National Service Framework For Older People Research Articles

Beyond the NSF: Continuing Older People's Involvement and Engagement

In this article we report findings from a small scale user‐controlled study which explores involvement and engagement in terms of the legacy of the National Service Framework for Older People (NSFOP) and the new opportunities that are opening up around community well‐being and active citizenship. A key finding of the study is that, when participating in implementation of a major policy initiative, older people's reference groups and forums require good support: practical help with administrative tasks and more professionalised support to help develop members' skills as activists and campaigners. We distill what this means for practice in a commissioning framework which can be used to specify support services that may be provided to older people's groups by external organisations such as the voluntary and community sector. Here, involvement and engagement are understood as a dynamic relationship between three stakeholder groups (older people, the statutory sector, and the voluntary and community sector). We pinpoint likely tensions in these relationships and how they might be addressed.

'There Are Wonderful Social Workers but it's a Lottery': Older People's Views about Social Workers

This paper draws on the evaluation of the impact of the English National Service Framework for Older People (NSFOP) on the experiences and expectations of older people, four years into its ten-year programme. The NSFOP focuses on achieving cultural changes so that older people and their carers are treated with respect, dignity and fairness. The evaluation took a mixed methods consultation approach in ten localities. This paper focuses on what was said by older people, their carers and in voluntary sector groups about social workers’ roles and activities. The data suggest that they find social workers’ roles unclear and variable. They appreciate a person-centred approach, informed about older people’s needs in a confusing social care system. Their perceptions tally with those of social workers that the tasks of care management can be reductionist, but older people also desire specialist knowledge combined with a relationship that is ‘on their side’. Social workers’ roles in rationing support and means-testing did not seem to promote such models. At a time of rising expectations about the skills of social workers and of changes to social work roles in England and Scotland, this study provides one of the few examples of information directly gathered from older people themselves.

Elderly people's perspectives on health and well-being in rural communities in England: findings from the evaluation of the National Service Framework for Older People

Addressing the problems of meeting the needs of ageing populations in rural areas is recognised as a political and service delivery challenge. The National Service Framework (NSF) for Older People (NSFOP) set out a series of service standards to raise quality, to redress variations in service use and to enhance the effectiveness of services across health and social care in England and alluded to the challenges of meeting such standards in rural communities. This paper reports findings from the consultations undertaken with 713 elderly people as part of the midpoint review of the NSFOP in 2006, presenting and analysing the views and experiences of elderly people from rural areas. The consultations to engage with elderly people employed a mixed methodology that included public events, focus groups and individual interviews. The data reveal participants' views of how different patterns of social change in diverse country areas in England influence health and well-being in later life. The costs and benefits of centralization of services, and the pivotal issue of transport are important themes. The findings raise questions about the unclear and contradictory usages of the term 'rural' in England and the portrayal of rural ageing as a homogeneous experience.

Four years on: The impact of the National Service Framework for Older People on the experiences, expectations and views of older people

Evaluation of the impact of the National Service Framework for Older People (NSFOP) on the experiences and expectations of older people, 4 years into its 10 year programme. the NSFOP is a comprehensive strategy designed to promote fair, high quality, integrated health and social care services for older people in England. It emphasises (i) the need for services to support independence and promote health, (ii) the specialisation of services for key conditions (stroke, falls and mental illness) and (iii) advocates a cultural change in services so that the older people and their carers are treated with respect, dignity and fairness. It has a 10-year timetable for implementation, starting in 2001. A mixed methods approach to evaluation was taken in ten purposively selected localities in England. A portfolio of methods (listening events, nominal groups and interviews) was used with older people and carers to focus on processes as well as on outcomes and to allow for the possibility of conflicting or differing judgements about service quality. One thousand eight hundred and thirty-nine people participated in public listening events, 1,639 took part in nominal groups and 120 were interviewed individually. The existence of the NSFOP was not widely known beyond the NSFOP local implementation teams and voluntary sector activists. Many, but not all older people, identified themselves as members of a group that was subject to age prejudice that altered the quality and standard of their care. This identity included a role as carer for others, but there was less emphasis on the rights of older people. Positive changes in primary care services were offset by difficulties in accessing general practice and a sense that services were becoming impersonal. The quality of social care at home varied from sensitive and personal to fragmentary, hurried and impersonal. Hospitals treatment was perceived as improved in speed and quality in most places, but hospitals were also seen as risky and insufficiently caring, with discharge sometimes being unprepared, over-zealous and disorganised. If asked, older people do not perceive improvements as the result of a NSFOP, but nonetheless they do perceive improvements in systems. It is difficult to attribute any of the changes in experiences that we identified to the NSFOP itself, but we can see that other change processes run contrary to some aspects of the NSFOP whilst some trends are congruent with the aspirations of the NSFOP. Government initiatives face the difficulty of distinguishing experiences that may be attributable to multiple causes. They are influenced nonetheless by the outcome of public consultation since these provide relatively rapid means of feedback and commentary by citizens and regulators on the performance of services.

