@GeriSoc Improving Healthcare in UK Care Homes 2021

Another Month has passed since my last post 😦 . So what brought me back this time. This week the British Geriatrics Society published a new report aimed at improving the quality of healthcare for care home residents. As they state, the COVID-19 pandemic has had a devastating impact on older people, with 35.6% of the 130,000 UK deaths ( and more, who knows the real figure) occurring in people living in care homes. Many others suffered from worsening physical, mental and emotional health as a result of lockdowns and visiting restrictions. Their new report sets out how care home staff and visiting healthcare professionals can work together to ensure high-quality healthcare is delivered to the 400,000 older people who live in care homes.

The report which you can access and download HERE is called “Ambitions for Change: Improving Healthcare in Care Homes. It notes that the COVID-19 pandemic created extraordinary challenges for care homes, and argues that government, commissioners, care home providers and other stakeholders must now ensure that the structures, support and skills are consistently in place to ensure care home residents have access to the same standard of healthcare as everyone else in the UK. It advocates for treatment on site whenever possible, to avoid the potential harms of hospitalisation. It also recommends the systematic use of Comprehensive Geriatric Assessment to ensure personalised individual care is planned and delivered. It also points out that person-centred, compassionate care is paramount because many care home residents from admission to a home are already frail and in the last two years of their life.

If you don’t do anything else read their 11 recommendations which you can view at: https://www.bgs.org.uk/resources/ambitions-for-change-improving-healthcare-in-care-homes

The Burden of Healthcare Associated Infections in #Scotland

Well, a month since my last post. So apologies as I am not contributing as I am supposed to be. Let’s hope I am a bit more consistent from now on as we head towards a new academic year. So what’s made me come back to the Blog?

This month an article appeared quite quietly in the Journal of Hospital Infection which is the official journal of the Healthcare Infection Society. Not one of my usual sources for this blog. They have reported a study carried out by Glasgow Caledonian University on behalf of the Scottish Government that is the first comprehensive study in Scotland which shows the the full impact of Hospital Acquired Infections (HAI’s) on patients and the cost to the NHS.

Understanding how widespread HAI’s are prevention and control measures can be be targeted to those people who would benefit the most. Perhaps not surprisingly that will be the old and the frail.

The study has found that 1.1% of Scottish patients (or 11 in every 1,000) develop infections in hospital. This compares with estimates in the rest of the UK of 7.8% and around 3% in Europe. The most common infection type is urinary tract infection (UTI) followed by septicaemia, lower respiratory tract infection, gastrointestinal infection, surgical site infection and pneumonia. Most of the infections are caused by E.Coli, Norovirus and S. Aureaus. The most likely place to pick up an HAI is in intensive care.

There are many reasons why a person can develop an HAI but being ill or receiving treatment in hospital may mean that your immune system is compromised and people as a result are more prone to infection.

So none of this is unknown except the very low rate in Scotland, so why is this study so important that I thought I should blog about it? This is the most comprehensive study of incidence and and impact of of HAI’s done in the UK in the last 20 years and the first of its kind to focus on the healthcare system in Scotland. More studies like this are required to ensure that whole systems are learning from best practice across all Westernised healthcare systems. Whatever Scotland is doing other countries need to learn from and, of course, 11 in 1000 is a number that perhaps could be reduced further !

To see the complete study go to Bed-days and costs associated with the inpatient burden of healthcare-associated infection in the UK available at:

https://www.journalofhospitalinfection.com/article/S0195-6701(21)00190-0/fulltext

https://www.journalofhospitalinfection.com/article/S0195-6701(21)00190-0/fulltext

and Evaluating the post-discharge cost of healthcare-associated infection in NHS Scotland and

https://www.journalofhospitalinfection.com/article/S0195-6701(21)00189-4/fulltext

Deconditioning Increasing in Lockdown? Try the LifeCurve App!

According to a new survey by Age Scotland released this week, older people are in danger of losing the ability to do daily tasks because of the pandemic. This had led to concerns that the restrictions could have a serious impact on our health over the next few years. Tens of thousands of older people could be experiencing “deconditioning” – declining physical fitness caused by lack of activity and spending long periods of time sitting. This can lead to a loss of muscle strength, balance, flexibility and overall mobility, which can leave people more vulnerable to falls, more likely to become frail and therefore likely to require social care support in the years to come.

