ADDING LIFE TO YEARS
ANNUAL REPORT 2002-03
CHAPTER 2: MAJOR HEALTH CARE ISSUES
Adding Life to Years contained a number of recommendations on CHD, including the need for increased professional awareness of heart disease in the elderly, improved rehabilitation and support for older people with CHD through better co-ordination between hospital and primary care, monitoring, through transparent audit, of access by older patients to appropriate investigation and treatment and the use of NHS Quality Improvement Scotland standards to assess the care provided to all age groups, including older people.
The recommendations on stroke were that stroke patients admitted to hospital should be managed in a stroke unit by a co-ordinated multi-disciplinary team, that rehabilitation should be co-ordinated between hospital and primary care to ensure continuity and that NHS Boards should ensure that stroke care reflects current SIGN guidelines.
These recommendations were drawn to the attention of the Reference Group responsible for converting the report of the CHD & Stroke Task Force into the national CHD and Stroke Strategy, published in October 2002. The development of Managed Clinical Networks in each Board area for both cardiac services and stroke will address the concerns about better integration of hospital and community services and equity of access to services. It is one of the key principles of Managed Clinical Networks that patients should be fully involved in their development and operation. The cardiac services MCN in Dumfries & Galloway illustrates the very effective role which older patients can play in this work. MCNs must also provide services according to a clear evidence base. In relation to the local cardiac services and stroke MCNs, that will be the relevant SIGN Guidelines. The national Strategy also has as one of its priorities the development of national databases for CHD and stroke, and these will enable the type of monitoring and auditing required by Adding Life to Years.
NHS Quality Improvement Scotland has also been developing clinical standards for stroke services, and these form another vehicle for taking forward the relevant Adding Life to Years recommendations, especially access to stroke units.
The recommendations in Adding Life to Years relating to cancer were: that older people should have full access to the service developments that follow from implementation of the Cancer Plan; that they should have access to appropriate investigation and treatment on the basis of individual need; that clinical standards should adequately assess the care provided to all age groups, including older people; and that older patients with cancer should have access to rehabilitation, to enable them to cope with the impact of disease and treatment.
Cancer Scenarios: an aid to planning cancer services in the next decade published in April 2001 provides a review and a foundation for planning in the next decade. It predicts that in the next 10 to 15 years, with an ageing population, more people will be living with cancer. As the risk of cancer increases with age we can therefore predict that more cancer patients with have particular needs because they are older.
The publication of Cancer in Scotland: Action for Change in July 2001 signalled a renewed drive to tackle cancer and its causes. It sets out a programme of investment and reform designed to transform the way cancer services are delivered and monitored. Its main aim is to secure better access to quality assured services, increase patient involvement in clinical trials, and secure real and lasting health improvements for all patients including older people.
To take forward the implementation, three Regional Cancer Advisory Groups (RCAGs) and tumour specific Managed Clinical Networks have been established in the North, South East and West of Scotland. Together they are already improving local decision-making and planning of cancer services and had key roles in decisions on the investments supporting Cancer in Scotland. The regional tumour specific Networks are responsible for quality assurance and quality improvements of their services.
An additional 60 million has now been distributed to NHSScotland to support implementation of the strategy. This additional investment has secured at least 330 extra staff including doctors, nurses, radiographers and pharmacists. Almost 7 million has been targeted to vital equipment for diagnosis and treatment, bringing significant improvements in standards of care and more rapid diagnosis and treatment.
A further 1 million is available to support regional cancer research networks, mapped on to the three clinical networks, in order to improve quality by at least doubling patient participation in trials. There is also an additional 1 million over 3 years to underpin the programme of organisational change and redesign of cancer services across Scotland. The Cancer Service Improvement Programme aims to accelerate the pace of change and bring improvements for patients throughout their journey of care.
By identifying cancer very early in its development, treatment can begin at a much earlier stage than might otherwise be the case. From 2003-04 the upper age limit for routine invitation for the Scottish Breast Screening Programme will rise from 65 to 70 years and will be implemented over the three-year round of screening. This means an extra 50,000 women will be routinely invited for breast screening each year.
Cancer is one of the greatest health problems facing Scotland and direct involvement of individuals in their own care requires relevant information that is both accessible and comprehensive. Cancer in Scotland: Action for change - A Guide to securing access to information was published in March 2003 aimed at securing improved access to information needed by patients and their families/carers.
An Implementation Framework has been developed to routinely monitor progress towards achieving the various objectives set out in Cancer in Scotland: Action for Change. RCAGs provide 6-monthly monitoring reports on their cancer investment plans which, in turn, feed into the Implementation Framework. These reports are public and available on the Cancer in Scotland website at www.show.scot.nhs.uk/sehd/cancerinscotland
Mental Health and Older People
Mental health remains a priority for the Scottish Executive and NHSScotland. Mental health and well-being in later life are essential elements of active healthy ageing. The Adding Life to Years report made recommendations designed to improve recognition and treatment of depression among older people, and to improve services for people with dementia.
Mental Health will benefit from the Executive's proposals for modernisation of primary care, giving Community Health Partnerships (evolved LHCCs) a key role in the planning and delivery of co-ordinated mental health services. Attention to how that care is delivered for all ages and all needs and how Community Health Partnerships link to other care providers - hospitals, social work, housing, the voluntary sector and others - is of significant importance.
Funding for Mental Health Services
Recent years have seen record spend by NHS Boards and local authorities on mental health services NHS Boards and local authorities plan to spend over 626 million on mental health this year (2003-04). There will also be additional new investment of over 24 million over the next 3 years in promoting good mental health and preventing suicide. Any and all increases must be matched by a programme of service redesign and modernisation through joint working, an agenda set out for mental health in Partnership for Care. That programme will focus on the promotion of good mental health.
