[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 3 Issue 2, September 2012].
The UK has the second highest rate of avoidable mortality among 16 high-income countries, and variations in health outcomes between social groups are widening. The delivery system for health and social care has not kept pace with the population’s growing needs and expectations. Doing “more of the same” within existing models of care is unlikely to be the solution. Innovative models are required to supply suitable high quality, sustainable solutions and better value.
This paper from the King’s Fund shows how existing services struggle to meet demographic pressures, the changing burden of disease (with an increasing prevalence of long-term conditions, including dementia and other mental health problems) and rising expectations from the public.
“There are 700,000 people living with dementia in the United Kingdom (of whom approximately 570,000 live in England), and this figure is expected to reach 1.4 million over the next 30 years (Department of Health 2009). Among those with late-onset dementia, it has been estimated that 55% have mild dementia, 32% have moderate dementia and 13% have severe dementia. The proportion considered to have severe dementia increases with age, reaching 23% among people aged 95 and over. A high proportion of people with dementia need some care, ranging from support with activities of daily living, to full personal care and round-the-clock supervision. The burden of disease has shifted away from life-threatening conditions to long-term conditions”. (p.10).
It is proposed that too much care is provided by hospitals and care homes, and that treatment-centred services receive higher priority than prevention.
Integrated care is the exception rather than the rule. Traditional divides between GPs and hospital-based specialists, hospital and community-based services, and mental versus physical health services result in care which is often fragmented.
Existing models of care are outdated by recent technological changes which could revolutionise how patients interact with service providers.
Care relies too heavily on expensive professional expertise and direction, although patients and users want to play a more active role in their care and treatment.
It is proposed that implementation of new models of care should involve the following strategies: decommissioning outdated models of care; supporting NHS organisations to innovate and to adopt best practice; building on the potential of new providers to introduce innovation; developing a culture which encourages “peer support for learning and innovation”; and encouraging new models of care at the local level.
Ham, C. Dixon, A. [and] Brooke, B. (2012). Transforming the delivery of health and social care: the case for fundamental change. London: The King’s Fund, September 2012. 52p. ISBN: 9781909029 00 2.