Redesigning care for frail older adults Time for action

It has become increasingly obvious that our way of caring for our senior citizens has got to change. There are new stories in the media every day, and the sector is flooded with reports and recommendations from politicians, specialist societies and think tanks.

The titles and language may differ – long term conditions, co-morbidities, health and social care – but the principles are generally the same and the evidence is clear. We need to improve the standards of care we offer to frail older people.

The challenge is in making the change happen and this is where most local health economies are struggling.

They can start the ball rolling by commissioning services with a focus on improved care for older people. These services should consider:

• the proactive management of frail older adults to reduce the number of non-elective hospital attendances and admissions
• enabling a short hospital length of stay by having a robust team to monitor and care for older patients on discharge
• up-skilling the various healthcare professionals practising in primary and community care in the care of frail older adults.

Short to medium term changes like these will help to better manage those who are already known to the health and social care system. Importantly, this will help free up funds from expensive secondary care, so that they can be redeployed to primary and community care, further improving the proactive care and management of the older adult population.

There are a few places in England and Wales where this sort of service redesign is already being implemented, with varying results. Some good examples are South Sefton in Liverpool (their proposed integrated care model is in its early stages), the North Wales model and the ‘Integrated care model for older people’ in South Warwickshire. These early pioneers are making a good start and we can learn from them. I’m looking forward to hearing more about how some of them are getting on at a meeting organised by the British Geriatrics Society next month.

However, with so many different health and social care organisations currently involved in providing care for older people, reinvesting any cost savings is going to be really challenging. I would be very interested to hear from those who have been successful in transferring costs from secondary to primary and community care and keeping their secondary care provider financially stable.

As a Health Foundation Quality Improvement Fellow I spend a lot of time these days focused on the longer term challenge: how best to redesign care for older people from a population health perspective. In my opinion, we should be focusing not just on individual health factors within each local economy, but on the social determinants of wellbeing and health in the general older adult population. The King's Fund has made several suggestions and recommendations along this theme.

You are unlikely to find anyone disagreeing with these ideas, however implementing this shift in focus is more complicated. This is mainly because no one individual, group or organisation can be held solely responsible for all of the various components necessary for the seamless integrated care of our senior citizens.

In some senses the biggest challenge we face is to bring these different groups and organisations together to work towards a shared vision and goal. I would like to know of any area in the UK that is attempting to do this so that we can learn from you and share with those willing to learn.

Asangaedem Akpan is a Consultant Geriatrician and Health Foundation Quality Improvement Fellow