Living Well in Later Life: a review of progress against the National Service Framework for Older People

The Healthcare Commission, the Audit Commission and the Commission for Social Care Inspection published on 27 March 2006 a joint report assessing progress in improving health, social care and local council services for older people in line with standards set out in the National Service Framework (NSF) for Older People and taking into account subsequent policy developments. The NSF published in March 2001 sets national standards to ensure that services of a high quality are available to all older people within ten years. The NSF has led to positive achievements but, at the halfway mark, the review found that in order to achieve sustainable improvement in the experiences of older people using public services further action is required in three key areas:

• tackling discrimination through ageist attitudes and an increased awareness of other diversity issues;
• ensuring all the standards in the NSF are met including further guidance on the next steps in implementing the NSF from the Department of Health to be published in April 2006;
• and strengthening working in partnership between all the agencies that provide services for older people to ensure that they work together to improve the experiences of older people who use services.

The report identifies areas of progress:

• explicit age discrimination in access to services has been addressed by most health and social care services
• better quality care for people who have had a stroke
• the number of flu vaccinations has increased
• the number of people who have stopped smoking has increased
• more people are being supported to live at home
• there has been a reduction in delayed hospital discharges
• there is a growing interest in the wider wellbeing of older people, with services such as leisure and culture playing an increasingly important role

Specific issues identified that need further action are:

• the full implementation of the single assessment process across health and local authority partners; older people should have a copy of their assessment and a personal care plan
• a change in culture is required, moving away from services being service-led to being person-centred, so that older people have a central role in designing their own care, but also in planning the range of services that are available to all older people
• all aspects of mental health services for older people need to improve
• integrated falls services are at an early stage of development and they need to progress in line with the five components of an integrated falls service as set out by the DH
• the management of medicines needs to be addressed including the review process
• NHS trusts and local authorities need to work together to ensure that they are reviewing their progress against the NSF as part of a framework for managing performance
• working in partnership needs to be strengthened to provide a seamless service and make the best use of resources

Recommendations for action by health and local authorities include:

• ensuring the human rights of older people are upheld and that they are treated with dignity and respect at all times
• strengthening and extending the role of adult protection committees
• taking action to ensure standards set out in the NSF are met
• increased use of best practice models of end of life care
• improving the effectiveness of partnership arrangements for services for older people
• developing a coordinated approach to promote health and wellbeing
• partner organisations need to translate shared visions into a shared strategy for services for older people including a joint workforce development strategy

The report recommends action by central Government to include:

• following on from Opportunity Age, the Government needs to develop a cross Government national programme of work to help shape a more positive culture on attitudes to ageing
• the development of ways to measure outcomes for older people based on the performance of all partners working together
• a requirement by the DH for PCTs to provide good quality podiatry and general foot care services

The Healthcare Commission, the Commission for Social Care Inspection and the Audit Commission will continue to monitor performance and develop indicators to support improvement in all areas as part of their ongoing assessment of health and social care organisations.