- Update

There has been considerable change at the Department of Health but Ian Philp’s impression is that, from John Reid down, ministers are fully supportive of the Older People’s programme.

They understand the logic that if you get it right for older people, you get it right for the whole of the Health Service.

Probably the most important development over the coming year will be the independent inspection of the progress with the NSF undertaken by CHAI/The Audit Commission and the Social Services Inspectorate. Although the work on the inspection started under old CHI, it will be delivered by new CHAI.

This assessment will look in detail at progress against the NSF milestones and standards, but will also look in depth at older people’s and carers’ experience of older people’s services. Not surprisingly, with her background in geriatric medicine, Linda Patterson is taking a lead role, although there has been a very wide process of consultation with all relevant bodies, including the BGS, to ensure that the inspection is properly focused. Pilots will be occurring in early 2004, and the main study between 2004 and 2005. Based on a stratified sampling approach, they will look at 28 health and social care communities in the first year, and on this will base their report on progress with the NSF. It is not clear yet how new CHAI will then roll out the programme in the future to other communities, but those that have been inspected will need to follow a programme of improvement with very specifically defined organisational responsibility. Those who remember the pre-1991 HAS visits may see some slight similarities.

Modernisation Agency
Not to be outdone by the National Older People’s Task Force, the Modernisation Agency have now set up a group looking at older people’s services in terms of all the streams of work being undertaken by the Modernisation Agency. There is cross representation between the Older People’s Task Force and the Modernisation Agency group, which is chaired by Christine Beasley, so hopefully coherent messages will continue to emerge.

Over the summer, the Stroke Association, the National Osteoporosis Society and the Alzheimer’s Disease Society have had a combined campaign to try and raise public awareness, particularly around the stroke, falls and dementia sections of the NSF. I have mentioned before, the concerns that Standard 4 on general hospital care seems to have made the least progress, and the Department of Health have been specifically targeting a team looking at general hospital care to try and produce an action plan in the Autumn. The challenge is how this will sit beside the political pressure being put on Chief Executives at the moment, to deliver to budget and in A&E, or else...

Falls
A major piece of work has been carried out by both the Department of Health and Help the Aged on falls. Two documents have been produced from this, one called “Preventing Falls”, which is available on the Help the Aged web site. The other is specifically designed to inform commissioning agencies (i.e. PCT’s), why they should be, and how they should be, investing in falls services. It is entitled “How do we help older people not fall again?” (snappy title!), and is available on the Department of Health NSF web site. Interestingly, this piece of work used as its gold standard the AGS/BGS Guidance on Falls, and based all their research and advice on the work in that document. It does illustrate that where the BGS can produce high quality clinical guidance, it can be taken very seriously and usefully by other organisations.

The last discussion of the day was around the effect of the department’s emphasis on “choice” over the coming year. Choice was originally described for projects where people on long waiting lists for surgical procedures were offered a choice of going abroad or to other UK providers, rather than continuing to wait on the waiting list. I think many clinicians were surprised by the very high proportion of patients who were prepared to move to get their treatment performed expeditiously. This is now the big idea for the rest of the NHS. What choice means in older people’s services is certainly a complex discussion, particularly when many resources are simply not available to give people choice, and there are concerns that this could again raise expectations in the same way that the patients’ charters did during the 1990’s. There is also a complex discussion about information and how much genuine information one needs to make an informed choice. One choice that might be pursued, is whether people should have the right to move to an intermediate care environment before they have to make a decision regarding permanent long-term care. No doubt there will be further thinking about this issue over the next few months.

David Black