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Last Updated: Wednesday, 20 July, 2005, 19:53 GMT 20:53 UK
Policy on caring for older people

Improving the standard of hospital care on offer to older people in the NHS came, most recently, to public attention in 1997. Older patients, their relatives and their carers started talking about their experiences of hospital care. A picture emerged suggesting that older patients were being treated insensitively and disrespectfully in hospitals.

A series of articles in The Observer newspaper launched the campaign. Martin Bright, a journalist, wrote a series of accounts of the treatment he had seen his grandmother receive, at the age of 88, when she was admitted to hospital following a stroke. On one occasion she was found by relatives lying in her own faeces and on another lying on a pillow sodden from a leaking drip. He wrote

"It's hard to believe just how grim our hospitals have become until you have personal experience of their collapse."

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Help the Aged, the Relatives Association, the British Geriatric Association and the Royal College of Nurses united behind the newspaper's campaign for 'Dignity on the Ward.'

The government responded. Then health minister, Frank Dobson commissioned an independent report from the Health Advisory Service into the care of elderly patients on acute wards in general hospitals called "Not Because They Are Old."

This focus on the older patient was carried through to the NHS plan which, in 2000, had a whole chapter dedicated to older people under the banner of "Dignity, Security and Independence in Old Age." Health services across the NHS would recognise the need to "treat the person, not just the most acute symptoms," paying attention to aspects of care like nutrition and helping elderly people move around. Ageism would not be tolerated in the NHS and there would be 'better and new services' for old people.

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As well as pledging higher standards for patients, the government also set in motion work with nurses. In 1999 the Standing Nursing and Midwifery Advisory Committee (a statutory body which advises health ministers in England and Wales) began to investigate the nursing of older patients in the NHS. Their report, published in 2001, largely confirmed the findings of the earlier, patient-focussed 'Dignity on the Ward' campaign. It found 'major deficits in the standards of nursing care given to older patients in acute hospitals, with some of their most fundamental needs remaining unmet."

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The report also made it clear where a nurse's responsibility lay and stated that these responsibilities should not be shifted onto less qualified staff:

"Too many nurses regard fundamental skills such as bathing, dressing and assisting patients with feeding as tasks that can be delegated to health care assistants, often without supervision... qualified nurses should continue to be involved in the delivery of essential care."

At the same time, the committee published a guide to best practice in nursing the elderly.

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In the same year the government's strategy for action and reform in the healthcare of older people was published. This service framework had been promised as part of the NHS Plan. It set out eight general standards for care of the elderly across the NHS and outlined ways of achieving them. Standard four related to general hospital care.

"Older people's care in hospital is delivered through appropriate specialist care and by hospital staff who have the right set of skills to meet their needs."

There are also standards of care relating to specific illnesses such as stroke, falls and mental illness.

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The Healthcare Commission, the Commission for Social Care Inspection, the Audit Commission and Kings College London are currently working together to produce a national report on progress in England on implementation of the National Service framework for (NSF) Older People which should appear in December 2005.

Background research will be published on their website as it is completed. Studies of care delivered to older people in Leicester, Liverpool, Buckinghamshire and Brent are already available:

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More recently the government have produced "Standards for better health" which lists in broad terms the minimum standards which patients in the NHS can expect.

Though these standards do not specifically mention older people, it is significant that they include aspects of care that were found to be inadequate in the treatment of older people in hospital back in 1997. For example, that "staff treat patients, their relatives and carers with dignity and respect."

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