Those who cannot remember the past are condemned to repeat it
George Santayana (1863 - 1952), The Life of Reason, Volume 1, 1905

History is more or less bunk. It’s tradition. We don’t want tradition. We want to live in the present and the only history that is worth a tinker’s damn is the history we made today. Henry Ford (1863 - 1947), Interview with Chicago Tribune, 25 May, 1916

By sheer coincidence of the material offered to your Newsletter editorial team this month, this issue pays tribute to people who have and, in some cases still are, the pioneers of innovative service and academic excellence in geriatric medicine.

With reference to George Santayana’s quote above, whether the lessons learnt from “another country” affect the decision makers of today is a moot point.

Stories like those of Bim Bhowmick, Noah Morris et al., are often stories of determined individualism, which produces an organic growth of service for a local patient community. Dissemination of good local experience leads to models of care being established elsewhere with local modification. In the twenty-first century service development based on good practice are gone and new methodologies are in use.The President’s column in this issue critiques, with more than a little scepticism, new ‘models of service planning’. This raises the question, how much do the views of a Specialist Society for older patients influence these developments? Being “on the side of the angels” after service changes have been implemented, possibly to the detriment of our patients’ best interests, helps no one.

This brings us, neatly again, to the issue of academic (geriatric) medicine and health services research. Some departments of elderly care medicine have suffered in recent times, influenced no doubt by such issues as the Research Assessment Exercise (RAE), (http://195.194.167.103/) on the rating of their efforts. To an objective observer, never were so many service changes ripe for academic / research review prior to their implementation. However the ground in this field of endeavour seems not entirely fertile at the moment.

I recently attended a Workforce Development Confederation meeting where new roles and responsibilities were being defined and commissioned to deal with the agenda of ‘long term conditions’. Clearly this is an agenda that impinges directly on our core business. As we know, three levels of needs-complexity requiring different types of intervention from health and social care have been identified to cope with this agenda, and therefore the Confederation was discussing the arrival of increased numbers of community matrons, case managers, primary care assistant practitioners and intermediate care facilitators. See
www.content.modern.nhs.uk/cmsWISE/HIC/HIC7/HIC7.htm.

We understand the need for research and evidence to inform service development, but it is quite clear that there are large gaps in the evidence base, especially around the management of chronic disease management/ long term conditions.At this meeting I raised the issue of the lack of evidence to support the proposed changes under discussion and the potential research that should/could be commissioned before the changes were introduced. One response from a fellow attendee was interesting. He mentioned that they had been discussing such issues with a psychiatrist recently, and it was his opinion that the number of changes occurring in the National Health Service at any given time was so large, it was impossible to subject such proposed interventions to a process of randomised controlled trial, and by implication other quantitative methods of research in order to prove their benefit prior to introduction.This was a stark reminder of belief systems that lack validity.Let us hear loud ongoing support for academic (geriatric) medicine and research especially in the health services area. Please watch the compendium on the BGS website as some guidance on academic geriatric medicine will appear under the Training Section.There are many who are pursuing careers in academic geriatric medicine, as exemplified by Alisdair MacLullich’s article in this month’s Newsletter. Further reading material on the development of academic careers in the UK in the next number of years can be found at http://www.content.modern.nhs.uk (select change 7)

I was tempted to comment on a recent documentary on television, which covered the quality of care of older hospital in-patients again. Instead I am going to commission some comment on what effect these programmes have on the viewer and policy makers. My objectivity is shot on this one, especially after some folk close to the BGS opined that such programmes made them feel that the sooner voluntary euthanasia was introduced the better!

Kevin Kelleher