The following files are secured pdf versions of the powerpoint files supporting presentations delivered at the BGS Incontinence in Older People Conference in 2016. These are published with the presenters' permission and the onus for assuring that copyright permissions are adhered to is vested in the individual presenters. They will remain on the BGS website under Resources/Powerpoint Library for two years:
Janet Browning: The value of good continence care for older people
Karen Irwin: Improving continence services for older people with long term conditions and disability
Alice Macleod: Health Foundation Improvement Project: Promoting continence in care homes
Alex Miodrag: The battle for hearts and minds
Susie Orme: Why treating urinary incontinence in older adults is cost effective
Jenny Stuart: How to integrate continence services and secondary care to develop pathways of care
Reported in The Guardian (21 October): Two years after NHS England unveiled the Five Year Forward View (pdf) – its blueprint for community-based, integrated healthcare able to cope with the pressures of a growing and ageing population – the central bodies are still not doing enough to make it happen.
The King’s Fund is about to publish analysis of progress in reforming the way the NHS works to allow the new care models outlined in the Forward View to flourish. Speaking to the Guardian’s Healthcare Professionals Network, chief executive Chris Ham identified four ways in which the system is hampering local reforms – a shortage of cash to kickstart change, too little progress on a payment system which encourages collaboration, the need to sort out the debacle of the contracting rules which emerged from the Lansley reforms, and rushing change.
“The big concern we’ve got is the importance of a transformation fund to prime new care models. Virtually all the money in the Sustainability and Transformation Fund is going into sustainability and deficit reduction. It leaves precious little left over to support transformation,” he says.
“It is difficult to see how you stem rising demand unless there is the resource to invest in the out of hospital services. More money has to be found to prime those services, which are creaking at the seams. The NHS and its leadership need to explore other avenues [to raise cash], such as the work going on in relation to the NHS estate to generate income.”
Reported in The Guardian (18 October): Our tireless volunteering and caring roles holds together the social fabric; targeting our benefits would jeopardise this.
The case against us crumblies is that we occupy space, property and, crucially, hospital beds and NHS resources disproportionately while enjoying benefits to which we are not entitled, through favourable treatment from successive governments. Our response to date has been to plead that we have contributed throughout our working lives and are therefore entitled to these benefits. And we have a strong case. We have made a massive difference. It was the product of our working lives that generated an explosion of economic growth, accompanied by a major redistribution of wealth and with it an enlightened social contract.
It was our generation that got its hands dirty at the sharp end in poor neighbourhoods. That is where social justice has been engineered through a real investment in social capital, with excluded people taking ownership, with buddies, mentors, citizen advocacy, parent partnerships, credit unions, key workers, outreach, mediation services, citizens’ advice bureaux and multi-agency working.
In the wider world, the hungry are getting seeds, the thirsty wells, the naked sewing machines, the imprisoned advocates, the poor fair trade, disabled people a more level playing field. All these initiatives have been the instruments of empowerment, of giving a parochial hand up in place of the patriarchal handout. That is all the work of our generation. They were our initiatives.
And more. It is also our generation whose youthful activity pioneered remedial action for an abused planet, which dragged us out of the gender dark ages, which started to make cracks in the glass ceiling, which began the process of cultural diversity. We are the generations that brought ages of deference to an end and have enabled today’s generations to hold the director class to account.
NICE has published, in September 2016, a guideline which covers optimising care for adults with multimorbidity (multiple long-term conditions) by reducing treatment burden (polypharmacy and multiple appointments) and unplanned care. It aims to improve quality of life by promoting shared decisions based on what is important to each person in terms of treatments, health priorities, lifestyle and goals. The guideline sets out which people are most likely to benefit from an approach to care that takes account of multimorbidity, how they can be identified and what the care involves.
The guideline includes recommendations on:
- taking account of multimorbidity in tailoring an approach to care
- how to identify people who may benefit
- how to assess frailty
- principles of an approach to care that takes account of multimorbidity
- delivering the approach to care
The guideline is intended for healthcare professionals as well as people with multimorbidity, their families and carers.
Reported in The Guardian (14 October): Theresa May has told the head of the NHS that it will get no extra money despite rapidly escalating problems that led to warnings this week that hospitals are close to breaking point.
The prime minister dashed any hopes of a cash boost in next month’s autumn statement when she met Simon Stevens, the chief executive of NHS England, senior NHS sources have told the Guardian. Instead she told him last month that the NHS should urgently focus on making efficiencies to fill the £22bn hole in its finances and not publicly seek more than the “£10bn extra” that ministers insist they have already pledged to provide during this parliament.
She told him the NHS could learn from the painful cuts to the Home Office and Ministry of Defence budgets that she and Philip Hammond, the chancellor, had overseen when they were in charge of those departments, according to senior figures in the NHS who were given an account of the discussion.
