Effects of participating in community assets on quality of life and costs of care

Effects of participating in community assets on quality of life and costs of care: longitudinal cohort study of older people in England
BMJ Open 2020;10:e033186. doi: 10.1136/bmjopen-2019-033186
Current policy commits to substantial expansion of social prescribing to community assets, such as charity, voluntary or community groups. A prospective 18-month cohort survey (n=4377) of self-reported participation in community assets by older people with long-term conditions and quality of life linked to administrative care records concludes that participation is associated with improved quality of life and reduced costs of care.

Abstract

Measuring and optimising the efficiency of communityhospital inpatient care for older people: the MoCHA mixed-methods study.

Measuring and optimising the efficiency of community hospital inpatient care for older people: the MoCHA mixed-methods study.
Health Serv Deliv Res 2020;8(1) January 2020

• This study found that the efficiency of community hospital wards is comparable with acute hospitals and that modifiable performance factors might lead to potential efficiency savings.

Older adults: cost-effective commissioning: Return on Investment resources

Older adults: cost-effective commissioning
PHE 28 January 2020

• Return on investment resources to help local commissioners in designing and implementing services to support older people's healthy ageing. The tool can be adapted to local conditions, presents results showing the economic benefits of each intervention and has a built-in user guide.

Productive healthy ageing profile

Productive healthy ageing profile
PHE Fingertips tool

• The Productive healthy ageing tool (launched June 2019) provides data and further information on a wide range of topics relevant to healthy ageing. Indicators can be examined at local, regional or national level. The aim of this tool is to support PHE productive healthy ageing policy and inform public health leads and the wider public health system about relevant key issues.
• Also includes an extensive collection of further resources on a wide range of topics including falls, inequalities, early interventions, technology, care & support services, carers, mental health and wellbeing

Older Men at the Margins: Guidance for practitioners and services providing groups for older men.

Older Men at the Margins: Guidance for practitioners and services providing groups for older men.
Age UK April 2019

• The Older Men at the Margins project identified ways of alleviating loneliness and reducing isolation for older men across hard-to-reach and seldom-heard groups. 
• This guidance sets out the learning from the research and highlights important factors to be considered to meet the diverse needs of older men through group programmes and interventions. It will be of use to professionals and services who wish to set up groups, or who are already running groups for older people.

Improving community support for older people’s needs through commissioning third sector services: a qualitative study.

Improving community support for older people’s needs through commissioning third sector services: a qualitative study.
Journal of Health Services Research & Policy, 24(2), 116–123. 10 April 2019
https://doi.org/10.1177/1355819619829774
An exploration of the relationships between commissioning organisations and third sector organisations across one region of England, both with an interest in supporting the needs of older people identified a diversity of commissioning arrangements for third sector services. Service data, including assessments of needs and outcomes, were reported to commissioners, however commissioners did not appear to use this to full advantage to inform future commissioning decisions. 

Abstract

Better evaluations to support the needs of older people in the UK

Better evaluations to support the needs of older people in the UK
RAND Research Report 2019

• How can evaluations of complex interventions, such as services for older people in the UK, be improved? Findings from workshops with evaluators, commissioners of evaluations and services, and those delivering services:
• Evaluations were too often not focused on major challenges and consequently findings were 'unsurprising' or even trivial
• Evaluation findings were often not available when decisions had to be made.
• Evaluations were often designed as stand-alone pieces rather than building on previous evaluations and contributing to future evaluations
• Competition, a lack of clarity in communication, and poor knowledge management/mobilisation led to a reluctance to share information, pool data, or drew on the evaluations of potential competitors.
• Evaluations often failed to use routine data and ignored the costs imposed on service providers and users

Personalised Integrated Care Programme: Evaluation of impact on hospital activity

Personalised Integrated Care Programme: Evaluation of impact on hospital activity
Nuffield Trust 31 January 2019

• Age UK’s Personalised Integrated Care Programme (PICP) aims to improve the lives of older people through practical support, underpinned by a change in the way that the health and care system works together for these people locally. The scheme is targeted at older people who are deemed to be at risk of a future emergency admission.
• Detailed analysis (n=1996) concludes that it has almost certainly not been able to reduce costs or emergency admissions. While in some areas there was no apparent impact on hospital activity, overall there was a higher than expected use of emergency and outpatient services, and a corresponding increase in costs. 
• The results suggest that the scheme may be identifying unmet need in the population, which manifests in greater use of hospital care. 

The association between living alone and health care utilisation in older adults

The association between living alone and health care utilisation in older adults: a retrospective cohort study of electronic health records from a London general practice
BMC Geriatrics 2018 18:269 3 December 2018

• A retrospective analysis of health records of patients over the age of 64 living in south east London [n=1447], found that living alone was significantly associated with a higher probability of utilising emergency department (odds ratio 1.50) and general practitioner services (odd ratio 1.40).

Beyond barriers: how older people move between health and care in England

Beyond barriers: how older people move between health and care in England
CQC 2 July 2018
A review of local health and social care systems in 20 local authority areas found that 

• while individual organisations intended to work together but mostly focused on their own goals. 
• where there was good planning between services, the way services were funded did not support them to work together.
• organisations managed performance against their own responsibilities rather than how this affected older people, collected information for their own purposes and planned their workforce in isolation to other services.
• the regulatory framework focuses only on individual organisations.

