‘Just one person’
Recently, NICE published guidelines on Older people with social care needs and multiple long-term conditions. Many older people fall into this group of having more than one long-lasting health problem. NICE looked at all the evidence – from research, from older people and carers, and from practice – and made recommendations on what makes the most difference and what we should aim for.
One of these recommendations is: ‘Ensure that older people with social care needs and multiple long‑term conditions have a single, named care coordinator who acts as their first point of contact.’ An accompanying resource, based on older people’s views of why this matters, stated what this looked like: 'just one person'; and why this matters: because older people too often feel that 'there is no-one there'.
Why do we continually fail to provide something that older people continually ask for?
I think the fundamental problem is that social care and health are not set up to provide this kind of experience. Our targets, processes, funding – ultimately what defines us as successful – do not include providing a pleasant experience for customers.
Maybe the Care Act 2014 gives us a new incentive – ‘promoting wellbeing’ should include ensuring that older people don’t feel that 'there is no-one there' when they need it. However, it takes a lot to change from caring about outputs to outcomes, particularly when our targets and processes are still largely set up to count things, and our funding is so short.
So what would change this?
Ideally, we would not need a single, named care coordinator. This is a fix for a deeper problem – the problem of uncoordinated services where older people have limited power and where professionals have limited time and resource to work together. If we could change the nature of our services, then we wouldn’t need a coordinator. Older people would have the power themselves, or with their advocates, to coordinate a responsive and clear set of services.
We are a long way from that. So our next best option is to identity coordinators or set up coordinators where we can. I think the best coordinators we currently have are:
- Older people with experience of services – often supporting others through user-led organisations or the voluntary and community sector.
- Carers with experience of services – often supporting others through carers organisations.
- Advocates who have built up expertise in supporting people to navigate systems.
- Social workers, nurses, occupational therapists or others with particular specialisms and links to other agencies – for example palliative care social worker and community matrons.
- People with coordinator roles who have built relationships and understanding of systems - for example attached to GP practices or local authorities.
Services and individual practitioners can try and identify who these people are, involve them, and replicate these kind of roles where possible.
The final option, which we need to take regardless of what else happens, is to get closer to this experience by all of us acting like we are 'someone who is there'. In NICE’s work, older people identified what they would value in a coordinator:
- A good listener and an effective advocate.
- The ability to establish trust and build confidence.
- An understanding of the importance of face to face contact and keeping in touch.
- Respect for the full history of each individual.
- The ability to work well with others.
- Status and authority, and the ability to make changes.
- Recognition of the importance of equality and diversity.
All of us – whether in our professional or personal lives - when we come across older people who are coping with a range of health problems and trying to gain access to support can:
- Share what we know
- Find out who might be able to help
- Ensure that the older person gets a response, not just a contact to use
- Check back on what has happened.
It does take a bit more time but it is what people want and need. Let’s be that 'one person' who makes a difference.
About the author
Gerry Nosowska is a social worker and RiPfA Associate. She will be co-presenting an open access webinar with Doris Richards, Chair of One Voice for Age and an older person, exploring how we can get closer to the ideal of 'just one person' on 22 November at 12pm.
'Just one person': genuine care coordination for older people: Open Access Webinar
22 November, 12-1pm, online