According to the survey, two thirds of people over 50 say they are now less active than they were before the pandemic. About half fear that spending so much time at home has led to a loss of strength and mobility. Age Scotland are also reporting that almost half of the 3,000 people who responded to their survey had reduced their social interactions significantly, and 53% of respondents stated that the pandemic had made them feel lonelier.

This survey is in line with an Observatory for Sport in Scotland Survey published on the 6th of June that reported In total, 47 per cent of the adult (18 years plus) population of Scotland (just over two million people) felt that their participation in sport and exercise activity was a lot or a little less over the last 12 months than the equivalent period before Covid-19, with men reporting more of a drop than women. Around 32 per cent reported doing about the same as pre-pandemic and 14 per cent reported doing more activity in the past year. Just over four in 10 people said that they were walking more in their local area during the 12 months of the pandemic compared with the 12 months previously, but his has not compensated for the declines in activity through sport and exercise. To access this report CLICK HERE

Researchers at Strathclyde University who carried out the Age Scotland survey say that after the closure of vital support services during lockdown, it is important that people get back to being physically and socially active as soon as possible, to stop further decline. Older peole need to get back attending groups where they can be physically, mentally, socially active as soon as possible in order to protect both their current and long term health.

One way to combat this deconditioning could be by using an innovative app called LifeCurve, developed by researchers at Strathclyde and Newcastle University, It’s based on research that found that we lose the ability to do things in a particular order as we age. The good news though that the types of loss and speed of loss is not set in stone at a particular age. We can improve our position by staying physically active and keeping up with regular daily tasks. This can slow the ageing process and help us to live a healthy, independent life for longer. People often assume that as they get older it is inevitable that they will stop being able to do the everyday activities that are important to them. This is not the case.

The app aims to provide evidence-based information and advice that can help people have a better ageing journey. 

To find out more about the project from the which the App was developed go to https://stillgoingproject.co.uk/

To download the App go to The Life Curve App

#DementiaAwareness #LetsTalk Good News!

This week is #DementiaAwareness week across Scotland. So I thought I’d post some good news.

The NHS has introduced a revolutionary new app to help diagnose Alzheimer’s Disease that only takes five minutes to complete and is more accurate than established pen-and-paper tests like the Montreal Cognitive Assessment Test. (MoCA).

The test uses artificial intelligence to assess a person’s brain function by showing them large numbers of black and white photographs and asking them to identify which ones contain an animal. It is hoped it will identify people at high-risk of developing the disease up to 15 years before symptoms appear, so that steps can be taken to slow its progression. Animals are used because they elicit strong reactions in people giving a greater insight into brain activity. The test can identify differences in reaction speed and accuracy that become evident long before the memory loss that current tests focus on.

It is hoped it will identify people at high-risk of developing the disease up to 15 years before symptoms appear, so that steps can be taken to slow its progression. It was created by two Cambridge University PhD graduates, through their company, Cognetivity, and has been approved by the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA).

You can find out more about the test by watching the video below.

North Staffordshire NHS trust and the Sunderland GP alliance of 35 practices have just started using the app to help monitor and diagnose patients with suspected dementia.

Dr Rebecca Chubb, who is in charge of older people’s services at the North Staffordshire NHS Trust and has just started using the app, said:

“We’re very excited by the potential of the test to drive improvements in how we assess our patients in the dementia pathway. This is a fantastic piece of innovation that could one day be used in clinics up and down the country.”

Even more good news! Very soon, the first drugs that can slow, or even halt, progression of the disease could become available. These drugs would be a gamechanger – especially if cases of dementia were picked up very early, giving the drugs plenty of time to work. The US Food and Drugs Administration is expected to due to rule by June 7th on whether the most advanced of these drugs can be used in clinical practice and it is hoped that the UK and Europe will also allow this shortly afterwards. The drug, known as aducanumab, works by helping to untangle clumps of plaque in the brain and could be the first to slow, or even halt, disease progression. Trials have found that patients given the drug saw improvements in their language skills and ability to keep track of time and place, with a slower loss of memory. The drugs currently used to help those with dementia can only mask symptoms and it is over 20 years since most of these medicines were approved.

