodd Bond mriai Transforming social networks, environments and technologies for longer living. Dundalk Institute of Technology
    • 2. <ul><li>What problem(s) are we trying to solve ? </li></ul><ul><li>Whose problem(s) are we trying to solve ? </li></ul><ul><li>Are there preferred mechanisms to go forward ? </li></ul>Focus on ageing Overview
    • 3. Based on Appropriateness Evaluation Protocol (AEP) used in National Bed Utilisation Audit 2008. (Dr. D.Bedford studies) Reasons for admission Reasons for continuing stay AEP day of admission Severity of illness (10 criteria) Intensity of service (7) AEP day of care Medical procedures (10) Nursing/life support services (7) Patient’s condition (8) Cost/Benefit impact framework Services inter-relationships Nationally: 13% outside AEP admission criteria 39% outside AEP on day of care North East: 19% outside AEP admission criteria 47% outside AEP on day of care Secondary Care System older person A&E OP Clinics Inpatient D&T Primary care system GPs PCN/PCT HomeCare LTC Municipal / voluntary services HA NGOs Volunt. Prom /Prev
    • 4. Acute hospital Out-patient Inpatient Outside AEP performance 2008 Alternatives Long term care Non-Acute Rehab Hospice Respite With Therapy Home GP Home care package Community nursing With Therapy Admission avoidance (19%) Cases/ Episodes 49 15 14 13 25 3 3 7 9 Discharges (42%) 23 38 10 38 23 20 20 15 Accelerate discharge (47%)
    • 5. Outside AEP performance 2008 Some questions it raises Hospital centric: The solution for in-patient care is out-patient care. Technology: not well understood – HIH -> IV therapies Solution dependencies: on service capacities outside hospital The apparent low dependency on GP practice The invisibility of family, carers and volunteers The ‘quality’ of connected services and places - and the quality of the connections/communications Hospitals are ‘very expensive serviced hotels’ - the purpose of health system management is to minimise bed numbers and maximise bed utilisation ? Hospital avoidance and cure alternatives – not illness avoidance and health promotion and maintenance Assumption that the ‘inside AEP’ is coherent !? Acute hospital Out-patient Inpatient Non-Acute Rehab Hospice Respite With Therapy Home GP Home care package Community nursing With Therapy Long term care Cases/ Episodes 49 15 14 13 25 3 3 7 9 Discharges (42%) 23 38 10 38 23 20 20 15
    • 6. Community / civic engagement Person-centred – empowerment Active ageing – wellness – learning Employment - participation Well-being promotion Injury prevention Acute Care Reduced independence Costs allocated to engagement and well-being and participation Costs allocated to prevention Current costs associated with the management of acute and chronic care Current costs associated with long term care Active Ageing Vulnerable Reducing Burden ? Liberating Bounty ? 85% 15% What problem: - to mould a paradigm shift More than a business case Need to re-balance investment priorities (flip the pyramid) in line with population Dynamics reflecting policy commitments to active and positive ageing.
    • 7. Active Ageing Vulnerable Low SES High SES Consumer market: Public health: Public housing Public | private health: <ul><li>Inclusion ? </li></ul><ul><li>Access </li></ul><ul><li>Digital literacy </li></ul>Threshold of reduced independence Whose problem ? Which ‘market’ is it ?
    • 8. Whose problem ? Which geographies and cultures ?
    • 9. <ul><li>Global village </li></ul><ul><ul><li>But exclusion / vulnerable / segregation </li></ul></ul><ul><ul><li>People of all worlds – have needs, and possibilities </li></ul></ul><ul><li>Can’t avoid some concrete starting points </li></ul><ul><ul><li>In-equity / social determinants of health </li></ul></ul><ul><ul><li>Poor access / affordability / poverty </li></ul></ul><ul><ul><li>Institutional and market failure in delivery </li></ul></ul><ul><li>Can’t ignore </li></ul><ul><ul><li>the social, political and economic context in which these products and services will operate </li></ul></ul><ul><li>Tension between </li></ul><ul><ul><li>liberal market economy approach and ‘liberation’ pressure from vulnerable demanding universal right. </li></ul></ul><ul><li>Unique focus </li></ul><ul><ul><li>Is it about – disease, disability, frailty & age related decline </li></ul></ul>Whose future ? - Universal access ? Is health a traded good – or is it a right ?
    • 10. As co-designer As participant As subject As questioner Involvement complexity Contextual complexity As consumer Local Regional National EU/Intern. Building capacity to maximise pan-european involvement Mechanisms towards a better future User participation and co-ownership
    • 11. <ul><li>Step sizes and sequences: </li></ul><ul><ul><li>Small incremental improvements – maintaining / lubricating </li></ul></ul><ul><ul><li>Incremental component replacement / improvement / re-configuration </li></ul></ul><ul><ul><li>Major re-think / re-design </li></ul></ul><ul><li>Forward pressures: </li></ul><ul><ul><li>Expansion and multiplicity </li></ul></ul><ul><ul><li>Infolding / centredness / increased complexity / integration </li></ul></ul><ul><li>Human resources: </li></ul><ul><ul><li>Culture change / professionalisms / vocation / specialists / generalists / on-line experts / relationships - patient client, customer, person or partner ? </li></ul></ul><ul><li>R&D mechanisms: </li></ul><ul><ul><li>simulators, test labs, living places, new paradigms of user involvement (from subject to co-creator). </li></ul></ul>Mechanisms towards a better future More than a transposition of the present METANOIA Mindset change Co-operation Shared visions ? Common motivations ? Balanced interests Acute hospital Out-patient Inpatient Non-Acute Rehab Hospice Respite With Therapy Home GP Home care package Community nursing With Therapy Long term care Cases/ Episodes 49 15 14 13 25 3 3 7 9 Discharges (42%) 23 38 10 38 23 20 20 15
    • 12. As a starter: Which future do we want. Improving trajectories for longer living Technology view Market view Personal view Industry view Socio-political view

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