Old age mental health services in England: implementing the National Service Framework for Older People Sue Tucker 1 * , Robert Baldwin 2 , Jane Hughes 1 , Susan Benbow 3 , Andrew Barker 3 , Alistair Burns 2 and David Challis 1 1 PSSRU, University of Manchester, Manchester, UK 2 Manchester Mental Health and Social Care Trust, Manchester, UK 3 Royal College of Psychiatrists, London, UK SUMMARY Background There is much variation in the services provided for older people with mental health problems. In England, the National Service Framework for Older People (NSFOP) sought to address these inconsistencies and improve care. This study describes the situation three years after its publication. Methods A postal survey of old age psychiatrists collected data on the NSFOP mental health model: the range of specialist mental health provision, the nature of the specialist:generic service interface and the degree of interdisciplinary/interagency working. Results Three hundred and eighteen (72%) consultants responded. Considerable differences existed in the deployment of key professionals within community teams, with more than a third lacking ring-fenced social work time. Few services had dedicated rehabilitation beds and nearly a third lacked separate facilities for people with organic and functional illnesses. Increasing numbers of consultants had access to a memory clinic and there was some suggestion that liaison services were developing, but little indication of increased support for care homes. Several services had yet to agree protocols with primary care, or to implement measures promoting effective information-sharing and integrated care, and there was little evidence that the introduction of the Single Assessment Process (SAP) had significantly changed practice. Although just over half of consultants reported that mental health services were improving, less than a quarter considered community provision adequate. Conclusions Three years after the publication of the NSFOP there remained significant gaps in services for older people with mental health problems and substantial variation in provision between districts. Copyright # 2006 John Wiley & Sons, Ltd. key words — mental health; older people; service provision; team working; multi-disciplinary working; integration INTRODUCTION The developed world is witnessing an ongoing rise in life expectancy, a phenomenon that is expected to play an increasingly important role in developing countries over coming years (WHO/WPA, 1997). The con- comitant rise in the number of older people with mental health problems poses a considerable chal- lenge for policy makers, for such disorders have a significant impact on individuals’ quality of life and are associated with increased resource use (Kavanagh et al., 1995; Moriarty and Webb, 2000; Alexopoulos et al., 2001). The enhancement of community-based care and the provision of mental health services that are compre- hensive, accessible, responsive, individualised, multi- disciplinary, accountable and systemic are broadly universal aims (Challis, 1996; WHO/WPA, 1997; Marshall, 1999). Not all areas can live up to such aspirations however, and although the UK was reported to be one of only three nations with a wide range of mental health services for older people at the INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIARTY Int J Geriatr Psychiatry 2007; 22: 211–217. Published online 20 September 2006 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/gps.1662 *Correspondence to: S. Tucker, Research Fellow, PSSRU, Dover Street Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK. E-mail: Sue.tucker@manchester.ac.uk Copyright # 2006 John Wiley & Sons, Ltd. Received 2 November 2005 Accepted 10 July 2006