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At the vanguard of improving care in care homes

Nottingham City, one of six areas in the country selected by NHS England as a ‘vanguard’ site to develop a new model of enhanced healthcare in care homes, describes its ambitious vision for an outcomes-based model which is fit for the future.

The Vanguard sites were announced following publication of the NHS Five Year Forward View (October 2014) which sets out a series of new ways of providing care. It is intended that the Vanguards act as the blueprints for the future NHS, inspiring the rest of the health and care system.

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Editorial

I realised one of the highlights of my clinical career to date whilst on holiday in late May. The email from my secretary commenced with the customary heart sink mid-holiday introduction.

“I know you’re on holiday but……”

Dare I read on? Was it a complaint, or an adverse event?  Had I somehow misread the AMU rota and failed to turn up for my on-call? What followed was, in fact, delightful:

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President's column

It will be the BGS’s 70th birthday in 2017. As one of the biggest medical speciality societies in the country, we aren’t in danger of disappearing and our membership (3,250 at the time of writing) is at a record high.

At this rate the BGS will be old enough to be one its members’ own patients! The Society’s foundation coincided with that of the NHS and caught the eye of ministers early on as a potential solution to pressing problems.

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BGS Spring 2015 - Nottingham: Conference report

Society’s focus on obesity must not obscure the opposite problem faced by many older people - the danger of malnutrition.

So widespread is the risk – an estimated 1.3 million of people aged over 65 suffer from it – that the entire first day of the BGS’s Spring meeting was devoted to the subject.

Lesley Carter, manager of Age UK’s taskforce partnership, spelled out the scale of the crisis: 93 per cent of the malnourished lived in the community, 22 per cent of people over 60 skipped meals to cut back on food costs and a third of those aged 65 or over were at risk of malnutrition on admission to hospital. “This must be recognised as a priority across all disciplines,” she said.

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Policy Update - Taking stock after the general election

Now that the dust has settled following the election of a new UK parliament and the formation of the Conservative Government, it is time to take stock of the policy landscape and the prospects for some of the policy priorities identified by the BGS prior to the General Election. The focus in this article is on England.  Policy issues in Scotland, Wales and Northern Ireland will be considered in future articles in the context of devolved Assembly and Parliament elections taking place in May 2016.

The BGS had called on the incoming Government to end the divide between free health care and means-tested social care. Though the divide remains, the number of stakeholders calling for free social care at end of life is growing and that pressure point is a potential source of change in the future. 

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Can doing nothing sometimes be the best approach?

Is  there a more misunderstood medical intervention than resuscitation? It is a treatment that promises so much. Many take it as a sign that doctors are doing everything they can to keep vulnerable patients alive. The reality is quite different.

This was Isabel Hardman writing in The Times following the outrage expressed over the campaign to discuss with patients, their wishes in the event of a crisis resulting in a decision as to whether or not to rescucitate.

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NHS Benchmarking Network for older people in acute settings

In July last year, the BGS announced its partnership with the NHS Benchmarking Network. The project collected data looking at the journey that older people take from A&E, through to short term assessment units, elderly care wards and support discharge processes. Here, Leigh Jenkins comments on the progress of the initiative.

Wouldn’t it be great if you could benchmark the acute services provided for older people in your hospital, against others trying to do similar things? Might this be the start of a quality improvement process, allowing you to see how other hospitals do things differently and possibly better?

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BGS PR and Communications Update

In this update, Ed describes how, despite its daunting and chaotic nature, twitter can achieve effective change in clinical practice.

It has been a busy few months, as always, for the Society’s communications and media work. 

Of course, the biggest BGS event in recent months has been the Spring Meeting in Nottingham. Social media was abuzz with discussions, learning points and interesting information from all of the sessions; 750 different people sent 4,000 tweets across the three days of the conference, reaching more people than ever before and breaking all of the records we set at the Autumn 2014 meeting in Brighton.

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Eastern Academic Health Science Network

Academic Health Science Networks (AHSNs) connect academics, NHS researchers and industry in order to accelerate the process of innovation and facilitate the adoption and spread of innovative ideas and technologies across large populations.

