‘A destructive vicious circle’: what does the future hold for health and social care?

Jill Mortimer is Age UK’s Health and Care Policy Adviser and tweets at @Age_UK.

What’s really happening in health and social care services? Over the last few years, we used in Age UK’s Care in Crisis campaign to document the devastating budget cuts that meant fewer and fewer people were getting public support for help with their day to day activities.

But what about the NHS? Hasn’t it been protected through the last five years of cuts in public services? If so, what lay behind last year’s winter crisis? And why is Monitor, the health services financial regulator, now talking about the ‘worst financial crisis in a generation’?

Nice one NICE: developing the policy narrative on preventing disability, frailty and dementia in later life

David Oliver (BGS President Elect and Consultant Geriatrician) and David Buck (King’s FundSenior Fellow, Public Health and Inequalities) discuss the National Institute for Health and Care Excellence (NICE)’s new guidelines on preventing disability, frailty and dementia in later life. The article can be read in full on The King’s Fund Blog:

Life-expectancy is now 79 for men and 83 for women, and when we reach the age of 65 we can expect to live another two decades on average.

Living longer lives is a cause for celebration but there are still major inequalities in life expectancy and healthy life expectancy at birth, in rates of premature deaths, and in life expectancy at 65 between different socioeconomic groups. We also face a rising prevalence of long-term conditions, dementia, disability and frailty related to rapid population ageing, which has big implications both for individuals and for health and social care systems.

The holy grail of prevention would be to reduce inequalities in the health of older people, to improve their overall health and to ‘compress morbidity’, delaying the onset of poor health until the last few years of life. The King’s Fund has contributed to this debate with its work on adult behaviour change and improving care for older people, and its Time To Think Differently programme of work. But now, somewhat surprisingly, the National Institute for Health and Care Excellence (NICE) has added its voice, in the guise of guidelines released for consultation on preventing disability, frailty and dementia in later life.

‘So what?’ you cry, yet another bunch of stuff to wade through. But this time it’s different – what is so interesting about these guidelines is not so much the detail but the principles and linking themes behind them, and the fact that, instead of just advising clinicians, the guidelines include direct advice to the government on health and wider social policy.

So what’s in it? For starters, NICE calls for government interventions to make smoking and drinking less affordable and accessible; and to make the maintenance of healthy weight and regular exercise more affordable and accessible. Hardwiring these recommendations on affordability into local and national public health strategies is a challenge to those, of any party, who do not see price as a policy lever on behaviours other than tobacco use. Given that Public Health England also supports minimum unit pricing of alcohol, two important government health bodies have now put their cards on the table….[continues]

Read the article in full on the King’s Fund Blog

‘To resuscitate or not to resuscitate’ is not the question, or is it?

Amit Arora is a consultant physician in care of older people and Chair of the England Council of the BGS. 

A landmark ruling was recently handed down by the Court of Appeal in the case of Janet Tracey v Cambridge University Hospital NHS Foundation Trust and others. The Court ruled that Cambridge University Hospital Trust violated Mrs Tracey’s (Article 8 of the European Convention on Human Rights) Right to Respect for Private Life in failing to involve her in the process which led to making a DNAR decision. It also said that it was a duty of common law to consult.

NICE guidance and the importance of considering multimorbidity

Amit Arora is a consultant physician in care of older people and Chair of the England Council of the BGS. 

Finally, multi-morbidity may be recognized- is this wishful thinking or a BGS victory for our patients?

Whatever it is, it is time for action!

NICE is committed to developing more relevant guidance for GPs that takes into account the complexity of patients they see in daily practice with multiple long-term conditions, the chief executive of NICE told delegates at Pulse Live.

Opening the first day of the conference in London on 29^th April 2014, Professor David Haslam said NICE recognized current single-condition guidance was impractical for GPs dealing with patients with multimorbidity. ‘Single long-term conditions – which is the way NHS is organized generally apart from primary care – is the rarity.’ This of course is a cause close to the hearts and minds of many geriatricians. I have myself written about this on this blog and in some submissions to the health agencies in past.

