promoting healthy older people

7/30/2019 Promoting Healthy older People

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July 9th

2010

Guy Dewsbury PhD

www.gdewsbury.com

The current trend in which older are becoming more aware and more responsible for their own

health has a clear link to trends that have been identified by the Department of Health, the

Kings Fund and the World Health Organisation. Tracing things back to their origin is somewhatdifficult as there has always been a certain amount of rhetoric on older peoples health. A

decisive change can be seen to some extent with the Governments release ofOur Healthier

Nation (1998) in which it is mentioned that there should be a people should improve their own

health supported by communities working through local organisations against the backdrop of

the Government which will be achieved through the introduction of NHS direct; Health skills

programme and the expert patient. This was followed the following year by the WHO directive

Health 21 (19999), which set out the agenda for a healthy society and cites healthy ageing as

one of its 21 targets. In the UK 1999, the International Year of Older Persons, also saw the

introduction of the Health Act (1999) which advanced pooled budgets and joint commissioningof integrated service between health and social care. Saving Lives: Our Healthier Nation (1999)

set out targets by which there would be reductions in death rates of cancer, coronary heart

disease, stroke, accidents, and mental illness, which will be achieved by the introduction of NHS

Direct, Health Skills and Expert Patients; the establishment of the Health Development Agency

and increased education and training for health and establish a new Public Health Fund. In the

same year the DH released the Long Term Care The Governments response to the Health

Committees Report for Long Term Care (1999) in which they introduce the National Service

Framework for older people and calls for more consistent data on older people health and

social policy. Urge to move towards Danish model of care of older people.

The new century heralded a plethora of publications from on older peoples health, which

started with the DH publication entitled Outin the open: Breaking down the barriers for older

people (2000)which introduces the notion of commissioning services for older people and the

NHS plan: The governments response to the Royal commission for long term care (2000)

announced the development of Intermediate Care Services to enable older people retain
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independence at home, integrated services for older people. These papers were followed in

2001 by the establishment NSF for older people (2001) which set out to root out age

discrimination by providing person-centred care and promoting older peoples health and

independence and fitting services to older peoples needs. The key passage of this NSF is the

establishment of Standard 8 refers to the promotion of health and an active life in older age.Also in 2001 the DH released a paper called Caring for older people a nursing priority (2001) in

which it asserts the need for nursing as a key part in enhancing older peoples autonomy and

independence. Nurses, it contends, must attend to the whole person not just the acute

symptoms. In this way, nursing changes its focus from acute care to prevention.

The year 2002 WHO released their influential document on Active Ageing (2001) which

continues where their Health21 agenda document left off by demonstrating that WHO consider

health from a life-course perspective and aims to enable older people to get the best possible

quality of life for as long as possible through local community strategies. The DH document

Information services for older people in England (2002) considers the strategies required to

provide health and social care information to older people including educational needs and

other opportunities and also calls for monitoring wellbeing which underpins independence and

healthy ageing. This year the Kings Fund released a document entitled Great to be Grey (2002)

which reflects on the recruitment and retention of older staff.

The DH document called Better health in Old age (2004) promotes the development of older

people as active citizens within their communities and within their families, helping to create a

stronger and more prosperous society and has a whole section on promoting health and active

life in reports and case studies. Also in 2004 the DH released Choose Health: making health

choices (2004) builds on previous DH documents and extols the virtues of making healthy

choices; providing better information; demand for health as market influence; (Page 86 is

interesting as it goes through some of the reasons why older people do not take exercise.). The

DH documents were compounded in 2005 by the release of the Kings Fund report entitled The

business of caring (2005) which found older people experienced restricted access to care and

practical support, limited choice and control over care services, and were being put at risk by

untrained staff and difficulties with funding. The document calls for a culture that sees older

people as equal partners focusing on their rights as well as needs and suggests care services

should be responsive to fluctuating needs and unpredictable health. The DH also released a

number of documents on which the first was entitled independence, wellbeing and choice

(2005) in which it advances that care service should support independence whist providing

choice and control over how their needs are met and the NHS and social care should have

shared agenda. The DWP and DH released Health work and well-being caring for our future

A strategy for the health and well-being of working age people (2005) which focused on


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likely to be unsustainable for a number of reasons. A New Ambition for Old Age: Next steps in

implementing the National Service Framework for Older People: A report from Professor Ian

