Rodd Bond

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

What problem(s) are we trying to solve ?
Whose problem(s) are we trying to solve ?
Are there preferred mechanisms to go forward ?
Focus on ageing Overview

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

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%)

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

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.

Active Ageing Vulnerable Low SES High SES Consumer market: Public health: Public housing Public | private health:
Inclusion ?
Access
Digital literacy
Threshold of reduced independence Whose problem ? Which ‘market’ is it ?

Whose problem ? Which geographies and cultures ?

Global village
But exclusion / vulnerable / segregation
People of all worlds – have needs, and possibilities
Can’t avoid some concrete starting points
In-equity / social determinants of health
Poor access / affordability / poverty
Institutional and market failure in delivery
Can’t ignore
the social, political and economic context in which these products and services will operate
Tension between
liberal market economy approach and ‘liberation’ pressure from vulnerable demanding universal right.
Unique focus
Is it about – disease, disability, frailty & age related decline
Whose future ? - Universal access ? Is health a traded good – or is it a right ?

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

Step sizes and sequences:
Small incremental improvements – maintaining / lubricating
Incremental component replacement / improvement / re-configuration
Major re-think / re-design
Forward pressures:
Expansion and multiplicity
Infolding / centredness / increased complexity / integration
Human resources:
Culture change / professionalisms / vocation / specialists / generalists / on-line experts / relationships - patient client, customer, person or partner ?
R&D mechanisms:
simulators, test labs, living places, new paradigms of user involvement (from subject to co-creator).
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

As a starter: Which future do we want. Improving trajectories for longer living Technology view Market view Personal view Industry view Socio-political view

Rodd Bond

by CASALA CENTRE

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