Caring in partnership:

Transcription

1 Three years on Caring in partnership: older people and nursing staff working towards the future An RCN Nursing Older People Strategy progress and evaluation report

2 Acknowledgements This third year review of the implementation of the RCN Strategy for Nursing Older People is based on material generated and collected during 2006/2007 by RCN members and associate fellows, as well as members of the National Pensioner s Convention, Age Concern and Better Government for Older People. We are grateful to the members of Better Government for Older People and the National Pensioner s Convention who have worked with us throughout the life of the strategy. Thanks also to Matthew Rice who facilitated the review workshop, to Pauline Ford who facilitates the strategy work, and to Beverley Willie and Michelle Wong for their ongoing administrative support. The development of Caring in partnership: older people and nursing staff working towards the future, and the subsequent annual progress reviews, have been supported by an educational grant from Pfizer. We are grateful to Pfizer for their Educational Grant which enabled the development of the Strategy and the achievement of much of the work. We are especially appreciative of all the help we received from members of the National Pensioners Convention and Better Government for Older People. Their contribution helped us to stay grounded in the reality of older people s experiences and to balance this with the needs of nursing. Author Three years on Caring in partnership: older people and nursing staff working towards the future was written by Hazel Heath, Independent Nurse Consultant, and edited by Pauline Ford on behalf of the RCN, its members and staff. RCN Legal Disclaimer This publication contains information, advice and guidance to help members of the RCN. It is intended for use within the UK but readers are advised that practices may vary in each country and outside the UK. The information in this booklet has been compiled from professional sources, but its accuracy is not guaranteed. Whilst every effort has been made to ensure the RCN provides accurate and expert information and guidance, it is impossible to predict all the circumstances in which it may be used. Accordingly, the RCN shall not be liable to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by what is contained in or left out of this website information and guidance. Published by the Royal College of Nursing, 20 Cavendish Square, London W1G ORN 2007 Royal College of Nursing. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Publishers or a licence permitting restricted copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. This publication may not be lent, resold, hired out or otherwise disposed of by ways of trade in any form of binding or cover other than that in which it is published, without the prior consent of the Publishers.

3 ROYAL COLLEGE OF NURSING Three years on caring in partnership: older people and nursing staff working towards the future Contents 1 Background 1.1 Introduction Strategy core principles 2 Box 1: Principles to underpin practice The RCN Nursing Older People Strategy: context and purpose 3 Figure 1: The RCN Older People Strategy: Supporting structures and inter-relationship with other elements of RCN work Evaluating progress 4 3 Internal review of progress Review of progress during 2006/ Evaluating the strategy: strengths Evaluating the strategy: ways of working Aims for 2007/ Summary: older people strategy objectives: progress to date 13 2 The developing policy context Policy trends around the UK, Scotland Northern Ireland Wales England 8 5 Summary: older people strategy objectives: plans for 2007/ Conclusions 34 References 35 1

4 CARING IN PARTNERSHIP 3 YEARS ON 1 Introduction In May 2004, the Royal College of Nursing (RCN) produced its first ever strategy to promote the contribution nurses can make to meeting the needs of older people and ensuring their health and wellbeing. Caring in partnership: older people and nursing staff working towards the future (Ford and Waddington, 2004) was developed by the Forum for Nurses Working with Older People and the RCN Mental Health and Older People Forum, together with the RCN gerontological nursing staff and other key RCN internal stakeholders. The Strategy was developed in partnership with older people and some of the organisations representing them. In developing the strategy, the RCN wanted to establish its vision for nursing older people and develop a work plan. We wanted to ensure that the strategy document would inform good nursing practice by equipping nurses to contribute more effectively to the changing pattern of services for older people, in all care settings. In 2004 the RCN set a demanding action plan to implement the strategy, identifying 39 milestones we hoped to achieve over the following three years. In these three years, a great deal has been achieved, other initiatives are ongoing, and some have yet to commence. This document reviews progress. Overview of this document Section 1 continues to look at the background to the Strategy s development, its inter-relationship with the strategic direction and practice of the RCN, and the underlying principles informing the strategy. Section 2 discusses the developing policy context around the UK. Section 3 discusses the internal implementation of the Strategy, opportunities and challenges, achievements and future aims The tables in Section 4 summarise the achievements of the RCN Nursing Older People Strategy over the last three years. Tables in Section 5 set out plans for 2007/ Core principles The RCN Nursing Older People (NOP) Strategy identified a set of five core principles which underpin good nursing practice with older people (See Box 1). From these principles, the RCN and its partners developed a three-year action plan the NOP Strategy - designed to raise awareness of the nursing needs of older people and the need for greater partnership working, particularly with older people and their carers. The five core principles that should underpin nursing older people Valuing older people by challenging discrimination; recognising and responding to diversity; preserving the dignity of older people; listening and responding to their views and facilitating older people and their advocates to contribute to decision making. Maximising potential by working with people to help them recognise their potential, regain and maintain their confidence, family links and social networks, and to manage risks appropriately. Nurses need to maximise their own potential through accessing training and learning opportunities. Ensuring good quality physical, mental and emotional care by meeting the needs of the whole person; understanding and responding to the special needs of people with dementia and other long-term conditions. Enabling through information by sharing information with older people and their carers about their illness, treatment and care options and ensuring access to advocacy support where necessary. Working in partnership with older people to ensure they are true partners in their own care; developing multi-disciplinary partnerships to enhance the assessment and care options that can be made available. 2

