Health Improvement Review External Stakeholder Engagement Events – Summary of Feedback
Older People
Needs & Issues
Access – Health care; Financial support; Social care; Non-patronising frequent & fun Leisure & exercise; Equitable services; Cheap, reliable and widely available transport; Carers support advice & training; Information; Adequate housing options; Employment; Education; Personalised care; Support for older workers; Support for volunteers; Early help for small issues such as home maintenance; Basic needs (e.g. Nail cutting); Many not receiving service due to access rather than service not being available; Infrastructure - public transport routes do not match; Limited opportunities to provide health improvement to this group;Change in access / independence;Lack of choice;Healthy eating;Choice e.g. Death at home, housing;
Social Inclusion & Inequities - Intergenerational and befriending schemes; Need to promote independence and Quality of Life; Consider ‘older people’ in 3 categories identified in CMO’s Physical Activity guidance (‘Actives’, ‘Transition’ & ‘Frail Elderly’); Need to recognise increasing working age; Focus on ‘resilience’; Identify local champions; Need to create positivity amongst elderly reinforced by changing attitudes towards elderly; Promote community cohesion where family support isn’t available; Identify and address ‘isolation’; Recognise and prevent anxiety and depression;Older/frail (condition level of dependency) 50+;Social isolation; Empowering healthy choices. Education not just intervention;Alcohol linked to social isolation;Changing dynamics of family networks/social change;Transition from working life;Impact of lifelong worklessness at this age group;Sensory impairment. Deafness, eyesight;Ageing population stigma;Caring for frail partners;Domestic abuse;Homelessness;Poverty;
Service Delivery – Care homes; Identifying and addressing gaps in services; Reduce duplication; Improve ‘value for money’; Multi-agency collaborations; power-sharing with service users; Joined-up thinking; Need to ensure evaluation considers outcome measures; Older people planning focus on the need of services rather than preventing the need;Criteria for identifying need –‘ Frail’ wider than ‘physical fragility’;Too much politics for short term aims;Too much performance measurement rather than outcomes;Evidence base;Complexity of services – not person centred;Development/progression of chronic disease.; Where is help available?;Disability;Multiple carers - Joined up;Medication -Remembering / Multiple / Weight relating dosing;Dignity of care;NHS service reconfiguration – community care/ Dr Contract;Need to focus on keeping people independent;Joined up system – communication/training;Staff skills – patients with complex needs;Lack of integration in relation to service;Hospital system – average age 85 –support structure;Coordination; Older people involvement in service developments;Need time – build relationships; More proactive care;
Communication – Information on what’s available; Promotion of NHS Direct Wales; Recognise complexities; Differing needs for different groups; Consider ‘Targeted’ v ‘Universal’ information; Need to recognise the relationship between ‘mental’ and ‘physical’ health; What promotes ‘wellbeing’; Consultations in context. i.e. People’s own homes; Promote respect & dignity;Clash between health improvement /ill health;Importance of promoting health i.e. Physical activity/nutrition to risk ill health;Perception of decline; Significant no. of older Welsh speakers (1st language);
Resources – IT to free up capacity & resources; Recognise people’s ‘assets’ rather than deficiencies; Use DWP ‘Ageing Well’ model; Income gap widens;Transport generally not just public transport;Valuable resource of elderly; Housing/suitability; Food;Community base service - £;9% older people in North Wales;Funding benefits, etc. (1/8 in employment); Support for carers - Not all identified;
Personal Impacts- Challenges of loss of confidence; Bereavement, grief;65 and Healthy;(?) identity/’status’;Challenge of maintaining health and well being; Emotional well being when facing a changing future;Disempowered to life style change;Asking for help difficult;Malnutrition; Ill health immunity;Hips. Falls. Dementia/Alzheimer’s;Family at distance;Loneliness;Support networks;Supporting confidence building;Fears of crime;Anxiety and confusion;Depression;Loss value /acknowledgment ;Guilt;Invisibility. Skills recognition;Loss of control/ Mobility; Loss of privacy;Resilience building needed;
Needs & Issues Wordle
Current Services
