|Implemented in this survey?|
The National Service Framework for Older People (2001) sets national standards and service models for the care of older people. It is designed o address service failings in this area, and will assume increased importance in the light of growing numbers of older people.
Like many other countries, England faces challenges associated with an ageing population. Demographic projections suggest that the numbers of people in the 65-79 age group will rise from 6.7
million in 2000 to 8.5 million in 2020 and 10.2 million in 2040. The numbers in the 80 years and older group is forecast to rise from 2.4 million in 2000 to 3.1 million in 2020 and 4.5 million in
People in older age groups are more prone to suffer from disease and disability. In particular, they are prone to multiple co-morbidity and chronic disease. Services in England for this age group have not always been well organised. There have been no national standards. The National Service Framework for older people was published in March 2001 in order to address these problems. It sets out a number of national standards and service models that local health organisations are expected to meet in providing services for older people. These may be viewed as guidelines and protocols on best practice. Local health organisations are due to be assessed on their performance in meeting these standards through the central NHS performance management system. This is essentially an administrative system for assessing organisational performance.
To set national standards and specific best-practice service models for the care and treatment of older people
.Managerial line management and accountability within the NHS.(non-financial
Older people, Local health, etc.
|Medienpräsenz||sehr gering||sehr hoch|
The policy of National Service Frameworks is an example of a regulatory approach that is desirable when service standards vary between local areas and acceptable standards are not achieved everywhere. It is probably an approach that is more appropriate in a national system (with command and control) than in a highly devolved and/or privatised system. However, with the growth of evidence on best practice in service models it can be viewed as a developmental approach capable of application in a wide range of systems. An NSF in relation to older people is particularly important given the growing numbers in this age group ,and their multiple and complex needs spanning health and social care. The English experience recognises the need for this approach and offers the example of the production of guidelines and protocols on best practice. However, it also reveals the barriers to implementation in the case of an age group that often receives low priority in practice and is often the victim of 'ageism'.
The Labour government has introduced a programme of National Service Frameworks (NSFs) with the aim of raising standards of care throughout the NHS and reducing unacceptable variations in standards. The general intention is that standards will be informed by the work of the National Institute for Clinical Excellence, that they will be set out explicitly in National Service Frameworks, and monitored by the newly formed Commission for Health Care Audit and Inspection.. The NSFfor older people addresses the special need of this group. It emphasises the need for effective partnership working between different health and social care agencies, and pays special attention to services that are particularly important for older people such as those dealing with stroke, falls and mental health problems. The general aim is to root out age discrimination, provide person-centred care and promote independence among older people. There have been no outside political pressures that have led to this initiative. It is really a management strategy designed to address longstanding failings in the way that NHS services have been delivered. It is however specifically aimed at services or older people and will form an important part of an evidence-based, national strategy that will become even more important as the numbers in this group increase.
Reforms introduced by the Labour government that was elected in 1997
|Implemented in this survey?|
The government has stated that services for older people have not previously had a national focus and that there have been reports of poor, unresponsive and sometimes discriminatory services. The NSF is designed to demonstrate a new and systematic response to these concerns. The NSF was put together after widespread consultation that took place for over a year with a wide range of interested parties. A reference group comprising health professionals, social service professionals, older peoples' organisations and members of the public - significantly under the co-chairmanship of a senior medical professional (a geriatrician) and a director of social services - was used in drawing up the NSF.
The approach of the idea is described as:
The major thrust of the NSF was bringing together the NHS and social services in an attempt to coordinate better the services for older people. England has previously had a poor record of co-ordination between health and social care. Health has been the responsibility of the NHS and social care the responsibility of local government. There have been separate organisational and management structures, and separate funding streams. Also very different cultures. The development of the NSF brought together the different agencies with the aim of improving interagency working. This was not easy and the lengthy delay in publishing the NSF was attributed to the serious problems associated with defining the relevant roles for health and social services.
The NSF did not require primary legislation except where budgets between health and social care were to be pooled.
The NSFs are aimed at all local health and social care organisations. Each local area has a local implementation team and the implementation of NSFs is one of their tasks. According to some experts, however, the pace of implementation has been disappointingly slow. There are several reasons for this. The needs of older people, despite being emphasised in official documents, often receive low priority when actual decisions are made. Progress on addressing age discrimination, for example, has been very slow. The failure to attach specific budgets to the older persons NSF is another reason for slow progress. Paradoxically, achieving some of the major aims of the NSF - such as eliminating age discrimination - could jeopardise other more immediate NHS targets such as reducing waiting times. That is, if all elderly people were offered timely services the system could not cope and waiting time targets would not be met. Discrimination is a form of rationing. Although meeting NSF standards is part of the performance assessment framework on which local NHS organisations are judged, in practice meeting these standards is often viewed by local managers as a lower priority than achieving waiting time targets.
There is very little performance management of the NSF for older people implementation process. The Department of Health has adopted a 'light touch'. Part of the reason for this may be that, as pointed out above, full implementation could 'let the genie out of the bottle' and threaten other NHS priorities on which performance management is stronger. As far as I know there are no plans in place for formal evaluation. The scope of the NSF is really too wide to permit a single evaluation.
As stated already progress on the NSF has been slow. Benefits in terms of improved services for older people have not been substantial so far. It may be that there are wider societal values at stake here that tend to place lower priority on the needs of older people than other groups within the population. These tend to exert countervailing influence despite the formal commitment to the NSF expressed in official documents
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
As the above accounts suggest, I believe that the policy is desirable but that it has little impact to date because of a slow rate of implementation. Whether this state of affairs persists depends on whether these are short-term problems the NSF has only been in existence for just over 2 years) or whether there are more major social/managerial structural obstacles to implementation.
Department of Health (2001) National Service Framework for Older People. London: Department of Health.
Ray Robinson, London School of Economics