Agenda item

Frail Elderly Pathway

To receive a presentation on the Frail Elderly Pathway.(20 minutes)


Stuart Rowbotham, Director of Health and Wellbeing provided a presentation on the Frail Elderly Pathway.


During the discussion of this item the following points were made:


·         There was a connected, inter-dependent Berkshire West wide health and social care system.

·         4 CCG’s (Wokingham, North & West Reading, South Reading and Newbury & District), 3 local authorities (Wokingham, Reading and West Berkshire) and 3 providers (Berkshire Healthcare NHS Foundation Trust, Royal Berkshire NHS Foundation Trust and South Central Ambulance Service) were working together as the Berkshire West 10 (BW10) to deliver a health economy wide programme.  Whilst the BW10 had previously submitted a bid to be national Integration Pioneers this had not been accepted.

·         There was a commitment to whole system integration. 

·         Drivers for the Frail Elderly Pathways included:

o   Demographic pressures across the system;

o   Scale of frail elderly costs;

o   Costs and sustainability;

o   Austerity – fiscal strategy;

o   Long established policy aspiration for health and social care integration;

o   Better Care Fund.

·         A high level pathway was being developed.  The Frail Elderly Pathway was a design or template for responding to health and care needs for ‘Sam’, a frail elderly person and described what ‘good’ looks like from Sam’s perspective.  It had been designed by stakeholders including staff, the voluntary sector and patient voice and had been supported by the King’s Fund.

·         Expected outcomes were a person centred, joined up response to Sam's needs through his later years life stage and a new health and social care paradigm that was affordable and sustainable.

·         Stuart Rowbotham outlined the commitments to the Frail Elderly Pathway.  He emphasised that there was a need to do things differently to ensure the sustainability of the health and social care system.

·         There was a commitment between partners to undertake economic modelling of the impact of the pathway across the system and to share risks and benefits

·         More could be done to further the prevention agenda.

·         Members noted the underpinning themes.  Stuart Rowbotham explained the Connected Care Programme.

·         Currently over 75 year olds made up less than 7% of the Berkshire West population but it was expected that this would increase by 17% over 5 years.

·         8770 people in Berkshire West met the frail elderly definition.  This was only 2% of the Berkshire West population.  However, this 2% consumed 28% of health and adult social care resource in Berkshire West.

·         The total health and care spend on the frail elderly population was £187m; this included an estimated £5m spent by NHS England on primary care (appointments and other contacts with general practice).  Using the BW10 total of £182m, the frail elderly health and care cost per head was £20,750 compared to £1,070 for the rest of the BW10 population.  The Committee noted the breakdown of the total spend on Frail Elderly.

·         Whilst Wokingham was already high performing even more efficiencies would be required. 

·         Councillor Sleight asked what the situation would be for those who became frail elderly and lived on the Wokingham/Bracknell (Berkshire East) border and whose GP may be located outside of the Wokingham CCG.  Stuart Rowbotham commented that the local authority and CCG boundaries were not completely coterminous and that whilst a common system was hoped for eventually, there would always be boundaries.


RESOLVED:  That Stuart Rowbotham be thanked for his presentation.

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