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I recently returned from an intermittently sunny Bournemouth and a lively successful BGS conference in an excellent venue.

The main programme was varied and interesting and was preceded by a Wednesday afternoon joint session on Dementia, organised with partners from the EUGMS – very topical in view of the recent long awaited launch of the national dementia strategy (see Duncan Forsyth’s on this issue). Also, see a pair of excellent state of the art review articles around dementia care - references in box below.

How to get more delegates and members?
The only regret about the Bournemouth meeting was that the number of delegates could have been higher (486 - down from our heyday of 600-ish). How much of this was due to the time of year, or travel to the south coast, I am not sure. I realise that shift work, tight job plans and limited study leave budgets all have an impact on attendance, but the meeting is a principal income generator and showcase for the Society and research by its members, as well as an important chance for us to network, exchange ideas and support one another and, of course, to gain speciality-specific CPD. My own view is that we need to push much harder to attract both interested doctors from allied specialities and a much larger number of professionals from nursing, pharmacy and the therapies, both to the Society and to the meetings, and it would be good to know if people agree, or have ideas for upping our attendance.

Dignity in Nursing Care
Soline Jerram’s commentary in this issue on the latest Nursing and Midwifery Council guidance on dignity points up the fact that we need professionals with specialist skills in the care of older people from all the disciplines. Though, on a personal note, with regard to the NMC, I do feel we now have more than enough resources to describe what dignified and undignified care is and need to move towards solutions – one of which has surely got to be around adequate staffing levels and skills-mix. Education and awareness raising can take one only so far, but if someone’s drowning, the appropriate response is to throw them a lifeline, not to describe the water.

Public Relations
Speaking of marketing, awareness-raising and greater engagement, I am delighted to announce the appointment of our first ever press, public relations and parliamentary affairs officer, Iona-Jane Harris, who was appointed from a field of over 140 applicants and started in April. As a consequence of her appointment, we will now be in a stronger position to engage with the media both proactively and reactively and push the cause of better specialist care for older patients.

Commissioning
In this time of recession, the days of large tranches of money coming from the English Department of Health earmarked for specific services are over, following the massive additional investment made by the Labour government in the Health Service. We are also gradually moving away from a target-driven culture to other “levers” to improve access and quality. So when it comes to delivering new and improved services for instance, on the back of the stroke or dementia strategies, then local commissioning is now seen as the engine of change. For most of us clinicians, phrases such as “world class commissioning” can seem like confusing or platitudinous management-speak – what does it mean? And will it actually force commissioners, for once, to prioritise services for older people? “We will believe it when we see it” – many will say. So in this issue we have provided an introduction to the concept (see paper by Graham Mulley and progress made in Wales by Antony White).

Falls and Bones
In addition to my BGS role, I have recently taken over Finbarr Martin’s work at the Department of Health, specifically around commissioning of falls and bone health services, and we are due to launch a commissioning toolkit to be presented at all SHAs in England in May and June – watch this space. This might give a better notion of how commissioning might drive service improvements. And we know from the latest RCP national audit on falls and bone health that we still have a long way to go in providing the truly “comprehensive services to reduce falls and fractures” envisioned in the 2001 NSF.

Ethics and Law in the care of older people
At the Bournemouth Meeting, two sessions which attracted large numbers of delegates and a great deal of interest were around physical restraint use and around the new deprivation of liberty safeguards to support the code of practice for the Mental Capacity Act (which came into force on April 1). I know that there has been a lot of interest in the guidance on Advance Care Planning in which the BGS played a major role⁴. The care of frail older people raises complex ethical and legal dilemmas daily, for those of us at the coalface, and the interest in these sessions flagged up just how keen people are for more information and support. For those especially interested, there are a number of part time Master’s Programmes in Healthcare ethics and law around the UK, as well as some shorter courses, and several of our members have undertaken them. But the BGS ethics SIG (which ran the sessions in Bournemouth) would welcome more active members so please get on board. Contact them through the editor.

The rise and role of the regulators
Also in Bournemouth, we enjoyed an excellent talk from Prof Martin Marshall on the sometimes confusing role of regulatory bodies in healthcare. This was highly topical in view of the report on the Mid Staffordshire trust and other fairly recent public enquiries such as the one on Clostridium at Maidstone and Tunbridge Wells. We also had the recent Panorama Programme on the sometimes poor quality of home care services contracted out to private companies. (We have all heard patients reporting poor as well as good experiences with home care and this programme – uncomfortable viewing – showed us why). And as I write the verdict from the Gosport War Memorial Inquest is about to come in. There was an enlightening piece in the BMJ 2007 on the history of public enquiries in NHS and UK social services. But a common feature of such enquiries seems to be the narrative of problems being flagged up repeatedly by frontline staff and not acted upon. There was, to my mind, an excellent letter in the Times by John Spivey FRCS, stating that the NHS rewarded and promoted staff who reported only good news up the line – the “don’t bring us problems, bring us solutions” culture, meaning that those in senior positions were often shielded from day to day operational problems and tended to “manage upwards”, in looking for their own career progression. It is also interesting to note that the HCC had given Mid Staffs a decent report, just as Ofsted had for Haringey social services in 2007, leading one to wonder whether inspections tend to the superficial. Still, in one of the regular re-organisations that seems to occur in quangos including regulatory bodies, the Healthcare Commission and CSCI have now merged to become the Care Quality Commission (CQC), with the complaints function being taken over by the Obudsman and it was heartening to see the announcement that CQC plan to toughen up inspection standards for care homes. I will do my level best to interview someone from CQC for the next newsletter. If any members have questions they would like me to put, then please let me know.

Jumping for Joy
Finally, on a more light-hearted note, two stories caught my eye recently. Firstly, the headline that “putting make up on can prevent accidents in elderly women. And no, it wasn’t published on April 1 (well, not in the newspaper at least). The study led by the research communications director from the cosmetics giant L'Oreal (a conflict of interest perhaps?) found that older women who applied make-up in the morning stood straighter and had fewer falls than those who did not.

Dr Patricia Pineau, of the University of St Etienne in France, claimed that the findings could help prevent many debilitating accidents. Her team studied 100 women, aged between 65 and 85, as part of a study originally intended to measure the effect of wearing make-up on self esteem. The women were fitted with belts to measure their posture and were given special insoles to test their centre of gravity. The team concluded that those who wore even a small amount of make-up appeared to be more stable on their feet.

"They held themselves differently to those who did not wear make-up," Dr Pineau was quoted as saying.⁵

My second heartwarming story was about 97 year old George Moyes undertaking his first skydive from 10,000 feet with a maximum speed of 120MPH to raise money for the RNLI.⁶

“It was the first time but it won’t be the last,” he said afterwards “I do not sit around, I get about, I go for a walk every day and I do my own cooking, washing, ironing, everything," he said. "I have just been lucky to be so agile." And on the basis of finishing right where I started, the man in question was from Bournemouth, though I am pleased to say he didn’t attribute his successful ageing to regular applications of mascara.

David Oliver

BGS Newsletter, May 2009
Issue 21 ISSN 1748-6343 21