Future trends in health
and social care
Implications for Occupational
Therapy
Candace Imison
Deputy 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
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
Projected number of younger adults with learning
disabilities by 2030, thousands, England
350
300
250
›
There has been reducing
mortality among people
with learning disabilities
and among children with
severe and complex
needs (Emerson and
Hatton 2008)
200
150
100
50
0
2010
Source: Snell et al 2011
2030
More people living on their own
Unprecedented financial pressures
10
4% real: £170 bn
9
OBR 2012: £136 bn
8
Match GDP: £132 bn
7
5
0% real: £84 bn
Actual
4
3
UK NHS spend
2014/15:
2
£132 bn
1
2032
2029
2026
2023
2020
2017
2014
2011
2008
2005
2002
1999
1996
1993
1990
1987
1984
1981
1978
1975
1972
1969
1966
1963
0
1960
Percent GDP
6
An ageing and more demanding
population
% Increase last 20 years
NHS
Spend
0-64
65-84
85+
Source: DH - Departmental Report 2006
133% by 2035
1989/90-2009/10
Less deference, greater expectations,
less solidarity?
24/7 services
Instant access
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
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 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.
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 - 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
Patient activation – major driver of healthcare costs
Implications for services
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
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 longterm/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
Key issue – integrate mental and physical
health support
Comprehensive hospital service
Comprehensive population health service
Focussed
factory
Networks
Traditional DGH
Specialists
Population
Focus
Primary
Care
Self Care
Social
Care
Community
Care
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
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
Integrated OT
Flexible OT Working
•OT follows the client –
Community/Hospital/Interme
diate Care
•Shared responsibility and
problem solving
•Reduced waiting
lists/referrals
•Higher skilled OTs with
greater job satisfaction
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%20Torb
ay%20Experience.pdf
Workforce to support integrated care
Good
evidence
•The creation of new roles working across
professional boundaries supports integrated
delivery.
Some
evidence
•No one “right” staffing model. Teamworking more
important than individual roles.
•A focus on the service user/patient helps
overcome professional boundaries.
•Understanding of different roles and
responsibilities is important to successful
integration within a team.
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