This National Service Framework (NSF) is welcome. It confirms that the health and welfare of older people is to be addressed as a priority — and comes only fourth in the series of such publications — after cancer, coronary heart disease and mental illness. All the publications intend to improve services and reduce inequalities between services received by different groups in different parts of England.
Old age psychiatrists, and other professionals, have waited with eager anticipation for this publication's delivery, uncomfortable that older people and people with dementia had been excluded from the otherwise excellent NSF for Mental Illness. There were delays in delivery and ‘false start’ announcements of publication before Christmas 2000. All this added to the excitement and sense of moment. Momentous it has indeed proved, and interest has been heightened by controversy, antipathy and expressions of doubt from senior sources within the establishment of care of the elderly.
A great deal of work was undertaken by expert working groups — including members with diverging views. Their contributions were interpreted by civil servants and subject to the stamp of Professor Philp who was appointed Tzar toward the end of the process. These editorial intrusions have irritated some of the figures from the working groups, but they have resulted in a brave and fairly cohesive document, which will help us improve the health of older people and the services they receive. Our society and our government stigmatises and discriminates against older people, particularly those with mental illness and from disadvantaged groups and localities. This phenomenon is nailed.
Some health care professionals have sought to interpret ‘equity’ for old people in terms of admission to the same acute hospital wards as younger people. This false vision of equity is confronted.
Older people with serious mental illnesses of all kinds, including those who survive into later life with chronic or relapsing disorders, require the same discipline and quality of care guaranteed to younger people with mental illness by the NSF for Mental Illness.
The exclusion of older people from consideration by the NSF for Mental Illness is declared, politely, to be unacceptable.
A comprehensive framework ranges from health promotion to continuing and terminal care across the boundaries of personal, family, voluntary, social and health service responsibilities — pretty thrilling for a Department of Health publication. The practical implication of the NSF for Older People is the presence of a hierarchical strategy of implementation: national, regional and local mental health professionals are involved at all levels and should be included in working groups for all eight standards (and the group considering medication).
The process and its outcome will bond old age psychiatry more securely within health care for the elderly. Its interface with general psychiatry will benefit from clarification, informed by a determination that the best interests of individual patients and their families remain paramount.
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