Professor Ian Philp

National director for older
people�s services
Appointed: November 2000

My achievements

I see my role as a champion for elderly people, using my experience as a clinician and communicator to shape this role. The national service framework for older people (published in March 2001) needed a compelling vision about treating older people with dignity and respect, overcoming fragmentation of services, and ensuring timely response to needs. I obtained widespread commitment to the framework, centred on what elderly people expressed as their needs, but with professional consensus and an explicit evidence base feeding into the policy context.

The framework for older people has a bigger reach than other frameworks, covering 46% of the NHS spend and 60% of the social care spend and the work of more than one million healthcare and social care practitioners.

The framework has changed NHS culture, particularly in relation to age discrimination. It used to be routine to refuse patients heart bypass surgery if they were old. But since the framework was published the number of people aged over 65 years getting heart bypass surgery has risen by 16% and the number aged over 80 has increased by 65%.

Another achievement has been the development of intermediate care services to bridge the gap between patients� acute care in hospital and their returning home. More than 200 000 elderly people have benefited from these services, which has helped to reduce demand on acute hospital care and reduced delayed discharges of elderly people�from 12.9% of older patients before the framework was published to around 6% now. In the next phase we are well placed to deliver consistent, high quality services for people who have had a stroke or a fall and people with mental health problems.

Probably my biggest achievement has been to maintain change while taking people with me. I don�t believe that you win by imposing things on people. I have set up a coalition of over 50 organisations�professional groups and advocacy groups�which are working with me nationally. We might not agree on every detail, but the framework is accepted as the way forward. A network of around 2000 older people�s champions, based in local services, will help ensure we get it right.

What others say

Dr David Black, consultant geriatrician and chairman of the England council of the British Geriatrics Society: To be treated as a priority area in the current NHS you need a tsar. The challenge faced by Professor Philp has been the wide remit of the national service framework for older people, significantly wider than that of the other published frameworks. It is also genuinely multidisciplinary and can be delivered only through the health service and social care working together.

Having a consultant geriatrician appointed as national lead was a major boost for geriatric medicine. Only one other member of the national older people�s task force is a doctor; the rest come from the professions allied to medicine, social services, important charities, such as Age Concern and Stroke, and nurses and healthcare managers working in services for elderly people. Not all these groups see the world in the same way as doctors, and one of Professor Philp�s major achievements has been to be seen by all these groups as leading and championing all aspects of elderly people�s services.

The framework for older people was the first framework without ringfenced funds and with many soft milestones rather than hard numerical end points. This has presented another challenge, as the focus in the health service over the last two years has been on waiting lists and accident and emergency targets. His response has been to mobilise a large number of champions across the healthcare and social care services to keep up local pressure. Progress has been made in combating ageism and in improving care of stroke patients. Intermediate care is still patchy, and improving general hospital care is proving a challenge. The big battle, and that needing the greatest funds, is yet to be fought: to deliver comprehensive services for people who have had a fall. This will prove a critical leadership challenge.

There can be no doubt that having a geriatrician as a national director has helped geriatric medicine. However, the appointee is still a government employee and is thus responsible to ministers, and like other tsars he may find that it is not always easy being in a leadership and management role rather than in a role as a representative for a specialist society. However, if that debate is constructive it can help patients who need the skills not just of geriatricians but of all the other professions to be on board.

The final challenge for Professor Philp will be to convince the rest of the NHS that by getting care for elderly people right you will get care for all patients right.

Gordon Lishman, director general, Age Concern England: Age Concern is encouraged by the energy, passion, and commitment that Professor Philp has put into the promotion of the "champions," who are vital in rooting out age discrimination in the NHS. Many local Age Concern offices have been strongly involved in this.

Professor Philp has also engaged the support of local Age Concern offices in delivering cultural change up and down the country. Some are working with primary care trusts to promote health and active ageing (standard 8 of the national service framework).

Terry Butler, social services director, Hampshire County Council and co-chair of the Department of Health�s expert task group on choice for older people: The national service framework for older people is the best one, in my view, because it�s the only framework that covers social care.

I have only recently got to know Ian, while working on the government�s choice consultation; Ian is a member of our task group that reported in November.

His contributions have been excellent, alongside those of other experts, including a very helpful service user. Ian�s listening skills have been to the fore, and he has avoided the temptation to spout forth on his undoubted considerable experience and expertise.

It seems to me that this tsarship is a long haul journey. In co-chairing the framework with Denise Platt, he has achieved the right "launch," with what I consider to be excellent national standards that are potentially very powerful in addressing age discrimination, developing better services, and promoting a healthy and active old age.

The key issue now is implementation. It�s really down to us in the field to get on with the business of delivery. There�s only so much a national tsar can do in that respect, although I�ve no doubt that Ian will be working to improve standards, by managing performance and training staff in the healthcare and social services to communicate better with elderly people and to combat age discrimination.

I�m particularly impressed that Ian keeps his hand in, by seeing patients on a weekly basis. Social care professionals who have moved into government might learn from that. There is no substitute for dealing with real people, and I�m sure this underpins Ian�s marked ability to view the services from the user�s�or the patient�s�perspective.