Mental Capacity and Deprivation of Liberty – an update on reform

Caroline Cooke is Policy Manager at BGS and Premila Fade is BGS’s End of Life Care Lead.  Here they explain the background to, and significance of, the report published by the Law Commission, “Mental Capacity and Deprivation of Liberty” on 17 March 2017.

What are DoLS?  The Deprivation of Liberty Safeguards (DoLS) are a set of protections for adults who lack the mental capacity to consent to deprivation of their liberty by, for example, admission either to hospital or a care home for treatment or care.  They were introduced as part of the Mental Health Act 2007.  The intention behind their introduction was to ensure that no-one is deprived of liberty without good reason, and the right of legal challenge is built into the authorisation process.  The idea was to close the so called ‘Bournewood gap’ whereby adults admitted informally (i.e. not via the Mental Health Act) did not have an automatic right to appeal.  The European Court of Human Rights (HL v United Kingdom) ruled that this lack of safeguards was a breach of article 5 ‘The right to Liberty’ of the Human Rights Act. Continue reading

Feedback required from BGS members in England on the STP process so far…

Professor Tahir Masud is President-Elect of the BGS and heads the Clinical Gerontology Research Unit at Nottingham University Hospitals NHS Trust. 

Sustainability and Transformation Plans (STPs) were announced as part of NHS England’s NHS planning guidance 2016/17 – 2020/21. These documents created a new funding environment for NHS providers that aims to achieve collaboration by bringing together commissioners and providers of health and care services to support delivery of the NHS Five Year Forward View. To receive funding providers have to demonstrate that they have worked with each other, commissioners, the public and local authorities to create plans that will address the three gaps identified in the Forward View: 1) health and wellbeing, 2) care and quality and 3) finance and efficiency.  Continue reading

Suffering in silence: A global epidemic

This blog is the collaborative work of BGS President-Elect Prof Tahir Masud and his team Aneesha Chauhan, final year medical student, University of Oxford and Sanja Thompson consultant physician, Geratology department, University of Oxford.

Everyone has experienced loneliness. Acutely, it is a transient, often mild experience that is relieved by meaningful social interaction. However, we are living in an epidemic of chronic loneliness. More than three quarters of GPs in the UK say they see between 1 and 5 lonely people a day. Furthermore, recent prevalence data revealed that 30% of the elderly are “sometimes lonely” with 9% suffering from severe loneliness. It is being increasingly recognised that loneliness is a pathological state, with its own epidemiology, risk factors, presentations, and increased mortality and morbidity. Continue reading

It’s not how old you are that matters, so much as how you are old…

Professor Martin Vernon qualified in 1988 in Manchester. Following training in the North West he moved to East London to train in Geriatric Medicine where he also acquired an MA in Medical Ethics and Law from King’s College. He has been the British Geriatrics Society Champion for End of Life Care for 5 years and was a standing member of the NICE Indicators Committee. In 2016 Martin was appointed National Clinical Director for Older People and Person Centred Integrated Care at NHS England.

mj-vernon-officialWhile celebrating successful ageing we must not be led into complacency. There is marked inequality between least and most socioeconomically deprived areas with men living on average up to 8 years less in the most deprived areas.

The NHS England Five Year Forward View notes that support for frail older patients is one of the three areas that the NHS faces particular challenges. It is therefore potentially game-changing that we are now making positive steps towards addressing this through routine frailty identification and promoting key interventions targeted at falls risk identification and medication review. Continue reading

Delivering high quality care for older people – are you sure you do?

Dr Christine McAlpine is a geriatrician and stroke physician in Glasgow, Chair of the British Geriatrics Society Scotland Council and the geriatric medicine speciality adviser to the Chief Medical Officer for Scotland. She chaired the multiprofessional group which produced the Healthcare Improvement Scotland Standards for the care of older people in hospital, published in 2015. She tweets at @CHRISTINE030214

bgs-principles-and-standards-page-001Health care for older people is core business for the NHS. Getting health care right for older people helps ensure we get it right for everyone.  Today the BGS publishes ‘Effective healthcare for older people; Principles and Standards‘, with a particular focus on those living with frailty.

The Principles and Standards are for the health care of older people in any setting –  not only for geriatric medicine wards, but for all of the health care departments older people may encounter – Emergency Medicine, ophthalmology, gynaecology etc – across the spectrum of care.

