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Debate on Quantity of Care versus Quality of Care

How can Asia move away from the hospital approach towards long term care? Read the comments here
How can we sustainably fund high quality long term care for our elderly? Read the comments here

Q1 27 Jul

" Overall, the recent study in Singapore is commendable as it looks into the economy and cost side of things. There are however a few key elements that needs more distillation, deliberation and discussion:

Costing: While the additional cost on nursing and operational support are reasonable (for the new model), there is a under costing on the land/space element. The use of the current TOL subvention will not be able to show the true impact on total costing; let alone inflation land cost over time. A fairer way is to reflect land to be costed at least at the market rate for land/rental. The reason is that the private sector single bed nursing home basic charges are over $5000 per month. So the current costing done now appears very conservative.

Evidence based: Yes there are studies that show positive outcome under this model. However it is not those type of evidence  like “specific antibiotics for a special bacteria infection”. The evidences are generally correlations; and there are many other variables and varying sensitivity and specificity are not scientifically validated at the same time. There is a overloading or emphasis on “dedicated, home like,” infrastructure and mixed up with patient centre care and independent. Furthermore, there seems to be over zealous focus that this should be “gold standard” for all nursing home and all types of patients. So the question will be if we are given dollar (or even lesser), can we provide similar good outcome by focusing on other elements like good rehab, patient centre care, plenty of social recreations and activities... more day activity spaces etc

Theory: There are in fact studies that focus on loneliness/ depression track. For a given nursing/rehab care, the singular most important factor is how to prevent any elderly of feeling lonely... if this factor is not prevented, it will lead to detachment and depression and then all forms of care plan will fail. This lonely effect can occur regardless whether the elderly is in a dormitory or in a dedicated single room.

Comparative: Many of the benchmark countries have two key facts that differ from Singapore; land and use of caregiver (foreign maid). Since land is plenty in these countries, they can have all the space. For these countries, foreign domestic maids are not common, so they will definitely need a service provider to employ the caregiver. For Singapore land is scarce so the issue of opportunity cost and finite land must be considered. In Singapore, even the lower income family can afford a maid (with subsidy) 

Dedicated space and home-like: I agree that if an elderly do need this for good outcome, then there must be an economical way to support them. The answer is simple “stay at home”. For the $106 dollar a day, it is more than adequate for the elderly to have caregiver (maid, trained in Caregiver skills) and then go to the local day care/social care on a daily basis. They can have all the privacy, dedicated space, all the memories and yet have the dedicated care and also the social activities. These provision will cover literally all the middle income group and even the lower income.

Gap: So the gap are really the “elderly living alone or poor or those living in rented flats”. Even the highlighted group like dementia care, if the “dedicated personal space is so important”, they should really stay at their current home. For those who are living in rented flats, they too can stay put... it is a matter of working out an arrangement between HDB and MOH to have some service provider to set up assisted living shop within the rental block of elderly. 

We support MOH direction to build up capacity in the community like the new Active Aging Hub and more senior care centre. So that more elderly (even the less independent) can remain in the community. Increasingly the NH (because it is land and manpower intensive) should only cater for those who are frail elderly, higher Cat 3 and 4. There can also be merit however to have specialised type of NH or wards for the psychiatric or more complex type of dementia  cases. But the notion to have all remaining NH beds based on these consultancy model remains a big question mark. " 

Dr Ow Chee Chung, CEO, Kwong Wai Shiu Hospital, Singapore

" The demand on single room for elderly is in high these days due to their behavior change as well as more privacy is needed. I have visited some new properties (Eden in Johor ) are using the cabinet to divide the beds. These are not ideal to protect the privacy of one's daily life. In addition, The ceiling lighting, snoring noise from next bed and activities around the nursing station may not be the ideal setting for retired elderly who plans for long stay in the Hospital ward-like environment. Our retirement project in Hong Kong only provides one unit/ residence per senior +  spouse or sibling in the same gender of the immediately family members. "

