User Perspective on Solutions that Integrate Health & Social Care Jonathan Ellis Policy Manager – Health & Social Care

About Help the Aged Our vision is of a future where older people are highly valued, have lives that are richer, and voices that are heard Raising funds to improve older peoples’ lives Providing services to older people Funding biomedical research in to ageing Funding international activities Distributing grants to older peoples’ groups, forums and organisations for specific projects Campaigning with older people via a network of over 700 independent older people’s groups and forums

Summary Who are our older population? What does integration mean to older people? What really matters to older patients and service users? Integration in policy? The opportunity provided by Single Assessment? The benefits of integration for older people? The challenge of truly seamless, integrated services for the future?

The context: demography and demand 16% of the UK population over 65 in 2001 (21% by 2026) Two-thirds of hospital inpatients over 65 Older people make up 40% of emergency admissions Two thirds of district nursing patients are over 65 40% of NHS spending on older people 70% of people over 65 report long standing illness Over 55% of older people describe their health as ‘good’ or ‘very good’ Only 5% of people over 75 live in a care home Half of people over 85 use district nursing service

What does integration mean to older people? “ Health and well-being depend on more than just health care: they depend on quality of life. Improving the quality of life of older people requires a concerted effort across central and local government, the health service and other essential providers to tackle the causes of ill-health, and better information is needed so that older people and their families can find help themselves” Health & Older People (2000) Our Future Health: Older People’s Priorities for Health and Social Care. London: Help the Aged

What older people want One place to access advice and support I don’t want to have to keep telling everyone my personal affairs Why don’t professionals speak to each other? I don’t want professionals arguing about whose ‘budget’ my care should come from I want professionals to see me as a real person, and not to pigeon hole me I don’t understand what they are talking about half the time. It’s like a separate language

What does integration (often) mean to professionals? Isn’t this just a ‘take-over’? Will I be expected to do things outside of my normal role? Who’s going to manage me, and will they understand me? Will I still have professional development opportunities? Do they understand us? What do they do? How will information be shared? What happens when we disagree? Why are we doing this?

Mary’s Story A Case Study of Dis-integration

What really matters to older people? Access to services Quality of services Cost of services The configuration of services

‘Joined-up’ policy opportunities Tackling delayed transfers of care Does the system of reimbursement promote or impede joint working? Does reimbursement improve the patient experience or outcomes? Introducing patient choice from 2004/5 Information to support choice at six months and choice of hospital at the point of referral from 2005 The necessity of a ‘whole-system’ response Implementation of Single Assessment from April 2004

The importance of single assessment The 12 Key Steps to Implementing Single Assessment 1.Agree purpose and outcomes 2.Agree shared values 3.Agree terminology 4.Map care processes 5.Estimate numbers 6.Agree the steps 7.Agree the link between diagnosis and assessment 8.Agree domains and sub-domains 9.Agree approaches, tools and scales 10.Agree joint working arrangements 11.Agree the SAP summary 12.Agree a joint staff development strategy

The importance of single assessment One person - one story - one voice Multiple points of access Less duplication of information Assessment proportionate to need Recognising the older person’s status as the only true expert Knowing where to go Better information, better access and better support ‘Joined up’ lives need ‘joined up’ assessment!

Integration can… … tackle poor/inequitable access … ensure the user experiences a ‘single system’ … simplify complicated systems and processes … reduce conflict between separate services/parts of the system … improve communication and information … reduce unnecessary duplication … reduce waiting times … ensure services are led by needs, not budgets … better understand older people’s needs (not just health & care) … facilitate greater control and choice … ensure that the older person remains at the centre

Towards a ‘whole-system’ future? Need to confront ageism and other types of discrimination against older people. Recognise the vital role that older people play in our society. Encourage healthy lifestyles for older people. Have a joined up partnership approach to how all services are delivered Ensure specialist services are responsive, flexible, integrated and of high quality. ADSS/LGA (2003) All our Tomorrows: Inverting the Triangle of Care

Conclusion The challenge isn’t just to integrate services but to engage the ‘whole system’ in providing quality services for older people, that values them and promotes their independence and well being. The principal aim of service integration must be to promote quality of life in older age, by improving the accessibility and suitability of services Integration of health and social care is just the beginning…?