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Engaging with older people: the role of nursing in Wales

Lorraine Morgan
WNA President
Staff Tutor
Faculty of Health and Social Care
Open University

Lorraine Morgan outlines the work being done as part of the Strategy for Older People in Wales and explains how its implementation has improved the outlook for patients

The introduction of the Strategy for Older People in 2003 was a landmark moment in Wales and received international recognition for its vision and scope.1 The development of the Strategy was originally concerned with confronting ageism and tackling age stereotypes, while recognising the vital role played by older people in Wales. It is one of the overarching strategies for the government of Wales.

The Welsh Strategy was the product of extensive consultation, research and expert views about the lives of older people in Wales, both in 2002 and in the future. The aims, objectives and more detailed programmes and projects reflected the findings of the report of the Advisory Group published in
May 2002.2

The Strategy recognised that, over the next 20 years, demographic changes will significantly alter the balance of the population and mean that future policies and programmes in Wales will need to reflect the demands of an ageing society. It also recognises that there is a need to improve the quality, quantity and responsiveness of services for older people. This key phrase should have caused the nursing family in Wales to consider further their role in meeting the requirements of this Strategy.

Phase 1 of the Strategy (2003-08) aimed to:

  • Recognise the vital role played by older people.
  • Offer a comprehensive, challenging and dynamic framework for progress.
  • Establish a National Partnership Forum for Older People (NPF).
  • Establish the position of a Commissioner for Older People.

Phase 1 had its background in the UN Principles for Older People of independence, participation, care, self-fulfillment and dignity.3 The Welsh Assembly Government's statement was for the Strategy to be an agent for change.

The key aims within its first Phase were to:

  • Tackle discrimination and promote positive images.
  • Promote capacity to work and learn.
  • Promote and improve health and wellbeing.
  • Promote high-quality services and support ... to maximise independence.

In Wales, local government has been identified as the key agent for change, and the main provider of the Welsh Assembly Government's Strategy for Older People in Wales, playing a leading role in taking it forward.

Each local authority has appointed an Older People's Champion, who is normally a Cabinet Member, and who has a role in ensuring that the issues affecting older people are kept at the forefront of policy and service development.

There is also a Strategy for Older People Coordinator in each authority, whose role is to design new approaches to the development of policy and service development in conjunction with other departments and agencies, including local Health Boards and voluntary organisations. 50+ Forums for older people to attend and to organise have developed all over Wales. In each area a local action plan has been developed which feeds into the local Community Plan and the local Health, Social Care and Wellbeing Plan.

The progress made over five years (2003-2008) has increased awareness of older people's issues within strategic frameworks. A Healthy Ageing Action Plan has been established and funding been given to various projects around Wales to encourage a better quality of life for older people of all ages. This is an ideal place for nurses working in the community to engage further.

The My Home Life Cymru initiative has been particularly groundbreaking in terms of dealing with the excluded voices of older people and also of nurses working in care homes who have had little obvious recognition for their practice development work and research. The initiative, derived from the My Home Life UK social movement, is an All Wales Care Homes project funded by the Welsh Assembly Government. It was first managed by Help the Aged Wales and then by Age Cymru from 2010. Its mission is to improve quality of life in care homes for those who are 'living, working visiting and dying' there.

The second phase of the Strategy encompasses 2008 to 2013, and its aim is to build on the foundation of the first five years, informed by research and further consultation. The emphasis of this phase is on mainstreaming - considering older people's issues across all areas of a local authority's work and broadening the focus beyond health and social care. There is also continued emphasis on the participation and engagement of older people and ensuring that the diverse communities of older people have opportunities to make their voices heard.

In 2004, the National Partnership Forum (NPF), set up as the advisory group through the Government of Wales Act 1998, was asked to give expert and informed advice, and provide a focus and impetus for debate. It was also tasked with challenging, discussing and reviewing ideas and policies. It was finally required to scrutinise the implementation of the Strategy and the work of the new Commissioner.

Its membership comprises public appointments by the Minister for Older People. It has an appointed independent chair. Members cover health and social care sectors, education, research, older people organisations and there are lay members (individual older people).

The Older People Commissioner was appointed in 2008 and her first review, concentrating on the treatment of older people in hospital, is being released in mid-March 2011.
The National Partnership Forum in this Phase became more active, with several work stream groups developed, and reports undertaken to challenge the gaps in policy and provision on four new themes:

  • Valuing Older People - maintaining and developing engagement.
  • Changing Society - recognising and encouraging older people in the workforce as well as tackling poverty.
  • Wellbeing and Independence - promotion of healthy lifestyles, emphasis on prevention and refocusing on quality of life.
  • Making it Happen - the implementation of the Strategy.

One such group produced a scoping report on how the Strategy and health and social care policy was supported in workforce streams. This included practice guidelines, research and critical conversations between care professionals. The full report can be viewed on the NPF website when it is completed in spring 2011.

