Decent health care for older people

Abstract

Our population is ageing. The need to pay for decent care for older people becomes more pressing, and last month's Wanless report recommended how to provide long term care fairly.1 But what is decent care? The national standards for the health, treatment, and social care of older people in England—set in 2001 in the national service framework (NSF) for older people—provide a good grounding. Last week the UK national director for older people, Professor Ian Philp, presented the next steps for the framework in the report A New Ambition for Old Age, which examined how the framework is being implemented and announced new aims and targets.2 The national service framework for older people set out eight standards to improve the experiences of older people and their carers who are using health, social care, and other services (box 1). A standard on medicines management followed later. Last week's report added a further 10 programmes for implementing the framework, under three important and timely themes: dignity in care, joined up care, and healthy ageing. Box 1: National service framework for older people Standards are focused on Rooting out age discrimination Promoting person centred care (including a single assessment process for care records) Intermediate care General hospital care Stroke services Falls services Mental health in older people Promoting health and active life in old age What has improved since the framework was launched five years ago? A third of older people needing intensive daily help in England now receive this in their own homes rather than in residential care; delayed discharge from acute hospitals has been reduced by more than two thirds; and specialist services for people with stroke and for those prone to falls continue to improve.2 In 2000-1, 12 900 people aged 60 and over who had attended NHS stop smoking services had successfully quit smoking a month later; this total rose to 42 900 in 2003-4. And uptake of influenza immunisation among those aged 65 and over rose from 65% in 2000-1 to 71% in 2003-4.2 Such health gains now need to be built on, however, with campaigns among older people to promote greater physical fitness, reduced obesity, and better management of sensory impairment and incontinence. These campaigns could be run by voluntary organisations such as Age Concern and Help the Aged and be supported by teams in primary and secondary care. Furthermore, many targets set in the overall NHS plan are still directed mainly at younger people and largely ignore the milestones set in the national service framework for older people. Other national service frameworks were supported with new monies, and despite older people being the prime users of primary care, secondary care, and social services and having benefited from a reduction of four hour waits on trolleys, investments have not been made in more specific services such as general hospital care for older people or an effective continence service.3