New year, new beginning. Although, if you were one of the twenty or so trusts that declared a major incident, or the even larger number that declared internal incidents, simply to get through the festive period, you might be forgiven for believing it was the beginning of the end.
As a community geriatrician I found myself working shifts in the Emergency Department and staying back to plug gaps in the AMU receiving rota of an evening. Colleagues found all elective and non-clinical activities cancelled just to meet the day-to-day workload. At the height of all this activity, an ED colleague stopped me to give thanks for the work that the Geriatric Medicine Department had done to find her 25 beds the day before. She said we’d responded in a way that no other specialty seemed willing, or able, to do.
It’s difficult to know how to respond to this. Does one feel angry, when the hospital is overwhelmed by older frail patients, that this is seen to be an emergency predominantly for geriatricians? Surely it should be an emergency for all appropriately skilled doctors who care about patients and patient care. Or should we be flattered that we’re seen as being more capable than others at providing care to the oldest and most vulnerable patients? At least it’s an acknowledgement that we have a particular skill-set, which needs to be learned, and is not possessed by all colleagues however much it should be. The answer is probably a bit of both.
At a practical level we are physically unable to care for such overwhelming numbers all by ourselves. An additional consideration is that the elective clinics, outpatient, rehabilitation and community geriatrics services that we are cancelling to support the acute take are exactly the sort of things most likely to take pressure off the system. There’s an element of cutting off the nose to spite the face here.
It’s at times like this that we need to remain focused around the BGS statement on the Role of the Geriatrician, produced by Finbarr Martin at the end of his presidency (see box below). This reminds us of the role we have to play in delivering hands-on care but also that we have an even more important role as leaders, managers, educators and researchers. We have to show the rest of the medical profession the way.
Coming into a new year, this means we need to keep focused on the work of the Future Hospitals Commission, which aims to make General (Internal) Medicine a priority for all medical specialties. We need to continue to try to influence the broader response to the Shape of Training Review on making training about core skills in care of older people mandatory for all doctors. We need to continue our work with Age UK on understanding lay perceptions of frailty and frailty-specific services, so that we can harness patient-power to drive change. The BGS has strategies in place to support each of these programmes of work.
There is also the opportunity for us to harness the crisis and use it as a platform (albeit a burning one) from which to advocate for service improvement. We have to avoid the temptation to say, “I told you so,” but service managers and commissioners looking for a raison d’etre could do much worse than consult Fit for Frailty Part 2, the Silver Book and the Commissioning Guidance for Care Homes.
One thing that should fill us with hope is the high calibre colleagues who are increasingly finding a home within our specialty as higher medical trainees and consultants in geriatric medicine. I felt honoured to attend the Second Annual Trainees Leadership and Management Meeting in Birmingham in December. Specialist trainees from around the country wowed us with their enthusiasm, eloquence, intelligence, accumulated experience and skills and, above all, their absolute determination to make the world a better place for older patients with frailty. The Geriatrics 4 Juniors (G4J) Conference, also in Birmingham, in November introduced me to a cohort of FY2s and CTs desperate to come and make a difference within the specialty. What a fantastic group of people to carry the torch forward!
The success of both these events mean that they’re sure to run again towards the end of 2015. We’ll announce them through these pages as they become available but please do start preparing your trainees to attend these excellent days in advance. One thing is clear from both, geriatrics is now a specialty chosen by star doctors who want to make a difference. How’s that for something to look forward to?