Older People National Service Framework Summary

Standard 1

Rooting out age discrimination

• NHS services will be provided, regardless of age, on the basis of clinical need alone

• Social care services will not use age in their eligibility criteria or policies to restrict access to available services

Standard 2

Person-centred care

• NHS and social care services treat older people as individuals and enable them to make choices about their own care. This is achieved through the single assessment process, integrated commissioning arrangements and integrated provision of services, including community equipment and continence services

Standard 3

Intermediate care

• Older people will have access to a new range of intermediate care services at home or in designated care settings, to promote their independence by providing enhanced services from the NHS and councils to prevent unnecessary hospital admission and effective rehabilitation services to enable early discharge from hospital and to prevent premature or unnecessary admission to long-term residential care

Standard 4

Standard 5

Stroke

• The NHS will take action to prevent strokes, working in partnership with other agencies where appropriate

• People who are thought to have had a stroke have access to diagnostic services, are treated appropriately by a specialist stroke service, and subsequently, with their carers, participate in a multidisciplinary programme of secondary prevention and rehabilitation

Standard 6

Falls

• The NHS, working in partnership with councils, takes action to prevent falls and reduce resultant fractures or other injuries in their populations of older people

• Older people who have fallen receive effective treatment and, with their carers, receive advice on prevention through a specialised falls service

Standard 7

Mental health

• Older people who have mental health problems have access to integrated in mental health services, provided by the NHS and councils to ensure older people effective diagnosis, treatment and support for them and for their carers

Standard 8

The promotion of health and active life in older age

• The health and well-being of older people is promoted through a coordinated programme of action led by the NHS with support from councils

Medicines and older people

• The NSF Medicines Management Booklet aims to ensure that older people:
• gain the maximum benefit from their medication to maintain or increase their quality and duration of life
• do not suffer unneccessarily from illness caused by excessive, inappropriate, or inadequate consumption of medicines

• Audits of all age-related policies to be completed, with the outcomes to be reported in annual reports

• Completion monitored by Regional Office (RO) (new measure)

• From this date, Service and Financial Frameworks (SaFFs) and Joint Investment Plans (JIPs) to include initial action to address any age discrimination identified. Strategic direction to be reflected in Health Improvement Programmes (HImPs)

• Completion monitored by RO (new measure)

• Analysis of the levels and patterns of services for older people, in order to facilitate comparisons across health authorities (HAs) and establish best practice benchmarks based on health outcomes and needs

• For some key areas, intervention rates may be used to monitor access to services. The benchmarking exercise will be critical to develop a better understanding of appropriate intervention rates for a population. We are undertaking further work to develop measures for older people based on health outcomes. In the meantime, monitoring access to services may include examining the rates of the following procedures and interventions key to providing quality of life for people aged 65+, 75+ and 85+:
• elective cataract surgery
• elective hip replacement
• elective knee replacement
• community equipment
• and those which reflect national clinical priorities to ensure that older people are accessing surgical interventions and medical treatments for the major illnesses on the basis of clinical need:
• revascularisation
• treatment for end-stage renal failure (new measure)

• Once this work is complete and we have appropriate benchmarks, local health systems should, from 2003/04, be able to demonstrate year-on-year improvements in moving towards these benchmarks

• Completion monitored by RO (new measure)

• Local arrangements for implementing the NSF are established

• Numbers/rates of people aged 75+ entering long-term institutional care (total in Performance Assessment Framework [PAF])
• Numbers/rates of people aged 75+ in nursing and residential care (total in PAF)

• The single assessment process is introduced for health and social care for older people

• Proportion of total people aged 75+ receiving long- term intensive support who are receiving this at home (total in PAF)
• Numbers/rates of people aged 75+ admitted to hospital as an emergency (SaFF and proposed PAF indicator). We will investigate continual collections on an age-standardised basis*
• Numbers/rates of people aged 75+ whose discharge from hospital is delayed (overall total collected by Winter and Emergency Services Capacity Planning Team and in SaFF and proposed PAF indicator)
• Numbers/rates of people aged 75+ readmitted to hospital as an emergency within 28 days of discharge (SaFF and proposed PAF indicator). Continuing the collection using age standardisation will be explored
• Numbers/rates of people aged 75+ who receive an assessment under the new single assessment protocol (new measure)
• Numbers/rates of people aged 75+ in receipt of an individual care plan (new measure). Information to be collected at year end on an age-standardised basis

Waiting time for social services packages:

• For new older clients, the proportion where the time from first contact to first services is more than 6 weeks (version of Personal Social Services [PSS] PAF Performance Indicator specifically for older people), broken down by whether referral from primary/community health, secondary health or other
• As above, except the proportion where the time from first contact to provision or commission of all services in the care plan is more than 6 weeks (new measure)
• Numbers/rates of people aged 75+ receiving overnight respite care commissioned by Social Services Department (RAP)
• Numbers/rates of people aged 75+ of key staff:
• district nurses
• health visitors
• physiotherapists
• occupational therapists
• chiropodists and podiatrists
• health care assistants
• support workers
• pharmacists
• These cannot be broken down into the proportion of staff grades assigned to older people, but can give a general measure of access by dividing by population adjusted for age and need

• All health and social care services to have reviewed the information they provide on older peopleÍs services and the formats in which it is available, and to have developed an action plan to correct any shortcomings. This should be reflected in the local Better Care, Higher Standards charter

• Completion monitored by RO/Social Care Region (SCR) (new measure)

• Systems to explore user and carer experience should be in place in hospitals and in all NHS and PSS organisations

• This milestone ensures that the focus is on exploring user and carer experience. Performance measures will be developed to allow benchmarking and performance . This will include management regular use of the surveys to be developed within the national programme for NHS patients and carers

