After 15 years as a consultant in the West Country, I was appointed Medical Director to BUPA’s Care Services in 2000 - a unique role in the UK.

It has been quite a journey from the Monday morning ward round in Weston-Super-Mare to the office in Leeds! Here, I will try to provide some insight on the sometime new, sometime familiar ground I now tread.

Firstly, many will not be familiar with BUPA’s range of activities identifying it principally with health insurance and hospitals. BUPA is much larger than that! It comprises Wellness, a healthcare screening service and a diverse and growing international portfolio including Sanitas, a major health and care company in Spain, businesses in Asia, and most recently a major insurance company in Australia. The Care Services division principally concerns the management of over 17,000 care home beds across the UK, BUPA Healthcare professionals a major staffing agency, Goldsborough estates (retirement/sheltered accommodation) and Surgichem a company that supplies the NOMAD medication measured dosing system. The scale of our provision and commitment to public service should not be underestimated; about 70% of our beds are state funded, principally by social services departments. BUPA is currently the largest single operator of care beds in the UK and further development is planned.

Clive Bowman Medical Director, BUPA Care Services

Remarkably, it seems widely accepted that care in one’s own home will be possible for all older people and that coupled with a “compression of morbidity”, institutional care will become largely redundant. Evidence in the form of vignettes of inappropriately placed people in care homes are quite simply irrelevant to the increasing dependency and medical complexity more generally observed. There is an inescapable reality that a cure for neurodegenerative disease, particularly the dementias, remains beyond the horizon and that for any reasonable planning, proper institutional provision will be necessary.

As Medical Director I have responsibilities for the standards of services and contribute to strategic development. My team currently comprises, a head of quality, a head of performance, hotel services manager, leisure services adviser, an analyst, a coordinator -additionally a mental health consultant and a tutor. Our regional business teams have Quality and Development managers that with the operational managers and home managers and their staff, all contribute to an information flow on performance. The experience and commitment of colleagues is matched by their ability to laugh at me as well as with me! My accountability is to the Managing Director of Care Services and professionally, to BUPA’s Group Medical Director. Accountability takes several guises; formal board reporting complemented by regular one to one sessions with a variety of colleagues both in Care Services and the BUPA group. For those wary of accreditation, validation or indeed valediction, this corporate commitment combined with a 360-degree personal feedback and an annual service organisational profiling may appear excessive, even intimidating. After an initial acclimatisation I commend them as enormously constructive and no, I am not, nor never will be just a number!

Policies, procedures, clinical governance, complaints, adverse event and critical incident management form a large part of the team’s day to day work. Developing effective systems of CPD support for the 5000 plus registered nurses is another important matter. The development and provision of new intermediate and specialist care services is something of a passion, shared with many potential partners for whom the common difficulty remains commitment. One size does not fit all and understanding and developing differentiation and diversity is a recurring theme.

BUPA’s vision statement “taking care of the lives in our hands” strongly influences our services. Irrespective of funding our residents are customers and are valued as such. The new found discipline of budgeting for and working to an annual plan after years of discarded strategic documents and nefarious efficiency savings, vacancy factors and un-funded service expectations, has been welcome. The transparency and accountability is a new discipline!

Perhaps the principle triumph of geriatric medicine has been the prevention of inappropriate admission to long-term care through access to modern medicine, rehabilitation, planned care and community support. The specialty’s birthplace in long-term care, though a matter of great debate and opinion remains remarkably poorly characterised and developed. I have long sought a greater understanding and development of care. It is clear that the appetite for research and development investment in care is a poor runner up to the genome and allied phenomenon. For the foreseeable future, innovative commissioning, provision and evaluation are the most likely means of progressing care from anecdote and iterative development to a solid evidence base. BUPA will seek to be at the forefront of those providers, offering a more complete solution than merely a serviced bed. The RCP report, “The health and care of older people in care homes: A comprehensive interdisciplinary approach: A report of a joint working party”, published in June 2000 offers insight into how that may shape up.

The greatest constraint now and for the foreseeable future remains the serious shortage of staff. Improving and developing NVQ training that will allow care staff enhanced roles, responsibilities and opportunities, in turn allowing nurses take on a greater role in planning care will allow a restructuring of the roles of doctors in both primary and secondary care. The care and support worker inquiry commissioned and reported by the King’s Fund makes many useful observations and recommendations that would help the kick-start this chain of events and another area of our activity.

There is much more. The unknown is how far we will really be able to make a difference. No major obstructions have been encountered – watch with interest!

Clive Bowman