For those of you who missed it, in mid-November, Panorama, the flagship BBC Current Affairs Programme, ran “A Carer’s Story”.

It was “care in the community” operating on behalf of frail older people. The programme was sensitively edited and “the stories” used in the programme had been approved for broadcasting by the individuals concerned. (Journalistically the ethical issues surrounding such a video-diary documentary are interesting and surely a topic for discussion at a future BGS meeting).

The vignettes in the programme described how carers ought to be trained and educated in preparation for their role. Fran, sadly, had very little preparation for the jobs she took on and she was quickly exposed to personal and intimate tasks she had to do for people she did not know and vice versa. The documentary exposed the high turnover in staff operated by the agencies. Properly prepared care plans would be essential to cater for lack of continuity in staff. Unfortunately, these were shown up as being very poorly prepared. Moreover, skills such as aiding with transfers, hoist usage, etc. often caused Fran to teeter on the edge of “acopia”.
However she worked on …..

Time is money
The agencies who had employed Fran asked her to take on extra duties, owing to staff shortages and other problems. Taking on this work meant cutting into the already meagre time allocated to her alloted patients. The message of the programme is once again, time is money.

Two-thirds of domicillary care is now contracted to not-for-profit or private agencies. Since April 2003 registration is required with the National Care Standards Commission.

Throughout the documentary the dignity of older people was challenged because of poor carer preparation, inadequate training and lack of compliance with basic standards. The strains in the system were evident and its regulation is evolving.

As a Society, we can see that current changes in health care modelling and provision favour community care, either domestic or in the care home environment, as an increasing trend. A documentary like this one portrays the end result of demographics, achievement of health care targets, reducing length of stay and “bed pressures”. Such polemical pieces expertly made should form part of our professional dialogue with our trainees, members of our multidisciplinary teams, our managerial colleagues, social care partners and policy makers.

Terrified of growing old
Fran was only 27 years of age and on her last day recorded in her video diary at the end of the documentary, “When I started as a carer I had no idea that I would be as upset by what I saw as I have been. More than anything else it made me absolutely terrified of getting old”.

One can speculate how such a programme will affect recruitment to the speciality of geriatric medicine into the future. Hopefully it will act as an incentive and a spur to take on the challenge. The realisation of western health care systems concerning the need for improvement in chronic disease management has arrived, and is the challenge for geriatricians and the institutions we work within, into the immediate future.

Wishing you all a prosperous and peaceful 2004.

Kevin Kelleher
Editor