New frontiers in health service reform

Investing in workforce training and patient-centred models of care are critical to reforming health services in the face of an ageing population, says a senior geriatrician and chair of the Victorian Government’s clinical leadership group on the care of older people in hospital.

Speaking ahead of his presentation as part of an AAG webinar on Health Reform and Older People, Associate Professor Peter Hunter said an ageing population was transforming the business of contemporary hospitals.

“It’s a truism to say that the work of hospitals today is about caring for older people,” he said. “Almost every clinician who works in the hospital system barring those who work in paediatrics and maternity will essentially be dealing with an older population, so it’s no good to push older people aside and say ‘well that doesn’t interest me’.

“Most health professionals will be dealing with older people, and as a result models of care need to reflect our ability to look after older people and clinicians need to have some basic skills and knowledge about assessing and properly managing their needs,” he told AAA.

The Victorian Department of Health predicts that by 2022 people over 70 will use 45 per cent of bed days and 70 per cent of hospital costs will relate to chronic and complex conditions.

A/Prof Hunter said there were four important dimensions to caring for older people in hospital which included having the right environment, skills, models of care and attitudes towards ageing.

“You need hospital environments that are older-person-friendly – that’s about setting up environments that actually prevent people from having functional decline.

“Hospitals can be dangerous for older people. We need the right beds, the right chairs, the right lighting to avoid people becoming weaker, more frail and confused.”

He said the right models of care were person-centred and cut across the whole continuum of care. A particular focus on the patient experience of care also represented a new frontier in healthcare improvement, he said.

Service improvement was also supported by clinical training that armed health professionals with the skills and knowledge to care for older people. “That gets back to what happens in clinical schools and in medical and clinical training.”

The final piece of the puzzle involved tackling ageism and recognising that the care of older people was complex, interesting and important work, he said.

Integration with aged care 

While he said there was more work to done to strengthen the interface between aged care and the rest of the health system, he said the priority for models of care should be to treat older people in their own environment.

“Treating people in the residential aged care facility is actually a much better thing to do because it doesn’t come with the additional risks that you associate with a hospital admission such as the risk of falls, pressure ulcers, increased confusion and malnutrition.”

To support health services, the Victorian Clinical Leadership Group is developing a series of projects to demonstrate how Australia’s National Safety and Quality Health Service standards can be applied to the care of older people.

A/Prof Hunter also pointed to the work of leading institutions such as the King’s Fund in England and the US-based Institute of Healthcare Improvement as offering important frameworks for thinking about service improvement.

The webinar will also feature Carolyn Gullery from the Canterbury and West Coast District Health Boards in New Zealand, who will share learnings from the board’s experience of implementing an integrated health care system. Ms Gullery will highlight how the Canterbury integrated system succeeded in working through the major earthquakes that struck in 2010/2011.

The Health Reform and Older People webinar takes place on 23 July. 

Australian Ageing Agenda is the media partner of the AAG.