5 ROYAL COLLEGE OF NURSING 1.3 The RCN Nursing Older People Strategy in the RCN context The RCN Nursing Older People Strategy (NOP) was the first of its kind to be developed in the RCN and brings together all RCN work on nursing older people. It interlinks with other key elements of RCN work (see Figure 1). The NOP Strategy was developed just before the RCN s overall strategy. It brought together a range of internal and external stakeholders, all of whom had an understanding of, and influence over, nursing older people - they could influence RCN members and staff, challenge assumptions, reflect patient experiences, keep nurses grounded in reality and ultimately help to deliver the necessary work. Stakeholders included Help the Aged, Age Concern, Alzheimer s Society, Better Government for Older People and the National Pensioners Convention. The greatest challenge was in modifying the RCN s ways of working in order to work with external agencies, and particularly with older people. Figure 1 shows how the RCN Strategy, the NOP strategy, the forum action plans and other elements inter-relate. The NOP Strategy encompasses the whole RCN - members and staff - across the UK. Their activities are co-ordinated from the RCN s Nursing Directorate, and the NOP Strategy is linked to the RCN Strategy and operational plan. There is a circular movement of influence, with the RCN NOP Strategy influenced by the RCN Nursing Directorate Plan, and in turn the forum action plans. The NOP Strategy helps ensure that when other departments are considering their own work plans (for example, when developing their publications), they take into account the needs of nursing older people. The Professional Nursing Department (PND) gives support to implementing the NOP Strategy. A forum organiser is employed full time to provide support to the forums. The Professional Nursing Department s Gerontological Nursing Adviser provides support to the forums and leads on some elements of strategy work. Importantly, all the RCN strategies focus on the business of nursing. Figure 1: The RCN Older People Strategy: supporting structures and inter-relationship with other elements of RCN work RCN Strategic Plan A five year strategy guiding RCN work. Available as hard copy or on website RCN Nursing Directorate Operational Plan Themes Also five year plan, but updated annually Forum Action Plans* RCN Nursing Older People Strategy Developed at the time that the RCN was developing its Strategic Plan RCN Governance Standards and RCN Policies** Staff and Governance group ensures that these are adhered to Professional Nursing Department Adviser and Forum Organiser Support the work of the forums Governance Sub-Group of the Professional Membership Structure Action Group)*** Oversees forum work from member perspective *Forum action plans are determined by the forum committees, and state their priorities for the year ahead. ** The RCN Governance Standards and RCN Policy responsibilities concern codes of behaviour; for example, corporate responsibilities and financial management. *** The Governance Sub-Group of the Professional Membership Structure Action Group overseas forum work from RCN members perspective. 3

6 CARING IN PARTNERSHIP 3 YEARS ON 1.4 Evaluating progress The RCN undertook to carry out an annual review of progress achieved against the work identified in the action plan. Reviews so far (Waddington, 2005, 2006) have identified a range of achievements and challenges. Implementation strategies have included: Dissemination of the NOP Strategy through a range of conferences and workshops, including the National Pensioners Convention, local and national meetings The development of more effective partnerships with older people, so that they could be more involved in helping to promote the strategy and the achievements within it The development and dissemination of practical tools and material to support nurses, including publications on outcome indicators in continuing care, rights risks and the use of restraint, and an updated version of the RCN Assessment Tool Promoting a positive image of nursing older people through increased training opportunities Involving older people directly in all aspects of strategy work - for example conference planning and delivery. 4

