Decent NHS care for older people still too patchy

May 18, 2006

Good, respectful NHS care for older people is still too patchy, argue senior members of the British Geriatrics Society in this week's BMJ.

Last month's government report A New Ambition for Old Age examined how the national service framework (NSF) for older people is being implemented and announced new aims and targets under three themes: dignity in care, joined up care, and healthy ageing.

So what has improved since the framework was launched five years ago, ask the authors?

A third of older people needing intensive daily help in England now receive this in their own homes rather than in residential care; delayed discharge from acute hospitals has been reduced by more than two thirds; and specialist services for people with stroke and for those prone to falls continue to improve.

But such health gains now need to be built on, say the authors. Despite older people being the prime users of health care and social services, investments have not been made in more specific services, such as general hospital care for older people.

Care for older people is still not sufficiently integrated, they add. The increasing emphasis in the NHS on moving patients rapidly through the emergency system towards discharge may benefit younger people at the expense of effective planning and specialist assessment of the frail and old.

The separation in the NHS of medical specialties from psychiatry is also hampering the provision of effective, humane, and responsive services for older people with mental health problems, such as dementia and depression.

They suggest that better coordination of care for people with complex needs will be achieved by strengthening commissioning arrangements between the NHS and local authorities, to ensure that social care is not provided without medical problems being treated.

The dignity of older frail patients is also infringed every day in many different ways, they warn. The establishment of a seven point plan to improve dignity in care is to be welcomed.

"This report contains much that is praiseworthy," they conclude. "We hope that the levers set out in this report really convince providers of health and social care to reorganise their priorities."
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BMJ

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