Chronic illness management (CI) is one of the biggest public health challenges facing many countries around the world, especially those that are not adequately prepared to maximise the opportunities of population ageing. In Ireland’s case, chronic illness management takes up around 80% of the country’s 20 billion EUR annual health spend. But more than the financial impacts, people who live with poorly managed chronic illnesses become deconditioned due to reduced physical activity, causing immobility, social isolation and loneliness and imposing a huge burden of care on families, communities, and governments.
In Ireland, Noel McCaffrey is working to improve the management of chronic illness especially among older people by pioneering the provision of medically-led clinical exercise programmes in community settings. A social enterprise established in 2019 called ExWell Medical scaled nationally a similar programme he had successfully led in Dublin City University for over 12 years. The insight and innovation involved in the transition was bringing all CI cohorts onto one common programme with shared content and delivery structures, eliminating the need for individually unsustainable programmes for specific illnesses and providing a scalable model. In other words, Noel McCaffrey recognised that holistically addressing the needs of people rather than focusing on one disease or condition at a time – integrated care – not only resulted in better outcomes, but was also more resource efficient.
In 3 years, Noel McCaffrey has grown ExWell from 3 centres to 17, now hosting over 1000 participant visits weekly. ExWell’s 3 pillars are exercise, social interaction and impact measurement. Its reports consistently show that key outcome measures improve quickly (within weeks). The improvements exceed thresholds for meaningful clinical impact. The biggest relative improvements occur in those starting off the weakest – the very people who might lack the confidence to take part. Noel McCaffrey’s innovative and impactful work through ExWell shows what can be achieved in the area of healthy ageing by simply being attentive to what older people need rather than being constrained by previous ways of doing business.