7 ROYAL COLLEGE OF NURSING 2 The developing policy context 2.1 Policy trends, Older people continue to be a focus of health and social care policy and, around the UK, a range of new services and new roles are developing which offer opportunities to work with older people in new ways. Nursing remains central to the delivery of care for older people and effective clinical leadership is at the heart of creating high quality, modern, patient focused services. RCN leadership programmes run around the UK have been positively evaluated in contributing to leadership development. There are, however, fundamental challenges which inhibit the delivery of person-centred services for older people. As the RCN (RCN, 2007) observes, the NHS deficits crisis is real and entrenched. Deficits are leading to a serious reduction in the NHS workforce. Crucial health services are being cut, access to care is being restricted, treatments are being delayed or cancelled and patient care is suffering as a consequence. At the same time as cuts in jobs, there is an underlying shortage of nurses and nursing workloads are increasing. The RCN s General Secretary (RCN, 2007) warns: Almost 60 years on from its creation and in spite of record and welcome levels of investment our NHS is caught up in a rip-tide of deficit-led cuts, rushed reforms and poor workforce planning that is hitting services, hurting patients, undermining staff morale and threatening the hard-won progress made over recent years in raising health outputs, improving clinical outcomes and modernizing the delivery of care. The RCN concludes that if NHS spending falls after 2008, the progress made in improving clinical outcomes and increasing NHS outputs over recent years could be lost. The independent sector, and in particular care homes, also faces challenges with rising costs, extensive regulation and levels of state funding which providers claim are inadequate to achieve desired standards of service (RNHA, 2007). Despite the challenges, however, new service models are evolving - such as communities where people can live and receive care when the need arises. Services which use the skills of both NHS and independent sector staff are also being developed around the UK, for example in offering palliative care for people with dementia. Pressures currently experienced across health and social care not only impact on crucial services, they also impact on the members and staff of the RCN who are trying to implement the Nursing Older People Strategy. Broad policy trends are consistent around the UK: a drive to combat age discrimination. Age discrimination legislation has been implemented health service operations increasingly shifting from acute, hospital-driven models to more communitybased models, with an emphasis on services as close as possible to people s homes more widespread working across organisational and professional boundaries, in partnership with people and communities, to deliver integrated services new nursing roles developing an increased focus on long-term conditions, particularly for older people an increased emphasis on promoting health, on preventative health strategies and on anticipatory care new services developing specifically to reduce unscheduled hospital admissions resources increasingly targeted at those with greatest risk of ill health, with an emphasis on targets and fiscal prioritisation more support for self-care and a growing emphasis on individuals responsibility for their own health a reducing number of care homes. Care homes are developing new models of service (such as intermediate and rehabilitative care) for a more diverse range of residents (for example, people with severe disabilities). Some care homes have been redesignated as housing support services continuing priority on policies and schemes to support carers an increasing emphasis on adult support and protection, along with zero tolerance of abuse of vulnerable adults. Policy and guidance about this is growing 5

8 CARING IN PARTNERSHIP 3 YEARS ON dignity has become a focus of government campaigns. Within these broad policy trends, policies within the four countries of the UK are distinct. 2.2 Scotland Strategy for an ageing population: In March 2007, All our futures: planning for a Scotland with an ageing population (Scottish Executive, 2007a) was published. This is a long-term strategy outlining the opportunities and choice available to people as they get older. It emphasises improving the quality of life for older people and ensuring that services are in place so that people can live a full life as they grow older. Developing Community Hospitals: December 2006 saw the launch of a new strategy to enhance the vital role community hospitals play in Scotland s changing NHS. Developing Community Hospitals (Scottish Executive, 2006a) sets out a blueprint for re-organisation of community hospitals and their services, in order to meet recommendations made in Delivering for Health (Scottish Executive, 2005a). Mental health nursing: In April 2006 a national review of mental health nursing in Scotland and a five-year action plan on developing this workforce were published. Rights, Relationships and Recovery (Scottish Executive, 2006b) aims to improve future mental health services for patients and their families. The main aims are to: support the role of mental health nurses in the recovery of patients mental health and enhance their role in areas such as health improvement, therapy and preventative care strengthen the leadership in mental health nursing improve support to newly qualified staff nurses involve people who have experienced mental health problems in service planning redesign education programmes to prepare people to be mental health nurses increase the number of nurse consultants. More emphasis will be placed on supporting mental health nurses in the workplace and the development of training opportunities for nurses, and the plan sets targets for this. It also sets out an intention to increase numbers of nurse consultants, with emphasis on acute in-patient care and older people. Free personal care: An independent evaluation of Scotland s free personal care policy was published in February 2007 (Scottish Executive, 2007b). It finds that the majority of recipients receive their payments or personal care services without undue delay or complication. It also makes recommendations to improve implementation. Supporting carers: The Future of Unpaid Care in Scotland, published in April 2006 (Scottish Executive, 2006c), set out a ten year vision with four immediate priorities for action: young carers, carers breaks, carers health and carers training. NHS Carer Information Strategies Guidance has been issued. Care home standards: A new initiative to ensure that older people receive the highest quality of care from care homes was launched in March 2007 (Scottish Executive, 2007c). From April 2007, new measures will be introduced, including staff training requirements and clearer information for service users and families. Adult support and protection: A new Bill aiming to offer greater protection to adults at risk of abuse was approved by MSPs in February 2007 (Scottish Executive, 2005b). The Adult Support and Protection (Scotland) Act 2007 will give new powers and a statutory responsibility to local agencies to investigate any risk of harm or abuse to adults living in care homes or in the community. Local health checks: A new wave of preventative care programmes, to be implemented later this year, was announced in February 2007 (Scottish Executive, 2007d). These Keep Well services illustrate the movement from treating ill-health to preventing it, as locally as possible. Resources are targeted where most needed. 2.3 Northern Ireland Restructuring Health and Social Services: Between 2006 and April 2008, Health and Social Services in Northern Ireland will be restructured. Developing Better Services (DBS) (DHSSPS, 2006a): this strategy is changing the way in which health care services are provided throughout Northern Ireland. The 6

