Acting without delay – How the independent sector is working with the NHS to reduce delayed discharge

NHS Confederation, June 2017

This report from the NHS Partners Network highlights examples where the independent sector is working with the NHS to avoid delayed discharges of care.  Reducing delayed discharge – where often frail and elderly patients are unable to leave hospital due to necessary care, support or accommodation in the community being unavailable – is arguably one of the biggest priorities for the NHS.

Delayed discharges and transfers of care (DTOCs) have a significant impact on the ability of NHS acute trusts to provide routine treatment such as elective surgery. It is vital, both for the patient and the trust, to be able to discharge patients speedily to avoid adverse effects to patient flow.

Recognising and managing frailty in primary care

This updated document summarises guidance and evidence for managing frailty. It is based on national guidance and existing sources of synthesised and quality-assessed evidence | University of York Centre for Health Economics | Yorkshire and Humber AHSN Improvement Academy

Image source: Keromi Keroyama – Flickr // CC BY 2.0

  • Frailty is a distinct health state where a minor event can trigger major changes in health from which the patient may fail to return to their previous level of health.
  • Simple tests that have been recommended by NICE for frailty in primary care are gait speed, self-reported health status and the PRISMA 7 questionnaire.
  • Exercise programmes, particularly high intensity interventions, may improve gait, balance and strength and have positive effects on fitness.
  • Medication review forms part of the holistic medical review of people with frailty.
  • Supported self-management can improve health outcomes. However, the value of case management is still to be proven.
  • Discussion about end-of-life care is important to most older people, but is often neglected.

Full document: Effectiveness Matters. Recognising and managing frailty in primary care

Innovations to improve care for older people

The Health Foundation has published details of four projects funded through the Innovation for Improvement programme.

The projects are using new and interesting approaches to improve care for older people and include people managing their own risk of getting a pressure ulcer; remote assessment using smart glasses; extending primary care teams; and continence promotion in care homes.

Support for carers

Thomas S, Dalton J, Harden M, Eastwood A, Parker G. Updated meta-review of evidence on support for carers. Health Serv Deliv Res 2017;5(12)

The University of York Centre for Reviews and Dissemination has published Updated meta-review of evidence on support for carers.

This review updates what is known about effective activities to support carers of ill, disabled or older adults.  The report concludes that there is no ‘one size fits all’ intervention to support carers but potential exists for effective support in specific groups of carers.

 

Care for older people

‘Worked up? Speak up’ – Care for older people campaign launches | Care Quality Commission

 

The aim of this campaign is to get more people aged 60 and over, and their friends and families, to share their experiences of health and social care. Research has shown that older people are less likely to complain about services and less aware of the different ways they can share their views.

Telecare is more than just technology – it has the power to create care networks for older people

Telecare is a range of remote care technologies and associated services that have been developed to accommodate an ageing population while helping people to stay in their homes | The Conversation

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Image source: Moyan Brenn – Flickr // CC BY 2.0

Over the next 25 years, the percentage of people aged over 85 is set to more than double, with one in four in this age group already counting as “frail”. In the over 65s, this is estimated at one in ten. At the same time, the number of people, such as family, who might be caregivers is reducing due to different patterns of marriage and parenting, people living apart at greater distances and more women in paid employment.

Traditionally, elderly people who need care in their own homes rely on paid or unpaid carers. Telecare can be thought of as a form of care at a distance, which can allow older and frailer people to live independently. While some might see a risk of decreasing social contact, it can provide safety and security to those people who because of mobility problems and other health issues are housebound. Telecare should be considered as an aid, not a solution to growing demands for care.

Telecare can provide some care on a personal level through attachments that can develop between users and telephone operators, who regularly check in with the telephone operators for weekly test calls.

Read the full blog post here

Helping older people maintain a healthy diet

This review of evidence looks at ‘what works’ in supporting older people to maintain a healthy diet and reduce the risk of malnutrition. | Public Health England

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Malnutrition in older people can have a significant impact on their health and social care needs.It has been estimated that the greater use of healthcare because of malnutrition results in:

  • 65% more GP visits
  • 82% more hospital admissions
  • 30% longer hospital stay

Identifying and treating malnutrition is an important preventative measure that will reduce demands on health and care services

This review of evidence is intended for anyone working on older people’s health, particularly those working on nutrition and those supporting older people in daily living. It reviews the relevant national standards, such as nutritional and catering standards, relevant NICE standards and guidance, national and international evidence.

Finally, it looks at promising practice from England, to see what others are doing and the impact their work is having. For the purposes of this study older people are defined as being aged 65 or over.

Full Impact assessment : Helping older people maintain a healthy diet: A review of what works