This post has been adapted from a report that appeared in the i newspaper on Saturday 29th of May 2021

Illegal Discharges; Unnecessary Deaths

This week saw the publication by the Mental Welfare Commission in Scotland of a review of the legality of moves of patients from hospitals to care homes at the height of the pandemic. Their new report – Authority to discharge – report into decision making for people in hospital who lack capacity – is a study of a sample of all discharges from hospitals to care homes from March to May 2020.

The Commission studied 457 individual moves – representing around 10% of all such moves reported at the time by Public Health Scotland – looking at legal authority behind each decision to move a person who did not have capacity to decide for his or herself. The data was supplied by every Health and Social Care Partnership (HSCP) in Scotland apart from Highland, who did not meet the timescale for the report.

Of the 457 cases, the Commission found unlawful moves of 20 people. For some of these moves, there had been specific pandemic related reasons, for example, a misinterpretation that easement of the Social Work Act had been enacted as a result of the Coronavirus (Scotland) Act 2020 when in fact this legislation was never activated and was removed in September 2020. One HSCP introduced an alternative to applications for guardianship orders, making decisions ‘internally’ rather than recourse to the courts, the critical safeguard for individuals. This particular practice started in response to the pandemic and ended in August 2020. 

The Commission analysed all of the 457 cases further to assure legal rights were respected and protected beyond the 20 clearly unlawful moves.  The Commission asked about the 338 moves said to have been authorised using a Welfare Power of Attorney or Adults with Incapacity legislation. They found that those working in hospital discharge were not always fully aware of the powers held by attorneys or guardians (this was the case in 78 out of 267 cases of power of attorney related moves) or indeed whether the attorney’s powers had been activated or guardianship orders granted. The Commission also found confusion in relation to the reported nature of the care home placement, with potential impact on rights to protection of property where the person was admitted to a care home but remained liable for their property.

Essentially practice was not consistent within some HSCPs or across them despite the range of existing guidance and policy to draw on. As a result Mental Welfare Commission made eight recommendations in the report for HSCP’s including asking for each of them to conduct a full training needs analysis and training programme for their staff to ensure they understand the law, capacity and assessment. There are two recommendations for the Care Inspectorate, including asking them to take account of this report in their inspection activity. There final recommendation is for the Scottish Government to monitor the delivery of their 8 recommendations and to ensure consistency across HSCP’s.

Last month the Crown Office revealed that at least 3,400 Scottish care home residents may have died from Coronovirus since March 2020. See the interactive map of where they died produced by the BBC from the Crown Office figures which you can access HERE.

There is going to be a public inquiry into what has gone wrong during the Coronovirus pandemic. Moving vulnerable people out of hospital’s where COVID-19 cases were reported to Care Homes with virtually no recorded cases at the time, almost everyone admits now was clearly the wrong thing to do. Many countries did it, including all the UK home countries and many other legislations across the Western World. Finding out that many of the moves may have been carried out illegally and without the consent of those involved who ultimately were still moved, just highlights the injustice done to care homes. Many of those homes did object to the practice and did complain at the time but the discharges and transfers continued nonetheless.

Its time for our care homes to be treated as the valued part of the Health and Social Care system that they really are, and not as the dumping ground and easy solution for NHS problems, as could be argued when you put the two stories above together.

As Julie Paterson, chief executive of the Mental Welfare Commission, said:

“People who lack mental capacity and who are being cared for and treated in care homes and hospitals are among the most vulnerable in our society …worryingly our report found endemic examples of poor practice. Lack of understanding of the law, lack of understanding of good practice, confusion over the nature of placements, misunderstanding over power of attorney. These findings are very disappointing and may mean that many more moves were made without valid legal authority. … We call on Health and Social Care Partnerships across Scotland, the Care Inspectorate and the Scottish Government to read our report in detail and act swiftly on our recommendations”.

#MentalHealthAwarenessWeek2021 Couldn’t be more Timely.

