Bupa Private and Confidential Date if required

1

Formative Opportunities in Disintegrated CareSchool for Social Care Research Annual Meeting May 2012

Clive Bowman Divisional Medical Director Bupa Care Servicesbowmanc@bupa.com

Spain

Sanitas

Sanitas Hospitals

Sanitas Residencial

3800 people in 38 homes, 

United Kingdom

Bupa UK Membership

Bupa Health Assurance

Bupa Wellness

UK Care Services 18,700 people in over 300 homesHealthcare at Home

* Cromwell Hospital

Bupa Commissioning

China

Representative Office Beijing

Hong Kong

Bupa Hong Kong

Thailand

Bupa Thailand

Saudi Arabia

Bupa Arabia

Australia

Bupa Australia/ *MBF

Bupa Care Services3,693 residents in 48 homes

New Zealand 

Bupa Care Services

2,809 residents

US

* Health Dialog

Bupa International:

Offices in Brighton, England; Copenhagen, Denmark; Miami, US; Dubai, UAE; Cairo, Egypt; and Hong Kong

Insurance businesses

Provision businesses

Integrated health services

India

* Max BupaCare Homes

Bupa 2012

Disease = Health ServiceSqualor = HousingIgnorance = educationIdleness = employmentWant = Social Insurance

Are we stuck in a mindset ?

Moulds can be broken

Bernard Isaacs: 1972 Survival of the unfittest ‐ analysed the various reasons for admission to geriatric wards: therapeutic option (expecting rapid recovery); medical urgency (needing hospital treatment); basic care (unfit to provide food, warmth, cleanliness and safety for themselves); or relief of strain on relatives. 

Also the Geriatric Giants ‐ impairment of intellect (cerebral dysfunction), incontinence, immobility  & instability (falls).

2003* 2006 2009Bupa Bupa United Kingdom Australia New Zealand Spain Full Census

Dementia 36% 38% 44% 53% 50% 46% 46%Heart Disease 10% 10% 21% 39% 47% 28% 27%Stroke 22% 21% 20% 18% 23% 9% 19%Diabetes 8% 9% 14% 18% 20% 20% 16%Arthritis 13% 12% 18% 25% 18% 16% 19%

* The 2003 Census only asked for primary reasons for admission to be counted, and did not count all medical diagnoses

36%38%

44%

53%50%

46% 46%

10% 10%

21%

39%

47%

28% 27%

22% 21% 20%18%

23%

9%

19%

8% 9%

14%

18%20% 20%

16%13% 12%

18%

25%

18%16%

19%

0%

10%

20%

30%

40%

50%

60%

Bupa Bupa United Kingdom Australia New Zealand Spain Full Census

2003* 2006 2009

Dementia Heart Disease Stroke Diabetes Arthritis

Leading diagnoses

Changing care home activity

Health

Dementia

Housing

Time

Activity

Care home trajectories today

Convalescence

Function

Time

Palliative care

Respite

Fluctuating illness

Chronic disease

The challenge in ageing today

Time

Function

To dying from & where’s the finish line

Where’s the transition  from living with…..

Medicare analysis of dying

• 20% Short period of evident decline - typical of cancer. Most patients with malignancies maintain comfort and functioning for a substantial period. However, once the illness becomes overwhelming, the patient's status usually declines quite rapidly in the final weeks and days preceding death.

• 20% Long-term limitations with intermittent exacerbations and sudden dying - typical of organ system failure. Patients in this category often live for a relatively long time and may have only minor limitations in everyday life. From time to time, some physiological stress overwhelms the body's reserves and leads to a worsening of serious symptoms. Patients survive a few such episodes but then die from a complication or exacerbation, often rather suddenly. Ongoing disease management, advance-care planning, and mobilizing services to the home are key to optimal care.

• 20% Sudden death or not classifiable

• 40% Prolonged dwindling - typical of dementia, disabling stroke, and frailty. Those who escape cancer and organ system failure are likely to die at older ages of either neurological failure (such as Alzheimer's or other dementia) or generalized frailty of multiple body systems. Supportive services at home, like Meals on Wheels and home health aides, then institutional long-term care facilities are central to good care for this trajectory.

Adapting Health Care to Serious Chronic Illness in Old AgeJoanne Lynn, David M. AdamsonRand Health White Paper WP-137 (2003)

Moulds can be broken

Archie Cochrane’s Effectiveness and Efficiency Rock Carling lectureContributed to foundations to evidence based medicine and the role of theRandomised trial, what is often forgotten is the discussion about  the problems of ageing. Cochrane did not foresee the potential of population data sets

Primary preventionPublic healthEducation

HousingDiagnosis and cure

Communities

Care and Support at homeSecondary prevention

Retirement and Pensions

Employmemt

End of Life Care

Management of long term conditionsNew “space” to be developed “Formative Care” 

From Compliance

States a minimum performancestandard that everyone must achieve

Uses hierarchy, systems and standardprocedures for co-ordination andcontrol

Threat of penalties/sanctions/shamecreates momentum for delivery

Based on organisational accountability (“if I don't deliver this, I fail to meet my performance objectives”)

To Commitment

States a collective goal that everyonecan aspire to

Based on shared goals, values andsense of purpose for co-ordination andcontrol

Commitment to a common purposecreates energy for delivery

Based on relational commitment (“If Idon’t deliver this, I let the group orcommunity and its purpose down”)

From the old world to the new world

Source: Helen Bevan, NHS Institute of Innovation and Improvement, 2011

Care Home Shopping List

1. Purpose: understand (evolving) role and value in Health and Care, Research needed.

2. Capability: Develop positive attitudes and skills3. Resourcing: Talk to the Treasury on the basis of

evidence