Introduction

Over the past 50 years, there has been a steady increase in the number and proportion of people over the age of 60, with an overall increase of nearly a third. In Wales, a higher proportion of people are over the age of 60 years than in England, Scotland or Northern Ireland. The service and policy context for older people living in Wales is therefore particularly important and in a unique development, a Commissioner has been appointed, namely Mrs Ruth Marks.

The most recent report of the Chief Medical Officer for Wales highlighted a number of key issues with respect to older people. This included the need to prevent chronic conditions as well increasing knee and hip replacement surgery in people aged over 65 years. The report also highlighted the historic deprivation of the South Wales valley communities which has left a legacy of health inequalities for some older people.

In Wales, there are currently 22 Local Authority areas and 22 co-terminus Local Health Boards. This has made joint working possible in the delivery of local services, although the NHS in Wales will be re-structured in 2009 to eight organisations. 2009 will also see numerous other developments relevant to the provision of services for older people. This includes a Dementia Action Plan and also an Older People Workforce Development Network.

There is also a vibrant voluntary and private sector for older people in Wales. On the former, Age Alliance Wales is an umbrella organisation while on the latter, there are robust working relationships with national bodies such as Care Forum Wales. National Welsh organisations, such as the Public Health Service and Local Government Association also play an essential role to the older people agenda in Wales. The Deputy Minister of Health and Social Services, Mrs Gwenda Thomas AM, also makes a significant contribution, for example by sponsoring awards for Dignity in Care.

The main focus of this paper is on important policy areas for older people in Wales, namely the Strategy for Older People and also the National Service Framework for Older People.

Strategy for Older People in Wales

In January 2003 the Welsh Assembly Government launched their comprehensive and integrated Strategy for Older People in Wales. It was the first of its type in the UK, and was developed with the involvement of older people living in Wales. The strategy provided a framework for all statutory bodies in Wales to plan for an ageing society and improve services to older people

The five key aims of the Strategy for Older People in Wales were:

• To reflect the United Nations principles for older people to tackle discrimination against older people wherever it occurs, promote positive images of ageing and give older people a stronger voice in society;

• To promote and develop older peoples’ capacity to continue to work and learn for as long as they want, and to make an active contribution once they retire;

• To promote and improve the health and well-being of older people through integrated planning and service delivery frameworks and more responsive diagnostic and support services;

• To promote the provision of high quality services and support which enable older people to live as independently as possible in a suitable and safe environment and ensure services are organised around and responsive to their needs;

• To implement the Strategy for Older People in Wales with support funding to ensure that it is a catalyst for change and innovation across all sectors, improves services for older people and provides the basis for effective planning for an ageing population.

Each Local Authority in Wales received grant funding to:

• Employ a full time strategy coordinator
• Set up local 50+ forum
• Liaise with existing forums for older people in the local area
• Undertake project work to support the implementation of the strategy locally

The voluntary sector also received grant funding to facilitate them in supporting the implementation of the strategy in their area of interest.

In the first three years of the strategy in place, excellent progress was made. In 2006 an independent evaluation of the strategy was commissioned, a task and finish group was established to oversee the review. A fundamental principle of the review was the involvement of older people. The review found that overall good progress had been made particularly at local authority level. There are now Older People’s champions drawn from the elected membership and coordinators employed in each local authority area. Every local authority in Wales has established a 50+ forum to ensure that there is opportunity for older people to participate in the decisions that affect them. The key message for the review was to strengthen the focus of the strategy into fewer key objectives, and develop evidence of the impact that the strategy was having on the lives of older people living in Wales.

Strategy for Older People Phase 2 Living Longer Living Better

Phase 2 of the Strategy Living Longer, Living Better was launched on the 13 March 2008 by the Deputy Minister for Social Services, Gwenda Thomas. Assembly Government Ministers agreed that the next phase of the strategy should concentrate on the following four key strategic and cross-cutting themes:

• Valuing Older People - Maintaining and Developing Engagement
• Changing Society – The Economic Status of Older People
• Well-Being and Independence and
• Making it happen – Implementation

The support for Local Authorities to implement the Strategy continues. By 2008, £13 million had been invested in the Strategy with 80% of that funding going to local authorities and the voluntary sector to support local initiatives. The Welsh Assembly Government has also funded the Welsh Local Government Association to employ an Ageing Policy Officer who provides day to day ongoing support for the Local Authority coordinators, has established a network for them, and is producing good practice guidance for them, their champions and elected member in general.