From Paper to Practice: The Views of Occupational Therapists on the Impact of the National Service Framework for Older People on Practice

Philp (2003) outlined the fundamental role that occupational therapists could have in implementing the National Service Framework (NSF) for Older People and reforming services for older people (Department of Health 2001). A research project was undertaken, which aimed to investigate the views of occupational therapists about the implementation of the policy in order to identify the key areas and issues that have had an impact on practice. The research design was qualitative and took the form of focus groups. The focus group data were analysed using a long-table analysis method (Krueger and Casey 2000), which identified five key themes: a raised profile of older people's services, a changing delivery of services, a revisiting of occupational therapy core skills, assessment and resource allocation. The emerging themes suggested that the NSF for Older People has had an impact on the practice of the occupational therapists involved in the focus groups.

Specialist services for older people: issues of negative and positive ageism

This paper reports findings of a study in 2004 of the development of specialist services for older people in the National Health Service (NHS) in England, as recommended in the Department of Health's National Service Framework for Older People (NSF-OP). The study was funded by the Department of Health as part of a programme of research to explore the Framework's implementation. Information was collected through a questionnaire survey about the nature of specialist developments at three levels of the NHS: strategic health authorities (SHAs), provider Trusts, and service units. This produced an overview of developments and a frame from which to select detailed case studies. Analysis of the survey data showed that there were variations in the way that the NSF-OP was being interpreted and implemented. In particular, there was inconsistency in the interpretation of the NSF-OP's anti-ageism standard; some concluded that the strategy discouraged services exclusively for older people, others that it encouraged dedicated provision for them. The tension between creating age-blind and age-defined services was played out in the context of existing service structures, which had been shaped over decades by many local and national influences. These conceptual and historical factors need to be taken into account if services are to change, as developments are shaped by ‘bottom-up’ local processes as well as ‘top-down’ policy initiatives. In particular, the tension inherent in the NSF-OP between negative and positive ageism, and its varied interpretations at local levels needs to be taken into account when evaluating progress in implementation.

Old age mental health services in England: implementing the National Service Framework for Older People

There is much variation in the services provided for older people with mental health problems. In England, the National Service Framework for Older People (NSFOP) sought to address these inconsistencies and improve care. This study describes the situation three years after its publication. A postal survey of old age psychiatrists collected data on the NSFOP mental health model: the range of specialist mental health provision, the nature of the specialist:generic service interface and the degree of interdisciplinary/interagency working. Three hundred and eighteen (72%) consultants responded. Considerable differences existed in the deployment of key professionals within community teams, with more than a third lacking ring-fenced social work time. Few services had dedicated rehabilitation beds and nearly a third lacked separate facilities for people with organic and functional illnesses. Increasing numbers of consultants had access to a memory clinic and there was some suggestion that liaison services were developing, but little indication of increased support for care homes. Several services had yet to agree protocols with primary care, or to implement measures promoting effective information-sharing and integrated care, and there was little evidence that the introduction of the Single Assessment Process (SAP) had significantly changed practice. Although just over half of consultants reported that mental health services were improving, less than a quarter considered community provision adequate. Three years after the publication of the NSFOP there remained significant gaps in services for older people with mental health problems and substantial variation in provision between districts.

