Will there be a new direction for older person care?

  • Sir David Nicholson says that hospitals are 'very bad places' for older people, and an alternative must be found.

     The head of the new NHS Commissioning Board believes that community-based care is much more suitable for frail, older people than hospital care.

    Sir Nicholson told the Independent that we need a revolution for older person care, as the current system is not working.

    Sir David also said that preventing falls and managing long-term conditions was a priority, as was treating common conditions in the community, and said money would be spent to keep patients with dementia out of hospitals:

    If you think about the average general hospital now, something like 40% of the patients will have some form of dementia.

    They [hospitals] are very bad places for old, frail people. We need to find alternatives.

    The nature of our patients is changing - and changing rapidly. You are getting a larger and larger group of frail, elderly patients who are confused.

    The figure of 40% that David gives being likely to be higher than the real figure, which was looked in to by Full Fact. They seemed to conclude that there is no actual figure as so many patients do not get their dementia recognised as a reason for admission as they have also gone in to hospital for other reasons, even if their dementia contributed to the admission, so in fact highlights his point that it is an overlooked area and a change in attitude for how this is treated needs to be addressed.

    Sir Nicholson wants there to be a change in the direction of care and there will be a move towards community-based treatment centres as the future for older person care, as well as a change in attitude towards how older people are treated by the health-care system.

    He compared the change in care for older people to the issues in mental health care which resulted in a shift in attitude towards mental health patients several decades earlier.

    Sir David said:

    In the 1960s and 1970s, there was a whole series of national scandals about care of mentally ill patients.

    The response was not just to say that the nurses who looked after these patients needed to be more caring, but actually there was something about the way we treated these patients and the model of care that needed to change.

    Michelle Mitchell, Charity Director General at Age UK, agrees with the direction David Nicholson is looking to move the NHS in, but wants to see a clear outline of the future plans and the consideration of older people:

    For too long older people have received second or even third rate care from the NHS, so it is good that David Nicholson is highlighting these issues, which Age UK has campaigned on for many years.

    This vision isn't simply about moving older patients out of hospitals and into the community - the treatment of older people needs a radical overhaul from the organisation of care to the training of staff, including GPs. It is crucial that there is also fair and lasting reform of social care working in partnership with the NHS and other essential services.

    We now look forward to seeing [David Nicholson's] words turned into action and the publication of a clear road map to making this change happen, with older people consulted throughout the process.

    The NHS Commissioning Board

    Set up last year as part of the Government's controversial health reforms, the Commissioning Board will, from April, take over responsibility for all aspects of running the NHS from the Health Secretary, Jeremy Hunt.

    So as the head of the board, ideally this means he will have a big impact on the direction of care and we will see a shift in attitude and consideration towards older people.

    He is looking forward to the Commissioning Board's new independence and the possibilities for change this will bring:

    What used to happen was that because politicians were very powerful [NHS managers] thought that the way you got things done was to get the politicians to say it needs to be done and then tell everybody to do it.

    But of course change doesn't happen like that. All you get is a system which is constantly trying to read the runes of what the politicians want. That is a very difficult place to be.

    One of the things I said early on was if NHS managers spent as much time managing their services as they did trying to manage the centre we would all be better off.

    This shift [to the board] will allow people to take more control over their own affairs but also feel much more accountable to their patients.



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