AHSNs are catalysts and facilitators of change across whole health and social care economies, with a clear focus on improving outcomes for patients.  Eastern Academic Health Science Network has chosen “older people” as one of the two priorities focus areas for our Patient Safety Collaborative.  We launched our PSC in October 2014 at an event with colleagues from across the region.  Speeches from the presenters at the event, including Dr Mike Durkin, National Director for Patient Safety at NHS England, are available on our YouTube channel.

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Lifetime achievement award for BGS Vice President of Research and Academic Affairs, Professor Gordon Wilcock

The International Association of Geriatrics and Gerontology has awarded the Silver Medal for lifetime achievement to Professor Gordon Wilcock, Vice-President for Academic Affairs at the British Geriatrics Society.

Professor Wilcock’s career spans 45 years as a geriatrician, researcher and national clinical leader. He has been a practising doctor since 1970, and a consultant specialising in Geriatrics and General Internal Medicine since 1976. He was Professor of Geriatric Medicine in Bristol from 1984 to 2006, then Professor of Clinical Geratology at the University of Oxford from 2006 to 2013, where he still holds an Emeritus Chair. He established pioneering memory disorder clinics at both universities, and a specialist memory ward in Bristol, as well as major programmes of research with a focus on Dementia.

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Invitation to research active members - Featured Researcher: Terence Ong

As part of the BGS’s research strategy, we invite research active members to contact us. We would like to know how you became engaged in research; how you found your research project; the obstacles you had to overcome and what your research is about. Here, Terence Ong, Research Fellow at Nottingham University Hospitals NHS Trust describes how he became an ‘accidental academic’.

I think of myself as an ‘accidental academic’. I never considered research as a particular career path, tending to focus more on my clinical training. However, a chance encounter with Prof Opinder Sahota led to him asking me if I was interested in taking time out of programme to work as his research fellow for twelve months. For me, it came at the right time as all the clinical training was leaving me a little jaded. I therefore saw Prof Sahota’s offer as a way of beefing up my CV without extending my training too much. 

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BGS Special Medal - Interview with Brenda Stagg

Ed Gillett speaks to Brenda Stagg, the winner of the BGS’s  Special Medal - an award which was inaugurated in 2015 to celebrate the achievements of people who are not members of the Society, who promote the health and wellbeing of older people throughout society.

It’s a warm summer afternoon in Toxteth, and I’m standing in a church hall breaking out my best disco moves to Dancing Queen by ABBA. It’s fair to say I hadn’t planned for the day to turn out quite like this.

I’m in Liverpool to meet Brenda Stagg, a Dementia Support Manager at the Alzheimer’s Society: she has recently been awarded the 2015 British Geriatrics Society Special Medal in recognition of her work with older people across the city, and I’m here to find out more about her work.

I meet up with Brenda at the Neurosupport Centre, an office hub which houses several different organisations focused on neurological disorders. It offers support services, resources and meeting spaces for colleagues from healthcare, social care, the third sector and service users alike.

Over a cup of tea in the library, Brenda explains how she came to work for the Alzheimer’s Society: “I started working for Liverpool City Council twenty-one years ago, eventually managing a homecare support team working with older people in the community, so I’ve always worked predominately with older people in a social care setting. 

In my last 10 years at the council, I specifically worked with dementia, not only with people who’d been diagnosed, but with their carers and families as well. There have been lots of changes in the Council over the years though, mostly due to budget cuts, and eventually my job was reorganised. 

“It became quite removed from working directly with older people, and that’s the part I really enjoy. At the Alzheimer’s Society, I get the best of both worlds: my colleagues are amazing and I love managing staff, but I still work operationally too.”

I ask what an average day consists of: unsurprisingly, given the huge varieties between different diagnoses of dementia and the needs of individuals and their carers, there’s no real pattern. 

“I support people living with dementia and their carers, attend memory clinics, help join up different services, pick up referrals and help people through their diagnosis… it could be anything really!”

Brenda’s focus on working directly with older people isn’t difficult to understand once you meet her in person. She’s full of enthusiasm and energy for her work, but also very softly-spoken, and thoughtful in her approach to the complex issues and sensitivities around dementia. It’s easy to see why an older people living with such a challenging and scary diagnosis might value her positive, calming presence.

