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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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