This practical guidance has been written to help commissioners, service providers, nurses, medical, and allied health professionals, understand the difference care and compassion can make to the service experience of frail older people, and also to the financial situation of health and social care organisations. The guide covers the following themes:
- Reducing healthcare-related harm
- Care with compassion
- Case finding and assessment
- Levers and incentives
- Measuring outcomes
The authors believe that the implementation of this integrated care pathway “has the power to transform the way vulnerable older people experience health and social care”.
High quality care for all
Page 6 illustrates with a pyramid, how NHS England will ensure that its vision for high quality care will be delivered to all. It shows what they mean by quality services, the goals they are aiming to achieve, and what patients are looking for.
The main purpose of this pathway is to avoid frail older people reaching crisis point, causing them harm, and requiring emergency care, which puts stress on the patient and on the services. The guide provides the tools and good practice examples to show commissioners how they can better manage care delivered to the elderly.
There is a greater risk of avoidable harm in the elderly compared to younger people, mainly because of:
- Medication errors – more likely to happen when people take multiple medicines;
- Falls – other conditions increase the risk of falls in the elderly, such as poor eyesight, delirium, and heart problems;
- Pressure ulcers – as older people become more sedentary or are restricted to bed due to other illness;
- Emergency admissions – where the care delivered may not be the most appropriate for the patient but is the best available at the time.
And of course, treating patients with this integrated care pathway will not only improve their patient experience, but also ensure that health and social care services are delivered to the right people at the right time. This means that commissioners and service providers will be able to plan their services and allocate resources more efficiently.
Tools, interventions and outcome measurement
The “high quality care for all” pyramid clearly depicts the vision of NHS England. There are details of scales, such as The Edmonton Frail Scale, being developed to help identify frail people, so that they can receive the right care at the right time, rather than leaving it until they require emergency care. Examples of interventions to support the elderly include:
- Maintaining healthy activity and independent living;
- Coping well with long-term conditions;
- Coping well with complicated, multiple conditions;
- Quick and easy support close to home during times of crisis;
- Good acute hospital care when necessary;
- Good discharge planning and support;
- Good rehabilitation services;
- Appropriate high quality nursing and residential care;
- Dignified and respectful end of life care.
The authors recommend that measures for evaluating implementation of the pathway should include the following aspects, and they provide examples of suggested measures in an accompanying table:
- Patient experience;
- Harm reduction/avoidance;
- Quality of life;
- Support systems; and
- Cost savings.
It is important that the measures are decided at the start of the implementation process, so that everyone is clear what outcomes they are aiming for.
This document is full of useful supporting material and practical assistance, including, case studies from 14 sites around England, scales and the list of best interventions. Commissioners and providers should choose the best scales that they should use for their patient population. Teams in clinical commissioning groups and provider organisations should think about each of the interventions described and should see if they are implemented and if not, how they can be. An important step which should be carried out at the start of implementing this pathway, is to think about which outcomes need to be measured, thus ensuring that you easily identify where your interventions are beneficial or not. This will require strong communication channels and multidisciplinary team working and commitment by all involved in the care pathway.
Safe, compassionate care for frail older people using an integrated care pathway: practical guidance for commissioners, providers and nursing, medical and allied health professional leaders (PDF)
NHS England, South
Making our health and care systems fit for an ageing population (PDF)
D Oliver, C Foot, R Humphries
The King’s Fund