The last year has proved very challenging for members of the Society’s Policy Committee. Changes in personnel have been accompanied by a need to adapt to the new structure and the establishment of the National Councils.

The traditional role of the Policy Committee has been to monitor developments in health policy across the United Kingdom and to provide policy statements and service guidelines in response to changes, but this had led to potential overlaps between the work of the Committee and the National Councils.

Responding to Change
In order to meet these challenges the Committee has adapted by strengthening the links with the National Councils through cross representation, and by sharing work with policy implications for the Society nationally. Second, the Cerebral Ageing and Mental Health SIG (with links to the Royal College of Psychiatrists) and the Primary and Continuing Care SIG (with links to Royal College of General Practitioners) have taken on additional responsibilities for developing shared policy in conjunction with the Colleges and the Policy Committee, and are now represented at meetings.

Developing the BGS Compendium
One of the core functions of the Policy Committee is to update and develop the content of the compendium. Now web based, the current statements have been reviewed, updated and in some cases of obsolescence, removed altogether. The Committee is about to relaunch the new compendium, divided into 3 sections.

Section 1: Statements of BGS Policy
The statements listed below are intended to represent the core principles and values of the Society and its members.

The BGS abhors ageism in any shape or form. In the NHS this can be masked as upper age cut offs for beneficial treatments or the assumption of frailty on the basis of age alone. It can also be manifest as the socialisation of problems from frail older people, particularly those in care homes; thus all care home residents should have access to specialist secondary and multidisciplinary health care when needed.

All older people are entitled access to a relevant specialist when they are ill. This can mean access to a specialist in geriatric medicine if they have complex health care issues, multiple pathology or rehabilitation needs on the one hand. On the other, older people who are under the care of a geriatrician are also still entitled to the opinion of other system-based specialists.

Specialist departments of geriatric medicine will differ in the style of service they provide but whatever service they subscribe to, they should ensure that their first priority is the frail older person who will most benefit from their care. Appropriate professional behaviour in all staff working with older people will ensure older people are afforded dignity and respect. This in turn will encourage and enable older people to make informed choices about their treatment.

Older people who are ill or who lose independence are entitled to care which ensures that an informed search is made for any reversible medical illness and cause of the deterioration. On the whole this will require either admission to hospital or, for those patients who are better managed outside of an acute hospital, the availability of geriatricians in the community.
All health care for older people should be multiprofessional, goal orientated and enabling. Multiprofessional working needs to be formally and clinically led to optimise the multi-disciplinary team’s efficiency. Doctors should be members of the multiprofessional teams. However, team leaders do not have to be doctors.

Health and Social Care departments must develop joint strategies, underpinned by national legislation which enable older people to lead active lives in the community. Geriatricians need to play an active part in the planning of such strategies.

Section 2: Clinical Guidelines
This section will be developed primarily by the SIGS and sections co-ordinated by the Clinical Practice Effectiveness Committee (CPEC) and it will be reviewed every 2 years. Occasionally liaison with the Policy Committee will be necessary. These guidelines assist with the management of individual patients, rather than with service development. Initial topics include the detection and management of delirium, assessment of pain in older people and management of depression in patients with acquired brain injury.

Section 3: Service Guidelines
This is a modernised version of the earlier compendium providing advice to geriatricians, health professionals, Trusts and commissioners. The aim is to review the statements every three years, and this will form a large proportion of the Policy Committee workload. The section on training will be undertaken by the Education and Training Committee. This section will be divided into 5 chapters:

The Speciality of geriatric medicine
This section covers BGS aims and functions, Standards of Specialist Care, and a variety of topics such as CPR advice, nutrition, rehabilitation and advance directives.
Acute hospital based issues in health care for older people
This includes advice on acute medical care, the older person in Accident & Emergency departments and orthogeriatric care.

Non-acute hospital and community based issues in health care of older people
This includes statements on intermediate care, the role of the geriatrician in the community, day hospitals, continence, and assessment of older people for continuing care.

Training
This includes guidance on the training of specialist registrars to complement the new curriculum, and also the recommended undergraduate curriculum in geriatric medicine.

Individual service specifications
Guidance is included on the importance of vision in preventing falls, Parkinson’s Disease and ortho-geriatric services.

Current Policy Issues
One of the major topics for the last year was the service implications and training needs arising from the establishment of General Practitioner posts with Special Interest in Older People (GPwSI-OP). Members will recall an article in the September 2003 issue of the newsletter by Gill Turner and Joe Neary describing the opportunities and training possibilities developed with the Royal College of General Practitioners and Primary and Community Care SIG. The Policy Committee strongly supports development of these posts within the agreed framework.

