The National Service Framework for Older People

The United Kingdom is ageing fast. In common with much of the remainder of the universe the population of older people is increasing ( HM Government ( HMG ) , 2010 ; Nolan, 2001, Improvement and Development Agency ( IDeA ) , 2009 ) and their prevalence in the population is predicted to lift to 29 % by 2031 ( Association of Director of Social Services ( ADSS ) , 2003 ) . For the first clip, the figure of pensionaries will outweigh Numberss of those under age 16. In 1980 it was suggested that work forces aged 65 could anticipate to make 78, nevertheless, predicted life anticipation today would widen to 85 and by 2050 it is expected to stretch to around 89 old ages. This should no longer be looked upon every bit exceeding as older people can now anticipate to populate over a 3rd of their lives above pensionable age ( HMG, 2009 ) and the progress in life anticipation can be seen as a major achievement for public wellness ( Gillam et al, 2007 ) though it is besides a major challenge.

In 2001 the Department of Health ( DH ) launched an ambitious policy taking to put criterions for older people ‘s attention in all wellness and societal attention scenes. The National Service Framework for Older Peoples ( NSFOP ) was established to put national criterions that would better services, drive up quality and eradicate disparities in attention. It was, province Williams and Webster ( 2002 ) , a “ cardinal vehicle for guaranting that the demands of older people were at the bosom of wellness and societal services reform. ” This essay will discourse the development of the NSFOP, and it ‘s patterned advance since 2001, in a political context with peculiar mention to the inequalities experienced by older people associated with societal exclusion.


Life anticipation in 1856 was merely 40 old ages and early studies recognised how the inequality of socioeconomic conditions impacted enormously on wellness ( DH, 2008 ) . The historical association between age and sick wellness is widely acknowledged. Under the Elizabethan Poor Law of 1601 the aged were cared for in hapless houses, frequently referred to as the feared ‘workhouses ‘ ( Donaldson and Scully, 2009 ) . The duty of the Poor Law transferred to local authorities and was so replaced by the National Assistance Act in 1948, merely as the National Health Service launched.

Recognizing the nexus between poorness and inequalities The Black Report ( 1980 ) , commissioned by the old Labour authorities in late 1970 ‘s, saw societal isolation coming under close examination for the first clip. It was published as the Conservatives claimed power in 1979 despite their efforts to keep its completion, so non backing its findings as it disclosed a noticeable gradient between societal category and disease prevalence connoting the association between income and wellness ( Lewis et al, 2008 ) . Black et Al ( 1980 ) besides noted that any wellness betterments on the portion of the impoverished could non fit those experienced by the more flush in society. On re-election of the Labour party in 1997, a farther study reaffirmed the being of the inequalities antecedently reported on by Black, adding that those spreads between the hapless and the flush had, if anything, widened ( Acheson, 1998 ) .

The fact that some persons are more or less susceptible to hapless wellness has noteworthy branchings for public wellness ( Donaldson and Scally, 2009 ) and wellness inequalities experienced earlier in life have been found to go on in ulterior life ( Acheson, 1998 ) . The term ‘health inequality ‘ refers to the difference in wellness experienced by one group above another due to one group ‘s advantage of the other, with the difference being noted as evitable and unjust ( Flowers, 2006 ) . Marmot notes that this reflects New Labour ‘s political orientation that any wellness inequalities which could be avoided are unfair ( Marmot, 2010 ) . Such differences may be economical, demographical ( age, gender, ethnicity ) , societal ( category ) or geographical ( Acheson, 1998 ; Gillam et Al, 2007 ; Lewis et Al, 2008 ) . Historically, older people experience more ill-health, trusting on wellness and societal attention services more so than other groups in society yet frequently falling foul of ‘The Inverse Care Law ‘ which states that those in greatest demand are least likely to have support services ( Tudor- Hart, 1971 ) . This is by and large due to factors such as pre-disposition to certain disease, poverty-related unwellness and decease, the common intervention of older people and their societal isolation ( Lewis et al, 2008 ) .

