Promises to listen to our elders

The “Care Standards for Older people in Hospital”, which replace the previous 13 year old standards, were published this month.


As a doctor working in NHS Scotland whose work for twenty years has been dedicated to our elders, I submitted feedback on the initial draft. I started out by saying:


With the recent  publication of the Standards I wrote to the Chair of Healthcare Improvement Scotland asking for clarification on the involvement of “older people” in the development of these NHS Scotland standards.


In the Scotsman, the Chair of the the group developing the Standards, Dr Christine McAlpine stated that “we need to involve patients”:

Care Standards 12 June 2015a

In this article, Dr MacAlpine said:

Care Standards by Dr MacAlpine1

The Editor of the Scotsman summarised:

Care Standards in Scotsman - 9 June 2015b

Healthcare Improvement Scotland and Dr MacAlpine have stated the following:


[Please note: my appreciation is that 1345 may not actually 
represent 1345 separate individual comments. I say this as my 
two-page feedback on the drafts was separated into more than a 
dozen entries.  This would appear also to be the case for 
other "stakeholders"]

Having read though all the responses I found that none of the responses read as if ‘first-person’ comments. The comments read as if almost entirely by “stakeholders”. If so, this would represent Scotland’s elders by-proxy.

Unsure about this, I wrote to the Chair of Healthcare Improvement Scotland, for clarification. The following was confirmed:


Healthcare Improvement Scotland have fully listed the “stakeholders” involved in the Consultation:

Consultation Feedback Report (stakeholders) Care Standards 2015

Having read carefully through all 1345 comments I am still left wondering whether the voices of our elders have been given reasonable opportunity to be heard? [proportionate to the experts, the stakeholders, and those directly tasked with authorising the final standards]

The ‘ladder of participation’ [below] has been widely cited in collective approaches to developing and drawing-up the best approaches to care:ladder of involving our eldersIn my letter to the Chair of Healthcare Improvement Scotland I asked for the average age of those directly involved in developing the Care Standards.

I also specifically asked if anybody deemed an “older adult” was part of the group who were tasked with drawing up these Care Standards for “older people”.

The reply I received from Healthcare Improvement Scotland stated that such information is exempt “in line with Data protection policy.”

Long before the final Care Standards were published I gave the following personal considerations on the draft Care Standards :

016 comment on Care Standards 2015

In the same week that the Care Standards for Older People  this analysis was published in the BMJ.


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