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The Second Cultural Revolution in Geriatric Medicine

There is general agreement that the distinction between leadership and management is that leadership creates the culture of an organisation and that management works within that culture.

There are many different definitions of culture but the most highly respected writer in the field is Edgar Schein who says: “Culture is the shared tacit assumptions of a group that it has learned in coping with external tasks and dealing with internal relationships.” (Source: Schein, E.H. (1999) The Corporate Culture Survival Guide. John Wiley & Sons (p.186)).

The leadership has to determine the correct belief and assumptions that it wishes to permeate the organisation, and the whole population, if one of the jobs of the leadership is to think of the health of populations as well as the health of individuals.

The British Geriatrics Society (BGS) can be proud of the culture change that it has achieved by providing leadership in the last seventy years. When the BGS was founded, the prevailing beliefs and assumptions of not only the public, but also the medical profession, were that the problems of older people were due to the ageing process and not to treatable disease, and therefore that older people needed “care” rather than accurate diagnosis and effective treatment and rehabilitation.

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Editorial

 

So the BGS has turned 70, and we have been celebrating the great strides made in the care of older people since its birth. Apart from the national celebrations, attended by our Patron, the Prince of Wales, the various national offices of the BGS have held their own events to mark the anniversary.

As we grow, it is especially important that our history is documented and we are fortunate to see many contributions to this work. In particular, we have Dr Michael Denham, (BGS president 1992 - 1994) who provides valuable and dedicated service, charting the sociological trends in which the great philanthropists were forged, leading to the birth of the National Health Service and of geriatric medicine in the United Kingdom.

Geriatric medicine having at its centre, the whole person, as opposed to a single organ, has all the breadth and scope of general medicine. We have at times therefore struggled to focus on any single digestible message.

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President's column

It’s been a busy three months since the last newsletter. We marked our 70th anniversary in March, and were delighted that over 100 of our members and some close friends of the Society were able to join us when Prince Charles came to help us celebrate.

We took the opportunity to showcase some of the important work of our members and the Prince was genuinely interested. It was a great occasion and we attracted some welcome publicity for our work. “Little Dorrit” (the “Pets as Therapy” dog) who also met the prince, stole the show for the press. She featured in publications as far flung as the Barrhead News (from Scotland), the Macclesfield Express and the Isle of Wight County Press…and also the Daily Mail…sorry!

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BGS Spring Meeting 2017 - Conference Report

Policy makers pay far too little attention to ageing - with serious consequences for both individuals and society as a whole, a leading academic told the BGS’s Spring Meeting in April. “By ageing I don’t mean old age – there’s plenty of policy on that – but ageing across the life course,” said Prof. Alan Walker, professor of social policy and social gerontology at Sheffield University.

The revolution in longevity was all too often portrayed as bad news with phrases like the silver tsunami, the dependency time bomb and the pensions crunch, added Prof. Walker who illustrated his point with a cartoon showing the road sign of old people crossing, but this time loaded with bags of cash and the caption ‘greedy geezers’.

The doom merchants always portrayed increased life expectancy as an economic burden. “Care costs are projected to quadruple by 2045 with the reasoning: more older people, more social care costs, more public expenditure.

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Older Person Whisperer on avoidance of advance care planning

The Older Person Whisperer says: Sometimes I’m asked to do comics about particular issues. I did this comic for our amazing and dynamic End of Life Care Facilitator. Everyone knows we should be doing advance care planning and as geriatricians we should be at the forefront of these conversations. A colleague of mine conducted some interesting research, looking at why doctors sometimes avoid these conversations. These are some of his findings in comics form.

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BGS Communications in action

Since my last report there have been a number of positive developments including a special drinks reception to celebrate the Society’s 70th Anniversary, the launch of a BGS Election Manifesto and high profile media appearances by several of our members.

BGS 70th Anniversary
To help celebrate the Society’s 70th Anniversary in 2017, and raise the profile of the BGS, a special drinks reception was held on the 6 March, which was attended by our Patron, The Prince of Wales. A communications campaign was launched to coincide with the drinks reception which included a BGS blog series celebrating geriatric medicine as a speciality, a new Anniversary Logo and a special lifetime achievement award which was presented to Baroness Sally Greengross at the anniversary drinks reception. The event received widespread press coverage, featuring in 291 publications including The Daily Mail, Nursing Times and The York Press.

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BGS Policy update - June 2017

This time last year we were all wondering what the outcome of the referendum on remaining or leaving the European Union would be, and how it would impact on the health service in the UK. Now, a year later, at the time of writing, we are fast approaching a General Election and we have updated our key calls for action and are doing all we can to use our expert policy voice to influence improvements in healthcare for older people.

In this column I have outlined some key developments we are involved in and set out some of the ways in which you can engage in BGS’s influencing work.

BGS election manifesto. Following the announcement of a general election in June, we have developed our own election manifesto which makes seven calls on the incoming Government in this, our 70th anniversary year. Please share widely, including with your local candidates before the election and with your elected MP in your local area after the election. You can download a copy here

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Patient Reported Experience Measure (PREM) for older people

Tools such as the National Audit In-patient Survey and the Family and Friends Test provide users with the opportunity to give feedback but are unlikely to capture the experiences of older people adequately. Dr Jackie Morris and Dr Fiona Thomson were charged with designing a Patient Reported Experience Measure (PREM) specifically for older people in hospital.

Members of the BGS Clinical Quality Group were aware of excellent work done by NHS Benchmarking (NHS BM) in relation to the National Audit of Intermediate Care (NAIC) and the data collection for their newer topic of Older People’s Care in Acute Settings. The NAIC included a validated PREM questionnaire but although it had the advantage of being readily available, not all questions were relevant to the acute setting.

