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Professor David Oliver


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Professor David Oliver

  1. 1. Making Health Services “Age Proof and Fit for Purpose” David Oliver National Clinical Director for Older People (England) Consultant Physician, Royal Berkshire Hospital Visiting Professor of Medicine for Older People, City University
  2. 2. What this is about… <ul><li>People, their families and their communities </li></ul><ul><li>Whole systems and their joint-working </li></ul><ul><li>Specific services or agencies for people who need or use them </li></ul><ul><li>Policies as opportunities to drive improvement </li></ul><ul><li>Where the public, professionals and voluntary organisations can do to lead, whoever is in power </li></ul>
  3. 3. What we aspire to.. <ul><li>“ A comprehensive service available to all based on need and irrespective of age, gender, ethnicity etc.....reflecting needs and preferences of patients families and carers” </li></ul><ul><li>NHS Constitution 2008 </li></ul><ul><li>“ Discrimination has no place in a fair society which values all its members. should be differentiated by age only when justifiable or beneficial” </li></ul><ul><li>Equality Act 2010 </li></ul><ul><li>Does reality match this aspiration?... </li></ul>
  4. 4. What our ageing society means for health and wellbeing <ul><li>Some facts and figures </li></ul><ul><li>Why ageing is a success story to celebrate, not a “time bomb” “burden” or “tsunami” </li></ul><ul><li>What ageing means for population health and wellbeing </li></ul><ul><li>And what older people value in health and in care </li></ul><ul><li>The good news. Its not all doom and gloom </li></ul><ul><li>The downside. Growing population prevalence of </li></ul><ul><li>Long term conditions, inc. dementia </li></ul><ul><li>Disability </li></ul><ul><li>Frailty </li></ul>
  5. 5. What this means for health and social care services. “Older People R US” <ul><li>Primary Care </li></ul><ul><li>Acute Hospital – including case mix </li></ul><ul><li>Social Care </li></ul><ul><li>Voluntary and Family Care </li></ul><ul><li>People using multiple services </li></ul><ul><li>Interface issues – communication, co-ordination, duplication, inefficiencies </li></ul><ul><li>Need to focus more on prevention (1y, 2y, 3y) and early intervention and - “inverting the triangle” </li></ul>
  6. 7. Audit Commission 2000 (“the vicious circle”) Has much changed?
  7. 8. <ul><li>If we design services for people with one thing wrong at once, but people with many things wrong turn up, the fault lies not with the users but with the system, yet all too often these patients are labelled as a problem or deemed inappropriate” </li></ul><ul><li>Rockwood K 2005 </li></ul><ul><li>“ If we always do what we’ve always done, well always get what we’ve always got” </li></ul><ul><li>Robbins A </li></ul>
  8. 9. Stephen Dorrell. On Integration. HSJ 5 May <ul><li>“ Change is also driven by the changing demands of clinical care. Some of the greatest current inefficiencies are because traditional institutions and structures are being used to deliver care to a quite different type of patient.”… </li></ul><ul><li>“ Systems designed primarily to treat occasional episodes of care for normally healthy people are being used to deliver care to people who have long term and often complex conditions. The result is too often that they are passed from silo to silo without the system having sufficient ability to coordinate the different providers.” </li></ul><ul><li>“ The requirement for the NHS and social services to manage a change in the way care is delivered so that it is more coordinated, more integrated and less episodic is therefore driven by both the clinical desire to deliver high quality care and the economic imperative to deliver the Nicholson challenge.” </li></ul>
  9. 10. What do we mean by “Quality” in care <ul><li>Outcomes (including receiving evidence-based treatment which will deliver them) </li></ul><ul><li>Experience of using services (includes personalisation) </li></ul><ul><li>Safety </li></ul><ul><li>Efficiency (including unwarranted variation) </li></ul><ul><li>[Fairness/non-discriminatory] </li></ul><ul><li>[Joined-upness/Integration] </li></ul><ul><li>How are we delivering on this… </li></ul>
  10. 11. Why its not all bad news. We need a balanced diet, not an “Atkins” of scandal and scaremongering <ul><li>Generally high satisfaction ratings </li></ul><ul><li>Especially among older people </li></ul><ul><li>Lots of fantastic care delivered by fantastic people </li></ul><ul><li>Lots of great examples of leading services to share </li></ul><ul><li>A focus on solutions needs a focus on spreading the lessons and helping others to deliver </li></ul><ul><li>However, its not all good news either… </li></ul>
  11. 12. Evidence that services must do a lot better. (More to follow from NHS Confed/Age UK Commission?) <ul><li>Experience e.g.: </li></ul><ul><ul><li>Ombudsman, CQC, All Parliamentary Enquiry, Dementia (including in hospital), End of Life Audit </li></ul></ul><ul><li>Effectiveness e.g.: </li></ul><ul><ul><li>RCP Audits (falls, bone health, continence), NHFD, NCEPOD </li></ul></ul><ul><li>Safety e.g.: </li></ul><ul><ul><li>Mid Staffs, Falls, Infections, Pressure Sores, Readmissions, Medication error </li></ul></ul><ul><li>Efficiency e.g. </li></ul><ul><ul><li>Major unwarranted variation in admissions, bed days, spend on long-term care, delayed transfers </li></ul></ul><ul><li>Fairness e.g. </li></ul><ul><ul><li>CPA review for Equality Act, Cancer Intelligence Network, All Parliamentary Enquiry </li></ul></ul>
  12. 13. Solutions (in any system and under any government) <ul><li>“ For every complex problem, there is a solution which is simple, obvious and wrong” HL Mencken </li></ul><ul><li>Education and training, skilled workforce </li></ul><ul><li>Inspection and regulation </li></ul><ul><li>The law (rights, equalities, criminal, mental capacity, negligence etc) </li></ul><ul><li>Targeted programmes and investment </li></ul><ul><li>Empowerment and involvement of patients/carers in designing services, feeding back on quality </li></ul><ul><li>Awareness raising, information and advocacy from organisations such as AGE UK and professional societies </li></ul><ul><li>Effective lobbying of decision-makers </li></ul><ul><li>High quality clinical and professional leadership to get everyone up to the standards of the highest performers </li></ul><ul><li>System incentives and levers to deliver the change we want </li></ul><ul><li>Collaboration between agencies in localities </li></ul>
  13. 14. Some real opportunities (England) at a time of change in health and social care <ul><li>Older People’s Services as the key to delivering the £15-20bn Efficiency (QIPP) challenge </li></ul><ul><li>Clinical commissioning as chance to redesign pathways </li></ul><ul><li>Coalition commitments </li></ul><ul><ul><li>e.g. “enable more older people to live independently”, “improve discharge from hospital” </li></ul></ul><ul><li>Continuing focus on Dementia </li></ul><ul><li>New monies into re-ablement and social care </li></ul><ul><li>After health futures forum, focus on integration </li></ul><ul><li>Role of health and wellbeing boards </li></ul><ul><li>Role of NHS commissioning board in driving clinical quality through outcomes, quality standards etc </li></ul><ul><li>Reform of adult social care following Dilnot Commission </li></ul>
  14. 15. Thank you <ul><li>Questions.....? </li></ul><ul><li>[email_address] </li></ul>