Posts Tagged ‘older people’

Join up services to improve elderly care

By Mike Broad - 8th February 2012 3:00 pm

Older people are being let down by fragmented care services, says an influential group of MPs.

Joined up services are key to securing better outcomes for older people and other vulnerable groups - and to delivering the required efficiency savings for the NHS - the cross party committee says.

The report calls for the development of a new, integrated legal framework to support integration of health, social care and other services around the needs of the individual and promote coordinated commissioning.

The three “overlapping but confusing” frameworks that currently exist should also be replaced with one outcomes framework for older people.

Stephen Dorrell MP, chair of the Health Select Committee, said: “Our central recommendation is that the key to joined up services is joined up commissioning.

“We recommend that the government should place a duty on the new clinical commissioning groups and local councils to create a single commissioning process, with a single accounting officer, and a single outcomes framework for older people’s health, care and housing services in their area.

“This would improve outcomes by making it easier to move money around the local health, housing and social care system. It will also play a significant part in delivering the Nicholson Challenge for the NHS of 4% efficiency saving every year over the next four years.”

Recent reports on the crisis in elderly care by Age UK and the King’s Fund have shown that 800,000 older people are lacking the services they need, and this is set to rise to 1 million by 2015.

The report calls on the government to coordinate policy more effectively across Whitehall and regularly rebalance national spending across health, housing and care services. It recognises the widening ‘funding gap’ in social care services - between the number of people who need care and the amount of money currently in the system.

The Health Select Committee says GPs to identify much earlier, and assess more clearly, the needs of carers providing essential informal care to the old and the vulnerable.

Dorrell added: “This government, like its predecessors going back to the 1960s, has stressed the importance it attaches to joined up services. Growing demand, coupled with an unprecedented efficiency challenge, makes it more urgent than ever before to convert these fine words into fine deeds. We look to the government to set out in its Social Care White Paper how this vital objective will be met.”

Furthermore, the committee supports the recommendations in the Dilnot report for a series of caps on care costs and identify the level at which it thinks these caps should be set.

Commenting on the report, Dr Linda Patterson, clinical vice-president of the Royal College of Physicians, said: “We agree that older people are being let down by fragmented care services. The changing demographic and associated increase in medical conditions make this one of the key issues of the day, as it touches the lives of everyone involved in health and social care.

“If there were better integration of health and social care services, people would be able to stay as long as possible in their own homes, living productive independent lives.”

Read the full report.

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Care of the elderly - the NHS can only do so much

By Katherine Teale - 21st February 2011 9:58 am

Damning, harrowing, disgraceful, shameful, shocking, inhumane and callous. The headline writers had a field day this week following the report by the NHS ombudsman Ann Abrahams, describing the care of ten elderly patients.

No one can deny that the care these individuals received was terrible. Perhaps an even more shocking fact is that I’m sure there is not one single doctor reading this who can’t call to mind at least one similar case.

Why, then, is it such a difficult nut to crack? Why, with all the extra resource which has been put into the NHS since 2000, is this still happening? Does it, as the government would have us believe, reflect an inherent problem with the NHS as an organisation?

“No” said Ray Tallis, arguing articulately on the Today programme. Elderly patients can receive equally terrible care in non-NHS institutions, for instance private nursing homes.

But it’s hardly a ringing endorsement of any organisation, and shows us at our very worst, with  everyone involved (nurses, doctors and managers) rushing to blame each other.

While individuals need to take responsibility for their own actions, we also need to look at wider causes. As a society, it is undeniable that we do not value old people. We worship youth - in fact the media is obsessed with it. Actors and  presenters (at least the female ones) are dropped at the first sight of a wrinkle. Old people are a nuisance, expensive, and not even nice to look at. They can’t get to grips with new technology, and struggle with mobile phones. Everything has to be explained - often several times, and they don‘t understand our jokes. They drive far too slowly, hogging the middle lane. There’s nothing glamorous about old age, especially when it’s poor, with bad teeth and dementia.

