A radical rethink of care: report from the Parliamentary Committee on Health

Dr Jackie Morris is currently Dignity Champion for the British Geriatrics Society, and a Trustee of the British Institute of Human Rights.

On 23 February, I attended a meeting of the Parliamentary Committee for Health on behalf of the BGS; this particular meeting focused on the challenge of delivering high quality, integrated and compassionate care for older people.

During, the meeting (chaired by Baroness Masham of Ilton), we heard from a varied panel of speakers including Lord Warner, Professor Martin Green, Roy James (President of the Association of Adult Social Services), Caroline Abrahams (Charity Director of Age UK), and Helen Birtwhistle (Director of External Affairs at the NHS Confederation).

Health & social care costs: big data, or huge problem?

Rachel Elliott and Matthew Franklin are reporting on behalf of the Medical Crises in Older People (MCOP) research team. Read the first part of their blog on identifying health & social costs here.

As part of a programme developing and evaluating care in older people, our recent study in Age and Ageing reports health and social care costs over a three month period for older people discharged from Acute Medical Units (AMU) by applying unit costs to patient-level data obtained from six different agencies: hospitals, primary care, social care, mental healthcare, ambulance services, and intermediate care. This is the first study to do this in England, but obtaining resource use data from individual services for this analysis took months, which was costly and of no use for real time patient management.

New clinical guidelines in Age and Ageing journal

David Stott is Professor of Geriatric Medicine at the Institute of Cardiovascular and Medical Sciences at the University of Glasgow and is Editor in Chief for Age and Ageing journal. 

Clinical guidelines are intended to help health care practitioners adopt best practice. Good guidelines have the potential to reduce variations to practice and improve patient outcomes while ensuring efficient use of health-care resources.

There are however a plethora of guidelines, often with contradictory advice and of variable quality.

Importantly, for care of older people, guidelines have often lacked relevance due to restricted focus on single-organ disease, ignoring the realities of frailty with multi-morbidity, cognitive impairment (acute and chronic) and disability. However this is gradually changing, and guidelines now are emerging that are directly relevant for care of frail older people.

Given the increasing importance of guidelines in clinical decision making, this year Age and Ageing has added clinical guidelines as a new category of article. The journal is now publishing both ‘stand-alone’ guidelines (3000 words) and commentaries (1500 words). Already two papers have been published; the best practice guidelines for the management of frailty by Turner and Clegg give advice on the management of frailty in community and outpatient settings. The summary of the National Osteoporosis Society Vitamin D guideline by Aspray et. al. charts a rational approach to the confusing topic of when to measure 25-hydroxy vitamin D, and when and how to treat. I am keen to encourage further submissions of high-quality guideline articles to Age and Ageing.

Must clinical guidelines be followed for all patients? Obviously not! Here we can follow the logic of Margaret Thatcher (Scott Enquiry) who said ‘…Guidelines are for the guidance of officials to be consistent. Of course they have to be followed, but they are not strict law. That is why they are Guidelines and not law and, of course, they have to be applied according to the relevant circumstances.’ Therefore guidelines should be seen as important in informing practice but not in dictating it.

Integrated care – how to make a mountain out of a molehill?

David Stott is Professor of Geriatric Medicine at the Institute of Cardiovascular and Medical Sciences at the University of Glasgow and is Editor in Chief for Age and Ageing journal.

Integrated health and social care has been promoted as a key solution to the challenge of providing high quality care with a restricted budget. Philp summarises current thinking in a New Horizons article recently published in Age and Ageing.

The aim of providing a fully integrated system including coordination of organisation of health and social services sounds sensible. After all who would argue for disintegrated and disorganised care?

However there are problems and challenges, not with the concept of integration, but in the organisation and systems that are being ‘pushed’ to effect integration.

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.