Anonymous, Hong Kong SAR

" Alzheimer’s Australia NSW has done a lot of consulting work with providers of residential aged care and we have found that high levels of care, satisfaction, wellbeing can be achieved in rooms with 2-3 residents. Our market is driven to deliver 1 bed rooms as this is primarily what family members want for their loved one for privacy and dignity reasons. This is fair and reasonable, but overlooks the value of social connections, increased foot traffic in multi-bed rooms, higher visitor numbers, and higher frequency of interaction with staff. We have also done some work with an organisation called Group Homes Australia who are using suburban houses of up to 8 bedrooms to run a very homelike service. They are not Government funded, unlike the traditional residential aged care providers with facilities up to 200 beds. Our debate doesn’t really focus on the room configuration, but more as you say on the quality of care. This is influenced by the number of staff, the attitudes and qualities of the staff, and the qualification they possess. Our consulting work also highlights the critical importance of leadership of a facility in influencing the quality of care that takes place. "

Mr Brendan Moore, General Manager, Policy, Research and Information, Alzheimer's Australia NSW

" As a nation like Singapore becomes more affluent, the middle and upper income group of seniors demand for better facility in which they can afford with or without government subsidies. This had proven by the evolution process of the more advanced western nations whereby some 60 years ago or more, they had started with multi-beds rooms to what is now the private single bed room. It had been proven that dignity & lifestyle of seniors were enhanced in this environment. Clinical outcome was not compromised , rather it was better. However, multi-beds rooms are still applicable to the lower end of the market to make it affordable for the seniors and the Government alike. In short, the market needs both the single bed and the multi-bed rooms. One must always respond to market needs at all times. "

Mr Tan Choe Lam, Founder & Managing Director, Jeta Gardens Group, Australia and Malaysia

" When we discuss the future eldercare landscape it has to start with - Do what seniors want and What do our seniors want? Seniors want to LIVE! Not to be cared for!

Can we live, when we are in a nursing home? Don’t get me wrong. Nursing homes are doing a good job, keeping us breathing and our heart beating. But are we alive?  What does it mean to live, to be alive? I am alive when I have a reason to wake up for, when I may do things to feel the rush of adrenaline. What is there to look forward to? What purpose is there for me to live one more day?

Let’s start with a change in our approach to care. We need a culture of choice and self-control for seniors so that seniors get rehabilitated quickly, to be well enough to go home or be assisted by home help. When in a nursing home, seniors should be able to live. Today architects are told to pack beds into nursing homes. We provide too little social space. Where can family or friends chat with the seniors, other than his bedside? Nursing home should not be design like a hospital as this is where our seniors are supposed to live (nursing home) for an extended period of time.

If our nursing home is going to be the HOME to our seniors, it has to be beyond “home-like” environment, beyond just single beds. It has to be a home where our seniors have a choice and control over their food, activities, social interaction, moments of quiet, sleep, what they wish to wear and even how they wish to do up their hair. Like home, they should be able to do things with their family and friends. Our seniors should also be able to take a stroll in the neighbourhood!

Lastly, seniors of the future will be better educated and knowledgeable, used to independence and want to live life!Homes should be the first choice for seniors to be in, followed by day centres and their last choice should be institutions like old age homes or nursing homes. Wherever they are, we should strive to give seniors a sense of purpose, empower and support them to live independently as much as possible with ample opportunities to interact with other people, including family and friends. "

Ms Lim Sia Hoe, Executive Director, Centre for Seniors, Singapore

" Only a small percentage of patients can or willing to pay for single bed rooms nursing care homes. Do in the ratio of 20% single bed rooms and 80% 4-6 bed rooms. "

Dr John Heng, Co-Founder, Director, SynPhNe Pte. Ltd., Singapore

" It would be a mistake to relate the question of single vs multi-beds rooms to purely economic, efficiently and sustainability considerations. We should take into account of the elderly’s preferences rather than that of their younger contacts/relatives. Misconceptions (driven by generationally-based cultural and social differences) and misalignments in care quality often derive from projecting relatives’ wishes or perception of what quality of care is over the elderly’s wishes and preferences.

Many older generations (typically but not exclusively pre-WWII) might actually feel happier in a multi-beds room context than they would be in an isolated single bed room. The notion that a single-bed room is of a higher quality is a modern perception which might be misaligned with the elderly’s perception, and might become a requirement only decades from now for elderly belonging for example to the “baby boomer” generation, more attuned to topics such as privacy and self-social-isolation.

