APPENDIX 13
Supplementary evidence by CDNA (18A)
QUESTIONS ASKED BY JOHN AUSTIN MP: 11 DECEMBER
2003
1. ROLE OF
THE HEALTH
VISITOR WITH
REGARD TO
VISITING THE
ELDERLY
The 1990 GP Contract placed a contractible obligation
upon GPs to undertake health/independence check on all people
over 75 years of age. This obligation could be carried out by
the GPs in whatever way they felt was suitable for their practice.
Some GPs employed nurses and health visitors specifically to undertake
the checks but in many cases the "checks" were carried
out either by community nursing staff as an additional duty or
by practice nurses and the GPs themselves on an opportunistic
basis.
Research has shown that the content and quality
of the checks was very questionable, some practices undertaking
very thorough health and social checks whilst others using cards
produced by drug firms, a tick style check.
Due to the actual volume of the work and the
number of fit active 75 year olds most practices found that some
form of criteria had to be introduced in order to ensure that
those who could be in need were the patients that were seen, many
patients in the "at risk" category would be known to
the practice staff. Some form of criteria would be arrived at
to identify patients that may require assistance to maintain health
and independence.
The questionnaire would be sent to patients
on or around their birthdays asking questions such as:
— Do you take more than three medicines?
— Have you had a fall in the last six
months?
— Can you get into a bath or shower
unaided?
— Do you require help/aids to walk?
— Have you any problems you would like
to discuss?
— Any affirmative replies would then
ensure that the patient would then either receive a telephone
call or a visit.
This "check" enabled the identification
of many health and social problems if carried out diligently,
however the majority of staff carrying out these checks would
have been unable to recognise abuse or abusive situations and
it is also doubtful that many patients would disclose an abusive
problem in a short one-off meeting.
The new 2003 GP Contract contains no obligation
on the part of GPs to offer health checks to older patients so
in many areas these existing checks will cease.
2. TRAINING FOR
NURSES ON
RECOGNITION AND
RESPONSE TO
ABUSE OF
THE ELDERLY
At present nurse training in the recognition
and response to abuse of the elderly and vulnerable person is
not a mandatory requirement. The Nursing and Midwifery Council
(NMC) give the educational establishments guidance and instruction
on the content of the courses they run and they validate each
course. This ensures that all courses, and all nurses have the
same basic instructions, the same level of training. It also enables
the educational establishments some independence, allowing lecturers
with special interests the opportunity to include their subject
in the curriculum.
The NMC have no plans at present to include
elder abuse into the curriculum of pre-registration students although
the Community and District Nursing Association (CDNA) will continue
to apply pressure on them to do so. We believe that students entering
the nursing profession should be aware of the problem and at least
be able to recognise professional abuse and know enough not to
follow poor, or abusive practice. This knowledge of where and
how to report incidents they observe will be especially important
as in many areas student nurses now have practical placements
in private nursing homes.
The subject should also be included in all courses
that involve care of the elderly. The majority of nurses working
in Accident and Emergency departments, elderly care wards and
community settings have no training in the recognition of abuse—this
training should be mandatory. Mandatory training at present includes
Child Abuse, Resuscitation, Moving and Handling Patients, Fire,
and in some areas Continence care.
The CDNA believe that training should be introduced
into all courses that involve the vulnerable and elderly and also
included in the annual refresher training courses.
17 December 2003
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