RORY’S VALUES
Improving services for older people
© 2014 MA Healthcare Ltd
T
he NHS has seen many changes since its establishment in 1948, but the most dramatic has been in the needs of the people it serves— particularly those of older people. However, while health and care needs have changed, many of our services have remained the same. As nurses, we work as part of multi-professional, multi-agency and third-sector teams and we all want to see that the NHS serves the generation of older people who have helped to create it for us and for generations to come. Achieving this vision will mean focusing on improving care for the most vulnerable, particularly the frail elderly. Older patients with long-term conditions will require treatment and care from the NHS, third-sector and social-care services. Therefore, we need primary care, urgent and emergency care, third sector and social-care services to work together as part of a more integrated out-of-hospital service to address the totality of a person’s needs, rather than responding to individual conditions or care requirements with fragmented services. To support this, the four UK Governments are working with NHS, social care and the third sector to set out a plan for improving out-of-hospital care for vulnerable older people. In Wales, they have a Commissioner for Older People who serves as their champion. She works to ensure they have a voice and that the issues that matter to them are being addressed by our policy makers and public services in Wales. In Scotland, we have an Older People’s Inspectorate, in Northern Ireland, there is the Regulation and Quality Improvement Authority and in England, there is the Care Quality Commission (CQC). These representatives monitor the standards of care for older people in acute, continuing care, mental health and social care facilities—but is this enough? In my experience, older people and their families and carers are very clear about what constitutes good public service. In most countries around the world, populations are growing older, with people aged 60 and over growing faster than any other age group. At the end of 2008, a demographic milestone was passed as the number of pensioners in the UK outnumbered the children (Department of Health (DH), 2013). In the next 10 years, the number of people aged over 80 is likely to increase by 29%, and by 85% in the next 20 years (DH, 2013). By 2050, the changes will be even more dramatic as it is predicted that there will be around 250 000 people aged over 100 in comparison with 10 000 in 2008 (DH, 2013). Preventive, integrated and person-centred agendas have emerged across all four countries and older people, in particular, need these agendas to be delivered on. We cannot afford not to deliver because integrated, timely support, delivered in a way that is
British Journal of Nursing, 2014, Vol 23, No 10
accessible to older people will always cost less than waiting until a crisis occurs. So how do nurses influence and promote service models for older people that: ■■ Focus on outcomes and enablement ■■ Shift focus from ‘services’ to ‘support’ ■■ Support carers and communities to advance supported self-care ■■ Establish a community capacity-building programme in collaboration with the third sector ■■ Develop information, advice and assistance to help older people make key decisions and navigate the care system ■■ Create clear pathways into and through services, particularly for older people with complex needs ■■ Continue to expand integrated working. There are innovative models of care and I ask that you seek out these models within your local authorities, and share them with colleagues to improve services for older people, their families and carers. Some of these models may identify areas for reduced costs and they will help us to provide better care. The Nursing and Midwifery Council (NMC) Guidance for the Care of Older people (NMC, 2009) is constructed around the views of older people and it sets out what older people can expect when receiving care from nurses. This framework can help nurses to focus on the issues that matter to older people so that we can deliver safe, effective, person-centred care. Another question worth asking is whether all of our Governments within the UK should appoint an Older People’s Commissioner. After all, we all have Commissioners for Children. An Older People’s Commissioner in all four countries could provide an independent voice and champion for older people, driven by what matters to them. The Commissioner works to make the relevant country a good place to grow older—not just for some, but for everyone. They would promote awareness of the rights and interests of older people, challenge discrimination, and encourage best practice, as well as review the laws affecting the interests of older people, and have a wide range of legal powers to provide support in delivering the change that older people want and need to see. Deeper engagement with older people, their families and carers will enable organisations across the public, third and private sector to get it right for BJN older people all of the time.
Rory Farrelly NHS Greater Glasgow and Clyde Director of Nursing Acute Services Division
Department of Health (2013) Improving care for people with dementia. DH, London. http://tinyurl.com/bs5rtxj (accessed 13 May 2014) Nursing and Midwifery Council (2009) Guidance for the care of older people. http://tinyurl.com/nnuu2fh (accessed 13 May 2014)
The views expressed in this column are those of the author
543
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 27, 2015. For personal use only. No other uses without permission. . All rights reserved.
