Newsletter January 2010

Dear Colleagues

Welcome to our January newsletter. I hope you have all had an enjoyable festive period and had fun in the snow. Since the last newsletter we have had an excellent autumn meeting near Dublin and Council members have been involved in a number of initiatives on your behalf. This is the 50 th anniversary of BGS Scotland so our autumn meeting will have a different format from normal – see below.

The website continues to evolve. We have added a “What's New” section which has the advantage of encouraging the secretary to continue to make updates. We continue to receive great support from our webmaster, Johan Rossouw, and a more major upgrade is currently being considered.

Finally you will recall that we mentioned the sad death of Dr Pat Beausang, Consultant at Stirling Royal, on August 16th after a short illness. In this issue we begin with an obituary as well as news of a sponsored run being undertaken by Brendan Martin in Pat's memory. Brian Chapman, Secretary

Pat Beausang

Consultant in Geriatric Medicine, Stirling Royal Infirmary (b 1966; q University College Cork, 1991, BSc , MB BCh, BAO, MRCP (I)) , died from Acute Leukaemia on 16 th August 2009.

Pat, a twin to James and one of six children, was born on the 9 th of July 1966 and brought up in Ballincollig, Co. Cork, Ireland. He was from a medical family, his father (Dr John Beausang) having been a general practioner. He won an academic scholarship to the Christian Brothers College in Cork City prior attending University College Cork. Pat excelled at University and won a Health research board scholarship for his intercalated BSc in physiology which was subsequently awarded with 1 st class honours.

Pat qualified as a doctor in 1991 and commenced his postgraduate training at Cork University Hospital. He decided to pursue a career in geriatric medicine and was noted by his contemporaries at the time to be meticulous & hardworking, yet immensely practical. They described his common sense approach to complex medical issues as “The Beausang Method”.

Pat moved to the West of Scotland in 1995 to take up a Specialist Registrar Training in Geriatric Medicine. He rotated through various hospitals including Stonehouse Hospital, the Southern General Hospital, the Western Infirmary and Gartnavel General Hospital.

He completed his training in 2000 and commenced in post as a consultant physician in Geriatric Medicine at Stirling Royal Infirmary. His main areas of interest were in movement disorder and orthogeriatrics but the Day Hospital at Stirling, with its multiplicity of challenges and rewards was an area of particular focus. He was modest and unassuming but had a dry and at times wicked sense of humour. However at all times he was dedicated to the care of his patients.

Outside of medicine Pat was a keen athlete and had previously participated in 10 km races. He was also a keen follower of football and Liverpool Football Club was the focus of this interest. In addition to football he had a very broad and detailed knowledge of sporting facts in general.

His family however was his abiding love. He met and married Cat in 1999 and had renewed his wedding vows in July 2009 just prior to his sudden illness. He is survived by Cat and his two children, Orla and Louie, whom he adored. He had taken up swimming lessons very recently to keep up with Orla and Louie.

As one of his friends from university stated, “I've always thought that you are lucky to meet a handful of real friends throughout your life. To those of us who knew him, Pat will be remembered as a true friend, regardless of time or distance, and we are better for having known him.” Alan Mckenzie and Sheila Johnstone

London Marathon

Here are the details of the leukaemia charity with which I have secured a Golden Bond place for the London Marathon on 25th April 2010.
I applied for a Golden Bond place with the Elimination of Leukaemia Fund (ELF) soon after I heard the sad news about Pat; I believe that he was an enthusiastic runner. ELF awards a number of grants to help advance the treatment and cure of blood cancers across the whole age spectrum. It is currently funding medical research in the region of £1 million; the Leukaemia Research Centre, Glasgow is a beneficiary.  Further details about the charity ELF, registered charity number 282886, are available on their website http://www.elf-fund.org.uk . I hope to create a "Just Giving" site for on line sponsorship donations. My fund raising target is £2000. Anyone interested in sponsoring me can contact me at brendan.martin@lanarkshire.scot.nhs.uk

Scottish Older People's Assembly

On October 2 nd 2009, 300 older people, including myself, attended the first ever meeting of the Scottish Older People's Assembly held in the Scottish Parliament at Holyrood. The fact that the gathering was organised jointly by the Scottish Government, Age Concern and Help the Aged in Scotland, National Pensioners Convention, Alzheimer Scotland, the Scottish TUC, COSLA, WRVS, Scottish Pensioner's Forum, West of Scotland Seniors' Forum and the Older People Advisory Group will help to explain the wide variety of issues raised by the delegates.