This week is Mental Health Awareness week in the UK. Its also the 21st Mental Health Foundation supported Mental Health Awareness Week. This year the theme is connecting with nature. You can find out more and get involved in the weeks activities by visiting the website at https://www.mentalhealth.org.uk/campaigns/mental-health-awareness-week or following the #ConnectWithNature and @MentalHealth on Twitter.

So why is it so timely? Last week the Office of National Statistics published a short report entitled Coronavirus and depression in adults, Great Britain: January to March 2021 which is an analysis of the proportion of the British adult population experiencing some form of depression in early 2021, by age, sex and other characteristics. It also includes comparisons with 2020 and pre-pandemic estimates.

Their figures reveal that depression rates have doubled since the COVID-19 pandemic began. Indicating that there is a growing mental health crisis already occurring across the UK. The Health Foundation’s director Jo Bibby has pointed out that it is particularly concerning that those in more precarious economic positions or burdened by existing inequalities – young people, women, clinically vulnerable adults, disabled people and those living in the most deprived areas of the country have been disproportionately affected.

This suggests that inequalities in our society have worsened as a result of the pandemic a fact that is becoming clearer with each passing day. Perhaps more worrying is that despite the increasing rates of depression, diagnoses by GPs have fallen by almost a quarter, suggesting access to mental health care at this dreadful time is in serious decline. A situation that requires to be addressed as soon as possible.

As Louis Appleby wrote recently in a BMJ opinion piece on the effect of Covid-19 on suicide rates

Recovery can be a dangerous time, as restrictions are lifted and we look at our lives in a new way. We need to ensure support for anyone lonely or mentally ill, in turmoil or financial hardship. We need to re-discover the values that unite us and the benefits of mutual support. We need to reassure ourselves that there is a way out of this crisis and a better, fairer, more compassionate society at the end of it. 

Insight into a different future @DesignAge_

According to the International Longevity Centre UK, across the G20, spending by older households exceeds the combined GDP of Japan, Australia, Canada and Brazil. And yet many products and services available in the wider economy still fail to meet the needs of an ageing society.

So last year it was good to see the creation of a new organisation, the Design Age Institute, which will work with a variety of stakeholders from design, business, policy and academia, to stimulate the new economy that an ageing population is creating and provide a range of strategic design services to business and industry. Their goals underpin the UK Government’s industrial strategy, which aims to position the UK as a major exporter of new products and services for an ageing population. The video below outlines what the Design Age Institute aims do.

If you want to spend even a few minutes looking at the research projects and the Start Up Companies that they are working with go to Research Projects and/or Start Ups . I was particularly fascinated by the Giraffe Reader a device that my Dad would have loved to try out and Biomanufacturing Textiles from Waste which reveals a little bit about my ‘greenness’ and cloth buying habits see https://www.bbc.com/future/article/20200310-sustainable-fashion-how-to-buy-clothes-good-for-the-climate

These examples are only scraping the surface of a fascinating website. Go and take a look a look or visit them on Twitter @DesignAge_

Introducing #socialcarefuture

This week I am introducing you to #socialcarefuture This is a growing movement of people with a shared commitment to bringing about major positive change in what is currently called “social care.” #socialcarefuture is a broad movement in the UK working towards a new vision where we can each be supported to make choices about where and with whom we live, on equal basis with others, to pursue our life goals and to be and feel connected to our wider community.

The group has started with the premise that examples of doing things better are already with us. Innovators have been developing better approaches to social care in spheres including management and ownership and the use of professional skills. Groups of people using social care and community organisations have led the development of mechanisms that can transfer power to those requiring care and organisations that can support individual and group advocacy. This movement aims to move these approaches from the margins to the mainstream.

Over the past year, with their partners Equally Ours, research company Survation they have been exploring how to shift how people think and feel about social care. In April 2021 #socialcarefuture published their report Building Public Support to Transform Social Care which you will find HERE.

Well worth looking if you are involved in changing how others think about and value social care.

They have a very interesting Blogging page. I’ll pick out a recent one (20th of April 2021) where you can access their guidance regarding communicating about social care. To view this CLICK HERE.

There you will find the link to another of their Blogposts  5 tips for changing the way people think about social care

NOW is the time to support their stance. Follow them on Twitter, Facebook and via WordPress.

