Background The nation has an ageing population and our local demographic is approximately five years ahead of the curve in relation to this. It is projected that our 65+population will increase by 18 000 and the 85+population will increase by 6500 by 2039.
Aims Our new coordination centre will mean we can reach more of our population earlier, preventing inappropriate admissions to the acute setting and enabling a planned approach to care. Our desire is to give the correct dose of care to each person at the right time, meaning our finite resources are used effectively and people are not smothered in a blanket of care and become ‘a patient’.
Method The criterion for referral into our coordination centre is the last five years of life. All people referred are assessed and a plan put in place. The plan will range from light touch support, including access to our 24/7 support line, social programme and rapid response service, to CNS involvement. Our vision is that more people will fit in to the criteria of the former, enabling a planned approach, with patient’s wishes achieved and stress and anxiety managed.
Results Although the project is still in its infancy we have already seen significant positive outcomes from this new way of working. This includes callers able to talk to an expert no matter when they phone, call backs and checking in with people who might otherwise be missed, a heightened awareness of the number of people that will be requiring our services as we move forward and admission avoidance.
Conclusion Accepting referrals for people in the last five years of life is innovative and bold, a brave new model that we believe is necessary to meet the changing needs of our community. #therightdose.
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