Commissioner for Older People

A key commitment in the Strategy for Older People was the creation of the Office for the Commissioner for Older people in Wales. The Commissioner for Older People (Wales) Act gave the Welsh Assembly Government powers to establish an independent Commissioner whose role is to help promote and safeguard the interests of older people and to speak up on their behalf.

The First Minister of the Welsh Assembly Government, the Rt Hon Rhodri Morgan AM has announced that Ruth Marks MBE was the first Commissioner for Older People in Wales and came into post on the 21 April 2008.

The newly appointed Commissioner is a champion for older people, in the same way that the Children’s Commissioner has been for children and young people. The Commissioner for Older People is independent, and her role is to ensure that the interests of older people in Wales, who are aged 60 years or more, are safeguarded and promoted. The Commissioner is a source of information, advocacy and support for older people in Wales and their representatives.

The Commissioner has been appointed by the Assembly for a term of four years, renewable once.

National Service Framework for Older People

The NSF for Older People in Wales is a 10 year framework, launched in March 2006. It was developed with the advice and contribution of a wide range of stakeholders, including older people, health and social care professionals and managers, academics, representatives from the voluntary and independent sectors and Assembly officials. The NSF sets national evidence based standards for the health and social care of older people in Wales and sits firmly within the framework of the Strategy for Older People. The themes of prevention, early intervention, promoting independence and integrated services, dignity and nutrition cut across each of the 10 key standards:

1 Rooting out Age Discrimination

2 Person Centred Care

3 Promoting Health & Well Being

4 Challenging Dependency

5 Intermediate Care

6 Hospital Care

7 Stroke

8 Falls and Fractures

9 Mental Health in Older People

10 Medicines and Older People

The implementation plan for the NSF is comprised of three stages, with a formal review held in between each stage. Stage 1 of the NSF has a focus on setting down the structures, processes and foundations that underpin the delivery of the NSF in Wales. Stage 1 ends on March 31 st 2009 and a joint review of the impact of the NSF is underway, by Health Inspectorate Wales and Care & Social Services Inspectorate Wales.

Based on an analysis of self-assessment data, the current position in Wales suggests that the implementation of stage 1 has been largely achieved. Whilst recognising this overall position, however, it may also be acknowledged that some of the standards, including mental health, stroke and falls and fractures, face challenges. For example, national audits on stroke and also in falls and fractures have identified that there remain significant gaps in provision in Wales.

A realistic view of the progress made on the NSF is therefore required, particularly given that the programme was initiated without specific funding. However, investments in service areas, for example the £2.5 million Welsh Assembly Government funding set aside for the development of stroke services, will benefit the progression of the NSF for Older People.

During 2008/ 2009, a re-configuration of the NHS in Wales will be taken forward. Transition management arrangements will be needed on a range of issues, including the NSF, so as a minimum, 2009/ 2010 will be a year of consolidating the progress made during stage 1. Existing partnerships in Wales have therefore been asked to prepare a locally sensitive interim action plan for 2009/ 2010.

Wales is also in year one of a three year Dignity in Care Programme and this is making a tangible contribution to implementation of the NSF. The Dignity in Care National Co-ordinating Group is chaired by Dr Win Tadd, Cardiff University. In addition, a Social Care Subgroup has been established, Chaired by Angela Roberts, Crossroads Wales. The intention is for products to be delivered from the three year Dignity in Care programme and this is likely to include work on organisational development, improving services to vulnerable groups such as ethnic minorities and raising awareness throughout Wales.

Closing remarks

Through a comprehensive range of initiatives, Wales has demonstrated leadership and a genuine commitment to progress the agenda for older people in Wales. There are plans for these initiatives to continue in Wales and further improvements and development will follow on from the evaluation of the NSF.

Websites of interest:

http://www.wales.nhs.uk/documents/cmo-report-2007-e.pdf

http://adjudicationpanelwales.com/topics/statistics/publications/focusoldpeople08/?lang=en

http://www.wales.nhs.uk/sites3/home.cfm?orgid=439  

Thank you to Gareth Morgan and Andrea Nicholas-Jones, Welsh Assembly Government Older People & Long Term Care policy directorate, for contributing to this paper.

End of policy and practice section.