Reaction to the Feeley Report

It has been a long time since my last post in October. Easily the longest period my Blog has been silent since its creation over 3 years ago. Hopefully normal service will now be resumed.

Lots has happened in my blogs absence. One of the most significant has been the publication of the Independent Review of Adult Social Care in Scotland. The review was chaired by Derek Feeley, a former Scottish Government Director General for Health and Social Care and Chief Executive of NHS Scotland. The principal aim of the review was to recommend improvements to adult social care in Scotland, primarily in terms of the outcomes achieved by and with people who use services, their carers and families, and the experience of people who work in adult social care. It concluded at the end of January 2021 and the report, together with an accompanying short film, was published on 3 February 2021.

You can download the review to read FROM HERE and there is a useful short summary that includes the recommendations from the BASW that can be Downloaded From Here.

You can view the BSL Version of the video here

The report states that Scotland needs a new approach to social care. We need to create a National Care Service rather than just a National Health Service, that is based upon a new narrative, replacing crisis with prevention and wellbeing, burden with investment, competition with collaboration and variation with fairness and equity. The report states that we need to put people at the centre of it: people who use social care, their families and carers, and people who work in social care services. It focuses on 5 key areas.

  1. Adopting a human rights based approach;
  2. Argues for better Unpaid Carers rights, support and respite provision;
  3. Makes the case for a National Care Service which will work in close co-operation with the National Health Service;
  4. A national approach to improvement and innovation in social care that includes investment in improved social care support models that allow people to remain in their own communities;
  5. Support for the adoption of a collaborative and ethical approach to commissioning for the public good.

There has been a lot of reaction to the report since. An interesting one for my Blog readers is a recent one from Derek Feeley himself who reflects on the recommendations made in the report about Fair Work in the health and social care sector; See https://www.fairworkconvention.scot/guest-blog-derek-feeley-reflects-on-the-findings-of-the-independent-review-of-adult-social-care-in-scotland-report-and-fair-work/

He has also responded in person to Self-directed Support Scotland in a discussion hosted by the health journalist Pennie Taylor (Twitter @ptupdate). See https://www.sdsscotland.org.uk/derek-feeley-responds-to-social-care-review-questions/

Very interesting times ahead as we get closer to the election for the new Scottish Parliament who will be responsible for initiating parts or all of these reforms.

@CareQualityComm State of Care Report: Reform is Overdue

Last week the Care Quality Commission (CQC), the Health and Social Care regulators said in its 2020 State of Care Report that the COVID crisis has both exposed and exacerbated existing problems in adult social care. The CQC recognise that the sector which is already fragile, faced “significant challenges” around access to PPE, testing and staffing, and that coordinated support was less readily available to social care providers than for the NHS.

The State of Care Report says the long-standing need for reform, investment and workforce planning in adult social care has been thrown into “stark relief” by the pandemic. They have called for long-term funding and a new deal for the care workforce, which develops clear career progression, secures the right skills for the sector, and better values staff. There is also a need to invest in their training and support.

Ian Trenholm, Chief Executive of CQC, said:

“Failure to agree a funding solution continues to drive, year on year, instability in the market, and COVID has exposed and exacerbated that, particular in terms of funding. Money has been made available by the government, but it’s all short-term funding. What is required is a longer-term funding solution But it’s not just about money, it’s also about staffing and professionalising the adult social care workforce, making sure that working in adult social care has the prestige that it deserves. … every year we talk about social care being fragile. Now is the time for action. COVID has pushed social care even closer to the edge and we need to make sure that action takes place now.”

Boris Johnson said in his first speech  as prime minister, in July 2019 that his government would fix the crisis in social care once and for all, but no reform has yet been proposed despite more than 15,000 people dying from Covid-19 in England’s care homes. Covid-19 has also exposed further the inequalities in the service that exist for people from black and minority ethnic backgrounds, people with disabilities, and people living in deprived areas who have suffered more severely from its impact. The CQC press release about the report can be read here.

Another report on a similar topic, has been released by Skills for Care on thier Workforce Intelligence Website. They have released their report, “The State of the Adult Social Care Sector and Workforce in England” which amongst other things indicates that the vacancy rate is 7.3% (equivalent to 112,000 current vacancies). Their findings with a really useful infografic summary are available for access Here