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On a new ambition for old age

Dear Dave

I detect a new confidence amongst geriatricians. Geriatricians led the battle against age discrimination which denied many older people access to NHS treatments and services simply because of their age. Access to acute hospital services such as intensive care and cardiac procedures has been transformed. Access has also been improved in disease prevention programmes such as smoking cessation and blood pressure control. Geriatricians with interest in stroke care have helped ensure that two out of three people with stroke now receive the majority of their hospital care in a stroke unit compared with only one in four a few years ago.

However, with the National Service Framework for Older People in England, now halfway through its ten year implementation programme, there is still so much to do. I recently published "A New Ambition for Old Age", mentioned in David Oliver’s article, which sets out my aims for what I think we can achieve in the next five years. These are grouped under three themes: dignity in care, joined-up care and active ageing. The plans were developed with the help of the Older People's Specialists' Forum. The Forum consists of older people's specialist leaders from nursing, occupational therapy, physiotherapy, psychiatry and medicine. Jerry Playfer, James Barrett, Duncan Forsyth and Alex Mair ably represent the British Geriatrics Society on the Forum. I am indebted to them for their tremendous support and good advice. The finishing touches to "A New Ambition" were made at the BGS Conference in Gateshead where I had the benefit of advice from many colleagues.

One of the biggest challenges we face is to develop more joined-up care for older people with complex needs. I believe that geriatricians' expertise is undervalued and underused. Early access to geriatricians is needed for people with complex needs, falls and confusion at times of crises. We would improve outcomes for patients and reduce emergency bed days in hospital and the need for long-term residential and nursing home care if most people with these needs were quickly transferred to the care of geriatricians.

I was interested to see David Beaumont's and David Oliver’s suggestion in the last BGS Newsletter that the Society's core messages are to promote comprehensive geriatric assessment and the training of all practitioners in the care of older people. I agree with this. In particular, I would like the Society to continue to press for comprehensive geriatric assessment prior to long-term placement and to provide training opportunities for practitioners in centres of excellence in acute and community hospitals where comprehensive geriatric assessment is undertaken for older people with complex needs, falls and confusion.

I would be interested in colleagues' views about urgent care reform and in the development of community hospitals as centres for assessing people with complex needs, falls, confusion and for step-down and step-up intermediate care with geriatrics providing the bridge for patients between acute and community hospital care.

When I talk to national policy leads for older people's health from other countries, there is admiration and envy about the strength of British Geriatric Medicine. The speciality continues to expand. I believe its influence will become even greater as it helps shape reforms to urgent care, the development of community hospitals and the implementation of comprehensive geriatric assessment prior to long-term placement.

Prof Ian Philp
National Director for Older People