The concise 4-page paper includes core standards for care delivery and reminds us of the principles enshrined in human rights and equalities legislation. It outlines principles of health care for older people including effective, accessible and timely care; autonomy, choice and person centred care; and ensuring safety and dignity. Continue reading

An overview of the Policy Forum for Wales event

Hospital in Bridgend, Wales. He is a care of the elderly physician with an interest in Parkinson’s Disease and movement disorders.
flag_of_wales_2-svgOrganised by the Policy Forum for Wales, this event which was held on 19 October, provided the Welsh Government, and other agencies, the opportunity to engage with key stakeholders and discuss public health policy issues that particularly affect Wales. This seminar was about involving health and social care senior policy makers in developing a vision for Wales and bringing together multiple organisations (public sector, voluntary and third sector) to have a dialogue about how best to influence the Welsh Government’s health and social care policies.

The day was kicked off by chair Mr Huw Irranca – Davies AM, with a cross party group on cancer introducing the theme of the day. This was followed by brief from Professor Siobhan McClelland on current trends in health care in Wales including a £700 million gap in the budget for health and social care (10% of the total health budget). She emphasised that service configurations should be decided according to local need rather than by committee or Government mandate. Continue reading

Incoming President of the BGS calls for respect for ‘victims of underfunding’

eileenDr Eileen Burns, who takes office today as the new President of the British Geriatrics Society, has called for public recognition that older people facing delays in discharge from hospital are the victims of underfunding of social care and not ‘the problem’. Dr Burns is urging members of the public, and media, to reject pejorative terms like ‘bed blockers’ and urge the Government to give social care the priority it deserves.

Dr Burns is only the second female President since the Society was founded in 1947. She has been a consultant geriatrician in Leeds for twenty-two years, and is an expert in community geriatrics. The primary focus of community geriatrics is to reduce admissions to hospital, and prevent delayed discharges and re-admissions, by ensuring that older patients receive adequate and appropriate care within their community.

Accessible social care is a key factor in reducing hospital admissions and delayed discharges for older people. According to research published earlier this month by Age UK, the number of older people in England who don’t get the social care they need has soared to a new high of 1.2 million – up by a staggering 48% since 2010. Continue reading

Dementia friendly communities; compassionate and collaborative

Dr Fiona Marshall is a neuroscientist working on treatments for Alzheimer’s disease and other conditions. Dr Marshall also volunteers as an Alzheimer’s Research UK Trustee and is Founder and Chief Scientific Officer of Heptares Therapeutics.

dementiaIn recent years there have been major initiatives to change the way that society is able to respond to the growing number of people with dementia – we are aiming for “dementia friendly societies” where people with dementia and those who care for them are not alienated, or even merely tolerated, but enabled to sustain their local connections and lead meaningful lives. Living with dementia is often full of many challenges and can leave families isolated, lonely and exhausted; as a society we need to minimise these ongoing issues and promote valued connections within local communities. Continue reading

Choosing the right care for people from nursing homes: Hobson’s Choice, Morton’s Fork or Buridan’s Ass?

Glenn Arendts is Associate Professor in Emergency Medicine at the University of Western Australia and Chair of the Geriatric Special Interest Group of the Australasian College for Emergency Medicine. He writes about his Age & Age paper. 

donkeyHobson’s Choice: A choice where there is really only one option
Morton’s fork: A choice between two equally unpleasant alternatives
Buridan’s Ass: A hungry donkey placed equal distance from two identical bales of hay cannot use reason to choose between them, and so dies of hunger

Take a straw poll of hospital emergency department (ED) staff and you will find majority support for the following statement: “too many people from nursing homes are sent to the ED”. That your poll results may say something about the views of some hospital staff toward nursing home (NH) residents is immaterial. Acute medical care of dependent people with life limiting illness is an area of legitimate concern, and the prevailing orthodoxy is that ED is a less than ideal place to deliver it. For decades, health services have invested in a variety of programs and interventions to reduce the transfer from NH to ED. Continue reading

Esther Clift’s African Blog Series; Part 4 ‘Healthy ageing’

Esther Clift is a Consultant Practitioner Trainee in Frailty with Health Education Wessex. This is the final part of a four part BGS blog series about her time in Africa. She tweets @EstherClift

healthy-ageing“Healthy ageing” is defined by the World report on ageing and health as the process of developing and maintaining the functional ability that enables well-being in older age.

What does that look like in developing countries?

I have had the privilege of travelling through some of Kenya and Uganda and I asked how people view their prospects, as they grow older. Some like Nathani in rural Jinja, Uganda, a retired academic and researcher with a PhD from Strathclyde University felt that his future was tied up in his land, and his children. He had both, and at 74 was fit and well, and held in high esteem by his community. He described his children as his wealth. Continue reading