There is significant grounds demoing that societal isolation and solitariness can be damaging to older people ‘s wellness, wellbeing and quality and life ( Abbott and Freeth 2008 ) impacting one in seven people over age 65 ( Greaves and Farbys, 2006 ) . Social isolation ( and exclusion ) causes inequality since it prevents people from take parting in

normal activities within their society as a consequence of factors outwith their control ( Le Grand, 2003 ) . Marmot ( 2010 ) declares that the societal features of a community and how healthy behaviors are promoted and facilitated habitually can lend to societal inequalities in wellness. He describes the nexus that connects and binds older people to each other, their households and friends within and outwith their communities, as holding a major impact on the effects of such inequalities as “ societal capital ” . Muntaner et Al ( 2000 ) depict societal capital as “ all types and degrees of connexions among persons, within households, friendly relationship webs, concern and communities ” and, since the 1990s, it has been widely considered to hold an influence on wellness ( Almedon, 2005 ; de Silva et Al, 2005 ; Pearce and Davey Smith, 2003 ; Coulthard, Walker and Morgan, 2002 ) . Therefore, Wainwright ( 1996 ) promotes the possibilities that societal capital may offer a public wellness policy alternative to “ big scale authorities redistribution ” such as decreasing the public assistance province station World War 2. The societal webs that build societal capital create civic engagement, trust and “ reciprocality ” ( Gillam et al, 2007 ; Pearce and Davey Smith, 2003 ) . These indexs of societal capital have been strongly related to rates of mortality ( Pearce and Davey Smith, 2003 ) as societal webs are affected as people age. Losing partners, spouses and friends reduces societal capital, taking to depression, solitariness and a loss of community engagement ( Office of the Deputy Prime Minister ( ODPM ) , 2006 ) . Putnam ( 1993 ) declared the following on his findings on societal capital: –

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“ Of all the spheres in which I have traced the effects of societal

capital, in none is the importance of societal connection so good

established as in the instance of wellness and wellbeing. ” ( Putnam, 1993 )

The fact that wellness is by and large dependent of factors such as diet and lifestyle do it slightly beyond Government control. Increasing societal capital to cut down inequalities such as societal exclusion may, therefore, be an easier mark for authoritiess as they consider it to be something they can hold greater control over. Hence, in 1989 Thatcher ‘s Government published the White Paper ‘Caring for People ‘ . Deemed to be the starting point for sing the community attention strand of policy around societal exclusion it set rules to help with societal integrating in ulterior life. When New Labour came to power in 1997 with their ‘Third Way ‘ policies based on “ rhetoric of community, partnership & A ; strong authorities ” ( Klein, 2001 ) claiming they would look after the poorest first, Blair made undertaking societal exclusion one of his precedences ( ODPM, 2004 ) , recognizing that older people sometimes get ‘lost ‘ between wellness and societal attention services.

The wellbeing of older people is non merely attributable to income, but besides involves lodging, wellness, attention, conveyance and societal contacts. Recognizing this the Local Government Centre directed the driver against societal exclusion ensuing by establishing a biennial research programme, Better Government for Older Peoples ( 1999 ) , aimed at developing schemes to supply a seamless and more accessible service for older people. One consequence of this was the launch of the NSFOP ( 2001 ) that would put criterions to cut down fluctuations in attention which consequence in equalities including exclusion. Blair ‘s Secretary of State, Alan Milburn declared, in his forward, that Labour were “ determined to present existent betterments for older people ” and their precedences lay with looking after the poorest in society. The NSFOP was expected to present betterments in both wellness and societal attention for all older people over a fit timescale of 10 old ages.

With older people ‘s prevalence in the state quickly increasing as discussed, and the subsequent costs lifting well, the docket was set for the development of the NSFOP. The policy devising rhythm continued with preparation of an External Reference Group of histrions including the Professor of Health Care for Elderly People, the Chief Inspector of the Social Services Inspectorate, the Director of Social Services, and other practician and direction groups working in the field of attention for older people such as Help the Aged and the Carers National Association. Policy development besides included those in Primary and Secondary Care with specific disease direction cognition and from Community Care including those organizing the User Reference Group. Proposals were agreed based on evidence-based adept sentiment and consideration of the values which underpin attention services ( NSFOP, 2001 ) . Evidence included systematic reappraisals, single intercession instance surveies and besides cardinal experiences of older people themselves and their carers. Further input would be required across the execution period of the policy from wellness and societal attention by organizing Local Implementation Teams tasked with circulating the policy ‘s aims.

Policy execution would be continual over the 10 twelvemonth period and was based around eight ‘Standards ‘ of attention aiming progess towards improved service proviso, One and Eight being most pertinent to cut downing exclusion. Standard One ( Rooting out age favoritism ) tantrum neatly with New Labour ‘s docket to cut down age-related stigma and increase just entree to services based on demand ( Baldwin, 2003 ) so is possibly predictable. It promised to scrutinize all age-related policies, measuring service forms across the state to set up illustrations of best pattern with a position to puting benchmarks on which to mensurate future betterments originating from the NSFOP. Standard Eight ( The publicity of wellness and active life in older age ) aimed for a joint NHS/Council attack to increasing just entree to services to assist people remain good and independent, therefore detering exclusion. Health publicity enterprises for older people have been shown to supply early returns in improved wellness, independency and wellbeing doing them economically reasonable investings for any Government ( DH, 2006a ) peculiarly when advancing healthy ripening is cardinal to the wellness inequalities agenda ( DH, 2003 ) .

