Framework puts care for older people on course for reform

The long-awaited National Service Framework for Older People was
revealed this week by the Department of Health.

Billed as “a full-on assault on age discrimination” by health
minister John Hutton, the framework outlines eight national
standards to improve the quality of care for older people (see
box).

Building on the NHS Plan launched last year, it lists key
interventions, performance indicators and “milestones” to ensure an
integrated approach, all to be monitored by the Social Services
Inspectorate and the National Care Standards Commission.

“The framework is not just about a range of key interventions,”
said Hutton, “it is about a culture shift.”

Key to this aspiration is the increased representation of older
people and their interests in a model of joint working between
health and social care agencies. Local arrangements for
implementing the framework are to be established by June 2001.

“The framework is a step in the right direction,” said Rita
Stringfellow, chairperson of the Local Government Association’s
social affairs and health executive. “It will provide a platform
for developing a more holistic approach to services for elderly
people.”

Age Concern director general Gordon Lishman added: “The document
must become the cornerstone for promoting and improving the health
of older people, but must also ensure that older people are treated
as individuals, not simply as a group.”

Under the framework, local authorities and health bodies will
have to review and report on all their age-related policies by
October 2001. Other initiatives include the appointment of older
patient champions on each patient forum and professional champions
on councils and NHS boards.

Councils and the NHS are encouraged to use the Health Act 1999
flexibilities – including pooled budgets and joint commissioning –
to ensure an integrated, person-centred approach to service
provision. Key to this is the introduction of a single assessment
process by April 2002.

Single assessments will “put an end to piecemeal, repetitive
assessments and offer co-ordinated delivery of care”. Older people
will receive individual care plans detailing objectives and
outcomes.

The framework also builds on the intermediate care guidance
issued in January, focusing on unnecessary hospital admissions and
rehabilitation.

“The framework adds a clearer service model for intermediate
care so the money can be spent in the right way,” said Ian Philp,
the DoH’s national director for older people’s services. £1.2
million has been allocated for further research beginning in
October.

Eight national service framework standards

• Rooting out age discrimination: access to health and social
  care services will not be restricted by age.
• Person-centred care: treating older people as individuals
  through the single assessment process and integrated commissioning
  and service provision.
• Intermediate care: a new range of services to promote
  independence by preventing unnecessary hospitalisation and
  admission to long-term care.
• General hospital care: specialist care delivered by
  appropriately-trained staff.
• Stroke: preventive action and access to diagnostic services,
  treatment and rehabilitation.
• Falls: joint preventive action.
• Mental health in older people: access to integrated NHS and
  council services to ensure effective diagnosis, treatment and
  support.
• The promotion of health and active life in older age: programme
  of joint action.