TS

A

TS

LSA

A

AA

TSA

LLS

LT

HEALTH AND SOCIAL CARE SUBSTITUTION NOW

Home Community Secondary Hospital

Tertiary Hospital

Social Care

Substitution typeL LocationT TechnologyS Staff and/or skillsA All

Patient pathwayThe Welsh Institute for Health and Social Care

A

A

A

A

AA

TS

LLS

LT

HEALTH AND SOCIAL CARE - 2050

Primary Home and Self Care

Secondary Community Care

Social Care

Substitution typeL LocationT TechnologyS Staff and/or skillsA All

Patient pathwayThe Welsh Institute for Health and Social Care

Tertiary DX and TX Daycare Science

Centres

HEALTHCARE POLICY 2020TOWARDS A HOSPITAL FREE NHS

MORTON WARNER

THE BURDEN OF DISEASE FOR TOP TEN LEADING CAUSES OF

DALYs, IN MILLLIONS, IN 2020, DEVELOPED REGIONS

Males

Disease or Injury DALYs Cum%

All Causes 95.1

1. Ischaemic heart disease 12.3 12.9

2. Cerebrovascular disease 5.6 18.8

3. Trachea, bronchus & lung 5.5 24.6

cancers

4. Alcohol use 5.2 30.1

5. Road Traffic Accidents 4.8 35.1

6. Unipolar major disorder 3.4 38.7

7. Chronic obstructive 3.2 42.0

pulmonary disease

8. Self-inflicted injuries 2.9 45.1

9 Oesteoarthritis 2.2 47.4

10.Dementia & other 2.1 49.6

degenerative & hereditary

CNS disorders

Source: Murray CJL & Lopez AD (1996) Quantifying Global Health Risks: Estimates of the Burden of Disease and Attributable to Selected Risk Factors. Cambridge, Mass: Harvard Press.

Females

Disease or Injury DALYs Cum%

All Causes 65.4

1. Unipolar major disorder 6.4 9.8

2. Ischaemic heart disease 5.7 18.5

3. Cerebrovascular disease 4.3 25.1

4. Osteoarthritis 3.4 30.3

5. Dementia & other 3.4 35.5

degenerative & other

hereditary CNS disorders

6. Road traffic accidents 2.0 38.7

7. Chronic obstructive 1.7 41.3

pulmonary disease

8. Trachea, bronchus & 1.7 44.0

lung cancers

9. Breast cancer 1.7 46.6

10. Diabetes mellitus 1.4 48.7

REDUCING OLDER AGE SELF-CARE DEFICITS THROUGH ENABLING TECHNOLOGIES

Self-Care Deficits Possible Technology Interventions

•Functional•Knowledge•Communication•Environment

Bundles 3 - 8: Specific to 6 DALYs self-care deficits

Bundles 2: Generic to all DALYs self-care deficits

Bundle 1: All older people’s general needs

Soft Hard technologies

Situation 1 Situation 2 Situation 3

Default- Institutional Full use of existing Use of future

care required now technologies - increased technologies - increased

home care? home care?

SELF CARE DEFICITS AND OLDER PEOPLE NEEDS

•Ischaemic heart disease

•Cerebrovascular disease

•Unipolar major disorder

•Trachea, bronchus & lung cancers

•Osteoarthritis

•Dementia & other degenerative CNS disorders

DALY Groups

Functional

Knowledge

Communication

Communicating

with

Environment

Deficit Areas

Special Needs

Activities of daily living; instrumental activities of relating to fluid and nutrition intake, chewing, elimination, mobility, medication management cognitive impairment

Knowledge relating to diet, fluid intake, bowel and urinary function, disease management, availability of support services

Isolated residential location, lack of transport, absence of communication devices eg telephone, hearing aid, physical or cognitive impairment of speech and language. Housebound due to physical or cognitive impairment or mental condition

Inability to control environment, eg heating, lighting; difficulty manipulating household fixtures eg doors, taps, associated with physical or cognitive problems. Issues associated with sensory loss, particularly safety.

ACTIONS AND BUNDLE TECHNOLOGY NEED FOR HEALTHY ELDERLY

LOW (£) MID (£) HIGH (£)NO BUNDLE 1000 MOVE 14,040,000 14,820,000 19,292,000

BUNDLE 2 543 HOME457 MOVE

TOTAL 1000

2,110,6416,416,280

8,526,921

5,404,4796,772,740

12,177,219

8,697,7748,816,444

17,514,218

BUNDLE 3 543 HOME (BUNDLE 2)402 HOME (BUNDLE 3)

55 MOVE

TOTAL 1000

2,110,6414,008,744772,200

6,891,585

5,404,4799,819,654815,100

16,039,233

8,697,77415,6301621,061,060

25,388,996

ACTIONS AND BUNDLE TECHNOLOGYY NEEDED FOR FRAIL ELDERLY

Actions 1. Comprehensive general assessment

2. Define care plan to meet elderly needs

3. Rehabilitation

4. Define follow-up strategies

5. Plan re-assessment

6. Home hazard assessment

7. Installation of assistive devices

Refined Bundle 2

• Addition to multidisciplinary team of technician, geriatrician, chiropodist, social worker

