Implications of the NSF for older people on the future development of Elderly Medicine Dr Declan O’Kane

1. Implications of the NSF for older people on the future development of Elderly MedicineDr Declan O’Kane Implications of the NSF for older people on the future development of Elderly Medicine

2. NSF for Older people • Published 27th March 2001 • This is a 10 year plan focused on • All older people at Home, in • Residential Care and in Hospital Care Implications of the NSF for older people on the future development of Elderly Medicine

3. Set of Standards • Rooting out age discrimination • Person centred care • Intermediate care • General Hospital care • Stroke • Falls • Mental Health in Elderly • Promotion of health and active life in older age Implications of the NSF for older people on the future development of Elderly Medicine

4. NSF – A driving force for change • Ambitious and Promising ! • Sufficiently vague to cover most fields • Sufficiently precise to demand specific changes and improvements • NSF empowers patients, their carers and representative organisations and their health professionals – the Geriatrician • Driven by Clinical Governance Implications of the NSF for older people on the future development of Elderly Medicine

5. NSF Implications for Future Developments of Elderly Medicine • Urgent expansion of stroke units • The super specialisation of stroke medicine • Expansion of Day Hospital • Changes to Ward Infrastructure • One-stop TIA clinics • Falls/osteoporosis service • Rapid access clinics Implications of the NSF for older people on the future development of Elderly Medicine

6. NSF implications contd.. • Expansion of Rehabilitation – Increased rehab beds and community/home rehab • Development of Intermediate care • More Community based schemes • Movement away from the DGH as the hub • Decreasing use of DGH beds – use only for the acute episode Implications of the NSF for older people on the future development of Elderly Medicine

7. Delivering the NSF - The Ubiquitous Geriatrician • The “competency” argument of patient care to breakdown traditional boundaries • Geriatricians managing the older traditional “orthopaedic” and even “urology” inpatients with urologists and orthopaedic surgeons as visiting experts • Should ALL elderly sick be under a Geriatrician ? Is it better for patient ? Implications of the NSF for older people on the future development of Elderly Medicine

8. Huge increase in demand of elderly care – acute and non acute • More work ! Lots more…. • Where will we get the doctors ? Nurses ? Carers ? • Increasing elderly population • Declining “carer” population Implications of the NSF for older people on the future development of Elderly Medicine

9. How can we deliver ? We will need help • Doctors in training need more and better exposure and training to Geriatric Medicine • New Foundation courses should include a compulsory Geriatric Medicine block • Expanding and increasing SpR trainees. • We can’t do it all ourselves but we would like to ! • To move from a Consultant led service to a consultant delivered service will need huge expansion Implications of the NSF for older people on the future development of Elderly Medicine

10. Trying to deliver the NSF – changes in Elderly Medicine over the next 10 yrs • An increasing amount of elderly work would be done by specially trained GPs – the GP specialist ? Encourage Diploma in Geriatric Medicine • The Geriatrician would fit in to this model as a more peripatetic specialist • Geriatricians - an overseeing role, co-managing elderly patients with GPs and other hospital specialists – surgeons, physicians etc. Implications of the NSF for older people on the future development of Elderly Medicine

11. Trying to deliver the NSF- changes in Hospital care • Patients would not wait in hospital beds for diagnostic procedures • Care delivered to the patient where it best suits the patient to be. “Patient Centred Care” • Less use of the DGH for the non acutely well patient • DGH Bed numbers may decrease with Merger of Sites and new build • Shortfall made up by community schemes/at-home schemes and Intermediate Care Implications of the NSF for older people on the future development of Elderly Medicine

12. NSF- New treatments that will alter Elderly medicine • New drugs and other treatments – thrombolysis for stroke etc..dementia treatments… • New Technologies – communication/monitoring/warning • Less invasive Diagnostics – Total Body MRI • NHS IT project Implications of the NSF for older people on the future development of Elderly Medicine

13. But will it all happen ? The downside.. • No funds specifically allocated for NSF • Raymond Tallis – NSF means “Nothing so far” or “No Sodding Funds” • No mention of Chronic Respiratory disease in elderly ? Continence provision is low profile. • NSF is driving force – if you’re not in it then you end up at the back of the queue • Urgent work - Stroke Units reduce disability and mortality by 30% Needs urgent action now and not by 2011 !! Implications of the NSF for older people on the future development of Elderly Medicine

14. Summary • NSF – focuses medics, minds, money, management and manpower • Elderly Medicine - Implications of huge increases in work across all specialties • The Geriatrician is the cornerstone of management of the elderly patient • Will require new partnerships and team-working • Ultimate NSF dividend should be a fitter, healthier older population Implications of the NSF for older people on the future development of Elderly Medicine