Funding for the Voluntary Sector
The Scottish Executive continues to provide financial support for a number of voluntary organisations with an interest in mental health, many of whom will support elderly people with mental health problems. Funding this year under the section 16B grant scheme amounts to 408,000. This includes 79k funding for Age Concern, Alzheimer Scotland-Action on Dementia, and the Dementia Services Development Centre. Funding next year for Alzheimer Scotland-Action on Dementia includes 95,481 Section 10 grant, and an 18,576 Section 9 grant. The Dementia Services Development Centre will also receive an 161,917 Section 10 grant in 2003-04. The Mental Illness Specific Grant, increased to 20 million in 2003-04, supports over 400 local projects providing a variety of services.
National Programme for Improving Mental Health and Well-being in Scotland
The National Programme is a key part of the Scottish Executive's Health Improvement and Social Justice strategies. It has a number of key aims, including the promotion of positive mental health and promoting social inclusion and social justice for people with mental health problems. This in turn includes addressing inequalities and closing the opportunity gap.
Older people can be particularly susceptible to depression, dementia and to social exclusion. One of the National Programme's six priority areas for action in 2003-06 is to Improve Mental Health and Well-being in Later Life, i.e. to promote awareness of the issues and support developments which enable older people to achieve a life which is satisfying and rewarding.
The NHS Health Scotland programme on health in later life fully recognises the important role of mental health and well-being. The National Programme is working in partnership with the Scottish Executive's Older People's Unit and NHS Health Scotland to develop a programme of mental health promotion work. As part of this work, older people and professionals have worked together to explore the key components of mental well-being in later life. The lessons learned from this event will form the basis of future work by NHS Health Scotland and the National Programme. Key areas for action are likely to include awareness, early intervention and mental health promotion.
Over 4 million was allocated from the Health Improvement Fund to support the work of the National Programme from 2001-04. The initial work of the programme focuses on promoting positive mental health and well-being, preventing suicide; and undertaking a national campaign to challenge and eliminate the stigma and discrimination which people with mental health problems in Scotland still face.
20 million over the next 3 years has been allocated from the Health Improvement budget to continue the work of the National Programme. Older People have been identified as one of the six priority areas for the Programme and a plan of work will be identified soon.
The Mental Health (Care and Treatment) (Scotland) Act 2003 sets out a framework for modern and improved care and treatment of people with mental health problems and will benefit older people with mental illness.
The updated and extended duties on local authorities to provide care and support for people with mental illness should prove of particular benefit.
And in those relatively few cases where compulsory treatment may be necessary, the individuals concerned will benefit from improved procedures which will protect their rights, promote their participation, and help ensure they receive good quality care.
Mental Health and Well-being Support Group
The Support Group was started in March 2000 to make services better for those who need them and of course those who care for them.
What the Support Group does is:
makes sure that those employed by the NHS and local authorities are working together to provide the best services;
helps the NHS and local authorities plan to make care better;
helps point out work that is good and help introduce other ideas; and
publishes reports on what they find during their visits across Scotland.
To do all this the Support Group visits each Health Board area in Scotland to meet all the NHS and local authorities, the voluntary bodies, those who use services and their carers. For every visit a user of services and a carer are invited to join the Support Group. The members of the Support Group talk to them all to find out how needs are identified, whether the plans that the NHS and the local authorities have are the best ones, and the intended timetable for actioning these plans. It then publishes a short report of what it thinks is needed in each place to make services better. The reports are followed up to make sure that what was said should be done, is done. An assessment rating of the stage reached by partnership agencies is published following each visit are available on www.show.scot.nhs.uk/mhwbsg
Free Personal and Nursing Care
From 1 July 2002 free personal care was introduced for people aged 65 and over. The burden of financial worry has been taken away from pensioners in need of care services, so they can be confident that they will get the free personal care and support they deserve in their old age. There should be no more charges for personal care at home - and substantial help is available towards care home costs. Everyone will get the nursing care they need free whether at home, in hospital or in a care home. Implementation overall appears to be going well. We have extended NHS principles to personal and nursing care to ensure fairness for older people. A key element of the policy is to end inequity whereby the cancer sufferer gets personal care free and the stroke/dementia sufferer has to pay.
Funding for Free Personal and Nursing Care
250 million was made available over the first 2 years. 107 million in 2002-03 and 143 million in 2003-04. The local government settlement allocations will provide resources of 147 million in 2004-05 and 153 million in 2005-06 for the continuing implementation of free personal and nursing care. People coming into the system should be assessed in accordance with normal practice. There is no requirement to change local protocols on monitoring and reviewing care needs which should form part of the overall care management arrangements that already exist.
Guidance was prepared in close collaboration with the Association of Directors of Social Work and is explicit on the need to integrate processes for assessment and payment into authorities' current management and financial support procedures. There should be no waiting lists and those assessed as needing it should receive free personal and nursing care.
The Executive will continue to monitor the practical effect of the policy across all local authorities who were also consulted about the monitoring arrangements. A Free Personal Care Joint Group has been established to look at any problems arising in any local authority area. The Scottish Executive is working through this group with officials from the Convention of Scottish Local Authorities (COSLA), Society of Local Authority Chief Executives (SOLACE) and Association of Directors of Social Work (ADSW). The Group provides a forum for working constructively with local authority partners to resolve any local concerns with the implementation of free personal and nursing care.