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Practice comment

‘We must be proactive if older people are to get decent care’


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


Readers' comments (9)

  • so what happened to this project? why has it not been further developed or implemented?

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  • Nothing happens quick in the NHS. I was working with stroke patients at the time of the publication of the NSF for Older People, which I was quite excited about. That was until Stroke was section 5, and not being credited with an NSF in it's own right. Stroke can affect a foetus and young people, not just the older person. The same goes for some other so called 'long term conditions'. It takes years of finding out that these standards are not being met and it takes derogatory publications from the Healthcare Commission, etc. before things are put into action. 10 years down the line, there are new strategies published for these conditions, and at last something seems to be moving. For those of you older enough to remember, or be aware of, it took 30 years for cardiac units to be set up based on the evidence that they save lives. Stroke units (and I mean by definition, not in name) save more lives than cardiac units. How much evidence do we need. Do we really want to save lives or save money. I am not critical of the article, but the system.

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  • huge amounts of money are spent on investigating and producing all these protocols, frameworks or whatever other fancy name officials chose to give to these documents, many of which are out of date before they are of any use. although they keep a few highly paid administrators employed. why are nurses an doctors who have received training in the care of patients not left to put their expertise into practice with this funding put to better use for their work instead of their efforts being constantly interfered with and hampered.

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    I am eternally sick when i read these topics about elderly care. We have constantly abused this demographic,We had it right when we had specialised hospitals ,maybe they needed some enhancement from the institutionalised atmosphere. With a good care team the patients would get all the care they need . The care would be centralised beds available,teams attached to each centre ,ongoing care ,which by the way they deserve ,Come on stop spending money on research for a while and give the required care for our elderly.

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  • why should we be talking about 'older people' anyway. it is a discriminatory label and everybody, whatever their age, should receive care appropriate to their needs.

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  • .Anonymous | 17-Mar-2011 10:38 am

    I agree but 'older people' is far better than 'geriatric' which I still hear although less so, and ambulance staff 'geri-ferrying'.

    With all these pension changes, NHS and state, when do we become 'older', if we have to? We have specialist accommodation, etc., for the over 55's, but retirement age of up to 68! Confusing or what?

    Having said all that, if admitted to hospital there is better care for patients in advanced years with multiple conditions by a physician with expertise in this sphere, rather than just treating the presenting condition, with the result of a readmission sometimes.

    It all boils down to individualised care, which we began to embraced until all the bureaucracy and rigid guidelines and targets were implemented

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  • even more confusing a gerontologist, in a recent lecture I attended, said they have had to reclassify old age as there is an increasing number of centenarians. these are now early or young old age, middle old age and advanced old age.

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  • It appears the 'reclassification' of elderly is defined by 'pensionable age', in other words it boils down to MONEY. It becomes a psychological debate, where the older person would gladly accept a different definition and 'category' to be put in.....government result.

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  • 'pensionable age'

    sadly your comment seems to sum up older people accurately. whether they are labelled as you say above, or 'elderly', geriatrics, or even as baby-boomers, etc. it all means the same. they are over a certain age and probably retired and therefore little further use to the economy and society and cost, or will cost, money in care. unless they have children or grandchildren who they can still help and sometimes even help to support financially, or unless they continue to work or do some sort of voluntary work they are of little use to society. although it seems to be forgotten that a proportion of them still pay income tax which must be a reasonable source of revenue for the government considering the numbers and rising numbers.
    In my view, people are people, whatever their age, whatever their role and status and no matter at what stage they are at in their life, which changes, they should all be entitled to the same benefits and care and treatment by the nhs within the appopriate areas of specialism based on clinical need an not age. by this I mean from neonatology to gerontology, that is excellent and what is needed but should not mean any less because of a certain age or other label category but based on individual needs and limited only by clinical status of the patient and safety of certain more invasive interventions.

    Packaging goods and services in the name of economy that we so often have to put up with in modern life cannot and should not apply to healthcare with so many individual variations with differing clinical, psychological and physical needs and psycho-socioeconomic and familial status and backgrounds. Previously clinical practitioners used their skill and experience and often based their knowledge on previous similar cases they or their colleagues had seen and often networked around the country or even globally. it seems now that they are more and more confined to the dictates of management or guidelines published by organisations who have no contact with the patient and which means that their hands are tied and prevented from delivering the care that they have learned during their training and developed as a result of their experience. something which the non-clinical management running the budgets and resources do not have.

    Such packaging of goods and services and the way society is now organised around, and dependent on, this system has lead to much frustration, stress and 'dis-ease' in society which is one major cause of all stress-related illnesses and now this 'model' has infiltrated into the delivery of healthcare itself! Good and individualised quality healthcare cannot be negotiated and bargained for then bought and sold in the marketplace or successfully managed by non-clinicians!

    my previous comments:

    Anonymous | 12-Mar-2011 9:32 am
    Anonymous | 14-Mar-2011 7:17 am Anonymous | 17-Mar-2011 10:38 am
    Anonymous | 17-Mar-2011 11:39 pm

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