How can we use quality data to make Care Homes safer?

Safety In Care HomesDr Adam Gordon is Clinical Associate Professor in Medicine of Older People at The University of Nottingham and an Honorary Consultant Geriatrician at Derby Teaching Hospitals NHS Trust; he tweets @adamgordon1978. Here he describes a project to benchmark and report the prevalence of care problems in UK care homes.

Care homes do a lot of good work. There are almost three times as many beds in UK care homes as there are in National Health Service hospitals. Care home residents are amongst the most vulnerable members of our society.

Up to 80% have cognitive impairment, some two thirds have behavioural symptoms, all need help with their activities of daily living and many are approaching the ends of their lives. Much of the excellent care that takes place to care for these very vulnerable citizens in the 320,000 UK care home beds goes unreported. When things go wrong, however, the media are quick to respond.

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BGS Spring Meeting

4451736917_75a0098a01_oTom Dening is a Professor of Dementia Research at the Institute of Mental Health, University of Nottingham. 

Spring in Nottingham! What could be finer? Little spring flowers bursting out all over University Park, Nottingham Forest on the verge of play-off contention, the ice floes beginning to break up on the Trent, students shedding their furry parkas and starting to sit on the grass….

And what better way to spend your time than to check into to the East Midlands Conference Centre at the end of April for the BGS Spring Meeting? Even better, stay at the eco-friendly Orchard Hotel next door and barely have to move for 3 days. The programme has been finalised, and booking is in full swing! I’ve even forgiven them for spelling my name wrong in the advertising booklet.

I have been (peripherally) involved in the organisation of this event, which has been led by my colleague Rowan Harwood form Nottingham and the BGS events team; it’s the first time I have worked with the BGS on something of this kind. The planning for the event started about 2 years ago, so clearly a lot of time and thought has gone into the final agenda. The programme has got something for everyone and most people will probably be interested in quite a lot of the sessions. I’m of course pleased to see that there’s a whole day for the Dementia Special Interest Group but also a session on the first morning of the main conference about aggression, with three top class psychiatrists/psychologists.

My own contribution is to co-facilitate a workshop on The Geriatrician as Manager, with Stephen Fowlie, who is the Medical Director of Nottingham University Hospitals NHS Trust. He’s the real deal, being a current MD (as opposed to being an ex, in my case) and a real geriatrician (as opposed to a psycho-, as in my case). Why have we suggested this session, and what relevance has it alongside topics like falls, respiratory disease, infections and so on?

Everyone probably has their own thoughts on doctors and management, but in many ways management and clinical medicine are inseparable. In almost every case, it’s not just us doctors dealing with individual patients and their families. There are hosts of other people, especially in the typical geriatric medicine scenario of multiple complex morbidity, where the outcomes are damage limitation or end of life care, rather than cure and restitution of full function. Some of these others are members of your own clinical team, but many of them are not. They include the support staff in the hospital, for example cleaners, caterers and porters, but also (obviously indirectly!) the finance team and ultimately the Trust Board. These latter folk help to determine the success of the hospital, dealing with commissioners, regulators, the media and the public, and these things in turn influence what your hospital is like to work in.

The job of the doctor starts with assessing and treating patients as they are admitted, and extends beyond this into the relationship that they have with their clinical team. But it goes further: what we do at the coal face gets translated into the data supplying both the people who buy our services (commissioners) and those who oversee them (regulators, the CQC in particular). There is no clear cut-off point dividing our clinical activity and these other processes. Some doctors relish the complexity and the challenge of dealing with hospital systems: they may  for example show an aptitude for the politics, or they may see engaging with management tasks as a potent way to get things done. It is this area that Stephen and I will be looking to explore in our workshop, and we look forward to meeting you in Nottingham

Photo credit: 3dpete via flickr.

More Care Less Pathway: End of life care after Neuberger

Dr. Martin Vernon is a Consultant Geriatrician in South Manchester and is the BGS End of Life Care Lead.LCP

Few can have escaped the media driven political debate that erupted in 2012 over the care of dying people in hospital and at home but you may be wondering what has happened since then.  In July 2013, the Independent Review of the Liverpool Care Pathway published the report More Care, Less Pathway. In response to its recommendation for a system-wide strategic approach, the Leadership Alliance for the Care of Dying People (LACDP) was established to provide a focus for improving care of dying people and their families.  You can learn more about the group here.

A Clinical Advisory Group (CAG) was established in September 2013 to consider Review recommendations specific to clinical practice and how these should influence practice. Dr Bee Wee, National Clinical Director for End of Life Care, chairs the group.  The British Geriatrics Society is represented by me and the group includes representatives from NHS England, Royal College of Physicians, palliative care professionals, hospice and care home organisations, the Care Quality Commission, and a layperson. Continue reading

Health in care homes: can we do better?


Dr Adam Gordon is a Consultant and Honorary Associate Professor in Medicine of Older People at Nottingham University Hospitals NHS Trust and the University of Nottingham. He also edits this blog.

Arrangements to provide health care to UK care homes are often inadequate.  In the British Geriatrics Society’s Failing the Frail Report, based on a national survey by the Care Quality Commission, 57% of residents were reported as being unable to access all health care services required. In 2011, a collaboration of health care groups led by the British Geriatrics Society published Quest for Quality, which went so far as to describe existing arrangements as “a betrayal of older people, an infringement of their human rights and unacceptable in a civilised society”.

So, can we do better?

Since 2008, the Medical Crises in Older People (MCOP) research programme at the University of Nottingham has been working to better understand the challenges and opportunities that society faces in providing effective healthcare to care home residents. As this work draws to a close, we are hosting a conference entitled “Health in care homes: can we do better?” in Nottingham on June 14th, 2013.  Details of the conference can be found here.

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