Improving services for older people
© 2014 MA Healthcare Ltd
T
he NHS has seen many changes since its establishment in 1948, but the most dramatic has been in the needs of the people it serves— particularly those of older people. However, while health and care needs have changed, many of our services have remained the same. As nurses, we work as part of multi-professional, multi-agency and third-sector teams and we all want to see that the NHS serves the generation of older people who have helped to create it for us and for generations to come. Achieving this vision will mean focusing on improving care for the most vulnerable, particularly the frail elderly. Older patients with long-term conditions will require treatment and care from the NHS, third-sector and social-care services. Therefore, we need primary care, urgent and emergency care, third sector and social-care services to work together as part of a more integrated out-of-hospital service to address the totality of a person’s needs, rather than responding to individual conditions or care requirements with fragmented services. To support this, the four UK Governments are working with NHS, social care and the third sector to set out a plan for improving out-of-hospital care for vulnerable older people. In Wales, they have a Commissioner for Older People who serves as their champion. She works to ensure they have a voice and that the issues that matter to them are being addressed by our policy makers and public services in Wales. In Scotland, we have an Older People’s Inspectorate, in Northern Ireland, there is the Regulation and Quality Improvement Authority and in England, there is the Care Quality Commission (CQC). These representatives monitor the standards of care for older people in acute, continuing care, mental health and social care facilities—but is this enough? In my experience, older people and their families and carers are very clear about what constitutes good public service. In most countries around the world, populations are growing older, with people aged 60 and over growing faster than any other age group. At the end of 2008, a demographic milestone was passed as the number of pensioners in the UK outnumbered the children (Department of Health (DH), 2013). In the next 10 years, the number of people aged over 80 is likely to increase by 29%, and by 85% in the next 20 years (DH, 2013). By 2050, the changes will be even more dramatic as it is predicted that there will be around 250 000 people aged over 100 in comparison with 10 000 in 2008 (DH, 2013). Preventive, integrated and person-centred agendas have emerged across all four countries and older people, in particular, need these agendas to be delivered on. We cannot afford not to deliver because integrated, timely support, delivered in a way that is
British Journal of Nursing, 2014, Vol 23, No 10
accessible to older people will always cost less than waiting until a crisis occurs. So how do nurses influence and promote service models for older people that: ■■ Focus on outcomes and enablement ■■ Shift focus from ‘services’ to ‘support’ ■■ Support carers and communities to advance supported self-care ■■ Establish a community capacity-building programme in collaboration with the third sector ■■ Develop information, advice and assistance to help older people make key decisions and navigate the care system ■■ Create clear pathways into and through services, particularly for older people with complex needs ■■ Continue to expand integrated working. There are innovative models of care and I ask that you seek out these models within your local authorities, and share them with colleagues to improve services for older people, their families and carers. Some of these models may identify areas for reduced costs and they will help us to provide better care. The Nursing and Midwifery Council (NMC) Guidance for the Care of Older people (NMC, 2009) is constructed around the views of older people and it sets out what older people can expect when receiving care from nurses. This framework can help nurses to focus on the issues that matter to older people so that we can deliver safe, effective, person-centred care. Another question worth asking is whether all of our Governments within the UK should appoint an Older People’s Commissioner. After all, we all have Commissioners for Children. An Older People’s Commissioner in all four countries could provide an independent voice and champion for older people, driven by what matters to them. The Commissioner works to make the relevant country a good place to grow older—not just for some, but for everyone. They would promote awareness of the rights and interests of older people, challenge discrimination, and encourage best practice, as well as review the laws affecting the interests of older people, and have a wide range of legal powers to provide support in delivering the change that older people want and need to see. Deeper engagement with older people, their families and carers will enable organisations across the public, third and private sector to get it right for BJN older people all of the time.
Rory Farrelly NHS Greater Glasgow and Clyde Director of Nursing Acute Services Division
Department of Health (2013) Improving care for people with dementia. DH, London. http://tinyurl.com/bs5rtxj (accessed 13 May 2014) Nursing and Midwifery Council (2009) Guidance for the care of older people. http://tinyurl.com/nnuu2fh (accessed 13 May 2014)
The views expressed in this column are those of the author
543
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 27, 2015. For personal use only. No other uses without permission. . All rights reserved.