Lacking – Access to psychological therapies and counselling services particularly in relation to alcohol, substance misuse & HIV; Long term funding; Appropriate language; Culture of Care; Active engagement with service users; Access for minority groups (e.g. People with dementia/ geographically isolated); General lack of co-ordination between services and sectors; Dignity as an underpinning principal for service providers; Community transport; early help for small issues;Extracare housing – not available everywhere; Variations/not all universally available; Age well centre - £ issues;
Available – Primary care; Secondary care; Community Nursing; Physical & Mental Health services; Screening services; Opticians; Pharmacists; Dentists; Health Charities; Private & alternative providers; Therapists; NHS Direct; Housing services; Social services inc. Meals/ social care etc.; 999 services; Day services; Leisure/ recreation/ libraries/ bus passes; Communities First; regeneration projects; Age Cymru; Luncheon clubs; Church groups; Pensioners clubs; University of 3rd Age; Employers; Domiciliary care services; Residential homes; Nursing services; Volunteers; Respite care; Hospices; National Exercise referral Scheme; Befriending services; Community cafes; Community transport; Healthy, Wealthy & Wise; Hospital discharge scheme; Care & Repair; Helping Hands; Formal and informal carers; Families & relatives; DWP Ageing Well; Age Cymru Community calculator; Careers support groups; Walking the way to health; Life style programmes (NERS locally); Social foot care - Age Concern; Schemes in Voluntary Sector;Expert patient; Older People’s Forum; Pre-retirement courses; Volunteering;Falls prevention programmes; Moving more often; LIFT; Training care;Staff menu/nutrition;Age well centres; Caia Parc Health Team (Wrexham);Case Rep; Handy man services; Mobility/balance classes; Accident prevention; Small community groups. E.g. community clubs/drops-ins; GPs; Sport;‘Garden share‘; Allotments; Health promotion;Support for chronic conditions; Numerous statutory agencies; General NHS and LA; Tele health; Enabling/ re-enablement;Memory clinics; Adaptations/equipment in existing home;Intergenerational projects;Leisure centre land; ‘Community’ land used for growing veg;Volunteering; GP contract;Direct payments – through local authorities;Learning disabilities; NERS;Carers outreach; Alzheimer’s Advocacy;Dementia awareness training; Singing for the brain;
Potential – 5 Ways to Wellbeing; Better use of planning & design services; Transferable ‘Good Practice’ (Acknowledging need for planning & preparation to adopt to local needs/ capacities); 50+ Health Checks ; Workplace pre-recruitment schemes; Many above localised- Not universal in some cases but can contribute to well being/maintaining independence;Focus on local initiatives;Locality development; Challenges with out of hours; Care and repair; Care housing;
Current Services Wordle
Opportunities
Partnerships – Public/ private/ 3rd sector; Chance to break down silos; Intergenerational working; Volunteer programmes; NERS; Community networks; local public health teams working with community & 3rd sector; Building capacity within communities; –‘Joined up thinking’;Localities and review of stakeholders - To (must) include other sectors/stakeholder. Eg community first; Potential ‘Hub’ to bring in additional support of local partners (With H+SC foundation);Frail elderly-Need support from partners with prevention/early intervention;More resources of all participants;Prevention and early intervention including voluntary and third sector partners, and other programmes eg. Fall prevention, community first, etc; Intergenerational, older people into schools example, skill use – IT project young people teaching older people;Older people ‘teaching’ e.g. Knitting in after school clubs; Need to address barriers e.g. CRB requirements, teacher volunteers etc; Co-production;Work with people to develop services – focus on service users;Need for integrated services. Health/social services/ GPs/PHARM; Better communication between agencies;Community focus services delivered in community settings;
Good practice examples – Betsi Cadwallader falls programme in partnership with NERS programme; Age Cymru Community Calculator; Carmarthenshire falls prevention work with carers; WRVS transport partnership; Age Cymru Dance programme; Age Cymru LIFT exercise programme; Oral healthcare training with care homes, hospitals and domiciliary services; Podiatry training for care homes, 3rd sector and private sector delivered to national standard; Gwent Frailty project; Cardiff & Vale Wyn campaign; German over 65 prostate screening programme; Time banking; Build on ‘Pontio’ – Bangor, and other community health enhancing activity;Open doors (‘Agor Aelwyd’);Person centred on persons holistic needs, health. E.g. Anglesey example of falls prevention assessment which includes holistic needs and local service in village;
