Dying Comfortably

Last month saw the publication of one of those papers that helps confirm something that you always believed you knew. So what did it confirm?

Very old people are more likely to die comfortably if they die in care homes or at home when compared to hospitals. The study carried out by a nursing team at the University of Cambridge found that the oldest old do not always receive effective symptomatic treatment at the end of life. While that is true in most settings up to four times more are likely to die comfortably in a community setting when compared to hospital. So what’s the message? Training for end of life care needs to be improved for all staff, at all levels but perhaps more telling is the need for governments (not just in the UK) to review the funding of long-term care so that more people have the opportunity to die in their home/ care homes than currently so that late admission to hospital is less likely. Not a new message but maybe its time to sit up and take notice. To download the paper go HERE

Sticking with the same topic an End of Life Care resource called “Let’s Talk About Death and Dying” has been produced by Age UK and the Malnutrition Task Force. The materials were produced in a response to a survey showing yet again that conversations about death remain a taboo topic. The new video is below:

 

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Oncogeriatrics? My “What’s wrong with the BBC’s Health Tracker” Rant

This week I am going to refer to another Blog piece from the British Geriatrics Society because it’s written by someone working locally in the West of Scotland. Dr. Kirsty Colquhoun has been a consultant geriatrician, working in Glasgow, since August 2015 and her specialty is Oncogeriatrics. Not a term I am either familiar with or like but let’s just go with it. In her blog she discusses the BGS Oncogeriatrics Conference on 7 December 2017 at the Wellcome Collection in London. Worth a look even if it’s just to get your hands on the Cancer Services Coming of Age Report from 2012. I may not like the name chosen for what she does but I would support her in her efforts to see Comprehensive Geriatric Assessment used in cancer care as well as other areas where it’s also extremely useful. See this Cochrane Review   about its use.

This week also saw the release by the BBC of their NHS Tracker. The tracker uses the latest published data on performance against three key NHS waiting-time measures:

  • A&E treatment
  • cancer care
  • planned operations and care, such as knee and hip replacements

and pulls this data from currently published NHS and Government office data to allow comparisons across the UK, but be warned there are differences between how the targets are measured in each part of the UK. So is this a good thing or a bad thing? My own feelings are neither of these. It’s missing the point completely. Of course, the NHS is missing its targets. Its grossly underfunded, short of staff and very short of staff in key positions, like radiology, gerontology and more…. Do we really need another measure of how bad things may be getting, or should we tackle this! (chronic underfunding when compared with other westernised economies)

 

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From https://epianalysis.wordpress.com/2012/07/18/usversuseurope/

Enriching End of Life Care and 4-year-olds in Care Homes

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A few weeks ago I blogged about attending a public lecture on issues related to end of life care in hospitals in three different countries. What I should have added the was that around the same time NHS Education for Scotland and Scottish Social Service Council also published a new framework to support the learning and development needs of the health and social service workforce in Scotland. The new framework is part of addressing the 10 commitments made by the Scottish Government to be met by 2021 with regard to Palliative and End of Life Care and can be found at the NHS Palliative and End of Life Care Community of Practice page which you can click here to view.

This week also saw Channel 4 in the UK showing quite an unusual programme on an intergenerational experiment to introduce children into a care home and film what happens. One of the doctors involved in setting up the experiment was Dr Zoe Wyrko, a Consultant physician at University Hospital Birmingham and she has written about her experience and the programme on the British Geriatric Society’s Blog. See Old People’s Home for 4-year-olds

 

 

Our New Masters Pathway!

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Since last year the NES/SSSC National Dementia Champions teaching team, which I am part of has been working towards setting up a Masters Programme that will extend the work they do to create an Expert Level of Dementia Practice course. To put this into context click here to see the Promoting Excellence Knowledge and Skills Framework site

Details of the new MSc in Gerontology (with Dementia Care) can be found at

http://www.mastersportal.eu/studies/156034/gerontology-and-later-life-studies.html

or contact me directly at raymond.duffy@uws.ac.uk

Other big news was the publication of Scotland’s Third National Dementia Strategy 2017-2020. which although a little later than expected has finally arrived! To read about and download the strategy click here 

Alzheimers Scotland’s comments on the new strategy can be viewed by clicking this link 

Part of the new strategy is a commitment to test new ways of supporting people with advanced dementia and at the end of life including testing Alzheimers Scotland’s Advanced Dementia Practice Model. Very timely for the team here at UWS, as advanced dementia is a key theme throughout our new programme.

