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About the BGS

The British Geriatrics Society is the professional body of specialist doctors, nurses, therapists and other professionals concerned with the health care of older people in the United Kingdom.

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BGS Senior officers' vacancies

Expressions of interest are invited for the post of Deputy Honorary Treasurer (deadline: midnight, 28 July) and Deputy Meetings Secretary (deadline: midnight, 1 September). Click here for job description and instructions on applying.

Age & Ageing Journal

Age and Ageing  is the British Geriatrics Society’s international scientific journal. It publishes refereed original articles and commissioned reviews on geriatric medicine and gerontology.

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Vacancy: DGM Question writing group

The BGS and RCP (London) is seeking clinicians with an interest in geriatric medicine to join the question writing group for the diploma in geriatric medicine.

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King's Fund Report: Quality improvement in mental health

Published by the King's Fund (20 July 2017): A growing number of mental health providers (in the UK and beyond) are beginning to embed quality improvement across their organisations, with some encouraging results. The approach is based on the concept that sustained improvement is best achieved by empowering frontline teams, service users and carers to design, implement and test changes to services.

This report describes the quality improvement journey of three mental health organisations (two in England and one in Singapore). It provides key insights and lessons for others considering embarking on a similar journey.

Key findings

  • Embracing quality improvement requires a change in the traditional approach to leadership at all levels of an organisation, so that those closest to problems (staff and patients) can devise the best solutions and implement them.
  • Doing quality improvement at scale requires an appropriate organisational infrastructure, both to support frontline teams and to ensure that learning spreads and is taken up across the organisation.
  • Tools and approaches used in the acute hospital sector can be adapted for use in mental health care, including in community settings.
  • Success is most likely when there is fidelity to the chosen improvement method, and a sustained commitment over time.
  • The strong emphasis on co-production and service user involvement in mental health can be harnessed as a powerful asset in quality improvement work.

Download the report from the KF website

A timely statistical reminder that living longer is something to be hoped for, not feared

Reported in the Independent (18 July 2017): Sir Michael Marmot has collected data which suggest that life expectancy growth rates are slowing rapidly

For several years now, we’ve been drowning in ominous forecasts showing an exploding old-age dependency ratio, and projections of much higher structural spending on health care for the elderly – spending which will need to be paid for by higher taxation or lower spending on almost everything else.

Ageing featured prominently in last week’s Fiscal Risks report from the Office for Budget Responsibility.

Between 2000 and 2015, life expectancy at birth increased by one year every five years for women and by one year every 3.5 years for men. But since 2015, that life expectancy growth rate has fallen to one year every 10 years for women and one for every six years for men.

Fiscal austerity from the Government since 2010 might be a contributory factor in the slowdown. In truth, there’s not much empirical support for this link. Official data on excess winter deaths did show a spike in 2014/15, at a time when the NHS and social care were under serious strain. But they fell back in the most recent figures.

Until we have more evidence, the best argument against the underfunding of social care and the NHS is that it creates a great deal of discomfort and misery for the elderly while they are alive – something for which we have an abundance of evidence – rather than jumping to the conclusion that it is driving them to an earlier grave as well.

Ministers needs to provide answers on social care

Reported by Inside Housing (requires subscription) (19 July 2017): We’ve known for some time that sheltered housing is a precious resource. Now we know just how precious. Research by Demos, commissioned by Anchor, Hanover and Housing & Care 21, demonstrates the enormous social value of sheltered housing – which is worth £486m a year. According to Demos, supported housing saves the NHS, emergency services and social care services at least:

  • £300m per year from reduced length of in-patient hospital stays
  • £12.7m per year from preventing falls by residents of sheltered housing
  • £156.3m per year from prevention of falls which result in hip fractures
  • £17.8m per year from reduced loneliness

According to Demos, each year 600,000 older people attend A&E following a fall, and around a third of them are admitted to hospital. Every year 300,000 people aged over 65 are hospitalised for a hip fracture. In light of these statistics, Demos highlights how sheltered housing presents a very effective resource to tackle the primary drivers of health and care costs among older people – namely poorly insulated houses, falls and loneliness. Such findings should feature in government thinking as they consider the report of the joint select committee inquiry into funding reform for supported housing. 

Falls and fractures: consensus statement and resources pack

On 14 July 2017, Public Health England published a new consensus statement supporting commissioning for prevention of falls and fractures and its resource pack. The guidance was produced by the National Falls Prevention Coordination Group (NFPCG). The NFPCG is made up of organisations involved in the prevention of falls, care for falls-related injuries and the promotion of healthy ageing. The resource pack identifies resources to support delivery.

The guidance is aimed at local commissioning and strategic leads in England with a remit for falls, bone health and healthy ageing.

