A New Dawn?


Its April the 1st 2016 and today is the day that what has been heralded as the single biggest reform to the way health and social care is delivered in Scotland, since the creation of the NHS, becomes fully operational. Legislation to implement health and social care integration, passed by the Scottish Parliament in February 2014, will come in to force today bringing together NHS and local council care services under one partnership arrangement for each area.

In total 31 local partnerships have been set up across Scotland and will manage almost £8 billion of health and social care resources, including those currently associated with 96 per cent of delayed discharge and 83 per cent of unplanned admissions in the over 75s. So this is of huge significance to the future care and management of older people across Scotland. From today the partnerships are responsible for the health and care needs of patients, in particular older people, to ensure when people move between hospital and care settings their journey is better coordinated and as seamless as possible. I suppose the key question now is will we notice the difference? (Or how long until this makes a difference?)

The aims behind the whole project and what it is hoped it will achieve are detailed at  http://www.gov.scot/Topics/Health/Policy/Adult-Health-SocialCare-Integration/Principles

Today also sees the launch of the National Living Wage but I have a real concern about that terminology because this so called National Living Wage is anything but that. It’s the National Minimum Wage and its a bit of UK Government spin suggesting that most people could live on this pay level alone. Why do I think that, see:


Some thing else happens today that appears to be getting more attention than the Scottish reforms and that’s the great Manchester Experiment. At midnight tonight, the 10 Councils in the Greater Manchester Combined Authority take direct control of their annual health and social care budget of £6 billion. Money previously administered by central government ministers in London (so devolution essentially). To find out more about their plans see: http://www.bbc.co.uk/news/uk-england-manchester-35933922



Eyesight and What Effect is Your Environment Having

You might have seen this reported on BBC’s Breakfast News last week, but I thought it was worth highlighting here. There is growing pressure on hospital eye services which is endangering patients’ eyesight, warned the President of The Royal College of Ophthalmologists, Professor Carrie MacEwen. She noted that there has  been ‘an increase of up to 30% in eye clinic attendances over the last five years’, explaining that ‘over 100 million outpatient appointments were made in England alone during 2013-14, of which 10% were for eye care.’ Reasons for the increased demand included the ageing population (of course), coupled with the fact that many common eye conditions which were previously untreatable, such as age related macular degeneration, can now be treated successfully. What she found particularly concerning was the fact that much of the increased demand for eye clinic appointments comes from patients with chronic eye diseases, who are the most vulnerable and at the greatest risk of irreversible loss of vision. To see her full report go to:



Also published in the last week was a report from the WHO called “Preventing Disease Through Healthy Environments”. The WHO have undertaken an analysis that indicates that 23% of global deaths (and 26% of deaths among children under five) are due to modifiable environmental factors. Young children and older people bear the brunt of the environmental risks, the report finds, with children and under-fives and adults aged 50 to 75 most impacted. So what environmental factors are we talking about and just what diseases can be linked to our environment?

To get some insight into this fascinating topic see:




Dementia in BME Groups

 This week I am going to draw your attention to a new group that has been created called Race Against Dementia. Race Against Dementia is an alliance of groups currently providing information and support to people from Black, Asian and minority ethnic communities in the UK. Black and minority ethnic (BME) groups and the views that they have of dementia and dementia care receive very little attention in this country so any group prepared to bring the issues of minority communities to the fore is most welcome.
To find out more about this alliance visit their website which is very new at
On the website is a link to their good practice guidance. As their campaign develops I am sure more resources will be added.
On the theme of healthcare for BME groups you may find the following interesting video called “Dementia Does Not Discriminate”
and an older video by the Runnymede Trust called Race and Dementia:

Integrated Care in the UK



Integrated care has become the become the new mantra in older people’s care and rightly so. It is enshrined within law in Scotland and most UK public healthcare services are expected to embrace it. Integrated care has been described as ‘person-centred coordinated care’. The three important features of integrated care are:

  • Services working together across the health and social care sectors.
  • People’s control over the planning of their care.
  • Achieving the results that are important to people who use services, their families and their carers.