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Since the rhythm of the NSFOP was set until 2011 the concluding phase of rating remains uncomplete. However, several documents have been published analyzing its advancement and sing the following stairss to be taken to run into its purposes ( Baldwin, 2003 ; DH, 2003 ; Commission for Healthcare Audit and Inspection ( CHAI ) , 2006 ; DH, 2006b ; Cornes et Al, 2008 ; ODPM, 2006 ) . Whilst observing that there was still a long manner to travel, each study agreed advancement had occured and made mention to some important development in Government policy as a consequence of the NSFOP including: Opportunity Age ( HMG, 2005 ) ; Independence, wellbeing and pick ( DH, 2005 ) ; and Our wellness, our attention, our say ( DH, 2006b ) . Such progress includes increased chest malignant neoplastic disease surgery for the over 85s, 39 % more hep replacing operations for the over 65s and an increased coronary arteria beltway processs for the over 65s. Although, an progressively aging population would logically ensue in increased necessity of these operations with or without the NSFOP. Other services have non faired so good. Older People ‘s Mental Health enterprises have focused specifically around those who are still of working-age, irrationally since many older people suffer reduced mental wellness after retiring due to the loss of focal point and a feeling of no longer being of worth, frequently ensuing in depression and isolation from the remainder of society ( CHAI, 2006 ) . The “ deep-seated attitude to ageing ” ( CHAI, 2006 ) is still apparent in some services and merely 15 % of older people have been found to be in contact with wellness and societal attention services at any one clip. Whilst the CHAI study that spend on these services for the over 65s has increased – 40 % of the NHS budget in 2001 increased to 43 % for 2003/2004 and £5.2 billion of societal services budget increased to £7billion in the same period – it is ill-defined whether this increased service bringing consequences from the NSFOP model or is merely due to the amplified demand of an progressively aging society. Many of the enterprises stemming from the NSFOP designed to better older people ‘s wellness and wellbeing whilst cut downing societal exclusion have been found to be inconsistently accessible to older people, ensuing in continuation of the exact job they aimed to rectify. Baldwin ( 2003 ) agrees, believing the NSFOP to be ideologically sound yet found it to ironically increase age-related exclusion in relation to some wellness services.

Many enterprises aimed at bettering older people ‘s wellness and societal attention have their roots based preponderantly in a top-down medical theoretical account in which the primary aim is to guarantee that attention is provided. Jack ( 1995 ) argues that it is critical to recognize the demand for authorising older people since they are amongst the most disempowered in society, frequently being regarded as a job by service suppliers due to their increasing Numberss ensuing in lifting costs. Nusberg ( 1995 ) agrees and is quoted by Thompson and Thompson ( 2001 ) as stating:

“ Older people are one of the last groups with which the impression of

authorization has become associated. Yet the privilege it represents –

the ability to do informed picks, exercising influence, continue to do parts in a assortment of scenes and take advantage of services – are

critically of import to the wellbeing of seniors. ”

Having picks and being able to keep control over determinations about their ain wellness is of great importance to older people and unless the medical theoretical account is challenged, older people will go on to be societal excluded and considered a minority group, being treated by service suppliers and policy-makers as receivers of attention, instead than merely as older grownups with the same scope of jobs as younger 1s. The NSF Next Steps ( DH, 2006a ) recognises the possible that older people can lend to their local communities, in bend bettering their ain wellness, independency and wellbeing. Through audience with older people, the Public Service Agreement 17 ( HM, 2010 ) acknowledges their diverse demands and aspirations observing their part to society as “ an of import factor in wellbeing, independency and connection in ulterior life ” . New Labour aimed to back up older people to lend more to society by taking forward their programs from the HM Treasury Final Report ( 2007 ) to advance and back up best pattern in volunteering and mentoring. Renewal of civil society formed a component portion of Blair ‘s political orientation and many policies on wellness inequalities developed during New Labour ‘s reign refer to the function of society, promoting Wanless ‘s statement that finally everyone is responsible for their ain wellness and that of their households ( Wanless, 2004 ) . This ideal has been reflected in some of the NSFOP advancement studies, about utilizing older people ‘s deficiency of battle in inequality-reducing enterprises as a ‘get-out ‘ clause for the timescales non holding been reached. This swing towards go throughing the duty of cut downing inequalities such as societal exclusion over to society under the streamer of ‘civil engagement ‘ is set to go on through Cameron ‘s political orientation of ‘The Big Society. ‘

