WP 04
Ymchwiliad i barodrwydd ar gyfer y gaeaf 2016
Inquiry into winter preparedness 2016/17
Ymateb gan: Age Cymru
Response from: Age Cymru
Consultation Response
Winter preparedness
September 2016
Introduction
Age Cymru is the leading charity working to improve the lives of all older people in Wales. We believe older people should be able to lead healthy and fulfilled lives, have adequate income, access to high quality services and the opportunity to shape their own future. We seek to provide a strong voice for all older people in Wales and to raise awareness of the issues of importance to them.
We are pleased to respond to the Health, Social Care and Sport Committee’s inquiry into winter preparedness in Wales. We welcome the committee’s decision to look immediately at the issues of winter preparedness. The issue of excess winter mortality disproportionately affects older people, for example through avoidable slips, trips and falls or due to cutting back on heating out of fear of the cost.
General comments
· Prevention in the community: Whilst we acknowledge that much of the focus of this inquiry will be concentrated upon the preparedness of the Local Health Boards and the Welsh Ambulance Service Trust for winter 2016-17, we would like to stress the importance of preventative measures in the community in order to minimise the number of older people who end up requiring treatment from the NHS.
Older people are at higher risk of unscheduled admission. Avoiding unscheduled admission to hospital is a major concern for the NHS because of the impact on the individual admitted, the high cost of emergency admissions, and the disruption that can be caused to elective care.
Through its Healthy Ageing Initiative, Age Cymru is involved in supporting both the Choose Well and Beat Flu promotions by strengthening the messages underpinning its own Spread the Warmth campaign, working with our local Age Cymru partners and our high street retail presence. Age Cymru also produces a Winter Wrapped Up guide for older people which covers topics such as keeping warm (inside and out), flu vaccination and advice on financial entitlements.
· Influenza vaccinations (the ‘flu jab): Flu can be more serious for some groups of people, including older adults, even if they are fit and healthy. These groups are more prone to complications that can arise from being infected with flu. To this end, promoting the importance of the free jab for older people is essential. It is important that older people are informed that their free vaccination may be available from a local community pharmacy as an alternative to making an appointment at their GP surgery.
Those working with older people, including health and social care professionals should also be vaccinated in order to minimise the risk of passing on the illness to the older people for whom they care. It is therefore worrying that take-up rates by these staff groups have been relatively low in the past. It is also important that carers of older people are vaccinated and we would recommend that carers should be eligible for a free vaccine in order to protect the vulnerable people for whom they care. It is important that these groups, as well as older people, understand that the vaccination only protects them from a year and keep their vaccinations up to date.
· Slips, trips and falls: Falls prevention is an important issue for the work of Age Cymru. Through our Healthy Ageing Initiative, we are engaged in the work on falls prevention through the Ageing Well in Wales expert advisory group on falls and are in collaboration with 1000 Lives Plus to establish a national falls prevention taskforce. As part of this work, Age Cymru and other partners, led by the Older People’s Commissioner for Wales, will be promoting a new campaign ‘Steady on…Stay safe’ from February next year.
The Ageing Well in Wales programme has identified the importance of reducing the impact and number of falls as a national issue that requires a coherent response. The Strategy for Older People[1] recognises that fear of falling is reported as a key concern for older people and a major contributing factor to their social isolation. In 2015, the Chartered Society of Physiotherapy (CSP) estimated that nearly 15,000 falls in Wales could be avoided through the use of physiotherapy-led preventative interventions[2]. The risk of slipping and/or falling, resulting in injury is aggravated during poor winter weather conditions.
Falling – and the fear of falling – can have a major impact on older people. The physical aspects and injuries are obvious but potentially more damaging is the less obvious impact that falls can have on confidence. Older people tell us that anxiety about falling, even if they have never fallen, preys on their mind. A lack of confidence can lead to people limiting what they do, resulting in a higher chance of social isolation and loneliness and the additional associated health risks. People may, however, be reluctant to seek help and advice in case relatives or care professionals think they are no longer able to cope independently.