9 ROYAL COLLEGE OF NURSING DBS vision is for high quality, safe services which are accessible for all and provided by well trained, motivated staff in modern settings. Priorities for Action Targets : The Planning Framework for Health, Social and Public Safety Services in (DHSSPS, 2006b) sets out detailed targets and objectives that should be reflected in board and trust plans. The framework outlines ten key priorities for health, social and public safety services for improving health and well-being; helping people to live healthier lifestyles, to be actively involved in their own care, promoting their own health and wellbeing and that of their communities safer, better quality services reductions in hospital waiting times significant improvements in emergency care fully integrated care and support in the community improvements in children s services better mental health and learning disability services effective financial control and improved efficiency reforming the workforce infrastructure improvements. The key priorities are supplemented by 40 targets and actions. Two examples relevant to older people are: by 31 March 2008, boards and trusts should contribute to a reduction in the gap in life expectancy between those living in the fifth most deprived electoral wards and the Northern Ireland average from 3.1 to 2.5 years for men and from 2.5 to 1.5 years for women by March 2008, older people with continuing care needs should wait no longer than eight weeks for assessment to be completed and should have the main components of their care needs met within a further 12 weeks. Achievement of the priorities, targets and actions will be closely monitored. Single Assessment Tool: The DHSSPS has commissioned the development of a Single Assessment Tool (DHSSPS, 2005b), to be developed in association with the University of Ulster, which will be used to gather all the information necessary to plan home care services for people with complex needs. This will enable them to continue living at home, with appropriate home care support, or to make a decision regarding the need for nursing or residential home care. Dementia: A new dementia services centre, based on the model of the Stirling Centre in Scotland, has recently opened in Northern Ireland. 2.4 Wales National Service Framework for Older People in Wales: The National Service Framework (NSF) was published in March 2006 (Welsh Assembly Government, 2006a). It aims to improve: the health and well being of older people access to primary and community based services designed to promote older people s independence and support them to stay living in their own homes; access to and quality of specialist health services. The NSF addresses health and social care services across primary, community and secondary care, and focuses on the prevention and treatment of stroke and falls and fractures, services for older people with mental health problems, and the effective management of medicines. The NSF is the main policy drive for dignity in care, and any initiatives in older people s care will be driven through the NSF. The Strategy for Older People in Wales (Welsh Assembly Government, 2007a): Launched in January 2007, this is set in a ten-year framework and provides an action plan with more detailed objectives and programmes. The five key aims are: reflecting 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 7