Senior Whitehall sources have confirmed that Hammond’s statement on 23 November will contain no new money for the NHS, despite increasingly vocal pleas from key NHS organisations and the public’s expectation of extra health spending if Britain voted to leave the EU.
Reported in The Telegraph (16 October): A third of elderly patients may be being prescribed unnecessary medication, putting them at needless risk of side-effects and costing the NHS millions, a study has shown.
A review of 1,800 over 75s at NHS Croydon found that the average patient had been prescribed six different drugs. But after a reassessment hundreds of prescriptions were cancelled, with up to one third of patients taken off at least one drug. Hundreds of prescriptions were stopped because they were no longer effective and dozens because the patients were experiencing side effects or drug reactions.A further 121 patients were sent to their GP for further review, and 89 patients had their dose reduced.
The most common drugs which were stopped were the blood-thinning drugs warfarin and clopidogrel, aspirin, alendronic acid for osteoposrosis, cetirizine for hay fever and allergies, laxido for constipation, omeprazole for gastric reflux and adcal-d3, a drug to boost calcium and vitamin levels.
The research, carried out by pharmaceutical consultants Interface Clinical Services, predicted that the changes would save the NHS around £192,000 a year.
See also: Research finds ‘chemical cosh’ patients are more likely to suffer strokes (Islington Tribune)
Reported in the Nursing Times (17 October): Student affairs editor, Alan, questions whether the nursing profession is evolving into the leadership role that the health service needs. The word “nurse” has somewhat lost its meaning to me. Hours of lectures surrounding professional identity have yet to alter my opinion, because the nurses I see rarely give it a thought. Not knowing how to define their profession beyond their day to day tasks does not affect their work. They look after the patients in front of them and that is enough. We are entering a workforce that appears less and less sure what it wants to be.
Reported in the Guardian (6 October): Life expectancy has increased by 10 years across the globe in the past 35 years, thanks in part to efforts to treat infectious diseases such as Aids and malaria, but diet, obesity and drug use are now major causes of death and disability while too many women still die in childbirth, data reveals.
The Global Burden of Disease study, which regularly reviews the causes of illness, disability and death in every country in the world, shows health is improving but not to the same extent or in the same ways in every country. And as people live longer, they are suffering from more ill health and disability in their old age.
“Development drives, but does not determine health,” said Dr Christopher Murray, director of the Institute. “We see countries that have improved far faster than can be explained by income, education or fertility. And we also continue to see countries – including the United States – that are far less healthy than they should be given their resources.”
Life expectancy from 1980 to 2015 has risen globally by more than a decade to 69 years in men and 74.8 years in women. The cause of 70% of deaths is non-infectious diseases that often have lifestyle origins, such as heart disease, stroke and diabetes, but also include dementia. HIV/Aids, which was a major killer, accounted for 1.2 million deaths in 2015, which is a reduction of a third from 2005.
Reported by ITV (7 October): The NHS "would not cope" without workers from abroad, nursing leaders have warned.
New figures suggest the number of EU nationals joining NHS hospitals has soared - around one in five nurses recruited in England 2015/16 were non-British EU nationals, up from one in 14 in 2011/12. During the same period, the proportion of British nurses joining hospitals dropped from roughly 78% to 70%. The figures show foreign nurses make a "critical contribution" to the NHS, the Royal College of Nursing (RCN) said.
The Department of Health said overseas workers "form a crucial part of our NHS and we value their contribution immensely". The new figures are based on analysis by the Press Association and showed that of the 33,000 nurses recorded as joining hospitals in 2015/16, just over 6,000 held an EU nationality other than British.
See also: Immigration crackdown could lead to staff shortages, say recruiters (Guardian)
Reported in Care Management Matters (4 October): The Care Quality Commission (CQC) has issued guidance around needs assessments on hospital discharge. The regulator says that, ‘There have been some concerns expressed that care home providers will not readmit people after periods in hospital without conducting full, in person assessments of need.’
The CQC is seeking to clarify the legal requirements around this and offer some best practice guidance. It says that this approach applies equally to community adult social care services.
Regulation 9 of the 2014 Regulated Activities Regulations says that providers must undertake a needs assessment before providing a service, and do so in collaboration with the person being cared for or someone with legal powers to make relevant decisions. The CQC says that this is an important requirement and one of the fundamentals of providing good care. However, it explains that while needs assessments of people not previously admitted to a service will normally require face-to-face contact, where an existing service user has been admitted to hospital, regulation 9 does not necessarily require the provider to physically see the person when reviewing their needs and planning the re-start of their care on discharge.
The CQC goes on to say that, ‘Where a provider is confident that they can rely on information from hospital or care management staff, and that on the basis of this information they are able to meet the person’s needs, they do not necessarily need to see them in person. This includes in relation to gaining consent to their care and treatment being transferred back to the care home.’