Integrated care is key for dementia patients | Letters

If dementia is now a leading cause of death in England and Wales (Report, 15 November), this is partly due to increasing awareness and diagnosis of dementia, along with improving treatments for general medical disorders. These figures highlight the need for science-driven, clinically oriented research to improve diagnosis and treatment. There is currently research investigating the earliest brain changes associated with dementia, and development of novel pharmacological and psychotherapeutic interventions to improve outcomes.

However, these figures also highlight the urgent need to improve access to advance care planning and palliative care for patients who have end-stage dementia. Patients with advancing dementia experience significant psychiatric and medical comorbidities, which can pose difficult management issues for relatives and attending physicians. Advance care planning is a targeted intervention that promotes autonomy in end-of-life decisions, before individuals lose decision-making capacity.

Multidisciplinary working, involving psychiatrists, physicians and other health professionals, is required to facilitate holistic and dignified care. Service development, as well as research, is required to tackle the challenges that dementia poses, especially at the end of life.
Dr Kethan D Jethwa
Leicester

• Alzheimer’s dementia increases in incidence with age, and there is no effective treatment. It is therefore inevitable that, as longevity increases, more cases will be reported. As a consequence, more people die with the disease, but this does not mean that it was necessarily the cause of death, nor that the underlying incidence of Alzheimer’s is increasing.
Dr Bob Bury
Leeds

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Integrated care is key for dementia patients | Letters

Are private health budgets the solution to integrated care?

‘Pulling well being and social care personalized budgets into one pot will aid make support about them a lot more integrated and responsive.’ Photograph: Alamy

Integration employed to suggest common assessments, merged teams and management restructures. Occasions have altered, and it’s no longer just about shifting occupation titles and Tupe – Transfer of Undertakings (Safety of Employment). Above the last handful of years the health and social care method has begun to embrace the concept of “man or woman-centred, co-ordinated care” that shifts the target from organisations back to the knowledge of the man or woman needing assistance.

Some of this has turn into necessary simply because men and women obtaining care are no longer willing to accept that specific models of institutionalised provision are proper for them just due to the fact they have a particular diagnosis. Decision and management, even though becoming policy terms that have been repeated so usually that there is a threat of shedding the meaning, do resonate with us all personally in the decisions in lifestyle that are most important: where we reside, who’s in our existence, and how we spend our time.

Much of this shift, although, has come about because the wellness and social care technique is dealing with increasing pressures that conventional remedies cannot address. For a man or woman with a number of extended-phrase situations, better co-ordinating the wellness and care they acquire will be significantly appreciated, and possibly much more powerful – but it only goes so far. One thing more than this is needed if we are to make a step adjust in how we react to the complicated health wants of men and women. With two thirds of emergency hospital admissions currently being associated to people’s lengthy-phrase situations, the health method has as considerably interest in assisting folks to handle their prolonged-term problems better as it does in diagnosing and treating acute illnesses.

Key to supporting individuals to remain as healthier as they can is interest to psychological properly-being, developing social capital, and discovering techniques to look right after their own overall health. These types of solutions and responses cannot be prescribed. They need to have to come from a deeper knowing of the particular person, and what they have and worth in their daily life. This skills is the person’s to deliver into the conversation – a different conversation with a various electrical power stability.

Revolutionary approaches to supporting people to remain out of hospital are combining a variety of health-related and non-health care answers, by means of a wider group of partners. The neighborhood and voluntary sector can play a important part in addressing underlying sensible issues this kind of as housing support, as effectively as loneliness, isolation and boredom. Rotherham’s social prescribing pilot does just this and early evidence about how people most at threat of hospital admissions are kept healthful at property is encouraging.

What if what would actually assist is possessing anything fully “off menu”? Elements to modify a bicycle so that a person with motor neurone disease can even now use it to hold match? Reflexology for an individual residing with MS? Not to deal with the issue, but to help cope much better with its results.

What if obtaining this variety of open strategy to planning their care actually produced an effect on peoples’ good quality of existence and psychological effectively-being? What if it also manufactured a substantial reduction in lengthy-keep hospital use? The massive-scale personal overall health price range pilot evaluation showed these outcomes.