Prevention of falls is vital. We should not focus solely on post-fall interventions. Age Cymru produces an ‘Avoiding slips, trips and falls’ guide for older people which covers issues such as eye tests, foot care and medicines management as well as some of the more obvious risks. This guide has been, and is being, used by many hospitals across Wales, which is great for older people. However, this throws up questions about sustainability as Age Cymru struggles to find the resources to produce a sufficient number of copies to reach demand in the absence of external contributions.
We believe there needs to be a more consistent approach to falls prevention across Wales and a national mandatory minimum standard of support that all older people receive. This should comprise:
- Access to information
- Preventative interventions
- Care
- And signposting to other services or support.
Whilst slips and falls may occur disproportionately during the winter months due to adverse weather conditions, an effective approach to falls prevention can benefit older people all year round.
· Fuel poverty: Fuel poverty has been highlighted in the past by Public Health Wales as a key contributing factor to winter demand as people struggle to keep their homes warm. Public Health Wales has found that people at higher risk of the health effects of cold are also at higher risk of fuel poverty[3]
Fuel poverty is a significant problem for many older people in Wales. In Wales, fuel poverty is defined as needing to spend 10 per cent or more of household income on fuel to maintain a heating regime adequate to safeguard comfort and health. Around 386,000 households were estimated to be in fuel poverty in 2012, equivalent to around 30 per cent of all households in Wales. Older people are the group most likely to suffer from fuel poverty. On average there are around 1,600 excess winter deaths each year in Wales, the vast majority of whom were older people. At the root of many winter deaths are cold, badly insulated homes.
The Welsh Government has targets to eradicate fuel poverty which were set out in the Welsh Fuel Poverty Strategy in 2003 and reiterated by the Fuel Poverty Strategy 2010. Unfortunately the first two targets – to eradicate fuel poverty amongst all vulnerable households in Wales by 2010 and social housing by 2012 – were missed and there is no realistic prospect of achieving the final target of eradicating fuel poverty completely by 2018. In addition, many of the mechanisms and measures contained within the 2010 Fuel Poverty Strategy are out of date or no longer applicable. The Welsh Government’s continued commitment to funding an energy efficiency programme specifically aimed at reaching fuel poor households has been extremely welcome. However, the relatively small size of the Nest annual budget means that the overall reach of the scheme has been small. We are keen to see a renewed approach to tackling fuel poverty that will provide a clear programme of support that vulnerable households are able to access.
· Appropriate hospital discharge: if older people do end up being admitted to hospital during the winter, it is essential for both the older person and the hospital that the older person is discharged appropriately to ensure hospital flow is maintained as best as possible.
Too many older people are stuck waiting in hospital beds for much longer than necessary, often during complex discussions between different agencies over who should fund a long-term care package. We regularly hear of cases of older people waiting in hospital for a care package, without knowledge of why they are waiting, or any information as to their options and rights in this process. We hear from our local Age Cymru partners that the majority of older people they speak to do not even know that there is a discharge planning process, let alone that they have a right to be involved in it from the point of admission.
At the other extreme, older people are sometimes discharged without appropriate measures taken to ensure that they will be safe and cared for whilst they recover at home. One person told us: “You can be discharged the day after surgery even if you live alone. There was no discussion about who would look after me, how far my family lived from me or if my house was suitable for me…how did they know it was safe for me to go home?” Discharges may also take place at inappropriate times, such as at night, causing unnecessary stress and anxiety for those being discharged. There have been a number of projects funded under the Intermediate Care Fund to improve discharge outcomes, for example the Extended Hospital Service in Gwent. In order to maintain and improve flow through hospitals, those pilot schemes that have been effective should be extended across Wales and adapted to local circumstances as appropriate.
We hope these comments are useful and would be more than happy to provide further information if required.