The National Service Framework for Older People - Book Report/Review Example

The risk of falls is very common among the elderly, and the risk appears to increase with age (Ballinger & Payne, 2002). A fall can be defined as a person coming to rest on the floor or ground without conscious intent (Robertson, Delvin, Schuffham, Gardner, & Buchner, 2001). Studies indicate that falls of the elderly increase are associated with mortality, early admission to nursing care, restricted mobility and inability to carry out daily activities (Cummings, Thomas, Szonyi, Frampton, Salkeld, & Clemson, 2001; Salked, Cummings, O'Neil, Thomas, Szonyi, & Westbury, 2000; Tolly & Atwal, 2003).For the elderly in the community the risk of fall is a serious problem and so a large amount of research has explored antecedent risk factors to design preventative interventions (Kinn & Galloway, 2000). The National Service Framework (NSF) for Older People (2001) was developed to focus on the needs of the elderly, such as reducing the risk of falls, implementing preventative programs, and provision of primary care services when falls do occur and following treatment (Tolly & Atwal, 2003). The following presentation will present a critique of the NSF legislation for Falls among the elderly. Firstly a brief background to the NSF Standard Six: Falls will be presented. Secondly, various implications of the legislation in relation to health practices and services for the elderly will be detailed. Finally, a conclusion shall synthesis the main arguments, and will highlight the advantages of the NSF Standard Six legislation. Falls appear to be the dominant reason that an elderly person is admitted to hospital or nursing home care, regardless of the seriousness of the injury (Mackenzie, Byles, & Higginbotham, 2000; Skelton & Todd, 2005). As such, falls among the elderly incur serious costs for the wider community as well as causing distress, immobility, and a decline in autonomy or even death for the elderly person (Skelton & Todd, 2005). The Department of Health anticipates that unless dramatic action is taken, the incidences of falls would increase over the next three decades (Department of Health, 2001). A predominant concern amongst health workers was that falls services, like many other elderly oriented services, were diverse in terms of expertise and service delivery (Department of Health, 2003). Specific interests among individual service workers may have lead to good service provision, but also to gaps in knowledge and to the debate of important issues. As such, the current approach, at the national level, is not person-centered nor coordinated, which can constrain client access to services, the continued development of falls services, and can place strain on the actual service providers (Department of Health, 2003). The NSF for Older People was published on March 27th, 2001. The legislation was to set new national standards for integrated delivery of health and social care service models in regards to the elderly (Department of Health, 2001). Integration is emphasized as the key to reducing resource waste and to providing a national standardized service approach. The Single Assessment Process (SAP) was adopted to streamline assessments, allocate resources efficiently, to focus on outcomes, and to provide person-centred practices in the care of the elderly (Cohen, 2003). The NSF document was created with input from an External Reference Group, comprised of elderly people and their carers, as well as health and social service workers, and partner agencies to the Department of Health (Department of Health, 2001). This reflects the dedication of legislators to provide a comprehensive document inclusive of the views of the people who will be directly affect by it. However, the literature fails to indicate if all elderly populations were represented, such as the homeless, the disabled and ethnic minority groups. Whilst the document will contribute positively to service provision for the elderly, it may also negate the individuality of health workers and de-motivate them because they may feel less encouraged to be innovative. Or they may feel threatened with the introduction of multidisciplinary assessment procedures such as the SAP, as they must collaborate with practitioners whose theories and approaches are not familiar (Cohen, 2003). Standard Six: Falls of the NSF document addresses the need for new investment and cultural change to the services for prevention, treatment and recovery of falls (Department of Health, 2006a). The aim of the legislation was to reduce the incidence of falls, and so reduce serious injury due to falls, as well as develop protocols for efficient treatment and rehabilitation of those who experience falls. As such, the legislation is extremely focused. However, it ignores evaluative practices that are essential to any program to ensure that goals are being met, and to what degree. In July of 2002 it was announced that funding for new equipment would be pooled to enable diverse organizations to enter partnerships to access resources. Councils would no longer be able to charge for resources so as to encourage relationships between service providers. Additionally, conflicting information across the nation would be reformed (Department of Health, 2006b). This appears to be a positive step towards integration of services, as equal access to resources would be available, which would promote partnerships, and a unified approach to information dissemination would benefit clients in getting the most up-to-date peer-reviewed health and social care. r In 2003, a Priority and Planning Framework for 2003/06 stated that it was essential that by April of 2005 an integrated falls service was established nationally between health and social care services (Department of Health, 2006b). Additionally, the National Institute for Clinical Excellence was required to construct guidelines on falls prevention by 2004, and for osteoporosis prevention by 2005 (Department of Health, 2006b). It is anticipated that these guidelines will contribute positively to the development of efficient falls services. However, it is not clear the degree to which elderly consumers are included in these additional decision-making processes, if at all. There are numerous implications for falls services and practices due to the NSF document. For example, there has been an increase in literature that actively investigates the