A Framework for Older Peoples’ Workforce Development and Educational Requirements

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Well, I am late posting again this week although I’ve got a list of very good excuses that I won’t mention.

There was only one topic that I wanted to share anyway and that’s because it is a cause I was certain to support. On the 12th of February BGS Nurse and AHP Council released a position paper on the professional workforce development and educational requirements of those supporting the health and care of older people in the UK.

They believe that all health and care staff and professionals require knowledge and skills to enable them to work effectively with older people an assertion that is in line with recent position papers from the British Geriatric Society (2018) on the Primary Care of Older People which calls for increased education and training.

Their work identifies 5 levels in the workforce where they feel specific knowledge and skills are required. I would suggest taking a look, particularly if your career lies predominantly in this sphere of care. Their position statement can be found HERE

I’ll pick out one thing because it is so important!

All health and social care focused undergraduate curricula, where graduates will work with older people, the focus on the older population must be recognised as the golden thread that runs throughout each programme. Education curricula regulators need to respond to this call as do Higher Education Institutes who must make it a priority to review their course content to reflect this new horizon of population demand and long-term supply need. The BGS cannot reinforce enough the urgency for providers to respond now and ensure fit for the future undergraduate curricula are in place.

Three years of Blogging about the need for this and still waiting for transformation.

 

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Why Missed GP Appointments Matter

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The paper highlights that missed general practice (GP) appointments are a significant risk marker for all-cause mortality, particularly in patients with mental health conditions.  People with mental health conditions who missed appointments risk of death also increased with the number of appointments they missed. To the point that missing more than 2 appointments per year placed them at 8 times greater risk of dying (in the next year) than those who missed no appointments. They died prematurely, commonly from non-natural external factors such as suicide.
The research led by the University of Glasgow, used routinely collected primary care data from 824,374 patients across Scotland during a 3-year period from September 2013 to September 2016. They then took this information and linked it to the Scottish death records for patients who had died within a 16-month follow-up period.
The study also showed that patients with a greater number of long-term conditions had an increased risk of missing GP appointments, despite controlling for number of appointments made thus also placing them at risk. What is not obvious in the study is that that if you missed a GP appointment and had dementia and another long term illness this also placed you at a significantly higher risk of death.
So what can we learn from this. As the authors state
“…missing multiple appointments provides a risk marker of all-cause mortality even after you control for other factors. Also… GPs, the acute sector and other NHS services should consider how best to facilitate engagement of patients with patterns of repeatedly missing appointments because for non-attenders the existing primary health care appointment systems is ineffective.”
So rather than vilify people who miss GP appointments as time wasters who need to be penalised/punished maybe its time to ask “Why are you not here?”
An interesting view to take on this issue is provided by the Medical Defence Union who have an item on their website called
I would suggest reading it, particularly if you are a practice nurse or work in outpatients.

The Ongoing Tragedy of the UK’s Excess Winter Deaths!

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In common with other countries, more people in the UK die in the winter than in the summer. Health Protection Scotland and other agencies point out that the deaths can often be attributed in part to cold weather directly (for instance deaths following falls, fractures, and road traffic accidents), in part to cold weather worsening chronic medical
conditions (for example, heart and respiratory complaints), and in part to respiratory infections including influenza.

Last winter though was carnage though particularly if you were a woman or aged 85 and over (See Excess Winter Deaths England and Wales)

If you combine the England, Wales and Scottish figures the number of excess UK winter deaths last winter was 54,879.

Sadly, our national disgrace continues and if anything things might slowly be getting worse after many years of improvement when the overall trend had been downwards since 2013-14 there has been a rising trend.

To give this more of a context in Scotland the  +4,797 deaths considered to be excess was the largest number since winter 1999/2000. The +50,100 deaths in England and Wales was the highest recorded since winter 1975 to 1976.

Research released by the E3G group in February 2018 indicates not just why this happens but why this should be a source of national embarrassment. Iceland, Finland, Norway and Sweden all have fewer winter deaths per capita population than we do and there is little doubt that they are colder. To learn more and access the E3G group report CLICK HERE

I agree with the authors of the report that this preventable tragedy must end. It’s time for the UK Government’s (England Wales and Scotland) to get a move on and do something significant to provide the capital investment necessary to make many more UK’s homes warmer and safe for human habitation.