It’s that same personal connection which crops up time and again when we discuss Brenda’s motivation for her work:

“A lot of people, when you ask them about dementia, view it as terribly negative thing: they don’t always realise that even after they’ve had this diagnosis, an older person can still live a fulfilling life in the community, still go out and see their friends, just as long as they have the right support.

“There’s that saying: when you meet one person with dementia, you’ve met one person with dementia. You can’t apply lessons from one person to another, or use the ethos of how you’d wish be treated. 

“I think you just have to treat people with dignity and respect. A big thing is making sure that they’re not talked above, that they’re included in decisions: sometimes there’s that sense of frustration when people get missed out or don’t have involvement in their own care.

“It can be little things: making that phone call to someone who was really upset and talking things through with them can just give them such a sense of being listened to, even if you can’t solve all the problems. Or it could be someone’s been given a diagnosis but hasn’t fully understood it, and you’ve sat down with the family and explained everything, and helped move the situation on for them a bit and improved their quality of life.”

By happy coincidence, I’m able to see this person-centred approach in action later in the day. After our conversation in the library, Brenda shows me around the Alzheimer’s Society office, and introduces some of her colleagues. 

Even so, it’s clear that earlier comments about front-line work being the thing which truly inspires her are true. Brenda’s face lights up when I say that, contrary to her assumptions, I’d love to go along to a meeting: before you know it we’re out the door and whizzing across town to a music and singing session in Toxteth.

Once there, Brenda’s in her element: chatting away to people living with dementia, their carers, and other Alzheimer’s Society staff and volunteers. Rosie, the musical facilitator, explains that their original session on Fridays got so full that they had to start a second one on Thursdays, with a whole group of new faces joining today. The atmosphere is so warm and welcoming that I would have assumed everyone had been friends for years.

And so, before long we’re busting out “Living Doll”, “Da Doo Ron Ron” and a collection of other classics. I’m fairly sure my haphazard singing is letting the side down a little, and the less said about my “Dancing Queen” in particular the better, but no-one seems to mind.

I meet Steven, who now cares for his best friend after he was diagnosed with early-onset dementia five years ago, and Meg, who was a nurse for 25 years before being diagnosed herself with dementia. “It’s so important” she tells me “to have people around you who understand. I’m lucky, in that I know how hard people work, and I’m so grateful that they’re looking after me now”. 

We sing “Stand By Me”, and its lyrics about fearlessness and love in the face of an encroaching darkness feel beautifully poignant. Something quite overwhelming and difficult to describe sweeps across the room: wistful in some regards, but also optimistic and cheerfully defiant.

Earlier in the day, I’d asked Brenda what one change she’d make to improve dementia care.

“That’s such a tough question, there are so many things. Obviously there’s a key question about research, about trying to help people understand why they’ve got this diagnosis, or provide better treatments; there’s been no real movement on medication in 20 years.

“And the other thing is for proper investment in social and support services for home: there are sometimes very few services available, either due to budget cuts or the assessment process, so people can’t always get the services they need at home.”

More important though, is what she leaves unsaid: that those services are often only as good as the people running them. The other thing I learn very quickly about Brenda is that she’s exceptionally modest: quick to downplay her own work, or gloss over any mention of her award whenever anyone asks. 

She has to explain everything when we arrive at the music and singing session, and when everyone cheers and claps for her you can see she’s delighted, but a little embarrassed too. 

I ask Brenda what’s next for her career, where she goes from here: “Well, I don’t know, really… would I like to be in a more senior role? I suppose so, maybe, but then strategy’s not really my forte, and I’d miss that day-to-day connection with people”. 

The implication is clear: why climb the ladder when you’re already doing the thing you love? It rather sums up Brenda’s approach: quietly spectacular, unassuming, and absolutely focused on the older people she cares for. Seeing her in action is both humbling and inspiring, and brings home just how thoroughly deserved her award is: just don’t rely on her to tell you about it herself.

Ed Gillett
PR and Communications Manager

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