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The British Geriatrics Society is the professional body of specialists in the health care of older people in the United Kingdom.

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The UK voted to leave the EU: what now for the NHS?

NHS Confederation: The prospect of Brexit has also raised questions about what it means for the NHS.

While debate has mainly focused on the possible financial impact, it is important to be aware that the EU has far-reaching and subtle effects on the health sector beyond purely economic considerations. Let’s look at some of the key interlinks between domestic and EU health policies. Around 130,000 EU health and social care professionals currently work in our system, equivalent to 10 per cent of our doctors and 5 per cent of our nurses. EU law on mutual recognition of professional qualifications has facilitated and speeded up NHS recruitment of these professionals to fill job vacancies and reduce dependency on expensive agency staff.

As the largest employer in Europe, the NHS has been affected by EU labour law such as the Working Time Directive, which has helped limit excessive working hours, but whose implementation for doctors in training has profoundly reconfigured their working patterns, resulting in changes to the organisation and delivery of patient care in some areas.

NHS organisations have also been impacted by EU competition and procurement rules, which aim to prevent anti-competitive practices damaging the interests of consumers, and seek to uphold ‘fair play’ within the EU’s internal market. Read more...


July issue of Age and Ageing journal out now

BGS blog: The July 2016 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.

A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more. 

Hot topics this issue include: Frailty index based on basic laboratory and clinical measures; Dietary protein and ageing; Do you want to live to be 100; Social engagement and cognitive ageing; Selective serotonin reuptake inhibitors and progression of dementia.

For more information on the July issue, see the BGS blog.


CQC here to stay after five-year plan pulled it out of 'special measures', says Behan

GP Online: Speaking on the future of regulation at the Health+Care conference in London, Mr Behan stressed that regulation was essential and the CQC was here to stay, even if providers do not always like the process.

'We could be abolished tomorrow and we'd be reinvented the next day,' he said. 'We need regulation, and the last thing we want is the lack of continuity and misbalance [caused by getting rid of the CQC].'

But he admitted that the CQC had not been performing to an acceptable standard, which merited it launching its new strategy earlier this year.

‘The CQC strategy was about needing to rescue the model of regulation. I’ll be direct, the CQC was in special measures, we weren't in a position where we could continue.

‘Our ambition for next five years is to target inspections to where they are needed most. This is so can contribute to a healthcare system where people trust our expert judgements, have confidence that we will identify good and poor care and that we will encourage improvements and effective use of resources.’


What if there were community services for older people 24/7?

Professor David Oliver blogging for the King's Fund 'What if' series: 

What if community services really were available to all those older people who need them 24/7?  The most frequent users of our services – whether acute, primary or community, mental health and social care – are older people. I am not talking about those remaining in fair health, but those living with multiple long-term conditions, frailty, dementia or age-related disability. Getting their care right is crucial, especially with an ageing population, rising demand, and pressures on workforce and funding.

So what would our utopia look like?

I’m focusing on people who need access to rapid assessment or additional support in a crisis, who need services that run on a stopwatch not a calendar. To achieve this, properly funded and staffed primary and social care is a must, as is a better focus on planning and support to live with long-term conditions. And planned social care would be available 24/7. It’s often night-times that are the deal breaker that make staying at home impossible.

In this wonderful new health service, when people did require urgent primary care they’d see their GP or nurse practitioner quickly – in their own home if needs be. Around 90 per cent of urgent care is urgent primary care, remember. If it’s not working well, there is additional strain on already rammed A&E departments and beyond.

Read more on the King's Fund Blog

See also: What if 'assisted dying' were legalised?

Ugly scourge of ageism after Brexit is a slur on our older people

After the EU referendum some young people have hurled abuse at pensioners, accusing them of robbing them of their future.

A new divide has broken open after the Brexit vote. Not just the obvious one between those who wanted to stay in the EU and those who wanted out. Now we have a generation divide.

I am on one side of that. I am 65, therefore, apparently, I am a crusty old bigot who shouldn't have had a vote equal to that of a youngster's because, as one blogger bluntly put it, I'm going to be dead before long anyway. I shouldn't therefore be allowed to help share a future I won't be part of. says: "Not content with racking up insurmountable debt, not content with destroying any hopes of sustainable property prices or stable career paths, not content with enjoying the benefits of free education and generous pension schemes before burning down the ladder they climbed up, the baby boomers have given one last turd on the doorstep of the younger generation."

So it's the old people who are to blame. We broke the banks.
Read more in the Belfast Telegraph

Medication reviews in nursing homes

GP Online: GP Online offers advice on implementing medication reviews in nursing homes.

Polypharmacy is an increasingly significant problem amongst residential and nursing home patients. As patients live longer, they are likely to acquire more diagnoses, with more medications prescribed. These may be initiated in secondary care without an up-to-date knowledge of the patient’s other medication. As hospital practitioners become more and more sub-specialised, GPs are absolutely critical to ensuring that medications prescribed by individual specialties are appropriate for that person. This is based on an extensive knowledge of the patient, knowledge of the drug, access to the complete medical record and the shared approach to prescribing that we often apply.

The following advice covers: 

  • Setting up a medication review
  • The medication review
  • What interventions may occur?
  • Common side effects and interactions
  • Personal experience

Guardian Focus on Occupational Therapy

Occupational therapists' role: 'We save money and improve quality of life'

When the College of Occupational Therapists commissioned a survey about the image of the profession, the answer came back that it was seen by decision-makers as “nice to have” rather than essential. Its leaders are determined to change that. In a major new campaign, called Improving Lives, Saving Money, the college is aiming to demonstrate the key roles that occupational therapists (OTs) can play in a changing and increasingly integrated health and care system. More to the point, it will spell out what cash the system can save by making better use of their skills. “It’s a two-year campaign that’s about enabling our members to position themselves in front of commissioners [of services] and make the case for return on investment,” says Julia Scott, the college’s chief executive. “We have to prove upfront that we save money as well as improve people’s quality of life.”

