In July, the BGS office received a request from a member whose Trust was reviewing the organisation of older people’s services.

A quick email survey of service models was conducted to help provide data for the review meeting. Sixty lead clinicians were asked whether their service is age-related. Responses were received from 54 Trusts, and sorted into one of three models; needs related, integrated and age related. In trying to categorise the services, a degree of ambiguity was found in some cases, in respect of the needs related and integrated models.

A number of members provided comments on the service models operating in their hospital, some of which are summarised below:

• The move from an age-related to an integrated service was partly driven by the reduction in junior hours and introduction of a shift system in one Trust.
  
• Some respondents referred to the significant increases in workload and resources required to move from an age-related service to an integrated service.
  
• Some respondents referred to the relationship between admission policies and NSF Standard 4
  
  
• Within integrated services (shared acute take) the existence of needs related rehabilitation facilities under the care of geriatrician are mentioned.
  
• There is increasing reference to a needs related stroke facility within hospitals, in some cases linked to the geriatrician led rehabilitation ward.

Overall there appears to have been a shift to, or there is existing pressure to convert to an integrated model, held back in some cases by a lack of resources. Others, on the other hand reported pressure to go to a needs related basis.

In Grimsby ‘there is a dedicated Day Hospital where there is rapid assessment and management of older patients with subacute crises to avoid inappropriate admissions. Outpatient services and some rehabilitation for older people with unstable complex medical problems also take place in the Day Hospital’.

There is one quote which is explicit in lauding the merits of an age related service - ‘a lower hospital admission rate per population, shorter length of stay and lower readmission rate, which I think is a reflection of better care for older people in Age Related Service’.

Others take the opposite view ‘we do not take ALL patients over a certain age, as this would in our opinion, deprive patients of the best care from another specialist if appropriate. We also take any patient <65, whose needs would be better met on our unit, e.g. stroke or patients needing rehabilitation’.

For a copy of the results in detail please contact Louise-Wykes@bgs.org.uk

Louise Wykes
BGS Office