Look at the big picture of care for older people, says NHS Confederation

Dr Mark Newbold: 'Services [for older people] at home are not available at the time they need them'

The commission’s report, published on 28 January, says some of the most successful health and care systems used data to drive improvements, rather than passive monitoring of a system.

It says that the best systems used improvement methodologies to analyse where the problems in their urgent care system lay. They introduced a new approach and then measured the difference this made.

The report is aimed primarily at managers and commissioners. But the group was particularly impressed by cases where these methodologies were used by staff at all levels who were motivated and encouraged to drive the improvements.

Physiotherapist Esther Clift, a consultant practitioner trainee in frailty, told Frontline: ‘It’s absolutely critical that we help to devise some of the metrics and we’re included in the conversation about what makes appropriate and meaningful measurement.’

‘We need to find our voice to articulate what patients’ needs are, so that the metrics are multi-professional and meaningful to patients as well.’

A case study in the report about Sheffield Teaching Hospitals NHS Trust shows that five years ago older people admitted in an emergency had to wait about 5.5 days to be discharged once they were fit enough to leave hospital.

Patients now go home within an average of 1.1 days and one of the keys to addressing this issue was that the trust gathered data about processes and combined them patient stories.

Among the other key recommendations in the commission’s report are:

• a greater focus on proactive – rather than reactive – care
• more use of multidisciplinary teams that could operate in hospital and the community
• leaders should be encouraged to enable staff to innovate and produce their own solutions
• a new model for health and social care that focuses primarily on the needs and personal goals of individuals

The commission was set up in response to concerns that the care system was increasingly ill adapted to the needs of older people and particularly those with long-term conditions or frailty.

Dr Mark Newbold, chair of the commission, said: ‘Older people do need to access A&E at times, and the best hospitals tailor their service to meet their needs.

‘But all too often, they are forced to go to A&E because the alternative services to help them be cared for at home are not available at the time they need them.’