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To campaign or not to campaign? Not nearly as weighty (or snappy) as Hamlet’s question, but one of considerable importance to the BGS in the context of its external profile.

Over fifty members attended a special parallel session at Harrogate, addressing the question of how far, if at all, the Society should be involved with and be seen as, a campaigning organisation. Chaired by Dr David Oliver, the session took the form of a debate, with Drs Kevin Kelleher and Dave Beaumont taking different viewpoints.

Obviously, we could enter into a semantic debate about what is meant by "campaigning" versus "influencing" or "consulting”, but it is worth remembering that the very formation of the “Medical Society for the Care of the Elderly” back in 1947 by Marjory Warren and others, was in many respects a first campaigning step to force society from turning a blind eye to the needs of the frail older person. Today, you have only to look at the number of government inquiries we respond to, or to the impact that our “Dignity Behind Closed Doors” initiative is having to realise that we are in fact active on the campaign front.

Just how far should we go as a campaigning organisation? Should we focus on one big issue, looking for major topics in the public arena, or adopt a quieter more influencing role? When thrown open to the floor, the following messages came through:

The Society should:

• Strike the right balance – are we acting for all matters that affect frail older people, or just focussing on clinical medicine aspects?
• Retain the respect of others – campaigning on a major scale could damage this
• Not campaign on a single issue
• Engage with older people themselves, through various patient groups to get our message across – we are too limited at present
• Campaign at all levels, from the grass roots upwards as well as from government downwards
• Continue doing what it is good at but engage with more experienced organisations when the opportunities arise
• Consider changing its name. One suggestion put forward was “The British Society for Health in Ageing”. Is it time to revisit this thorny topic?
• Continue to be respected as the leading authority on the clinical welfare of the frail older person, at the same time expanding our campaigning activities to as wide an audience as possible

Although the audience may have been subject to “self-selection” bias, our interpretation was that there was a clear majority in favour of more campaigning, albeit that there seemed to be a wish that we avoid the more “crass” connotations of that activity”. From the chair, Dr Oliver had of course, to maintain an air of impartiality, but it was all an act! We are after all a specialty caring for an often neglected or marginalised group of patients. And we have a particular message to get across about their right to evidence based specialist assessment and intervention and about the benefits for patients and the whole system in getting the care of older people with frailty and long term conditions right. Only last year, the report "Living well in later life" stated that "too many hospitals and staff still displayed deep rooted and negative attitudes to older people" and that hospitals needed to made "age proof and fit for purpose". Only last month, the HCC report "Caring for Dignity" highlighted ongoing deficiencies in basic care for many older people in care settings. The BGS gave extensive evidence to the parliamentary enquiry into human rights and the RCP audit of falls and bone health services showed that NICE guidelines and NSF's notwithstanding, most older people with falls and fractures get a raw deal. So my intuitive feeling is that we have always campaigned! Apart from Warren, Irvine, Exton-Smith et al’s campaigning zeal, are their modern counterparts not pushing as hard for better care in dementia, stroke or continence?

Perhaps the key faultline is whether we should be more pro-active - seeking to influence the agenda rather than react to requests for comment. (There is a full list of our main consultations and external activities in the annual report) We are still not always seen as a "go to" organisation and risk being regarded as a group primarily about the interests of doctors. One strategy, which has proved increasingly effective, is to ally ourselves with other key players such as Help the Aged or the Royal Colleges - a strategy which has proven effective recently, in getting our views into the mainstream media.

We had just thirty five minutes to tackle the question: campaign or not to campaign, at Harrogate – hardly enough time to do it justice. We would like to throw the debate open to all of you through these pages – do email, using the link at the top of this page, and let us know what you think the Society is doing well (and not so well) on this important matter.

David Oliver
Alex Mair

BGS Newsletter, December 2007
Issue 14 ISSN 1748-6343 14