A collaborative piece of work was undertaken by representatives from NHS BM and BGS CQSG - the PREM used in NAIC was adapted to take account of work by the Patient Association, NICE1 and Age UK2.

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Interested in joining a BGS Special Interest Group or Section?

In addition to their broad spectrum of expertise in caring for older people, many BGS members have chosen to practice or research specific clinical and management areas. Our Special Interest Groups (or SIGs) and Sections enable these members to come together to pursue their special interests, and physicians, scientists and allied health professionals from outside the Society may also join.

The SIGs and Sections are valuable resources that help share best practice within and across relevant disciplines, as well as enabling the Society to respond to NICE and SIGN guideline developments and government consultation documents. They serve as the Society’s source of clinical innovation, deriving and maintaining high standards of clinical care, and disseminating specialist knowledge.

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Scotland Spring 2017 - Update

News from the devolved nations
The BGS Board of Trustees meets roughly every quarter. The Councils of the devolved nations report to the Board, issues affecting the National Health Service in their respective nations, activities of the national council and concerns and preoccupations of the membership within that nation.

Responsibility for the NHS in Scotland is a devolved matter and rests with the Scottish Government. The Cabinet Secretary for Health and Wellbeing has responsibility in the Scottish Cabinet for the NHS in Scotland. Of the £34.7 billion controlled by the Scottish Government, around £11.9 billion is spent on Health.

The Scottish Government sets national objectives and priorities for the NHS and signs delivery plans with each NHS Board and Special NHS Board, monitoring their performance. NHS Boards in Scotland are currently all purpose organisations: they plan, commission and deliver NHS services and take overall responsibility for the health of their populations.

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Northern Ireland Update - Spring 2017

The changing political landscape in Northern Ireland
Northern Ireland remains a highly politicised environment and therefore influencing and effecting change is very difficult. The country is currently on its fourth Minister for Health since Dr April Heaney took up office in 2014.

The recent elections were precipitated by a failure of the power sharing agreement between the two main political parties. Unfortunately since the elections there has been no resolution to date, between the parties to form a government, with a deadline for the negotiations of ‘Good Friday’ – 14 April 2017. This was, however, extended in the wake of the announcement of the General Election to be held in June. Talks aimed at restoring the power-sharing executive will resume after that.

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BGS Wales Spring Meeting 2017

The Welsh branch of the BGS Spring meeting was organised by the Glan Clwyd geriatricians at the Glyndwr University in Wrexham,. Delegates from all over Wales attended the meeting over two days in March.

On the first day of the meeting we had a full training event for all specialty trainees in geriatric medicine in Wales For South Wales trainees, we had a video-conference link. There were some high quality presentations including a masterclass in neuroimaging, updates on movement disorders, endocrine conditions, inflammatory bowel disease, and dementia and falls. There was a novel session on driving assessments in older people which we found very useful. Dr Adhiyaman and Dr Chatterjee shared their experiences from the coroner’s court and gave us very useful tips. The day also provided the opportunity for trainees all across Wales to socialise and network.

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In Memoriam: Professor Gwyn Seymour

Professor David Gwyn Seymour, Chair of Medicine for the Elderly at the University of Aberdeen, died on the 17th December 2016 from disseminated malignancy.

He was born in the South Wales village of Ynysybwl and the doctor he became was fundamentally shaped by the rich social traditions of the tight-knit, caring mining community he grew up in. He studied Medicine at Birmingham University and during an intercalated year in 1970,while studying Anatomy he met Ruth, marrying two years later.

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In Memoriam - Dr Wallace Dickie - 1923 - 2016

Dr Albert Wallace Dickie (known as Wallace) passed away peacefully at home, on the 28th February 2016, surrounded by three generations of his family. He was aged 92.

Wallace was born in Monaghan Town, Ireland in 1923. Shortly after his arrival the family moved north of the border to Enniskillen, Co. Fermanagh where his father established a successful hardware business. He always spoke very fondly of growing up in Enniskillen.

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Deconditioning Syndrome Awareness and Prevention Campaign: why is everyone talking about it?

In my early days as a NHS doctor, I used to see patients being admitted to hospital who I thought would become well enough to go home in 3-4 days. Several days later, I would find them on the wards, sometimes in a worse condition.

I wondered: Why? Was my assessment wrong? Did a new event happen? Was the system inefficient? Why are they still here?

Later, I realised that many of these patients had lost their ability to function at their pre-admission levels and had ‘deconditioned’, resulting in their needed help in activities of daily living. They had become ‘deconditioned’ because they had stopped using their normal abilities in those crucial early days during illness and recovery. It is widely cited that ‘every ten days of bed rest in hospital can lead to the equivalent of ten years of muscle ageing in people aged over 80 years’. Adverse outcomes of unnecessary bed rest can include: reduced muscle strength, increased risk of falls, reduced mobility, de-personalisation, depression, loss of self-confidence and demotivation. These effects can be collectively be termed as “Deconditioning Syndrome”. It can happen in hospitals, in care homes and even in patients’ own homes, if they are not maintaining their functional abilities.

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In Memoriam: Robert Kane 1940 - 2017

Bob Kane, who in 2009 was awarded the BGS Medal for the Relief of Suffering Among the Aged, died suddenly on the 6th March 2017 in Minneapolis. 

Bob was a giant among geriatricians and those caring for older people and chronic disabilities. He had major influence in the US and here in the UK where he had many friends  who will miss him, his generosity and supportive friendship. 

Bob was borne in 1940 and trained at Harvard and Kentucky and went on to be Professor in the Department of Medicine UCLA and then Dean of the School of Public Health at the University of Minnesota and then held the Minnesota Chair in Long Term Care and Ageing until the day he died. He had worked with many prestigious organisations across the world including the WHO, the  Rand Corporation and the London School of Economics.

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