Memorandum by Age Concern England
RELATIONSHIP BETWEEN HEALTH AND SOCIAL SERVICES
(HSS 34)
6. TRAINING AND
PROFESSIONAL BOUNDARIES
Training needs
6.1.1 Older people make greater use of both
health and social services than younger adults. Age Concern believes
it vital that training in general practice, social work, therapy,
nursing and medicine should take greater account of the ageing
process, and of the medical needs, treatment programmes, changing
social circumstances, and potential of older people.
6.1.2 It is equally important that those
providing services for older people through a contractual relationship
with statutory authorities have undergone appropriate training
to relevant levels, and that opportunities are taken by statutory
authorities to offer training to private and voluntary sector
providers. All staff must receive regular, ongoing training to
keep them up to date with relevant changes in treatments, systems,
legislation or local processes. This requires recognition by all
professions of the likelihood that they will come into contact—or
need to access—professional support and services external
to their professional knowledge. Joint training sessions which
front-line social services, health, housing and independent sector
provider staff attend could, for example, help ensure that all
those involved in the delivery of services, equipment or treatments
have a common understanding of each other's work, and thus are
able to identify when, and how, to appropriately refer an individual
older person.
6.1.3 Training in different professions
must include aspects which fully reflect the likely nature of
work. For example, occupational therapy training must, given the
high likelihood that occupational therapists will work in the
world of housing adaptations and equipment, include relevant training
in housing.
6.1.4 A key requirement, particularly in
the delivery of community care, continuing health care, and housing
adaptations, is knowledge about and understanding of variations
in criteria set by different authorities. If the Government sets
national eligibility criteria they could become a required element
of training for all professional and ancillary staff, proving
an extremely useful and effective tool for inter-agency work across
professions.
6.1.5 Age Concern believes that:
— training for all those who work
closely with older people should contain multi-discplinary elements,
be relevant to the demands which will be placed upon them, and
should encompass workers within the statutory, private and voluntary
sectors.
Professional boundaries
6.2.1 It is vital that manpower planning
examines the skill elements required for effective service delivery.
For example, the shortage of trained occupational therapists in
some parts of the country continues to contribute to delays in
assessments of older people for aids, equipment and adaptations.
There is also a wider need to address the broad and longer-term
training and personnel requirements for the future, particularly
as the post World War II and 1960s "baby boomer" cohorts
reach retirement and older age in the next century. This cannot
be done without revisiting professional boundaries for the delivery
of an effective service.
6.2.2 In addition, attention should be paid
to those professions which are dedicated to the care of older
people. For example, multi-disciplinary assessments of older patients
and hospital discharge procedures are carried out more effectively
in specialist geriatric wards than on other wards and the skills
of geriatricians should be available to other colleagues within
the hospital both in terms of identifying appropriate services
for older people and reducing readmissions. (Services for people
who are elderly, Health Advisory Service, 1997).
6.2.3 There are some concerns as to where
professional boundaries may be leading the provision of care for
those with highly dependent needs who are not living in NHS settings.
In particular, these concerns centre on the questions raised by
the General Medical Services Committee as to how needs for general
medical services for such individuals should be met in the future.
The valuable role geriatricians could play in community settings
needs to be fully recognised and greater emphasis must be placed
on the need for GP training in the care of very frail older people.
6.2.4 Many older people continue to be affected
as professional boundaries are redrawn. In particular, this has
affected their access to some NHS services. For example, many
nursing tasks, previously carried out by NHS staff, are now carried
out by care assistants or non-registered nurses. These include
the supervision and administration of medication; bathing services;
and general nursing care in nursing homes. In some areas, unqualified
care assistants and not NHS chiropody staff may undertake simple
nailcutting tasks. Reports of older hospital patients not being
assisted with eating, (Hungry in hospital?, ACHCEW, 1997),
raise serious concerns as to whether professions generally follow
an holistic view of care.
6.2.5 This is not to suggest that improvements
in treatments and services do not involve professionals in increasingly
complex and technical tasks. However, it does seek to question
why some services are not only no longer provided by those professionals
but, certainly in the case of the NHS, are no longer considered
part of its proper or central role so that, surreptitiously, services
are taken away by the state with no effort to consider how they
will otherwise be provided for individual older people.
6.2.6 There may be a need to reconsider
the "community carer" post envisaged by Sir Roy Griffiths,
working across health and social care boundaries. Such a post
might take on the work of home help or home care assistants, community
nursing assistants and residential care staff, for which specific
training from both health and social care professionals would
be required.
6.2.7 Age Concern believes that:
— the Government must review the
way in which redefinition of professional roles leaves vulnerable
older people in the community with insufficient skilled care.
— the potential for geriatricians
to play a key role in community settings and the importance of
the need to train GPs in the care of very frail older people should
be central to any discussion for future manpower needs, so that
individual older people receive the most appropriate NHS care.
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