Older people - policy and reports

This page of the resource aims to signpost key policies and related initiatives across the UK that address care of the older person.

We also include here reports and reviews which impact on policy developments. We have focussed on reports published in the past three years.

You will find further policies and strategies at Specific areas of care.  
 
The policies and reports are arranged by country. Many of the reports are in PDF format - see how to access PDF files.

UK wide

Nursing and Midwifery Council
As part of its role in setting standards of practice and ensuring quality guidance the NMC has produced these resources to support the care of the elderly:

Social Care Institute for Excellence (SCIE) Older people
This section of the SCIE website brings together all of the resources produced by SCIE which are relevant to care of older people. This includes: hospital care; home care; housing and care; medication; mental health; end of life care; participation. Resources include relevant videos from Social Care TV.

Reports

Over the past few years a number of reports have highlighted issues and concerns around the delivery of dignified care to older people, for example Care and compassion (Parliamentary and Health Service Ombudsman 2011), and Dignified care? The experience of older people in hospital in Wales (Older People's Commissioner for Wales 2011).
These and other related reports are described in more detail at Dignity - reports and reviews.

Other recent reports highlighting similar concerns and reflecting on issues that impact on quality of care are are:

Commission on Improving Dignity in Care for Older People (2012) Delivering dignity: securing dignity in care for older people in hospitals and care homes
This is the final report which draws on the submissions to the consultation on the draft report published in February, in addition to the body of evidence gathered over the first eight months of the Commission’s work. The report and its follow-up programme of activities aims to builds on the good practice already in place and focus on how to tackle the underlying causes of poor care. It calls for a major cultural shift in the way the system thinks about dignity which will require “empowered leadership” on the ward and in the care home, and changing the way staff working with older people are recruited.
The Commission was established as part of a joint initiative from the NHS Confederation, Age UK and the Local Government Association (LGA), to help improve dignity in care for older people in hospitals and care homes see Commission on improving dignity in care.

British Geriatrics Society (2011) A quest for quality in care homes: an inquiry into the quality of healthcare support for older people in care homes:  A call for leadership, partnership and improvement
This report marks the start of a process of partnership to develop impetus, resources and clinical guidance that will support the NHS to play part in improving the experience and the quality of life of residents in care homes. Its recommendations were developed through collaborative inquiry of stakeholders drawn from care homes, social care, NHS (including primary care) and academia.

Equality and Human Rights Commission (2011) Close to home: an inquiry into older people and human rights
“The inquiry has found that although many older people receive care at home which respects and enhances their human rights, this is by no means a universal experience. It uncovered areas of real concern in the treatment of some older people and significant shortcomings in the way that care is commissioned by local authorities”.

International Longevity Centre (2011) Living beyond 100: a report on centenarians
This report and executive summary, published with the support of Age UK, consider the policy implications of the growing centenarian population, examining the demography; health and need for social care; housing and wealth; and quality of life for this group. It aims to understand more about this celebrated group through summarising evidence about the lives people lead past 100, while identifying gaps in the evidence base and proposing key policy recommendations to address the issues raised.
 
Joseph Rowntree Foundation: A Better Life
A Better Life is a five year programme (2009-2013) which has commissioned a range of work to increase understanding of what can help people with high support needs now and in the future. From this work the programme will produce recommendations for policy and practice. The programme has produced a number of publications:

PANICOA (Preventing Abuse and Neglect in Instiutional Care of Older Adults (2011) Dignity in practice: an exploration of the care of older adults in acute NHS Trusts (PDF 2.71MB)
This report presents independent research commissioned by the National Institute for Health Research (NIHR). It aimed to build on earlier research in order to develop a body of evidence based on explorations of the experiences of service users and their carers together with interviews and observations of the behaviours and practices of providers.

University of Birmingham Health Services Management Centre (2011) Time to care? Responding to concerns about poor nursing care
This paper makes a series of recommendations to support nurses working in acute hospital care to deliver a better service for patients. Seven core recommendations focus on leadership; the need for a recognised training programme for health care support workers and the need for a systematic approach to supporting nurses with the emotional stress of caring work.

WRVS (2011) Shaping our age: Voices on well-being: a report of research with older people
This report presents the key findings from phase one of the Shaping our Age research project, in which a diverse range of older people define their well-being, the factors that shape it, the barriers to well-being, the impact of services on well-being and suggested improvements.

For policy, strategies and related initiatives on: dementia; dignity; nutrition and hydration; patient safety; safeguarding see Specific areas of care.
For national regulatory and care standards see Standards and guidance.

