Older Mind Matters

Sense and nonsense

A friend drew my attention recently to the report from the Select Committee on Public Service and Demographic Change entitled Ready for Ageing? (see it here). It makes a number of recommendations: here are three, paraphrased for brevity:

· The NHS will have to radically transform to deal with the increasing demand and costs that result from an ageing population.

· This radical transformation will require health and social care to function well 24 hours a day and seven days a week.

· Health and social care must be commissioned and funded jointly, in order to facilitate joint working and use resources efficiently.

It would be good to ask people on the ground what they would suggest in terms of transforming health and social care to ensure services are fit for purpose for older adults and particularly older adults living with a dementia. What could we suggest? Here are two thoughts for starters:

· Hospitals to stop moving older people around the wards – why can’t the staff come to the patients instead of the patients having to move to suit the staff/ organization?

· Social services to keep case files open on people with a long-term condition (including dementia) – even better to review them regularly as well.

And a third thought which is not intended to be political – looked at coolly and calmly, how can it ever make sense to try to make a profit from the care of vulnerable older people?

3 comments (Add your own)

1. Emyr wrote:
Some of you may know, or have guessed, that I'm a histopathologist. I have an interest in a variety of things, including Coronial autopsies, and biopsy and resection specimens from those with gastrointestinal disease. And I won't be following Susan's suggestion that staff should go to sufferer.

I do, however, have a less flippant contribution, and that is that we need to guard against the recent trend in clinical record keeping. Recently, I was reading a set of clinical records before the autopsy of an elderly person, to find that they consisted of basic demographic data and six pathway-cum-protocol booklets, all of them fairly hefty. I didn't keep the details, but there was one for the Liverpool Care Pathway and another for an acute urological admission. However, none of these appeared to cross-reference with any of the others (I didn't check in infinite detail because to do so would have taken several hours), and I failed to understand the timeline of the terminal events. This kind of methodology may be fine when there is only one health issue to be dealt with, but I can't envisage anything other than chaos if it is applied to the elderly with complex multiorgan problems.


Fri, August 9, 2013 @ 5:20 PM

2. David Jolley wrote:
Thanks as ever for the thought-provoking nudges.

Emyr may know that his observations are so very pertinent as we have been struggling to persuade colleagues in a mental health trust that it is not helpful let alone essential to reduce plans for the care of people who have dementia to a care-pathway: they have six other conditions the course and interactions of which are not predictable in any detail - and they and their family and friends have a life to lead.
A bespoke account of the individual is what is needed. It shows respect and conveys proper values.
In the end the pathologist is always right

I like Susan’s points. Well I like them fairly well!

Having a system whereby hospitals and other services address the interests of patients rather than conditions is accepted best practice in the eulogies for ‘person-centred’ care. Why don’t we put this into practice? Peter Horrocks and colleagues wrote about it and showed how it can be done 40 years ago http://ageing.oxfordjournals.org/content/15/6/321.short
Bagnall et al (1977)Geriatric Medicine in Hull. BMJ (2) 102-104

Primary Care does maintain all its patients on the register and increasing identifies the most vulnerable to regular review. A similar approach by Social Services must make sense with lists shared by the two organisations and available as needed to others such as the police, fire service, ambulance service who become in helping and monitoring.

The point about profit needs thinking about. Having the option that some people will chose to use services provided by independent, profit-making businesses seems reasonable to me. The skewing of rules so that it is required that that majority of care is delivered by such organisations defies logic and natural justice: it is outrageously and shamefully political in its motivation. This should certainly be reversed.

I do not understand why it is believed that the commissioner/provider has advantages. The system we worked with in the 1970s whereby Health Authorities were responsible for the health care of their defined population and given a budget to do their best with was simpler and worked. There was planning in conjunction with a co-terminus Local Authority and delivery through community and specialist services which included hospitals. Mental Health services were not set apart from other specialist services and we were pleased to have world-leading, specialist services for old people (Geriatric Medicine)

Will the new Dr Who bring us a future which has learned from the best of the past?

Mon, August 12, 2013 @ 7:13 AM

3. Donna wrote:
Some of the research projects similar to those at New Cross may be a starting point where wards have multi-skilled staff and people with dementia are nursed on that small bedded unit whatever their existing health issue with care bundles in place. Its worked well. Coupled with raid and a package of education this may be a model that needs to be rolled out.

Mon, August 12, 2013 @ 9:36 AM

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