Recorded Dementia Diagnoses 2016/17

Reported in Care Management Matters (17 July 2017): The latest statistics on dementia prevalence in England have been published by NHS Digital. The annual report brings together GP-level data on recorded dementia diagnoses.

The Department of Health, on behalf of the Secretary of State for Health and NHS England, directed NHS Digital to establish this data collection in order to receive specific dementia diagnosis data. These data support the Prime Minister's challenge on dementia 2020, which aims to improve the national diagnosis rate of dementia.

For each general practice included in this data collection, NHS Digital receives a count of the number of patients with a dementia diagnosis in their clinical record, as well as a count of the total number of registered patients at the practice.

In 2016-17, it reports that:

  • 422,000 people aged 65 and over in England have a recorded dementia diagnosis. This represents 1 in 23 people aged 65+ registered with a GP.
  • 1 in 5 women aged 90 or over have a recorded dementia diagnosis, the highest prevalence for any group.
  • There were 207,797 unique patients aged 65 and over admitted to hospital in an emergency with a diagnosis of dementia (provisional data).

Other key facts in this report include:

  • Recorded dementia prevalence at 30th June 2017 is 0.770% (1 person in 130).
  • When considered alongside monthly data previously collected, this indicates a progressive increase in recorded prevalence from June 2016 (0.763) to June 2017 (0.770).

Social care war as NHS fines 22 councils for bed blocking

Reported in The Times (16 July 2017): One in six councils in England have been fined by the NHS for bed-blocking as the health service and local government go to war over social care funding. The NHS has fined at least 22 councils for causing delays in discharging patients and threatened 11 others with charges. The news will fuel tensions between local government and the health service, which have been pitted against each other in the battle to close a £22bn hole in health funding. Earlier this month, council leaders hit out at “last-minute plans” to further penalise authorities that fail to reduce bed-blocking. Under proposals from Jeremy Hunt, the health secretary, councils that underperform in helping NHS patients go home could have their share of a £2bn social care fund — announced in April’s budget — withheld. Last night, Izzi Seccombe, a Tory council leader who speaks on community wellbeing for the Local Government Association, said creating divisions could “exacerbate the social care crisis”.

NHS holds on to top spot in healthcare survey

Reported in The Guardian (14 July 2017): Commonwealth Fund analysis of healthcare systems in 11 nations finds NHS is the best, safest and most affordable

The NHS has been judged the best, safest and most affordable healthcare system out of 11 countries analysed and ranked by experts from the influential Commonwealth Fund health thinktank.

It is the second time in a row that the study, which is undertaken every three years, has found the UK to have the highest-rated health system.

The NHS has held on to the top spot despite the longest budget squeeze in its 69-year history, serious understaffing and the disruption caused by a radical restructuring of the service in England in 2013.

Its ranking is even more notable because the thinktank found the UK to put the fourth smallest amount of GDP into healthcare among the 11 nations. While the US spends 16.6% of its national income on health, the UK comes near the bottom, investing just 9.9%. Only New Zealand (9.4%), Norway (9.3%) and Australia (9%) put in less.

The UK emerged with the best healthcare system overall, just ahead of Australia, with the Netherlands a little further behind. A group of experts assessed them against 11 criteria designed to measure the effectiveness of different health systems.

“The UK stands out as a top performer in most categories except for healthcare outcomes, where it ranks with the US near the bottom,” according to the Mirror, Mirror 2017 report from the US-based Commonwealth Fund.

Royal College of Psychiatrists - Dementia Report 2017

The Royal College of Psychiatrists have published a third round of findings and recommendations on the diagnosis and treatment on dementia.

Download the full report and executive summary from this page.

Key findings
Delirium recording requires improvement: In more than half of casenotes of people with dementia, there was no recording of an initial screen or check for symptoms of delirium. Inconsistency in what is recorded and communicated may affect clinical care and thereby increase a person with dementia’s risk to developing delirium.

Personal information to support better care must be accessible: A ward spot check carried out during the audit looked for the document with key personal information about care needs and communication that should be completed for people
with dementia, and found that only half of these patients had one in place. Forty percent of staff said that they could not access this information most of the time, and under half of carers said definitely, staff were well informed. Services must meet the nutritional needs of people with dementia Catering services in hospitals should be able to provide for the needs of people with dementia, who may not be able to eat full meals at regular times and need finger food meal alternatives and snacks available at any time to ensure they are nourished. Less than 75% of staff said that they could obtain finger foods or snacks between meals for these patients. Twenty-four percent of staff thought people with dementia had nutritional needs met only sometimes, or were not met.

