Linking health and social care service funding to service user outcomes, instead of staff tasks, will improve support for older people with frailty, according to new best practice guidance.
The Fit for Frailty guidance (part two) recommends a move away from traditional ‘activity based’ contracts – where services are costed on time and delivery of tasks – to the model that sees providers paid for helping service users to achieve agreed goals.
This would ensure that outcomes relevant to older people with frailty, including quality of life, loneliness and pain, are properly considered in the development of services, the guidance says.
It also states that older people with frailty have the ‘most to gain’ from health and social care integration, and joining up services, such as personal budgets, is essential.
Professor John Young, national clinical director for integration and frail elderly at NHS England, and a member of the Fit for Frailty working group, said:
“Services which properly take into account the needs of older patients with frailty are already successful realities throughout the UK, but they are far from widespread. This guidance aims to help commissioners build on those examples, and make them routine.”
The guidance, published by the British Geriatrics Society, also recommends the creation of a series of health and care pathways to help prevent avoidable admissions to hospital and delayed discharges.
For example, it sets out a ‘pull out of hospital’ pathway, which would include providing safe alternatives to admission, sharing information about care plans and ensuring post-acute care is readily available and accessible.
Caroline Abrahams, charity director at Age UK, said: “At the moment older people who are living with frailty too often end up in a crisis situation with no other choice but to be admitted into hospital or a care home.
“By being proactive and taking account of the needs of the whole person, the crisis could be prevented and longer-term quality of life improved.”
The guidance also recommends services to:
- Ensure all older people with frailty receive a review of medical, functional, psychological and social needs, based on the principles of comprehensive geriatric assessment.
- Make interventions available to older people that improve their overall physical, mental and social functioning, focusing on an individual’s strengths, not deficits.
- Develop shared care and support plans by involving older people with frailty, their families and domiciliary care staff throughout all stages of the process.
The document follows Fit For Frailty (part one), which gives advice on the care of older people living with frailty in community and outpatient settings, including the development of personalised plans and routine assessments to identify the condition.
Gill Baker, vice president for clinical quality at the British Geriatrics Society and project lead for Fit for Frailty, added: “It is the job of clinicians and service providers to ensure that individual differences are accommodated, in order to restore control, preserve dignity and facilitate person-centred care for older people living with frailty and those close to them.”