BGS Scotland Report - Autumn 2018

Since 2016 legislation has been in place to bring together health and social care in to a single, integrated system, with thirty-one Integration Authorities now responsible for £8.5 billion of funding for local services, which was previously managed separately by NHS Boards and Local Authorities.

There is therefore a very different framework in Scotland for health and social care compared with other parts of the United Kingdom. One of the biggest differences is the focus on integration and collaboration in Scotland, compared to the focus on competition and choice in England. The Scottish Government continues to work towards their 2020 vision, which aims to shift the balance of care from acute settings to the home, and the balance of power to patients and carers.

At ground level, progress with integration is variable and there is considerable regional variation in how quickly patients in hospital can be assessed and discharged with increased social support.  Availability of carers is often a key factor, despite additional Government investment.

Geriatricians working with Government
Dr Graham Ellis continues to work with Health Improvement Scotland on the topic of frailty and how to tackle the issue at a population level. They have published summary evidence around this subject which can be accessed using the links at the end of this paper.  There is a review of the Frailty tools available and a guide for Primary Care Teams undertaking multidimensional assessment for older people.  

The Health Improvement Scotland iHub is a very rich source of resources for Geriatricians and anyone interested in the care of older people both within Scotland and beyond. 
The Chief Medical Officer, Dr Catherine Calderwood has now published her third Annual Report on Realising Realistic Medicine. Each Health Board has a clinical lead for this programme and we are pleased to note that Dr Rowan Wallace, an active member of BGS Scotland, has taken on this role in her own Health Board.

Members of BGS Scotland continue to attend the Cross Party Group on Ageing at the Scottish Parliament. There are no meetings with the Health Minister or the Chief Medical Officer scheduled at the moment, but this will be a topic to discuss at forthcoming council meetings.  

Improvements at the Front Door
Frailty at the Front Door – (the Scottish version of the Acute Frailty Network) is gathering pace and early results suggest real progress on achieving better access to Comprehensive Geriatric Assessment within the first 24 hours in hospital.  

There has been an explosion of Advanced Practice Roles in Scotland such as *ACE nurse/*ECAT/Frailty nurse and therapist roles in the acute units in Scotland. 

Where they exist, these initiatives are proving very positive and the practitioners involved have had their first stand alone conference in 2017.  From a BGS point of view we have reflected this with a plan to add a nurse and an AHP representative to the BGS Scotland council.

Raising Standards
Also relating to work within hospital care, the Scottish Patient Safety Programme has delivered some improvements on themes affecting older people including work on reduction of pressure sores.  There is also targeted work on delirium recognition – championed by the Scottish Delirium Association.  A number of BGS members are prominent leads within the latter, including Professor Alasdair MacLullich and Dr Claire Copeland.

Benchmarking
Scottish Care of Older People (SCoOP) Project is a national evaluation project focussing on care of older people across Scotland in both Primary and Secondary Care settings. It is a joint initiative set up in late 2016 by three partners: Health Improvement Scotland, the British Geriatrics Society Scotland Council, and the University of Aberdeen as the lead Academic Institution with representatives from other Scottish Universities with Clinical Academic Departments in Geriatric Medicine.  It will evaluate the variation in service provision for older people who require health and social care in various settings to serve as a driver for standardisation and improvement of care across Scotland.
The BGS are supporting this programme, which is currently undertaking a second round of surveys.  The challenge remains achieving adequate funding for this important programme.

Education and Training
Geriatric Medicine remains a popular career choice in Scotland, though there remain concerns about variation in recruitment to Specialty training posts in different parts of the country.  The trainees annual meeting was held at the end of August in Glasgow, with introductory remarks from the BGS Scotland Chair.  It was well attended and BGS materials were available for any trainees who have not yet taken up membership of the organisation.

Patricia Cantley
Chair, BGS Scotland