Tag Archives: cost effective

Creating sustainability in health and social care

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The question of the sustainability of funding for health and social care services has been in the spotlight recently. The Conservative Party manifesto contained proposals around making individuals pay for more of their social care costs, to deal with the “challenges of an ageing society”. Meanwhile, figures suggest that NHS Trusts in England overspent by £770m last year despite a focus on efficiency savings.

However, creating and maintaining sustainability in health and social care is much broader than financial sustainability. It means considering other factors, including environmental, training and project management issues. This takes planning, commitment and an understanding of the aims and expectations of staff and senior management.

A research symposium earlier this year (hosted by Healthcare Improvement Scotland and partners) explored these issues further, looking at the evidence underpinning ways to create sustainable health and care systems.

Environmental sustainability

Environmental sustainability is something which all organisations are being asked to address and improve. The issue of climate change has led to a focus on behaviour change and a more sustainable use of resources.

  • Buildings – This includes the planning of new healthcare buildings, as well as adaptations to existing structures to make them more energy-efficient. Alternative building materials and designs have been used in new projects to improve energy efficiency, with some buildings even incorporating wind turbines, solar panels and geothermal capture centres. Reducing waste water and improving temperature regulation through heat capture and insulation techniques are also being adopted. While these may be costly initial spends for many, the long-term cost savings are also significant, as well as ensuring that the buildings meet minimum national requirements for energy efficiency and contribute to emissions reduction targets.
  • Resource, waste and recycling management – In many offices and clinical centres, individuals are encouraged to be personally responsible for their own reduction in waste and improved use of recycling facilities; however, this must also be facilitated at an organisational level. Clearly labelled recycling bins, promoting reduction in of the use of disposable water and coffee cups, and encouraging employees to use less paper when report writing (printing double sided for example, or going paperless where possible) are all simple ways in which environmental sustainability can be promoted in health and social care settings. Innovative techniques such as reusing water in internal plumbing, or creating bespoke recycling facilities to help reduce the amount of clinical waste incinerated, are being developed.
  • Remote monitoring and the use of technology – There have been major advances in the use of remote technology to host meetings, video-conferences, follow up appointments and assessments for those in receipt of reablement care via tele-health. Remote monitoring of patients, as well as the use of tele-health and other digital platforms can allow consultations and routine check-ups to take place without either party having to leave the house or office, thereby reducing vehicle emissions used in transport. In social care, remote meetings and cloud-based reporting can allow front-line social workers to remain out on visits instead of having to return to the office to fill out reports, again reducing vehicle emissions.

Sustainable resource management

In the face of more limited funding, joint working between health and social care is being heralded as a new way of cost saving, making the most of ever-depleting resources in the face of ever-greater demands. Being efficient with resources, through effective planning and management is one of the key ways to ensure resource sustainability in the long term, especially for the NHS and local authority social care teams.

Approaches include:

  • Making full use of the entire health and care ecosystem – This means using the entirety of the health and social care ecosystem, its capacity, expertise, resources and the end-to-end care it can provide. It means engaging carers, GPs, nurses, and pharmacists to improve efficiency, make better use of resources, spread the workload and improve satisfaction levels and outcomes for service users.
  • Using careful and well-managed commissioning models – This means making good decisions about commissioning and outsourcing to make best use of funding and other available resources. It also means allocating to appropriate projects, being mindful of the possible consequences of payment by result frameworks, and getting the best value possible.

Sustainability in practice

The final level of sustainability in relation to health and social care practice involves the sustainable implementation of programmes. This means finding ways to ensure that implementation is carried out in ways that ensure long term success and positive outcomes. It involves understanding context, and the culture of the organisation and makes reference to something discussed previously in our blog on implementation science.

Ensuring sustainability in practice requires multiple efforts including:

  • Making sure that practice becomes embedded into everyday work
  • Sharing best practice
  • Maintaining motivation among your workforce
  • Using robust, local evidence in a way that is clear and concise.

Understanding what kind of evidence leads to sustainable programme implementation is also important: economists prefer cost-based strategies, chief executives want one-page summaries, professionals want examples of other organisational based programmes and what was required to implement effectively, and councillors want case studies based around the positive impact on services users. Case studies can at times actually be the least helpful because even in a failing programme there is usually one example you can use to find positives.

Another issue with evidence is the reluctance to report on issues or challenges, or failed projects, when actually some of the greatest insight can be gained from this. All of the learning that can be gained from failures could be useful when trying to make programmes more resilient so they can be more sustainable.



Final thoughts

The concept of sustainability in health and social care cuts across many areas of organisational management and personal practice and behaviour. Encouraging and participating in sustainable practice can mean anything from being more environmentally friendly by digitising reports, recycling paper or changing to energy saving lightbulbs to promoting sustainability of resources through efficient and effective management, utilising the skills, expertise and resources of the entire health and social care ecosystem.

These approaches to sustainability should not only help health and social care as a profession to be less impactful on the environment but will also allow organisations to save money, improve efficiency and ultimately improve outcomes for patients and service users as a result.

* The 5th Annual Research Symposium: Evidence for sustainability – exploring the current evidence underpinning ways to create sustainable health and care systems was held on 16 March 2017. It was jointly hosted by Healthcare Improvement Scotland, Health Services Research Unit and the Health Economics Research Unit at the University of Aberdeen, and the Nursing, Midwifery and Allied Health Professions Research Unit at the Chief Scientist Office.

If you enjoyed this blog, you may also be interested in other articles on implementation theory and commissioning in health and social care.