Thorough pre-admission assessment and consultation with the elderly are essential to determine a best individual setup to maximise well-being. While important, sustainability and economic matters are secondary aspects respect to the elderly’s well-being goal. The fact that a multi-bed might be more sustainable than a single bed is a collateral rather than a primary benefit. "

Mr Giovanni Di Noto, Chairman & CTO, cloudyBoss Pty Ltd, Thailand

" I think to live in single bed room is an essential right for every people. It helps to improve the elderly's quality of live and it helps caregivers in caring for people with dementia or in the end-of-life stage. However, the cost performance of the single room care will be much higher than multi-bed room care. "

Dr Jun Sasaki, Founder & Chairman, Yushoukai Medical Corporation, Japan

" I think we have to respect and respond to the particular needs of individual elder who either can or cannot afford for single room. Indeed, having group room would encourage socialisation and networking, whilst single room can respond to those who are used to having a private life. "

Mr Timothy Ma, Executive Director of Project Flame, City University of Hong Kong, Hong Kong SAR

" It should be an option provided by the public system with tiered subsidy. Market demand is there and a basic human need for long term stay context. "

Mr Isaiah Chng, Director, ProAge, Singapore

" Preferably for those with difficult personality and affecting other persons. " 

Mdm Low Mui Lang, Executive Director, The Salvation Army Peacehaven Nursing Home, Singapore

" What is the experience of living with dementia? Does it make you less of a person than you are now? Will it change what is “right” for you as a person if you develop dementia? Until we grapple with the fundamental paradigm of what it is to live with dementia, we will always struggle to set an agreed standard of high quality care with evidence based outcomes in environments that enable, enhance and sustain wellbeing and personhood. The debate if having 4 or 5 strangers share a bedroom with you as it is a cheaper option is one that a developed society in the 21st century should not be needing to have. The ageing of our populations, the increased prevalence of dementia and the necessary responses by Government and society should not be a shock or a surprise. We have known this reality was coming for decades, yet have done little to prepare for it. We should not now be offering sub-standard living environments because we have failed to be ready for this growing need.

If you need to ask if shared bedrooms are ok consider how you would respond to the following scenario: You arrive to check into the hotel that you have booked for a vacation. The lady on the reception desk tells you that due to demand they are having to put extra beds into the hotel rooms and that you will now be sharing that bedroom and bathroom with 2 complete strangers. What would your response be? Why do you think your response would be any different if you had developed a cognitive impairment? How about if the vacation wasn’t for two weeks but the rest of your life? We need to find viable and sustainable funding models to support our older generation, especially those with dementia, but should never accept poor long term care environments to be an acceptable answer to societies failure to adequately plan for the care needs of older people now and into the future. Evidence shows that a lack of control and decision making, boredom and loneliness are key concerns of the general public when considering the option of long term care homes, this has created stigma and fear of what the future might bring as you age or develop dementia. Developing homes where people have privacy, control of their front door and are welcoming of the community to maintain relationships should be the goal, after all isn’t that how we choose to live our lives in the 60 previous years of adulthood? "

Mr Jason Burton, General Manager, Education, Research & Consultancy Department, Alzheimer's Australia 


Japan e-card 3 Aug

Debate on Quantity of Care versus Quality of Care

What is your opinion on single bed rooms for nursing home care? Read the comments here
How can we sustainably fund high quality long term care for our elderly? 
Read the comments here

Q2 3 Aug

" Having read the Straits Times articles it seems as though the biggest hurdle you face is Government legislation being very restrictive. We have that too, but not as restrictive. Providers in Australia can pretty much build to whatever configuration they like and the residents frailty, acuity and complex care needs are what dictates the funding from Government.
 "

Mr Brendan Moore, General Manager, Policy, Research and Information, Alzheimer's Australia NSW

" One can set up a studio or suite - similar setting in a private hospital room to allow more privacy with easy access to medical attention. " 

Anonymous, Hong Kong SAR

" The Government first need to acknowledge the market demand of a more conducive & enticing facility for seniors. Hospital brings along the negativity to seniors. The Government also needs to roll out new legislations to encourage private sector as well as NFP organisations to invest in aged care products that serve the needs of the market, particularly the middle to the upper end of the markets. " 

 

Mr Tan Choe Lam, Founder & Managing Director,Jeta Gardens Group, Australia and Malaysia

" The solution is actually simple, budget-driven with far-reaching multilateral outcomes for the healthcare sector at large in Asia. In countries reaching demographic tipping points in terms of support ratios (China, Singapore, Thailand, Myanmar and Vietnam), there’s nearly a continuous elder segment overrepresentation in the acute care sector, especially hospital emergency units, an unacceptable mix for the following reasons:

