Carolyn ScottName: Deborah Sturdy
Name: Deborah Sturdy
Job title: Nursing Officer, Older People, Department of Health, England
Responsibilities: Advises ministers, chief nursing officer, senior civil servants in the Joint and Social Care Unit; contributes to social care policy and health policy of older people. Instrumental in promoting the progress of the NSF for Older People. Provides nursing advice to all national policies in relation to older people and works closely with statutory boards, professional organisations, the voluntary and independent sector organisations representing the views of older people.
Qualifications: MSc, RGN
Previous career: Senior nurse manager in medical/elderly directorate and also senior nurse for dementia services in Bristol NHS Trust; senior nurse for acute adult care at Gwent Healthcare NHS Trust. Independent nurse consultant, including adviser to the Joseph Rowntree Foundation, developing a long- term care nursing assessment system. Development manager, older people, joint appointment between health and social care for Swindon and Ridgeway Downs Primary Care Groups.
Why do you do the job you do?
I have been driven since being a student nurse to try and make care for older people better and to try to make a difference. That was really based on my early experience working in an older person's ward, when I was quite shocked at the care that I observed. At that point I wanted to give up nursing, but I was told by my tutor that I had two options: to leave or to try to do something about it.
This job is a unique opportunity to influence the whole national agenda and to be able to influence national priorities around older people. It is a role that I see as a position of great privilege.
How do you work with and support others?
I think we need to develop confident, visible and vocal leaders in older person care. That is why I have been so committed to investing my time in professional networks and in a programme of leadership work undertaken with the NHS leadership centre.
I act as a mentor to several nurses, which I see as mutually beneficial relationships in that I learn as much from them as I hope they learn from me. I also offer people the opportunity to come and shadow me so they can look at the role of the nurse at government level.
I meet with a professional advisory group about four times a year. The group comprises 10 people from a variety of backgrounds: directors of nursing, professors of nursing, a nurse specialist, two modern matrons and, soon, a ward sister.
I also co-ordinate two networks, one for nurse consultants for older people, with a membership of about 60, and a modern matron network that is just about to be opened up to a group of nurse specialists.
I have a personal commitment to be out and about in the service every week and make a lot of clinical visits. I learn a huge amount from these and continue to be impressed with the people I meet. The visits help me check my sense of reality, which is important, because when I am sitting with the minister I need to know that what I am saying reflects the world out there.
In this job I am the only nurse in the specialty at this level and I do not have natural peer support, which is why I have to develop external relationships.
What are the priorities for older person care?
One challenge is to get across the message that nursing older people is at the heart of the NHS. Older people, in terms of adult nursing, reach into every aspect of healthcare, except obstetrics and paediatrics. Furthermore, two-thirds of hospital beds are occupied by people aged over 65.
I think developing the workforce and finding the people with the right skills is going to be our greatest challenge. I feel very passionate about the need to review pre-registration education and training. I am not sure that the nurses we are preparing today are actually fit for purpose for the service we are creating - for nurses working independently as community practitioners, for example.
What has been achieved?
Investment and reform in the NHS has benefited older people significantly, simply because there are so many people using the services.
The NSF for older people in England has set the course in terms of a 10-year plan. To have that level of commitment and direction has been significant and has really helped. Feedback from practitioners in the field is that the NSF has helped them to have a voice at the table that they did not have before.
There are eight standards (see Box, right) with some quite specific targeted milestones, and that programme in terms of the five-year milestones comes to the end next year. But that is not to say the job is finished. The job is endless, really.
I think some of the other underpinning work around the single assessment process has opened many doors; for example, NHS-funded nursing care, and growing partnerships with the independent sector, where many older people are being looked after.
What is coming next?
We have just invested £5.8 million to support 40 'transformational' projects around improving the experiences of older people in hospital care. Examples of these projects cover skills development across older persons' services, mental health issues in acute care settings, and looking at patient pathways and flows for older people.
I hope that there will be a lot of shared learning coming out of this work that can be used more widely. We have specifically chosen projects that we felt could be easily replicated.
Another piece of ongoing work is a poster project with Help the Aged and a group of older people and nurses. The posters will show contrasting images of how the nurses might see the people and how the people see themselves. Taking part in this work was one of the most exciting and refreshing things that I have done for a while. It made me reflect how important it is that we involve people in the decisions we make about service development.
This project has the potential to have some real impact in terms of challenging people's perceptions of older people within the hospital setting.
This year, three pilot teams in care homes in Northumbria, Kent and South London have been using Essence of Care clinical benchmarking for improving clinical care. This has been an overwhelming success.
This year, too, the Health Select Committee into Elder Abuse made 40 significant recommendations. This is a really important area where nurses can have a key role in the detection and management of elder abuse. We are also working with the charity Action on Elder Abuse and the Nursing and Midwifery Council to see how we can develop some helpful work for the profession on this.
We are working, too, with the National Institute for Mental Health on developing practice guidance and materials for nurses working in acute care settings and care homes.
Some other work is with the learning disability services. Because people with a learning disability are living longer than they have done before, we have the potential for increased need for treatment; for dementia, for example.
It is important, therefore, to raise awareness, and we are working with a group of experts from the field and with service users to develop helpful information. A series of seminars will probably be organised for early next year.
What is happening with Assessment?
Older people benefit from good, rounded, multi-professional assessment. This is a fundamental part of the process of caring for older people.
We are introducing a single assessment process to try to streamline assessment for older people, which should ensure that it is proportionate to the needs of the individual wherever he or she presents in the health and social care system.
I think there is frustration about the enormity of the task of introducing a new system - we all know how difficult and challenging changing practice can be, whatever the issue. Working multi-agency is even harder.
What would you like to say you have achieved?
I would like to see leaders across the health service finally acknowledge that older person care is the core of the NHS, and to support that through visible leadership throughout their organisations. I would like it to be acknowledged that nursing older people is complex, challenging and needs a multiplicity of skills and expertise.
I think this is a much maligned specialty. We have got to recognise that so much good has happened in the past two years, and we have to celebrate that and recognise that we are at the heart of the service. People are still battling with some of the prejudices about the specialty, but I continue to be impressed by the passion and enthusiasm of the people I meet every day.
I think the opportunities in nursing have never been greater, but I think that nurses in this specialty have not yet unleashed their potential.
I would like to see them maximising media opportunities to promote their work and to celebrate the excellence that is out there - there is a huge amount of that.
Nurses in the care of older people are at the forefront of change within the NHS and should take that responsibility seriously for the collective good of the profession and stand up and be counted.