10 CARING IN PARTNERSHIP 3 YEARS ON 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. Strategy for social services: Fulfilled Lives, Supportive Communities (Welsh Assembly Government, 2007b) sets out the direction for social services between 2008 and Modern, accessible, high quality and personalised care is at the heart of a ten year vision for social services launched in February The strategy outlines a vision of social services centred on the needs of citizens and communities. The focus is on ensuring that people are supported earlier and are helped to retain their independence for longer. Commissioner for Older People: The Welsh Assembly has pledged to appoint a Commissioner for Older People in Wales. The Commissioner will be able to: act as a source of information, advocacy and support for older people encourage best practice in their treatment publish reports and make recommendations issue guidance examine individual cases where wider issues of principle are involved assist an older person to make a complaint or to take a case to court review the effect on older people of the way in which public bodies, such as the Wales Assembly Government and local authorities, carry out their functions. Care package for disabled and older people: The Health and Social Services Minister announced in February 2007 that thousands of disabled and older people on low incomes will benefit from the introduction of extra assistance from the Welsh Government. New safeguards are also being introduced from 9 April 2007 for disabled and older people who are charged for non-residential services by their local authority. Consultation on revised carers strategy: In December 2006 the refocused strategy for carers in Wales was published for consultation. The focus includes health and social care, information on a range of issues to help people provide care, including rights and benefits and medicines management and support. A Carer s Champion has been appointed. 2.5 England A new ambition for old age: Next steps in implementing the National Service Framework for Older People (DH, 2006a), was published in April This sets out the priorities for the second phase of the Government s 10- year National Service Framework (NSF) for Older People in terms of dignity in care, joined-up care and healthy ageing. It consists of ten programmes driven nationally and covers the second half of the ten year NSF Older People: dignity in care dignity at the end of life stroke services falls and bone health mental health in old age complex needs urgent care care records healthy ageing independence, wellbeing and choice. Also published was A new ambition for old age: Next steps in implementing the National Service Framework for Older People: A resource document (DH, 2006b), which provides supporting information for the next steps in implementing the NSF. Continuing care: A proposed new National Framework for NHS Continuing Healthcare and NHS funded Nursing Care in England (DH, 2006c) was issued by the Department of Health for consultation in This had two main purposes: it sets out a single policy on who should receive NHS funding it proposes a standard process for assessing 8

11 ROYAL COLLEGE OF NURSING eligibility for these services, including national tools to support decision-making. The National Framework planned to remove the banding system for NHS-funded registered nursing and the requirement for a separate determination to decide the band. In its place, the NHS will continue to fund registered nursing care via a weekly rate which takes account of a national average. Primary care trusts will continue to be responsible for assessing a person s nursing needs and for deciding what nursing should be provided. In January 2007 the Department of Health issued a Referral Tool (RT) and a second draft of a Decision Support Tool (DST) and in June 2007 the new National Framework for NHS Continuing Healthcare and NHS funded Nursing Care was published (DH, 2007a) followed by Directions. Safeguarding Vulnerable Groups Act 2006: Planned for implementation in 2008, this legislation instigates a centralised vetting and barring system which enables employers to make real time checks of employees through secure access to electronic databases. This aims to provide a comprehensive and consistent measure of protection for vulnerable people in a wider ranges of settings, including the NHS. Dignity in care: A Department of Health national campaign to place dignity and respect at the heart of caring for older people featured: the Dignity Challenge a ten point plan that lays out the national expectations for what constitutes a service that respects dignity a new network of local champions of dignity volunteers working to raise the profile of dignity in care locally the Dignity in Care Practice Guide to help people take up the dignity challenge. National policies are being reviewed, including safeguarding vulnerable adults, complaint reforms, training /registration of the workforce and improving care environments. A Recipe for Care: In this document (DH, 2007b), Professor Ian Philp, National Director for Older People highlighted that new services for older people are helping them to maintain their independence and avoid unnecessary hospital admission. A Recipe for Care identified five key elements of older people s care: long-term conditions managed in the community, integrated with social care and specialist services early supported discharge, whenever possible delivering care closer to home general acute hospital care whenever you need it, combined with quick access to new specialist centres partnership built around the needs and wishes of older people and their families. early intervention and assessment of old age conditions 9