Pulling collectively well being and social care personal budgets into one pot for people will support make assistance all around them more integrated and responsive, and less irritating. The real chance, however, is to co-make new solutions with the particular person from across medication and civic existence, creating on the person’s own skills and strengths. Some thing various is only achievable if we give people the room and control to envisage it, and the right assistance to enable it to happen. Anything various is attainable, and well being and social care personalized budgets are a effective element of the solution.

Zoe Porter is programme manager for the personal health budgets delivery staff at NHS England. She will be speaking about integrated health and care personal budgets – early learnings at Wellness+Care 2014.

Well being+Care 2014 takes spot on 25 and 26 June at ExCel, London. Passes are free of charge for NHS and public sector teams, but you need to have to register in advance.

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Are private health budgets the solution to integrated care?

Integrated care needs men and women to make it take place

Health and social care professionals are getting asked to function collectively for the better good. Photograph: John James/Alamy

Integrating wellness and social care has been on the national agenda for more than twenty many years nevertheless, regardless of the introduction of numerous policies, strategies and initiatives to provide it, we are even now not there nevertheless.

The properly-documented drivers for joining up well being and social care, this kind of as capability troubles in acute hospitals and individuals residing longer, are resulting in an unsustainable situation consequently we must see a radical change in the way we provide care.

Encouragingly we are seeing adjustments to the way colleagues in and out of the NHS are addressing these troubles. Non-acute companies such as neighborhood pharmacies are expanding their remits to aid ease inpatient pressures on hospitals, and care experts are in a position to control their relationships with neighborhood patient groups with the help of support redesigns and new technologies.

The emphasis on delivering integrated care has so far been on the “challenging” elements such as reorganisation, commissioning, functionality and regulation. In reality Chris Ham, chief executive of the King’s Fund, in a latest blog about the barriers to integrated care, identified these aspects as priorities.

Nevertheless a single crucial issue was missing, and that is the attitudes of folks – nurses, GPs, clinicians and management – concerned in delivering care.

Specialists in the sector are a lot more receptive to change than ever ahead of. Why? Since they recognise that the way we function and interact with colleagues inside and across distinct organisations has to adjust in order to accomplish the vision for integrated care.

Consider the instance set by the Canterbury District Wellness Board in New Zealand in the wake of Christchurch’s devastating earthquake in 2011 – which accelerated their strategies for joining up overall health and social care.

In the face of adversity, a “can-do” culture was embraced in order to provide integrated care in quick time. Initiatives have been led by staff, rather than imposed by management, resulting in situations in which well being pathways have been drawn up by hospital professionals and GPs functioning collectively and agreeing greatest practice at a regional level.

In England, overall health and social care pros at all ranges are getting asked to type and create relationships – operating collectively for the greater very good. But this does not usually happen naturally and often personalized politics get in the way, creating it hard to pull in the identical course.

Leaders are typically defined by their powerful personalities. Consequently, troubles can occur if you enforce a doing work connection between two leaders, for example one from a nearby authority and one particular from a neighborhood neighborhood health organisation, who have differing opinions or philosophies. It can then become quite difficult to progress with the task in hand.

But leaders also see the greater picture and this is essential for integrated care. I bear in mind two heads of IT working collectively as a end result of their respective trusts merging. Both had quite diverse approaches and every reason to conflict rather than co-operate, but they rapidly established that, by utilizing every other’s encounter and skills, they could attain considerably a lot more collectively than individually.

The several changes going on all through the NHS, including the transparency of supplier efficiency, heavier scrutiny of regulation and the introduction of new legislation, lead to a fear of the unknown for numerous care experts. That worry frequently final results in defensiveness and resentment amongst workforces, and fertilises an unproductive blame culture and a reluctance to co-operate.

The potential is about our potential to harness relationships that overcome that fear. If there is a willingness from men and women to tackle long term problems with each other then we will have a much far better possibility of achieving our objectives. Integrated care wants men and women to make it take place – every little thing else you can get past.

Andrew Clegg began his career as a nurse and is now a clinical specialist at Orion Overall health.

