Shelagh O’Riordan is a Consultant Community Geriatrician and Clinical Director for Frailty Services with Kent Community NHS Trust and tweets @jupiterhouse1 Asan Akpan is a consultant Geriatrician at Aintree University Hospital NHS FT and tweets @asanakpan
In September 2017, the BGS put a call out to its members for Geriatricians with an interest in care homes and Community Geriatrics to represent the BGS at the newly established Hospital to Home Programme Board, an NHS England oversight group and part of the Urgent and Emergency Care (UEC) Transformation Delivery Programme.
Shelagh had just come to the end of a role at the Royal College of Physicians and, after 14 years, swapped her hospital role for a community one. Asan moved to a different hospital over 4 years ago to do mostly community geriatric medicine and has contributed to developing the service described on page 26 of the joint report on integrated care for frail older people by the BGS and RCGP.
This seemed like an ideal opportunity to potentially have national influence and meet others working in a similar field. We both applied and were nominated to represent the BGS.
The Hospital to Home (H2H) Programme is one of six programmes within the UEC Delivery Programme, led and governed by NHS England and NHS Improvement. The oversight H2H Programme Board is chaired by committed community geriatrician Prof Martin Vernon who has been National Clinical Director for Older People and Person Centred Integrated Care at NHS England since 2016.
There are a number of key representatives from NHS England, including pharmacy and community health services, together with representation from NHS Improvement. There are also those from outside NHS England, from organisations representing Adult Social Services Directors (ADASS) and Local Government Associations. As far as we know, apart from the chairperson, we are the only direct frontline health staff attendees… which may explain the first problem we came across!
Shelagh attended the first meeting in person and Asan dialled in from work. It was difficult to follow matters due to the high use of acronyms we didn’t recognise and speaking in a language which seemed to be English but not as we knew it! We struggled to identify the goals of the Board and see what the outcomes would be. We have now been attending for 6 months and it is becoming clearer. This clarity was further helped by Prof Vernon, who had a detailed discussion with us to clarify and answer our questions.
The Board has subsequently developed a “Value Proposition” which outlines what the Hospital to Home Programme plans to achieve in 2018/19, and importantly how and what it will influence in terms of achievements in community services around the country over the coming year. This focuses on:
- Preventing avoidable admissions
- Ensuring safe and timely transfers of care
- Improving the patient experience by working together and reducing cross-sector barriers.
This leads us to the question of what the BGS has to offer in achieving the above and how we can actually “represent” the BGS on this Programme Board, rather than just giving our own views. As geriatricians who both work in the community, we have a rather different view to those only working in acute hospitals, and the goals of the future need to be shaped by those who provide care for older people with frailty in all settings.
So, we would love to get your views. Imagine a future with greater emphasis on providing care for frail older people in their own homes rather than in hospital.
- What will the role of the geriatrician and other professions specialising in frailty and older people’s care be?
- How can geriatricians contribute to the wider health and social care community?
- Will we all be working across the boundaries of acute and community services, with the majority of our work outside of hospitals?
- Can we be aligned to geographical areas, providing continuity of care to people wherever they are in the system?
- What would need to “give” to allow this to happen? Can we support but not provide some of the work we currently provide in hospital e.g. surgical liaison and peri-operative care? Can we really train everyone in the principles of frailty care to allow this to be done?
- What needs to change in terms of training of geriatricians? Currently there is no requirement to train a geriatrician in care outside of hospitals, despite the fact that many new jobs advertised specifically look for geriatricians to provide community services. How can we train future geriatricians to do this without impacting on acute rotas as geriatric trainees are currently key providers of this work?
Please take the time to respond, as this will enable us to accurately “represent” the BGS. It is definitely true that something needs to change to allow people to receive the care they need at home or closer to home, avoiding inappropriate or prolonged hospital admissions. It is also true that if we continue to do the same, we will continue to get the same outcome. The question is – what do we at the BGS need to change to allow this to happen?
Please email your responses to firstname.lastname@example.org