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Ageing and Dying Well

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1. What changes to models of care would have the greatest impact on improving the health outcomes and patient experiences of older people, and their families and carers?

2. Across the other themes and challenges the Stocktake is considering, where should we highlight specific recommendations and actions that need to be focused on older people specifically?

3. How can local health and care systems (including the voluntary sector) work alongside primary care to improve the experience of people and their families at the end of life?

 

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Working across boundaries and utilising existing resources to maximum

In my past working life within a local health economy in London, I worked with the stakeholders within Local Public health Directors, Acute, Community, LAS and Primary care and set up a hub and spoke frequent attender model that used the health coaches and champions (at that time, this was paid for as part of the Live well, Ageing well project) to inreach and outreach and provide 1:1 bespoke support to people that did not require ED, but were still turning up as they needed befriending and...

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Anticipatory care plan sharing

In East Surrey we reduced the number of inappropriate ED attendances from care homes by 75% - this reduced further during covid for obvious reasons and and as stayed low at present. What used to be a big factor in ED presentations has reduced dramatically. Patients with frailty and those patients highlighted in in the previous DES - at risk of admission - had less dramatic results but the premise of sharing information particularly about plans for future care - made visible to the ambulance...

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Oral health in care homes

PCNs need to facilitate improved communication and connectivity between providers based on patient need. Dental care for those in residential care settings should be joined up with their regular care. GPs working with residential care providers should have an automatic link to other services, such as domiciliary dental care to ensure that an oral healthcheck is undertaken by trained dental professional on admission to the care home with regular follow up checks.  As more people age...

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