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Strategy for Older People III
Yesterday saw the Welsh Government launch its Strategy for Older People in Wales phase 3 document. Wales has had such a strategy since 2003, and yesterday’s document represents its latest incarnation. Along with the establishment of the Older People’s Commissioner for Wales and a network of older People’s Champions across the nation, the Strategy for Older People has given Wales the right structure to make our country a great place to grow old. But is that structure and intent matched by action?
The previous two iterations of the Strategy (the first running from 2003-2008, and the second from 2008-2013) were lengthy documents, full of worthy ambition and admirable rhetoric – but the latest incarnation feels like a game-changing document, much more focussed on strategic-level changes, and crucially is much more explicit about how its impact will be measured so we can evaluate whether change has been achieved. This is instantly apparent when comparing the new Strategy with its erstwhile colleagues. It runs for ten years rather than five, meaning it can have a longer-term outlook to focus on structural change rather than ‘quick wins’. It covers the whole gamete of state services rather than focussing too heavily on health and social care. It is also (mercifully) shorter, snappier, and has clear messages about what will be delivered and what ‘good’ will look like if change is secured.
Royal Voluntary Service Cymru strongly welcomes the document, but in particular we are encouraged by the twin sections on Social and Environmental Resources.
The former highlights the importance of social wellbeing for older people – something which we know from our Shaping Our Age study to be a key determinant of quality of life. The Strategy talks at length about wellbeing, and cites key evidence linking social isolation with poor health and early death. Even more importantly, the Strategy makes a commitment to monitor loneliness and engagement amongst older people as a key indicator of success – something which will transform how we look at so-called ‘softer’ interventions such as befriending schemes and lunch clubs. From our own work with older people, we know that these services, far from being ‘low-level’ assistance, are actually seen as vital to helping older people feel independent and valued.
The other key section, on Environmental Resources, reflects just how important the built environment and community services are to older people. That includes public realm issues – making adequate provision for public toilets, street lighting and park benches, which collectively make for age-friendly communities – but it also includes lifeline services such as transport. It is hugely encouraging to see the Strategy recognise that Welsh community transport currently is not sufficient to meet older people’s needs. Yet at the same time, we know that community transport has a return on investment of £3 for every £1 spent. By monitoring the number of community transport journeys as a key indicator in the future, we can start to improve older people’s lives in Wales.
This is the start of a long ten-year journey to turn ambition into reality – and there will of course be challenges on the way around implementation. But a Strategy which identifies the right issues, sets out clear ambition to deliver them and explicitly identifies how success will be measured is a very encouraging start. Royal Voluntary Service Cymru looks forward to working with the Welsh Government to make it happen.
Posted by at 00:00
Thursday, 23 May 2013.
Will the crisis in A&E increase pace in integrated health and social care?
This last week has seen some historic announcements that should have a lasting impact on the future of health and social care. Last Friday saw the publication of the draft Care and Support Bill after its public consultation and pre legislative scrutiny by the Joint Committee, led by Paul Burstow MP. The draft Bill has been amended and much improved. But there is still a way to go and many more amendments are expected as the Bill passes through report and committee stages in parliament.
Tuesday of this week saw the announcement by minister Norman Lamb MP, of plans to quicken the pace of joined up and integrated health and social care. This new initiative has been backed by health and social care leaders through a "shared commitment" to deliver integration, whose signatories include the Association of Directors of Adult Social Services, Local Government Association, Monitor and NHS England, as well as the Department of Health. Sign up by these bodies is critical to the success of these ambitious plans.
The goal is to deliver an improvement in service users' experience of care and getting much better value for money from health and social care. Barrier to integration will be removed. Far too many older people experience failures in integrated care and don’t receive the right support at the right time that could improve outcomes and save money. A number of local pioneers will be established. By the end of the year new indicators of progress on co-ordinating care and support, based on service user's experiences will be set up to gauge progress on integration. National Voices will set out what good integrated care looks like for service users.
But this will all be locally led with no central blue print. The concept of integrated health and social care is not new and there are good examples out there already. Will this plan with its new pioneers make a difference to the levels and pace of change? This week there is continuing hand wringing over the delays at over stretched A&E departments around the country. We know that emergency readmissions of those aged 75 and over, within 28 days of discharge have risen from over 187k to over 201k in the past year alone. At the last count, delays in discharging older people from hospital beds accounted for some 76% of all adult delays. Proper integration of health and social care isn’t a luxury or a nice to have but essential if the A&E services and hospitals can focus on the service for which they were set up to do. It is possible that the crisis around A&E will be as much a driver to integrate health and social care as the new Government announced plan.
The report Integrated Care and Support: Our Shared Commitment acknowledges that all sectors working together can provide older people with support to remain in their own home and that they don’t end up being discharged from a service into a void. At present to much of the systems financial resource is spent in the acute sector that would be better spent in the community. The authorities need to work in cooperation with all organisations including those in the charitable sector, like WRVS, who can provide the support and the resources to make the aim of integrated health and social care a reality.
Posted by Steve Smith Public Affairs Manager (England) at 00:00
Thursday, 16 May 2013.