12 CARING IN PARTNERSHIP 3 YEARS ON 3 Internal review of progress 3.1 Review of progress during 2006/2007 In February 2007, RCN forum committee members met for a review of progress on implementing the Nursing Older People Strategy during 2006, from the forum committees perspective. The workshop also agreed a work programme for 2007/2008 and secured commitment to working together on these priorities. Attendees of the workshop are listed in Appendix 2. The workshop aimed to: clarify background, context and purpose of the RCN Nursing Older People strategy record individual contributions to the five core principles explore the strategy s impact on individual forum committee members identify current and effective ways of working and how these may be developed in future plan the work of using the strategy and forum action plans. The meeting also highlighted the achievements of the strategy so far, and ways in which the RCN had continued to work in partnership with older people, through a range of initiatives such as the Education Think Tank, planning the 2007 conference, and developing principles for RCN publications. Forum members acknowledged the efforts of all their RCN colleagues who champion the needs of older people, and the older people, carers and others who are active partners in this process. The rest of Section 3 looks at the conclusions drawn by the workshop through its analysis of the strengths and weaknesses of the Strategy, of the opportunities for the future, and at the ideas it developed for increasing the efficacy of the strategy. 3.2 Evaluating the strategy: strengths The Nursing Older People Strategy: is an important tool for developing opportunities to influence nursing practice (such as improving older people s nutrition or preventing abuse). In particular, it sets out ways of influencing practice through listening to older people s experiences of nursing and what is important to them. gives a framework, focus and direction which the forums lacked before it was developed, and helps work cohesively helps forums work meaningfully with other stakeholders, particularly older people recognises the achievements of RCN work in improving nursing for older people offers opportunities to further raise the profile of older people s nursing, in terms of past achievements and future potential, with the RCN and its members, including through events at RCN Congress 3.3 Evaluating the strategy: ways of working Discussions identified particularly helpful ways of working and considered changes to help the forum committees become more effective in implementing the Nursing Older People strategy. Clarifying the strategy: The document is too wordy to be easy to use, and its purpose is not clearly defined. The document s structure can be restrictive and inflexible, which could reduce creativity if activities were not recorded and developed within the strategy. Ways of improving the document s usability: a user-friendly, short document (possibly an A4 sheet) containing the core principles of the strategy 10

13 ROYAL COLLEGE OF NURSING and summarising its outcomes will make the strategy more widely available a laminated card containing outcomes of the strategy would also improve dissemination aims could be clarified by developing a mission statement/ vision for the future a more tangible action plan for users and practitioners would increase understanding and implementation. Improving dissemination of the strategy: The Congress 2006 fringe event was highly successful, and the profile of the work has been raised in the RCN. To build on this in the future: the document should be more widely marketed through RCN Bulletin, Ageing Matters and on the forum webpage. forum members need more support in disseminating the strategy the summary of achievements could be published in Nursing Standard and Nursing Older People the core principles could be relaunched through the website and Ageing Matters more could be done to show how the document could be used to support activities outside the RCN the strategy could be promoted through another Congress fringe event, and an event organised to celebrate achievements to date the document must be used to be successful. Ongoing evaluation will be important in monitoring its use and the achievement of objectives. Improving communication Communication improved during 2006, particularly via , and there is much better partnership working with older people. Committee members are now clearer about the role of the RCN Adviser and about the expertise that each member brings to the committee. Further improvements: when the Nursing Older People website is running, communication opportunities will increase the development of a forum address would help communication with RCN members a communication template in the form of a standard questionnaire on the website could ask specific questions about RCN nursing older people work and this would help to target responses to ensure that RCN work is responsive to expressed membership requirements. Building links Representation on national groups is working well. For the future, it will be important to: engage with other RCN forums and regional groups around the UK, and in particular to build links with other groups such as the RCN Rehabilitation Forum build further links with external organisations such as the British Geriatric Society engage a wider range of older people partnerships regarding mental health issues bring a nursing student representative onto the forum s committees build international links. Training and direction Forum committee members have gained confidence through their work, as a result of the Nursing Older People Strategy. It was noted that: greater understanding of, and preparation for, working on forum committee would be helpful, as would additional training on specific aspects such as public speaking forum chairs should be more directive about expectations of the work and about deadlines training will be needed for website development. Resources The issue of forum resources, particularly time, is ongoing. Resources available to work on the plan are small there are a limited number of RCN advisory staff, and forum members have full time jobs as well as their forum work. 11

14 CARING IN PARTNERSHIP 3 YEARS ON 3.4 Aims for The workshop clarified the role of activists and staff in taking work forward, and identified priorities for : making the strategy as user-friendly as possible, in order to maximise everyone s opportunity to participate identifying ways the strategy can be disseminated, and helping forum committee members feel empowered to do so keeping up the momentum of implementing the strategy continuing to raise awareness of older people s issues within the RCN membership. The workshop agreed to: build links with other forums and further external groups produce a user-friendly document outlining the principles of the strategy produce a laminated card containing areas already achieved from the Strategy plan a celebration event with external partners publish a summary of achievements in Nursing Standard and Nursing Older People. 12

