The SWISH project Smarter Working In Social & Health care Dr Steve Iliffe, Kalpa Kharicha: University College London Prof Jill Manthorpe, Prof Cameron Swift, Dr Danielle Harari: King’s College London Prof Claire Goodman: University of Hertfordshire The SWISH project

The SWISH project Smarter Working In Social & Health care Enhancing access to services for older people and contributing to health and social care commissioning and service delivery, using an integrated expert system – Health Risk Appraisal for Older people (HRA-O) The SWISH project

Three objectives To examine and refine a method to improve older people’s and carers’ access to information + services and to identify older people at risk of declining health and well being To examine the potential of an approach to enrich NHS databases with social information, and to provide social care databases in local councils with health profiles of older citizens To explore the feasibility of an approach for profiling the health and well-being of local populations, to inform health and social care commissioners and others concerned with the planning, delivery and evaluation of local services

The Health Risk Appraisal for Older people (HRA-O) expert system Questions: Comprehen- sive self- completion questionnaire on health & social well- mailed by GP to all people aged 65 & over Answers: freepost to data entry centre. Entered into bespoke software - EDMT Expert system: HRA-O Information: “To get an attendance allowance claim form, call this number” Advice: “You appear worried about this, LOCAL SERVICE may be able to help and we recommend that you contact them or get back to us if the problem continues” Local signposting: “Contact Anytown’s Carers’ Centre on/at…..” Alert professionals to unmet need, enrich electronic medical records, data can populate SAP Clinical function Collate data to provide population perspective Commissioning function Personalised tailored response to each individual

Consultation process 77 older people 64 practitioners and managers NHS, social care, voluntary sector and local government organisations in 2 London boroughs

Adding social care domains – which do older people and practitioners think are key? Recent life events Housing and garden maintenance Transport, both public and private Financial management Carer status and needs The local environment Social networks and social isolation

Feedback to older people from the system – what do older people find helpful? Tailored feedback to the individual Advice about self-management of long term conditions Accurate and informed sign-posting to local services both within and beyond health and social care Inclusion of voluntary sector, local government, benefits advice and solutions to housing problems, exercise or leisure facilities and opportunities, home and community safety

Do older people find this type of approach acceptable? 1592 people aged 65 and over registered at 3 general practices Up to 3 completions of HRA-O over 4 years

Response rates over 4 years Randomisation group A (n=1240) B (n=1263) C (n=636) Total (n=3139) T_0 (2001) Pro-Age baseline (4 practices in Pro-Age) 1090/1240 (87.9%) /1240 (87.9%) T_1 (2002) Pro-Age follow-up at 1 year 940/1240 (75.8%) 1066/1263 (84.4%) 485/ 636 (76.3%) 2491/3139 (79.4%) SWISH eligibility check of patients from participating practices (2005) (3 practices in SWISH n=1789) 458/604 (75.8) 549/700 (78.4) 380/485 (78.4) 1387/1789 (77.5) T_2 (2005) SWISH follow-up at 3/4 years 292/458 (63.7%) 353/549 (64.3%) 193/380 (50.8%) 838/1387 (60.4%)

Which older people find it acceptable? Characteristics of responders Men, younger, better off financially, more educated, have used more preventive care services, better functioning, report better self-rated health, higher levels of physical activity, better diet, less likely to be socially isolated and drink hazardous amounts of alcohol Regression analyses: successive completion associated with being financially better off, less likely to use tobacco and being in greater pain Economically active and socially important section of the older population eg carers, and those for whom early preventive care interventions may be most useful, generally not yet high users of services, men?

Implications for policy and practice: 1 For older people New version of HRA-O can incorporate social dimensions of health and well-being Iterative development, user involvement and practitioner engagement = high validity, transferability and usability Tailored feedback to older person gives potential to enhance self-management of conditions + sign-post to local services both within + beyond health and social care Potential to be customised to fit local services and resources

Implications for policy and practice: 1 (cont) Falling response rates and characteristics of non- responders make it unsuitable as a health promotion tool for repeated use without further adaptation We draw this to the attention of those developing self assessment and to those developing Life Checks

Implications for policy and practice: 2 For practitioners Comprehensive data, potential to enrich medical and social care records Multi-domain risk assessment maximises potential to identify unmet need and risk in people already known to services Potential ‘at-risk’ group in non-responders Baseline dataset and measurement of subsequent change Contribute to other assessment processes - including the Single Assessment Process - and other locality profiles. Comprehensive resource with information about local services and networks

Implications for policy and practice: 3 For commissioners and service providers Population level data on older people who have regular but limited contact with some health services but little contact with social care, even if carers Profile locality needs and trends Highlight which low level services or preventative services are well developed or which need market or public sector stimulation.

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