Developing specialist practice for older people in England: responses to policy initiatives

AbstractPractice development can be a local initiative, or it can be shaped by ‘top‐down’ policy agendas. Following the launch of a National Service Framework for Older People (NSF‐OP) in England, a study was commissioned to examine the development of specialist services and staff for older people, one of the key recommendations of this policy.A two stage study was conducted, the first stage being a questionnaire in three parts to identify practice developments across a range of agencies, and the second to carry out case studies to identify processes in more detail. This paper reports on some of the findings from the first stage of the study, focusing on the data from National Health Services. This suggested that definitions of specialism are unclear and roles are ambiguous, which has implications for training and practice development. Other data, however, suggested that the development of services for older people was not simply a response to the NSF‐OP, but had been in progress for variable lengths of time before this. Copyright © 2005 John Wiley & Sons, Ltd.

The National Service Framework for Older People: England's approach to ending age discrimination in services and therapeutics.

In 1997, the new Labour Government in the UK embarked on an ambitious programme of reform. One of the key changes has been the publication of a series of National Service Frameworks. The National Service Framework for Older People (NSFOP) sets out a 10-year programme that has as its principal standard rooting out age discrimination. Together with its companion documents, a series of robust milestones and standards are set out that have to be met. Although generally welcomed by the profession, the NSFOP has been criticised by some because it mandates the initiation of new 'intermediate care' services that may be seen as denying older people the opportunity for admission to mainstream hospital care. Monitoring tools covering both procedures and prescribing have been developed. The government-produced frameworks mirror guidelines produced by the profession and include a number of prescribing recommendations, e.g. the use of antihypertensives and aspirin (acetylsalicylic acid) in the prevention of stroke, and the use of calcium, vitamin D and bisphosphonates in the treatment of osteoporosis. In tackling age discrimination, both direct and indirect barriers to effective prescribing need to be considered. The evidence base on the effectiveness of medication in older people is more limited due to the previous systematic exclusion of older people from clinical trials. The consequent lack of evidence of efficacy, coupled with perhaps a natural reluctance to prescribe potentially toxic medication, may lead to underprescribing. Other indirect causes of age discrimination may include difficulties for older people attending hospitals for drug monitoring, and the difficulties of translating the results of trials into meaningful endpoints that older patients can understand and thus make valid decisions about whether they wish to take the particular drug or not. At the same time as the NSFOP argues against age discrimination, other government policies may operate in a contradictory manner. Examples include the trend to make drugs available over the counter in pharmacies and for which the patient has to pay rather than receive them free, the restriction of some prescription-only drugs from the health service, and the need for referral to specialist services for some drugs, e.g. sildefanil, which older people may be reluctant to access. Successfully combating age discrimination is likely to require a regulatory framework, continued monitoring, tackling indirect forms of discrimination, as well as embedding antidiscrimination policies in all facets of health education.

Older people as health service consumers: background to a study.

User involvement in health care has received a high profile within the NHS Plan (Department of Health, 2000a), giving patients a greater say in their treatment and in the way that the NHS works. Older people, i.e. those over 65 years of age, as a group, are the highest users of hospital and community services (DH, 2001a). The national service framework (NSF) for older people (DH, 2001a) highlights the need to listen to older people, help them make informed choices and involve them in achieving a healthy lifestyle. While the NSF for older people rightly attempts to ensure fair and equitable access to health care services for older people, it is assumed that they want to be involved, and want to exercise their rights as users. This assumption needs to be tested. This study, presented as a series of four articles, sets out to explore if there is a consumerist ethic among older people in relation to health care. The first paper outlines some of the literature reviewed together with the methodology.

National Service Framework for Older People: promoting health.

In March 2001, the National Service Framework (NSF) for Older People set out standards for the care and treatment of the over 60s in England. In Wales, a strategy for older people is expected in 2002. The eight standards of the NSF for Older People include strategies to reduce falls, strokes and poor mental health among older people as well as improving general and intermediate care. The final standard "Promoting health and active life in older age" is an overarching theme. As well as strategies to promote health in older people, the NSF requires service providers to develop long-term strategies to promote health throughout life in order to prevent chronic illness. This should include the prevention and treatment of osteoporosis. In promoting positive role models, the NSF for Older People is reflecting social trends in tackling ambivalence about ageing. Key themes of the standard include empowerment and improving quality of life for older people. Patient-centred care and the appointment of older people's champions are possible routes towards this aim. Although there is evidence of some patient-focused models of health promotion, a review of the literature suggests that these are limited.