ABSTRACT
High-quality services for older people need to be planned. Developing these services requires a detailed knowledge of many aspects of health and social care, and an appreciation of current national and local political, economic and sociological factors, and a prediction of how they may be likely to change. This needs to be related to local factors such as geography, transport and culture and compared to existing resources, and their uses. In this chapter we discuss the demographics of the older population, review the range of services used to deliver care to older people, and discuss how these services may change. (See also the chapters on rehabilitation by Young and preparing for a consultant post by Patterson and Brown.)
REFLECTIONS ON THE EVIDENCE BASE AND IMPLICATIONS FOR GOVERNANCE
Clinical governance will emphasise the use of interventions proven to improve patient outcome in the most cost-effective manner. Many older patients do not present with a single diagnosis. They therefore differ from the patients included in most clinical trials on which evidence rests. Many will have multi-system disease. Often their social circumstances are precarious, and may be as important in considering discharge plans as their medical conditions. It may be difficult to show benefits from some components of multidisciplinary interventions. This will have implications for older patients when commissioners of services (Primary Care Groups, Trusts, and Health Authorities) are allocating scarce funds and demanding evidence. Throughout this chapter, key points are accompanied by some of the potential
questions on governance. Readers are invited not only to consider how these issues impinge on their current practice, but also to reflect on their own practice.