• Assistive devices to match patient’s needs (from list in Table 5.2b and 5.2c)

COHORTS DISTRIBUTION BY AGE GROUP AND GENDER

[8 missing data returns]

Frequencies (%)Cohort 1 (awaiting or very recently

admitted to institutional care)Cohort 2 (discharged from DGH to

community hospital)Age Groups

Male Female Male Female

Up to 64 2 (5.7) 0 7 (13.0) 9 (10.6)

65 – 69 1 (2.9) 3 (3.6) 8 (14.8) 6 (7.1)

70 – 74 4 (11.4) 5 (6.0) 9 (16.7) 7 (8.2)

75 – 79 6 (17.0) 8 (9.5) 14 (26.0) 20 (23.6)

80 – 84 5 (14.1) 12 (14.3) 9 (16.7) 22 (25.9)

85 – 89 10 (28.6) 28 (33.3) 5 (9.3) 11 (12.9)

90+ 7 (20.0) 28 (33.3) 2 (3.7) 10 (11.8)

Total 35 (100) 84 (100) 54 (100) 85 (100)

ABILITY TO STAY AT HOME WITH TECHNOLOGY BUNDLES AVAILABLE, WITH AND WITHOUT

EXISTING INFORMAL CARER

Care at homewith Bundle 2

only

Care at homewith Bundle 3 in

addition

Institutionalcare required

Total

Carer exists 54 39 6 99

Carer does not exist 15 12 1 28

Cohort 1 (awaitingor very recentlyadmitted toinstitutional care) Total 69 51 7 127

Carer exists 41 16 24 81

Carer does not exist 54 2 2 58

Cohort 2(discharged fromDGH to Communityhospital) Total 95 18 26 139

COSTS / 1000 OLDER PEOPLE / YEAR (INITIAL YEAR): HOME v RESIDENTIAL AND NURSING HOME CARE

LOW (£) MID (£) HIGH (£)NO BUNDLE 1000 MOVE 14,040,000 14,820,000 19,292,000

BUNDLE 2 543 HOME457 MOVE

TOTAL 1000

2,110,6416,416,280

8,526,921

5,404,4796,772,740

12,177,219

8,697,7748,816,444

17,514,218

BUNDLE 3 543 HOME (BUNDLE 2)402 HOME (BUNDLE 3)

55 MOVE

TOTAL 1000

2,110,6414,008,744772,200

6,891,585

5,404,4799,819,654815,100

16,039,233

8,697,77415,6301621,061,060

25,388,996

COSTS / 1000 OLDER PEOPLE / YEAR (SUBSEQUENT YEARS): HOME v RESIDENTIAL AND NURSING HOME

CARE

COSTS / 1000 OLDER PEOPLE / YEAR : COMMUNITY HOSPITAL v DIRECT RETURN TO HOME FOLLOWING

STAY IN DISTRICT GENERAL HOSPITAL

LOW (£) MID (£) HIGH (£)NO BUNDLE 1000 to community hospital 1,940,000 3,880,000 5,820,000

BUNDLE 2 683 directly home317 to community hospital

Total = 1000

2,654,821614,980

3,269,801

6,797,8991,229,960

8,027,859

10,940,2941,844,940

12,785,234BUNDLE 3 683 directly home (bundle 2)

130 directly home (bundle 3)187 to community hospital

Total = 1000

2,654,8211,296,360362,780

4,313,961

6,797,8993,175,510725,560

10,698,969

10,940,2945,054,5301,088,340

17,083,164

A. Local authorities will need to reconsider housing and community regeneration policies and programmes to include smart home adaptations of vacant properties.

B. The provision of a capital trust fund and extra monies for start-up costs. The NHS should enter into a partnership with local authorities to manage the processes.

C. Flexitibilities in provision to accommodate the changing state of frail elderly people.

D. Need linked on a timely basis to supply logistics with well-ordered ‘just in time’ systems.

E. Equipment maintenance undertaken in such a way as to diminish down time.

AVAILABILITY OF TECHNOLOGY BUNDLES: SAVINGS IN INITIAL AND SUBSEQUENT YEARS, FOR THREE LEVELS OF CARE, BY %

CARE REQUIREMENTS

LOW MEDIUM HIGH

A. Availability of Bundle 2(54.3% stay at home; 45.7%go into care)

B. Availability of Bundles2 and 3 (94.5% stay at home;5.5% go into care)

Savings, Year 1 %

Subsequent Years%

28.6

47.2

17.8

23.4

9.2

12.0

Savings, Year 1 %

Subsequent Years%

50.9

70.7

[ 8.1 ]

17.8

[ 31.6 ]

[ 6.0 ]

PROJECT SHIFT

Morton Warner