Delivering high quality care for older people – are you sure you do?
Dr Christine McAlpine is a geriatrician and stroke physician in Glasgow, Chair of the British Geriatrics Society Scotland Council and the geriatric medicine speciality adviser to the Chief Medical Officer for Scotland. She chaired the multiprofessional group which produced the Healthcare Improvement Scotland Standards for the care of older people in hospital, published in 2015. She tweets at @CHRISTINE030214
Health care for older people is core business for the NHS. Getting health care right for older people helps ensure we get it right for everyone. Today the BGS publishes 'Effective healthcare for older people; Principles and Standards', with a particular focus on those living with frailty.
The Principles and Standards are for the health care of older people in any setting – not only for geriatric medicine wards, but for all of the health care departments older people may encounter - Emergency Medicine, ophthalmology, gynaecology etc - across the spectrum of care.
The concise 4-page paper includes core standards for care delivery and reminds us of the principles enshrined in human rights and equalities legislation. It outlines principles of health care for older people including effective, accessible and timely care; autonomy, choice and person centred care; and ensuring safety and dignity. There are standards for care in acute illness, emphasising the importance of and excellent evidence base for Comprehensive Geriatric Assessment; standards for community service provision including the importance of an integrated care system addressing the priorities of older people and their families; and specific standards for care homes and specialist geriatric medicine units. Useful references signpost readers to further publications expanding on all these themes.
So - what’s your role in this? Guideline writers recall the olden days of ‘spray and pray’ when a learned group wrote standards, printed hundreds of copies and sent them out widely to hospital wards with the instruction to ‘follow these’. We know now that the likelihood of achieving improvement by that approach is close to zero. Firstly of course the standards have to be up to date and relevant – as these new BGS standards and principles are. Then people delivering care to older people need to decide how to use the standards to improve their service, and put a plan in place to do so then review progress.
In addition of course other agencies can use the standards to assess whether a service which says it is delivering good care to older people really is doing so. Look at your own service; decide how to measure whether these care standards are being delivered, and if they are not then look at what the barriers are and how can they be changed. Discuss the way forward with other members of the multidisciplinary team and with users of your service – patients, families, and colleagues in other services. Then make changes and reassess your performance to see if you’re achieving or getting towards the standards of care you are aspiring to. Chart your progress in posters placed in the area where the visitors congregate before the ward doors open – encourage debate and feedback.
Local ownership is the key to achieving improvement and these principles and standards will help you make a difference to the service you provide for the older patients you and your team care for. View 'Effective healthcare for older people; Principles and Standards'