Implications of the NSF for older people on the future development of Elderly Medicine Dr Declan OKa

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Implications of the NSF for older people on the
future development of Elderly MedicineDr
Declan OKane
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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

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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

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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

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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

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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

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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 ?

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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

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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 cant 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

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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.

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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

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NSF- New treatments that will alter Elderly
medicine

• New drugs and other treatments thrombolysis for
  stroke etc..dementia treatments
• New Technologies communication/monitoring/warnin
  g
• Less invasive Diagnostics Total Body MRI
• NHS IT project

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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 youre 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 !!

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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