Recommendation 200

Registered older person’s nurse

Accepted in part
Consideration should be given to the creation of a status of Registered Older Person’s Nurse.

The Department of Health and its system partners have considered this recommendation and feel there are better ways of improving nursing care for older people. Caring for older people is core to the job of the vast majority of nurses working in wards throughout hospitals and across community settings. The focus on the complex physical and emotional needs of frail older people throughout nurse training will be strengthened to ensure that older people needing nursing care will benefit from a nursing workforce that is trained to deal with their needs.

Many older people in hospitals are under the care of specialist teams (for example orthopaedics or cancer services) and require nurses to have those specialist skills.  Additionally care of those older people who are frail, with many conditions, can take place in their own home and care homes as well as in hospitals.

All registered nurses at the point of qualification need to be competent in managing and implementing care for older people. As a nurse’s career progresses we need to ensure they have the opportunity to specialise in the care of older people. In doing so, we need to ensure they have the right skills – not just their clinical expertise but also their decision-making and judgement skills, so that they can help navigate older people through the complex systems of health and social care. To do this they need to build from the firm foundation of their undergraduate experience to develop their expertise at each stage of their career. This is why we are proposing to offer access to practical, continuous professional development and have a clear and rewarding career path from novice to expert.

The government has asked Health Education England, as part of its Mandate for 2013-2015, to work with Higher Education Institutions to review the content of pre-registration nurse education to ensure all new nurses have the skills to work with the large numbers of older people being treated in the healthcare system. Furthermore Health Education England, working with the Chief Nursing Officer, the Director of Nursing at the Department of Health and Public Health England and the nursing profession, will develop a bespoke older persons nurse post-graduate qualification training programme. Completion of this training programme and demonstrable expertise in working with older people will allow nurses the opportunity to become part of an Older Persons Nurse Fellowship programme that will enable nurses in this field to access a clinical academic pathway. The first cohort of students will commence on the post-graduate programme in September 2014.

Improving hospital care for people with dementia and their carers is a key component of the Prime Minister’s Challenge on Dementia. The recent National Audit of Dementia Care in Hospitals showed that hospitals are making progress in improving dementia care in hospitals, but that there is still work to be done. Dementia champions are in place in most hospitals, the health needs of people with dementia are better assessed and there has been a welcome reduction in antipsychotic prescribing. The report shows that high quality dementia care is achievable and we want to see this delivered in every hospital.

We want people with dementia to be receiving better quality of care from informed and trained staff. Through the Commissioning for Quality and Innovation programme, NHS England has asked all hospitals to identify a senior clinical lead for dementia and to ensure that carers of people with dementia are adequately supported and that this is reported at board level. We want to see all staff being capable and competent in dementia care and, in January, we launched a new e-learning package for all health and social care staff.

The Department of Health supported the Dementia Action Alliance in its call to action on improving the quality of care for people with dementia in hospital, which asks all NHS acute trusts to commit to become dementia-friendly and over 140 hospitals have signed up to this challenge.


It is essential that those nurses caring for older people, whether in hospitals, care homes or the community, have the right compassion, skills and values to look after what can often be some of the most vulnerable people in our society. A bespoke older persons’ nurse postgraduate qualification will be delivered as an annual Older Person’s Nurse Fellowship. A programme for 24 participants is being commissioned from King’s College London, who will make it available across the country. There will be two cohorts of 12 students. One commenced studying in November 2014 and will finish in October 2015, and the second will begin in March 2015 and finish in February 2016.

As part of the implementation of the Prime Minister’s Challenge on Dementia, on 25 July 2013 the Secretary of State for Health announced details of the 116 successful projects, 42 projects within the NHS (including hospital wards) and 74 within a local authority setting (including care homes) awarded a share of a £50million fund to create pioneering care environments designed with the needs of people with dementia in mind.

Funding was awarded to projects that demonstrated how practical changes to the environment within which people with dementia are treated will make a tangible improvement to their condition, with work completed by end March 2014. An evaluation of the projects will published shortly, and in March 2015 the department will publish the best practice Dementia Friendly Environments Health Building Note guidance.