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The NSF, seven years on |
| Email your comments When the National Service Framework for Older People was introduced I’d been working with older people for twenty years. It was clear that many of them did not benefit from evidence based care delivered by carers with a real understanding of ageing and age related problems. It is unthinkable for children to be cared for by nurses who are not specially trained to meet the needs of children. Intensive care units would not be run without nurses who have specialist knowledge in intensive care. But the same privilege was not afforded older people and too often they were at the mercy of care and medical staff who did not have specialist knowledge of gerontology. Time and again I saw reversible conditions ascribed to ageing. I saw people prescribed inappropriate medication that made things worse not better. Demographic changes led to increasing numbers of older people requiring assessment and treatment. I saw pressures building in acute and community settings. These pressures meant that there was less opportunity for staff to properly diagnose, treat and provide holistic care. The NSF was a potential turning point. At last, an evidence based document that identified most of the geriatric giants. The NSF not only identified the giants it set out a programme of action that if implemented could make an enormous difference to the quality of care older people receive. Seven years on things are a little better for older people. Intermediate care has been one of the great successes. It has, in my view given many older people the time and the space to fully recover following illness and injury. But there is so much to be done. We still have a mountain or two to climb in our efforts to ensure that older people receive high quality care. It can be done but radical action is required. We need to educate pre-registration students so that they understand the needs of frail older people and put gerontology at the heart of nursing, therapy and medicine. We need to change the culture in the health service so that caring for older people is viewed as a core skill and a highly skilled specialism. Moreover, we need to attract the brightest and best to our specialty. The role of the nurse consultant is crucial in driving through these changes. Functioning as clinician, educator and strategist we can help to move elder care forward. The problem is that there are so few of us. In London, a city with nine million people, there are a handful of nurse consultants. Many acute and primary care trusts consider expert nurse clinicians and educators to be either unnecessary or an unaffordable luxury. If we are to move forward, support from the Department of Health would be helpful. It could encourage NHS Trusts to improve services for older people and to ensure that staff working with older people have at least a basis grounding in gerontology. Until then those of us who are privileged to work as nurse consultants will continue to advocate the principles begun by the NSF. As Churchill said, the NSF may not be the end; or the beginning of the end; but it may well be the end of the beginning. With support we could see it come to fruition. Linda Nazarko BGS Newsletter, March 2008 |