Building on Solid Foundations
Professor Ian Philp
National Director for Older People and Neurological Conditions
The Older People’s NSF launched in 2001 was a 10 year programme of reform – now that we have passed the initial milestones of that document it seems a good time to take stock of what we have achieved so far and look forward to building on that in the rest of the decade. The reasons for having this NSF are still as valid now as they were then – tackling age discrimination and enhancing dignity and respect for older people, developing integrated systems of care, improving services for old age related needs, as well promoting health and active life.
In Better Health in Old Age( Department of Health, 2004) I set out specific ways in which we had delivered improvements to services for older people across the whole system of health and social care . For example, we have the highest levels ever of older people taking advantage of prevention and health promotion activities. Those quitting smoking in 2003-4 using smoking cessation services in the NHS were greatest in people aged 60 and over. The numbers of women aged 65 and over who were screened for breast cancer went up almost 50 per cent between 2000 and 2003.
We have seen a major investment in community services to benefit older people. One way has been through the innovative use of intermediate care where we are ahead of many other countries in providing a means for people to regain mobility and independence following acute hospital care. Most of the country is also now served by integrated community equipment services and we have reached our PSA target for supporting more people to live in their own homes with intensive home care two years early.
One major effect of this concentrated activity has been to sharply reduce the amount of delayed discharge, in which older people are kept unnecessarily in hospital. The annual report of the NHS published recently showed that there was a further 16 per cent fall in delayed discharge over the past year which had already been reduced by two thirds between 2001 and 2004. We are on course to eradicate this as a major problem from our healthcare system, thanks to the joint work of NHS and social care staff.
Changes in culture and attitudes towards older people can be seen in the improved access they now have to treatments and care. For example, the proportion of people aged 75 and over receiving heart surgery increased from only two per cent in 1993 to 10 per cent in 2003.
It would be wrong to suggest that age discrimination has been completely eliminated – it is in society as a whole and health and social care systems are a reflection of that. For instance, in the past the mental health needs of older people have been neglected and they have not received the attention and resources they deserve. We will put that right and I am joining together with Louis Appleby the National Director for Mental Health to launch a concerted effort to ensure that mental health services for older people are available on the basis of need not age. This will be achieved through better co-ordination and commissioning of services, spreading excellence in specialist practice, and skilling up generic staff to care for these needs in mainstream NHS and social care settings.
The next five years represent a great opportunity to build on solid foundations and at the same time refresh the agenda. I want to align the next phase of reform with our major priorities. This means:
• maximising health promotion and an active life for older people, by encouraging exercise, walking, swimming and dance along the lines of the Choosing Health White Paper.
• Reducing emergency bed days and acute admissions by expanding services in the community.
• Ensuring dignity for people throughout their lives by promoting independence, well-being and choice.
• Increasing the integration of health and social care services to meet the needs of older people.
I will soon be publishing details of the activity we need to progress these themes and will be working closely with stakeholders in the voluntary and private sectors. My overall message remains – if we get things right for older people then we will get them right for everyone.