  • An imbalanced acute sector mix compromises medical tourism strategies in some South-East Asian countries
  • Albeit amalgamated under the same healthcare sector, acute and elder care are incompatible disciplines
  • An acute care bed costs in average 8 to 12 times more than a high-care residential eldercare bed

Reallocating a fraction of the acute sector budget (for example 10%) toward residential eldercare and home care services would free up precious and expensive capabilities in the acute sector (arguably up to 40% or more) while contributing to the building from the ground up of an entirely new and efficient eldercare industry in Asia. "

Mr Giovanni Di Noto, Chairman & CTO, cloudyBoss Pty Ltd, Thailand 

" For elderly, it is very difficult to treat their disease. Almost all of their diseases are chronic, multiple, complicated, and easy to recurrent. Thus, it is more important to support their lives with diseases (or disorders) than to treat them. We should allow them to live their life to the fullest, with dignity and gracefulness. "

 Dr Jun Sasaki, Founder & Chairman, Yushoukai Medical Corporation, Japan

" We have to adopt a more comprehensive and total care model, i.e. let long-term care home not only focus on elder institution, but it can also refers to being at home with the support of ample community care. "

Mr Timothy Ma, Executive Director of Project Flame, City University of Hong Kong, Hong Kong SAR

" There are a few steps that can be work towards long term care: 

Step one – recognise that “Age is not a Disease”, and that at every stage of all our lives what we strive for is “Quality of Life” – this remains the case for aged persons as much as for teenagers and young adults. Inside every 80 year old is trapped a 30 year old – just ask them.  

Step two – having come to terms with step one – accept that Medical and Nursing Care contribute only a very small part to that Quality of Life – choice, security, independence, support and respect are far more important.

Step three – Aged Care is NOT about Medicine and Health Care – meaningful aged care models must put Medicine and Healthcare in their rightful place and that is NOT at the center; doctors and nurses are not the experts in what it means to be old.  The elderly, what they want and how they want it should be at the center of the system – medicine and healthcare providers play a minor support role.  In my professional experience about 90% of what we pay highly trained nurses to do can just as capably be done by other far less qualified (and less costly) staff – or daughters and sons for that matter.  Pay nurses well for the expertise they have, not for the things others can do just as well.

Step four – plan care and support services in collaboration with each elderly person those services are being provided too – ask what assistance they want, how and when they want it and actively encourage them to do all they can manage to do for themselves – that’s respect, that’s choice, that’s independence (however limited it may be).  The experts in aged care are the elderly – we need to stop being so paternalistic/maternalistic – that’s disrespectful. 

Step five – employ technology as a key mechanism to monitor and manage much of the medical/chronic disease components of health care for the individuals – in collaboration with Doctors and Healthcare professionals.  This will improve outcomes, reduce hospitalization/admission rates, hospital lengths of stay and significantly reduce costs on the aged and healthcare systems across the board.

Support elderly people in their choices and we’ll find most want to stay at home – so provide a “home-like environment”.  That means providing service into the home for as long as possible, then when the person is no longer capable of living in their home, build “home-like” care facilities (communities) supported by in-home/quality of life care models. 

Aged Care, focused on “Quality of Life” can be delivered in any location, you don’t need a sub-acute hospital type model, which is what nursing homes are (they are unnecessarily expensive and were established for the convenience of the system – doctors and nusres). 

Independent living, low care support, high care, complex and many clinical care services (including palliative care) can and should in fact, be provided in the location and environment of choice – the elder persons choice.  For the most part, such models are considerably less expensive both for the individual and for governments and provide much better outcomes for the individual, the system and staff alike. To not pursue a Quality of Life, elderly person centric approach to aged care is quiet simply “lazy politics and lazy, inept care”.

Get some young people involved with the elderly – the creative and the wise. "

Mr Nick Loudon, Chief Executive Officer, Seasons Living Australia Pty Ltd, Australia

" Understanding that the person living has medical diagnosis and not a digital medical diagnosis itself. "

Mdm Low Mui Lang, Executive Director, The Salvation Army Peacehaven Nursing Home, Singapore

" As our population ages rapidly, there is insufficient fewer younger generations to support the elderly. Hence we should create more retirement villages or elderly day care centers to support the elderly. "

Dr John Heng, Co-Founder, Director, SynPhNe Pte. Ltd., Singapore

" 'Patient, Client, Service User or Resident?' - putting personal care needs first!