(CQC 2015)

At the end of last year the Care Quality Commission (for England) began a review looking at care for older people. It will explore how different services are organised and coordinated, and how this affects the quality of care that people receive. Details of their project can be found at:


The reason for highlighting this to you is not so much the projects, as the resources about integrated care that they have brought together on this page. So yes, please take a look at what they are doing, but take a look at what else you can access from here and you will get a really good idea where we are with integration. If you need something similar with more of a Scottish focus you can look at http://www.ccpscotland.org/hot-topics/integration-health-social-care/

The Healthcare Professionals Shortage in England, Wales and NI


I am not sure if you will have seen these news items from last week before as they slipped under the radar in between all the stuff on the USA election and the EU refugee crisis. However in response to an FOI request from the BBC, the following figures were released rather quietly. The data that the BBC were given shows that  on 1 December 2015, the NHS in England, Wales and Northern Ireland had more than 23,443 nursing vacancies – equivalent to 9% of the workforce. In fact in some areas, for example emergency departments in England and Wales, there were 1,265 vacancies for registered nurses – about 11% of the total. (No wonder NHS staff feel stressed, and overworked… that’s because they are trying to paper over the gaps!)

This is despite the findings of the Francis Report into the scandal at Stafford Hospital which identified that a shortage of nurses was a key factor in the poor care of patients.

So what is being done about it? Are we hiking up training numbers hugely? It appears not, we continue to poach staff from some of the poorest healthcare systems in the world. 2/3rds. (i.e. 69% ) of all NHS trusts and health boards are seeking staff overseas.

For more details about this see http://www.bbc.co.uk/news/health-35667939

and http://www.bbc.co.uk/news/business-35687873

NHS Scotland’s numbers have still to be released. I await them with interest.

How Many?…and Flowers!

As most of you who read this post are aware, the UK is facing a substantial rise in the number of people living with dementia as we head into the future. Fortunately we are a relatively rich country and we have already begun trying to address the problems that this may cause us in the future. However what about a country who have more people with living with dementia than the whole population of Scotland already and face a rise to around 36 million people living with dementia within its borders by 2050.

Welcome to China! An interesting article on the situation facing China was published in the Economist this week and it makes for frightening reading. Ticking time bomb fails to describe it…

See http://www.economist.com/news/china/21693241-china-ill-prepared-consequence-ageing-lots-people-dementia-state-minds?fsrc=scn/tw/te/pe/ed/stateofminds

Here is a bit of contrast. if your wife was losing her eyesight over a prolonged period what would you do to help. I doubt if this is one of the things that you would come up with but what a beautiful story…


A Positive Choice

On Wednesday the Royal College of Nurses (RCN) in Scotland published ‘A Positive Choice: everyday stories of nursing excellence in older people’s care’ – eight stories celebrating the expertise, technical knowledge and compassion of nurses and health care support workers (HCSWs) who care for our older people. 

The stories in ‘A Positive Choice’ are aimed at dispelling the myths that exist about older people’s care by showcasing the vital role that nurses and HCSWs play in caring for older people in Scotland. The dedication, knowledge and skills and enthusiasm of people working in this specialty shine through the words of the nurses and HCSWs featured. So a good news story for once and I hope you find them an interesting read. To download the booklet go to: https://www.rcn.org.uk/scotland

Bringing you write up to date, today was the day that Catherine Calderwood, Scotland’s Chief Medical Officer (CMO) published her first Annual Report. In it she talks about about a concept that she has labelled Realistic Medicine. If you want to know more about what that means, there is a short video that accompanies report which you can find at: https://www.youtube.com/watch?v=Vto9kt-S9p0&feature=youtu.be

You can download the full report or a summary at http://blogs.scotland.gov.uk/cmo/