Many things are happening which should ensure that real change occurs in delivery of older people’s care.

This was Prof Ian Philp’s view at the quarterly meeting of the National Older People’s Task Force - this despite the opinion expressed by the represenative of Carers UK that carers were not yet seeing any change in older people’s services.

Prof Philp said that one of the chief dangers was that of “superficial delivery” but he feels that the political commitment to change is becoming increasingly secure. Older people’s services are fully embedded in the next three year plan from 2003-2006 and there appears to be a genuine engagement among politicans who realise that they can only change the NHS by full involvement in the problems of older people. Prof Philp sees an increasing role for users of the service and is trying to engage with them to encourage their involvement at local levels. Workforce development (not just of consultants) is still seen as being the key to long term sustainable change and that work is ongoing. Finally, Prof Philp is linking much of the work of the Modernisation Agency in all its guises.

Focus on Champions
There is a growing focus on Champions, who are seen as being “the grit” to ensure that local initiatives continue to reflect on the needs of older people. A Champion’s resource pack has now been placed on the internet www.doh.gov.uk/nsf/olderpeopletoolkit.htm This is an excellent document not just for Champions but for any geriatrician and indeed, for any SpR. I do recommend that you look at this and you might even consider printing off the whole 100 pages. Surprisingly, the Department of Health has no database of Champions so they are trying to develop this. They will be appointing a national lead for Champions who will keep them involved in the whole process of delivering the NSF, including NSF updates and an active web page.

Change Agents Team
A part of the Modernisation Agency is the “Change Agents Team” which has primarily worked with Trusts and Health Communities where there are perceived to be significant discharge problems. They are now working with 24 health economies across the UK. Their approach is to “do a lot of small things well” and “not come in with a single big new idea”. Interestingly, they do have two questions which they now ask of organisations:
a) do you know what services should be in place to prevent unnecessary admissions to hospital? and
b) are your services planned so that no older person who is admitted to hospital should be discharged directly to long-term care.

This second question is of course immensely powerful and gives a clear direction of travel that most geriatricians would sign up to. However, most places are still a long way from delivering.

We had an update on nursing and a presentation of a small Department of Health survey of Directors of Nursing about changes occurring as a result of both the NSF and the Essence of Care document. The key findings were that most Trusts had now appointed Modern Matrons, usually including a nurse lead for older people’s services. Many Trusts are trying to implement essence of care and have undertaken skill mix reviews. A little surprisingly there is very little reported difficulty in nurse recruitment. Finally, 50% of Trusts feel that standards have improved and the rest believe that standards have been maintained. This survey was done in response to concern that, Standard 4: (General Hospital Care) was not improving at all as a result of the NSF, but was actually deteriorating. What is your view on this survey? Send me an e-mail: david.black@qms-tr.sthames.nhs.uk.

Dr David Black
Geriatrician Member
National Older Peoples Task Force