I remember once having a frank conversation with a group of medical students who were unimpressed with their placement on an elderly care ward because the patients, they complained, “take so long to give a history”. How boring and tedious examining an 80-year-old in chronic heart failure, when their friends were coming home with stories of articulate young patients on coronary care. So much quicker and more exciting.

Consider also how we regard people who do jobs which involve getting their hands dirty - whether that be cleaning, looking after elderly people, or mending cars. The further removed you are from the actual dirt, the more highly you are respected, and the more you get paid.

If we don’t respect or value those who care for elderly patients, is it so surprising that elderly patients are sometimes treated disrespectfully? Nor are  compassion and kindness encouraged in our modern world - you only have to watch an episode of Dragon’s Den or The Apprentice to see those qualities lose out every time to selfishness, greed and arrogance.

Perhaps a few of those newspapers which so quickly rushed to press, should seriously think about how they portray older people. Yes, the NHS must get its house in order - but it can’t cure all the ills of society.

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Advice for doctors on managing end-of-life care

By Dr Michael Devlin, deputy head of advisory services at the MDU - 23rd November 2009 12:28 pm

Poor communication between doctors, and with patients and relatives, is compromising good end-of-life care according to the recently published National Enquiry into Patient Outcome and Death (NCEPOD).

The review - called Caring to the end? - examined the care of patients who died within four days of admission to hospitals in the UK. While 60% of 2,195 patients in the study were judged to have received good medical care, in just over one-third of these cases there was room for improvement and a handful were judged to have been less than satisfactory.

Problems highlighted in the report include poor communication between and within clinical teams. This included failure to consult consultants at an early enough stage, particularly in the evenings and at night time. In some cases where patients were not expected to survive there appeared to be inadequate communication with patients and relatives about appropriate limits to treatment.

The report’s recommendations included:

1. Better systems of handover must be established, and this must include high quality legible medical record keeping.

2. Systems of communication between doctors and other health care professionals must improve. In particular, trainees must seek consultant input at an early stage to assist in the management of emergency patients.

3. The training of nurses and doctors must place emphasis on the basic skills of monitoring vital functions, recognising deterioration, and acting appropriately (which will often be to seek senior input).

The findings echo those of a 2007 report on over 16,000 unresolved NHS complaints which found that care surrounding a death was a factor in 54% of complaints about hospitals, including relatives being given contradictory or confusing information.

Treating and caring for a patient towards the end of their life is invariably challenging for all concerned and emotions may be raw.

The MDU advises doctors that they have a clear, ethical obligation to ensure patients who are dying receive the same respect and standard of care as all other patients, while relatives and partners should be treated with understanding and compassion. If the patient’s prognosis is poor, it is important to ensure their palliative and terminal care needs are identified and that these are clearly noted in the medical records and communicated with colleagues, particularly during handovers.

The following points may helpful in this difficult area:

1. A doctor must recognise and work within the limits of their professional competence. They must be prepared to contact the doctor in charge of the patient’s care if they are not sure how to manage a sudden or unexpected change in their condition.

2. It is important to talk to the patient about their condition or prognosis even where it may be difficult or distressing. Patients may appreciate the opportunity to invite a friend or relative to be present during the discussion.

3. A doctor should establish with the patient what information they want you to share, who with, and in what circumstances, which can help to avoid disclosures that patients might object to. They can also help to avoid misunderstandings with, or causing offence to, anyone the patient would want information to be shared with, such as close relatives or friends.

4. Give patients adequate time to reflect and ask questions, and to change their mind. They should ideally be given the opportunity in advance to decide what arrangements they would like in the final stages of his illness.

5. Information should not be forced on patients if they are clear that they do not want too much detail of their prognosis, but they should be made aware of the impact this might make on future decision-making processes.

6. It may be appropriate to formalise and discuss an advance care plan which would allow patients to indicate what treatment they would like if they lose capacity, or the ability to effectively communicate their wishes. It may also be appropriate to discuss cardio-pulmonary resuscitation if it is likely this may be an option.

