The post-war history of hospital care for older people in Britain in the first phase of its National Health Service (NHS) emphasises a detrimental Poor Law legacy. This article presents a regional study, based on the South West of England, of the processes by which Victorian workhouses became the basis of geriatric hospital provision under the NHS. Its premise is that legislative and medical developments provided opportunities for local actors to discard the ‘legacy’, and their limited success in doing so requires explanation. Theoretical perspectives from the literature are introduced including political economy approaches; historical sociology of the medical profession; and path dependence. Analysis of resource allocation decisions shows a persistent tendency to disadvantage these institutions by comparison with acute care hospitals and services for mothers and children, although new ideas about geriatric medicine had some impact locally. Quantitative and qualitative data are used to examine policies towards organisation, staffing and infrastructural improvements, suggesting early momentum was not maintained. Explanations lie partly with national financial constraints and partly with the regional administrative arrangements following the NHS settlement which perpetuated existing divisions between agencies.
(Publisher abstract)
The post-war history of hospital care for older people in Britain in the first phase of its National Health Service (NHS) emphasises a detrimental Poor Law legacy. This article presents a regional study, based on the South West of England, of the processes by which Victorian workhouses became the basis of geriatric hospital provision under the NHS. Its premise is that legislative and medical developments provided opportunities for local actors to discard the ‘legacy’, and their limited success in doing so requires explanation. Theoretical perspectives from the literature are introduced including political economy approaches; historical sociology of the medical profession; and path dependence. Analysis of resource allocation decisions shows a persistent tendency to disadvantage these institutions by comparison with acute care hospitals and services for mothers and children, although new ideas about geriatric medicine had some impact locally. Quantitative and qualitative data are used to examine policies towards organisation, staffing and infrastructural improvements, suggesting early momentum was not maintained. Explanations lie partly with national financial constraints and partly with the regional administrative arrangements following the NHS settlement which perpetuated existing divisions between agencies.
(Publisher abstract)
Subject terms:
NHS, hospitals, older people, organisational structure, health care;
The North West London pilot of integrated services was launched in 2001 to meet the needs of people with diabetes and those aged over 75. It brings together primary care, community services, acute care, social care and mental health. It aims to cut hospital use and nursing home admissions while reducing costs of services for diabetic and older patients by 24% over five years. The pilot is showing early signs of success, but clinicians explain that this is often despite NHS processes and not because of them. The article highlights the importance of listening to and involving patients and overcoming professional hostility.
The North West London pilot of integrated services was launched in 2001 to meet the needs of people with diabetes and those aged over 75. It brings together primary care, community services, acute care, social care and mental health. It aims to cut hospital use and nursing home admissions while reducing costs of services for diabetic and older patients by 24% over five years. The pilot is showing early signs of success, but clinicians explain that this is often despite NHS processes and not because of them. The article highlights the importance of listening to and involving patients and overcoming professional hostility.
Subject terms:
integrated services, NHS, older people, diabetes, health professionals;
The aim of this project is to have a champion in all care environments where older people receive care. The champions, who are experienced nurses and allied health professionals, attend an intensive two-day workshop of master classes by expert speakers with a focus on addressing values, attitudes and dignity. The intention is to improve care and support for older people; reduce stays in hospital; build reassurance and confidence in the care provided for older people in hospitals and other care environments; provide a proactive workforce to care effectively for a rising ageing population; and reduce the number of complaints.
The aim of this project is to have a champion in all care environments where older people receive care. The champions, who are experienced nurses and allied health professionals, attend an intensive two-day workshop of master classes by expert speakers with a focus on addressing values, attitudes and dignity. The intention is to improve care and support for older people; reduce stays in hospital; build reassurance and confidence in the care provided for older people in hospitals and other care environments; provide a proactive workforce to care effectively for a rising ageing population; and reduce the number of complaints.
Extended abstract:
Author
NATIONAL HEALTH SERVICE. West Midlands
Title
Achieving person-centred care for older people: Champions for Older People Project
Publisher
National Health Service. West Midlands , 2006
Summary
The aim of this project is to have a champion in all care environments where older people receive care. The champions, experienced nurses and allied health professionals, attend an intensive two-day workshop of master classes by expert speakers with a focus on addressing values, attitudes and dignity. The intention is to improve care and support for older people, reduce stays in hospital, build reassurance and confidence in the care provided for older people in hospitals and other care environments. provide a proactive workforce to care effectively for a rising ageing population, and reduce the number of complaints.
