Reported on gov.uk (21 September): Could we create a world without dementia in the near future? This is the question that for years no one has dared to ask. We assumed – wrongly – that dementia was just part of the ageing process instead of the disease of the brain it actually is. But 4 years ago that changed. The UK hosted the first ever G8 dementia summit, which set the explicit ambition to find a cure or disease-modifying therapy for dementia by 2025. Since then, governments have formally united in the fight against dementia, and adopted the first Global Action Plan on Dementia, during the World Health Assembly in May 2017. In the UK we have done much to improve diagnosis rates, from one of the lowest to one of the highest in Europe. This matters because an early diagnosis can support patients to make lifestyle changes that slow the progress of the disease – and also help families make adjustments to make their dementia journey easier.
Reported by the BBC (21 September): Nine in 10 GP surgeries in England have been rated as good and outstanding by inspectors.
It means general practice is the highest performing sector in the NHS, according to the Care Quality Commission ratings, above hospitals, mental health and social care. But inspectors did flag up safety concerns at one in seven practices.
The inspection regime has taken nearly three years to complete and involved more than 7,300 surgeries.
The safety concerns included problems with: storing vaccines at the right temperature; ; filling in prescriptions quickly enough; having defibrillators that work properly; learning from mistakes.
But some of these concerns were not considered serious enough to warrant the practice getting an inadequate or requires-improvement rating.
Reported in the King's Fund (16 September 2017): As the NHS approaches its 70th birthday, it continues to occupy a unique place in public consciousness. However, it is under significant pressure and facing perhaps its biggest challenges since it was established. With some questioning whether the NHS can be maintained in its current form, the King's Fund wants to initiate a debate about the ‘contract’ between the NHS and the public – what people can expect from the service and what their obligations are in return.
Through its project on the changing relationship between the public and the NHS, KF will explore what the public thinks about the NHS. Over the next few months, it will ask:
- what do the public think the NHS is for?
- how has this changed over time?
- what drives the relationship between the NHS and the public?
- are public expectations changing?
- where does the balance of responsibility for health lie between the NHS and the individual?
Ipsos MORI was commissioned to conduct a survey on the public’s attitude to the NHS. Do the public believe the NHS should be maintained? Do they still believe in its founding principles? What do they see as their responsibility when it comes to their own health? Do they want a say in how decisions that affect the NHS are made? Do they think people’s expectations of the service are realistic and do they think those expectations are being met?
Read more on the KF website
Reported in The Independent (17 September): Two in three Brions are willing to pay higher taxes to order to properly fund the NHS, a new poll has found – a significant increase in the number previously prepared to do so.
The research, carried out by Ipsos Mori on behalf of the King’s Fund think tank, found 66 per cent of respondents would be happy to pay more “in order to maintain the level of spending needed” for the health service."
In contrast, just 20 per cent are in favour of spending cuts to other key services such as welfare and education to boost funding for the NHS, while just ten per cent believe the health service should reduce either its range of services or the level of care to balance its books.
The researchers carried out interviews with 1,151 adults in an effort to find out about public attitudes towards the NHS as it approaches its 70th birthday next year.
Reported in The Guardian ( 16 September 2017): I spoke to the daughter of an 83-year-old woman this week who has never used a cash machine. She has never set up a direct debit or standing order. She has certainly never used contactless. But she has full mental capacity. It’s just that after 60 years of her husband running every aspect of the family finances, she has now found herself handling money for the first time due to his ill-health. Much has been done to help youngsters learn about money, with personal finance lessons introduced in schools. Do we need more of a national effort to help elderly people facing the same acute lack of financial understanding?
Separately, a friend told me about his recently widowed dad who had a knock at the door from a salesman pushing a walk-in bath. What followed was the standard rip-off: the deal would only last for a week, he’d check with his manager if he could offer such a discount – the usual garbage. All the 80-year-old had to do was put down a £3,000 deposit. Of course, once the money was pocketed, the salesman and the bath never materialised.
