Flooding in 2009 taught services in Cumbria valuable lessons about integrated care for an ageing population, explain Helen Ramsbottom and Mary Bradley.
Cockermouth is a historic market town on the edge of the Lake District with a population of approximately 8,000 people. The area hit the headlines in November 2009 when unprecedented flooding created chaos. The crisis prompted a surge of community action and support for those affected.
People in Cockermouth have a higher life expectancy than both the Cumbrian and national averages. The population aged over 85 is set to more than double in the next 20 years, with the number of people with dementia increasing by 130 per cent. Detailed resource analysis in Cumbria suggests a 60 per cent rise in hospital admissions.
Before the floods, discussions were underway between organisations working with older people to develop a new health centre, driven by the need to improve social care outcomes and address the prevention programme and local health and wellbeing issues.
Case Study - support to stay at home
Mrs B suffered a stroke some time ago and had been able to remain independent in her own home, supported by her daughter. She then fell and was admitted to Cockermouth Community Hospital. This brought into focus the need to review every aspect of her care to support both her and her daughter.
A multi-agency assessment highlighted the need to support Mrs B to maximise her income, have some minor aids and adaptations to her home, put in place a cleaning service, care alarm, and access to social activities. This was all coordinated by the Centre for the Third Age.
Mrs B now has ongoing support ensuring she is comfortable back home and that she and her daughter have the right support so she can continue to enjoy life.
As one of the first areas in which GP-led commissioning was tested, responding to the needs of an ageing population was already a priority. The floods were a catalyst to integrating health and social care services and showing what strengths and skills already lay at the heart of the community.
GP surgeries greatly affected by flooding in the town were relocated to a cottage hospital site. This was transformed into a hub for healthcare in the community, becoming the Centre for the Third Age. The centre opened in December 2010. It acts as a virtual and physical hub offering the following services from local organisations:
- volunteering opportunities;
- support to access benefits and maximise income;
- supported discharge from hospital;
- help at home;
- friendship groups;
- dementia peer support;
Local community clubs, societies and businesses place their information in the centre, creating a link to campaigns and awareness events held by partner organisations. This model facilitates integrated partnership working between the NHS, the third sector and the community. It provides a single point of contact in the Cockermouth area and is a way of:
- coordinating the prevention agenda and implementing best practice to prevent health issues developing;
- promoting independence; and
- improving overall health and wellbeing for older people.
The result has been a more active interface between health and the third sector with 70 referrals from GPs alone in the first month. Some 84 older people in the area have been identified as “at risk”; they have a prevention programme that aims to reduce their risk of being admitted to hospital. A district nurse was seconded to focus on case management and works closely with the centre on prevention.
This coordinated, holistic approach to prevention is supported by the community which, in effect, becomes a “virtual ward” with prevention as the core objective. An integrated admission avoidance team of health, mental health and social care professionals has enabled 141 fewer hospital admissions than in the comparable quarter of the year before. The model works because of the co-location of GP surgeries and community services, and referral systems that are geared to meet GP and patient needs.
Meeting older people’s needs with a preventive approach can create efficiencies – in Cockermouth there has been an approximate saving of £2.20 for every £1 spent on prevention in emergency bed days and £1.40 for every £1 spent on prevention for primary care services.
Initial project costs for the centre amounted to £75,000 including contributions from other local projects and small amounts of start-up funding enabling project staff and management support.
Age UK West Cumbria’s involvement in the Centre for the Third Age models a new level of partnership working in which the development of bold and new relationships is focused on patients’ needs. This integrated approach to prevention is vital if we are to continue enabling older people to age well, despite decreasing budgets.
Tips for success
Integrated partnership working between the NHS, third sector and community will benefit from:
- Accessing specialist agencies in a timely and appropriate manner, and clear ways of moving seamlessly between all parties
- Having a single point of contact and medium through which best practice around prevention for older people can be coordinated and implemented
- Developing a coordinated and holistic approach to prevention, supported by the community, which acts as a “virtual ward”
- Facilitating peer support and developing support networks through social inclusion; this will build capacity in the community so older people can come together and solve their own problems
- Having a centre, which acts as a vehicle to raise awareness about issues affecting older people