Person-centred care in a sustainable system

Dr Eileen Burns has been a geriatrician in Leeds since 1992 and is President of the BGS. She is currently Clinical Lead for integration in Leeds. She tweets @EileenBurns13 This blog originally appeared as part of Independent Age’s Doing Care Differently series. You can join the debate here.

We warmly welcome Independent Age’s new project, Doing care differently. Our members are passionate advocates for person-centred care. The role of geriatricians and specialist health care professionals starts with identifying the care and treatment that best suits an older person’s individual needs and wishes, and those of their families and carers.  Delays in access to social care, and also in intermediate care, for example, occupational and physio therapy, create unnecessary barriers to person centred care, leading to poorer health outcomes, an increased likelihood of presenting at A&E, and people having to stay on acute hospital wards for longer than necessary.  For older people with frailty the negative impact when this occurs is significant, and their health deteriorates with every additional day spent on an acute hospital ward. 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

Game Theory: chess, Jenga, frailty and the future of the NHS

AIOiSvIVLiz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust. She tweets at @lizcharalambou and is a regular guest blogger for the BGS.

During another busy shift last week, I worked with a student nurse who expressed an interest in the complications of older person care. I found the simplest analogy to be that of comparing frailty to the game of Jenga

Jenga is a game which involves removing one block at a time from a tower, until it is only a matter of time before the entire structure becomes so fragile that the whole thing comes tumbling down.

In older people, long term chronic illness is one such block; complications of unsupportive social situations, another. One urine infection, fall, or hospital admission can be the final block which causes their own personal tower to collapse, with devastating and life-changing consequences.

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A Long and Fortunate Life

Chris Roseveare is a Consultant Physician in Acute Medicine at University Hospitals Southamption, and is Editor of Acute Medicine Journal. He tweets at @CRoseveareshutterstock_958782

Shortly before my grandmother died, at the age of 90, she told me that she felt fortunate: fortunate to have maintained her health for so many years – and fortunate that the NHS had been there for her when she needed it. Not that she had ever been a great user of the Health Service – a thyroidectomy and essential thrombocythaemia required a few tablets, periodic blood tests and infrequent visits to the haematology clinic – but overall Peggy was right to feel lucky.

She was, of course from a generation which had lived through challenging times – she brought up two children, while her husband fought Rommel in North Africa, and endured the subsequent rationing that is hard to imagine in today’s society; she was a tireless fundraiser for the Royal British Legion and Women’s Royal Voluntary Service, for which she was awarded a well-deserved MBE; until her mid-80s she delivered Meals on Wheels, in her Morris Minor, to those Sussex residents for whom time had been less kind. After her own mother had died young, she had to endure the death of her own daughter from ovarian cancer; when her husband suffered a dense left middle cerebral artery stroke she drove daily to his nursing home for 2 years, to sit with him, help with his meals and provide personal care. She would never admit how these events must have affected her: a true exponent of the British ‘stiff upper lip’. Continue reading

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. thirdSector
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.

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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.wordle

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”. Continue reading

Trick or TREAT: Measuring the impact of TREAT- a new admission avoidance system for the over 70’s

Pandora Wright is a geriatric registrar, currently working at Central Middlesex Hospital North West London NHS trust. This blog refers to a study she led whilst working in the Royal Free London NHS Foundation Trust 2010-12.admissions

Hardly a week seems to pass without the media reminding us of the policy makers’ agenda: unplanned hospital admissions of elderly patients account for 80% of all NHS admissions, and perhaps because of their higher risk of medical and social complexity are seen as adding additional pressure to our already overstretched A&E departments. Continue reading