15 ROYAL COLLEGE OF NURSING 4 Overall summary: Older people strategy objectives Progress to date This section shows the objectives set out when the strategy was established in It shows an outline of work to date towards these objectives. As well as the specific objectives achieved, the strategy also provides a focus for developing the key enabling principles underpinning nursing older people; it can be used effectively to develop the way people and organisations work. For example, at University College London Hospital NHS Trust where RCN Associate Fellow Jonathan Webster is Consultant Nurse Older People, the strategy s five core principles have been used to underpin how staff aim to work with older people and their carers, particularly in clinical practice and service development. A principle document being developed by the trust will link in and be part of strategies for working with older people created by the London boroughs that work with the trust. Milestones Desired outcome Ongoing action Outcomes achieved AIM 1: To ensure older people are valued OBJECTIVE A: The RCN will actively root out age discrimination in its own organisation. A1: To review the RCN human resources strategy to ensure it is not age discriminatory To ensure that the RCN does not discriminate on the basis of age Issues highlighted with Human Resources Department and equality officer of the RCN (June 2005) Achieved. No further action required A2: To work with older people to examine RCN publicity material for negative stereotypes of older people Feedback and views from older people will inform all publications for nursing older people Lead forum member for any new publication will ensure older people have the opportunity to comment on penultimate drafts prior to publication Meeting held with publications team, Better Government Older People and National Pensioners Convention (2005) Publication developed highlighting this intention for Nursing Older People journal (June 2005) A3: To examine the language and internal workings of the RCN to ensure no stereotypes of older people are explicit or implied Language and images are positive and promote the value of older people Language is challenged as necessary Image commissioning works to criteria developed in partnership with older people RCN and Help the Aged exploring some joint work on language as part of the dignity project Publications: images and language addressed in a workshop with publications team and older people 13

16 CARING IN PARTNERSHIP 3 YEARS ON Milestones Desired outcome Ongoing action Outcomes achieved AIM 1: To ensure older people are valued OBJECTIVE B: The RCN will work with other key stakeholders to portray positive images of ageing B1: To work with older people and others to disseminate positive images of ageing Printed material associated with BSc uses positive images of ageing Positive images of ageing are promoted at every opportunity Actions agreed publication developed for Nursing Older People journal (June 2005) Positive images of older people and ageing in content of BSc(Hons) in Gerontological Nursing and all associated marketing Contributed to poster project See the Person OBJECTIVE C: RCN will raise the profile of older person abuse. The RCN will seek to ensure members are alert to its detection and respond appropriately C1: To review existing RCN older person abuse guidance with other interested parties, to identify gaps and priorities for nursing practice C2: To build on the review to develop a framework for good practice for wider dissemination Better informed public and nursing workforce, more able to recognise and respond to elder abuse Ongoing collaboration with partners (Action on Elder Abuse, Help the Aged, Age Concern) and older people s organisations. RCN is a member of Elder Abuse Strategic Alliance (England) Participating in campaigns e.g. with Help the Aged Ensuring that the topic of elder abuse is fed into other RCN projects, e.g. RCN/Age Concern Think Tank Lobbying to ensure mandatory training on elder abuse is incorporated in nurse orientation/induction programmes Awareness-raising activities, conferences, publications Working locally and nationally to raise awareness of elder abuse and educational needs of nursing students Selected topic for RCN political leadership programme T-shirt and badge campaign at RCN Congress 2005 Question to political party representatives at Congress 2005 Presentation at Congress 2006 event Two-page guidance produced and disseminated at Congress 2006 and 2007 Presentation at Congress Students Day Conference presentations February, October and November 2006 RCN Direct fact sheet updated Article published in Nursing Standard On behalf of RCN, gave evidence to Health Select Committee on Protection and Support of Adults Bill (Scotland) OBJECTIVE D: RCN will work with older people to develop its range of services for nurses working with older people D1: To work in partnership with older people to review the RCN nursing older people strategy and progress reports RCN and older people work in partnership on the RCN Nursing Older People Strategy National Pensioners Convention and Better Government Older People members actively engaged in developing and reviewing strategy External stakeholders contributed to the development of the strategy 2004 Better Government Older People and National Pensioners Convention attended review meeting 2005 and 2006 PF and Forums Age Concern members attended review meeting in

17 ROYAL COLLEGE OF NURSING Milestones Desired outcome Ongoing action Outcomes achieved AIM 1: To ensure older people are valued OBJECTIVE D: RCN will work with older people to develop its range of services for nurses working with older people D2: To involve older people in the development of conferences To establish a system to involve older people Older People are actively involved in all aspects of RCN older people conference. Forums and older people worked in partnership to plan and run conference in 2005 D3: To work with older people in the development of RCN publications Publications will appear in different formats depending on the topic, e.g. executive summary or bullet points All future RCN publications for nursing older people will have a nominated lead who will determine how to engage older people as stakeholders Forums working in partnership with older people Forums will encourage working in partnership with older people around the UK Images in publications have been adjusted to show more positive images of older people New documents have an endorsement from older people, e.g. This document has been produced in collaboration with Documents have been produced in appropriate fonts, colours and styles AIM 2: To maximise the potential of older people and nurses OBJECTIVE E: The RCN will support nurses in developing person-centred assessment processes that recognise the need to develop a holistic view of older people s needs E1: To develop a new edition of the RCN Nursing Older People Assessment Tool to reflect the contemporary policy on assessment and ensure it is linked into the single/unified assessment process New edition of publication Nursing assessment and older people: A Royal College of Nursing toolkit published in May RCN Publication code No further action planned E2: To develop paper and electronic versions of the tool for wide dissemination New versions of the tool Paper and electronic versions of tool produced in 2004 No further action planned E3: To provide guidance, advice and training on the use of the RCN Nursing Older People Assessment Tool To support nurses and organisations in their use of the tool As requested by organisations Nurses and organisations supported in their use of the tool as requested and upon demand 15

