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Contents Special CNO Bulletin – Nurses Delivering the National Service Framework for Older People This special edition of the CNO Bulletin brings you the core messages from the Nurses Delivering the National Service Framework for Older People conference which took place in London on 19 November. Contents
1. Delivering services for older people The importance of partnership and nurse leadership were key messages at the conference. Held at the Sofitel St James Hotel in London on 19 November, the event was organised by the Department of Health and the RCN, with speakers including chief nursing officer Sarah Mullally, national director of older people’s services Professor Ian Philp and RCN general secretary Beverly Malone. Improving care and maintaining dignity for older people are the main aims of the National Service Framework (NSF) for Older People. This will be achieved by developing services in areas such as mental health and stroke, as well as working towards eliminating age discrimination. Ms Mullally announced that 84 senior nurses who work with older people in the NHS and independent sector are to take part in an accelerated leadership development programme. She told more than 130 key nurses, managers and health professionals that the programme would deliver the leadership potential of modern matrons, or their equivalent, and was an example of collaborative working between the public, voluntary and independent sectors. "We will support them to be visible and vocal in their communities. They will promote the specialty and improve the care experience for older people," she said. Prof Philp stressed the importance of developing nursing leaders, drawing on his own experience in Sheffield, where the appointment of a strong nursing leader had turned around a failing hospital ward. "In many parts of the care system nurse leaders are making a difference, even in the most difficult environments," he said. Ms Malone spoke about the importance of partnerships, between health practitioners, the NHS and independent sector. She highlighted that barriers to partnerships had to be broken down and that nurse leaders are ideally placed to help build bridges and support partnerships. She said: "Partnership isn’t an easy thing to implement, but nursing is not a solo occupation or done in isolation. Partnerships create better working conditions and a higher standard of patient care."
2. Nurses set the standard – NSF progress update Ensuring that older people receive the treatment, care and respect they need and deserve underpins the entire National Service Framework (NSF) For Older People. And over the past two years, nurse-led initiatives throughout the country have played a major role in improving the care given to older people. Based round eight standards, the NSF covers health promotion, mental health, reducing the incidence of falls, caring for people who have had strokes, general hospital care, intermediate care, ending discrimination and treating older people as individuals. The targets are tough, but national director for older people’s services Ian Philp is confident they can be met. Visiting services around the country, he said that nurse leaders empowered staff to feel intensely proud of what they were doing. "This leads to great satisfaction among patients and their families and there's an upward spiral in which patient satisfaction reinforces staff pride," he said. In Merseyside, a nurse-led multi-disciplinary team has been established to help patients with dementia live in their own homes wherever possible. "Mental heath problems, such as dementia, are often just one of the health difficulties faced by older people," explained clinical services manager at Mersey Care Trust, Jane Dunn. "By offering practical support and continually assessing our patients we are able to ensure that the majority of our patients are able to manage at home." The role of nurses is seen as fundamental to the success of the NSF. "Over the next year, nurses have a vital role to play in ensuring key milestones are met," said Department of Health nurse advisor for older people Deborah Sturdy. "By continuing to initiate and lead projects, nurses will have more opportunity to improve patient care than ever before. "All general hospitals have now developed a nursing structure which clearly identifies nursing leaders with responsibility for older people. These nurses will take forward the major NSF milestones - they will challenge outdated stereotypes, age discrimination and ensure person centred care."
The National Service Framework for Older People is a ten-year programme of improvement for older people’s services. Since it was published in March 2001, development has been positive and progress is now starting towards the next set of milestones: Progress so far:
The future:
4. Deborah Sturdy – helping nurses to have an influence Deborah Sturdy is the Department of Health’s nurse advisor for older people. Here she looks at how nurses can play a major role in developing the specialty and how it is providing more career opportunities than ever before: "Most of my career has been spent working across older people services, and so I fully understand what a crucial field this is. "It is an exciting time to be working in a national post when there is both the commitment and drive to really change older people’s experience of care. "The National Service Framework (NSF) for Older People supports nurses in improving care of older people. It encourages the sharing of learning and expertise to build on partnerships across health and independent sectors. Nurses are therefore in an excellent position to influence policy in this essential specialism. "As nurse advisor for older people at the Department of Health, my job helps provide a view from the nursing front-line when developing policy. As well as feeding into the NSF for Older People, this has helped steer the introduction of the single assessment process and NHS funded nursing care in nursing homes. "It is important that I can draw on practice and experience from nurses in the field. Since being appointed I have developed a nurse advisory group consisting of 10 nurse leaders from health visiting, district nursing, intermediate care, acute hospital care and mental health nursing of older people. I have also set up a national nurse consultant forum for nurses working with older people. "These groups provide important sources of information in terms of how services can be developed to deliver the best care for the patient. I also visit services myself and listen to nurses and others about issues which are challenging them. "There are now numerous career opportunities in this specialty and nurses can choose from a range of roles including nurse specialists, nurse consultants, clinical leader roles such as modern matrons, intermediate care co-ordinators, and independent sector nursing. Such a diverse range of roles provides a variety of career paths for nurses in the field. "If you work within any sub speciality of adult nursing you are working with older people. We have to ensure that the profession takes this responsibility seriously and develops the right skills and attitudes to ensure a positive contribution. "I am extremely keen to hear your views on all areas of nursing older people. Please email your thoughts to deborah.sturdy@doh.gsi.gov.uk"
