The National Clinical Programme for Older Persons is a joint initiative between HSE Clinical Design and Innovation and the Royal College of Physicians of Ireland. The overall aim of the programme is to improve and standardise the quality of care for older people in Ireland.

The majority of older people are well, living independently in the community. With improved life expectancy, however, an increasing number of people suffer from multiple chronic illnesses, frailty, poly-pharmacy and other syndromes associated with ageing

The majority of older people are well, living independently in the community. With improved life expectancy, however, an increasing number of people suffer from multiple chronic illnesses, frailty, poly-pharmacy and other syndromes associated with ageing.

High quality health and social services for older people provide continuity of care, integrated between care settings. There are a number of key constituents to  comprehensive  services  including  GP  care,  public  health  nursing,  home  care  supports,  acute  hospital care,  rehabilitation  and  long-term  care. 

The ultimate goal is to facilitate the older person to lead an independent life, with dignity, at home in the community. Therefore the appropriate services must be available to each person when and where required. 

While most health care for older people is provided in the community, acute deterioration in health may result in referral to an acute hospital.

Older  people  with  complex  illnesses  and  deteriorating  health  benefit  from  specialist  geriatric  services, provided  in  a  dedicated  ward  by  a  multidisciplinary  team. In addition to improving patient outcomes and increasing service efficiency, specialist services can contribute to training and advise on the care of older people by other services in the hospital and community settings.

The National Clinical Programme for Older People is completing work across all settings where Older People require care including hospital and community. The objectives of the National Clinical Programme include:

Quality                                                                                                      

• Support the planning and delivery of health and social services for older people.
• Support older people to remain at home by optimising independence and clinical outcomes.
• Support the provision of services across all settings to optimise patient outcomes and independence by the provision of appropriate alternatives of care eg. day hospitals for older people.
• Improve the management of ill older adults across all health and social care settings

Access

• Every patient should have quick access to the right care in the right place at the right time including timely access to community and home care support services.
• Regardless of the setting, the health system will identify those older people that are at risk and address their health and social care needs appropriately early in the disease process to optimise outcomes.
• Improve the integration of services for older people across the continuum of health and social care.

Value

• Overall improvement in patient flow through the health and social care system by:
• Reduce delayed discharges in the acute hospital system Decrease AVLOS for > 65 years, > 75 yrs, > 85 yrs
• Development of community health and social services to meet population needs. 
• Reduce risk of inappropriate re-admission following discharge.
• Decrease risk of re-attendance at ED
• Reduce % of inappropriate admissions to acute and long term care