With social care in crisis and hospital wards at breaking point, redesigning health and care services for older people has never been more important for the sustainability of the NHS. But how is the health service responding to the challenge, and how will it affect the way pharma works with NHS in the future? Wilmington Healthcare’s Oli Hudson explores an age-old issue.

It is no secret that caring for older people is the mainstay of NHS business. Before the pandemic, around two-thirds of all hospital beds were occupied by people over 65, many with multiple and complex health conditions, aggravated by frailty. Treating these age groups accounted for more than two-fifths of all NHS spending back then. It is likely to be higher still today.

Wilmington Healthcare’s recent State of the Nation report, meanwhile, shows that older age groups bore the brunt of the closure of hospital services during the pandemic: adult patients in the 55 and over age bands experienced 2.5 million fewer spells of inpatient care in 2020-21 compared to the previous year, with over 85s seeing over a million fewer episodes alone.

COVID-19, in other words, had a massive, cratering impact on the continuity of care provided to hundreds of thousands of elderly people, who now make up a considerable proportion of the record waiting lists we are now seeing. It is a situation further compounded by long-standing shortages in social care provision and widespread workforce and capacity challenges across pathways.

Unsurprisingly, on a macro level, population age also plays a key role in determining how a particular system fares on health indicators, including access and waiting times, as well as the prevalence of cancer, respiratory conditions, diabetes, cardiovascular disease and dementia.

For all of these reasons, older patients now have a vital strategic importance for new integrated care systems (ICSs).

This is reflected, either implicitly or explicitly, in many of the five-year plans being developed by these systems. The Suffolk and North East Essex plan is a case in point: its ‘higher level ambitions’ include ‘the best quality of life as we grow older’ and ‘the care and support we need at the end of our life’.

On the ground, these commitments are manifested in the work that health and care organisations are doing to improve support for older populations. These include:

• The introduction of technology-enabled care, such as virtual wards and other remote-monitoring solutions, which can enable more patients to be cared for safely in their own home (or in a care home)
• The expansion of preventative health services, such as frailty clinics or falls assessment services, the presence of social prescribing professionals in GP surgeries, and greater join-up with social services and mental health teams, to help identify and support those at risk
• Investment in multidisciplinary community health support, such as improved out-of-hours crisis response services and a more proactive approach to supporting care homes through the Enhanced Health in Care Home programme
• Changes in the way hospital-based services work, such as the introduction of same day Emergency Care services, patient-initiated follow up (PIFUs) for outpatient care, and the continuing expansion of virtual clinics to support patients and primary care teams.

All these developments have practical implications for the way pharma works with the NHS – while also offering some gilt-edged opportunities to join forces with health professionals to deliver higher quality care for older patients.

For many conditions, there will be significant changes to the care pathway, involving different points of entry and taking in a much wider range of health and care professionals with a direct involvement in the patient’s ongoing care.

For example, there will be extended roles for nurses, allied health professionals, pharmacists and advanced practitioners, and more overlap between acute/specialist and community teams as more care is pushed outside of hospital settings. Pharma will need to reflect this broader perspective in its stakeholder mapping.

The new approaches also carry with them the need to manage risks and work closely with older people and their carers to educate and inform them about the changes in their care – which pharmaceutical companies can support by forging new strategic partnerships with NHS customers.

A case in point is ‘patient initiated follow ups’, which all Trusts are being encouraged to introduce where appropriate. Patients will need information and advice to help them understand their condition and when they may need to come forward for additional clinical care. Similarly, digital transformation creates the potential for digital exclusion of older age groups who may find it more difficult to transact with the NHS online or virtually.

Challenges emerge too when it comes to decisions about how drugs are administered for older patients. While the pandemic prioritised oral or subcutaneous methods over hospital-based infusion for practical, there is evidence that this creates issues with adherence among some patient cohorts.

How these risks might be mitigated – either by upskilling and supporting frailty teams and community-based health professionals, or by reverting to more traditional hospital-based infusion methods – needs to be part of the conversation pharma has with its NHS customers.

Industry’s response must also reflect the headwinds that many health organisations will be facing. Inadequate access to diagnostics, delays in hospital discharge due to lack of social care packages and skills shortages across the pathway may limit what the NHS can do for its older patients.

So how should pharma respond? Firstly, it is important to understand local realities. This may include looking at current diagnosis and referral patterns, waiting times, workforce capacity challenges, development plans, relevant patient surveys and any corporate commitments being made to improve service delivery.  Every system and locality will be different, so take time to gather evidence to inform your approaches.

Secondly, it is helpful to leverage relevant policy in making your case for change. For example, it is worth looking at the growing collection of Getting It Right First Time (GIRFT) reports, which outline best practice case studies and expose variations in clinical practice across a range of disease areas and specialties (including geriatric medicine). NICE guidelines are also influential in shaping clinical decision-making.  Make sure your value proposition is shown to be ‘going with the grain’ of national policy.

Thirdly, it remains vital to engage directly with the clinical community to raise awareness of disease and facilitate best practice across a given pathway. Pharma is often in a unique position to be able to describe and share what works, by drawing on a wealth of national and international experiences. Remember that this is invaluable evidence to help influence local decision-makers’ thinking.

In short, the unerring maths of demographic change tell us the challenge of supporting increasing numbers of older patients is not going away any time soon – indeed, the number of over-85s living in England is expected to double within the next 25 years.

By engaging intelligently with ICSs, pharma can make a significant difference to many older cohorts of patients today, while also playing a key role in making the healthcare system more resilient for the future.

Oli Hudson is a consultant at Wilmington Healthcare.
Go to wilmingtonhealthcare.com