Jackie Smith, Minister of State for Health attended the National Older People’s Task Force meeting in April to discuss the implementation of the National Service Framework (NSF) and improving older people’s services.

She was clearly of the view that good progress was being made on implementation, including the single assessment process, audits of age discrimination and intermediate care. The members of the Task Force were keen to tackle her on funding, in particular, the lack of hypothecated funding for Older People’s NSF, and also issues around monitoring and the priority Government gave to older people as opposed to waiting list targets.

The minister’s view on milestones seemed to be that the Government needed to know that the milestones were generally being met, but local monitoring processes were much more important for the detail, particularly as the Government was trying to cut back on the central command and control of the Health Service. The view on hypothecated funding appeared to be that the NSF for Older People was simply too large and so much embedded within all other aspects of delivering the National Plan, that it made little sense to have specifically earmarked funds. Members of the Task Force made clear their view that the real funding challenges; providing for stroke, falls and dementia services, were yet to happen. These services would need dedicated extra funding and the NSF might well stand or fall from the progress made in these areas.

Workforce group
The workforce group, where the interests of geriatric medicine are persuasively represented by Alistair Main, have made their bids, including a bid to increase NTN’s for geriatric medicine against an expected increase in NTN’s across all specialities. Alistair’s report appears on page 14-17.

Nurse Consultants and Champions
Many people will be meeting Ian Philp over the next 6 months as he tours all the Strategic Health Authorities with Dr Colin-Thome. This is part of a campaign to raise the profile of the Older People’s NSF with the new Strategic Health Authorities and PCT’s whilst at the same time, supporting the work of champions by celebrating best practice. In parallel there is a national push for leadership development for all those involved in leading the implementation of the NSF, including the Champions and nurse consultants.

Following the previous discussions with the Minister of Health, some monitoring of milestones on a national basis will become part of this year’s SAFF (Service and Financial Framework) process, and this should provide information that can be compared with other monitoring processes such as the work being done annually by the BGS and Age Concern. Although this data will appear quite “high level”, it is actually quite an achievement for the Older People’s Task Force to have managed to get this concession against a background of considerable pressure to ask for no more data to reported centrally.

Health and Social Services partnership
Real detailed monitoring of the NSF will eventually be carried out at local level by the Commission for Health Improvement and the Social Services Inspectorate. Although this is not yet formalised, some early work is beginning to suggest there is real change happening, in particular partnership working between Health and Social Services. There is also evidence that delayed discharges have fallen nationally and there is a specific team (The Change Agents Team) currently working in 10 parts of the country where there appear to be the most resistant problems.

For many geriatricians, a key part of the NSF was chapter 4 on General Hospital Care. This has probably received less attention so far, and the National Older People’s Task Force will be looking to see evidence for action and improvement in this area in forthcoming meetings.

Dr David Black
Clinical Director, Queen Mary’s Hospital, Sidcup