Context
Demographic shifts of an increasing older population, and particularly the numbers over 80, means mounting numbers of frail, vulnerable older people requiring more comprehensive, holistic and person-centred care. Given that the existing workforce may not be sufficient to meet this future need there is an urgent requirement to be creative with resources and engage with staff working with older people by improving and developing their skills and to embed this within education and training programmes. NHS West Midlands' Champions for Older People Project is a proactive and ambitious programme to tackle this head on: 180 Champions have attended the workshop and training with a focus on addressing values, attitudes and dignity. Evidence to support and drive the project came from a variety of sources. Benchmarking by the West Midlands' predecessor, the Birmingham and Black Country SHA on the National Service Framework for Older People, consistently found shortcomings in terms of adherence. The report by the Commission for Social Care Inspection, Audit Commission and Healthcare Commission 'A review of progress against the NSF for Older People' stated that some older people experienced poor standards of care on general hospital wards, and that all users of health and social care services deserve to be treated with dignity and respect. And a television programme showed frail elderly people enduring appalling conditions on a ward.
In the development of the programme it was considered imperative to listen to older people's views. This was reflected with user involvement within the team and addressing issues raised in a report for the Birmingham Advisory Council for Older People, 'Health in hospital: older people's experiences of being in hospital in Birmingham'. The team also learned from the DH report into Standard 4 projects and incorporated some of the best examples of practice across England . The programme dovetails into the national agenda and coincides with the major theme of 'Dignity in Care' in the recent 'A new ambition for old age: next steps in implementing the NSF for Old Age'.
Contents
The report begins with a letter explaining that this is a resource pack sent to those who attended the two-day workshop of master classes, defining an Older Person's Champion, explaining what such a Champion is, outlining their primary objectives for the next year - to cascade workshop presentations to colleagues and undertake service evaluation - and saying there will also be a dedicated website, mentors, Trust leads, champion network meetings, and dedicated presentations with speakers supporting the cascade sessions.
Section 1 is an introduction giving the background and context, ending with an outline of the programme structure and explaining that independent researchers have been commissioned to evaluate the programme and demonstrate if the project is making a difference particularly for sustainability in the future, service re-design and Trust ownership. It also outlines the next stage, which is to roll the project out to primary care and mental health trusts.
Section 2, the core of the pack, consists of the presentations with notes. Part A is about values and attitudes and discusses person-centred care. Part B covers safety: falls, elder abuse and protection of vulnerable adults, medicines management, and risk and independence. Part C discusses mental health, discussing dementia and depression, behaviour that challenges us and carers, and delirium and case studies. Part D is on dignity: end of life care, pain management, fluid balance and nutrition, privacy and dignity, continence/elimination, cultural issues, and hearing. Finally Part E discusses holistic care, with sub-sections on management rounds and on discharge planning and holistic care.
Section 3 contains documentation: the Champions Record of Training, learning outcomes, service evaluation, and the mentor's feedback form.
6 references
Subject terms:
NHS, nursing, older people, person-centred care, health care;
This long read sets out to examine the results for England of the first piece of research by the International Collaborative on Costs, Outcomes and Needs in Care (ICCONIC), which aims to advance international comparisons research by using patient-level data. The research focused on patients aged 65 and older admitted to hospital for hip fracture surgery and patients aged 65–90 hospitalised with heart failure and with a comorbidity of diabetes. Based on pre-pandemic data, the analysis is further evidence that the NHS in England remains a relatively low-cost health care system. The findings support previously stated concerns that the mortality rate in England among older patients with high needs is higher than average among comparable countries. England is performing relatively well in acute care according to the measures available (time to surgery and readmission rates), which suggests further scrutiny and investment may be needed to improve the availability and quality of post-acute care. The results also highlight potential opportunities to improve productivity – and free up additional capacity for tackling the backlog from the pandemic – by reducing length of stay in acute care for hip fractures. Hip fracture patients in England spend on average 21.7 days in hospital after their surgery, the highest of all 11 countries. It was not possible to adjust statistically for differences in comorbidities between countries, but we compared the number of comorbidities. England was towards the middle, so while case-mix adjustment may have reduced some of the differences we saw, it is unlikely to have eliminated them. With integrated care systems (ICSs) to be established as statutory bodies from April 2022, there is a clear opportunity to make a step change in terms of linking up patient data and using the insights generated to reduce delays in discharge and improve quality of care and patient experience.
