Bay area takes a balanced approach to health and social isolation

8 February 2019

It’s not just the practitioners of holistic and complementary therapies that recognise the value of balance in health.

With high levels of social isolation, the Bay health cluster of eight practices in south Wales is embracing the Balanced Lives programme developed by national charity Action for Elders. It aims to improve the physical, mental and social wellbeing of people over 65 through weekly sessions.

Patients are referred by the cluster’s GPs, district nurses, social care services and a long term conditions nurse specialist that the cluster employs to visit around 700 targeted people – many of whom are isolated through both distance and the lack of friends and family. The session is held in Sketty, an area of Swansea Bay with a high proportion of older people and pockets of economic and social deprivation. The sparsity of population also aggravates the problem of social isolation.

At the sessions:

•  The older people undergo physical movement and exercise, led by a professional physical mobility facilitator 
•  Group hosts encourage participants to talk to each other and build social confidence - including through group conversations exploring sensitive issues such as grief and bereavement
.  These often led to members developing shared interests and friendships they can build on outside. 
  Health prevention measures are provided – including checks on blood pressure, weight and vital signs 
  Information is shared to help older people take more control over their own health and wellbeing, including talks based on group needs that help members connect with other community groups and services.

Kirstie Truman, Bay health cluster lead, explains that the Action for Elders approach – with the charity match-funding the NHS contribution – stood out because of their experience in other parts of the UK. 

The cluster and charity are working together to secure funding that would ensure all the appropriate patients in the cluster have access to the group.

During the programme’s first year, it supported 41 older people, averaging over 20 people in a session. The reasons for referral ranged from stroke and multiple sclerosis through to anxiety, loneliness and depression. Some had balance issues or severe disability.

Although a full evaluation has yet to be completed, the cluster and Action for Elders are confident it will reveal both real benefits to the older participants and to the finances of local health and care services.

The latter include

•  Fewer GP appointments, nonelective hospital admissions and drug prescriptions 
•  Maintenance of independence, preventing or delaying residential care
•  Better management of long-term conditions, including dementia
•  Reduced reliance on primary care providers through improved self-care 

•  Increased capacity within community healthcare, particularly step-down support following a hospital admission.

Truman is looking forward to receiving hard data confirming the impact.

“That is the bit we are about to start looking at. So far the evidence is anecdotal.

“We are starting a quantitative evaluation shortly but the older people do seem to be much more confident and they enjoy the group and look forward to it which is really important. From my perspective the relationship that has been built with Action for Elders is excellent and the outcomes we have heard about from group are really positive but we need quantitative rather than qualitive date now.”

James Lewis, chief executive of Action for Elders, explains that the charity is transforming its reporting: “There are a number of ways of talking about data and evidence based outcomes are very important. From the start we have looked at evidence on reported improvement by going through a paper questionnaire with each person on arrival, at the end of each month and when they leave the course. In October we started using an NHS-accredited algorithm around health and wellbeing where the data is actually processed in Canada but it will allow us to feedback regularly to GPs.”

Improvements are expected to be shown across a range of physical, mental and social wellbeing indicators. For the former, Lewis says, these relate to areas shown to be particularly important in maintaining the physical health of older people. They are:  

• Improved balance and fewer falls
• Increased stamina
•  Reduced stiffness and pain in joints, improving mobility
•  Increased core strength and balance, with less reliance on walking frames and mobility scooters
• Better posture
• Better breathing.

Service users are initially referred for 36 weeks but Lewis says that for those referred with mental health issues – such as depression, anxiety and loneliness it is difficult to ask them to stop coming to something they enjoy and that benefits their health. 

Resources Primary/Community Services

Latest News

New code of conduct for AI systems

20 February 2019

The Department of Health and Social Care has issued a code of conduct for artificial intelligence (AI) and other data-driven technologies will ensure that only the best and safest systems are used by the NHS.

The code encourages technology companies to meet a gold-standard set of principles to protect patient data to the highest standards. It has been drawn up with the help of industry, academics and patient groups.

The aim is to make it easier for suppliers to develop technologies that tackle some of the biggest issues in healthcare, such as dementia, obesity and cancer. It will also help health and care providers choose safe, effective and secure technology to improve the services they provide.

Read More

More on GMS contract changes 2019/20

20 February 2019

NHS England has written to directors of primary care and senior CCG managers with further details of changes to the GMS contract for 2019/20. It includes notification of the one-off payment for indemnity inflation, changes to the value of QOF, global sum and out-of-hours payments, and the £1.761 per weighted patient for signing up to the forthcoming network contract directed enhanced service (DES).

Read More

Tobacco control assessment tools

19 February 2019

Self-assessment tools from Public Health England help local public health bodies to scrutinise their tobacco control work.

Read More

EU advice notice on falsified medicines directive

19 February 2019

The Safety Features Delegated Regulation, part of the EU Falsified Medicines Directive (FMD), will apply in the UK from 9 February 2019. Healthcare institutions are required to verify and decommission medicines supplied or administered directly to patients. All GP practices “personally administer” some medications and the decommissioning of these elements are covered by the GPIT operating model arrangements and centrally funded. According to the Medicines and Healthcare products Regulatory Agency (MHRA) FMD requirements would need to removed from law in the event of a no deal EU exit as we would no longer have access to the EU system. FMD preparations need to continue “with appropriate caution” given the possibility of a no deal scenario, the MHRA says.

Read More

NICE draft guidance recommends pertuzumab for early treatment of breast cancer

19 February 2019

NICE has published guidance recommending pertuzumab (Perjeta, Roche) for treating early HER2-positive breast cancer in people whose disease has spread to their lymph nodes.

Read More