Adding Life to Years

chapter 7 MAKING IT HAPPEN - AND THE AGENDA FOR FUTURE WORK

The work of the Expert Group has served to draw belated attention to the mismatch between service delivery by NHSScotland and the healthcare needs of Scotland's ageing population. In more positive terms, it has highlighted the importance of improving healthcare for older Scots as their numbers continue to grow.

In positive terms, the work of the Group has served to bring to more general notice many examples of excellent innovative practice in the care of older people. Such local initiatives, usually developed by health professionals working together and with patients and carers, and often crossing traditional service and agency boundaries, give grounds for real optimism.

Such good practice, preferably evaluated for effectiveness and cost-effectiveness, can be more widely shared, and generalisation of such practice - adapted of course to local circumstances - offers a relatively swift means of raising standards of care for older people across Scotland.

To some extent this process of generalisation of emerging good practice occurs already within professional and managerial NHSScotland networks. There is now a need to encourage a more systematic approach to the levelling up of healthcare provision for older people. To do this, and to ensure that the impact of the report of this short-life Expert Group is maximised, links with continuing developments, initiatives and agencies require to be utilised. Examples include:

• The NHSScotland Performance Assessment Framework (PAF) will provide a systematic scrutiny of services, including services for older people, from 2002. However, there are concerns that the exclusion of older age groups from many of the indicator areas specified is a weakness. Future versions should address this.
• The Scottish Health Advisory Service (SHAS) carries out a programme of visits and provides regular reports on services for older people. Updated SHAS standards will shortly be issued.
• The Clinical Standards Board for Scotland is finalising standards for older people in acute care, with an emphasis on the journey of care. A national report following visits all over Scotland is planned for April 2003
• The Information and Statistics Division of NHSScotland - whose work has greatly assisted in the preparation of this report - continues to develop more and more sophisticated data collection and analysis relating to the care of older people, covering such topics as elective surgery rates, trends in acute admissions, and delayed discharge
• The Scottish Commission for the Regulation of Care will, from April 2002, have responsibilities for ensuring standards of care in care home, day care and community settings, and will issue reports
• The Care Development Group implementation mechanisms will encourage the development of community services designed to support frail older people at home with increasing levels of care as an alternative to admission to a care home.
• Existing and emergent NHSScotland initiatives on major health problems - such as those on cancer, CHD and stroke, diabetes, and mental health - will include a focus on older service users - for most the majority group.
• The SEHD's Joint Future Unit is taking forward the implementation of the Joint Future Group's principles in conjunction with NHS Boards and Local Authorities. This work will include joint management, joint resourcing and a single shared assessment for health and community care services.

It is therefore clear that responsibility for taking forward the recommendations of this report lies with many agencies, NHS Boards, Local Authorities, clinical effectiveness and education bodies, voluntary agencies and patients groups.

To ensure co-ordination within NHSScotland and with other initiatives across the Executive in support of older people, SEHD will set up an Implementation Group, to be chaired by the CMO. This Group will monitor developments and the impact of change across Scotland, and report to Ministers and the Health Department Board.

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