National Service Framework (NSF) for Older People & Dignity in Care Dr. Gareth Morgan NHS Wales Policy Lead for Older People

Changing profile of illness More dementia anticipated Why do we need a NSF? The ageing population Changing profile of illness More dementia anticipated Health and social care

Sets out standards for health and social care The NSF standards…. Launched in March 2006 Sets out standards for health and social care Standard 1 – rooting out age discrimination Standard 2 – person centred care Standard 3 – promotion of health & wellbeing

Standard 4 – challenging dependency Standard 5 – intermediate care The NSF standards…. Standard 4 – challenging dependency Standard 5 – intermediate care Standard 6 – hospital care Standard 7 - stroke

Standard 8 – falls and fractures The NSF standards…. Standard 8 – falls and fractures Standard 9 – mental health of older people Standard 10 – medicines in older people Supporting standard – Workforce development

Considerations of dignity in care Dignity in care programme….. Considerations of dignity in care It does have subjective elements to it Holistic approach to care Not rocket science and person centred

Over 20 small grants funded 500 staff received training Dignity in care programme….. Programme launched in 2008 Over 20 small grants funded 500 staff received training Commissioner for Older People Action plans now been submitted

Review of the NSF for Older People Growing Old My Way Independent review by HIW & CSSIW

Purpose of Review The Welsh Government commissioned a fundamental review of the NSF to assess progress so that its future direction and development could be informed Care & Social Services Inspectorate Wales (CSSIW) and Healthcare Inspectorate Wales (HIW) carried out review Aim was to answer one fundamental and simple question, using pathway of an individual with dementia: ‘What impact is the NSF having on the quality of life of older people in Wales?’

Unannounced hospital visits. Issue of GP questionnaires. What did we do: A key aspect of this review was the gathering of the views of service users and their families and so Age Alliance Wales (AAW) was commissioned to facilitate service user and carers’ events across Wales. Stakeholder events involving service users and carers, commissioners as well as providers of services. Unannounced hospital visits. Issue of GP questionnaires.

Findings arising from our work in relation to the Older Peoples NSF: It can be said with certainty that the NSF has had an impact. It, together with related strategies and the role of the Older Peoples’ Commissioner, have raised the profile of older people in Wales and highlighted the need for them to be treated as individuals and without discrimination. All those who participated in our review valued the focus the NSF has brought to the need to think innovatively and outside of the box when providing care and support to older people. The full implementation and consequent benefits of the NSF are still a long way off. Health and social care still have a lot to do in terms of refocusing their approach and agenda to one of prevention and empowerment.

Findings arising from our work in relation to the Older Peoples NSF: A certain degree of bravery is needed by statutory health and social care agencies in being honest in their assessment of what they are good at and not so good at and then doing something about it. There is an inherent tension between a preventative approach and an eligibility framework that targets the highest needs as priority. Collaboration between health, local authorities and third sector organisations is needed to help to deliver the changes needed.

Health Promotion and prevention: Our review has highlighted that across Wales a number of innovative and valuable services and support mechanisms have been put in place. We were told that schemes and services that worked well. Yet, still variation in service patterns and evidence of ‘policy crowding’

Health Promotion and prevention: Greater investment is needed at a local level in health promotion, prevention and community services if we are to help and support people to live healthy and longer lives.

Findings arising from our work in relation to the Older Peoples NSF: Older people with complex needs often end up in hospital when in reality for many it is the last place they should be. When older people get admitted to hospital they are there for too long and as a result their independence and confidence is impacted upon.

Going forward and challenges…… Current policy initiatives include: Best practice & innovation Health & social care integration European Year Healthy Ageing Champions for Older People Gareth.Morgan5@wales.nhs.uk