The present shape of the South Birmingham service originates from the need, in the 1960’s, to clear the old Poor Law wards at Selly Oak Hospital.

The solution was the conversion, or building, of wards on three outlying sites, Moseley Hall, West Heath, and Rubery, with a relatively small number of beds left on the general hospital site. In the mid 1970s, in order to make the best use of these resources, the policy of admitting selected acute patients to peripheral sites, and of rehabilitating patients wherever they were admitted, was adopted, and greatly improved access to geriatric care. At the same time, Bernard Isaacs was appointed Professor, and established the academic department at Selly Oak.

This disposition of the service made the loss of large long-stay responsibilities in the late 1980s easy to manage, although Moseley Hall and West Heath both shrank, and the Joseph Sheldon Hospital at Rubery closed – to make way for a large retail development. In the early 1990s the shotgun marriage between two health districts and then ”integration” with general medicine led to a further loss of general hospital facilities, which had moved from being the responsibility of the Community Unit to the acute sector.

Symbiosis
Since those dark days, there has developed a symbiotic relationship between the two Trusts involved - University Hospital Birmingham Foundation NHS Trust and South Birmingham PCT. Because the community hospitals are well resourced, with SHOs (whose posts have recently been approved for four years by the RCP), plain X-ray facilities and so on – they can take a large number of patients with core geriatric problems directly, from GPs, A&E or the Medical Admissions Unit, into specialist care with an emphasis on rehabilitation – as well as more traditional transfers after acute care. Within Selly Oak, we have at last been able to start expanding our service in the hope of reaching more of those who need it, with a stroke unit and an orthopaedic intermediate care ward as well as generic geriatrics and out-patient services.

Day assessment and treatment
The community hospitals have adapted and innovated. We have wards specialising in the rehabilitation of people with stroke, amputation and orthopaedic problems, a respite care service, and what was built as an NHS nursing home when such things were in fashion, now provides elite long-term care for people of all age, who are so disabled as to qualify for NHS long-term care, but more importantly a valuable terminal care service, that supplements, but does not compete with, the work of the local hospice. To cure the problem of the traditional Day Hospital – supplying sitting and transport therapy - we operate a day Assessment and Treatment Service, which people attend for a specific appointment for a specific purpose, whether rehabilitation or a specialist clinic such as for falls, stroke, tissue viability or Parkinson’s disease. Specialist nurses have been vital in developing these services, and in supporting the wards.We look after the southern third of the City, ranging from inner-city to a few leafy suburbs – about 65,000 over-65s, with seven consultants, all but one of whom work in both Trusts, which is vital to our cohesion.

EWTD, staff...same ol’, same ol’
So what’s the catch? We face the same problems that so many do – working with Social Services, nurse and therapy staffing, junior doctors’ hours and the EWTD. The Chair remains vacant. We don’t meet the needs of frail old people fully in the DGH. We haven’t a continence service, or support nursing homes as we should. Despite policies, we sometimes have problems with patients more acutely sick than they appear in the community hospitals, and while a geriatrician may think nothing of travelling to three sites in a day, some of our more prestigious colleagues find a three mile journey quite a challenge. There’s the occasional difference between the two Trusts, but they know they need each other, and our older population needs one service, even if between two Trusts.

Ed Dunstan
Jed Rowe