5. New leadership programme targets nurses working with older people An accelerated leadership development programme to guide nurses working with older people will be offered to around 100 nurses in the NHS and the independent sector in the New Year. The programme aims to develop the leadership potential of modern matrons, or their equivalent, working with older people to raise standards of care and raise the profile of this important field of work. Older people make up the largest single group of patients using the NHS. Each of the 28 strategic health authorities will be asked to nominate a team of three people to take part in the development programme - one from an acute trust, a primary care trust and an independent care home. The training will include a series of events to promote leadership skills and enhance the patient experience. Those taking part will attend courses and master-classes which will be run by the Leadership Centre over a six-month period. Participants will also come together to develop partnerships between primary and secondary care and the independent sector as well as extending services for older people with mental health problems and learning disabilities. The National Service Framework for Older People recognises that strong nursing leadership is essential to provide patient focussed care along with dignity and privacy for older people when they are in hospital. Modern matrons will also provide the support and development for ward managers to help make this happen. Chief nursing officer Sarah Mullally outlined the benefits of the new approach: "Nursing older people is at the very heart of adult nursing. This programme will not only develop nurses for today, but leaders who can influence the future. "The launch of this programme provides a unique opportunity to promote care of older people, develop visible, vocal and effective leaders and generate change within the system as well as creating a sustainable network to help improve services and develop partnership working." Nurse consultant for older people at Northumbria Health Care NHS Trust, Sue Tiplady, said: "We have been seen as a Cinderella service in the past but this leadership programme will help nurses influence the strategic vision and put patients at the heart of the service."
Cutting across organisational boundaries and re-designing services around the patient is one of the guiding principles of the National Service Framework for Older People. Integrated services between health providers, social care and sometimes the private sector, promote faster recovery from illness, prevent unnecessary acute hospital admissions, support timely discharge and maximise independent living. Poole Intermediate Care Services – set up by the local primary care trust and social services department - has made the whole systems approach a reality and patients are now seeing real benefits of joint working. Intermediate care in Poole now includes:
Intermediate care manager for the Poole service Marianne Lambourne explained: "You have to have a strong vision which puts the patient first and then develop a truly collaborative approach. "We come to joint decisions, with social services leading on the commissioning using the Health Act flexibility, and our home care services are provided by the private sector. "This enables different professionals to work within one management structure. In this way older people can have their difficulties resolved without repeated visits by different carers." An Integrated Care Network has been set up to provide support for those wishing to progress partnership working. To find our more e-mail mbicn@doh.gsi.gov.uk.
7. Two years on from the NSF launch The National Service Framework for Older People will be two years old on 27 March 2003 The day will be marked with the publication of a report, highlighting progress over the last two years and signalling the challenge of the next two years. A conference, hosted by Professor Ian Philp, is currently being planned on this day for the 700 or so ‘champions’ who are driving change in older people services. We will keep you updated as more information becomes available.
The following links can help you find out more about nursing older people: www.doh.gov.uk/nsf/olderpeople.htm – Department of Health website for NSF for Older People including latest news, downloadable documents, good practice examples and website discussion area for champions. www.doh.gov.uk/jointunit/freenursingcare – Department of Health website with general information and guidance about NHS funded nursing care. www.doh.gov.uk/scg/sap – Department of Health website for the single assessment process for older people including key implications and guidance for local implementation. www.doh.gov.uk/intermediatecare - Department of Health website for detailing intermediate care for older people including executive summary and guidance to contracting for intermediate care services. www.doh.gov.uk/snmac.htm - Department of Health website for the Standing Advisory Committee for Nursing and Midwifery including recent reports such as Caring for Older People: A Nursing Priority (April 2001). www.doh.gov.uk/cno - Department of Health website for the Chief Nursing Officer for England including CNO Bulletin, speeches and events. www.doh.gov.uk/conferences/nsfolderpeopletour.htm – Department of Health website coverage of the Implementing the National Service Framework for Older People tour including overview of event and summary of presentations and speeches. www.nice.org.uk - National Institute for Clinical Excellence website. www.carestandards.org.uk - National Care Standards Commission, including minimum standards for care homes for older people. www.nursingleadership.co.uk – National Nursing Leadership Programme website including details of ‘modern matronship’, the appointment of new nurse consultants, and work on clinical benchmarking. The site carries information on leadership development and training for nurses.
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