Blueprint for improving standards of elderly care

Most of Scotlands hospitals have a good record of care. Picture: Ian Georgeson

THERE is a question which increasingly comes from our newspapers, TV, social media feeds, news websites and sometimes our friends and family.

Are those who should be looking after older people in our society – when they are at their most vulnerable – doing so with compassion, dignity and respect? If not, what is being done about it?

This subject is very close to our organisation’s heart. We have been carrying out independent inspections for the care of older people in Scotland’s NHS hospitals for just over a year. The good news is that, in the majority of our observations, we see staff treating older people with compassion, dignity and respect. However, in addition to the positive content of our reports, there has been uncomfortable reading for the hospitals concerned and for the public.

One thing is very clear to us: simply criticising the standards of care is not enough to ensure that change happens.

And that’s why, in Scotland, we do things a little differently. It may be a surprise to many but our NHS boards are open to constructive criticism – it helps them improve. However, sometimes additional help is required, especially when systems need to change or old habits are hard to break. So here’s the well-kept secret: your watchdog is actually more than a watchdog. Our organisation’s name – Healthcare Improvement Scotland – has “improvement” at its centre and with good reason. It is our main reason for being. Although we scrutinise and report publicly, we do not scrutinise and criticise to make headlines, but to help make improvements happen for patients.

Making improvements for patients a reality

First and foremost, it is NHS boards across the country who are responsible for, and make, improvements to the care we all receive. An organisation like ours cannot be in every area of every hospital at all times. However, in addition to our inspections and scrutiny we provide advice, support, tools and encouragement when it is required. We have a team of skilled improvement specialists who help ensure independent inspections are backed up with the kind of assistance needed to make many improvements for patients a reality.

Take the care of older people. Aligned with our inspection programme is an improvement support programme. It is a two-year programme which works with NHS boards to improve the care for older people in acute care by focusing on two key areas: identification and management of frailty, and identification and immediate management of delirium.

To make real change, people across the NHS in Scotland have to work together and our programme recognises this. We are engaging healthcare teams from acute hospitals across Scotland, piloting new approaches to delivering care, and sharing good practice on what activity is making the biggest difference.

To scrutinise, you need standards or guidelines to inspect against. In the case of older people in hospital care we measure performance against national guidelines, standards and good practice statements in

• dementia and cognitive impairment

• treating older people with compassion, dignity and respect

• preventing and managing falls

• nutritional care and hydration, and

• prevention and management of pressure ulcers

Many of these are produced by Healthcare Improvement Scotland and all are produced using the best international evidence known. They result in clear expectations from our healthcare system that every patient has the right to expect and this is what we scrutinise against.

Some might say Healthcare Improvement Scotland has a pioneering role. We are certainly supporting change through a unique combination of evidence-based standards and guidelines, improvement support and a scrutiny regime that is fair but challenging. Not many countries work the way that we do in Scotland, but we think it’s progressive, forward-thinking and could be a blueprint for the future.

• Denise Coia is chair of Healthcare Improvement Scotland, www.healthcareimprovementscotland.org

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