With the Spring Meeting 2004 being held in Londonderry, I thought it might be of interest to give some background on geriatric medicine and medical services in general, in Northern Ireland.

Although we think of devolution as being a recent event, the administration of Northern Ireland has been devolved since 1921 and health has been one of the devolved functions. Even under direct rule, when Ministers are from outside Northern Ireland, the administrative structures, including the Civil Service, remain distinct. Thus, Northern Ireland has the ability to devise its own systems, although it tries to ensure that its citizens receive the same standards as those elsewhere in the UK. However, policies from the Department of Health in London do not automatically apply to Northern Ireland, nor does funding. Northern Ireland receives its funding from the Exchequer in the form of a block grant and Northern Ireland Ministers distribute it among the different programmes according to their own priorities.

Local government was one of the most contentious areas in Northern Ireland until the early 1970s. This problem was resolved at the time, by removing a number of the important functions from local government and transferring them to agencies with appointed boards. The major functions which were removed were education, which is administered by five Education and Library Boards, housing, administered by the Northern Ireland Housing Executive, and social services.

At the time of the re-organisation of local government a re-organisation of the health service was also taking place. From 1948 – 1974 the Northern Ireland health services were administered in a tripartite system with different structures for hospitals, general practice, and public health. In 1974 four Health and Social Services Boards – Eastern, Western, Northern and Southern were established to administer health and social services, including public health. GPs remain independent contractors. Northern Ireland followed the 1991 changes in the health service with the introduction of health and social services trusts, some being for hospital services, some for community services, and some for both, with the four Boards becoming commissioners of services. The more recent changes have not occurred in Northern Ireland and we have no definite information as to how services might change.

Prof George Adams
Geriatric Medicine developed in Northern Ireland at the onset of the NHS in 1948. Professor George Adams, the second President of the British Geriatrics Society, was the pioneer, working in the Belfast City Hospital. The Belfast City Hospital was the former workhouse for Belfast and, as elsewhere, had a large number of ‘chronic beds’ occupied by older patients with long standing disabilities. From these Professor Adams developed a modern rehabilitation service and designed the first purpose built geriatric unit in the UK, Wakehurst House, opened in 1959. He took a particular interest in patients with stroke and published a number of influential papers on prognostic factors in stroke. In 1974 he brought his work on stroke together in a book called, ‘Cerebrovascular Disability and the Ageing Brain’. It is notable how much of the content of the book is still valid today.

With the passage of time, geriatric units developed in hospitals elsewhere in Northern Ireland and there now is a comprehensive geriatric service with specialist units in all general hospitals. The larger hospitals have full time specialists in geriatric medicine who provide acute care for older patients as part of a comprehensive geriatric service, while in the smaller hospitals the geriatricians take part in the general medicine rota. In all hospitals there now are stroke rehabilitation units and acute stroke units are being developed. There are active training programmes and recruitment to specialist registrar posts is highly competitive.

Specialist Training
The University Department of Geriatric Medicine came into existence in August 1976. The permanent staff consists of a professor, two clinical senior lecturers, a non-clinical senior lecturer with an interest in statistics and demography, and a non-clinical lecturer who is a bioscientist. Most trainees in geriatric medicine undertake research in the University department, usually leading to an MD degree. In recent years they have joined Dr Passmore’s research team on dementia. Undergraduate teaching of geriatric medicine has taken place for over 40 years.

The pattern of geriatric medicine is fairly uniform throughout Northern Ireland. Geriatric teams are involved in the acute care of older patients, have rehabilitation beds, and in most cases have day hospitals. They also undertake community outreach with home assessment visits. Many units still have some continuing care beds although most continuing care takes place in nursing homes. There are the usual problems of delayed discharge, and of unacceptable waiting times in A&E departments. We do not have a national service framework in Northern Ireland and intermediate care as a policy has not been introduced, although, as already mentioned, rehabilitation beds have been retained. Although there is still some old accommodation, most of the geriatric units are in relatively modern purpose-built facilities.

Londonderry awaits
We look forward to welcoming as many of you as possible to the Spring Meeting.

Bob Stout