 

 

 

 

 

#CarersRightsDay: We Need to Support an Increase in Carers Allowance Across the UK

Carers Rights day

Today is  

There are 759,000 adults carers in Scotland – 17% of the adult population and an estimated 29,000 young carers in Scotland – 4% of the under 16 population and without them the health and social care system would collapse.  So I am asking you to support Carers UK’s  campaign to increase Carer’s Allowance by at least £8.50, to match the changes being made in Scotland. Carer’s Allowance is the main benefit for carers and you can still get it even if you are working, so long as your earnings are no more than a weekly amount known as ‘the earnings limit’. The government has announced that the earnings limit will be going up to £123 per week from April 2019. While this should be good news for carers in low paid work, many of those on the National Living Wage (NLW) will not benefit. for more details see the post here at the CONTACT website

If you are looking after someone you might want to look at and download this handy guide for anyone caring for family or friends – it outlines your rights as a carer and gives an overview of the practical and financial support available:

Finally, on the same theme, a report from the Social Care Elf on a recently published paper called:

Sense of coherence and mental health of caregivers: a systematic review and meta-analysis

Which is about trying to identify early warning signs of psychological distress in carers.

See also

Inappropriate Prescribing: A Reminder

In 2017 the World Health Organization launched its third global patient safety challenge with the aim of reducing severe avoidable medication-related harm by 50% over a five year period. See Medication Without Harm

Demonstrating success in achieving this may be difficult, but countries such as the UK are in a strong position to meet the spirit of this challenge because we have strong integration of our healthcare systems and electronic health records which we could probably use more effectively.

A very important approach is to identify potentially inappropriate prescribing and correct it where necessary, with the expectation that intervening will avoid serious harm. Yet, around half of older patients are exposed to potentially inappropriate prescribing each year and hospitalisation puts them at an increased risk, a new study conducted in Eire shows.

See: https://www.bmj.com/content/363/bmj.k4524

The authors of this study point out that medicines management services for inpatients in Ireland are broadly similar to those in the UK.

Their finding is worrying because inpatient admissions can provide the opportunity for specialist teams to review and optimise management of older patients’ chronic conditions, including their drugs. So, although hospital admissions have the potential to improve management of drugs, this study suggests that the possible benefit of more appropriate prescribing after discharge to primary care is not being realised.

Something somewhere seems to be going wrong. The authors suggest that improving coordination of transitional care (hospital to home and vice versa) particularly for older patients with complex care needs has the potential to reduce mortality, hospital readmissions, and the number of readmissions. Time to look again I think at the UK’s electronic drug management systems and the organisation of discharges from hospitals.

Why is it so difficult to get an electronic summary care record from A to B in order to reduce discrepancies arising from transitions between hospital and primary care?

This is not a new problem its an old one but surely one that could be tackled and eradicated now

 

 

 

 

In Advance of Armistice Centenary Day

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St John’s Ambulance Brigade Nurse 1914

This year Remembrance Day on the 11th of November will mark the 100th anniversary since the end of the First World War. As part of the commemorations, Britain and Germany are joining in a call for bells of all kinds to be rung globally (at 12.30 hrs GMT/13.30hrs CET/12.30 local time) to replicate the outpouring of relief when 100 years ago the guns finally fell silent. The US Centennial Commission has already made a similar appeal to Americans.

For other events and activities taking place to mark the Centenary the following website is useful, click here on  Centenary News.

Of particular interest to me is a  Royal College of Nursing (RCN) online exhibition showcasing the lives of nursing staff during the First World War, which won the Women’s Network History Award for 2018. Called “Service Scrapbooks: Nursing and Storytelling in the First World War” this project digitised and transcribed photographs poems diary entries and illustrations ranging for 1909 to 1919. To go to it click here

this new archive contains a collection of digitised slides from Scottish Women’s Hospitals which is a haunting glimpse into life in a field hospital 100 years ago.

A very moving archive full of personal views of the war by nurses who were there.

My Blog is 3 Years Old Today!

birthday-492372_1280This is a bit of a landmark because when I started out this blog it was really as an experiment to see what I could do to keep my own MSc in Gerontology students up to date with developments in older people’s care occurring during their programme.

So 3 years on and I have posted 162 times. The site has been viewed by 2,299 different people, I have 33 followers and the most popular day to come to this site is a Monday (about 20% of all viewers)

So thanks to everyone who visits and spreads the word about this blog. It’s gone well beyond the “classroom” although I know many of my students do visit regularly. Please keep following and visiting. And remember that despite everything that’s going on, things are getting better.

For example; in the last 5 years across European mortality from the four major noncommunicable diseases (cardiovascular diseases, cancer, diabetes and chronic respiratory diseases have been on a 2% decline per year on average based on the data from 40 of the 53 countries in the European Region. In addition, a WHO 2017 progress review established that the WHO European Region is likely to achieve its target of reducing by one-third premature mortality from non-communicable diseases through prevention and treatment and promoting mental health and well-being earlier than 2030 and will probably exceed it.

See the WHO Factsheet by clicking here

Fantastic news that you probably haven’t heard.