Main contact: Dr Elena Schmidt
Project team: Dr Elena Schmidt (Principal Investigator), Dr Patrick Tobi, (Co-Investigator), Shahana Lais, Dr Jurgen Schmidt, Dr Amber Siddiqui, Hena Wali Haque, Dr Usman Siddiqui
Start date: 8th December 2008
End date: 31st May 2009
Project funder: NHS Havering
Background
The treatment of patients with long-term conditions (LTCs) is the key challenge to health care systems today. In England long-term illnesses affect the lives of one in three people. The burden of disease is particularly severe among older people. LTCs have a significant impact on the NHS, patients with chronic conditions account for 65% of all outpatient activity. The available evidence suggests that integrated care provided by multidisciplinary teams using common patient databases and risk assessment may lead to more efficient delivery of services, higher levels of patient satisfaction and improvements in patient quality of life. Havering has a rapidly ageing population. Older people constitute 17.5% of the population, which is significantly higher than the averages for London and England. By 2023 the population of over 65s is predicted to grow by about a quarter. Older people with complex chronic conditions are intensive users of health and social care services. Over 65s with long term conditions in Havering account for around 4,300 emergency hospital admissions, which cost about £13.8 million a year.
Aims
The aim of this project is to produce information and intelligence to inform the development of the Pilot Integrated Case Management programme for people with complex LTCs aged 65 years and over in Havering.
The work included:
Methods
The review has been based on the principles of the whole system approach and used multiple data collection methods, including semi-structured interviews with service providers, in-depth interviews with service users, documentary analysis and GIS mapping.
Stakeholder organisations (service providers) have been selected by purposive sampling using a range of local and regional databases. In total, 123 informants have been selected and 79 agreed to participate (response rate 64.2%). The interviewees represented NHS Havering, the Autonomous Provider Organisation, GP practices, social services, care homes and domiciliary agencies, Voluntary Sector Organisation,hospital trusts, mental health services, Ambulance service and pharmacies.
Ten service users have been selected by convenience sample and provided a broad cross section of men and women over 65 with differing ages, health conditions and living arrangements. Six of the interviewees were male. The median age was 73 years (range 65-88 years). Two informants were carers. All service user interviews were recorded on audio tape and transcribed verbatim for thematic analysis.
Documents/References:
The review of services indicated that NHS Havering and the London Borough of Havering are in the beginning of their trajectory towards an Integrated case management model: Some of the basic elemts of ICM, such as case managers, have been introduced; the need for integration of information systems, risk assessment processes and care pathways is widely recognized; an array of community-based services is either present or being developed; there are examples of effective cooperation between the statutory and voluntary sectors and between the statutory and private providers; there are examples of shared budgets and shared commissioning; and more importantly, most stakeholders are acutely aware of the importance of standardised operating procedures; breaking down the boundaries between the primary and secondary care; and acccess to jointly held and accessible patient information.
The main weaknesses encountered in the review relate to the functional aspects of service delivery: Most services operate individual, isolated databases, set up for the specific needs of one service; there is the lack of a unified referral system and a large number of stakeholders do not use any standard procedure for referrals; much communication about patient data occurs in a non-structured way; there are no unified criteria for risk assessment; some agencies do not perform any risk assessment and do not develop any care plans; many frontline staff lack information about the services available within the system; a Single Point of Access is at the first stage of development and very few stakeholders know about it or are able to use it. There are multiple procedures and indicators to measure organisational performance and outcomes of services; almost no agency measures or knows how to measure patients' quality of life.
The service user interviews showed a variety of opinions on personal health, quality oflife and availability of services reflecting a diversity of individual needs, personal circumstances and expectations of over 65s living in Havering. Provision of services by GPs is perceived as satisfactory but there is a feeling that GPs should provide more flexible appointments, visit patients at home and respond better to the needs of patients with dementia. Opinions about hospital care varied considerably. Most service users found hospital doctors helpful but some had complaints about nursing staff. A number of respondents were critical about social care. Many interviewees did not know what social support is available for over 65s, who is eligible or where they could ask for help; co-ordination between NHS and social services was perceived as poor. Care home services are generally well received, but these are largely privately paid and beyond the means of those on low incomes; Acitivities organised by the voluntary sector received positive feedback but the current provision of recreational services is reported to be limited and the service users have low awareness of what is available in the Borough.
The project results have been presented to the Havering Steering Committee on Integrated Care and to the Commissioners' Forum. The recommendations of the project will form the basis of a Pilot Integrates Case management project, which will be implemented in the next five years as an innovative approach to the delivery of care for over 65s. If successful, the new approach can significantly improve the relationship between different servce providers, lead to a more efficient use of resources and improve patients' quality of life.
All documents are available from the Institute for Health and Human Development and NHS Havering.
© 2010
For a general description of these pages and an explanation of how they should work with screenreading equipment please follow this link:Link to general description
For further information on this web site's accessibility features please follow this link:Link to accessibility information
The following message does not apply to screenreader users:
You will still be able to access all the essential content of this web site, but it will not look, or function, exactly as intended.