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“All it takes is one song to bring back 1,000 memories”: using music therapy in dementia care

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unsplash-ipod-music

Earlier this month, it was reported that dementia had overtaken heart disease as the leading cause of death in England and Wales. And caring for those with dementia is becoming the major social care challenge of the 21st century – over 1 million people in the UK are expected to have dementia by 2021.

Despite significant research into the condition, there are no long-term cures. As a result, health and social care teams, and researchers into the health and well being of older people, have started to promote non-pharmacological ways of alleviating symptoms and reducing distress to the patient and their family.

Many of these techniques are widely accessible, require little to no formal care training and can take place either in the patient’s own home or in a care home setting. One of these techniques is the use of music as a form of therapy. While specially trained dementia and Alzheimer’s music therapists exist to give formal therapy, carers and family members can also use music to help improve the quality of life of a person suffering from dementia or Alzheimer’s.

Benefits of music therpay in dementia care

Research and experiences from practice regularly show similar outcomes when using music with dementia care patients. The benefits that are consistently highlighted include:

  • Music evokes emotion – and this in turn can evoke memories which can help sufferers and family members to connect together.
  • Musical aptitude and appreciation are two of the last remaining abilities in dementia patients – it is one of the first cognitive skills we develop as new-born children and is one of the last things to leave us in degenerative cognitive diseases.
  • Music can bring an emotional and physical closeness – the association that a patient makes with a song can encourage them to complete actions such as dancing or hugging which they associate with that piece of music. It can also enhance feelings of security and safety among vulnerable patients.
  • Singing can be used as a way to engage and to encourage people to express feelings, even if it does not include words or sentences. It can be a way to encourage participation and socialisation, as well as stimulating brain activity, dexterity and physical activity if actions are also introduced to go along with the words.
  • Music has been proven to stimulate the release of hormones which gives it the ability to shift mood and manage stress.

“Come fly with me … Let’s make a cup of tea”

One project from Purple Angel music has rewritten and altered the lyrics to some well-known songs which are loaded onto an iPod and can be placed in a person’s home to remind them to carry out day-to-day tasks such as eating and drinking, locking their front door, turning off their fire and showering.

The pre-loaded iPod, which comes in a number of musical genres, contains two 12-hour tracks – one which plays the lyrically-amended songs at two hour intervals throughout the day to act as a reminder service, and the other which is 12 hours of silence, designed to allow the patient to sleep without having to remember to turn off the iPod.

Examples of the altered tracks include:

  • L.O.V.E,  I’d love a cup of tea – a song to encourage rehydration via a cup of tea
  • That’s Amore, That’s a bath day – a song to encourage taking a shower or bath
  • Let There be Love, Let there be lunch – a song to encourage eating
  • Can’t take my eyes off of you – a song to encourage night time requirements, like locking the door and turning off the fire.

A playlist for life

In August 2016, the Care Inspectorate backed a scheme called ‘playlist for life’ which encourages care homes to integrate music into their care for patients with dementia. Moving beyond just allocating a time to place headphones onto a patient and leaving them to listen alone (although at times this may be helpful too), the aim is for music to be a vehicle for connected care. It allows carers to use music as a tool to find out more about the person they are caring for and encourage them to engage through the music.

“Music can reveal previously hidden aspects of the patients to their carers; likes and dislikes, talents and memories – it all helps piece together the jigsaw of an identity obscured by illness.”

As the video above shows, using music can also be a way for family members to re-engage with the person suffering from dementia. It also  allows them to feel like they are directly involved in a positive element of care, as they are often invited to create the playlist, using songs that they know will evoke specific memories or emotions for the patient, and then listen along with them, interacting as they do so.

Similarly, Music for Life, a project run jointly by London’s Wigmore Hall and the charity Dementia UK brings specially trained musicians into care homes to work with patients, carers and family members in group and 1-2-1 sessions, creating and listening to music. Musicians, care home staff and managers meet after each session to reflect on what they have learned about the patients – knowledge that helps in future care and treatment.

Music as a communication tool

Formal research has supported the use of forms of music therapy, whether they be formally delivered by trained specialists or integrated into day to day caring by family or social carers. As mentioned above, research has demonstrated the positive effect it can have, both on the patient but also on their family.

Over 800,000 people currently live with the condition and roughly 25 million people – nearly half the UK population – are affected by it through knowing someone with the condition.

Music offers a way to care for people suffering from dementia in a sensitive, person-centred and cost effective manner. It can also be a vital tool to support families who can reconnect with their loved ones through a piece of music, even when other forms of communication have become difficult.

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How should we address loneliness and social isolation among older people?

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For elderly men sitting on a bench

Image courtesy of http://goo.gl/A8ykMA using a Creative Commons licence.

By Steven McGinty

“Loneliness and the feeling of being unwanted, is the most terrible poverty“– Mother Teresa

Yet, for many older people, loneliness and social isolation are the normal state of affairs. A recent study by the Office for National Statistics (ONS) found that 34% of people aged 52 and over felt lonely often or sometimes, with this figure reaching 46% for people aged 80 or over. Rather worryingly, a report by Age UK also suggested that over half of older people consider the television as their main source of company.

In many respects, these figures may not be too surprising, with some arguing that this is simply the by-product of changing societal attitudes. Conversely, it could also be said that these changes are a response to the demands of busy modern life. For example, a report published by the Royal Voluntary Service highlights that, because of uncertainty in the job market, many children have to move away from their parents for work reasons. The impact of this is that many older people are seeing their families less and less, with 48% of parents only seeing their children once every two to six months. Continue reading →