At Age UK we’ve been busy planning our annual flagship ‘For Later Life’ conference. We decided early on that we wanted to focus this year’s event on the theme of ‘transforming services for a better and longer life’, because this chimes with current concerns. As you have recently published a blog by British Geriatrics Society Honorary Secretary, Dr Adam Gordon, on “transforming primary care”, we clearly got that right!
At last, more policymakers seem to be waking up to the fact of demographic change and the need to respond. Currently we think many are concentrating too much on the risks and not enough on the opportunities, and action is admittedly often less obvious than words, but still, the penny has begun to drop and that’s good news.
Dr Peter Wallis, formerly consultant geriatrician – Birmingham Heartlands Hospital, was involved with the filming of a new BBC 2 Documentary Series
The department of elderly medicine at Birmingham Heartlands Hospital became aware of the BBC‘s interest in a documentary series about the care of older people following an advertisement in the British Geriatrics Society Newsletter (2012) placed by the BBC Bristol Documentary team. The intention was to produce a 3 part documentary series reflecting current issues in the health and social care of older people. Following successful discussions and with the agreement of partner organisations including social services as well as primary, community, mental health and ambulance service teams, filming took place during 2012/13. Filming was centred around the elderly care and general wards as well as the A&E department at Birmingham Heartlands Hospital and the patients with their stories were followed into community settings.
Dr Adam Gordon is a Consultant Geriatrician and Honorary Associate Professor in Medicine of Older People at Nottingham University Hospitals NHS Trust. He is Honorary Secretary of the British Geriatrics Society and also edits this blog.
The change of name, however, doesn’t change the fact that much that was of promise in the consultation documents for the Vulnerable Older People’s Plan, remains in the proposals outlined in the Transforming Primary Care document. There’s still considerable emphasis on continuity, effective communication and care co-ordination.
Laura Izzard is an Specialty Trainee in Geriatric Medicine at Kings College Hospital, London
PANICOA – the Prevention of Abuse and Neglect in the Institutional Care of Older Adults – is a joint research initiative between Comic Relief and the Department of Health.
Published in December 2013, the PANICOA report ‘Respect and Protect’ draws together the findings of eleven individual research studies commissioned to examine the complex issue of mistreatment of older people in hospitals and care homes. It outlines three vantage points i.e. “narratives” reflecting the perspectives of residents and patients, care staff and care organisations. Themes emerging from the PANICOA Narratives were used by the authors to produce a number of recommendations intended to reinforce and/or improve current practice.
Arthritis Research UK is working to improve the care of patents with osteoporosis, other metabolic bone disorders and musculoskeletal trauma by funding high quality clinical research.
They are now looking to extend the clinical studies group and add 4 new topic specific groups and are particularly interested in applicants from endocrinology, gerontology, orthopaedics and trauma, rehabilitation, primary care, clinical chemistry, study methodologists, health service managers and rheumatology.
Dr Ian Donald, consultant geriatrician with special interest in community care, health service development and management of frailty, urges geriatricians to join a clinical commissioning group and describes his own experience of being part of a CCG.
When Clinical Commissioning Groups (CCGs) were formed in April 2013, the legislation under the Health and Social Care Act 2012 envisaged that the CCG would be a new body built upon GP practices, which together make up the membership of the commissioning group. This “practice-led” GP commissioning was then amended to “clinically-led” commissioning. As a result, Secondary Care physicians have a statutory role on the governing body of each CCG. It was envisaged that:- “Individual members of the governing body will bring different perspectives, drawn from their different professions, roles, background and experience. These differing insights into the range of challenges and opportunities facing the CCG will, together, ensure that the CCG takes a balanced view across the whole of its business.” The regulations state that the Secondary Care Doctor should either be in practice or recently retired, and should not be an employee of an organisation which has a commissioning contract with that CCG.
Daniel Sommer is a Foundation Year 2 Doctor at Charing Cross Hospital in London. He is an aspiring Geriatrician.
Geriatrics was a difficult placement for me as a student. The way we learn in medical school makes cardiology and gastroenterology rotations an easy place to learn what we need to learn. The problems are fairly logical and the solutions are also fairly logical. My simple medical student brain could comprehend it. I didn’t quite cut it in Elderly Medicine. The patients and their issues (both medical and non-medical) are often complex, with multiple interactions and facets, requiring “illogical” treatments and strategies that don’t always follow rules or make sense. Without a pretty astounding understanding of physiology, pathology, ageing, sociology and public policy, it will all go over your head. What I saw was a bunch of crumbly, demented old people who didn’t seem to get better. Shame on me.
Payment by results (PbR) never fully addressed the management of long term conditions, and the importance of timely and seamless transition to and from the community for patients who live with them.
Year of Care (YoC) was suggested as a possible solution in 2011 by Richard Murray, Chief Economist at the Department of Health in his document, “Payment reform in the NHS”. The long-term conditions YoC tariff is designed to allow health and social care to be provided based on a person’s overall needs as opposed to what specific diseases they have. It fits with the work being undertaken across the NHS to make care better integrated. If it works as intended, it will allow funding to be moved around as needed to provide the most effective ‘package’ of care for the person over a 12-month period. The underpinning philosophy is that money should be present in the parts of the healthcare system best-suited to provide patient care. The financial model is based upon an annual risk-adjusted ‘capitation’ budget, based on levels of health care need. Continue reading →
Professor Kenneth Rockwood reviews an inspirational book about the life and ideology of Albert Camus, the French Nobel award winning author, member of the Resistance and erstwhile philosopher. Professor Rockwood draws parallels from Camus’ life, thoughts and actions that relate to our daily lives, present challenges faced by the NHS and our care of older patients.
Title: A Life Worth Living: Albert Camus and the quest for meaning.
Author: Robert Zarestsky.
Publisher: Harvard University Press
Year of publication: 2013.
The unsurprising flurry of books in the run up to the 100th anniversary, in 2013, of the birth of Albert Camus, has prompted many claims – notably by French politicians of both the Left and Right – to his legacy. So what about Camus as – if not geriatrician – then gerontologist? Continue reading →
The care of patients approaching the end of life is once again a controversial and high profile topic. The provision of high quality care to older patients with complex health and social care needs brings a unique set of clinical and ethical challenges. Lectures and interactive case discussions will cover symptom control in chronic pain, vertebral fracture and advanced heart failure; ways of delivering advance care planning for older people in the community; ethical decision making in advanced dementia, around nutrition at the end of life, and around escalation of care. Our endowed lecture will consider how we can deliver high-quality end of life care across the health service in the post-Liverpool Care Pathway era. A series of interactive cases will allow exploration of practical approaches to ethical dilemmas at the end of life.
This symposium will be of practical value to all healthcare professionals in the multidisciplinary team caring for frail, older patients including geriatricians, primary care physicians, general physicians and specialists in palliative medicine. Attendees will improve their knowledge of symptom control in difficult conditions, improve their decision-making in challenging ethical situations including advanced dementia, and will gain perspective on the recent debate regarding the optimal organisation and delivery of end of life care in the hospital and community.