Four overarching issues were identified by this desktop scoping survey, three of which were extremely pertinent to the role of nurses and nursing practice, as follows.

  • Effective models of communication and engagement are needed between care professionals and older people using their services.
  • Core mandatory learning and continuous professional development is required on the subjects of 'ageing' and 'working with older people'.
  • Noting a considerable absence of accessible 'critical conversations' by health and social care professional groups that illustrate their acknowledgement of the Strategy for Older People and their reaction to implementing the principles enshrined in this Strategy. Any serious conversations that address how professionals work with older people seemed to be 'hit and miss' or fragmented in their use.
  • Recommendations from this Report were presented to and accepted by the Minister for Older People at the National Eisteddfod of Wales in 2010. At present these are being actioned through work with the Older People Commissioner.

In January 2011 the Welsh Local Government Association presented a positive report on the success of the Strategy in austere times, and has successfully lobbied the government to continue to fund the Strategy Co-ordinator posts in local government. It has done this by providing some key evidence of success around positive health and wellbeing outcomes for older people. National milestones from the Strategy have included:

  • Free prescriptions for all.
  • The establishment of the World's first Older People's Commissioner.
  • Free travel passes for older people.
  • Free entry for older people in Wales' historic sites.
  • The creation of the National Partnership Forum for Older People.
  • The publication of the Older People's Wellbeing Monitor.

There are some key messages for nurses in Wales concerning the implementation and success of this unique Strategy. They are probably good messages for nurses working around the UK, as this Strategy may be replicated elsewhere as the evidence is shared.

Older people are now the core business of the NHS (hospital and community) as well as the independent sector in Wales. Nurses everywhere ignore this at their peril.

When making strategic and operational plans and bids for project funding, nurses in the community should always map the outcomes (not just outputs) against the themes of the Strategy. Using policy objectives often helps the senior executive when writing their strategic and operational plans and undertaking risk management exercises. It also might mean success! The Gwent Frailty Project is a good example of success for extra funding. This is about GP practices, Health Board and local authorities coming together for the benefit of older people outcomes and efficient services which produce value for money.

Practical achievements where there are real positive outcomes demonstrated by nursing intervention at any level raises the profile of the effectiveness of nursing practice and continues to make the case for the value of nursing. This is particularly important in the relationships between nurses in the community who see frail older people with complex conditions continuing to manage in their homes.

Many nurses now work in the housing sector as well as health centres and surgeries. For example, some ex-nurses work in or are board members of Care and Repair agencies and their home assessments have achieved a real difference for older people's safety and wellbeing in their own homes. These services in the voluntary sector actually save the NHS in Wales £7.50 for every £1 spent by Care and Repair on keeping older people safe in their own homes.4 Achievements and good practice need to be shared - this is the nurses' 'marketing action plan' and can be really effective in challenging weaknesses and bad practice. Sharing good practice is core to improving practice. Nurses in all care environments need to be making statements of good care that the public, in particular older people, can see in practice.5

We need to know who is driving good care and how you value the experience of older people, from assessment level right through to care planning and evaluation of outcomes. The implementation of the Community Nursing Strategy for Wales will be an ideal opportunity for nursing practice to meet the aspirations of older people. Unfortunately, the consultation document in 2009 omitted a clear recognition of older people as the majority client group of NHS Wales.6 It is anticipated that the implementation, with the clear participation of older people and the NPF will address this anomaly.

The Strategy for Older People in Wales is now well regarded as a model of effective strategy production. As well as setting out a tough objective to challenge societal stereotypes around ageing, it has encouraged a partnership approach across national and local government as well as the third sector.
A key strength was that this partnership approach was supported by funding to aid its implementation.

Nationally, the successes of the Strategy across Wales are numerous and Wales is a different place for older people since the publication of the Strategy in 2003. However, the nursing family in Wales needs to engage with this Strategy much more. We need strong messages about how nursing practice and nursing management can address the monitoring and the evaluation of older people's needs effectively and equitably.

References

  1. Welsh Assembly Government. The Strategy for Older People in Wales. Available from: http://new.wales.gov.uk/topics/olderpeople/?lang=en
  2. Welsh Assembly Government. When I'm 64 ... and more. Available from: http://wales.gov.uk/docrepos/40382/dhss/socialservices/reportsenglish/ol...
  3. Older People's Commissioner for Wales. UN Principles for Older Persons. Available from: www.olderpeoplewales.com/index.php?id=454&L=0
  4. Care and Repair Cymru (2011) http://www.careandrepair.org.uk/care-and-repair-services/
  5. Welsh Nursing Academy. Nursing Practice and Care of the Older Person in Wales. Available from: www.wna.org.uk/PublicationsPresentations/Presentations/tabid/1413/langua...
  6. Welsh Assembly Government. The All Wales Community Nursing Strategy. Available from: www.wales.nhs.uk/sitesplus/866/news/17475