NCEPOD Report launch “An Age Old Problem”

Professor David Oliver National Clinical Director for Older People 11 November 2010

NCD Role

• Clinical leadership for older people – with a focus on improving outcomes • Clinical input to cross government Ageing Society strategy • Promote prevention and early interventions for older people • Engage with leaders in health and social care and the voluntary sector • Support the integration agenda and implementation of Coalition priorities relevant to older people 2 DH template

“An Age Old Problem”

• Powerful report - acts as a reality check • Articulates what we know – we can and should be achieving better and more consistent outcomes for older people post-operatively • No defence of poor practice • This applies at every level in the system 3 DH template

Why getting it right for older people matters

• UK population is ageing rapidly - by 2033, almost a quarter of the population will be over 65 • People over 65 are the core users of acute hospital care - 60% of admissions, 65% of bed days, 70% of emergency readmissions, over 90% of delayed transfers • People long-term conditions account for 55% GP appointments, 70% of outpatient and emergency attendances, 77% inpatient days, 90% drug spend in over 75s • People over 65 account for 2/3 of acute and elective surgical admissions and a significant proportion of these are over 80 - often with complex medical needs or frailty and are at higher risk of postoperative complications • We cannot ignore the specific needs of such a significant patient group

NCEPOD Report adds to objective evidence of variable care

• Equality Act consultation and evidence review • National Audits (e.g. Hip fracture, stroke, continence, falls and fragility fractures) • All parliamentary enquiry into human rights of older people in health and social care • Work on dignity • Nutritional care as a registration requirement and 2007 Nt • Dementia strategy consultation • Surveys of staff or patients • Age UK “Hungry to be Heard” 5 DH template

NCEPOD Report key findings & recommendations

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Key findings

• Just over 1/3 of patients surveyed (38%, 295/786) received good care.

• Poor nutrition and serious associated illness were very common in the group studied.

• In over two-thirds of cases (67.7%, 653/965), patients were not reviewed by specialists in Medicine for the Care of Older People.

• Clinically significant delays occurred in 1 in 5 patients between admission and their operation.

• 1/4 of hospitals had no acute pain service. •

Key recommendations

• In elderly patients needing urgent surgery careful attention should be given to improving fluid status, reducing unnecessary drug treatment and anticipating nutritional support.

• Elderly patients undergoing surgery need access to routine daily clinical review from specialists in elderly care.

• Delays in surgery, which lead to poor outcome, should be subject to rigorous audit and rectified.

• Pain and its management should have a high priority to avoid patient suffering.

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Some levers for improving standards

• Implementing the Equality Act (no exemptions?) • National Clinical Leadership (NCDs for Trauma, Kidney care, DVT/PE, Older People) • National Hip Fracture Database and Best practice tariff – early involvement of specialists and shortened time to surgery • New Measures – Standardised Hospital Mortality Indicators (SHMIs) • QIPP work streams (including Safer Care) • CMOs recommendations on training in pain management “the fifth vital sign” • NICE Guidelines – existing and in development • Enhanced Recovery model (NHI, DH and Cancer Action Team) • Nutrition action Plan 2007 and nutritional care as a registration requirement from 2010 plus SCIE resource 7 DH template • Acute Kidney Injury initiatives/CQIN scheme

Secretary of state’s vision for health and social care

The reformed NHS

April 2012: Monitor established as economic regulator   By end 2010: Separation of SHA commissioning and provider oversight functions 2012/13: SHAs abolished  From April 2013: PCTs abolished   April 2011: Shadow Board established as special health authority April 2012: Board fully established  Autumn 2012: Board makes allocations to GP consortia for 2013/14 April 2012: HealthWatch established   April 2011: Support for shadow health and wellbeing partnerships April 2012: Health and wellbeing boards in place  2011/12: Established in shadow form  2012: All consortia formally established  April 2013: Consortia hold contracts with providers  become, or part of, foundation trusts  2013/14: All NHS trusts 2013/14: All providers regulated by Monitor    From 2011: Choice of care – long term conditions; diagnostic testing, and post-diagnosis From April 2011: Choice of treatment and provider – some mental health services 2012: Free choice of GP practice  2013/14: Choice of treatment and provider – vast majority of NHS services

And in future…

• Equity and Excellence: with:

Liberating the NHS

describes a system –

Patients

at the heart of everything –

Outcomes

among the best in the world –

Clinicians

empowered to deliver results • Focus on commissioning for better outcomes in 5 domains of NHS Outcomes Framework • Backed by National Quality Standards • Continuing focus on more person centred care • Strengthened role and priorities of CQC • Importantly local accountability and freedom to achieve better outcomes – the response to this cannot be top down 10 DH template

In Summary

• This report is important and necessary as it highlights deficiencies in the care of older people postoperatively in hospital.

• I commend the rigour and thoroughness and the constructive recommendations from NCEPOD to improve care • I am not here to defend poor practice. Instead we need to identify constructive solutions.

• Many of the solutions rest with good local clinical leadership and a greater focus on safety and quality for older patients.

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Thank you

• Questions.....

• [email protected]

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