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I am greatly enjoying the early months of my presidency. I am impressed by the skills, energy and enthusiasm of our members and of the office team.

In this issue, I will focus on ideas which could stimulate and inform us and help us ensure that old people get the very best care in a constantly changing NHS.

Meeting for Medical Directors and Heads of Specialist Societies
I attended this Department of Health conference, which I found enlightening and informative. Sir Bruce Keogh gave an overview, emphasising the key themes of medical leadership, innovation, health promotion and quality. He said that continuous change was inevitable and that Tsars would be major change agents. Lord Darzi summarised the Next Stage Review, iterating the need for quality (i.e. safety, effectiveness and positive patient experience) and arguing that the best teams measure what they do.

Liam Donaldson spoke on re-validation, the most important change in medical regulation since 1858. David Nicholson described the virtues enshrined in the NHS Constitution - these include care and compassion (geriatricians will be no strangers to these timeless values), quality (again) and ensuring that everyone in the NHS matters

The public admission of past errors was refreshing - in the past there has been change without evidence; finance has featured more than patient care; headlines have taken precedence over quality. Top-down management does not work. In future, there will be decentralisation. Translating research into practise will be stimulated. Other themes included the increased focus on prevention and health promotion; Commissioning - which will include working with clinicians to achieve better care and best value; improved efficiency (I was astonished to learn that PCTs spend £200 million a day) and the use of pathways (for clarity as well as for training).

There were many take-home messages for the BGS, most of which resonated with our strategic planning. We need to do more on prevention; encourage the gaining of leadership skills, particularly among our younger members (there may be Darzi grants for this purpose); develop expertise and influence in commissioning, the design of clinical pathways and metrics (quality measures). We have always championed pragmatic research and the increased importance of translational research will be heartening to academics in our specialty.

PR, Press and Parliamentary officer
I was impressed by the presentation at this conference by Sue Saville the ITN health correspondent. She suggested that we welcome the media into our hospitals - they can do much to amplify key messages and help us to make sure that our voice is heard

A comment made by many members is that the BGS does not have much national visibility. Indeed, many otherwise well informed people do not know that it exists. Our past experience with a PR agency was not a resounding success (an experience shared by other specialist societies). In order to raise the profile of Geriatrics and emphasise our key role and effectiveness, we need a public relations expert. This person would liaise with members in the four countries and the regions, discovering interesting research findings and examples of innovative high quality clinical practice. The PR officer would link with “instant experts” in the BGS, who could give wise and informed responses to news stories

The successful appointee could also help with political lobbying - we should influence the formulation of governmental policy, and not simply respond to departmental initiatives

I am very pleased that the BGS’s “cabinet”, the UKMC, approved the suggestion of such a post. As I write, interviews are being planned. There will be much more on this development in future issues of the Newsletter

Other aspects of Strategy for the BGS
The medical landscape of the future is going to be very different. Hospitals will be fewer and more specialised, focussing on high technology. More care will be delivered in other settings (“nearer to home” is the mantra). Some policy makers are talking of hospitals as “institutions of last resort”. The move towards the community seems to be inexorable. Geriatricians have always had a strong community dimension - for example, domiciliary visits, day hospitals, telephone advice to GPs and other community colleagues. Prof Ferguson Anderson, the world’s first professor of Geriatrics ran retirement classes in Rutherglen health centre in Glasgow. Other pioneers (such as Isaacs, Sheldon and Adams) have also done much good work outside hospital

We are faced with a threat and an opportunity. We must argue the case that to deprive ill old people of the opportunity for timely comprehensive geriatric assessment is ageist and not in keeping with the move to correct inequalities in health. My impression is that nowadays few crisis elderly admissions to hospital could be managed as well - or better - elsewhere. I am equally convinced that much impressive work can be done at home and in a variety of other settings. There are many excellent examples of community geriatrics and it is encouraging that many departments are developing skills in this field

Alex Mair’s Strategic Review explores this in more detail as well as outlining other important policy themes - commissioning, recertification, training, Specialty Certificate Examinations, the Dignity project. You can read find information or links to them on the BGS website.

Grandees
There is a veritable snowstorm of documents from such organisations as the Department of Health, Kings Fund, Scottish Parliament, NICE and the Royal Colleges. It is difficult to keep abreast of what has been published and even the most assiduous geriatrician would not be able to read them all. One solution is to appoint people with more time - as well as specialist experience and skills - who could scrutinise selected documents. They could then write a two page summary, giving a geriatric perspective on the publication, together with a brief commentary (which might rate the paper and advise on whether members would benefit from reading the whole document). The reports could feature on the website and in the newsletter

Initially, we plan to invite BGS members who have recently retired to be assessors - or “Grandees”. If you would like to be part of this enterprise, or know of someone who would make a useful contribution to this new service, please contact the Society’s scientific officer, Jo Gough, at Marjory Warren House.

A question for the Secretary of State for health
David Oliver and I attended the BMA Westminster political meeting in February. Alan Johnson, Secretary of State for Health, gave a summary of Labour’s achievements in the health service. I asked him why elderly people received only glancing references in Lord Darzi’s community review and why the planned vascular screening scheme excluded those over 74 years of age. Was this an oversight or an example of institutionalised ageism? He emphasised Labour’s achievements for old people, including the NSF and the recent Dementia strategy. He also promised to go back to his advisers on the question of an upper limit on screening. I have written a follow-up letter.

We need to be vigilant about other examples of (perhaps unwitting) ageism in elderly health care - something that our PR officer might pursue.

Graham Mulley

BGS Newsletter, March 2009
Issue 19 ISSN 1748-6343 20