Future trends in health and social care

1. Future trends in health and social care Implications for Occupational Therapy Candace Imison Deputy Director of Policy

2. Overview • Key Trends • Implications for the model of care • Implications for Occupational Therapy • Looking forward

3. Rising life expectancy

4. Rising numbers of older people

7. Population lifestyles present significant risks to their health

8. Obesity is associated with an increased risk of diseases including diabetes, heart disease, osteoarthritis and cancer.  Source: National Obesity Observatory 2012

9. 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.

10. Number of arthritis sufferers double in < 20 years Number of arthritis sufferers in the UK From 8.5million =>17 million in 2030 (Arthritis Care 2012)

11. Growing numbers of people with long term conditions and multiple conditions

12. Rising care needs

13. 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

15. More people living on their own

16. Unprecedented financial pressures

17. An ageing and more demanding population % Increase last 20 years NHS Spend 0-64 65-84 85+ 1989/90-2009/10 Source: DH - Departmental Report 2006 133% by 2035

18. Less deference, greater expectations, less solidarity? 24/7 services Instant access

19. Growing capacity to treat • 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

20. Regenerative Medicine Treat early-stage disease Aimed at returning to full health Stem cell technology could “cure” joint disease Source: Dr E Draper, JRI Orthopaedics

21. Genomics – could deliver significant gains in quality Costs of genetic coding falling dramatically • Many potential benefits • Many ethical issues

22. Apps in health care • providing information about services • providing information about conditions and treatments • supporting self diagnosis, management and monitoring • offering professional support and education • supporting clinical networks and sharing clinical opinion and advice • enabling the remote monitoring of patients • sharing diagnostic images and information.

23. 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.

24. Behaviour change is not easy

25. Patient activation – a key underlying issue

26. Emotion plays a key role in patient activation

27. Has a profound effect on health behaviours

28. Use patient activation measures - impact • Improved quality of life • Improvements in clinical indicators • Better adherence to treatment • Reduced symptoms • Reduced readmissions • Fewer visits to A&E • Fewer nights in hospital • Better engagement with professionals

29. Patient activation – major driver of healthcare costs

30. Tailor services including staffing and information to reflect patient activation level Coaching for least activated patients Maximise opportunities for highly activated patients to manage their own care Key context for any self care intiative Implications for services

31. 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.

32. The case for integrated care • Poor co-ordination of care for people with long-term/complex illnesses leads to poor care experiences and adverse outcomes • Age-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 patient • Increasing attention to care co-ordination to create more integrated, cost effective and patient-centred services Source: Nick Goodwin International Foundation for Integrated Care

33. Key issue – integrate mental and physical health support

34. Comprehensive hospital service Comprehensive population health service Focussed factory Networks Population Focus Primary Care Specialists Traditional DGH Self Care Social Care Community Care

35. Torbay Care Trust Health & Social Care Coordinator Focal 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 OT Flexible 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

36. Torbay - Impact • Minimal delayed discharges from local DGH & fewest excess bed days in south west • Lowest non-elective LOS in the southwest & 4th lowest in the country • Lowest occupied bed days for >75s patients with 2+ admissions • Acute beds reduced from 750 in 1998/99 to 528 in 2008/09 • I/C Access: 25% seen within 3½ hours; further 65% within 5 days • 95% of care packages available within 28 days & 99% of equipment available within 7 days • Res & nursing home placements reduced by 500 since Feb „06 –from 1,298 to 811 per week Source: Torbay Care Trust http://www.torbaycaretrust.nhs.uk/aboutus/Documents/The%20Torbay%20Experience.pdf

37. Workforce to support integrated care Source: Skills for Care – Evidence review – integrated health and social care 2013

38. 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

39. 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

40. 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