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Integrated care needs men and women to make it take place

Rare condition patients require integrated care from specialists and nearby teams

Earlier this month, senior NHS official Dr Martin McShane raised the pressing issue of how to improve and sustain principal care for the increasing variety of individuals with one or more complex, long-phrase overall health conditions in the Uk. With an ageing population in thoughts, McShane recommended that, with further coaching, some GPs and their practices could specialise in “complicated care”. He believes these new practices could assist to bridge gaps between specialised, hospital-primarily based solutions and ongoing healthcare closer to residence – for people with prolonged-term health situations such as diabetes and dementia.

These proposals have implications for the three.five million men and women in the Uk living with rare ailments. Any substantial investment and remodelling of care for these with lengthy-term conditions must consider the requirements of this patient group. McShane’s suggestion for specialised practices could be a solution for individuals with circumstances such as heart disease or Alzheimer’s, but is most likely to current challenges when applied to patients with rare, complex situations.

The lack of a sustainable and efficient approach to treating people with complex demands in the neighborhood, is an concern that is acquainted to several of the 60,000 men and women in England with muscular dystrophy and other uncommon neuromuscular conditions. The Muscular Dystrophy Campaign routinely hears from men and women who fall foul of the gap amongst the extremely specialised, skilled, hospital-primarily based teams they may see just a few times a year, and the day-to-day basic care they obtain from regional GPs, nurses and physiotherapists.

In some locations, exceptional muscle clinics and other regional centres of knowledge have been designed. Centres, such as those found at trusts in Newcastle, Leeds, Liverpool, Oxford and London, supply a regional hub for sufferers with neuromuscular problems and help major care pros doing work with them. Even so, their geographical spread is uneven and there are also handful of essential workers, this kind of as neuromuscular care advisers and expert nurses, in posts linking specialised and community services.

As with so numerous areas inside of the NHS, we need to have to see investment in these specialised centres to offer neighborhood-primarily based health experts with assistance by means of skills and suggestions. Nevertheless, in this case, there is certainly a strong financial argument for rebalancing present funding to improve providers.

Extreme respiratory infections, falls and cardiac issues all accompany forms of muscular dystrophy. Sadly, frequent and traumatic wellness emergencies are a fact of lifestyle for many households residing with the circumstances. Wellness specialists based locally, with complete expertise of medical background, a thorough understanding of a distinct issue and a direct line to regional specialists, can each avert crises and be available to advise emergency teams need to 1 arise.

NHS information signifies that around 40% of emergency admissions to hospital for this patient group could have been averted through preventative care – monitoring, early intervention and physiotherapy. This quantities to possible savings of up to £32m a year on emergency care. It appears unlikely that ‘complex care’ practices have a element to perform right here. It is not workable or useful to have a situation exactly where a severely disabled patient is forced to travel long distance to see a GP who, even though specialising in complicated care, is even now unlikely to come in get in touch with with a significant variety of patients with the identical unusual issue.

Some areas have benefited from investment in specialist centres and teams to improve ongoing care for those with neuromuscular circumstances. Following the crucial Walton Report in 2009, the quantity of professional neuromuscular care advisers and nurses in the Uk is increasing. Numerous operate each right with patients in the community by linking in with GP practices and clinics, and with neuromuscular consultants, professional physiotherapists and respiratory teams via professional expert centres. They are well positioned to share skills on how distinct conditions progress, and support evolve understanding of effective therapies with GPs and other overall health professionals delivering principal care.

The Muscular Dystrophy Campaign has also not too long ago acquired funding from the Department of Health to run its Bridging the Gap nationwide project. This is targeted on new regional neuromuscular forums and brings collectively people delivering main and expert care. The task will also work to enhance understanding of neuromuscular conditions amongst primary care practitioners by building on the web instruction modules for GPs and an on-line map of professional clinics and neighborhood companies.

McShane recognises the want for more informed experts functioning in principal care with the increasing number of men and women with prolonged-phrase conditions. Nevertheless, ought to proposals for complicated care practices move forward, this are not able to be at the detriment of investment in specialist experts at specialised centres functioning with individuals with unusual, extended-phrase problems. Their skills and support is important in making sure local community-based mostly teams have the expertise and expertise they want to defend well being and improve high quality of life.

Robert Meadowcroft is chief executive of the Muscular Dystrophy Campaign

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Rare condition patients require integrated care from specialists and nearby teams