Frailty: Messages from the consultation by the Older People s Commission for Wales

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1 Frailty: Messages from the consultation by the Older People s Commission for Wales October 2011 The Older People s Commissioner for Wales Cambrian Buildings Mount Stuart Square Bae Caerdydd / Cardiff Bay Caerdydd / Cardiff CF10 5FL ask@olderpeoplewales.com Web:

2 Introduction The Older People s Commissioner for Wales wants to encourage, promote and support the establishment of a Wales-wide approach to frailty which will result in positive change to the lives of older people in Wales. This report, based on discussions amongst health and social care professionals at a Commission seminar in March 2011, is intended to contribute to the development of a consensus and commitment to a new way of supporting frail older people. It aims to present a better sense of what we need to do next in Wales and where our individual and collective energy needs to be focussed. Frail older people often have complex needs. There is a growing consensus that services are failing frail older people too often and that the current systems of support need to change. There is lack of an accepted definition of frailty, or of the principles of frailty. However as a concept it is increasingly significant and widely recognised amongst those working with, and for, older people. The context of human rights and the United Nations Principles for Older Persons, which underpin the Commission s work, are of key importance when considering approaches to frailty. The 2010 Equality Act, will also have a significant impact on discrimination in health and social care. The role of the Older People s Commission is to drive change in practice by encouraging best practice in the treatment of older people, and by challenging age discrimination. A focus on frailty presents opportunities for us, and all those involved in supporting older people, to achieve improved services for older people 2

3 Areas of consensus The discussions amongst health and social care professionals at the seminar hosted by the Commission in March 2011 captured the following areas of consensus. Understanding frailty and older people There is still a lack of consensus in the definition of frailty amongst health professionals. In addition, there isn t an agreed approach to frailty shared across the health and social care spheres. As a result, frail older people who rely on social care and health services, particularly when vulnerable, are increasingly let down. An agreed set of principles and definition is required to improve shared understanding and coordinated services. Working in partnership The seminar emphasised the importance of service providers working in partnership across Wales to improve services for frail older people. Seamless services to those who are vulnerable should be the outcome of effective and efficient delivery of services. It is particularly important that service providers work in partnership across Wales to ensure that the current challenges to public finances do not hinder or undo progress already made in this area. The success of partnership working requires joint commitment between health and social care services as well as operational planning to ensure that partnership pathways are established and effectively embedded and monitored. Leadership Good leadership was identified during the seminar as a key factor in encouraging change and service improvement. It was recognised that staff need to be empowered to work effectively in partnership and provide person centred services. Leadership at every level is needed to drive change and improvements. There was also a consensus that it would be beneficial to have clearer and more precise direction from the Welsh Government 3

4 Engagement with older people, their families and staff A key message from the seminar related to the connection between older people and their families/carers, and professionals and decision makers. Those individuals outside services (ie. potential service users) are not sufficiently engaged. There is certainly scope for improvements in engaging older people in decision making regarding their care, but also in improvements in that support care delivery. During the consultation it was acknowledged that a person centred approach to considering the needs of older people was required. It was felt that current processes focus too heavily on specific health problems rather than considering the whole picture and it is due to this therefore opportunities for early intervention can be overlooked. This person centred approach is fundamental to the central premise of cardiologist Bernard Lown s book, The Lost Art of Healing: Practicing Compassion in Medicine, in which he states that: Healing is replaced by treating, caring is supplanted by managing, the art of listening is taken over by technological procedures. Doctors no longer minister to a distinctive person but concern themselves with fragmented, malfunctioning biologic parts. The distressed human being is frequently absent from the transaction. Areas for further dialogue Definition of frailty Seeking an agreed, common definition of frailty could be considered further to assist in the development of a shared understanding of frailty and its impact across both health and social care. A move toward developing a social model of frailty is needed in Wales to ensure services are person focused. 4

5 Agreed understanding of integrated services A shared understanding of the term integrated services across the health and social care service provision is necessary. From this a people pathway needs to be developed to use the current service infrastructure more intelligently. Barriers to partnership working that currently exist need to be identified and addressed. A clear plan and great leadership A clear plan and way forward is needed, which will require commitment at the most senior level within our public services to ensure that change. Change begins with a strong vision and effective leadership. Engagement what do people want? Services need to be flexible and guided by the service user s preference and choices. There should be regular opportunities to review services and any assessment should have the views of the service user as a central consideration. Empower and educate Services need to take a consistent approach in ensuring that older people are fully informed about the support options available to them. There needs to be more clarity about how the system of support services is effectively accessed and navigated. Older people need to know what their entitlements are and what to do if they are not happy with the services that they receive. Public services need to further empower older people by ensuring that they are full participants in the process of care planning and remain in control of the services that they receive. Staff working with older people need to receive training to ensure that they understand and are able to apply a new approach to how older people are empowered in the care planning and delivery process. 5

6 Learn from best practice Best practice examples need to be identified and shared across Wales. Evaluation and learning from the methodology of successful schemes is key. Examples of good practice Gwent Frailty Programme Anglesey Age Well Centre Next steps All need to take action. Take this report and use it in your sphere of influence to create patient focused, collaborative and community based services. Role of the Commission as an honest broker and to drive change in practice. Implications of the equality act Generate debate What it is that we should determine nationally and how we really support local ways forward? Harness local energy. 6