The National Service Framework for Older People: Demonstrating Care Practice in the Community

Introduction
This task aims to discuss a range of learning outcomes pertaining to care practice in the community, focusing specifically on the National Service Framework (NSF) for older people. The topic is discussed in parallel with the application of the minimum care standards and current policies that impact on older people as the specific target group for the care provision, as well as with the principles of practice in community care and the roles of formal and informal carers.
The conceptualisation of the NSF is based on the notion that improving the quality of care necessitates specific standards to measure such care and that such standards are evidence-based in order to determine their effectiveness (Nazarko, 2004).

The function of the NSF is to establish quality standards for social care. Its aim is to help older people in their long sustenance of healthy active and independent life. It specifically prevents needless hospital confinements and supports early hospital release. Its provision of specialist care is towards reducing long-term illnesses, in which healthy lifestyle is promoted to older people. The framework also ensures the importance of respect when facilitating care to older people, who are the most numerous of healthcare consumers (McDonald, 2010).
Learning Outcome 1: Applying the minimum care standards and relevant current policies
The NSF has eight care standards for older people, such as those dealing with age discrimination, individual-centered care, intermediate care, and healthy and active life promotion in older people, amongst others. Eliminating age discrimination as a care standard of the framework demonstrates how the NSF applied the minimum care standards. This is shown in its goal to provide services based on clinical needs alone and discounts any issues of age. Moreover, age will not be used by the framework’s implementation of social care services in specifying eligibility policies (McIntyre and Atwal, 2013). This focus on the removal of age discrimination in care provision is apparently to ensure that all older persons are equally provided with their needed care.
The second standard of care specified in the NSF clearly recognises the older people’s ability to make choices concerning the kind of care they receive. The framework ensures this through the adoption of the process of single assessment, and such other services ensuring this aspect for older people (McIntyre and Atwal, 2013).
The promotion of independence in care provision amongst older people is also seen in the framework’s third standard of care, which is intermediate care. It is emphasised that a new variety of intermediate care services will be accessed by this target group at home or in selected care settings to elevate their independence, alongside the help of the National Health Service (NHS). Further, the prescribed general hospital care specified by the Framework’s fourth standard of care speaks of the delivery of hospital care for these people, which is through proper specialist care by hospital personnel who possess the needed skills that will enable older people to meet their needs (McIntyre and Atwal, 2013).
The prevention and treatment of stroke amongst older people is also recognised by the NSF, and this is specified in its fifth standard of care. The NHS is the primary agency whose prevention of stroke amongst this target group is taken action. Through partnership with other relevant agencies, the NHS provides diagnostic services to those who are suspected to have undergone stroke and provides appropriate treatment through its specialist stroke services. It is important that carers participate in this stroke prevention and rehabilitation programme.
The sixth standard of care specifies the provision of the prevention of falls amongst older people, in which it purports to reduce resultant injuries. With the partnership working with councils led by the NHS, older people experiencing falls are provided effective treatment and rehabilitation. The NHS and the NSF recognise the importance of providing information to carers on fall prevention of older people; hence, as service users, they receive advise on the matter through a specialist falls service.
NSF’s seventh standard of care involves mental health of the elders. The framework ensures the provision and access to integrated services for mental health for those who have mental illnesses, which are through the NHS and councils. The eighth standard of care, on the other hand, involves health and active life promotion amongst older people, which is undertaken through synchronised programmes of action whose head is the NHS, aided by councils (McIntyre and Atwal, 2013).
Legal and political framework surrounds the care practice for older people, such as the Fair Access to Care Services, which specifies eligibility criteria for people needing care and identifies the amount of support that can be expected to help them get well and healthy. Moreover, the NHS and Community Care Act 1990 brought about major changes in the manner in which community care services must be provided. The change to funding arrangements for the care provision in the independent sector is considered one of the changes ushered by this care policy (Crawford and Walker, 2008).
