In 2001, when the National Service Framework for Older People was published, I was working as a newly appointed consultant nurse for older people. I welcomed the NSF because it was a way of highlighting the importance of developing services and care for older people.
Before then, work led by the King’s Fund on intermediate care and the RCN gerontological nursing programme had greatly influenced my thinking about the speciality. I viewed the NSF as pulling together strands and themes of work into one over-arching strategy - a strategy for improvement.
It was time for a cultural shift in the way organisations and professionals treated and provided care for older people. The NSF helped to encourage a multi-agency approach to service redesign and delivery and raised awareness about the specialist needs of people with complex age-related needs. These changes created a positive sea-change in older people’s nursing and care.
Caring and providing healthcare for some of the most frail and vulnerable people in society requires specialist skills and knowledge. The changes needed to deliver services better attuned to meeting the needs of older people and their supporters are clear - some might say obvious. We know that we have an ageing population and that the number of older people with complex age-related needs accessing health and social care services are increasing. So surely all organisations must now be attuned to meeting such needs more effectively?
We have certainly travelled a long way in a relatively short period of time. Since the NSF was published there has been a clear focus on adult safeguarding - witness the examples of National Dementia and End of Life Strategies along with evidence-based guide lines on falls and nutrition. We can also evidence how programmes of practice development can help develop effective work-based cultures, leading to greater person-centred ways of working with older people and their supporters. High profile campaigns on dignity and leadership have also brought to the fore important elements that need to underpin effective older people’s nursing.
However, challenges remain. Reports such as those produced by the Healthcare Commission, Patient Association, Age Concern and most recently, the health service ombudsman highlight whole system failings in care that cannot be condoned or justified. Issues relating to the “attitudes” and “values” of some staff working with older people, along with organisations that are not grasping the real issues related to service delivery, essential care and leadership in older people’s nursing, are a concern, especially when there is increasing pressure on finances and efficiency.
So where next for older people’s nursing? As nurses working with this group we have an important role in ensuring older people and their supporters receive the best care possible – there is nothing basic about essential skilled nursing. We need to celebrate our successes, of which there are many. And we should also recognise where care could be better and when to take action.
We should not be passive or reactive. Instead we need to be proactive in how we shape the agenda as nurses working with older people and their supporters.
Jonathan Websteris assistant director, quality and clinical performance, Bexley Care NHS Trust, honorary senior research fellow, Christ Church Canterbury University, and honorary nurse clinical director for older people, NHS London