Championing dementia means supporting staff: To support staff to deliver better care, nearly all hospitals have created dementia champions at ward level. Just under 70% of carers gave a high rating to care overall. Staff said they needed more support, especially out of hours when less than a quarter of staff said they could access specialist support for dementia always or most of the time. Involve the person with dementia in decision making Where a change in residence after discharge e.g. from their own home to a care home) was proposed, just over one third of patients did not have their consent to begin this process recorded, or evidence that a best interests decision making process had taken place, in the case that they lacked capacity.

Key recommendations touch on: delirium, ensuring staff receive training in delirium and its relationship to dementia, manifestations of pain, and behavioural and psychological symptoms of dementia, personal information use, dementia champions and decision making

Nurse research to ‘help older people live healthier lives’

Reported in the Nursing Times (10 July 2017): A nurse consultant is to develop and test an intervention to help community nurses support frail patients and help them to “live healthier lives”.

Helen Lyndon, a nurse consultant for older people, has begun a National Institute for Health Research (NIHR) clinical doctoral research fellowship at the University of Plymouth.

Ms Lyndon, who works for Cornwall Partnership Foundation NHS Trust, will conduct a feasibility study aimed at developing, implementing and testing a nurse-led intervention to improve healthy living in older people with frailty.

Known as the HAPPI study – Holistic Assessment and care Planning in Partnership Intervention – the research will take place over four years, and is being supervised by nursing academics at Plymouth’s faculty of health and human sciences.

Ms Lyndon recently completed a two-year secondment as the clinical lead for frailty with NHS England, and has spent the majority of her career in community primary care or home settings, with a particular interest in supporting older people with long-term conditions.

While undertaking her PhD, her fellowship enables her to continue with her clinical work.

She said: “The intervention I’m developing will ask the question ‘what can we do better?’ to help older people live healthier lives.

Trainee nurses embark on a new course to transform healthcare

Reported in the Coventry Observer (8 July 2017): TRAINEE nurses are embarking on a new course to transform healthcare.

Coventry University have launched a ‘nursing association’ course which aims to bridge the gap between healthcare assistants and registered nurses.

Over the next two years 29 trainees will spend one day at the university and the rest of the time working at hospitals, health or social care organisations or in the community.

Healthcare bodies across the county have signed up to take on some of the trainees, including University Hospital Coventry, George Eliot Hospital and Myton Hospice.

Coventry University is part of a second wave of 24 test sites chosen by Health Education England to deliver the training for the new role, with 11 other pilot areas launching courses earlier this year.

It will create 2,000 nurses across the country by 2019.

Care cost cap and asset threshold 'critical' to social care funding proposals

Reported in Care Appointments (7 July 2017): A cap on care costs and an asset threshold will be included in the Government's social care funding consultation, a health minister has said.

But Tory frontbencher Steve Brine stopped short of repeating his party's manifesto figures, which included a pledge to ensure a person's assets do not dip below £100,000 as a result of paying for care.

Mr Brine told the Commons a "capital floor and an absolute limit" on the amount people can be asked to pay are "absolutely critical two pillars that must go together". A negative response to Tory manifesto plans to make pensioners pay for social care by selling their homes after they died led to the Queen's Speech only referencing a pledge to consult on "proposals to improve social care".

The £100,000 asset threshold was designed to replace a £72,000 cap on contributions, recommended by the Dilnot report.

Tory Peter Bone (Wellingborough) also criticised his party's social care election pledges, saying they were only labelled the "dementia tax" by Labour as the proposals were "stupid".

Speaking in the Commons, Conservative former minister Sir Desmond Swayne asked Mr Brine: "What is the status of what was the announced Government policy that the Dilnot cap will be implemented in the financial year 2021/22?"

Mr Brine replied: "So the Prime Minister has been very clear about the importance of tackling this issue.

"As she said, we look after two million more over-75s in the next 10 years - we have to find a sustainable way of caring for older people.

"We will consult on detailed proposals, which will include a capital floor and an absolute limit on the amount people can be asked to pay.

"Our objective is that consultation will be to get the widest possible consensus."

Health inspectors sent into chaotic councils to fix social care crisis

Reported in The Telegraph (3 July 2017): Care Quality Commission inspectors are to be sent into chaotic councils for the first time in a bid to improve faltering social care services. The health watchdog will target town halls which are failing to provide enough care home spaces and community services as part of an effort to slash bed blocking in NHS hospitals.

The move, announced by Jeremy Hunt in Parliament last night, will be accompanied by the threat of financial sanctions for local authorities which fail to improve. Until now, the CQC, whose main task is monitoring standards in the NHS, has had the power to inspect individual care homes and social care providers. But under the new measures, inspectors will have the right to scrutinise councils themselves in an effort to tackle one of the root causes of so-called delayed transfers of care.

Reports of poor practice will be made publicly available.

The Department of Health has drawn up a list of 12 local areas where inspections will take place within a month, which include Birmingham, Manchester, Oxfordshire and Plymouth.

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