Learning Outcome 2: Discussing the principles of practice vis-a-vis care provision in the community
The central philosophy of community care is that patients have a great involvement in their own care and that a large or small institution can be replaced by a quasi-institutional setting (Daily Telegraph, 2007). Community care does not simply involve the question of transferring people from large institutions into smaller care settings, but arguably poses as a challenge to conventional theory and practice. Community care pertains to the provision of the exact level of support in order for older people to attain maximum independence in their own lives. In order for this to take place, the development of broad services for a range of settings is necessary. It must be noted that the core philosophy of community care is to undertake all possible things to promote patients’ independence and autonomy (Salter and Turner, 2008). The principles of care practice for older people lie in the idea that older people and their opportunities for well-being must be valued, and their psychological growth must be promoted rather than focusing on their deterioration (Nursing Midwifery Council, 2009; Hudson and Moore, 2009). Such underlying principles of practices in community care provision for older people is fostered further by the introduction of the NSF, which is considered one of the most strategic approaches in health care optimisation in the UK. This is because the NSF includes the recognition of cultural and social contexts in care provision and the importance of stressing these when designing health care programmes to meet the needs of older people. The framework is therefore carried out in partnership with social care and other organisations in tackling the various factors impacting health (Linsley, Kane, and Owen, 2011).
The NSF for older people establishes definite goals to address some of the vast challenges to health and long life. It describes a service model of care that aims to foster good metal health and early detection and diagnosis. Further, it tackles the need for personalised support and care in community settings by putting intermediate care facilities in utmost priority (Linsley et al., 2011). It is also worth-noting that the process of care provision for older people is associated with the multidisciplinary approach of Single Assessment Process (SAP), whose aim is the standardisation of the assessment processes for older people alongside NSF’s goal to foster independence for them, a principle that is highly pronounced in the Framework (Parker and Bradley, 2010).
The NSF is geared at enabling more responsive, effective, and accessible public services that are linked to addressing the needs of older people and providing world-class health and care services to them (Welsh Assembly Government, 2011). The Framework serves as a channel for delivering the principle of universal care based on the needs of every individual, in which these needs are assessed against available services, which promote health, independence, and dignity. Moreover, the NHS and care services regard older people as ones who are capable of making their own choices about the kind of care they will receive, which is attained through community apparatus and continence services. The promotion of person-centered care embodied in the NSF is in fact a guarantee to good practice (Wallace and Davies, 2009). The standards set within the NSF demonstrate underlying principles that ensure the basis of care, which is clinical need, rather than age, and that older people must be treated as individuals where their quality of life and independence are promoted alongside their right to make choices on the specific kind of care to be received (Worsley, Mann, and Olsen et al., 2013).
Learning Outcome 3: The roles of formal and informal carers
A carer can be defined as a person who provides regular service to a person needing care who lives in his/her own home or elsewhere. Formal carers are paid individuals whose profession is to perform a specific caring or support role. Informal carers, on the other hand, receive no charge in their care provision and/or support (Alcock, May, and Wright, 2012). A range of activities and locations are covered by the roles of the formal carers, such as undertaking such care of older people in an institutional setting or in their own home. In the case of older people most specially, it is likely that informal or family carers may be present to care for them. Despite their ‘informal’ category as carers, informal carers have a role in the care of older persons, specifically in the care planning and/or the process of assessment. Along with the roles of carers is the necessity for service providers to become sensitive to the needs of carers and regard them as partners in providing care to the elderly (Clissett, Porock, and Walker, 2013; Boom, 2008).
A key policy principle has been identified in the form of helping older people achieve independence whilst being connected to the community. Both formal and informal carers play a role in community care, which is within a systematic planned approach that keeps the carer as an integral element of the care system, with potential benefits for older people needing care. The carer plays the role of working in partnership with the patient and the services toward shared goals, including patients’ decision making about their care (Carnwell and Buchanan, 2008; Nay and Garratt, 2009).
The past decades witnessed changes in the concepts associated with the carer support sector. As it is necessary to distinguish formal from informal care, there is increased recognition of the fact that carers also have their own needs to be met. This is aligned to an evolving role of carers from being understood to carry the burden of care towards a strength-based approach to care (Nay and Garratt, 2009).
