The Francis report challenges the NHS at all levels. Many of the failings in care described in the report affected old and vulnerable patients. Policy, regulatory, organisational, funding and professional lessons must be learnt.
There must be an immediate focus on what we know will improve quality. Central to this is the need for health professionals to demonstrate clinical leadership. They should be advocating for patients and their carers, challenging poor practice and embodying good practice. No doctor or nurse should assume that failings in basic care, safety or dignity are someone else’s problem and all should speak out when they see neglect or poor care. This extends to clinicians in senior leadership roles in hospitals who should have a clear focus on the care delivered on wards and experienced by patients and their families.
Older people are not only the main users of NHS services but they are also a potentially vulnerable group with more complex needs. They deserve the same standard of treatment as we would expect for patients of all ages and this is very clearly set out in both the NHS Constitution and the Equality Act. It is vital that all health and social care staff working with adults (including managers at all levels, the hospital porter and the senior consultant) have sufficient training, skills and expertise in the specific needs of older patients. Also, staffing levels need to be such as to allow professionals sufficient time to listen to and look after the patients under their care.
The BGS recommends that all older patients entering hospital have a comprehensive holistic assessment which takes into account not only their acute and chronic illness but their psychological and emotional wellbeing. This process will ensure a full diagnosis, empower patients and assure their autonomy. There is good evidence that such an approach delivers much better outcomes for older people and reflects what they and their carers want for themselves.
The BGS is preparing a work programme to develop the leadership skills of our members; to improve awareness of older people’s needs’ in undergraduate and postgraduate clinical education; and to collect, develop and disseminate examples of evidence based good practice in older people’s health services. We are also piloting a toolkit to help staff identify frail older people when they first arrive in hospital so that they can be referred on for appropriate care by the right specialist in the right place. If you want to get involved contact Tom Thorpe.
Professor Paul Knight, British Geriatrics Society President