July 2018: Focus on Older People
Our latest HSMC update highlights the launch of BRACE, the new rapid service evaluation centre led by HSMC and funded by the National Institute of Health Research (NIHR) for five years. It also draws attention to a new research report published with Cancer Research UK (CRUK), as well as our wider programme of research focused on the needs of older people.
The health system faces two linked challenges: the growing proportion of older people with care needs (75% of 75 year olds have two or more long term conditions); and the continuing uncertainty about whether NHS and social care funding will be sufficient to meet current and projected needs. Focusing funding for service improvement on older people’s needs will be vital for efficient resource use and achieving the best individual outcomes. The new BRACE rapid service evaluation centre is well positioned to respond to this service improvement challenge by identifying promising interventions early on and ensuring they are more quickly understood.

There is nothing simple about getting services right for the oldest and most frail in our society. Not only are their needs typically the most clinically complex, but cognitive decline and dependency on others present further complications for care planning. In her recent thinkpiece on the announcement of extra funding for the NHS, Judith Smith argues that whilst the money is very welcome, it needs to be used to help address some known and persistent weaknesses in NHS and social care, so that we can "coordinate care for our frail elderly relatives in what is a fiendishly complicated and often fragmented care system”.

HSMC’s newly published research report Advancing care, advancing years: improving cancer treatment and care for an ageing population, led by Kerry Allen, with Hilary Brown, Karen Newbigging and Kelly Singh, highlights what needs to be done to improve the ways in which older people are able to make decisions about cancer treatment options, and be assured of more consistent care with improved individual experience. The research underpins CRUK’s approach to treating and caring for older people and informs a policy briefing, launched alongside the report. We found cancer services that serve older people best may be those that prioritise: generating better data about treatment outcomes in older people with multiple conditions; considering additional information (especially about frailty) in clinical treatment recommendations; and providing the space and skills to share complex decisions with patients and their families. A key recommendation is about the ways in which information needs to be shared across primary and secondary care teams involved in the care of an older person with cancer.

Robin Miller and Judith Smith are leading HSMC's contribution to the five-year National Evaluation of Integrated Care and Support Pioneers. Catherine Needham is leading a national evaluation of local authority activities in the shaping of social care markets with a focus on the extent to which services are able to be personalised to the specific needs service users. In order to assess the impact of the Care Act, the study combines critical policy analysis with practice insights and viewpoints of people who use services (including older people) in eight local authority sites.

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Related publications on older people
Jon Glasby, Kerry Allen and former HSMC academic Suzanne Robinson published a paper in the journal Social Policy and Administration reporting findings from an evaluation of a large scale closure programme of older people’s care homes and linked day centre provision. They found that if managed well, these transitions can result in improved outcomes for some older people.

Jon Glasby’s recent article for a Local Government Association think piece series on sustainable social care draws us away from the usual economic debates to explore the personal, political and philosophical dimensions of social care funding reform.