General Points

• We believe it is right that spending on the NHS in Wales has been protected but this will only be sustainable if that continues on a fully shared and co-productive basis with social services so that they are equal partners in principle and practice. The two services are inter-dependent in respect of caring for older people.
• Whilst an ageing population has meant that increased numbers of older people are benefitting from care in the NHS – by far the largest group in hospitals – that does not mean is it fair to “blame” older people for the financial burdens on the NHS. In fact, other increased burdens such as for buildings, technology and especially care innovations and medicines have risen far more significantly than because there are of more older people.
• Older People should be more involved in their own health and care and be provided with the information and support to better manage their medical conditions. More care should be delivered in older people’s own homes or closer to home, with a greater investment of resources in district nursing, general practitioners and social care.
• We support the case for change and development of new models of care proposed by the Parliamentary Review of Care in Wales (2018) but want to see that older people are meaningfully involved from the outset in the redesign of those services that will impact on their lives.
• The ambition to move more care out of hospitals and into the community and to instigate a primary-care led approach has much to benefit Older People. The commitment to make that happen and to shift resources from the acute sector into the community has been insufficient and needs stronger leadership and a clear plan.

What Do Cymru Older People’s Alliance Want To See:

Hospitals

• The protection of the older persons dignity and privacy during their hospital stay must be given the highest priority. They must be treated in the best way possible to meet their clinical and personal needs and not by reference to their chronological age
• The sharing of patients’ personal information in hospitals in the hearing of others must not happen. Neither should older people be expected to be asked to regularly repeat information about themselves and their medical histories.
• Care for older people with dementia in acute and community hospitals, must be improved through more training and support, better communications, and informed care.
• Discussions with older people in hospital should take account of any hearing or sight problems they may have. Relatives or friends should not be asked to routinely substitute for the older person in providing personal information and only unless absolutely necessary – it should normally be obtained directly and supportively.
• Older people must always be discharged from hospital in an effective and timely manner and not wrongly labelled as “bed blockers” which is insulting
• Staffing levels in hospitals, particularly at ward level must reflect the needs and volume of older people so that the time is available for decent care and meaningful interaction with older people.
• Hospitals must be responsive to the individual needs and requirements of older people and in particular the operation and monitoring of effective systems for assistance with eating and drinking and monitoring nutrition levels.
• It is vital that there are arrangements in place for Carers involvement in the older person’s hospital journey including discussions about discharge and on-going support needs at home.
• Schemes that promote knowledge and awareness of the needs of older people amongst ambulance and paramedic staff and other health professionals are beneficial and should be further promoted.

GPs and Primary Care

• Arrangements for Older people making an appointment to see a GP should be responsive to their individual needs and circumstances especially those living with sensory loss, dementia or a cognitive impairment, as well as their carers. Waiting times for appointments for older people should be minimised.
• Greater continuity of care is important to Older People as they build up confidence and trust with individual GPs and their staff and find it difficult when there are constant changes in the GP or nurse that they see.
• Accessibility of Primary Care Centres and GP buildings can be a barrier to good medical care for some older people, especially when there are problems with meeting their communication needs e.g. the use of hearing loops, seating, use of audio-visual announcements as well as physical barriers such as queuing and the use of automatic doors.
• The practice of Receptionists at GP surgeries asking individuals to describe the reason for an appointment i.e. to ensure they’re seen by an appropriate professional must be handled appropriately and explained to older people to avoid unnecessary distress and putting the privacy and dignity of the older person at risk.
• The perception that older people can only raise one issue within a ten-minute GP appointment can put their health and safety at risk particularly those living with a vulnerability such as sensory loss, dementia or cognitive impairment, or a complex condition.
• Older People requiring access to GP services in the Welsh language are experiencing delays and this must be addressed at a national and local level.
• Awareness of the existence of appropriate alternatives to seeing a GP (Nurse, health professional, Pharmacist) and support to access these should be explained and promoted for older people.

Approved by the COPA Board of Trustees June 2018