Department of Health Liaison Group meets with BGS England representatives

At a meeting with the DoH Liaison Group, attended by Prof Ian Philp and Mr John Holden the England Council discussed a range of topical issues. We present a summary of these here.

Health outside hospitals
The Secretary of State has announced a new consultation process, due to commence in September 2005, leading to an expected White Paper on "Health outside Hospitals" due to be published in early 2006.

The Department of Health (DoH) strongly recommends that the BGS meet with Mr Liam Byrne MP, before the consultation process on the "Health outside Hospitals" White Paper commences, to demonstrate how geriatric medicine can provide a positive contribution.

Assessment and reducing bed days
The DoH proposes to promote Integrated Care Networks, which will incorporate Chronic Disease Management, the immediate aim being to reduce the number of emergency bed days - a key DoH policy.

The BGS and DoH agree that speedier social care assessment, in parallel with clinical assessment, would go some way to reducing the number of emergency bed days. It was noted that an Australian model had produced successful results. However, simply reducing bed days can be dangerous, if insufficient diagnosis is being carried out. It was agreed that comprehensive geriatric assessment is a key part of success. CGA can be carried out by multi-disciplinary teams, away from acute settings.

Closure of rehabilitation beds
The BGS expressed concern at the rate of closure of rehabilitation beds, and the "warehousing" of patients

Diverting geriatricians to acute intake
On the topic of geriatricians being diverted into greater levels of acute work, the DoH suggested that focussing on the following issues would be useful:

• Reducing bed days - CGA can play a lead role in this
• Improving the patient experience, by reducing the number of people the patient encounters
• Proactive alignment with SAP terminology would be useful; adds weight to the workforce case, leading to greater PCT investment in geriatrician posts

There was general agreement that better quality assessment, particularly with patients displaying signs of dementia, would reduce hospital admissions. Involvement of care homes, GP's, community matrons and others would be required.

The DoH agenda
The DoH outlined the following topics which are at the top of the current political agenda for health:

• Health promotion
• Social care reforms
• Development of Integrated Care Networks - to include long-term
  conditions strategy
• IT and the Single Assessment Process
• Fully funded falls services
• Stroke - in the context of a medical emergenc
• A new vision for mental health
• Reform of emergency procedures for older people suffering with stroke or from falls
• Dignity of the older person in hospital
• Dignity of the older person at the end of life stage

Payment by Results (PBR)
The BGS delegation expressed concern that PBR was leading to closure of beds in many cases. The DoH stressed that PBR was quality driven, not results driven. Payment flow should follow the patient, not lead the patient.

It was noted that PBR is still being rolled out - dependant on service being provided.

“Coding” - the mechanism whereby presenting conditions are coded (in the same way that police assign codes to criminal offences and perpetrators) - remains an issue. It is the key whereby PBR is delivered but it is a difficult system to apply to patients with multiple conditions. "Upcoding" is inevitable in any system, although plenty of checks and balances are being built in.

The question of coding pure rehabilitation services was discussed. The DoH uses length of average stay, together with number of different identifiable interventions as the basis for coding. It is recognised that specialty situations need to be better recognised and coded, so that PBR can be seen to be transparent and effective. It was agreed that a presentation on PBR might be useful and this will possibly be done at the next meeting of England Council.

Alex Mair
Chief Executive