Emergency care featured very strongly in the early part of last year and the Committee co-ordinated statements on the assessment of older people in the Accident & Emergency department, and on the role of intermediate care in the Emergency agenda. These documents were submitted to the Emergency Services Czar Professor Alberti and further developments are awaited. Much of this work is now being followed up by the National Councils.

Representations have been made to the National Care Standards Commission who appeared to suggest on their website that pre-employment “police checks” would not be required for home care staff working with older people. Thankfully, that guidance has now been rescinded.

A query from the Northern region led to inconsistencies surrounding the use of monitored dosage systems (such as dosette boxes) being highlighted to the Department of Health England, leading to a commitment to establish National guidance.

Collaboration with the Cerebral Ageing and Mental Health SIG and Royal College of Psychiatrists has produced a thought-provoking document entitled “Position Statement on Specialist Medical Input to residential and nursing home residents”. Other issues being worked on at present include guidance on copying letters to patients, and proposals to extend professional regulation to unqualified staff working in Health and Social Services, including health care assistants and rehabilitation assistants.

Requests for Consultation
The Policy Committee has co-ordinated the BGS response to a number of legislative processes and proposals. Evidence was submitted to the House of Commons all party enquiry on Elder Abuse, and potentially adverse effects of the Patients Protection Bill proposals, and the Assisted Dying Bill have been highlighted to members of the House of Lords.

So, what can you do for us?
Some members have expressed the view that the work of the Policy Committee seems a little remote from mainstream Society activity, especially at regional level. In order to address this, the proposal is for a regular column to appear in the newsletter to update members on recent activities, and invite feedback on the compendium and policy statements. As an initial step, the Committee would value comments on the Statements of BGS Policy set out in the above section “Developing the BGS Compendium”, section 1. Comments on the tone, appropriateness and range of statements would be welcome, as would additional statements which might be added to the list.

If you have any (polite) suggestions please contact David Beaumont (david.Beaumont@ghnt.nhs.uk) or the editor (editor@bgsnet.org.uk)

David Beaumont
Deputy Chairman
BGS Policy Committee

Recent Additions to the Compendium
Members may be interested to hear that over the last 18 months a number of new documents have been added to the website. These include:

Standards of medical care for older people (current A3). Drawn up in the light of the National Service Framework, this document sets out the standards of practice that departments of geriatric medicine should be aspiring to, and are intended to act as a guide for service providers, trusts and commissioning bodies. A number of audit standards and clinical quality indicators are recommended to assist with evaluating practice. The areas covered include eliminating age discrimination, person centred care, non-acute care, acute assessment, stroke, falls, mental health services, health promotion, medicines management and palliative care.

Developing intermediate care to support the reform of emergency care services (current D6) This document was devised partly at the request of Professor George Alberti to support development of the Emergency Care agenda. It looks at ways in which intermediate care services could be developed to manage the older person in crisis at home, at the front door of the hospital or in the post-acute phase of illness. The document describes opportunities for early assessment and streaming into appropriate pathways of care, with implications for resources.

Core content of the undergraduate curriculum (current F2) This document sets out the knowledge, skills and attitudes required by today’s medical students. It covers knowledge of ageing theories, demographics, diseases, rehabilitation and medications, and clinical skills, assessment of cognitive state, appropriate investigation and teamwork. Important attitudes of respect, confidentiality, autonomy, ethics and self-awareness are highlighted.

Advice on nutrition in common clinical situations (current G1) This document complements existing GMC and BMA guidance, concentrating on nutritional issues in patients with stroke and dementia. It discusses practical and evidence based aspects of nutrition in these areas.

Palliative and end of life care for older people (current G7) This document highlights that end of life care of older people is often suboptimal, and reproduces 12 principles of “a good death”. Communication, honest prognostication and attention to spiritual needs are recognised as important factors, and integrated care pathways have a role in enhancing the quality of palliative care.

Importance of vision in prevention falls (current H1) This joint statement between the BGS and College of Optometrists highlights the association between poor vision and falls and hip fractures. Common causes of visual impairment are noted, with opportunities to improve refraction. Concerns over low take up of optometry services are highlighted with recommendations for screening of fallers and care home residents.

Parkinson’s Disease (current H2) This document highlights the high prevalence of Parkinson’s Disease among older people and makes recommendations on assessment tools, imaging, establishing multi-professional teams including Parkinson’s Disease Nurse Specialists and training/education.