England

Department of Health (2012) The impact of patient age on clinical decision-making in oncology
This report sets out the results of a study investigating the extent to which age is a factor in oncology treatment decisions. The result suggests that clinicians may over rely on chronological age as a proxy for other factors which are often but not necessarily associated with age, for example comorbidities and frailty.

Department of Health (2011) National Clinical Director for Older People
Professor David Oliver is the National Clinical Director for Older Peoples Services, seconded to the older people and dementia branch of the Social Care Division.

DH: Social care reform
This section of the Department of health’s website provides the latest news on the social care reform initiative.  A White Paper is due to be published in Spring 2012 will present policy recommendations. Recent activities such as the Caring for our future engagement process which will  feed into the White Paper are described.
The King's Fund have also created a section on their website discussing issues around the reform - see King's Fund: Social care.

Department of Health (2010) Partnerships for Older People Programme (POPP)
The programme was  funded by the Department of Health to develop services for older people, aimed at promoting their health, well-being and independence and creating a sustainable shift in resources and culture away from institutional and hospital based crisis care for older people towards earlier, targeted interventions for older people within their own homes and communities. This page includes links to the evaluation report and provides examples of POPP sites supporting people with dementia.

Other example show how services have developed through POPP:

The evaluation of the 29 local authority sites which piloted the programme between 2006 and 2009 found that a wide range of projects resulted in improved quality of life for participants and considerable savings, as well as better local working relationships. The Nuffield Trust was also commissioned to evaluate a small but carefully selected set of eight POPP interventions and examine whether these interventions were successful at preventing unplanned hospital admissions.  The report, published in 2011, is available at An evaluation of the impact of community- based interventions on hospital use: a case study of eight Partnership for Older People Projects.

Department of Health (2001) National Service framework for older people
The National Service Framework was published as the first ever comprehensive strategy to ensure fair, high quality, integrated health and social care services for older people. It has provided a 10 year programme of action to link services to support independence and promote good health, specialised services for key conditions, and culture change so that all older people and their carers are always treated with respect, dignity and fairness.
 
The priorities for the second phase of the NSF, followed three themes:  Dignity in care, Joined-up care and Healthy ageing and were set out in a report published in 2006, A new ambition for old age: Next steps in implementing the National Service Framework for Older People.

See also information at NHS Choices: national service framework for older people.

Reports

Age UK: Care in crisis: seven building blocks for reform (PDF 1.43MB)
This report aims to influence the White Paper on care reform which the Government expects to publish in spring. It outlines the current challenges which are described as “confusing, unfair and unsustainable” and demonstrates through personal stories the impact the crisis is having. The report outlines seven building blocks required to form the basis of a new care and support system.

Age UK (2011) Care in Crisis: causes and solutions (PDF 577.10KB)
This report presents evidence that care and support for older people in England has reached breaking point. It also shows that by 2014 England will be spending £250 million pounds less on older people's care than a decade previously.

All Party Parliamentary Group on Housing and Care for Older People (2011) Living Well at Home Inquiry 
The report highlights the significant role played by the older person's own home. "A suitable place to live can mean independence for far longer; it can prevent the need for residential care; it can reduce requirements for care at home; it can mean fewer accidents and hospital admissions; and it can allow people to leave hospital much earlier, with less risk of immediate readmission". The report is made available on the Counsel + Care website.

Care Quality Commission and British Geriatrics Society (2012) Meeting the health care needs of people in care homes
The review addressed how older people and people with learning disabilities living in care homes access healthcare services, whether they have choice and control over their healthcare and whether they receive care that is safe and respects their dignity. Some key findings are that only staff at 38 per cent of homes reported they got regular visits from GPs, with one in ten care homes saying they had to pay GPs to get them to visit residents. A third of homes also said they sometimes had difficulty getting medicines to residents on time. The regulator suggested that both care homes and the NHS need to address the issue.

House of Commons Health Select Committee (2012) Social care: fourteenth report of session 2010-12
This report claims that older people are being let down by fragmented care services. It concludes that joined up services are the key to securing better outcomes for older people and other vulnerable groups, and to delivering the required efficiency savings.

For policy, strategies and related initiatives on: dementia; dignity; nutrition and hydration; patient safety; safeguarding see Specific areas of care.
For national regulatory and care standards see Standards and guidance.

Northern Ireland

Commissioner for Older People for Northern Ireland
This is a new post which is independent from government. Claire Keatinge has been appointed as the first Commissioner for Older People in Northern Ireland. Through the Commission she aims to challenge age discrimination, promote the best in health, social care and public services, and ensure that the views and experiences of older people are widely understood by government.