As with most advanced healthcare systems across the world, many find themselves in the position of having to adjust rapidly to changing demands either through fundamental demographic changes and shifting population growth, or both. In these circumstances we are talking about the increase in the size of the population aged not only 60-65 plus, but 85 plus, brought about through increased longevity and increased healthy life expectancy, i.e. people are not only living longer but are increasingly looking to health and care providers (whether state or insurance lead programmes) to adapt in such a way that will help them maintain their long term health and care needs. This means healthcare systems need to be 'flexible' and 'responsive' to individual health and care needs, offering 'plurality' in provision, and wherever possible 'choice' in that provision - as the somewhat over used expression 'one size fits all' will simply not do! However, in accepting the case for plurality of provision in health and care services, governments and/or state providers must ensure that 'core standards', in the services to be delivered, are of a high quality and effective.

With this in mind, and by way of comparison, the UK models of 'home care' provision - covering England and the 3 devolved administrations - have a long history as part of the ongoing development of the wider 'whole healthcare system', which is 'co-lead' by the NHS, (essentially primary, secondary and community healthcare); Local Authorities, (including social care, rehabilitation, home care, and therapies in the community (in England); and a developing independent care sector.

In order to grasp how the 'whole healthcare system' operates in England, requires an understanding of how each component part of that healthcare system is defined - and is in the process of being 're-defined', as demands on the system increase.  For the purpose of this article, the key issues to be considered are as follows: where does acute hospital care provision begin and end for older people? What do we mean by 'intermediate care & reablement?' and when we speak of 'nursing home care' are we talking about 'assisted living' or long term 'residential health and care'? Defining the above, and understanding their differences will be crucial for any national government commissioner (or major insurance provider) of integrated healthcare.

In the late 1990's the UK recognised that the prevailing model of acute hospital care was unsuited to patients with complex long term conditions, and that a strategic shift in resources and the scope of the services provided would be required if the healthcare needs of older people, primarily those aged 65 plus were to be met.  The Care Standards Act 2000 lead the way, which was followed by the introduction of rigorous Care Homes Regulations in 2001, both of which provided the background and context to the publication of a series of 'national minimum standards' for the provision of services to older people in care homes, (enacted June 2003). A key 'standard', that was fundamental to the 'new approach' to care for older people was the need for 'privacy & dignity' in provision - a place where 'service users feel they are treated with respect and their right to privacy is upheld', (Standard 10). 

There are 7 sections which form the basis of the national minimum standards, these include:

  • Choice of home
  • Health and personal care
  • Daily life and social activities
  • Complaints and protection
  • Environment
  • Staffing
  • Management and administration

Standard 23, in the section on 'environment', gives details regarding 'Individual Accommodation & Space Requirements', and states that: a) Service users’ own rooms must suit their needs; b) Where rooms are shared, they are occupied by no more than two service users who have made a positive choice to share with each other. In 2016, shared provision is now the exception - with single room accommodation the most common form provision for older people in care homes in England. This approach has been further strengthened in acute hospital care (and mental health care) settings with the focus on ensuring that 'privacy and dignity' is maintained through increased provision of single rooms with adjacent single-sex toilet and washing facilities, (preferably en-suite).

This direction of travel was strengthened further by the introduction of the 'National Service Framework for Older People in 2001, which set out 4 key themes regarding the provision of healthcare for older people, namely:

  • Respecting the individual
  • Intermediate care
  • Providing evidence-based specialist care
  • Promoting an active, healthy life

Whilst the theme of 'respecting the individual' lends support to the requirements set out in the national minimum standards (2003) above, the recommendations concerning the development of 'intermediate care' services are critical to understanding the UK's attempts to reduce dependency on acute hospital care and the re-modelling of long term care in the community for older people. Responsibility and negotiations at local level in England between NHS (Healthcare) and Local Authority (Social Care) commissioners persist to this day, as to 'who' is responsible for the resourcing of 'intermediate care or reablement' services - on the grounds of 'where does healthcare service provision (medical & nursing - funded) end and social care (personal & therapeutic - chargeable) provision take over?'  However, both commissioners are convinced of the benefits that intermediate care and reablement services can provide, namely, that they can:

  • help to avoid unnecessary admission to hospital
  • encourage the person to be as independent as possible after a hospital stay or illness
  • help to avoid someone moving permanently into a care home before they need to do so.

