Lucy Aldridge is the Policy Coordinator at the British Geriatrics Society. She supports BGS's work to influence government and NHS policy on older people's healthcare, including monitoring the political and policy landscape, responding to government consultations, and supporting the development of policy positions. She tweets @LucyAldridge96.
Earlier this month, Dr Nicky Leopold, Vice-Chair of the BGS Wales Council, gave oral evidence to Senedd Cymru’s health and social care committee for their inquiry into supporting people with chronic conditions. This follows on from BGS’s written evidence which was provided to the inquiry last year.
Dr Leopold spoke about the importance of providing person-centred care to older people with chronic conditions, particularly as many older people have multiple conditions and have varying abilities to live well with them. Individualised care plans are important, since for some people with chronic conditions, even a minor illness may lead to hospitalisation.
The value of providing care in the community was also highlighted, with models such as hospital at home and virtual wards beneficial to those with chronic conditions, due to their reactive and person-centred nature. Dr Leopold used the Neath area as an example of good practice, where a responsive acute clinical team work to assess patients in their own home to determine whether hospital is an appropriate option. Rural areas were also highlighted as locations that need to be targeted with community care, such as populations covered by the Hywel Dda University Health Board, where people often live long distances from hospitals. Dr Leopold noted that reactive, equivalent and safe services need to be available in these areas, but hospital must never be denied to older people.
The committee heard of the importance of supporting older people living with dementia and the lack of dementia services in Wales. Dr Leopold highlighted that only small pockets of excellence exist, including only one health service in Wales which has a psychologist addressing older people’s memory loss. Examples of good practice include dementia support workers in Cardiff, who provide a vital touchpoint for patients and families, and a dementia hub in Swansea, where people can access information. Dr Leopold advocated for similar services to be rolled out across the country and for policy to be focussed on increasing public understanding of dementia.
Expanding on the BGS’s written evidence, Dr Leopold described the importance of proactive care services and primary prevention in reducing frailty amongst older adults, including those with chronic conditions. Focussing on primary prevention, the committee heard that preventing health problems such as diabetes and cardiovascular diseases will reduce the chances of frailty in older age. The importance of exercise was emphasised, which has benefits of reducing frailty in people of all ages, including those in their 90s. Dr Leopold noted that policymakers should focus on promoting exercise to all population groups, particularly those in middle life, and free exercise classes should be available. This will reduce the number of years people spend in poor health and save the NHS money in the long run.
Dr Leopold spoke about the importance of all older individuals with chronic conditions receiving a Comprehensive Geriatric Assessment (CGA) and highlighted that there are disparities in access across services. For those presenting at A&E where there is a frailty service, then a CGA is easy to obtain whilst for those receiving care in the community, there are more gaps. Additionally, the presenting illness will influence whether people receive a CGA, with surgical illnesses less likely to result in a CGA. It was highlighted that in most health boards, only 20-30% of older people receive a CGA, which is lower than it should be. This was attributed to CGAs being labour intensive, requiring four hours of multidisciplinary team assessment and intervention. Despite this, CGA is a cost-effective intervention. Individuals who receive CGA are more likely to be alive and in their own home in six months’ time rather than being admitted to a care home or having died.
When asked about the recommendations that should be included in the inquiry’s report, Dr Leopold summarised that prevention, multimorbidity, frailty, and improving reactivity of services should all be prioritised. Additionally, older people with chronic conditions should be empowered to think about their future and what matters to them.
Read more about the inquiry here.
