Merry Christmas-2023 in Review

Dr Katy Bettany is the Digital Media Editor for the BGS. She is also a practising Geriatric Registrar in the Southeast of England. She tweets at @katybettany. Bethan Arnold is ST4 Geriatric Medicine, and interested in front door frailty, community geriatrics and advance care planning. Bethan is also Digital Media Editor for the BGS and tweets at @bethkate90

It isn’t how we expected the Autumn Meeting’s conference dinner to end – with everyone enthusiastically singing along with the frankly excellent live band to Wheatus’s ‘Teenage Dirtbag’ – but on reflection, given the song’s strong theme of defiance and challenging the status quo, perhaps we should have.

It has been a busy year of challenging the status quo for the BGS and its members. In January, the BGS started the year with a joint statement with RCP London and RCP Edinburgh, highlighting the disproportionate harm older people face in the health and social care crisis and the required changes needed, as BGS President Adam Gordon put it, to “ensure that the NHS is there for older people when they need it most.” 

Later in January, the BGS was pleased to see older people living with frailty being put at the centre of NHS England’s newly published Urgent and Emergency Care recovery plan. The plan emphasised the importance of care outside of hospital settings, including the need for front door frailty provision. November saw the publication of its ‘Front Door Frailty’ resource, aimed at supporting healthcare professionals who want to offer a front door frailty service to older people presenting to emergency departments. The Urgent and Emergency Care recovery plan also places central importance on the expansion in capacity of virtual wards. This was reflected at the Autumn Meeting this year, with a stream focused on community and primary care, including the use of virtual wards and hospital at home. This highlighted some of the excellent work being done in this area across the UK, with a variety of models drawing from the full range of healthcare disciplines to deliver high-quality acute medical care to older people in their own homes (and, on occasion, boats!) in settings ranging from rural Wiltshire to central London.

Also spotlighted in the Autumn Meeting was the theme of Frailty in urgent care settings. Again, this showcased a range of exciting projects from around the country, all aimed at integrating and streamlining geriatrician and multidisciplinary team involvement throughout older people’s acute care journey, from the point of paramedic assessment onwards. While there were many causes for optimism, the stream also drew attention to the areas in which there is still much work to be done. Gaps and inequalities in both access to and outcomes of trauma care amongst older people remain a significant issue, while the SAMBA audit reflected the delay in timely senior medical review experienced by older people living with frailty during acute hospital admissions. Perhaps as “a very special bunch of people, with very special skills” (thanks, Prof Gordon!) we as healthcare professionals caring for older people should see these gaps as opportunities to continue to advocate for our patients against the backdrop of an increasingly challenging healthcare environment. As was pointed out by Esther Clift during one session, by getting the healthcare system right for older people, we make it better for everyone.

And this brings us to the excellent guest lecture delivered by RCPsych President, Lade Smith, whose talk on Ageing and Mental Health in an Unequal World was an inspiring glimpse into the impact of social determinants of health through the life course on both mental and physical health in older people. It challenged us to combat structural discrimination and the effect of our own prejudices, as well as inviting us to tackle the root causes of mental health inequality in practical ways, both by addressing physical health risk factors and wider issues such as loneliness.

Back in March, the BGS launched the Blueprint ‘Joining the Dots’, intended to help commissioners in the design and delivery of health and care services to ensure good quality and integrated care. The Blueprint provides evidence of where ‘proactive care’ (one of the three original streams of the Ageing Well programme, the guidance for which was published by NHS England this week) has been effectively implemented, forming a vital part of helping to delay frailty and maintain older people’s independence.

One of the biggest challenges in fulfilling the proposals put forward by NHS England in the recovery plan, writes Gordon, is record workforce shortages, and this remains the case. SAS grade and CESR (now portfolio pathway) applicants will be vital to workforce planning for the future, and the Autumn Meeting this year hosted a session dedicated to helping applicants understand and support others using this pathway. In May, the BGS launched ‘The case for more geriatricians’ – a report calling upon the government to plan ahead for an ageing population by investing in both recruitment and retention of NHS staff. As we head into another difficult winter, with ongoing pay disputes and industrial action, this call remains as relevant as ever.

In September, the BGS announced the relaunch of its updated Frailty e-Learning course, which is free for all health and social care professionals until June 2024. We know that professionals will be supporting older people with frailty across many new pathways and settings, and it is vital that they are equipped with the skills and knowledge to care for them.

In October, the BGS launched two new initiatives to support professionals with an interest in undertaking research in the field of older people’s medicine. The BGS Research Hub, providing curated content aimed at guiding researchers through the research process; and the BGS Research Project Grant (applications to which close on the 1st of March 2024), both feed into the strategic ambition of promoting research and the application of evidence based knowledge to clinical practice in the care of older people. Research into Ageing was unsurprisingly another key theme at the Autumn Meeting this year, with platform and poster presentations from across the world. The president’s poster round is always particularly inspiring, with presenters getting a few precious minutes each to explain their work and answer questions.

November saw the Joint Collegiate Council for Oncology, in association with the BGS and other bodies, publish new frailty guidance: ‘Frailty assessment and management in oncology services’, which provides practical advice and recommendations to ensure older people with cancer receive frailty informed care. This guidance was timed nicely with the BGS Autumn Meeting, with a stream focusing on Oncogeriatrics. Attendees were given plenty to think about and take home to their own workplaces, with the benefits of integrating geriatric and oncology services, and the different models of doing so, made obvious and inarguable.

Earlier this month, the BGS launched its report, ‘Smarter data, better care: Empowering care homes to use data to transform quality of care’, within which it made key recommendations for the effective use of a national minimum dataset to ensure we are making care decisions supported by meaningful evidence. The COVID inquiry, writes Gordon, highlights the importance of this endeavour, by reminding us “how little policy makers and healthcare leaders knew about care homes at the beginning of 2020” and that we must “never be in a situation again where we are asked to make life-or-death decisions about the most vulnerable members of our society without the data to do so.”

As we head towards the end of the year, it is natural to reflect on what has been achieved. A short while ago, the BGS re-issued and updated its joint statement calling for the protection of the rights of older people to health and social care, with the reflection that “not enough had changed during the year (despite some progress in the form of the Long Term Workforce Plan and the Intermediate Care Framework) and we are fast approaching a winter which threatens to be just as bad as the last.”

Whatever the winter and 2024 brings, we hope the spirit of challenging the status quo remains strong and that we are strengthened in our work for the cause by each other. This is a large part of the reason we enjoy the Spring and Autumn meetings so much – they provide such great opportunities to meet inspiring people and learn from each other’s experiences and successes. Happy Christmas from us and we look forward to seeing everyone again at the Spring Meeting in Birmingham for more live greeting and tweeting.