(Edited publisher abstract)
This long read sets out to examine the results for England of the first piece of research by the International Collaborative on Costs, Outcomes and Needs in Care (ICCONIC), which aims to advance international comparisons research by using patient-level data. The research focused on patients aged 65 and older admitted to hospital for hip fracture surgery and patients aged 65–90 hospitalised with heart failure and with a comorbidity of diabetes. Based on pre-pandemic data, the analysis is further evidence that the NHS in England remains a relatively low-cost health care system. The findings support previously stated concerns that the mortality rate in England among older patients with high needs is higher than average among comparable countries. England is performing relatively well in acute care according to the measures available (time to surgery and readmission rates), which suggests further scrutiny and investment may be needed to improve the availability and quality of post-acute care. The results also highlight potential opportunities to improve productivity – and free up additional capacity for tackling the backlog from the pandemic – by reducing length of stay in acute care for hip fractures. Hip fracture patients in England spend on average 21.7 days in hospital after their surgery, the highest of all 11 countries. It was not possible to adjust statistically for differences in comorbidities between countries, but we compared the number of comorbidities. England was towards the middle, so while case-mix adjustment may have reduced some of the differences we saw, it is unlikely to have eliminated them. With integrated care systems (ICSs) to be established as statutory bodies from April 2022, there is a clear opportunity to make a step change in terms of linking up patient data and using the insights generated to reduce delays in discharge and improve quality of care and patient experience.
(Edited publisher abstract)
Subject terms:
Covid-19, older people, health care, comparative studies, comorbidity, complex needs, NHS;
Summarises the views of health and care leaders on the pressures facing the NHS and social care ahead of the Comprehensive Spending Review. Although most respondents are involved in planning for reduced spending, many leaders do not see how the efficiency savings required to free up an additional £22 billion for the NHS can be achieved: two thirds of survey respondents are not confident that their area has a credible local plan to make the efficiency savings needed this year, with half of respondents saying their area’s savings plans are dependent on reducing agency staff spend. Asked to choose from a list which non-NHS public service most deserved to be ring-fenced, 53.3 per cent selected spending on older people's social care: many panellists expressed the view that NHS and social care budgets should be viewed as being interdependent. 96 per cent of respondents thought it should be a high or moderate priority to deliver improved urgent seven-day services in line with NHS England clinical standards: the quality benefits of seven-day urgent services were clear to respondents; the cost implications less so. However, only 37.8 per cent believed seven-day elective services should be a high or moderate priority.
(Edited publisher abstract)
Summarises the views of health and care leaders on the pressures facing the NHS and social care ahead of the Comprehensive Spending Review. Although most respondents are involved in planning for reduced spending, many leaders do not see how the efficiency savings required to free up an additional £22 billion for the NHS can be achieved: two thirds of survey respondents are not confident that their area has a credible local plan to make the efficiency savings needed this year, with half of respondents saying their area’s savings plans are dependent on reducing agency staff spend. Asked to choose from a list which non-NHS public service most deserved to be ring-fenced, 53.3 per cent selected spending on older people's social care: many panellists expressed the view that NHS and social care budgets should be viewed as being interdependent. 96 per cent of respondents thought it should be a high or moderate priority to deliver improved urgent seven-day services in line with NHS England clinical standards: the quality benefits of seven-day urgent services were clear to respondents; the cost implications less so. However, only 37.8 per cent believed seven-day elective services should be a high or moderate priority.
