Integrating Care for Older People: New Care for Old, a Systems Approach

By Christopher Foote; Christine Stanners | Go to book overview

Foreword

We are pleased and honoured to write a foreword to this volume. We have heard bits and snatches of the evolution of the EPICS project in South Buckinghamshire for over a decade, but it is impressive to see it laid out so clearly. It is a story well worth telling, replete with lessons for many. For those who are sceptical about systems theory or believe systems theory is impossible to reconcile with an emphasis on the human being, Christopher Foote and Christine Stanners illustrate how a systems approach can be used in the service of putting the older person’s interests, preferences, and basic humanity first. For those systems theory enthusiasts who give little thought to the people who pass through the system, the authors illustrate the emptiness of that approach. The book radiates a concern for the older person for whom the system is supposed to work and for those who labour in that system, but it also makes clear that without a systematic approach we are doomed to make little progress. Emily, lying on an emergency room gurney provides a strong leitmotiv as the authors help us understand that we may not even be asking the right questions about why she is lying there in a state of unnecessary crisis.

This book fills an important void. At a time when most Western societies face a pandemic of chronic illness, the authors have pointed to an effective way to approach the necessary reorganization of health care. At a time when many depair about how to improve the healthcare system, viewing physicians as intransigent, this book suggests that it is possible (although not always easy) to secure doctors’ co-operation in improving the care system. The recommendations are realistic. They do not call for a revolution, or even a reformation. Rather, they suggest how to build on the current infrastructure to make gradual but goal-directed modifications to bring our health and social service systems into more proper alignment with the realities of a world dominated by chronic illness.

The authors refer at one point to ‘wicked questions’, which can open the doors to new insights. Despite the title of this book, which implies a focus on the care of older people, we are tempted to ask what would happen if indeed the concept of age were eliminated. Should care be redefined to look at the generic issues of chronic disease and frailty regardless of age? Especially in the United States, where virtually the only

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