Department of Health, Social Services and Public Safety:  Older people’s health and wellbeing service framework
The overall aim of the Service Framework for the Health and Wellbeing of Older People, which is under development, is to improve the health and wellbeing of older people in Northern Ireland, promote social inclusion, reduce inequalities in health and improve HSC quality of care. This page provides information about the development of the framework.

Reports

Northern Ireland Human Rights Commission (2012) In Defence of Dignity: The human rights of older people in nursing homes (PDF 607.2KB)
The report finds that practices in nursing homes are failing to deliver many aspects of care in a human rights compliant way. It also finds that current laws and regulations fall short in their ability to protect residents.

For policy, strategies and related initiatives on: dementia; dignity; nutrition and hydration; patient safety; safeguarding see Specific areas of care.
For national regulatory and care standards see Standards and guidance.

Scotland

Scottish Government: Older people
This page brings together information about the Scottish Government’s  key agenda for older people as well as information about policies and sources of information on a range of topics including  community care, improving health, social justice and opportunities for older people to be involved in policy developments.

Scottish Government (2011) Reshaping care for older people: a Programme for Change 2011-2021
A Ministerial Group for Health and Wellbeing have developed a programme for reshaping care for older people through designing a new model for health and social care in Scotland. This document sets out a national framework which aligns with the NHS Quality Strategy in Scotland and supports other related strategies. It sets the context and describes the outcomes that the programme is aiming to achieve by 2021 and the themes through which the work will be taken forward.
The background to the development of the programme is described at Reshaping care for Older People.   There is also an information booklet about the programme.

NHS Education for Scotland: The Knowledge Network Scotland: Care for Older People Portal 
This portal provides information, resources and education for health and social care staff who support older people in Scotland
Delivering Services
This section of the portal  includes links to legislation and government publications in Scotland on: management of care homes; regulation and inspection; continuing care; service improvement.

Scottish Government (2007) All Our Futures: Planning for a Scotland with an Ageing Population: Volume One: Summary and action plan
Identifies six priority areas for strategic action and highlights the changes required in each area.

Reports

Mental Welfare Commission for Scotland (2010) Dementia: decisions for dignity
This report presents the findings from a special programme of visits that took place across Scotland between September and December 2010 to people with dementia in acute wards in general hospitals. The report includes key messages highlighting both good practice and where improvements are required.

Scottish Government: The Scottish Health Survey: Older people’s health
This report examines the current health status of people aged 65 and over in Scotland. It uses data from the Scottish Health Surveys (SHeS) of 2008, 2009 and 2010 combined to enable analysis by smaller age-groups than the main annual reports.

For policy, strategies and related initiatives on: dementia; dignity; nutrition and hydration; patient safety; safeguarding see Specific areas of care.
For national regulatory and care standards see Standards and guidance.

Wales

Welsh Government: Older People’s Commissioner
The Commissioner is a champion for older people and aims to be an ambassador and authority on older people’s issues.  Ruth Marks has been appointed as the first Older People’s Commissioner for Wales.
For further information, reviews and reports see the website for the Older People’s Commissioner for Wales. This includes information about the report on 'Dignified care' and what has happened since - see Dignified Care? Review: follow up.

Welsh Government: Older people
This section of the Welsh Government website brings together information for older people describing policy and initiatives on a range of topics.
 
Welsh Government: The strategy for older people in Wales 2008-2013
This is phase two of a strategy. Phase one (2003-2008) raised the profile of older people’s issues and concerns and promoted healthy ageing. Phase two builds on this focussing on economic status, general well-being and independence through four themes: valuing older people; changing society; well being and independence; making it happen – the implementation of the strategy.
 
Welsh Government (2010) Framework of services for older people
The Framework contributes to the achievement of modern, accessible and responsive services capable of meeting people’s needs and of being delivered flexibly, consistently and sustainably across organisational boundaries. It compliments other existing strategies such as the national service framework and the strategy for managing chronic conditions.

Welsh Assembly Government (2008) Healthy ageing action plan for Wales
This plan forms part of a continuum of Welsh Assembly Government initiatives to promote health in different age groups. This  plan spans the age range of 50 and over, recognising that some elements of healthy ageing begin at around this age, for example pre-retirement planning. The plan brings together in one document existing and proposed health promotion initiatives for older people and provides guidance for use at local level on key evidence based health promotion interventions with older people.

Welsh Assembly Government (2006) National service framework for older people
The NSF was launched in March 2006 establishing national standards and services in health and social care. It is based around ten standards. 

For policy, strategies and related initiatives on: dementia; dignity; nutrition and hydration; patient safety; safeguarding see Specific areas of care.
For national regulatory and care standards see Standards and guidance.