future trends in health and social care
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Future trends in health and social care. Implications for Occupational Therapy Candace Imison Deputy Director of Policy. Overview. Key Trends Implications for the model of care Implications for Occupational Therapy Looking forward. Rising life expectancy. Rising numbers of older people. - PowerPoint PPT PresentationTRANSCRIPT
Future trends in health and social careImplications for Occupational Therapy
Candace ImisonDeputy Director of Policy
Overview
Key Trends
Implications for the model of care
Implications for Occupational Therapy
Looking forward
Rising life expectancy
Rising numbers of older people
Population lifestyles present significant risks to their health
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Obesity is associated with an increased risk of diseases including diabetes, heart disease, osteoarthritis and cancer.
Source: National Obesity Observatory 2012
Stroke - rising numbers reducing mortality
The number of people having a stroke is predicted to rise from 1.06 million people in 2010 to 1.25 million in 2020
Mortality rates from stroke halved from 1993 to 2010, and this trend is expected to continue as a result of continued improvements in treatment.
Number of arthritis sufferers double in < 20 years
Number of arthritis sufferers in the UK From 8.5 million =>17 million in 2030 (Arthritis Care 2012)
Growing numbers of people with long term conditions and multiple conditions
Rising care needs
Rising numbers children with learning disabilities
› By 2030 it is estimated that the number of younger adults with learning disabilities (aged 18 - 64) may rise by 32.2 per cent
› There has been reducing mortality among people with learning disabilities and among children with severe and complex needs (Emerson and Hatton 2008)
Projected number of younger adults with learning disabilities by 2030, thousands, England
Source: Snell et al 2011
More people living on their own
Unprecedented financial pressures
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Perc
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DP
4% real: £170 bn
0% real: £84 bn
Match GDP: £132 bn
OBR 2012: £136 bn
Actual
UK NHS spend 2014/15:
£132 bn
% Increase last 20 years
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65-84
85+
1989/90-2009/10
An ageing and more demanding population
NHS Spend
Source: DH - Departmental Report 2006
133% by 2035
Less deference, greater expectations, less solidarity?
24/7 services24/7 services
Instant accessInstant access
A “cure” or “vaccine” for certain cancers.
An increase in the number of lifestyle drugs available
Devices that have the capacity to replace or integrate with human tissue
Biosensors that allow continuous monitoring of a patient
Pharmacogenetics support more effective treatments
In the longer term stem cells provide capacity to replace or repair organs
Growing capacity to treat
Stem cell technology could “cure” joint disease
Regenerative Medicine
– Treat early-stage disease
– Aimed at returning to full health
Source: Dr E Draper, JRI Orthopaedics
Genomics – could deliver significant gains in quality
Costs of genetic coding falling dramatically
-Many potential benefits
-Many ethical issues
Apps in health care
providing information about servicesproviding information about conditions and treatmentssupporting self diagnosis, management and monitoringoffering professional support and educationsupporting clinical networks and sharing clinical opinion and adviceenabling the remote monitoring of patientssharing diagnostic images and information.
People in charge of their care
Service users will be able use secure web connections to make and check appointments, see lab results, renew prescriptions, and communicate with doctors, therapists and nurses.
Behaviour change is not easy
Patient activation – a key underlying issue
Emotion plays a key role in patient activation
Has a profound effect on health behaviours
Use patient activation measures - impactImproved quality of lifeImprovements in clinical indicatorsBetter adherence to treatmentReduced symptomsReduced readmissionsFewer visits to A&EFewer nights in hospitalBetter engagement with professionals
Patient activation – major driver of healthcare costs
Implications for services
Tailor services including staffing and information to reflect patient activation levelCoaching for least activated patientsMaximise opportunities for highly activated patients to manage their own careKey context for any self care intiative
Virtual visits – remove geographical barriers to access
Health care can be done at a distance with video conferencing and remote monitoring of blood sugar, blood pressure, heart rate, and other health data.
The case for integrated care
Poor co-ordination of care for people with long-term/complex illnesses leads to poor care experiences and adverse outcomesAge-related chronic conditions absorb the largest, and growing, share of health/social care activities Practical solution to tackle the socio-determinants of ill-health and pathology of the complex patientIncreasing attention to care co-ordination to create more integrated, cost effective and patient-centred services
Source: Nick GoodwinInternational Foundation for Integrated Care
Key issue – integrate mental and physical health support
Comprehensive hospital service
Traditional DGH
Self Care
Focussed factory
Networks
PopulationFocus
SpecialistsPrimary Care
CommunityCare
SocialCare
Comprehensive population health service
Torbay Care TrustHealth & Social Care CoordinatorFocal point of referrals to zone team•Coordinating response and building relationships•Dealing with public and local professionals•Ability to set up packages of care •Refer complex cases to MDT•Seen as significant improvement to GPs
Integrated OTFlexible OT Working •OT follows the client –Community/Hospital/Intermediate Care•Shared responsibility and problem solving•Reduced waiting lists/referrals•Higher skilled OTs with greater job satisfaction
Intermediate Care Teams•Significant investment into Community IC Services 7 days per week•Ability to respond rapidly to prevent escalation in need•Ability to facilitate earlier discharge•Managing complex elderly in a community setting•Working in partnership with GP colleagues
Torbay - ImpactMinimal delayed discharges from local DGH & fewest excess bed days in south westLowest non-elective LOS in the southwest & 4th lowest in the countryLowest occupied bed days for >75s patients with 2+ admissionsAcute beds reduced from 750 in 1998/99 to 528 in 2008/09I/C Access: 25% seen within 3½ hours; further 65% within 5 days95% of care packages available within 28 days & 99% of equipment available within 7 daysRes & nursing home placements reduced by 500 since Feb „06 –from 1,298 to 811 per week
Source: Torbay Care Trusthttp://www.torbaycaretrust.nhs.uk/aboutus/Documents/The%20Torbay%20Experience.pdf
Workforce to support integrated care
Source: Skills for Care – Evidence review – integrated health and social care 2013
Team working and service improvement – essential skills
Traditional connection between
one profession and one
particular type of work loosening
Team working – critical
More protocalised care
“All teach, all learn” not just to do
the job but how to improve it
Acquire skills and share skills
The future opportunities and challenges for occupational therapy
› Significant growing demand for OT skills
› Particular opportunities around combined mental and
physical skills
› Playing a key role in
› Supporting patient activation
› Teams to support integrated care
› Improving people’s quality of life and independence
› Need for greater professional visibility and voice
› Need for more flexible roles and new ways of working
Looking forward
• Time of significant challenge, flux and uncertainty
• Importance of value + values
• Demands significant leadership, knowledge management and influencing skills
• Take care of yourself“ Generating compassion for others begins with compassion for oneself “
Michael West