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In their 2010 pronunciamento, the Coalition announced that they would safeguard age-related entitlements, free travel and increased chances for work, all of which would travel towards reduced inequalities for older people. The fact that cut downing the current shortage displaces all other planned steps has rapidly altered the Governments ‘ promises. Already the singing public disbursement cuts are doing concern for older people. Age UK ( London Evening Standard, 30/9/2010 ) suggest the poorest will be hardest hit losing an mean income of between 29 % and 33.7 % , yet merely 12 months ago in ‘Building a society for all ages ‘ ( HMG, 2009 ) , Gordon Brown stated pensionaries were now less likely to be in poorness than other groups with benefit alterations enabling the poorest families to be on mean £2100 per twelvemonth better off. Brown besides boasted more employment chances for older people. However, unemployment rates for the 50-65 age group are higher than the remainder of the working population ( Audit Commission, 2008 ) . The Coalition province one manner they will undertake solitariness and promote older people ‘s societal interaction is through publicity of digital engineering. Many older people remain affiliated to friends, households and societal sites through cyberspace usage in locales such as libraries yet the new Government program to shut many local libraries. They besides plan to change free coach base on balls privileges by increasing eligibility age to 65, yet a tierce of over 60s used a coach at least hebdomadal as their lone signifier of conveyance throughout 2007 ( Audit Commission, 2008 ) . Such alterations necessarily exclude older people further and are merely likely to increase isolation. The significant demographic displacement requires a extremist alteration in the manner the Coalition Government now proposes to back up its older people. Attitudes and outlooks need to alter across society, stereotypes should be shed and the premises about what turning older agencies must be challenged to undertake the inequality of being older along with the societal exclusion that frequently accompanies it.

The Centre for Policy on Ageing study ( 2010 ) cites about 75 policy paperss developed with an purpose to better older people ‘s services since March 2005. Even the really recent publication, ‘Building a society for all ages ‘ ( HMG, 2009 ) , starts by discoursing the prevalence in ageing and suggesting a programme to “ stop age favoritism and promote age equality ” . ‘Equity and excellence ‘ ( DH, 2010a ) , taking to emancipate the NHS, claims it will make a service which will “ extinguish favoritism and reduces inequalities in attention ” . However, in a really unstable fiscal clime, NHS Primary Care Trusts ( frequently the drivers behind the NSF ‘s ) will fight to accomplish the NSFOP 10 twelvemonth marks. Confronting the chance of immense debt, occupation losingss and at hand abolition any aspirations of developing farther enterprises needed to run into the NSFOP concluding aims will necessarily be crushed. Marmot ( 2010 ) provinces: “ Even backed by the best grounds and with the most carefully designed and good resourced intercessions, national policies will non cut down inequalities if local bringing systems can non present them ” . Evidence-based or non, in his 1997 pronunciamento TB said “ What counts is what works ” ( Klein, 2001 ) , nevertheless what ‘counted ‘ has non made any major betterments since the NSFOP launch harmonizing to the considerable organic structure of grounds and audience documents delivered later which fundamentally all make the same already recognised statements – that the population is ageing rapidly and older people remain stray from many indispensable wellness and societal attention services – yet non looking to travel frontward in what is being done to turn to the state of affairs.

Understanding how policy affects older people can be seen as ambitious, peculiarly in position of the altering demographics. A cardinal challenge in implementing policy is the demand to prosecute older people in the procedure by seting their demands at the Centre of policy development. Elbourne ‘s 2008 study to Government advises that “ policy shapers and service suppliers will be better prepared to be after & amp ; present policies that truly do run into the demands of older people when they begin to welcome the rich diverseness of positions and experience owned by this group ” . Likewise, Cattan et Al ( 2005 ) advocate the importance to policy and pattern of affecting older people in planning, developing and presenting activities that prove most effectual at cut downing inequalities. Older people frequently believe their parts are non valued and their voices travel unheard merely worsening the really jobs of favoritism, poorness, isolation and societal exclusion ( ADSS, 2003 ) which the NSFOP purposes to cut down. With ‘fairness as its basis ‘ , Equity and Excellence ( DH, 2010b ) promises to affect ‘patients, service users and the populace ‘ in all service developments. Politicians frequently acknowledge the wealth of experience that older people have to offer within White Paper rhetoric – possibly this is the clip to really listen and value that experience and so adhere to their promises and non utilize them merely for ballots. After all, the new Coalition ‘s mantra is “ No determination about me, without me ” .