In 2009, the Department of Health in England widened its definition to include aspects of organisational structure (integration) and again emphasised the outcome of maximising independent living. Intermediate care was thereafter defined as including:

  • a range of integrated services to promote faster recovery from illness
  • prevent unnecessary acute hospital admission and premature admission
  • to long-term residential care
  • support timely discharge from hospital and maximise independent living

Looking at the UK evidence and examples above, the key issue for Asia would seem to be the need to determine the role that 'intermediate care' services might play in helping health and care systems across the region to re-define what is understood by the term 'acute hospital care' (i.e. where it begins and ends) and re-model acute services within an effective integrated health and care system for long term care.

Whilst provision of adequate levels of funding and resources will be required to achieve (in some cases) this 'turning of the tanker' approach, a shift in government policy and a commitment to more 'person centred care' will be necessary in re-shaping the planning and development of future long term care across Asia. Diversity in the provision of that care should be welcomed, with new service providers, bringing new ideas and new technology, to be encouraged and nurtured. However, in so doing governments will need to ensure that robust systems of regulation and control, and effective patient safeguards are in place to guarantee the provision of high quality health and care services in the community. "

Mr Kush Sankla, Director, Solutions 4 Health, The United Kingdom


Japan e-card 3 Aug 

Debate on Quantity of Care versus Quality of Care

What is your opinion on single bed rooms for nursing home care? Read the comments here
How can Asia move away from the hospital approach towards long term care? 
Read the comments here

Q3

" We are wrestling with the same question and it will come down to allowing innovation to flourish which results in older people having a greater range of choices about their care. Part of this increased choice of options is that they can elect to pay more should they have the means to do so and are willing to pay more, over and above a base standard of care that the Government mandates as acceptable. "

Mr Brendan Moore, General Manager, Policy, Research and Information, Alzheimer's Australia NSW 

" The Government should keep providing subsidies to the most needed seniors for the lower end of the market and they should provide adequate subsidies to the middle market where they are require to co-pay subject to a threshold asset/income assessment. The market will then tell us which proportion of the seniors community can afford to pay for high quality long term care. " 

Mr Tan Choe Lam, Founder & Managing Director, Jeta Gardens Group, Australia and Malaysia

" There are ways we can sustainably fund high quality long term care for our elderly:

  • Promoting healthy aging at home to ensure residential admissions are contained to specific high to sub-acute care
  • Developing innovative social enterprise models to materialise self-sustainable residential sites
  • Hybridise resources to deliver both home and residential services through innovative models "

Mr Giovanni Di Noto, Chairman & CTO, cloudyBoss Pty Ltd, Thailand

" Everyone should play a part in maintaining their physcial health. Multi Professionals can engage the elderly in various physcial and mental activities to keep their body active. The elderly should reduce their dependence on insurance, they can seek help from community services. Multi Professionals should also find out what are the community services available and highlight them to the elderly. To create a new social community where the elderly can get together and socialise with one another, provide moral support when needed. " 

Dr Jun SasakiFounder & Chairman, Yushoukai Medical Corporation, Japan

" The second generations usually prefer having their elders be cared at a quality environment and are willing to pay for it. Quality of care actually is the sustainability factor for long-term care, whilst offering variety of choices according to the level of care required would also be another way of sustainability. "

Mr Timothy Ma, Executive Director of Project Flame, City University of Hong Kong, Hong Kong SAR

" Enable and empowered the older person "

Mdm Low Mui Lang, Executive Director, The Salvation Army Peacehaven Nursing Home, Singapore

" There is no 'once size fits all' for the funding of long term care for older people. Each government across Asia will need to determine what it can afford, and what resources can be brought to bear in the provision of an effective and integrated health and care system. The debate as to the benefits of 'state funded, contributory, non-contributory, or insurance based' health and care systems is ongoing across the world. The essential element however, is recognition of the need for 'co-production' - or 'public/private partnerships' involving the service user - in the resourcing and delivery of future provision. As solely 'top down' models of provision have been seen to flounder.  Furthermore shifting resources from acute hospital provision to innovative community settings will take time. In England, one current proposal being explored is for NHS Foundation Hospital Trusts to set up and provide intermediate and long term care in their own bespoke 'care homes' - the benefits of which, across a fully integrated pathway of care could be considerable. "

Mr Kush Sankla, Director, Solutions 4 Health, The United Kingdom


Japan e-card 3 Aug

 

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