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Held at the RSM, we were welcomed by Dr Justin Varney, consultant in Public Health Medicine to this joint meeting chaired by Baroness Sally Greengross.

Professor Carol Black was the first speaker, in her new role as National Director of Health and Work. She introduced us to the future and that ofr our ageing population. She presented the concept of ‘workability’, a person’s capacity to contribute to the work force during their lifetime. Recent trends have led to a reduction in workability, due to both earlier and, as a result of increased longevity, longer retirement periods. Incapacity benefit claimants have also lowered overall UK population workability.

Professor Black conveyed a need to address those factors which influence society’s workability. In doing so, she reviewed British Telecom’s encouraging mental health policy towards employee stress, contrasting this with deficits within small and medium sized business enterprises (presently employing 60% of the UK workforce). Earlier this year the Secretaries of State for Health and Work and Pensions commissioned Professor Black to undertake a review of the health of Britain’s working age population; for which she welcomed suggestions.

Professor Ian Philp, the National Director for Older People, working within the Department of Health, spoke eloquently of the necessity to drive reform of care for older people as a political issue, deeper into the public domain. There is a need to create long term plans despite the tendency for short term political cycles. The intuitive goal of increasing ‘dignity and care’ for older people has emerged from the drive to combat age discrimination; an issue beginning to be aired within the political arena. Unsurprisingly the issues of MRSA and Clostridium difficile are currently top political priorities for the NHS, bolstered by media coverage. However, therein lies an opportunity for older people, as the ‘vectors’ of C difficile, to raise the profile of need for improved care. UK politics needs to get in touch with the older person’s mind-set .

The next speaker was Nigel Edwards, Director of Policy for the NHS Confederation. He disputed health service polices which in general are based upon the elective surgery, or the single episode model which fails to account for patient complexity, ongoing outpatient management relationships and continuity of care. He criticised the traditional UK model of primary and secondary care as being outdated; challenging the ever increasing drive towards, and respect for, hyperspecialisation - a disparity given the increasing burden of co-morbidity. Research, which presently focuses on uni-morbidity diseases rather than what is in reality more commonly encountered, co-morbidity, further exemplifies this discrepancy. He went on to reinforce the need for intermediate care facilities, to criticise the decline in social care provision, and questioned the availability of the workforce needed to provide social care now and in the future. Presently motivation for health policy comes from the vocal young rather than the quiet older majority. A hot debate ensued.

Dr Mike Cheshire, Clinical Vice President of the Royal College of Physicians of London continued. Whilst NHS targets may have improved care provision, there have been unpredictable detrimental consequences. The four-hour trolley wait has led to increased admissions, ‘hot bedding’ and multiple bed moves per patient. He criticised payment-by-results as greatly increasing readmission rates, and as being ‘not fit for purpose’ for the elderly. The NSF for older people, issued without financial backing, is now having to compete with the priorities of other NSFs, which did come with money attached. Dr Cheshire expressed concern over the decline of geriatrics in undergraduate curricula and acknowledged a need for improved intermediate and community care training for geriatricians and trainees, as this is likely to be the direction in which our profession is headed.
The subsequent zealous question and answer session was only terminated by the desire to eat a tempting supper. A great evening was had by all. I left with a renewed enthusiasm to think large, to realise the importance of our evolving demographics and the pressing need to reform the systems which will underpin a high quality service for the older people of the future. We all have a responsibility to push forward the ‘dignity and care’ agenda for older people.

Celia Gregson
Wellcome Clinical Research Fellow
LSHTM

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