Philp, National Director for Older People (2006) sets out the priorities for the second phase of

the governments ten-year National Service Framework (NSF) for Older People under three

themes: dignity in care, joined-up care and healthy ageing. The final report of the Wanlesssocial care review team Securing Good Care for Older People: Taking a long-term view (2006)

estimated the contribution of demographic pressures and the need to improve outcomes

would increase the costs of older people's social care to 29.5 billion in 2026. Funding

proposals include restricting means-testing for personal care and putting in place a free

package of basic care, topped up by personal contributions matched by the state. The

ministerial concordat Putting People First, A shared vision and commitment to the

transformation of Adult Social Care (2007) sets out the transformation of adult social care, and

recognises that the sector will work across shared agendas with users and carers to transform

peoples experience of local support and services. It promotes enabling people to live their own

lives as they wish and promote their own individual needs for independence, wellbeing and

dignity. The Public Service Agreement (PSA) 17 issued by the Department for Work on Pensions

entitled Tackle Poverty and Promote Greater Independence and Well-being in Later Life

(2007) set out the outcomes the government seeks to achieve in the Comprehensive Spending

Review period to promote improvements in independence and well-being in later life for the

longer term. In A Recipe for Care - Not a Single Ingredient: Clinical case for change: Report by

Professor Ian Philp, National Director for Older People (2007) Professor Philp identifies a five-

point plan to improve older people's care: (1) early intervention and assessment of old age

conditions; (2) long-term conditions management in the community, integrated with social care

and specialist services; (3) early supported discharge from hospital and whenever possible

delivering care closer to home; (4) general acute hospital care whenever needed, combined

with quick access to new specialist centres; (5) partnerships built around the needs and wishes

of older people and their families. The result should be demonstrated by reduced need for

acute hospital care and increased investment in preventive services and community based

health and care services.

The All Party Parliamentary Local Government Group report Never Too Late for Living Inquiry

into services for older people (2008) reported the results of its inquiry into services for older

people. The inquiry focused on the key role and contribution of local authorities in promoting

the quality of life of older people. The Health and Social Care Act (2008) established the Care

Quality Commission; reforming professional regulation; updating existing public health

protection legislation; and strengthening the protection of vulnerable people using residential

care by ensuring that any independent sector care home providing care on behalf of a local

authority is subject to the Human Rights Act. The Independent Living, A cross-government


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strategy about independent living for disabled people (2008) five-year strategy joins current

and new policy initiatives to provide a coherent framework for making progress towards

independent living for disabled people, including older disabled people. The Darzi report

entitled High Quality care for all (2008) in which Lord Darzi identified a range of hospital

services that could be delivered closer to the patients home, including minor surgery and manyoutpatient consultations, although some services such as stroke and heart disease should be

more specialist and centralised. PCTs together with local authorities are to be responsible for

commissioning comprehensive well-being and prevention services. Patients with complex long-

term conditions were to be entitled to a named care coordinator, such as a community matron,

to help them access the services in their personal care plans.

The Personal Care at Home Bill (2009) offered free personal care at home for those with the

highest needs, regardless of means, such as those with serious dementia and with Parkinson's

Disease. It includes provision to invest in re-ablement and prevention to help people live at

home for longer. The national review of age discrimination and age equality in the health and

social care sector entitled Achieving Age Equality in Health and Social Care (2009) was set up

to help health and social care organisations meet the ban on age discrimination and the new

public sector equality duty in the Equality Bill. The review analysed evidence about the nature,

extent and variability of age discrimination in health and social care services

The white paper Building a National Care Service (2010) proposed fundamental reform of the

care and support system for all adults in England building a new National Care Service. The

King's Fund report Securing Good Care for More People: Options for Reform (2010) takes

forward the 2006 review of social care by the King's Fund (Wanless report) to provide fresh

evidence of the 'compelling need for reform' with projections drawing on revised modelling and

suggests a key principle of reform is that costs of care are required to be shared responsibly

between the individual and the state. The Audit Commission report on local government Under

Pressure: Tackling the Financial Challenge for Councils of an Ageing Population (2010)

examines the issues facing councils with an ageing population requiring a range of services as

public spending reduces. It suggests that councils are not planning strategically for an ageing

population and do not know enough about the costs. In addition, cost savings that could arise

from preventive services and better work with other organisations are not being explored fully

by councils. The Marmot Review Fair Society, Healthy Lives (2010) sort to propose an evidence

based strategy for reducing health inequalities from 2010. Action on health inequalities require

action across all the social determinants of health. Universal action is required but with a scale

and intensity that is proportionate to the level of disadvantage - called 'proportionate

universalism'. The fair distribution of health, wellbeing and sustainability are important social

goals. The Green Paper Shaping the Future of Care Together (2010) set out a vision for a new


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care and support system based on a National Care Service that is to be fair, simple and

affordable which include prevention services; national assessments; a joined-up service;

information and advice; personalised care and support; and fair funding. With the introduction

of the Equality Bill (2010) will make it unlawful to discriminate against someone aged 18 or

over because of age when providing services or carrying out public functions. It will not affectproducts or services for older people where age-based treatment is justified or beneficial. The

law will only stop age discrimination where it has negative or harmful consequences.

promoting healthy older people

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