Potential development – Tai chi; Exercise opportunities for people with dementia; Dietetic capacity grant scheme; Investment in prevention agenda; Unified assessment process if the IT support can be sorted out; Portable Health Record; Utilise young and unemployed; GP record system; Expanding existing community support universally;age-proofing environment /housing; Review core training / CPD and health professionals/social services/ Allied to health/ voluntary sector etc to reflect current/emerging needs/changes – linked with evidence/policy; Intergenerational/ role models; Invest in health improvement;Volunteering opportunities includingActive citizenship, ‘time on your hands’, Mental health/well-being, Alcohol use/misuse, Grand parenting roles/care for grandchildren and for their parents, Sexual health;Social capital building;Local signposting; Power/influence of local decision;Evidence needs led decision making locally;More determination of use of resources – needs based; Housing – more choice, opportunity, support - making it easier to move; Time out for carers – improvement opportunities, volunteering, etc. Respite, short breaks;‘Open house’ day care/activities;Accessibility key; Transport - planning, needs to be used correctly;Development of‘out of hours’ services; Over 50’s health check – how is it delivered?; Health service configuration;Systems. – hospital/GP/Discharge letter;Use of technology, education /training , sharing information;
Provisos – Need for robust evaluation and sustained funding to work with 3rd sector; Need to prepare for old age; Need to improve health literacy; Need to target ‘most in need’; Need to tackle failure, demand & waste; Need a real debate about ‘what is affordable?’; Need to tackle culture of dependency; Reframe health promoting messages: promote positive thinking/ Quality of life / “Can do’s” for older people;Promote the importance of self responsibility; Promote positive ageing across the board industry/ community/ orgs/ national; Challenge stereo types;Making bottom up vs top down centralisation;Opportunity to look at meeting needs differently; Focus on outcomes for individuals;Improvement –timescales/rapid access;Promote independence;Programme funding – need more long term focus; Focus on evidence-based programmes;Marketing – right language;
Opportunities Wordle
General summary points
The feedback in relation to services supporting older people identified a number of common threads; The main issues and needs were grouped generally under 6 headings:
- Access
- Social Inclusion
- Integration
- Communication
- Resources
There were evident issues associated with access to services across all sectors and addressing a variety of needs, many of which it was proposed, would be improved through better integrated services. The issues associated with social inclusion were focussed predominantly on the need to recognise the positive aspects of ageing and to treat older people with respect and dignity, valuing not only their past contributions to society but their ongoing and potential contribution. There was a strong focus on the need for maintaining independence for older people, with both the potential health risks from falls, isolation, poor diet etc. and the health impacts through hip fractures, malnutrition and dementia being seen as significant threats to such independence. The issues of loss of self-esteem, social value and mobility were also highlighted as being significant contributors to deteriorating health for many, particularly when they were socially and or geographically isolated.
It was recognised that the term ‘older people’ was inherently unhelpful and that at a time when the working age is being extended there were varying levels of need that weren’t related to chronological age. The communication issues were both specific regarding the need for accurate and timely information but also reflecting the value statements related to perceptions of ageing with a recognised need to promote a more positive message.
However, people did identify a range of potential untapped opportunities including intergenerationaland volunteering initiatives. There were significant service configuration problems that would need to be addressed to make the most of the opportunities including a refocusing of resources based on need and closer integration of services and delivery agents.
Synthesised Wordle of all key terms.
HI Review – Older People Summary23/11/2012 Version 0a