7. Competent patients have the right to give, or withhold, consent to treatment and their wishes must be respected.

8. Breaking bad news to relatives is always difficult as their anxiety may mean that not all of what you are saying is taken in. It’s advisable to set out the information in a clear and simple way, explaining any complicated issues in lay terms and avoiding medical terminology. Ensure they have the opportunity to ask questions.

9. It is advisable to record your discussion with patients and relatives in the patient’s medical notes.

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Making equality a reality in mental health services

Dr Dave Anderson, chair of the Royal College of Psychiatrists’ Faculty of Old Age Psychiatry - 31st October 2009 9:05 pm

It was welcome news when health secretary Andy Burnham announced last week that the NHS, under the new Equality Bill, will have to comply with age discrimination rules by 2012. There is no question that age discrimination exists in the NHS, and the bill - along with New Horizons - is an important step by the government in tackling discrimination.

But the problem cannot be addressed through national action alone. We are in desperate need of local change. Unless services are commissioned, configured and developed locally to better meet the need of older people, discrimination will continue.

The ageing population has been described by researchers as a demographic tsunami, and is the biggest challenge facing health and social care services today. Yet investment and development in mental health services has explicitly excluded older people.

The figures speak for themselves. For every 1 million older people with depression, 850,000 receive no treatment whatsoever. While 50% of younger adults with depression are referred to mental health services, only 6% of older people will receive a referral. And in a recent report by the Healthcare Commission, a service audit found that of 1,300 referrals for psychological therapy only 49 were for people over the age of 65.

There is no justifiable reason why an older person with the same need as a younger person is denied equitable mental health care, yet that is the current position. Earlier this month, the Royal College of Psychiatrists’ Faculty of Old Age Psychiatry launched a new position statement: Age Discrimination in mental health services: making equality a reality.

The statement and accompanying evidence document show how tens of thousands of older people are missing out on vital support and risking serious deterioration in their mental health purely because of arbitrary age limits.

Access to mental health services has traditionally been configured by age. Although having administrative benefits by creating clear accountability of services, this approach may be considered discriminatory, such as when a person attending any specialist mental health service is required to transfer to an older people’s service purely because they have reached the age of 65. In doing so, they can lose benefits of the relationships they’ve formed with those services and be disadvantaged. People over 65 may also be denied access to services available to younger people, such as 24-hour crisis resolution and home treatment services.

The college’s Faculty of Old Age Psychiatry believes all mental health services should be available to people on the basis of need, not age, and is calling on local services to abolish the arbitrary age limit. We know that local change can make a difference and we have gathered some excellent examples. For example, in 2006, following reconfiguration of services in Doncaster, a specialist older people’s mental healthcare home liaison team was established to deliver person-centred care and training to local registered care homes. In the first year, the team received 460 referrals and admissions to hospital reduced by 75%.

And in West Suffolk, the crisis resolution home treatment team for working-age adults was extended in 2006 to include people aged over 65. The number of older people admitted to hospital fell by 31% without any loss of patient or carer satisfaction.

But we also need to remember that people’s needs change as they progress through the life cycle. In moving towards equality for older people, we must guarantee their needs are addressed by mental health services specially designed to meet them. If this doesn’t happen, age discrimination will continue in another guise.

Our position statement clearly states the actions required at a local and national level. These actions include an urgent need to provide access to crisis home treatment, early diagnosis and intervention, care home liaison, general hospital liaison and access to psychological therapies.

The statement’s launch at the House of Commons was attended by 18 Parliamentarians, including shadow minister for mental health Anne Milton MP. It’s notoriously difficult to persuade busy Parliamentarians to find space in their diaries to attend such events, so we were enormously encouraged that so many came along. Just maybe, it’s a sign that ministers are starting to listen - and are prepared to give older people’s mental health services the attention they so desperately need.

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