The starting point must always be family members, but not everyone has helpful, able or willing offspring. The banks have a role to play here. Barclays has a great “digital eagles” programme that gives practical support to older adults at “tea and teach” sessions, helping them set up passwords, send emails, shop online and use Skype and Facetime. A broader programme like that, available in branches, jointly funded by the banks and aimed at the over-75s, could be hugely beneficial.
Reported by the Royal College of Physicians London (14 September 2017): The National Hip Fracture Database's (NHFD's) ninth annual report shows that while more patients are receiving early surgery and surviving a hip fracture, two in five are not receiving all of the recommended elements of a hip fracture programme that represent ‘best practice’.
The NHFD report analyses the process and outcomes of care of nearly 65,000 people who presented with a hip fracture across 177 hospitals. It reports much good practice within inpatient care, with the majority of patients getting prompt surgery, specialist geriatric assessment and consideration of their nutritional status.
But, across the country nearly 40% of patients are still not receiving the full package of care that represents best practice and are missing out on important clinical assessments that will improve their rehabilitation and recovery after this serious injury. In addition, in England, the full package attracts the £1,335 additional payment of Best Practice Tariff (BPT), so hospitals are missing out on potential income.
Some of the other key findings of the latest report include:
- A rise in length of hospital stays of 1 day in English hospitals, equivalent to the use of an extra 160 inpatient beds across NHS services in England.
- Over 85% of patients now receive surgery appropriate to the type of their hip fracture, but almost 4,000 patients that NICE recommend should be offered a Total Hip Replacement were not able to have that operation.
- An examination of patient outcomes at 120 days shows that from the 18,141 patients for whom the audit has this data, 9% (1,545) remain completely immobile 4 months after their injury.
The British Geriatrics Society makes two Rising Star Awards each year:
- One for research contributions that have translated into, or are in the process of being translated into, improvements to care of older people.
- One for clinical quality/ or work/project that demonstrates that they have improved the care of older people with frailty in their locality.
Both awards will be made to BGS members who have a programme of ongoing research or relevant project work. The award includes a cash prize of £250.00 to each winner from the Dr Jim George Memorial Fund.
There is increasing political and clinical interest in the concepts of multimorbidity and frailty. For those of us working with older people in primary and secondary care we feel that we intuitively understand these concepts. After all, we have been working towards improvement in caring for people with multimorbidity and frailty for many decades, and in some ways, doing so was the original raison d’être of the specialty of Geriatric Medicine.
However, although I have been working as a geriatrician for over thirty years, armed with my intuition, it is only in recent times that I have begun to truly understand the complexities of these issues. In recent years the concept of multimorbidity, and particularly frailty, have been injected with scientific understanding and explanation.
We have come to understand the great impact that these issues have on health and social care, and the pressures that they bring to bear. The complexity of multimorbidity in the context of frailty, dementia and polypharmacy particularly bears a substantial healthcare burden. If, like me, you struggle to understand the full picture of the relationship between frailty and multimorbidity, it is worth reading the article on New Horizons on Multimorbidity in Older Adults1. This overview helps explain the link between the concepts of multimobility and frailty and their relevance to the healthcare of older people.
Reported in the Guardian (25 August 2017): Experiences from the Canterbury region offer key lessons on how accountable care should work – and how it should not
As the NHS begins to grapple with the concept of accountable care systems, the experiences of the Canterbury region on New Zealand’s South Island offer important lessons on how – and how not – to do this.
The King’s Fund has been studying the Canterbury transformation for some time, and has just published its latest report [pdf]. The key finding is that it has coped with growing demand without expanding hospital capacity – but neither has it cut it.
Canterbury’s performance against the rest of the country is impressive; its 600,000 population has lower acute medical admission and readmission rates, shorter length of stay, fewer emergency department attendances, and lower spending on emergency hospital care. It is supporting more people in their homes and communities.
This year’s BGS Autumn Meeting will be returning to London after more than a decade. It is also my last meeting as Honorary Meetings Secretary and I want to highlight some of the advancements that have been introduced over recent years, and which have progressed while I have been in office. The meeting is the largest of its kind for specialists in older people’s healthcare and has grown in recent years to attract over 700 delegates.
Here are some great reasons to register for the BGS Autumn Meeting in London this year;