The UK versus the Netherlands: Where would you want your grandmother to be looked after?

Barry Evans and Rachel Cowan are Specialty Trainees in Geriatric Medicine currently working as Clinical Fellows in Quality Improvement for Integrated Medicine in the East Midlands. They recently had the opportunity to undertake an exchange with Anouk Kabboord – Elderly Care Physician trainee in the Netherlands.

dutchAt a time when the European narrative is being rewritten, a common challenge facing all European nations is population ageing. Seeing and learning from different European countries’ responses to an ageing population is an invaluable opportunity to learn, discuss and share innovation between countries. As part of Health Education East Midlands’ Quality Improvement Fellowship, we were recently able to set up an exchange between the UK and the Netherlands for geriatricians in training to see and learn from each other’s working environments.

One of the key differences in the Netherlands compared with the UK is the role of the elderly care physician (ECP) – a post which has evolved in response to medical needs of older patients with frailty undergoing geriatric rehabilitation in skilled nursing facilities or living in long-term nursing home care. An ECP fulfils the role of a community geriatrician connecting primary care and specialist care, whereas the clinical geriatricians work in acute hospitals only.

Barry’s specialist interest is quality improvement and his HEEM fellowship has focussed upon developing a surgical liaison service. He had the opportunity to see care home medicine with ECPs in Holland as well as to follow through all aspects of the hip fracture pathway. Rachel’s HEEM fellowship has given her the opportunity to pursue her specialist interest in old age psychiatry, and her quality improvement work focuses on the integration of physical and mental health care for older people. She experienced the ECP role in the context of mental health care for older patients. ECPs work alongside psychiatrists within the MDT that supports older people with psychiatric illness and dementia both in the community (including nursing homes specialised in mental health) and in acute psychiatric hospitals. We shared reflections on the unique role that ECPs fulfil in the Netherlands and how this could be translated to continuing care in the UK. The exchange gave us the opportunity to contrast the focus on geriatricians delivering predominantly acute care for older people in the UK, with a longer-term rehabilitation model that ECPs support in the Netherlands. Anouk, meanwhile, was able to see models of geriatricians working in pre-operative care, acute care and the emergency department – all of which represent possible extensions of the ECP role in the Netherlands, like future involvement in accident & emergency triage and liaison improvement with clinical geriatricians. In addition, she worked with an advanced nurse practitioner in a UK community hospital to establish a research project evaluating outcome measures in older patients undergoing rehabilitation.  Anouk’s reflection was that the exchange brought her new ideas on pre-operative care, acute care and preliminary thoughts about ECP involvement in accident & emergency triage and better collaboration with clinical geriatricians in the NL in the future.

Shared education events in Nottingham and Leiden allowed trainees from both countries to identify similarities and differences between the two healthcare systems. All agreed that to learn from the pros and cons of each others’ systems was stimulating, challenged preconceptions on what it means to be a geriatrician and generated ideas for innovation in both healthcare systems.

At the end of the exchange, one of the Dutch colleagues involved asked the very simple question which sums up the exchange experience: “where would you want your grandmother looked after?” The three of us paused but came up with a shared and unanimous response. Both systems have their positives and negatives – neither system is perfect and we can learn from each other. The most important similarity we experienced was the passion and dedication of all geriatricians to provide the best care for their older patients. A better question would be: “what can we do to design models of care in which our grandparents would want to be looked after, irrespective of geographical location?”

At times we can all be tough on ourselves and our own way of working. The brief spell spent in other systems during the exchange enabled each of us to recognise the strengths in our own countries’ ways of working, in addition to identifying the possibilities for extending and enhancing these by reference to work taking place elsewhere internationally. As our governments recalibrate the language of international collaboration it is important that we, as professionals, do what we can to build sustainable models for such shared learning.

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