1. TS A LS A A AA TS A L LS LT HEALTH AND SOCIAL CARE SUBSTITUTION NOW HomeCommunity Secondary Hospital Tertiary Hospital Social Care Substitution type L Location T Technology S Staff and/or skills A All Patient pathway The Welsh Institute for Health and Social Care A

2. A A A AA TS L LS LT HEALTH AND SOCIAL CARE - 2050 Primary Home and Self Care Secondary Community Care Social Care Substitution type L Location T Technology S Staff and/or skills A All Patient pathway The Welsh Institute for Health and Social Care Tertiary DX and TX Daycare Science Centres

3. HEALTHCARE POLICY 2020 TOWARDS A HOSPITAL FREE NHS MORTON WARNER

4. THE BURDEN OF DISEASE FOR TOP TEN LEADING CAUSES OF DALYs, IN MILLLIONS, IN 2020, DEVELOPED REGIONS Males Disease or InjuryDALYsCum% All Causes95.1 1. Ischaemic heart disease12.312.9 2. Cerebrovascular disease 5.618.8 3. Trachea, bronchus & lung 5.524.6 cancers 4. Alcohol use 5.230.1 5. Road Traffic Accidents 4.835.1 6. Unipolar major disorder 3.438.7 7. Chronic obstructive 3.242.0 pulmonary disease 8. Self-inflicted injuries 2.945.1 9 Oesteoarthritis 2.247.4 10.Dementia & other 2.149.6 degenerative & hereditary CNS disorders Source: Murray CJL & Lopez AD (1996) Quantifying Global Health Risks: Estimates of the Burden of Disease and Attributable to Selected Risk Factors. Cambridge, Mass: Harvard Press. Females Disease or InjuryDALYsCum% All Causes65.4 1. Unipolar major disorder 6.4 9.8 2. Ischaemic heart disease 5.718.5 3. Cerebrovascular disease 4.325.1 4. Osteoarthritis 3.430.3 5. Dementia & other 3.435.5 degenerative & other hereditary CNS disorders 6. Road traffic accidents 2.038.7 7. Chronic obstructive 1.741.3 pulmonary disease 8. Trachea, bronchus & 1.744.0 lung cancers 9. Breast cancer 1.746.6 10. Diabetes mellitus 1.448.7

5. REDUCING OLDER AGE SELF-CARE DEFICITS THROUGH ENABLING TECHNOLOGIES Self-Care Deficits Possible Technology Interventions Functional Knowledge Communication Environment Bundles 3 - 8: Specific to 6 DALYs self-care deficits Bundles 2: Generic to all DALYs self-care deficits Bundle 1: All older people’s general needs Soft Hard technologies Situation 1 Situation 2 Situation 3 Default- Institutional Full use of existing Use of future care required now technologies - increased technologies - increased home care? home care?

6. SELF CARE DEFICITS AND OLDER PEOPLE NEEDS Ischaemic heart disease Cerebrovascular disease Unipolar major disorder Trachea, bronchus & lung cancers Osteoarthritis Dementia & other degenerative CNS disorders DALY Groups Functional Knowledge Communication Communicating with Environment Deficit Areas Special Needs Activities of daily living; instrumental activities of relating to fluid and nutrition intake, chewing, elimination, mobility, medication management cognitive impairment Knowledge relating to diet, fluid intake, bowel and urinary function, disease management, availability of support services Isolated residential location, lack of transport, absence of communication devices eg telephone, hearing aid, physical or cognitive impairment of speech and language. Housebound due to physical or cognitive impairment or mental condition Inability to control environment, eg heating, lighting; difficulty manipulating household fixtures eg doors, taps, associated with physical or cognitive problems. Issues associated with sensory loss, particularly safety.

7. ACTIONS AND BUNDLE TECHNOLOGY NEED FOR HEALTHY ELDERLY

8. ACTIONS AND BUNDLE TECHNOLOGYY NEEDED FOR FRAIL ELDERLY Actions 1. Comprehensive general assessment 2. Define care plan to meet elderly needs 3. Rehabilitation 4. Define follow-up strategies 5. Plan re-assessment 6. Home hazard assessment 7. Installation of assistive devices Refined Bundle 2 Addition to multidisciplinary team of technician, geriatrician, chiropodist, social worker Assistive devices to match patient’s needs (from list in Table 5.2b and 5.2c)

9. COHORTS DISTRIBUTION BY AGE GROUP AND GENDER [8 missing data returns]

10. ABILITY TO STAY AT HOME WITH TECHNOLOGY BUNDLES AVAILABLE, WITH AND WITHOUT EXISTING INFORMAL CARER

11. COSTS / 1000 OLDER PEOPLE / YEAR (INITIAL YEAR): HOME v RESIDENTIAL AND NURSING HOME CARE

12. COSTS / 1000 OLDER PEOPLE / YEAR (SUBSEQUENT YEARS): HOME v RESIDENTIAL AND NURSING HOME CARE

13. COSTS / 1000 OLDER PEOPLE / YEAR : COMMUNITY HOSPITAL v DIRECT RETURN TO HOME FOLLOWING STAY IN DISTRICT GENERAL HOSPITAL

14. A. Local authorities will need to reconsider housing and community regeneration policies and programmes to include smart home adaptations of vacant properties. B. The provision of a capital trust fund and extra monies for start- up costs. The NHS should enter into a partnership with local authorities to manage the processes. C. Flexitibilities in provision to accommodate the changing state of frail elderly people. D. Need linked on a timely basis to supply logistics with well- ordered ‘just in time’ systems. E. Equipment maintenance undertaken in such a way as to diminish down time.

15. AVAILABILITY OF TECHNOLOGY BUNDLES: SAVINGS IN INITIAL AND SUBSEQUENT YEARS, FOR THREE LEVELS OF CARE, BY % CARE REQUIREMENTS LOW MEDIUM HIGH A. Availability of Bundle 2 (54.3% stay at home; 45.7% go into care) B. Availability of Bundles 2 and 3 (94.5% stay at home; 5.5% go into care)

16. PROJECT SHIFT Morton Warner