If frailty is viewed by some as a “commissioning Trojan Horse” this should be admitted

Dr Shibley Rahman is currently an academic physician in dementia and frailty. His contribution on the diagnosis of behavioural frontal frontotemporal dementia, published while he was a M.B./Ph.D. student at Cambridge in 1999, is considered widely to be an important contribution to the field, even cited in the Oxford Textbook of Medicine. Here he responds to Steve Parry’s recent BGS blog, The Frailty Industry: Too Much Too Soon?  He tweets at @dr_shibley.

In response to Steve Parry’s recent BGS blog, The Frailty Industry: Too Much Too Soon?, I would simply in this article like to set out some of the strengths and weaknesses in the conceptualisation of frailty, with some pointers about “where now?”

There is, actually, no international consensus definition of frailty (although there is one of a related term “cognitive frailty”).

In a world of fierce competition for commissioning, and equally intense political lobbying in health and social care, the danger is that a poorly formulated notion becomes merely a “Trojan Horse” for commissioning.

I must humbly depart from the views of some colleagues – for me, frailty is not just a word. I could likewise point to other single words which cause gross offence, which are unrepeatable in my blogpost here.

Take the high road or the low road…but don’t miss the BGS in Glasgow this November!

Dr Eileen Burns has been a geriatrician in Leeds since 1992 and is President-Elect of the BGS. She is currently Clinical Lead for integration in Leeds and Chairman of the BGS Community Geriatrics Special Interest Group. She tweets @EileenBurns13

The Autumn Meeting of the BGS in Glasgow this November looks to be a great event with a broad range of topics and sessions.

But the day that excites me the most is Wednesday November 23rd.

Many of us have been approached by commissioners of services to “move into the community” in some way (in whichever part of the UK we are based). Others have seen the need to look at alternatives to acute hospital care for older patients with less severe illnesses, and it’s been clinicians rather than commissioners or managers who have been the spark for new developments.

The British Geriatrics Society welcomes the NICE Delirium Quality Standards

Duncan Forsyth is Consultant Geriatrician in Cambridge and was a specialist adviser to the Quality Standards Development Group.

On July 24^th 2014, NICE published its Delirium Quality Standards to assist health and social care drive-up the quality of delirium management in hospital and care home settings. The standards cover: assessment; prevention; use of antipsychotic medication; communicating the diagnosis; information and support to those who have delirium and their carers. Delirium is probably the commonest complication of hospitalisation in older people and has a high prevalence in those in long-term care.

Do Mention the F Word: Frailty and Policy

David Oliver is a Consultant Geriatrician in Berkshire and a visiting Professor in Medicine of Older People at City University, London. He is President Elect of the British Geriatrics Society.

Frailty is something of an obsession for geriatricians. In a medical tradition based around “single organ” specialities and a branch of medicine which has sometimes struggled to make its identity distinct, its value clearer and its prestige higher, we know that older people with frailty and complex comorbidities are our bread and butter. And that applying skilled Comprehensive Geriatric Assessment, and whole systems, whole person care to a traditionally neglected group of service users defines what we do better than our non-geriatrician colleagues.

Clinical Commissioning Group – Why not join one?

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.

Hard Truths after Francis

Professor Paul Knight is Director of Medical Education and a Consultant Geriatrician for the Elderly at the Royal Infirmary in Glasgow. He is also President of the British Geriatrics Society.

The Westminster Government’s response to the second Francis Report was published as I was preparing to go to Harrogate for the BGS biannual conference and co-incidentally where I was due to speak on what the BGS had done and would do “After Francis”. So it wasn’t until a few days later that I managed to read in detail “Hard Truths. The Journey to Putting Patients First”.

Strategic planning in Intermediate Care is needed to “unstick” the NHS

Prof John Young is a Consultant Geriatrician in Bradford, UK and National Clinical Director for Integration and Frail Elderly at NHS England. Here he reflects on the 2013 National Audit of Intermediate Care. The full audit report can be found here.

I have been closely involved with the National Audit of Intermediate Care since its inception in 2008. The journey has been challenging but highly rewarding. The audit now covers about half the NHS – remarkable when you consider the commitment required by local staff to collect and submit the data.

The audit is important because it describes services that are otherwise relatively hidden from view in our conventional perception of health and social care. Yet intermediate care, or “care closer to home,” has been quietly developing during the last ten years or so. The focus has always been that of older people with co-morbidities/frailty – just the group that is now so much in the forefront of health and social care thinking. And intermediate care services have always been a platform to develop new ways of working – particularly multi-agency working – and so it is highly relevant to our current interest in service integration.

Meeting the Health Care Needs of Older Care Home Residents

Today the BGS publishes a two page guide for health service commissioners and planners which sets out what local services should be in place to meet the health needs of older care home residents. 

Nearly 400,000 older people live in care homes in the UK.  Their health and social care needs are complex.  All have some disability, many have dementia, and collectively they have high rates of both necessary and avoidable hospital admissions.  Standard health care provision meets their needs poorly, but well-tailored services can make a significant difference.

Named clinicians for vulnerable older people – how will it work in practice?

Prof David Oliver is a Consultant Geriatrician in Berkshire and a visiting Professor in Medicine of Older People at City University, London. He is President Elect of the British Geriatrics Society.

David writes in the King’s Fund blog on the how assigning named clinicians for vulnerable older people might work in practice:

Older people and their families have repeatedly expressed concerns about discharge from hospital being rushed, poorly planned or with insufficient involvement, notice or information. 

Digital inclusion and older people

Emma Solomon OBE is Managing Director of Digital Unite, an independent organisation that helps people, particularly older people, to understand and use computers, the internet and other digital technology.

image by southerntabitha

Having the skills to use digital technology is a must-have in today’s modern society. It can save us time and money, make us feel better connected, less lonely and better informed.

For the citizen as a patient, having digital skills means being able to book and cancel doctors’ appointments more easily, order repeat prescriptions, improve the access to information and services to support their own care and that of others.

By 2015, the NHS Commissioning Board aims to guarantee every patient the opportunity of online access to their own medical records. This is an ambitious target made even more challenging because today in 2013, many older people still either aren’t online or don’t have good enough digital skills to use such a service.