Golf In Society perfectly aligned with the NHS Ageing Well plan

Since I started Golf In Society four years ago, I’ve really struggled to get referrals from NHS professionals, in particular Primary Care Networks (PCN’s). It’s been a series of disappointments that at times make you consider whether there is demand for your social enterprise.

To me it’s always seemed a “no-brainer” that a service that enables people to improve their physical activity, stimulates cognitive function, increases social engagement and supports primary carers in a single intervention would be embraced by PCN’s.

Despite numerous visits, communication and distribution of leaflets, generating new referrals from PCN’s has remained a challenge.

However, after reading the Ageing Well part of the NHS long term plan it’s made me realise that Golf In Society is perfectly aligned with the ambitions of PCN’s.

It also leads on very nicely from the fact I mentioned yesterday that 1.7 million hospitals days are taken up by older people with dementia.

Before you read the sections taken from the Ageing Well NHS plan, here are two graphics that highlight the positive impact we have on people’s lives every time we deliver one of our golf sessions.

So let’s start by looking at the commitment from PCN’s to the Ageing Well long term plan.

NHSPrimary care networks will from 2020/21 assess their local population by risk of unwarranted health outcomes and, working with local community services, make support available to people where it is most needed.

Based on their individual needs and choices, people identified as having the greatest risks and needs will be offered targeted support for both their physical and mental health needs, which will include musculoskeletal conditions, cardiovascular disease, dementia and frailty. Integrated primary and community teams will work with people to maintain their independence: for example, 30% of people aged 65 and over,  and 50% of those aged 80 and over, are likely to fall at least once a year [9]. Falls prevention schemes, including exercise classes and strength and balance training, can significantly reduce the likelihood of falls and are cost effective in reducing admissions to hospital [10].

That’s the first box firmly ticked. You only have to see our golfers in action to see the difference it makes to their physical well-being and confidence. Here’s an interesting fact for you.

In over a 1000 hour of golf we’ve had no falls that have resulted in a hospital admission. Sure, we’ve had a few trips and stumbles but nothing that a quick brushing down and reassuring conversation hasn’t fixed.

So let’s move on to the commitment to carers who have for too long been the forgotten victims of Ageing Well agendas.

NHSCarers will benefit from greater recognition and support.

 The latest Census found that 10% of the adult population has an unpaid caring role, equating to approximately 5.5 million people in England – around 4 million of whom provide upwards of 50 hours care per week. 17% of respondents to the GP patient survey identified themselves as carers. Many carers are themselves older people living with complex and multiple long-term conditions. We will improve how we identify unpaid carers, and strengthen support for them to address their individual health needs. We will do this through introducing best-practice Quality Markers for primary care that highlight best practice in carer identification and support.

A huge tick in this box. When I started my social mission I’d never really considered the positive impact it would have on the lives of carers. The testimonials we receive from carers say it all.

And finally, let’s take a look at the commitment to dementia support.

NHSWe will go further in improving the care we provide to people with dementia and delirium, whether they are in hospital or at home.

 One in six people over the age of 80 has dementia and 70% of people in care homes have dementia or severe memory problems. There will be over one million people with dementia in the UK by 2025, and there are over 40,000 people in the UK under 65 living with dementia today [11]. Over the past decade the NHS has successfully doubled the dementia diagnosis rate and halved the prescription of antipsychotic drugs [12]. We have continued to improve public awareness [13] and professional understanding. Research investment is set to double between 2015 and 2020, with £300m of government support [14]. We will provide better support for people with dementia through a more active focus on supporting people in the community through our enhanced community multidisciplinary teams and the application of the NHS Comprehensive Model of Personal Care. We will continue working closely with the voluntary sector, including supporting the Alzheimer’s Society to extend its Dementia Connect programme which offers a range of advice and support for people following a dementia diagnosis.

I think this is where our service stands out as a perfect example of how a single intervention can be designed to meet the personal needs of ageing adults and their carers, no matter what challenges come their way later in life.

With over 450 golf sessions successfully delivered and so many lives transformed, I think we’ve earned a few “ageing well stripes”.

The desire to convince PCN’s to commit their support to our innovative intervention and why embracing it makes so much sense burns brighter than ever. It really is a “no-brainer”.

Hospitals and the Big D

I think we all agree that hospitals are the worst place for people living with the Big D to spend time.

Unfamiliar surroundings filled with strangers trying to talk to you are challenging situations to deal with at the best of times, let alone in a busy clinical environment. “Where am I?, who are you?, leave me alone, get off me” will be all too familiar comments made to hospital teams when treating patients with dementia. For the purpose of this blog I’m going to call them D-patients.

I realise that in certain circumstances there’s no alternative to a hospital admission. However, I’m sure we all agree that this needs to be kept to an absolute minimum for D-patients.

This is why I was saddened to read the recent Public Health England report titled “Older people’s hospital admissions in the last year of life”.
Older people are classed as 75 years and older. According to the report the largest total number of days spent in hospital (1,760,801 days) was in people who died from an underlying or contributory cause of death of dementia (see bottom chart).
As far as I can gather we need to address three issues here. Firstly, reduce the number D-patient admissions. Secondly, discharge them sooner into the safety and comfort of the place they know as home. And finally, reduce the number of D-patients passing away in hospitals.

As you can see most admissions for D-patients are emergencies. My experience as a carer leads me to believe that a large number of these admissions will have been as a result of a trip, slip or fall at home. Emergency services will probably have been involved.

In order to make my point, I’m going to share a harrowing incident I witnessed during my early days as a carer when an elderly man fell at home. His wife was too frail to pick him up. He was in a state of undress. When the ambulance arrived they couldn’t lift him safely. They called for more assistance. In the end three ambulances were on site and he was carried down the stairs using a bed sheet. You can imagine the distress this caused.

Three days after being discharged the gentleman had another fall in his bathroom and was hospitalised again. He never got the chance to live at home again as he was discharged into a nursing home. He died soon after.

The outcomes could have been so much better had the necessary adjustments been made to his home.

He would have lived longer, safer and independently in his own home that he adored so much. There would have been fewer emergency interventions, hospital admissions and number of days spent in an environment that caused him so much distress.

So my main point is that we all need to work much harder on keeping people living with dementia safe and secure in their own homes for longer. With the necessary adjustments to their living space this can be achieved.

If we achieve this then the outcomes will be fewer D-patient admissions, quicker discharges and more people spending their last year of life in their own home.

Imagine the positive outcomes for D-patients and the NHS if we reduced the 1.7 million hospital days by a third. Believe me, it’s achievable if we get the right primary and preventative measures in place when families first receive their dementia diagnosis.

We all know how distressing hospital stays are for D-patients. That’s why reducing the days spent in hospital is such an integral part of my D-plan.