It must be noted that there are several activities and functions that only formal carers – not informal ones – should perform, given their adequate knowledge, skills, and training. However, informal carers are also capable of receiving care training from formal carers in carrying out certain tasks (Leichsenring, Billings, and Nies, 2013). Home care integration is not possible in the absence of the active role of informal carers who serve as providers of direct care and who also manage and coordinate a range of support services that older people needing care must receive, such as recruiting and screening care workers. This is specifically true as long-term care needs cannot be covered completely by care system through professional services. Moreover, the role played by informal carers in caring for older people who are service users constitutes the major difference between care provided at home and that which is provided by care institutions (Tarricone and Tsouros, 2008). Informal carers are also increasingly viewed as co-workers who undertake a variety of tasks previously confined to trained formal carers. They are assumed to perform more increasing responsibilities, such as monitoring and medicating. The shift from formal carers to informal carers in care provision to older people is furthermore seen as a deliberate step by formal care services (Milligan, 2009). In addition, as older people increase in number, it is likely that informal care would receive growing reliance in order to link the existing care gap (Lamura, Donner, and Kofahl, 2008; Oliviere, Monroe, and Payne, 2011).
Conclusion
This paper discusses three learning outcomes on care practice in the community, whose focus is the National Service Framework (NSF) for older people. It highlights the minimum care standards and relevant current policies found in community care, as well as the principles of practice in community care provision and the roles of formal and informal carers. NSF’s care standards are tackled to address care provision for the elderly. The NSF therefore fulfils care provision in the community and demonstrates the principles of practice.
The central principle of community care is that patients are greatly involved in their own care and have the right to choose specific care services. Community care involves support that allows older people to attain utmost independence and control of their own lives. NSF demonstrates the principles of care practice through more responsive, effective, and accessible public services that are linked to the care provision for the elderly.
Formal and informal carers have corresponding roles to play in the care provision, and the activities and functions played by formal carers are now extended to informal carers. However, there is increased recognition of the strength-based approach to care from understanding carers as ones that carry the burden of care.
References
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Boom, H. V. D. (2008) Home nursing in Europe: Patterns of professionalisation and institutionalization of home care and family care to elderly people in Denmark France, the Netherlands and Germany. The Netherlands: Institute Zetten.
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Bibliography
Alcock, P., May, M., and Wright, S. (2012) The student’s companion to social policy. First Edition. London: Blackwell Publishers Ltd.
Boom, H. V. D. (2008) Home nursing in Europe: Patterns of professionalisation and institutionalization of home care and family care to elderly people in Denmark France, the Netherlands and Germany. The Netherlands: Institute Zetten.
Carnwell, R. and Buchanan, J. (2008) Effective practice in health, social care and criminal justice. London: Open University Press.
Clissett, P., Porock, D., and Walker, W. L. (2013) Placement learning in older people nursing: A guide for students in practice. China: Elsevier.
Crawford, K. and Walker, J. (2008) Social work with older people. Second Edition. Southernhay East: Learning Matters Ltd.
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Daily Telegraph (2007) Caring for loved ones – being a carer, paying care, choosing a care home. UK: Telegraph.
Hudson, A. and Moore, L. (2009) Caring for older people in the community. NJ: John Wiley & Sons.
Lamura, G., Donner, H., and Kofahl, C. (2008) Family carers of older people in Europe: A six-country comparative study. Berlin: Lit Verlag.
Leichsenring, K. Billings, J. and Nies, H. (2013) Long-term care in Europe: Improving policy and practice. First Edition. NY: Palgrave MacMillan.
Linsley, P., Kane, R., and Owen, S. (Eds.) (2011) Nursing for public health: promotion, principles, and practice. London: Oxford University Press.
McDonald, A. (2010) Social work with older people. London: Polity Press.
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Nursing Midwifery Council (2009) Guidance for the care of older people. London: Nursing Midwifery Council.
Oliviere, D., Monroe, B., and Payne, S. (2011) Death, dying, and social differences. Oxford University Press.
Parker, J. and Bradley, G. (2010) Social work practice: Assessment, planning, intervention and review. Third Edition. London: SAGE Publications Ltd.
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Wallace, C. and Davies, M. (2009) Sharing assessment in health and social care. A practical handbook for inter-professional working. London: SAGE Publications Ltd.
Welsh Assembly Government (2011) National Service Framework for older people in Wales. Retrieved on October 26, 2013 from http://www.wales.nhs.uk/documents/nsf%20for%20older%20people.pdf
Worsley, A., Mann, T., Olsen, A., and Mason-Whitehead, E. (2013) Key concepts in social work practice. London; SAGE Publications Ltd.

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