The National Older People’s Taskforce continues to meet on a quarterly basis to act as a source of advice, encouragement and, of course, constructive criticism to the National Director of Older People’s Services in delivering the NSF.

The taskforce brings a multi-disciplinary reality check to Ian Philp and the Department of Health officials. This is an important role because although the National Director has just about completed his twenty six visits to all the Strategic Health Authorities in England, he is of course being shown the best of all schemes.

At the moment the reality, across the country, is that there is enormous pressure on chief executives to deliver financial targets and A&E access targets. The financial problems have made the development of local delivery plans (LDP’s the successor to SAFF’s) very difficult, and there was a widespread view that delivering the milestones in the National Service Framework for Older People (NSF) had been pushed down the priority list. On the other hand, delivering access targets will greatly benefit many older people, and all of us individually have a challenge to persuade our health community that getting services right for older people in hospital means getting it right for the rest of the Health Service. Another area of some disappointment has been the new GP contract where the specialist clinical targets for older people unfortunately did not make the final contract.

On the Workforce Front
On a more positive note, the eighty new NTN’s for geriatric medicine will be widely welcomed and Alistair Main, who represents the BGS on the Workforce Group, reminds us how important it is to develop attractive training programmes which will pull trainees into geriatric medicine. There also appear to be leadership funds available for training the first cohort of GP’s with a special interest in older people. It is hoped that up to 300 of these could be trained in the first cohort. There is agreement that they will interface very closely with local geriatric services and where GP‘s do take on this role, it must help to deliver better services in the community.

Champions
A key part of the delivery of the National Service Framework, has been to identify and enthuse enough champions at a local level to keep progress moving forward on the National Service Framework, even if it does not make highest political priority. There is now a national database and up to 2000 people are registered on it. The DOH has appointed a National Development Manager, whose job will be to work with these champions, to develop them and encourage them in influencing local policy.

Evercare
The group were also updated on a Department of Health initiative with an American company called ‘Evercare’ that provides enhanced medical care and co-ordination of services to older Americans on behalf of the Federal Government. Evercare work principally by using specialist nurse practitioners and care staff to work with frail elderly people in both the community and institutional care with a view a proactive improvement in the quality of care and to prevent unnecessary hospital admissions. Independent evaluation has been by Professor Robert Kane from Minnesota, who is well known to many members of the BGS. The Department of Health through its primary care arm have invited Evercare to look at 12 PCT’s around the UK to see if they could develop (not deliver) local services in a cost effective fashion along the lines of the model provided in the USA. A number of geriatricians have been involved in this and the BGS and the National Older People’s Taskforce will be very keen to receive feedback from the geriatricians involved in local sites, if their PCT’s decide to fund one of these programmes.

Intermediate Care
Finally, the Taskforce spent a considerable period of time reviewing Intermediate Care. Ministers see Intermediate Care as a success for the NSF. The feedback was that nationally, progress has been patchy. There is no doubt that there are extremely well run and effective schemes, but unfortunately there are still a significant numbers of ineffective or poorly run schemes. The message coming up time and again is the need for clear leadership and management back up; proper partnerships between health and social care required; a single point of access; adequate medical input needed to be achieved; and the schemes need to be visible, pro-active and prepared to take on and solve problems.

“Cherry Picking” schemes are rarely seen as successful. An issue that also continues to come up is that of “professional silos” and a reluctance to work in a genuinely multi-disciplinary environment. Clearly, a lot of work continues to be required to get the most out of the funds that have been invested in Intermediate Care.

David Black