(Edited publisher abstract)
Subject terms:
surveys, cutbacks, integrated care, older people, NHS, financing;
London School of Economics. Centre for Analysis of Social Exclusion
Publication year:
2015
Pagination:
210
Place of publication:
London
The report uses the Adult Inpatient Survey 2012 to build up an in-depth quantitative evidence base on older people’s experiences of dignity and nutrition during hospital stays in England. It shows that just under one-quarter of inpatients reported that they were not treated with dignity and respect, or were only sometimes treated with dignity and respect during their hospital stay. The analysis estimates that this is equivalent to around 2.8 million people on an annual basis - of whom about 1 million are aged 65 or over. Inconsistent and poor standards of help with eating during hospital stays were also a key concern. In 2012, about a quarter of all survey respondents indicated that they needed support with eating during their hospital stay. This is a substantial proportion and points towards the issue of support with eating being a major issue for significant numbers of inpatients – just under three and a half million each year - rather than being a marginal or specialist issue. Of those who needed help with eating, more than 1 in 3 reported that they only sometimes received enough help with eating from staff, or did not receive enough help from staff. Logistic regression analysis suggests that, after other factors are controlled for, the risk of not being helped with eating is significantly higher for women rather than men and for individuals who experience a longstanding limiting illness or disability such as deafness or blindness, a physical condition, a mental health condition or a learning difficulty, or a longstanding illness such as heart disease, stroke or cancer. Perceptions of inadequate nursing quantity and quality, and lack of choice of food, stand out as having consistent, large associations with lack of support with eating during hospital stays. The report concludes that there was a widespread and systematic pattern of inconsistent or poor standards of dignity and respect, and help with eating, in hospitals in England in 2012, and these were a significant general problem affecting inpatients in the vast majority of NHS acute hospital trusts
(Edited publisher abstract)
The report uses the Adult Inpatient Survey 2012 to build up an in-depth quantitative evidence base on older people’s experiences of dignity and nutrition during hospital stays in England. It shows that just under one-quarter of inpatients reported that they were not treated with dignity and respect, or were only sometimes treated with dignity and respect during their hospital stay. The analysis estimates that this is equivalent to around 2.8 million people on an annual basis - of whom about 1 million are aged 65 or over. Inconsistent and poor standards of help with eating during hospital stays were also a key concern. In 2012, about a quarter of all survey respondents indicated that they needed support with eating during their hospital stay. This is a substantial proportion and points towards the issue of support with eating being a major issue for significant numbers of inpatients – just under three and a half million each year - rather than being a marginal or specialist issue. Of those who needed help with eating, more than 1 in 3 reported that they only sometimes received enough help with eating from staff, or did not receive enough help from staff. Logistic regression analysis suggests that, after other factors are controlled for, the risk of not being helped with eating is significantly higher for women rather than men and for individuals who experience a longstanding limiting illness or disability such as deafness or blindness, a physical condition, a mental health condition or a learning difficulty, or a longstanding illness such as heart disease, stroke or cancer. Perceptions of inadequate nursing quantity and quality, and lack of choice of food, stand out as having consistent, large associations with lack of support with eating during hospital stays. The report concludes that there was a widespread and systematic pattern of inconsistent or poor standards of dignity and respect, and help with eating, in hospitals in England in 2012, and these were a significant general problem affecting inpatients in the vast majority of NHS acute hospital trusts
(Edited publisher abstract)
Subject terms:
surveys, older people, dignity, nutrition, user views, NHS, hospitals;
This Mandate reaffirms the government’s commitment to an NHS that remains available to all, based on clinical need and not ability to pay; and that is able to meet patients’ needs and expectations now and in the future. Specifically, it reflects the priority to transform NHS care provision for older people and those with complex needs. It is structured around five main areas where the government expects NHS England to make improvements: preventing people from dying prematurely; enhancing quality of life for people with long-term conditions; helping people to recover from episodes of ill health or following injury; ensuring that people have a positive experience of care; and treating and caring for people in a safe environment and protecting them from avoidable harm. Further sections of the Mandate cover: freeing the NHS to innovate; the broader role of the NHS in society; finance; and assessing progress and providing stability.
(Edited publisher abstract)
This Mandate reaffirms the government’s commitment to an NHS that remains available to all, based on clinical need and not ability to pay; and that is able to meet patients’ needs and expectations now and in the future. Specifically, it reflects the priority to transform NHS care provision for older people and those with complex needs. It is structured around five main areas where the government expects NHS England to make improvements: preventing people from dying prematurely; enhancing quality of life for people with long-term conditions; helping people to recover from episodes of ill health or following injury; ensuring that people have a positive experience of care; and treating and caring for people in a safe environment and protecting them from avoidable harm. Further sections of the Mandate cover: freeing the NHS to innovate; the broader role of the NHS in society; finance; and assessing progress and providing stability.
