The British Geriatrics Society welcomes the publication of the report by the national director for older people, Ian Philp, “A New Ambition for Old Age”, which updates the 2001 National service framework for older people and sets the priorities for the coming years. The Society acknowledges the very significant progress made in the fields of Stroke and Community services including Intermediate care and in reducing Ageism in Healthcare since the NSF was published. We also welcome the fact that the report makes no attempt to “whitewash” areas where care is patchy or where progress is limited, in particular, the mismatch between the mere provision of a specialist service and the actual population coverage for people who require it.

The new priorities of dignity in care, system reform and healthy ageing are timely and commendable. Gains made in the fields of reducing smoking, and uptake of flu vaccination now need to be augmented by campaigns to improve Physical fitness at all ages , reduction of Obesity , better management of sensory impairment,and continence promotion.The Society fully supports these initiatives as well as the Joint Strategy for Stroke and greater integration of Falls services into the community. In particular, the report crucially recognises that the core customers of primary and secondary care and social services are older people and that systems, model of care, skills and attitudes are not designed around their specific needs.

The British Geriatrics Society has expressed its concerns widely over the lack of dignity and respect shown to older people in hospital , and particularly those with mental health needs – and about the lack of staff with appropriate specialist skills or training to care for those people. Older people with frailty-related conditions – often resulting in falls, immobility, confusion or apparent “failure to cope” need to be looked after by specialist multi-professional teams in an appropriate environment , where they can receive comprehensive geriatric assessment without multiple moves between wards and with timely and well-planned transfer of care back to the community.. We welcome the establishment of targets for enhanced personal and end of life care and managed networks to support the care of those with complex needs.

Although we cautiously welcome proposals to examine the emergency responses to crises of delirium and falls in the community , we must ensure that contributory illness is detected and managed appropriately - in hospital if necessary and not used as a reason to deny older people appropriate and legitimate care.

This report contains much that is praiseworthy. It also acknowledges that transforming attitudes to older people and systems which care for them cannot be reduced to simplistic “target” setting, requires a variety of approaches and will be iterative and gradual. However, the key targets in the NHS plan have tended to distort priorities – incentivising financial balance, or key targets such as four hour transit time at the expense of others- such as care quality or dignity for older people. Other NSFs have come with considerable investment – unlike that for older people. Despite concerted campaigning the latest Quality and Outcomes Framework for the GP contract is “light” on elderly care. The allied White Paper on primary care– despite and emphasis on maintaining a higher proportion of older people with complex conditions in their own home, is uncosted and the government have been guarded about the recommendations of the Wanless report on the funding of long term care.

We look forward to helping this plan in its key aims of improving and transforming attitudes in the care of older people. Let’s hope that the variety of levers set out in the report really do convince local provider organisations to reprioritise.