18 CARING IN PARTNERSHIP 3 YEARS ON Milestones Desired outcome Ongoing action Outcomes achieved AIM 2: To maximise the potential of older people and nurses OBJECTIVE F: The RCN will work with its forums and older people to develop a more positive approach to risk management F1: In partnership with older people the RCN s older people s forums will explore ways in which they can promote practice that maximises potential RCN is seen to contribute and influence policy development and practice Ongoing through forums, adviser, associate fellows and activists The RCN contributed to ( ): NHS Estates consultation on inpatient facilities for older people Department of Health work on information for choice Department of Health consultation on advocacy Vulnerable Adults England Forums Vulnerable Adults Scotland National Institute for Clinical Excellence and Health (NICE) work on falls National Institute for Clinical Excellence specialist adviser Setting up local groups for Nurses working with Older People in Eastern Region (CR) and with RCN Scotland in Scotland Founder member of Dementia Care Network in local area Elder restraint project with National Patient Safety Agency Contributing to Ask the Experts, Nursing Older People journal Contributed to the consultation for the Mayor of London s Towards an older people s strategy for London aimed at challenging negative perceptions and promoting the contribution older people make to London 2005/2006 Following consultation with members, made presentation at the Mayor of London s Capital Woman event 2006 Contributed to the original project Let s Respect Toolkit and currently involved in follow up work Member of the working group of the British Geriatrics Society to produce guidelines on Advanced Planning Member of Department of Health working group on Information prescriptions Jane Bleach F2: To prepare new material on rights, risks and the use of restraint New materials Restraint revisited rights, risks and responsibility: Guidance for nursing staff published January Publication code

19 ROYAL COLLEGE OF NURSING Milestones Desired outcome Ongoing action Outcomes achieved AIM 2: To maximise the potential of older people and nurses OBJECTIVE G: The RCN will influence the learning and practice development of nurses so that they can maximise the potential of older people G1: To promote the RCN BSc(Hons) in Gerontological Nursing to increase its take up Increased focus on RCN work to promote the educational needs of nurses working with older people Increased numbers of nurses working with older people undertaking this programme Marketing strategy continues to be implemented Innovative work on developing methodology to evaluate impact on practice Support of nurses on the political leadership programme wishing to influence the development of pre-registration curricula across the sector Recruitment now increased Help the Aged bursaries ( ) Education think tank for external stakeholders with Age Concern Age Care Awards evaluation research project Help the Aged have agreed to continue to sponsor G2: To develop a new edition of outcome indicators for nursing in continuing care New publication New edition of What a difference a nurse makes published in Publication code No further action planned G3: In partnership with Government nurses and RCN leadership programme, explore the potential for providing older people-specific clinical and political leadership programmes The potential of leaders in older people s care is maximised Forums participating in political leadership programme Department of Health commissioned Clinical Leadership for Nurses Working with Older People Programme sponsored by Department of Health in England. Completed and well evaluated Network established Political leadership programme mentorship undertaken ( ) Forums participating in political leadership programme Leadership programme in Dublin commissioned for Directors of Nursing Campaign for equal access to mental health services based on need, not age. Measured outcomes in influencing/changing the national agenda Two forum members are undertaking RCN Political Leadership Programme in 2006 Sponsorship for two forum members to the Political Leadership Programme. Completion of course and feedback to forum members. G4: To work with representatives of NHS and primary care trusts and the Independent Sector to develop a programme for rotational opportunities for nurses to move between acute and community settings, to broaden experience and understanding Evidence of best practice is disseminated Forums ongoing action Local initiatives, for example possible area for collaboration in Ellesmere Port and Neston PCT where two rotational posts between acute and community settings were quite successful. Experience may add to RCN learning Information collected on current opportunities being offered to staff and impact evaluated Results fed into the Education Think Tank No further action planned 17