In various BGS roles over the years, I have been very conscious that we are a four nation Society, with more members still working outside the United Kingdom.
With England comprising 84 per cent of the UK population, it might sometimes seem that Anglo-centric concerns predominate in our newsletter, website or e-bulletin - though to be fair, the chairmen of all four national councils are BGS trustees and our secretariat, including our policy and communications team, are committed to supporting BGS members working in all four nations.
For this edition of BGS Newsletter we asked Wales, Northern Ireland and Scotland councils to pen a quick update of key developments in their own systems and services, given that the organisation of health and care services has now been substantively devolved to each nation, with no direct control from Whitehall. Their contribution relates largely to their aspirations for the NHS in their respective countries, post-election.
Away from national specifics around organisation, funding and oversight of health care services, the patients we see, and the challenges we face in helping them, go beyond national boundaries or politics. And all of us can learn from innovations and models of care around the UK. One current example is the Health Improvement Scotland’s Older People in Acute Care (OPAC) programme. Another is the UK-wide drive to improve care for older people undergoing surgery – given fresh momentum by the drive from the Royal College of Anaesthetists focus on interdisciplinary perioperative care and building on the BGS POPS (Proactive care of Older People undergoing Surgery) section.
We are now just weeks from a General Election, so a focus on the politics of English Health and Social Care is inevitable and needed. Key decisions taken will affect our members, the organisations they work for and the patients and carers they see each day.
In February, we issued a pre-election Manifesto setting out six priorities on Health and Social care for older people in England. Despite different systems and structures, the central priorities will have resonance across the UK. We secured meetings with Liberal Democrat, Green and Labour health teams to discuss them and also had a dialogue with the Cabinet Office (see more detail in Patricia’s column on page 12). We may be one of many organisations, some with bigger voices and more clout, but it’s important to keep on posing the questions, keep on raising awareness, keep on responding to policy consultations. And there are numerous examples over the past few years in which the BGS, geriatricians and other clinicians interested in older people have had a major influence over national policy, guidelines or quality initiatives and informed wider debates.
Within the English context, it will be interesting to see post-election how much traction the NHS England Five Year Forward View still has. The new models of care it sets out, the buy-in from other national system leaders, and the focus on sustainable long-term changes in services rather than constant short term “quick fixes” and “serial pilotitis” are welcome. The recent King’s Fund Paper, Implementing the NHS Five Year Forward View, sets out some of the detail needed on implementation if it is to be a meaningful document.
Political promises versus reality
Between them, the parties are putting out welcome headlines and sound-bites around more integrated and co-ordinated care, care more attuned to people’s needs, a greater focus on dementia and mental health, beefing up the primary and community are workforce and allowing closer working, budget sharing and joint service planning between health and social care. However, none of them are promising funding remotely near the additional £4b per annum recommended by the King’s Fund in the Barker Commission on future funding, just to keep services at current levels. And the cracks are already widening – as the urgent care crisis and acute trusts’ rejection of national tariffs have shown. Hopes invested in drastic reductions in urgent activity have so far proved forlorn – perhaps unsurprising given the parallel crises in primary care workforce and social care funding. Even the Five Year Forward view has made heroic assumptions about our ability to generate £22bn in efficiencies and only asks for £8bn more over five years.
Whilst no party has pledged to reverse major cuts in social care funding which have made around 800,000 people with “substantial” care needs unable to access services, nor put social care on an equal footing (universal and free at the point of access) with NHS care, the 2014 Care Act came into force on April 1st and has been widely welcomed as a potential force for good.
Another development that hasn’t waited for a General Election is the sign off in March of plans to devolve an entire health and social care budget and control over services to the 2.6 million people and 10 metropolitan districts of Greater Manchester. This raises some interesting opportunities around the care of older people. However, the recent “healthier together” work there has thrown up much controversy and a lot of detail around risks of implementation is currently missing. We have asked a number of BGS members and local service colleagues to set out their views in a series of blogs. Anyone working in big conurbations around England will be following events closely.
One of these is Nottingham – the location of what should be a lively Spring Scientific Meeting spread over three full days and with a programme diverse enough to appeal to many members, some outstanding headline speakers, the possibility to book for “standalone” days and preferential rates for non-doctor members. We hope to see you there.