Letters

New beginning for care for elderly people?

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7308.337/a (Published 11 August 2001) Cite this as: BMJ 2001;323:337

National framework could transform care for older people in England

  1. Ian Philp (ian.philp@doh.gsi.gov.uk), co-chair of executive reference group for national service framework
  1. Department of Health, London SE1 8UG
  2. Department of Social Medicine, University of Bristol, Bristol BS8 2PR
  3. Murray Royal Hospital, Perth PH2 7BH
  4. Royal Bournemouth and Christchurch Hospitals NHS Trust, Royal Bournemouth Hospital, Bournemouth BH7 7DW
  5. Freeman Hospital Stroke Service, University of Newcastle upon Tyne, Freeman Hospital, Newcastle upon Tyne NE7 7DN
  6. Greenridge Surgery, Birmingham B13 0PT
  7. University of Manchester, Manchester M13 9PL
  8. University of Oxford, Oxford OX3 9DU

    EDITOR—Grimley Evans and Tallis criticise the national service framework for older people.1 I agree with them that the policy to reduce emergency admissions to hospital only among the over 75s is ageist. Application of the framework's age discrimination standard means that this high level performance measure will have to be changed to an age standardised measure.

    The framework model for intermediate care services requires there to be comprehensive assessment, active rehabilitation, and medical leadership involving both hospital specialists and general practitioners. There will be no return to 1960s-style convalescence and other forms of marginalising older people.

    On research strategy, the national framework supports the recommendations of the research and development strategic review to establish a national research advisory network for older people and for a directed programme of research; this has already commissioned a £1.2m programme to evaluate intermediate care.

    On information provision, the framework will ensure scrutiny by patients and the public of all age based policies. It will also ensure the involvement of older people in patient forums, the local strategic partnerships, and the development of personal care plans that reflect individual needs, circumstances, and priorities.

    The single assessment process will not replace medical diagnoses and decision making but will ensure that a single patient record is built up over time and shared among healthcare and social-care professionals, to replace the current inefficient and fragmented records systems.

    Milestones for implementation of the falls standard are longer than those for some other parts of the framework as evidence is emerging about how best to organise this key component of services. Achieving organised services for the prevention and management of falls will be a great advance in the care of older people.

    An inclusive approach was used throughout the development of the national service framework. The success of the …

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