Avoiding Serial Projectitis – Making Health and Care Systems fit for an Ageing Population

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. He writes on the King’s Fund blog about their paper, launched today.

By 2030, one in 5 people in England will be over 65 and at that age, men will on average live till 88 and women till 91. This population ageing shouldn’t constantly be catastrophised with language like “burden” “timebomb” or “tsunami”. In fact, it represents a victory for improved societal conditions and for modern healthcare – preventative and curative. Indeed, well into older age, most people report high levels of happiness, health and wellbeing and even over 80, only half say they live with life limiting long-term conditions.

However, despite the “upside” of population ageing, we need to be realistic about its inevitable implications for health and care services.

The government and the “societal benefits” of care

Zoe Wyrko is a Consultant Geriatrician at Queen Elizabeth Hospital Birmingham and is the workforce planning lead for the BGS. She tweets at @geri_baby

I like to think that as a jobbing geriatrician I have a fairly pragmatic attitude towards guidelines. I know that they exist, but I also know that they are not always directly applicable to a frail older person with multiple morbidities, so I’ll look at what they say with a hint of scepticism, and use them when they help me to provide the best care. Extrapolating from this, I tend to see NICE as an organisation that is more for other people than me. I know that the work they do is vital in standardizing care, bringing together groups of experts to decide on treatment pathways and helping to make decisions on which drugs to give when. I have even attended a stakeholder group for the preliminary stages of the guidance they are planning to issue for social care.

This week however, a statement made by Sir Andrew Dillon, head of NICE, has made me sit up and pay attention. It seems we should be afraid… very afraid.

The Liverpool Care Pathway has been made a scapegoat

“It is as illogical to discredit the LCP because of errant clinicians as it is to ban the Highway Code because of bad drivers.”

Claud Regnard, FRCP, a palliative care consultant, has called the demise of the Liverpool Care Pathway a “tragedy” in his paper published in Age and Ageing today.

After a series of media stories about the palliative care system causing malnutrition, dehydration, and premature death in patients across a wide age-range, the Liverpool Care Pathway (LCP) was subject to review by a panel under Baroness Neuberger. The panel delivered their findings on 15 July 2013. They said that the LCP needed to abandon its name, as well as the use of the word “pathway”, and that the LCP should be replaced within 12 months by an “end of life care plan”.

Lessons of the Francis Report are not just confined to the NHS

The BGS blog has recently hosted a lot of commentary about the Francis Report and its implications for the NHS, particularly in England. It can be useful, in times of reflection, to look outside of your immediate working environment to consider what can be learned from elsewhere. The Francis Report has implications for other healthcare economies.

Here Prof Des O’Neil considers its implications for care in the Republic of Ireland. This article initially appeared on the BMJ blog.

The terrifying Francis report from Mid Staffordshire demonstrated vividly how older people became early victims of poor leadership and standards in the NHS, very belatedly recognised canaries in the coal mine.

Across the Irish Sea, a new and unhappy phenomenon is arising for older people in a mixed private and public healthcare system. A somewhat messy and porous border separates the two systems, with public and private beds in public and voluntary hospitals, as well as exclusively private hospitals which provide elective care in the main. There is much less discussion within the profession than might be desirable about the impact of the system on professional practice, with the few studies available (from general practice) showing differing treatment patterns for public and private patients . The aspiration of the current government is for a system of universal coverage, based on the Dutch model, but few are holding their breath.

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.

7-Day Working: Enjoy these weekends while you can…

Amit Arora is a consultant physician in care of older people and Chair of the England Council of the BGS.

The Francis report, Bruce Keogh’s mortality review, the winter beds crisis, A/E crisis and Future Hospitals commission report from the Royal College of Physicians and some statements from the Hon Health Secretary have a common theme- Care of Older people. It comes as no surprise that finally the realization seems to have come that care of older people can be improved and though expensive, it is worthwhile.