• NHS organisations should have systems in place to ensure that all complaints from older people, or their carers and relatives, are analysed and reported to each Board

• Completion monitored by RO/SCR (new measure)

• HImPs and other relevant local plans should have included the development of an integrated continence service

• Inclusion monitored by RO (new measure)

• Systems to explore user and carer experience in PCTs should be in place

• Ensures that the focus is on exploring user and carer experience. Outcome performance measures are needed to back this up. These will be based on local survey questions which will feed into PAF indicators

• Single integrated community equipment services are in place

• Community equipment (which is predominantly although not entirely provided for older people):
• numbers/rates of people receiving community equipment
• time from first contact to completed assessment
• time from completed assessment to provision
• percentage of items of equipment costing less than £1000 delivered in less than 3 weeks (PSS indicator)
• percentage of items of equipment recycled by value

• All local health and social care systems should have established an integrated continence service

• Achievement monitored by RO/SCR (new measure)

• Local health and social care systems to have designated a jointly appointed intermediate care coordinator in at least each HA area; to have agreed the framework for patient/user and carer involvement; and to have completed the baseline mapping exercise

• Achievements monitored by RO/SCR (new measure)

• Local health and social care systems to have agreed the JIP for 2002/03

• At least 1500 additional intermediate care beds compared with the 1999/2000 baseline

• Number of people referred to non-residential intermediate care teams:
• to prevent inappropriate hospital admission
• to facilitate timely hospital discharge and/or effective rehabilitation

• At least 40 000 additional people receiving intermediate care services which promote rehabilitation and supported discharge compared with the 1999/2000 baseline

• Number of people referred to/receiving intermediate care in a residential setting (ïrapid responseÍ/supported discharge)
• to prevent inappropriate hospital admission
• to facilitate timely hospital discharge and/or effective rehabilitation

• At least 20 000 additional people receiving intermediate care which prevents unnecessary hospital admission compared with the 1999/2000 baseline

• Numbers of intermediate care beds
• Total expenditure on intermediate care (£1000s)
• Number of places in non-residential intermediate care schemes
• Social servicesÍ support for intermediate care is indicated by:
• households receiving intensive home care per 1000 population aged 65 or over
• older people helped to live at home per 1000 population aged 65 or over

These are both Best Value/PSS PAF indicators

• At least 5000 additional intermediate care beds and 1700 non-residential intermediate care places compared with the 1999/2000 baseline

• At least 150 000 additional people receiving intermediate care services which promote rehabilitation and supported discharge compared with the1999/2000 baseline

• At least 70 000 additional people receiving intermediate care which prevents unnecessary hospital admission compared with the 1999/2000 baseline

• In addition, the performance measures for Standard 2 will indicate progress on Standard 3

• PCG/Ts will have ensured that:
• every general practice, using protocols agreed with local specialist services, can identify and treat patients identified as being at risk of a stroke because of high blood pressure, atrial fibrillation or other risk factors
• every general practice is using a protocol agreed with local specialist services for the rapid referral and management of those with transient ischaemic attack
• every general practice can identify people who have had a stroke and are treating them according to protocols agreed with local specialist services
• every general practice has established clinical audit systems for stroke

• Collectively over time the milestones for stroke will reduce:
• mortality from stroke (Office of National Statistics (ONS) data)
• incidence of stroke (new measure; Health Episode Statistics (HES) data available but would need analysing)
• prevalence of inadequately treated high blood pressure

• Local health care providers (health, social services and the independent sector) should have audited their procedures and put in place risk management procedures to reduce the risk of older people falling

• Achievements monitored by RO (new measure)
• Collectively over time the milestones for falls will reduce:
• incidence of fractured femur (new measure; HES data available but would need analysing)
• deaths following fractured femur (ONS)
• avoidable harm through falls or hypothermia (PSS PAF)

• The HImP, and other relevant local plans developed with local authority and independent sector partners, should include the development of an integrated falls service

• All local health and social care systems should have established this integrated falls service

• HImPs and other relevant local plans developed with local authority and independent sector partners should have included the development of an integrated mental health service for older people, including mental health promotion

• Achievements monitored by RO/ SCR (new measure)
• In addition, the performance measures for Standard 3 about reducing premature admission to long-term care will indicate progress in this area

• PCG/Ts will have ensured that every general practice is using a protocol, agreed with local specialist services, health and social services, to diagnose, treat and care for patients with depression or dementia

• Health and social care systems should have agreed protocols in place for the care and management of older people with mental health problems

• HImPs, SaFFs and other relevant local plans should have included a programme to promote healthy ageing and to prevent disease in older people. They should reflect complementary programmes to prevent cancer and CHD and to promote mental health, as well as the continuation of flu immunisation

• Inclusion monitored by RO (new measure)

• Plans should also include action specific to older people, utilising the range of local resources, including those within regeneration programmes and reflecting wider partnership working

• Local health systems should be able to demonstrate year-on-year improvements in measures of health and wellbeing among older people:
• flu immunisation
• smoking cessation
• blood pressure management

• Flu immunisation rate in people aged 65+
• Numbers of excess winter deaths (ONS)
• Smoking cessation rates in people aged 60+
• Blood pressure
• high blood pressure detected
• high blood pressure effectively treated in people aged 65+

• Collective outcome measure
• Healthy Life Expectancy index under development

• All people over 75 years should normally have their medicines reviewed at least annually and those taking four or more medicines should have a review 6-monthly

• Proposed new measure for development

• Every PCG or PCT will have schemes in place so that older people get more help from pharmacists in using their medicines

• Achievement monitored by RO (new measure)