1. The Challenging Demographics for the General Physician Dr Phil Rushton Poole Hospital NHS Trust

2. Literal Approach The Demographics The Challenges The General Physician?

3. Old News

6. In the next 20 years Over-85s will double Over-85s will double Over-100s will quadruple Over-100s will quadruple

7. Whats the problem? Currently -Over 65s account for 60% Social Care Budget -Twice as NHS-costly -Hospital spend: Three times as much

8. Local Picture: Dorset

10. The Future?

11. DorsetChristchurchHighcliffe % aged 0-15 yrs 17.015.85.6 % aged 15-59 yrs52.848.225.3 % aged 60-74 yrs17.620.429.8 % aged 75+ yrs1.715.739.4 % households pensioner33.440.670.9 No. economically active178,51918,859709

12. Highcliffe Average size practice c10,000 patients 6 partners, 3 salaried

13. Highcliffe Highcliffe Prevalence (%) National Prevalence (%) Cancer4.41.7 CHD7.33.4 HF1.40.7 Dementia1.60.5 Stroke4.11.7 HT23.213.6 DM6.75.8

14. Highcliffe Particular stresses Home visits NH Drug Budget And yet: Admission rates low Prescribing rates low Staff retention good

15. Meeting the Challenge in Hospital Hospitals and medical specialities emerged in an era when many people died in childhood or midlife of single diseases. In 2012, the main activity of general hospitals is the care of (generally older) people with (multiple) long-term conditions.

16. The challenge.. Frailty Safe Discharges Readmissions Comprehensive Geriatric Assessment

17. Frailty: Complexity + Poor Reserve A state of reduced homeostasis & resistance to stress that leads to increased vulnerability & risk to adverse outcomes such as disease progression, falls, disability & premature death Non-specific decompensation: Acopia

18. CGA PainDelirium and Dementia DepressionNutrition and Hydration Skin IntegritySensory Loss Falls and MobilityADLs ContinenceVital Signs Safeguarding IssuesEnd of Life Care Issues

19. Safe Discharges: CGA + Community services: –IC, GP, DN, LTC, CM Care providers: –family, care agency, RH / NH, SW, 3 rd Sector

20. Readmissions The new geriatric giant?

21. Models of Acute Care: Resources RCP Acute Care Toolkit 3: Acute medical Care for Frail Older People Quality Care for Older People with Urgent and Emergency Care Needs: Silver Book Both support application of CGA within an integrated system.

22. Local Model: Poole

23. Problems Generic MAU not leading to CGA LOS > national average Necessity: Ward closures triggered by £10m overspend

24. Aims CGA: –Senior clinical review and initiation of treatment –Early MDT assessment Facilitate discharge Reduce non DME outliers (to close beds safely) Manage emergency activity

25. Ethos of unit Senior triage of admission calls –Present alternatives Early senior assessment –Medical, Nursing, Therapy Prioritised diagnostics support Early Discharge planning Daily MDTM Support from SS to keep POC open Support from IC (Care, Clinical)

26. Length of stay data

27. Occupied bed days

28. Re admissions

29. Limitations / threats Changing relationship with providers Gaps in service –Lack of Step-Down beds –Non-commissioned services –Local EMI NH provision Ongoing CIP White Paper…

30. Summary Ageing population Integrated Systems to deliver CGA, facilitate safe discharge Some successes, some Threats

31. Thanks