Promoting the health and social care of older people: gaining a perspective from outside the UK.

With people living longer, getting sicker and entering nursing home care later in their lives, the global trends point to preventing premature institution as a major public health and social care goal. Compared with the UK--Australia, Canada and the USA have a longer track record for introducing government Acts, policies and strategies which contribute to supporting older people in maintaining their health, safety and independence. They also have government Ministers for the Aged. In the UK, it is only very recently that we are witnessing new Government programmes such as the NHS Plan and Modernizing Social Services that begin to demonstrate its more determined approach to improve the life of the older person. An ageing population brings new challenges to policy-makers and planners in the statutory sectors. Various international conferences have been held to address ways in which countries are providing or developing their services, and their research regarding older people. Yet, whatever country one considers, nursing home care continues to give rise to many concerns. Developments in the USA managed care programmes have recently come under even more scrutiny from the Federal and State governments, insurance agencies, nursing home owners and, of course, older people themselves. This article raises issues that still need to be addressed in the UK. It reports briefly on an international conference (attended during the undertaking of a Winston Churchill Fellowship) which had some forward-thinking presentations addressing existing and future care needs of older people. It then concentrates on highlighting some of the current developments in the USA care system that might be learning lessons for UK policy-makers. It concludes with some additional considerations for delivering a National Service Framework for Older People in order that "The needs of older people are at the heart of the reform programme for health and social services."