Budget cuts leave occupational therapy posts unfilled as referrals rise

Occupational therapists (OTs) make up 2% of the adult social services workforce but are responsible for around 40% of referrals, illustrating just how vital their expertise is. But cuts to council budgets are putting them under increasing pressure as vacancies are left unfilled and waiting lists for services increase. National figures show that the number of OT posts in adult social care in England fell by 4% in the year to September 2015. And in London, 18% of vacancies for experienced OT practitioners in adult and children’s services are being left unfilled. Harold Bodmer, president of the Association of Directors of Adult Social Services and director of adult services for Norfolk county council, says: “Some of that is down to the cuts. What we are trying very hard to do is to put occupational therapy expertise to best use, so that some of their work can be done by other people with OTs overseeing them.”

What will scrapping bursaries mean for occupational therapy students?

Bursaries for OT undergraduates are about to disappear, so university students will need to apply for loans. Student places on accredited occupational therapy degrees are currently commissioned by the NHS, which also pays tuition fees. The health service contributes to living expenses, and an additional means-tested amount – up to a maximum of £4,442 outside London – is available. But it’s all change from September next year. The commissioning system in England is due to be abolished, and occupational therapy (OT) university students, along with other allied health profession undergraduates, will have to apply for a loan to cover their tuition fee costs and apply for a maintenance loan.The government argues the reform – which brings funding for these students into line with other undergraduates - will address the shortage of health professionals. Places will no longer be capped, allowing universities to recruit up to 10,000 more students to health profession degree courses, say ministers.

Elderly patients being given medical treatment of no benefit, review finds

Care Appointments: More than a third of elderly patients who are dying receive "invasive and potentially harmful" treatments in their last weeks of life, according to the biggest review of its kind.

Analysis of data from 1.2 million patients worldwide, including from England, found patients being subjected to "excessive" and unnecessary treatments that make no difference to the course of their illness. Researchers said families are part of the problem, with some struggling to accept that nothing more can be done for their loved ones, and expecting "heroic" interventions from doctors. Published in the International Journal for Quality in Health Care, it found around a third of elderly patients with advanced, irreversible conditions - such as cancer - were given treatments that were of no benefit to them. This included a third of cancer patients given chemotherapy in the last six weeks of life, 10% of all patients admitted to intensive care, 33% given antibiotics, cardiovascular, digestive or endocrine medicines, and 30% given dialysis, radiotherapy, blood transfusions or other life support.

A quarter of patients who had Do Not Resuscitate (DNR) orders in their notes were resuscitated, while up to half of patients underwent invasive blood tests and scans.

Playing card games aids stroke recovery

BBC: Playing simple card games, such as snap, can help stroke patients with their recovery, say Canadian researchers.

The scientists found it improved patients' motor skills. Playing Jenga, bingo or a games consol like Wii worked equally well. They told the Lancet Neurology that the type of task used for motor rehabilitation might be less relevant, as long as it is intensive, repetitive and gets the hands and arms moving.

The researchers designed their study to test whether virtual reality gaming, which is increasingly being employed as a rehab therapy for stroke patients, is any better than more traditional games for honing upper limb motor skills. The Canadian team recruited 141 patients who had recently suffered a stroke, and now had some impaired movement in one or both of their hands and arms.

Delirium research in care homes: Trojan Horses and Holy Grails!

BGS Blog: Delirium (often called ‘Acute Confusional State’) is a common and serious illness among older people. It can be very distressing for patients, their families, and for healthcare staff; and can lead to worsening dementia, hospitalisation and death.

There is relatively little research on delirium in general, but this is particularly true of delirium in the care home setting. This is despite the fact that residents of care homes are likely to be at particularly high risk of delirium by virtue of the high prevalence of dementia, older age, poor mobility and physical illness.

Delirium can be prevented. Studies in hospital patients have shown a reduction in delirium of one-third using multi-component interventions targeting its risk factors –which essentially involve the provision of basic good quality care.

Read more on the BGS Blog

How red bags are bringing NHS and care homes closer

BBC: Like many good ideas, the way the NHS and care sectors in the London borough of Sutton are working together more closely is a relatively simple concept.

When a care home resident needs to go into a hospital, a red bag is packed for them. It contains their details, vital information about their health conditions, supplies of medicine, and a change of clothes for when they are ready to be discharged.

"You would not believe how many people face delays simply because clothes can't be found for them," says Mary Hopper, a senior NHS manager in Sutton. "You have staff going to lost property trying to find them something to fit." The initiative also sees a member of the care home staff visiting the patient in hospital within 48 hours of admission. And this all helps doctors and nurses treat them more effectively.

The result is older people are spending less time in hospital - eight days, which is four fewer than before the scheme was set up.

Improving home care services for older people

NICE: Home care services need to prioritise older people’s needs and wishes so they are treated with dignity, a new NICE quality standard says. NICE has issued a new quality standard which highlights how social care providers can help older people maintain their independence for as long as possible. Around 470,000 people used local authority funded home care services in England last year. The majority of these will be people aged over 65 years old. The new quality standard encourages providers to ditch the ‘one size fits all’ approach. It says that home care plans should describe what each person wants and how their needs will be met. Family members and carers should be involved in the decision process if possible. Enough time should be given so that what they want can be achieved in a way that does not compromise their dignity and wellbeing.

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