(Edited publisher abstract)
Subject terms:
older people, long term conditions, health care, NHS, quality of life, government policy;
One in three people aged over 65, and half of those aged over 80, fall at least once a year. Falls cost the NHS more than £2 billion per year. With the number of people aged 65 and over predicted to increase by 2 million by 2021, the costs incurred of treating patients across health, community and social care services are set to rise further. This paper uses Torbay’s unique patient-level linked data set to explore the NHS and social care costs of the care pathway for older people in the 12 months before and after being admitted to hospital as a result of a fall. On average, these costs for each patient who fell were almost four times as much in the 12 months after admission for a fall as the costs of the admission itself. Over the 12 months that followed admission for falls, costs were 70% higher than in the 12 months before the fall. Comparing the 12 months before and after a fall, the most dramatic increase was in community care costs (160%), compared to a 37% increase in social care costs and a 35% increase in acute hospital care costs. While falls patients in this study accounted for slightly more than 1% of Torbay’s over-65 population, in the 12 months that followed a fall, spending on their care accounted for 4% of the whole annual inpatient acute hospital spending, and 4% of the whole local adult social care budget. The authors discuss how linked health and social care data can be used to inform policy and practice. The findings strengthen the case for an integrated response for frail older people at risk of falls. However, to allow comparison of different models of care, other localities need to emulate Torbay’s recording and analysis of whole-system data at the patient level - which, to the authors' knowledge, is the first time that such detailed analysis of the costs in the health and social care system has been carried out in relation to falls patients in England.
(Edited publisher abstract)
One in three people aged over 65, and half of those aged over 80, fall at least once a year. Falls cost the NHS more than £2 billion per year. With the number of people aged 65 and over predicted to increase by 2 million by 2021, the costs incurred of treating patients across health, community and social care services are set to rise further. This paper uses Torbay’s unique patient-level linked data set to explore the NHS and social care costs of the care pathway for older people in the 12 months before and after being admitted to hospital as a result of a fall. On average, these costs for each patient who fell were almost four times as much in the 12 months after admission for a fall as the costs of the admission itself. Over the 12 months that followed admission for falls, costs were 70% higher than in the 12 months before the fall. Comparing the 12 months before and after a fall, the most dramatic increase was in community care costs (160%), compared to a 37% increase in social care costs and a 35% increase in acute hospital care costs. While falls patients in this study accounted for slightly more than 1% of Torbay’s over-65 population, in the 12 months that followed a fall, spending on their care accounted for 4% of the whole annual inpatient acute hospital spending, and 4% of the whole local adult social care budget. The authors discuss how linked health and social care data can be used to inform policy and practice. The findings strengthen the case for an integrated response for frail older people at risk of falls. However, to allow comparison of different models of care, other localities need to emulate Torbay’s recording and analysis of whole-system data at the patient level - which, to the authors' knowledge, is the first time that such detailed analysis of the costs in the health and social care system has been carried out in relation to falls patients in England.
(Edited publisher abstract)
Subject terms:
falls, older people, costs, care pathways, NHS, social care, community care;
Health Service Journal, 122(6318), 2012, pp.19-21.
Publisher:
Emap Healthcare
An increasing ageing population and greater demand for services means services need to be commissioned that are more patient centric, effective, better quality and lead to better outcomes. The Ali-Cameron model, developed by the authors, puts forward an alternative commissioning model which could ensure that NHS services are more effective. The principles used for developing the model include: patient-centred care; innovation; use of existing best practice; quick decision making; light bureaucracy; rapid implementation; and integrated care delivery. It aims to build on how GPs naturally make clinical and business decisions.
An increasing ageing population and greater demand for services means services need to be commissioned that are more patient centric, effective, better quality and lead to better outcomes. The Ali-Cameron model, developed by the authors, puts forward an alternative commissioning model which could ensure that NHS services are more effective. The principles used for developing the model include: patient-centred care; innovation; use of existing best practice; quick decision making; light bureaucracy; rapid implementation; and integrated care delivery. It aims to build on how GPs naturally make clinical and business decisions.
Subject terms:
NHS, models, older people, commissioning, general practitioners, health care;
Care navigators models were introduced by the NHS London Leading Workforce Transformation Programme to address the challenges of complex systems and to help those with long term conditions access services. This article reports on a care navigator model to address the unplanned use of services by older people at Central and North West London Foundation Trust which focused on improving information and advice on adult social care to help all local residents, including self-funders.
Care navigators models were introduced by the NHS London Leading Workforce Transformation Programme to address the challenges of complex systems and to help those with long term conditions access services. This article reports on a care navigator model to address the unplanned use of services by older people at Central and North West London Foundation Trust which focused on improving information and advice on adult social care to help all local residents, including self-funders.
Subject terms:
NHS, older people, referral, social services, access to information, access to services, adult social care;