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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Social Care in Crisis

England and the rest of the country have now waited over a year for the Government’s long-promised Social Care Green Paper for it only to disappear amidst the current Brexit blizzard.

Parts of the new Long Term Plan for the NHS in England are dependent on securing realistic funding for social care and maintaining and increasing investment in public health. Neither of these looks particularly likely at the moment. The failure to address these concerns now means that local authority funding cuts have seen social care services stripped back to the bare minimum in most areas. Things are so bad that Age UK estimated that 54,000 people – or 77 people a day have died while waiting for a care package in the 700 days since the Westminister government first said in March 2017 it would publish its social care green paper.

Age UK has also said tightening eligibility for council-funded social care meant 626,701 people – 895 a day – have had requests for social care refused since March 2017. More than a million older people had developed an unmet care need in that time, such as needing help with washing or dressing.

Meanwhile, ministers continue to dither over these long-awaited plans and have failed to produce any additional funds admitting that delays to the publication of the paper and institution of the new funding arrangements are in part because of Whitehall’s overwhelming focus on Brexit.

Caroline Abrahams, charity director of Age UK, said:

“These tragic new figures demonstrate just how many older people are now suffering from the government’s failure to act decisively on social care. No one can say whether some of those who have died might have lived longer had they received care, but at the very least their final weeks and months might have been more comfortable and their families’ lives made easier had they been given more support.”

The charity said its helpline received calls daily from people struggling to get a care package in place, often putting great strain on their health and causing stress for loved ones. To read the full article form Age UK Click Here

Age UK  have also started a Care in Crisis Campaign which we should all support. They suggest contacting your MP using their pre-prepared letter.

If you live in England I think you should be doing that at the very least!

About the Report of the “Fair Dementia Care Commission” #fairdementiacare

dxkwtumwkae4bxoIt was easy to pick what I would Blog about this week because the Fair Dementia Care Commission Report was published on Tuesday (22nd. Jan 2019). The commission was established by Alzheimer Scotland to look at inequalities in access to health care and the impact of the current social care charges regime on people living with advanced dementia and their families in Scotland. Chaired by Henry McLeish, the commission brought together a small group of experts to work in partnership with Alzheimer Scotland to make a series of recommendations to the inequalities they uncovered.

Paying for care remains one of the most common issues Alzheimer Scotland is asked about principally because of the complexity and lack of transparency around the financial assessment processes used by social services across the different local authority areas. Most people, me included,  don’t understand how the process works.

What they found was that although its known that advanced dementia produces complex health, nursing and social care needs people with advanced dementia did not have equality of access to the health care they need – instead advanced dementia was only considered as an Illness requiring a social care response.

As a consequence, people with advanced dementia were disproportionately subject to social care charges for what were primarily health and nursing care needs which in Scotland are generally free!

The result has been that people with advanced dementia and their families and carers have been paying an estimated £50.9m per year in social care charges for care which doesn’t provide the health or nursing care they require and perhaps if they could access that care may possibly have been delivered free of charge.

The report highlights that the complex needs associated with advanced dementia have not been fully understood or recognised as health or nursing care needs and therefore have not been delivered free.

The report calls for authorities across Scotland to accept and recognise that people with advanced dementia must have the equality of access to free health care on a par with people who are living with other progressive and terminal illnesses. Something which I fully support.

If you want to find out more and access a full copy of the report go to “Former First Minister launches advanced dementia care report” and visit and support #fairdementiacare

 

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 Release of the NHS Long Term Plan

Last week saw the release of NHS England’s NHS Plan, a Plan which the Westminster government says will save almost half a million more lives with practical action on major killer conditions and investment in world-class, cutting edge treatments including genomic tests for every child with cancer. The Plan has been heralded as

…a  blueprint to make the NHS (in England) fit for the future will use the latest technology, such as digital GP consultations for all those who want them, coupled with early detection and a renewed focus on prevention to stop an estimated 85,000 premature deaths each year.

