The health care challenge for older people in Northern Ireland
Care can seem a minefield for many older people in Northern Ireland. They cannot always access it when they need it or it is a one fit all approach. For example older people and their family carers would like more choice and community based care options especially around short breaks. The reality is much of this is still provided in institutional care often at times that do not suit family carers.
Domiciliary care is also coming under increasing time driven constraints which is very unsatisfactory for many older people who want more than a flying visit and short conversation. Many older people in Northern Ireland are also becoming more isolated and cut off from their communities through bereavement, breakdown of family networks and reduction in informal care.
This experience of older people on the ground does not echo the high level policy drive towards greater choice and personalisation of care. Shared Lives offers a tangible opportunity to provide flexible care in the community in a safe and familiar family environment.
The challenge for Shared Lives in Northern Ireland is scaling the Shared Lives offer across from learning disability where it has operated successfully for 15-20 years. There are 4 long-standing Shared Lives schemes in Northern Ireland funded through learning disability directorates in 4 out of the 5 Health & Social Care Trusts. They currently support over 349 adults with a mix of day, short breaks and longer term placements.
If all Health Trust areas in Northern Ireland caught up with the largest Shared Lives scheme in the Northern Health & Social Care Trust nearly 1100 adults with a learning disability would be accessing Shared Lives care. This is also against a backdrop of an ageing population which a projected 75% increase in the number of people aged 65+ by 2039 and the number of care packages increasing by nearly 70% by 2037.
Key objectives for Shared Lives Plus with support from Nesta on the Accelerating Ideas programme is to establish new Shared Lives schemes for older people and also explore how existing schemes could be accessed by more adults needing care. The Shared Lives offer of personalisation, choice and normalisation of care within a community setting sits well with recent policy drivers.
There have been a wide ranging number of health & social care reviews looking at reshaping the current health system in recent years. This has included the Donaldson review (The Right Time, The Right Place) which led to the Bengoa Review (Systems Not Structures: Changing Health & Social Care) which was published towards the end of 2016. This was followed by the Health Ministers vision for the way forward “Health & Wellbeing 2026 – Delivering Together” in late 2016. In relation to adult social care there was the “Who Cares” consultation in 2013 and more recently the expert advisory panel on adult care and support (2017).
What is clear is that the current system needs to be reshaped and that examples of good practice around adult social care need to be scaled up. The collapse of the local assembly at Stormont in 2017 unfortunately has also left a vacuum in relation to decision-making. The former Health Ministers vison for reshaping healthcare is frozen at the moment until a new assembly is up and running and there is agreement on taking this forward with accompanying budgets.
Shared Lives Plus is in discussions with the Department of Health and Health & Social Care Trusts about how Shared Lives could be scaled up beyond learning disability to support older people. Shared Lives could provide a number of benefits to commissioners including:
- Step-down intermediate care for older people who cannot be discharged from hospital because a suitable care package is not available
- Day support to prevent recurring periods of ill-health or time spent in hospital
- An alternative flexible community based short breaks option for older people and their family carers
- Option to delay entry into longer term residential care and remain in the community
Shared Lives Plus held a workshop with stakeholders in the health & social care sector on the 1st June with very positive feedback on the opportunities to scale up Shared Lives for older people. We will be building on this goodwill to identify investment from commissioners to make this a reality for older people. The key message is that transformation needs to start now as the adult social care system struggles with growing demand for care from older people in Northern Ireland. Shared Lives is the right choice to build a more sustainable, asset based care model in Northern Ireland which allows older people to continue to live their lives in the community and receive person centred care.
Nesta in partnership with The Big Lottery are funding Shared Lives Plus as part of the Accelrating Ideas programme to grow and scale their model to benefit older people across the UK