11 november 2010 professor david oliver national clinical director for older people ncepod report...
TRANSCRIPT
11 November 2010
Professor David Oliver
National Clinical Director for Older People
NCEPOD Report launch “An Age Old Problem”
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• Clinical leadership for older people – with a focus on improving outcomes
• Clinical input to cross government Ageing Society strategy
• Promote prevention and early interventions for older people
• Engage with leaders in health and social care and the voluntary sector
• Support the integration agenda and implementation of Coalition priorities relevant to older people
NCD Role
“An Age Old Problem”
• Powerful report - acts as a reality check
• Articulates what we know – we can and should be achieving better and more consistent outcomes for older people post-operatively
• No defence of poor practice
• This applies at every level in the system
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• UK population is ageing rapidly - by 2033, almost a quarter of the population will be over 65
• People over 65 are the core users of acute hospital care - 60% of admissions, 65% of bed days, 70% of emergency readmissions, over 90% of delayed transfers
• People long-term conditions account for 55% GP appointments, 70% of outpatient and emergency attendances, 77% inpatient days, 90% drug spend in over 75s
• People over 65 account for 2/3 of acute and elective surgical admissions and a significant proportion of these are over 80 - often with complex medical needs or frailty and are at higher risk of postoperative complications
• We cannot ignore the specific needs of such a significant patient group
Why getting it right for older people matters
NCEPOD Report adds to objective evidence of variable
care • Equality Act consultation and evidence review
• National Audits (e.g. Hip fracture, stroke, continence, falls and fragility fractures)
• All parliamentary enquiry into human rights of older people in health and social care
• Work on dignity
• Nutritional care as a registration requirement and 2007 Nt
• Dementia strategy consultation
• Surveys of staff or patients
• Age UK “Hungry to be Heard”
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NCEPOD Report key findings & recommendations
• Key findings
• Just over 1/3 of patients surveyed (38%, 295/786) received good care.
• Poor nutrition and serious associated illness were very common in the group studied.
• In over two-thirds of cases (67.7%, 653/965), patients were not reviewed by specialists in Medicine for the Care of Older People.
• Clinically significant delays occurred in 1 in 5 patients between admission and their operation.
• 1/4 of hospitals had no acute pain service.
• Key recommendations
• In elderly patients needing urgent surgery careful attention should be given to improving fluid status, reducing unnecessary drug treatment and anticipating nutritional support.
• Elderly patients undergoing surgery need access to routine daily clinical review from specialists in elderly care.
• Delays in surgery, which lead to poor outcome, should be subject to rigorous audit and rectified.
• Pain and its management should have a high priority to avoid patient suffering.
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Some levers for improving standards • Implementing the Equality Act (no exemptions?)
• National Clinical Leadership (NCDs for Trauma, Kidney care, DVT/PE, Older People)
• National Hip Fracture Database and Best practice tariff – early involvement of specialists and shortened time to surgery
• New Measures – Standardised Hospital Mortality Indicators (SHMIs)
• QIPP work streams (including Safer Care)
• CMOs recommendations on training in pain management “the fifth vital sign”
• NICE Guidelines – existing and in development
• Enhanced Recovery model (NHI, DH and Cancer Action Team)
• Nutrition action Plan 2007 and nutritional care as a registration requirement from 2010 plus SCIE resource
• Acute Kidney Injury initiatives/CQIN scheme
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Secretary of state’s vision for health and social care
April 2011: Shadow Board established as special health authority April 2012: Board fully establishedAutumn 2012: Board makes allocations to GP consortia for 2013/14
2011/12: Established in shadow form 2012: All consortia formally establishedApril 2013: Consortia hold contracts with providers
April 2011: Support for shadow health and wellbeing partnershipsApril 2012: Health and wellbeing boards in place
April 2012: HealthWatch established
April 2012: Monitor established as economic regulator
2013/14: All NHS trusts become, or part of, foundation trusts2013/14: All providers regulated by Monitor
From 2011: Choice of care – long-term conditions; diagnostic testing, and post-diagnosisFrom April 2011: Choice of treatment and provider – some mental health services2012: Free choice of GP practice2013/14: Choice of treatment and provider – vast majority of NHS services
By end 2010: Separation of SHA commissioning and provider oversight functions2012/13: SHAs abolishedFrom April 2013: PCTs abolished
The reformed NHS
And in future…
• Equity and Excellence: Liberating the NHS describes a system with:
– Patients at the heart of everything
– Outcomes among the best in the world
– Clinicians empowered to deliver results
• Focus on commissioning for better outcomes in 5 domains of NHS Outcomes Framework
• Backed by National Quality Standards
• Continuing focus on more person centred care
• Strengthened role and priorities of CQC
• Importantly local accountability and freedom to achieve better outcomes – the response to this cannot be top down
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In Summary
• This report is important and necessary as it highlights deficiencies in the care of older people postoperatively in hospital.
• I commend the rigour and thoroughness and the constructive recommendations from NCEPOD to improve care
• I am not here to defend poor practice. Instead we need to identify constructive solutions.
• Many of the solutions rest with good local clinical leadership and a greater focus on safety and quality for older patients.
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