At the heart of the individual geriatrican and the BGS’s struggle with the national policy makers is the seemingly simple concept of a health service for older people which is proactive, “joined up” and multiprofessional, incorporating all the necessary elements of both medical and social care.

The models to achieve this ideal state of affairs have been legion and with variously creative names such as “Evercare” and “Kaiser Permanente”, to name but a few. From the “Single Assessment Process” to the “National Programme for IT”, trumpeted in the NHS Improvement Plan, there is an attempt to put in place, the building blocks whereby high standard, proactive, seamless care might be achieved, but playing devil on the other side of the story, is the never ending struggle to keep costs down and even to claw back resources for diversion into the political pot d’jour.

In Lanarkshire, Scotland, however, the battle seems to be going well. At the BGS National Council Study Day held in Edinburgh in June, Dr Anne Hendry gave an enthralling presentation on how the creation of a network for Stroke services in Lanarkshire had brought about substantial improvements in patient care. Putting into context, the changing picture of health need in Scotland, with people on average living longer, but still paradoxically dying sooner than their European counterparts, Anne said that current models of care tend to be acute and secondary care focussed, reacting to need in a disjointed manner with the patient almost a spectator. What is required for future health services is for the focus to be on long term conditions, community centred, integrated with Primary care and with the patient involved as a partner undertaking self management where possible, with support.

One method of achieving this is through Managed Clinical Networks where groups of health professionals and commissioning and providing organisations work together across boundaries to ensure high quality effective services. The core principles of a Network include patient involvement, a Lead clinician, a clearly defined structure, an understanding of desired improvements, a multiprofessional approach, a quality assurance programme and audit as an integral feature.

In Lanarkshire a strategic redesign programme is establishing managed clinical networks for long term conditions and for older people’s services, underpinned by new models for delivering unplanned care and planned care. The long term conditions networks are addressing the management of diabetes, hypertension, asthma /COPD, vascular disease, CHD and heart failure. The Network for older people’s services will encompass a number of clinical communities including stroke, falls and hip fracture prevention, and dementia, recognising that co-morbidity is common in these conditions and that they are associated with a high burden of disability, requiring a joint commitment to case management by health and social care and interdisciplinary teams. The model delivers targeted interventions, for example, to prevent falls by undertaking balance and gait exercises in the homes of patients as well as at the day hospital. The network is also providing resources for patient education, advice and support through expert patient programmes and peer support groups.

Anne went on to describe her experience of establishing a Stroke managed clinical network between localities in the Lanarkshire region to tackle challenges in achieving the National stroke standards relating to percentage of patients within an acute stroke unit, accessing CT within 48 hours, ensuring early prescription of Aspirin, documenting swallow status and undertaking rapid access TIA clinics. The significant gains obtained through redesign and integration of services across sites and organisational boundaries, demonstrates the potential benefits from implementing Managed clinical networks to raise the quality of services for older people.

What Lanarkshire’s experience confirms (yet again) is that if a high quality older people’s health and social care service is going to achieved, it will be through the ingenuity of individual professionals working within their own locality while struggling quietly against the obstacles put in their way by policy makers at both local and national levels.

The slides from Ann’s presentation may be downloaded here.

David Beaumont