Dr. Sally Lewis. National Clinical Director for Value in Health Wales

As we emerge from the worst of the pandemic, we must turn our attention to the impact it has had on other health and care needs building up over this period.

Health and care services are struggling to know how to address the backlog of meeting these diverse needs due to competing demands on resources.

In response to these challenges, it is vital we adopt a value-based approach to service delivery that prioritises the greatest needs of the population and direct resources to where they will have the greatest effect on the outcomes that matter to people. We must not resume low-value practices but must accelerate the development of new and more collaborative models of health and care if we are to meet the needs of people in our communities in a timely fashion. (Lewis,S, 2020)

The impact on older people

COVID-19 has had a profound impact on the health and wellbeing of the whole population and particularly those in more vulnerable groups. Recently I attended a roundtable event with the Older People’s Commissioner for Wales where a multidisciplinary group discussed how older people had been affected by the current situation. People reported experiencing loneliness and isolation affecting their mental health and wellbeing. They had difficulty accessing healthcare services (sometimes through digital exclusion) and became physically deconditioned from staying in their homes for protracted periods. (Age UK, 2021) As a result, all these issues are creating a much greater burden of ill health for older people.

Addressing older peoples’ needs has become an emergency. Failure to act is likely to cause a surge of ill health in older people as a secondary effect of Covid-19, which will put further pressure on healthcare systems globally. To prevent this from happening, we need to invest in health and care using a value-based approach so that we target resources where they are most needed, as well as strike up innovative cross-sectoral partnerships to achieve it. Voluntary and community groups play a vital role in helping older people reintegrate into their communities, enabling them to regain purpose and become more active. These activities, which fall outside formal healthcare provision, are every bit as important in achieving better outcomes for older people and must be supported as part of a package of high value care. (Older People’s Commissioner for Wales, 2021). Making the invisible, visible

So, where should we start?

The needs of older people in the community are well defined but the outcomes they and their carers experience are not always quantified.  We need to start measuring what matters most to older people right away.

The International Consortium for Health Outcomes Measurement (ICHOM) has established a standard set of outcome measures for older people (Akpan,A., et al, 2018). These outcome measures include physical outcomes (for example, falls), but also other important factors that affect quality of life in older people such as loneliness, autonomy, time spent in hospital, carer burden, pain and emotional health.

It is vital that we quantify and measure these needs so that we can co-create solutions to tackle these problems urgently, ahead of next winter. If patient-reported outcome data are made visible to health and care systems, it will help us know which outcomes matter the most for older people in the community, which will both improve their quality of life and reduce demand on acute health resources.

We have an opportunity to put value-based care in action. Let’s use this crisis to achieve more equitable outcomes for all members of our societies, particularly our older citizens.

Date published: 13/07/2021


Age-friendly communities. (n.d.). Retrieved June 14, 2021, from olderpeoplewales.com/en/ageing-well/afcs.aspx

Age UK research on impact of the pandemic on our older population’s health. (n.d.). Retrieved June 11, 2021, from www.ageuk.org.uk/latest-press/articles/2020/10/age-uk--research-into-the-effects-of-the-pandemic-on-the-older-populations-health/

Akpan, A., Roberts, C., Bandeen-Roche, K., Batty, B., Bausewein, C., Bell, D., Bramley, D., Bynum, J., Cameron, I. D., Chen, L.-K., Ekdahl, A., Fertig, A., Gentry, T., Harkes, M., Haslehurst, D., Hope, J., Rodriguez Hurtado, D., Lyndon, H., Lynn, J., … Banerjee, J. (n.d.). Standard set of health outcome measures for older persons. doi.org/10.1186/s12877-017-0701-3

Lewis, S. (2021). The Challenge of maintaining good health outcomes for all during the COVID-19 pandemic—a view from family medicine in Wales, UK. In Journal of General and Family Medicine (Vol. 22, Issue 1, pp. 3–4). Wiley-Blackwell. doi.org/10.1002/jgf2.363

Hear more from Dr Sally Lewis at our October Masterclass

Image of Dr Sally Lewis main guest speaker at our masterclass on 1 October 2021

Dr Sally Lewis will be guest speaker at our Value-Based Health and Care Masterclass on 1 October 2021. Visit our Masterclass page to find out more.