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Although the Christmas season is generally a quiet time for NHS related business, the last few weeks have seen a flurry of good news stories, at least as far as geriatrics is concerned.
The focus on care home medicine continues, this time endorsed by Sir Michael Parkinson, the government’s National Dignity Ambassador, on Radio 4. As is so often the case, it is only once people have to face up to the realities of care of older people in our society in the context of a loved one becoming more frail or having contact with the NHS, that they really start to ‘get it’. This is particularly true of senior doctors who aren’t geriatricians! In Sir Michael’s case, it was his experience of seeing his mother being subjected to undignified care in a care home that made him realise the importance of having a positive attitude towards frail older people. Whilst it would be in inappropriate to take undue advantage of the misfortune of others, it is worth making the most of such moments of revelation in attempts to improve services. As I am starting to appreciate in my own attempts to improve services, the evidence based approach is not necessarily stronger than the emotion based approach. Often both are necessary.
New National Clinical Director for Older People in England
Another good news story is that the Department of Health (DH) has appointed David Oliver National Clinical Director for Older People’s care in England, taking over from Ian Philp – a challenge for anyone. I am sure David will continue in his own indomitable way to push the case for better care for older people – although I was reminded by our President elect that suggesting the BGS might have any influence over DH matters is perhaps a little naive! Congratulations David – and commiserations to your colleagues in Reading who will have to cover you! Also, welcome news is the appointment of Professor Alistair Burns to lead on dementia care. A formidable duo.
The fact that DH sees the importance of such a role is encouraging, and perhaps there is additional reason for some cautious optimism. Many of our England members will have had some contact with, or may even have led, one of the Partnerships for Older People Projects (POPP) schemes. The national evaluation (carried out by the PSSRU, a well respected health services research unit) has reported back on the outcomes from these schemes. They were many and varied, but together have highlighted the importance of preventative, multidisciplinary care – and have suggested that health and social care services need to work together in order to improve outcomes – what a revolutionary concept!); Whilst some of the claims from the POPP schemes might be rather bold and a tad overstated (one scheme apparently reducing emergency admissions by nearly 50% - which would be a world first!), the enthusiasm surrounding these schemes is again something to exploit and build upon.
Revalidation is coming your way!
Linda Patterson and Paul Knight have provided a helpful overview on revalidation and work is in progress within the BGS to try and identify some of the metrics that might be helpful. I suspect that some metrics of interest, especially for any involved in acute work, will be process measures such as discharge rates, length of stay and readmission rates. A word of caution – for such metrics to be reliable and meaningful, they need a little bit of scholarly appraisal. For example, we recently looked at discharge and readmission rates for older people from our Acute Medical Unit. In order to obtain reasonably tight confidence intervals which allowed comparison from one consultant to another, we found that a sample size of at least 200 was needed to estimate the discharge rates to within 5 per cent and readmission rates (again to within 5 per cent) needed at least 160 discharges. As the financial squeeze hits and activity is being scrutinised, be careful about accepting or making snap judgments based on small samples!
Good luck!
Simon Conroy
BGS Newsletter, February 2010
Issue 25 ISSN 1748-634000 25