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a
policy guide
The
BGS Office regularly receives telephone calls from consultants and
other bodies asking for advice on BGS standards related to resources
needed for geriatric departments.
The
definitive statement the BGS has made on the issue of resources
was the article by Peter Horrocks in 1986, in “Age and Ageing”,
which then became one of the earliest BGS compendium articles.(1)
Such statements on the structure of a comprehensive health service
no longer work in the current NHS environment. The reasons for this
are numerous but include:
-
Different models of care
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Difference in resources between those with comprehensive community
services and those without
-
Differences in services between those that are entirely DGH based
and those that have community hospitals and considerable Intermediate
Care type services
-
Massive variation in the way that different health and social
care communities manage to deal with older people, in part due
to historical patterns of working rather than resource differences.
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References
1.
Horrocks P. The Components of a Comprehensive District Health Service
for Elderly People – A Personal View. Age and Ageing. 1986;
15 (6): 321-42.
2.
Consultant Physicians Working for Patients. The Duties, Responsibilities
and Practice of Physicians. 2nd Edition. Royal College of Physicians
London 2001
3.
Medical Aspects of Intermediate Care. Federation of the Medical
Royal Colleges The Royal Colleges of Physicians of London, Glasgow
and Edinburgh 2002.
4.
The National Service Framework for Older People. Department of Health
London 2001.
5.
Document A3 Standards of Medical Care for Older People – Expectations
and Recommendations. BGS Compendium of Guidelines, Policy Statements
and Statements of Good Practice at: www.bgs.org.uk
6.
User guide for Modelshire. HSC 2001/003 : LAC (2001)4 |
So
is there anything the BGS can offer to advise?
Consultant
numbers
There is information on consultant numbers. The document “Consultant
Physicians Working for Patients”2 clearly states that 6 whole time
equivalent consultants are required in geriatric medicine per 250,000
of the population. This is very similar to statements made before by the
British Geriatrics Society that 1 consultant per 4,000 of the population
aged over 75 is a minimum requirement to start achieving comprehensive
services. The latter figure is sometimes of more use to those parts of
the country with high proportions of older people. A statement has also
been made recently by the Federation of the Medical Royal Colleges in
the document, “Medical Aspects of Intermediate Care”, that
five fixed sessions of consultant time should be available in any locality
per 200,000 of the population.3
Bed
advice
Bed advice may be obtained by asking the local Director of Public Health
in your main PCT to ask for the resources predicted locally, using ‘Modelshire’.6
This program was designed to help Health Authorities estimate future requirements
for general, acute services and intermediate care facilities for 2003/4.
The most
important document arguing for adequate resources is the National Service
Framework for Older People4 which sets out the standards of care that
need to be provided and indeed, the structures and processes that need
to be in place. If for example, there is no falls service nor any service
to provide adequate input to geriatric/ orthopaedic rehabilitation, then
there should be strong arguments for new resources needed to meet the
standards set out in the National Service Framework.
Standards of care
The Policy Committee of the British Geriatrics Society have recently revised
the Standards of Medical Care for Older People5 compendium document A3
to take into account the National Service Framework. This clearly sets
out the key elements of specialist services for older people, as well
as quality indicators to act as prompts and ideas for monitoring performance.
Using this document in conjunction with the National Service Framework
is the way to move forward when considering improving services and when
putting forward arguments of resource allocation.
Dr
David Black
Chair England Council
Dr Gill Turner
Chair of the BGS Policy Committee
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