Intended for healthcare professionals


A new beginning for care for elderly people?

BMJ 2001; 322 doi: (Published 07 April 2001) Cite this as: BMJ 2001;322:807

Not if the psychopathology of this national service framework gets in the way

  1. John Grimley Evans, professor of clinical geratology,
  2. Raymond C Tallis, professor of geriatric medicine
  1. Radcliffe Infirmary, Oxford OX2 6HE
  2. Hope Hospital, Salford M6 8HD

    The National Service Framework for Older People,1 discussed in last week's news,2 displays a personality split between its ERG and its IG. An external reference group (ERG) of selected experts offered advice,3 but the framework was written by an “in group” (IG) of civil servants. The IG subserves a political agenda, and that agenda, unchanged over 50 years, is to keep old people out of hospital.

    IGians believe that care in proper hospitals is too expensive for old people. This partly reflects a preoccupation with cost per institutional day (money that might be saved by closing something down) rather than with cost per satisfied patient (money properly invested). But savings from putting old people in cheap, ill resourced accommodation are rapidly lost in unnecessarily prolonged lengths of stay, not to mention human misery. IGian fantasies are fed by studies of “inappropriate” use of hospital beds by older people. The definition of inappropriate is contentious, and the term is too readily attached to the patient rather than the treatment. Certainly some older people stay in hospital longer than they want because of the complexities and underfunding of social service care. There are probably many more old people, invisible to IGian research, who would benefit from acute hospital admissions that they are denied. The clearest expression of …

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