Creative and Cultural Activities and Wellbeing in Later Life

Creative and Cultural Activities and Wellbeing in Later Life
Age UK, April 2018

• This report outlines the importance of participating in creative and cultural activities to maintain wellbeing as we get older. The research identifies the key factors that enable participation and enjoyment of cultural activities and those that present barriers to participation. 

Projections of multimorbidity in the older population in England to 2035

Projections of multimorbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model
Age and Ageing , 23 January 2018

• Two-thirds of adults aged over 65 are expected to be living with multiple health conditions (multi-morbidity) by 2035. Seventeen percent would be living with four or more diseases, double the number in 2015. Two-thirds of these people would have a mental illness like dementia or depression.
• Findings are based on a computer model using data on over 300,000 people from three UK population surveys.

Improving Hospital at Home for frail older people in Exeter

Improving Hospital at Home for frail older people: insights from a quality improvement project to
achieve change across regional health and social care sectors
BMC Health Services Research 2017v 17:387 https://doi.org/10.1186/s12913-017-2334-9 

• This paper describes use of rapid cycles of PDSA tests to support the development of a community based Hospital at Home service for older people in the Exeter sub-locality to enable appropriate admission avoidance and early supported discharge. 
• The new service included a single point of access for referrals, joint geriatrician and community rehabilitation practitioners review for both admission avoidance and early supported discharge, extended weekday and weekend working hours, and an acute hospital ‘step-down’ ward for patients who were no longer acutely unwell.
• While discharge destination, length of hospital stay and number of referrals to the community team remained stable this was achieved against a backdrop of intense financial pressures, significant community bed closures, and difficult relations between hospital and community services. 

Local NHS and social care system reviews - Interim report

Local system reviews Interim report
CQC 19 December 2017

• Local System Reviews aim to explore how well local NHS and social care systems work together to support and care for people aged over 65. This interim report pulls together learning from six local system reviews across Halton, Bracknell Forest, Stoke-on-Trent, Hartlepool, Manchester and Trafford.
• It finds that the ‘whole system approach’ that focuses on integrated and person-centred care is not being realised as best as it could. For too many people, the experience of moving between health and social care services can be confusing. Care is too often fragmented and people are often uncertain about who is coordinating their care. Many people are worrying about what support will be in place when they return home from hospital, or who will be there to give their carer a break from looking after them full-time.

Framework for maximising the use of care homes and use of therapy-led units for patients medically fit for discharge

Framework for maximising the use of care homes and use of therapy-led units for patients medically fit for discharge
NHS England 18 December 2017

• This best practice framework aims to address two models and the implementation approach that needs to be taken by STPs and their Provider Organisations to address winter pressures.
• These models aim to describe ways of working to maximise the appropriate use of care homes and describe an operating model for optimising care of cohorted patients in Therapy-Led Units, who are Medically Fit For Discharge.

Flow of patients between the NHS and social care - local performance metrics

Local area performance metrics
Department of Health, 29 November 2017

• A new dashboard which allows local areas of assess the flow of patients across the boundary between the NHS and social care. 
• It provides a set of six measures indicating how health and social care partners in every Local Authority area in England are performing at the interface between health and social care. Included in the dashboard is a breakdown of delayed days attributable to social care per 100,000 of the population and the equivalent for NHS-attributable delays. 
• The metrics are:
• Emergency Admissions (65+) per 100,000 65+ population 
• 90th percentile of length of stay for emergency admissions (65+) 
• TOTAL Delayed Days per day per 100,000 18+ population 
• Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/ rehabilitation services 
• Proportion of older people (65 and over) who are discharged from hospital who receive reablement/ rehabilitation services 
• Proportion of discharges (following emergency admissions) which occur at the weekend 

When I’m 64 - The ILC-UK factpack on retirement transitions

When I’m 64 - The ILC-UK factpack on retirement transitions
International Longevity Centre UK 24 November 2017

• An exploration of retirement transitions and the experiences of today's 64 year olds with earlier generations in particular life expectancy, health status, inequalities and retirement age.

Recognising and managing frailty in primary care

Recognising and managing frailty in primary care
Centre for Reviews and Dissemination, University of York, May 2017

• A summary of guidance and evidence about recognising and managing frailty in primary care.
• Includes Key actions for the recognition and management of frailty in primary care.

Health and housing: building the evidence base

Health and housing: building the evidence base
Housing LIN, 3 April 2017

• This evidence review suggests that closer working between the NHS and the housing sector can help reduce hospital admissions and emergency department visits, speed up the discharge of older patients and maintain the independence of older people.

Sharing good practice will address barriers around discharge delays

Discharging older people from acute hospitals
Public Accounts Committee 19 July 2016

• The National Audit Office has estimated a gross cost of around £800 million a year for the NHS of older patients delayed in hospital when they no longer benefit from being there. 
• The committee concludes that the DofH NHS England rely too easily on differing local circumstances as a catch-all excuse for not securing improvement in performance and should be doing more to increase the pace of integration and make local accountability systems more effective.
• The DofH, NHS England and NHS Improvement have failed to address long-standing barriers to the health and social care sectors sharing information and taking up good practice resulting in unacceptable variation in local performance.