Department of Health - A National Service Framework (NSF) for Older People
An NSF is a document which is intended to drive up standards and reduce unacceptable variations in health and social services. It sets standards for services that the commissioners and providers of healthcare must meet. NSFs will not always be prescriptive in every detail, but the standards in them will be monitored by the Healthcare Commission. The NSF for older people was published on 27 March 2001. It sets new national standards and service models of care across health and social services for all older people, whether they live at home, in residential care or are being looked after in hospital. You can access the relevant section in the Department of Health website by clicking here.The NSF leads with plans to:
The NHS Plan also sets out a major package of investment to improve services and standards of care for older people. Integrated policy and practice development will be essential in developing and working towards the standards set out in this NSF.
This NSF was developed with advice from an External Reference Group (ERG), co-chaired by Ian Philp, now the National Director of Older People's Services, and Ms Denise Platt, Chief Inspector of the Social Services Inspectorate. The ERG brought together older people and their carers, health and social services professional staff, NHS and social services managers and partner agencies.
The NSF is a ten-year programme of improvement implemented through local health and social care partners, and national underpinning programmes. Progress will be monitored through a series of milestones and performance measures, and will be monitored by the Healthcare Commission.
Key Standards
The NSF for Older People, which can be viewed as a pdf document at the bottom of this page, has eight standards, concerned with the following;
1) Rooting out age discrimination
2) Person-centred care
3) Intermediate care
4) General hospital care
5) Stroke
6) Falls
7) Mental health in older people
8) The promotion of health and active life in older age
(Standards 2 (Patient Centred Care) and 6 (Falls) are of most relevance to optometrists).
Person-centred care (Standard 2)
The aim of this standard is to ensure that older people are treated as individuals and receive appropriate care, which meets their needs, regardless of health and social services boundaries. A key method of achieving this will be the introduction of the single assessment process. This was originally announced in the NHS Plan for England and will operate across health and social services to ensure a full assessment and evaluation of the needs of the older person. It is to be introduced by April 2002. It is intended to eliminate duplication in information collection and assist information sharing between professionals.
All older people should receive a good needs assessment, but the NSF recognises that some older people will benefit from a fuller assessment across a number of areas, and some may need a more detailed assessment in one or more specialist areas. Although the intention is that one front-line professional should carry out the fuller assessment, it is recognised that other professionals may need to come in to perform specialist assessments.
The fuller assessment includes the older person's senses (sight, hearing and communication), and may identify the need for further investigation by an appropriately qualified professional - such as an optometrist.
Falls (Standard 6)
The aim of this standard is to reduce the number of falls, which result in serious injury and provide effective treatment and rehabilitation for those who have fallen. The NHS is expected to work with local councils; one feature of this is to be that older people and their carers can receive advice from a specialised falls advice service.
The NSF specifically identifies visual impairment as one of the five major intrinsic risk factors in falls. It sets out a model for a falls service, as part of the overall specialist services for older people in hospital and community settings. The NSF specifies that the team should include a consultant in old age medicine, nurses, physiotherapists, occupational therapists, social workers, pharmacists and podiatrists, and goes on to state that this team should have access to a range of other professionals, including optometrists. The NSF suggests that these non-core team members are likely to only work part-time in the falls service. The falls team will play a part in the discharge arrangements for older people. Optometrists may also be able to play a role in the identification of older people in the community who are at most risk of falling.
Local health care providers were required to have audited their procedures and put in place risk management measures to reduce the risk of older people falling by April 2003. The integrated falls service was to be included in the HImP by April 2004, and the last date for the introduction of such a service was April 2005.
Department of Health Document 'How can we help older people not fall again? Implementing the Older People's NSF Falls Standard: Support for commissioning good services
This document, produced in July 2003, aims to provide guidance for commissioners to implement the NSF for Older People Standard 6 on falls prevention - the pdf document, at the end of the page, may take a short while to download as it contains graphics.
AOP Document on Falls
The AOP produced a paper (November 2003) on falls in the elderly which sets out what LOCs and individual optometrists can do to highlight the role they can play in the prevention of falls in the eldery. This can be viewed in the pdf document at the end of this page.
College of Optometrists & British Geriatric Society
The College of Optometrists, along with the British Geriatic Society, produced a paper (November 2003), endorsed by the Royal College of General Practitioners, entitled 'The Importance of Vision in Preventing Falls'. This can be viewed ibelow amongst the pdf documents.
Better Health in Old Age - A Progress Report
This report highlights progress since 2001 under the National Service Framework for Older People and sets out a vision for the future. It can be viewed ibelow as a pdf document.
Better Health in Old Age - A Resource Document
This document aims to provide a resource for NHS and Social Care staff involved in the implementation of the National Service Framework for Older People. It should be read in conjunction with ‘Better Health in Old Age – A Progress Report’. The Resource document details how national and local initiatives have delivered improved outcomes for older people since the introduction of the NSF. It provides examples of good practice through case studies, which may be adapted locally to improve the health, independence and well-being of older people. Finally, the document outlines work underway to drive forward further change and improvement for the future of Older People’s Services. The document can be viewed ias a pdf below.
Healthcare Commission - Living Well Later in Life
The Healthcare Commission is the independent watchdog for healthcare in England. It promotes continuous improvement in the services provided by the NHS and independent healthcare organisations.
The Healthcare Commission, the Commission for Social Care Inspection and the Audit Commission have jointly undertaken a review to create a national snapshot of the state of services for older people. The review looked at a range of services including care services and services that contribute towards the wellbeing and quality of life of older people. It also looked at progress against the Government’s National Service Framework (NSF) for Older People. This is the first collaborative in depth review carried out by the three commissions and the findings of this review have been published in the report Living well in later life: a review of progress against the National Service Framework for Older People. Please click here to access the review and background information.
