Caroline Wolverson York St John University |

Caroline Wolverson
York St John University |
Setting the Scene:
Health & Social Care
services for older
people in England
York St John University |
Health & Social care in England
• National Health Service – free access to health
care at point of delivery: this means everyone
can register with a General Practitioner to access
a primary health care service
• Social care: People entitles to assessment of
need & provision of services
• Recent change in Government wanting to
introduce competition & commercialism which
some would say is at the expense of collaboration
• More pressure on staff to demonstrate improved
outcomes with less funding
3rd sector –
private &
Social services
Changing to
Older People’s services in the UK
• In 2008 the number of people over 65 was
greater than those under 16 in the UK for the
first time ever
• People over 65 make up 16% of the
population but account for 43% of the total
National Health Service budget & take up 65%
of acute hospital beds
Services dictated by Government
Policy for example:
• National guidelines delivered at local level
• National Service Framework for Older People
• National Dementia Strategy (2009)
• National Institute for Clinical Excellence(2006)
Dementia Guidelines
• No Health Without Mental Health (2011)
The Focus of the Rhetoric
• Choice
• Personalisation: personal health & social care
• Partnership working
• Improving public health: prevention of ill health &
Health Promotion
• Independence, wellbeing & quality of life & active
• Person-centred care
• Early diagnosis for people with dementia
• Reablement services
The reality for older people
• There are some excellent services which have
been implemented over the last 10 years
• However, older people are still marginalised &
experience discrimination (frequent reports
particularly on standard of nursing & residential
home care)
• Lack of co-ordination between services &
pressure as to which agency funds services – is it
a health or social care need?
• Government concept of ‘The Big Society’
Occupational therapy with older
• Often not specific older people’s services –
particularly in physical health settings
• Challenge of implementing ‘Best Practice’ within
service constraints
• Recognition of multi-disciplinary approach - Few
services consist only of OT’s
• More skills sharing amongst different professions,
for examples, OT’s monitoring blood pressure,
physios & nurses providing basic equipment
• Increase in generic working, particularly in mental
health services
Key Roles
• Assessment of need in relation to occupational performance
• Provision of services to assist in maintaining daily routines, maintaining &
good health (NICE 2008)
• Reablement & rehabilitation
• Education/ training of care staff (COT/ NAPA (2007)‘Activity provision:
benchmarking good practice in care homes’)
• Education of carers
• Maintaining quality of life & wellbeing: promoting an active lifestyle
(Public Health Agenda)
• Maintaining opportunity for choice & decision making
• Prevention of admission to hospital or reducing hospital stay
(intermediate care services)
• Supporting independent living (Independent Living agenda 2010)
• Building the evidence base to support non-pharmacological interventions
to support people with dementia
• Falls prevention programme