While I support this development and the additional funds that accompany this move which will also filter through to the NHS in Scotland. They have their own plan, called the  Health and Social Care Delivery Plan.

I remain very concerned that the Green Paper on Social Care reform and spending is still posted as missing!  If the future is Integration of health and Social Care, then surely both papers needed to be released together… or at least within days of each other. However, we are still waiting…. See my own comment from June 2018 whihc you can see by clicking the link below

https://raymondsolderpeopleblog.wordpress.com/2018/06/23/where-did-that-green-paper-go-plus-nice-dementia-guidance-is-newly-updated/

Rather than give my own view of the details of the plan it’s worth reading what Caroline Abrahams, Charity Director, Age UK says about the plan which she had some involvement in shaping. Her view can be read here

https://ageukblog.org.uk/2019/01/07/the-nhs-plan-what-will-it-mean-for-older-people/

Also this week, The Journal of the American Geriatric Society, one of the principal journals for older people’s clinical sciences, innovative models of care, and health policy has released its list of top 10 articles from last year (according to Twitter activity). You can see the list at JAGS @AGSJournal. I’d recommend looking at 2 in particular that interested me

#1 Most Mentioned Article: Can Exercise Improve Cognitive Symptoms of Alzheimer’s Disease?

#2 Most Mentioned Article: Medical Costs of Fatal and Nonfatal Falls in Older Adults. (which I think I might have highlighted before.

The Importance of Food Shopping

The University of Hertfordshire’s Food and Public Health Research team have recently completed a study calledFood provision in later life” which was a study about older people’s experiences of getting food in the UK.

The research aimed to show how older people from different household types acquired food,  what food they bought and the people and places they acquired it from. The study was funded by the Food Standards Agency and the Economic and Social Research Council to explore the resilience of older people within the UK food system. One of their outputs was a research briefing, ‘Improving food shopping for older people’ is now available to read via this link.

It’s well worth reading before your next trip down to the supermarket, particularly if you shop with or for an older person as I do.

The video the team produced which is on the BSG’s Ageing Bites Youtube channel  gives you an idea of why this is such an important topic to consider, although it is often taken for granted that older people will manage.

One of the things I like most about this study though is that the researchers have gone on to to develop a “The Food in Later Life Game” to help people learn more about malnutrition in older people and the actions they can take to help prevent/manage it.

Launched on the 3 October 2018, the game aims to help retailers, professionals, volunteers and other members of the community who work with and live alongside older people to understand how to help the older generation remain ‘food secure’. You can find out more about the game at the following website:

http://www.foodinlaterlifegame.co.uk/index.html

When Should We Start Discussing Retirement?

At the start of December, a landmark event for those planning to retire occurred almost without anyone noticing. The 6th of December was the first day that someone turning 65 was no longer eligible to collect their state pension but would have to wait; see https://www.yourpension.gov.uk/when-will-i-get-it/ for more specific details. The State Pensionable age is going to rise in phases until between 2037 and 2039 it equalises at age 68 for all.

If you are a UK citizen and interested in finding out when you will be eligible for your state pension you can also go the following Government page: https://www.gov.uk/state-pension-age

On the 6th of December, the Centre for Better Ageing published a new report indicating that a significant number of people are worried about leaving work which highlights a lack of planning and preparation for retirement across society. Unfortunately, that’s not a new finding but what is worrying is that the poorest prepared are those on the lowest incomes. It also shows that women tend to engage in planning for life after paid work even less than men.  Very concerning when you consider the current Women Against State Pension Inequality (WASPI) campaign and the continuing plight of women born during the 1950’s.

The Centre for Ageing Better is calling on employers to consider the role they play in improving peoples’ transition into retirement and to provide their staff with a supportive environment in which to discuss, plans and prepare for retirement.  The government should also play its part by promoting existing guidance and support employers to have more open workplace discussions about age and provide employees with the tools they need to plan their transition towards retirement.

You can see their full report at  https://www.ageing-better.org.uk/news/transition-to-retirement-rapid-evidence-review