effectiveness of falls prevention programmes (Tolley & Atwal, 2003). Evaluation of preventive programs provides a clearer picture of what works and what doesn't from a person-centred viewpoint. This literature will contribute to future refinements of the NSF document. One study specifically surveyed occupational therapists and physiotherapists to establish if they provided preventative information, it they did how they evaluated a person as suitable for a program, and if they taught the elderly patient how to rise following a fall (Kinn & Galloway, 2000). Of respondents, 127 acknowledged that falls were in issue in their practice, over half provided preventative training and gave instructions on how to rise following a fall. Evidently an integrative approach would enhance the numbers of therapists providing preventative information, and would enable therapists to give a cohesive message of fall prevention if the information provided was standardized. In 2005 www.balancetraining.org.uk was set up by University of Southampton to investigate the best ways to provide balance training to elderly. Using online assessment and training the study is investigating two main forms of preventive information: providing advice; and inquiring into the elderly person's habits and then providing advice. This survey will contribute to a best practices approach in providing preventative information, and will likely encourage an integrative approach to be taken up by service providers. Research into multidisciplinary multi-factorial intervention programmes that assess risks of falls have been found to be very effective (Skelton & Todd, 2005). This reflects the integrative approach as the programs emphasise collaboration amongst service providers with the elderly person at the centre. Conferences such as the Falls Prevention in Older People held in February, 2006, focus on the collaborative development of falls prevention for the elderly (Healthcare Events, 2006). And the National Falls Prevention Day, this year to be held on June 27th, contributes towards public awareness of falls among the elderly, and allows professionals across the disciplines to disseminate information regarding falls prevention (Falls Prevention News, 2006). As such, the event positively contributes to an integration of services as, with knowledge, the public come to expect service providers to be collaborating and providing a standardized service that is person-centred. In conclusion, it is evident that the NSF document is critical to the optimisation of health and social service care for the elderly. Additionally, Standard Six: Falls is essential to ensuring the ongoing health and well-being of the elderly in the UK. However, the legislation may lack input from very isolated elderly within the community, such as the homeless and ethnic minorities. Overall, the legislation appears to have had a positive influence on falls services, as researchers investigate practices of professionals to enable best practices development, and as professionals contribute to developing multidiscipline relationships through conferences and national events. References Ballinger, C. & Payne, S. (2002) "The construction of the risk of falling among and by older people", Ageing & Society, 22, pp 305-324. Cohen, Z. A. (2003) "The Single Assessment Process: An opportunity for collaboration or a threat to the profession of occupational therapy" British Journal of Occupational Therapy, 66 (5), pp 201-208. Cummings, R. G., Thomas, M., Szonvi, G., Frampton, G., Salkeld, G., & Clemson, L. "Adherence to occupational therapist recommendations for home modifications for falls prevention", American Journal of Occupational Therapy, (Nov-Dec), pp 641-647 Department of Health (2001) "Modern standards and service models: National service framework for older people", Retrieved May 8th, 2006, from Department of Health Website: http://www.dh.gov.uk/assetRoot/04/07/12/83/04071283.pdf Department of Health (2003) "National service framework for older people: A report of progress and future challenges", Retrieved May 8th, 2006, from the Department of Health Website: http://www.dh.gov.uk/assetRoot/04/06/72/49/04067249.pdf Department of Health (2006a) "Standard Six: Falls", Retrieved May 8th, 2006, from the Department of Health Website: http://www.dh.gov.uk/PolicyAndGuidance/ HealthAndSocialCareTopics/OlderPeoplesServices/OlderPeopleArticle/fs/enCONTENT_ID=4002294&chk=WF1PDL Department of Health (2006b) "About the NSF for older people", Retrieved May 8th, 2006, from the Department of Health Website: http://www.dh.gov.uk/PolicyAndGuidance/ HealthAndSocialCareTopics/OlderPeoplesServices/OlderPeopleArticle/fs/enCONTENT_ID=4073597&chk=4wRxm%2B Falls Prevention News (2005) "National Falls Day", Retrieved May 8th, 2006, from Help the Aged Website: http://www.helptheaged.org.uk/Health/HealthyAgeing/Falls/ falls_prevention_news.htm Healthcare Events (2006) "A practical guide to developing a positive approach to falls prevention in older people", Retrieved May 8th, 2006, from Healthcare Events Website: https://secure.healthcare-events.co.uk/conferences/confdisplay.aspid=460 Kinn, S. & Galloway, L. (2000) "Do occupational therapists and physiotherapists teach elderly people to rise after a fall", British Journal of Occupational Therapy, 63 (6), pp 254-259. Mackenzie, L, Byles, J. & Higginbotham, N. (2000) "Designing the home falls and accident screening tool (HOME FAST): selecting the items", British Journal of Occupational Therapy, 63 (6), pp 260-269. Robertson, M., Campbell, A., Gardner, M., & Delvin, N. "Preventing Injuries in Older People by Preventing Falls: A Meta-Analysis of Individual-Level Data", Journal of the American Geriatrics Society 48. Salkeld, G., Cummings, R. G., O'Neill, E., Thomas, M., Svoni, G. & Westbury, C. (2000) "The cost effectiveness of a home hazard reduction program to reduce falls among older persons", Australian New Zealand Public Health (June), pp 265-271. Skelton, D. A. & Todd, C. J. (2005) "Thoughts on effective falls prevention intervention on a population basis", Journal of Public Health, 13, pp 192-202. Tolley, L & Atwal, A. (2003) "Determining the effectiveness of a falls prevention programme to enhance quality of life: an occupational therapy perspective", British Journal of Occupational Therapy, 66 (6), pp 269-276. www.balancing.org.uk (2005) Retrieved May 8th, 2006, from http://www.balancetraining.org.uk/fallsAdvice/02_whatDoing.jsp Read More