Being Home and Inspiration From Away

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This week the team I work with were involved in the publication of a new report looking at the preparedness of Scotland’s housing to deal with the increasing numbers of people living with dementia. Called “Being Home: An overview of the current housing situation for people affected by dementia in Scotland” it Is the first report of its type done in the UK that I am aware of. Very timely too as the UK begins to examine the emerging crisis it faces with regard to social housing in the wake of the tragic events at Grenfell Tower Block in London. To download the report go to this link.

I also attended a public lecture this week which looked at comparing work done on the likelihood of dying within a year after hospital admission in Scotland; with work done in both Denmark and New Zealand. Sounds depressing I know, but it gives you wonderful insight into just how frail our hospital population truly is.

What was really good about this wasn’t just the insight about international frailty it was finding out about the work of Merryn Gott and her team in NZ. Very inspiring, so I am going to suggest taking a look at her research team’s Blog which you can find by clicking on this link

The Te Arai Research Group which she is part of focuses on palliative care and end of life research and are located at the University of Auckland. Her own view of the public lecture in Glasgow that I was at can be found on the group’s blog at this location

Updated Guidance on Assisted-suicide and “The Hospital”

Following on from last weeks post about the possibility of another assisted suicide court case in England the RCN recently published revised guidance on the need for compassion when dealing with such requests. The guidance explains the law on assisted suicide and looks at the alterations to organisations and support that have occurred since the Liverpool Care Pathway was discredited. You can find it at Updated guidance on Assisted Suicide

This week also saw the release of a  six-part BBC documentary series called the Hospital which looks at six weeks during 2016 at St. Mary’s Hospital in Paddington. Billed as the story of the NHS in unprecedented times episode one was shown on Wednesday 11th. of January and is now available to watch on the iPlayer. The BBC page for the whole series is at THE HOSPITAL where there is also the opportunity to take part in an interactive quiz provided by the Open University. Episode 2 is due to be screened on BB2 on Wednesday night.

Welcome, 2017!

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It’s only the first week and already we have had two stories in the news in the UK that have huge implications for care of older people. In England, a terminally ill man called Noel Conway, has begun a legal fight for the right to die. This is not the first time that this has happened this though is the first case since campaigners lost their appeal at the Supreme Court in 2014. The Supreme Court made it clear at that time that it was up to Parliament to deal with any decision on amending the law. So in September 2015, MPs rejected plans for a right to die in England and Wales, in their first vote on the issue in almost 20 years.

It’s worth noting that Canada, California and Colorado all introduced assisted dying in 2016 and later this year the State government in Victoria, Australia, plans to introduce legislation to allow doctors to help the terminally ill to die. Whatever your thoughts on this topic, this case will raise the issue once again, one hotly debated already in Scotland by in response to the late MP Margo Macdonald’s Assisted Suicide Bill. This was rejected almost overwhelmingly by the Scottish Parliament  82 votes to 36 following a debate at Holyrood. You can read more about Noel Conway’s case at Shropshire News

The second story involves delayed discharges in Scotland. Following a Freedom of Information request it has been revealed that nearly 700 NHS patients ‘died while waiting to be discharged’ over a 19-month period. These patients had all previously been declared as medically fit to leave hospital. The challenge that this is causing Scotland’s NHS is outlined well in the following article taken from the Herald. See Herald Opinion on Delayed Discharge.

Scotland’s NHS delayed discharge figures are not a secret. They are published regularly by ISD Scotland see

http://www.isdscotland.org/Health-Topics/Health-and-Social-Community-Care/Delayed-Discharges/

Two stories that I have no doubt that will be re-visited as 2017 proceeds.