Reflections, resources and hopes

03 November 2023

Sally Greenbrook is the BGS Policy Manager. She tweets at @SallyGreenbrook.

Over the last week BGS has been sharing blogs about preparing for winter. While winter pressures are now widely accepted to be year-round pressures, it remains the case that the colder months are tougher for the NHS and social care and that older people tend to bear the brunt of this. In the opening blog of our series, BGS President Professor Adam Gordon reminded us (as if we needed reminding) of the horrors of last winter, considering how we can make this winter ‘less awful.’ That’s worth repeating: less awful. Adam’s not asking for miracles here, just for things to be slightly better for the system, healthcare professionals and especially older people. To help frontline healthcare professionals wherever they work with older people to make that difference, we are pleased to have four highly respected clinicians from across the BGS membership share their tips for how things can be improved this year and steps that individuals can take.

NHS England National Specialty Advisor and former BGS President, Dr Eileen Burns, turns our attention to winter in care homes, providing some top tips to those caring for older people living in care homes. Much of this focuses on ensuring that care home residents have access to the health services they need as far possible in the care home, reducing the need for them to go to hospital. Hospital admission brings harms as well as benefits for older people living with frailty and therefore it may be preferable in many cases for care home residents to be treated in the place they live. You can read more about what good quality healthcare in care homes looks like in the BGS publication Ambitions for Change. Look out also for our upcoming report from the event we hosted recently about minimum datasets for care homes.

Heading north of the border, Specialty Advisor in Geriatric Medicine to the Chief Medical Officer and former Chair of BGS Scotland, Dr Rowan Wallace, talks us through some of the initiatives being implemented in Scotland to help cope with winter. This includes boosting Hospital at Home Services and the Focus on Frailty package from Healthcare Improvement Scotland, which aims to ensure that people living with frailty have positive experiences of health and social care. Rowan highlights how her service in Ayrshire and Arran is using this additional resource, particularly in strengthening capacity both in Hospital at Home and in primary care. Rowan also reminds us that ‘every winter has its spring’ and that better times will come, as much as it might not feel it in the moment.

Turning to what happens after older people are discharged from hospital, NHS England National Specialty Advisor and Chair of the BGS Nurse and AHP Council, Dr Esther Clift, takes us through provision of intermediate care and the recently published Intermediate care framework for rehabilitation, reablement and recovery following hospital discharge. Provision of good quality rehabilitation and reablement is an essential component to supporting older people to recover from periods of ill health and reducing their chances of being readmitted to hospital. However, unfortunately in many areas resource is lacking to provide adequate rehabilitation for older people. The BGS Blueprint, Joining the Dots, provides more detail about the importance of rehabilitation and reablement in older people’s healthcare. While community rehab provision needs to be sustained for the long term, there are short-term measures systems can take for this winter to increase rehab capacity.

Returning to the theme of delivering healthcare in an individual’s usual place of residence, NHS England National Specialty Advisor and former Chair of the BGS Community Geriatrics Group, Dr Shelagh O’Riordan, has shared her top tips for virtual wards as we approach the winter. Acknowledging that different systems are at different levels of maturity, Shelagh has tips for established systems (like getting access to the ambulance stack) as well as those who haven’t yet set up virtual wards (could you start small, serving care homes?) The BGS publication Bringing hospital care home provides more tips to those thinking about setting up virtual wards locally.

Heading into the winter, we know it is going to be tough for a lot of our members. We remain hopeful that things might not be quite as bad as last year and we have welcomed relatively early announcements of funding and planning meetings from Government, such as the Number 10 summit Adam attended in September and the early publication of NHS England’s plans for winter. The winter flu and COVID vaccination programmes were also brought forward, starting with care home residents and staff. Here at BGS we’re currently updating our statement about protecting the rights of older people to health and social care. This statement resonated with so many individuals and organisations when we published it in January 2023 and sadly, little has changed since then. Most of the messages seem just as relevant and it is important that we reiterate them to politicians and healthcare leaders as we come into winter.

We know from our members that front door frailty services have made a difference to older people’s services wherever they have been successfully implemented. We currently have a clinical fellow working with us on developing a resource aimed at supporting members who want to set up these services. We plan to publish this resource in the coming weeks so please do keep an eye out for that.

It’s also a good time to ensure that as many healthcare professionals as possible have the skills and knowledge they need to care for people with frailty. The BGS Frailty E-learning module has recently been updated and relaunched. It is aimed at healthcare professionals working at Tier 3 level and is completely free of charge for everyone working in health and social care. There are also numerous resources about frailty on our Frailty Hub.

We’ve also contributed to a report being written by the Royal College of Emergency Medicine about progress against the Urgent and Emergency Care (UEC) Recovery Plan. The UEC Recovery Plan was published in January this year with the aim of improving the situation coming into this winter. However, progress against the plan has been slower than we would have liked and this is highlighted in the upcoming report.

We hope that wherever you are and whatever role you are in, our winter blog series has helped you to think about how your system is going to provide high-quality care for older people over the winter months and given you some ideas. Please do get in touch if you have implemented something that is making a difference in your area for older people and you would like to share it with BGS colleagues.


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