The NHS’s greatest success has become its most daunting challenge: people are living longer but increasingly with one or more conditions, a demographic change that drives up both demand and costs. As a result, the current model of care for our most vulnerable members of society is at a tipping point and is no longer fit for purpose.
In the latest report by the Deloitte Centre for Health Solutions, we estimate that the NHS and social care spend on over-65s living with at least one long-term condition is at least £30bn a year. However, this is spent largely on expensive acute intervention and residential care rather than on prevention, self-management, early intervention and helping people live well and independently for longer.
We examined the scale of this challenge and outlined a series of actions that health and social care providers and commissioners should consider. Some of these are already being piloted, but there is a strong case to be made for these to be expedited immediately.
In the short-term
Commissioners should look at levers such as:
• Focusing on offering joint personal budgets for the health and social care of all frail over 75s, while supporting them with care navigators to get best value out of these budgets. These should be reviewed annually.
• Adopting new funding models to provide the right care in the right long term care settings at the right time. This should include moving from volume to outcome, value-based payment models.
• Developing incentives to encourage providers to adopt technology to support the delivery of care and improve the interface between providers and patients, particularly between hospitals and care homes and general practices and people’s homes.
In the meantime
Health and social care providers should look at some of the following options:
• Notwithstanding the issues with care.data, expediting the inter-operability of data systems to allow multiple patients and providers to share data in real-time. Shared patient records are particularly essential for frail older people. At the same time, primary care practices should work with social care providers to offer annual health checks to patients aged 75 and over. They should also establish an electronic patient registry and track treatments and complications.
• Reviewing place of care and workforce capacity and capability. Geriatricians should come out of the hospital setting to assess and intervene in the community, and GPs should be reaching into hospitals to seek training in frailty management and providing appropriate care.
• Ensuring staff receive relevant training on the impact of ageing on health, and are certified to their level of competence in managing conditions associated with aging. A key concern raised in our report was that those who spend the most time caring for frail older people are typically those with the lowest skills and levels of pay.
• Increasing the input of primary community district nurses and other health professionals to manage older people who are frail. Currently there is no supply large enough to meet this demand, suggesting that in 2014-15 all staff will need to be more agile, accessing data and information on the move and spending more time with patients. Mobile technology has a key role to play in enabling this and delaying or preventing the need for more expensive institutional care.
These are by no means all the answers to the challenges facing the care system, and implementing these, particularly when the complex and varied needs of older, vulnerable people are taken into account, will be challenging. But the increasing numbers of frail older people aren’t in a position to wait for policymakers to take five to ten years to develop the more integrated health and social care system that successive governments have agreed is the desired model of care. There are good ideas being trialled, but the time has come for these to be examined and rolled out more widely.