The meeting started in style with bacon rolls and coffee before moving to the main debating chamber. The Presiding Officer of the Scottish Parliament welcomed all the delegates and then David Manion, a member of the Steering Group of the Assembly as well as Chief Executive of Age Concern and Help the Aged in Scotland, spoke on what the meeting hoped to achieve. The keynote address was given by Nicola Sturgeon, Deputy First Minister and Secretary for Health and Wellbeing. She took questions from the floor including giving reassurance on the future of the Vale of Leven Hospital and emphasising that the Scottish public was not at risk from foreign doctors running the out-of-Hours NHS services!

The highlight of the day, at least for me, was a very interesting discussion led by a panel including Sylvia Meehan, President of the Irish Senior Citizens Parliament; Ruth Marks, Older People's Commissioner for Wales; Shona Robison, MSP and Minister for Public Health; and Johann Lamont, MSP and Deputy Leader of the Scottish Labour Party. Ireland and Wales have been able to raise the importance of older people's concerns with good effect. The benefits of having free personal and nursing care in Scotland was emphasised but the tension that exists with Westminster over its control of the state pension and other benefits was evident.

After lunch the delegates divided into three groups for mini-debates on means testing or universal benefits, the future of caring for older people, and speaking up or being spoken for? Each was followed by an expert panel on a related theme. There were many important issues raised although some of the suggestions were not particularly pragmatic or sensible especially in the current economic climate.

Was it a success? A difficult one to call – it certainly gave older people and their representatives the opportunity to promote themselves and their issues up the agenda, and this chance was taken with open arms. The issues raised were vital but, as several folk commented, this was an assembly, not a parliament. It is doubtful if another talking shop is needed. And as Sylvia Meehan emphasised the future, in line with Scottish Government policy, is ‘intergenerational'. We await guidance from the Scottish Government whether the Assembly will be repeated. Brian Chapman

Reshaping Care for Older People Programme

Further to our last newsletter Anne Hendry is to be congratulated on continuing to lead on work in this area. Council was recently asked to review paperwork on Care Pathways from the Pathways workstream. In general we thought these were well conceived and written and we gave our support to the work. The concept of identifying frailty and managing it better in the community is to be commended although there is a slight concern where the resources to do this will come from. We need to be sure any changes will improve outcomes for older people and reduce the pressure on the acute sector before resource transfer from the acute sector occurs.

There is a great opportunity for members to contribute to the ongoing discussions around the implementation phase. Look out for notification of any local meetings.

Care Homes

Following on from the Care Home Medicine conference in Glasgow the Care Commission has asked to meet with representatives from BGS Scotland, RCGP Scotland and Iona-Jane Harris, the Press, PR and Parliamentary Affairs Officer at BGS Central Office. This will be an excellent opportunity to promote the work that has been done. Further discussions will also be held with Scottish Government officers and MSPs.

Day Hospital Care

It is 15 years since Roger Smith chaired the Scottish Geriatric Day Hospital Guidelines Working Party with representatives for the RCPEd, RCPSG and BGS Scotland, and yet many of the same questions are being asked today. Day Hospitals are peculiar to parts of Scotland and don't exist in many centres so why do we still retain them? The answer to this will be obvious to geriatricians but not to others outside the specialty and it is easy to see why. The evidence base for the traditional day hospital model of care where patients come for assessment and then receive rehabilitation over a several week period has been under scrutiny. Day hospitals have been criticised by their users as being time consuming to attend but do have real value for some. The rehabilitation element has been shown perhaps to be more effective in some community models and the Cochrane review was tepid in its recommendations for day hospital care saying essentially that it was “no worse than any other model” - faint praise indeed!

As a result many day hospitals have evolved to develop a role as acute assessment units with shorter lengths of stay and little in the way of rehabilitation or social care. There has been an increase in day case treatments with shorter length of stay. With the expansion in numbers of patient with dementia there is a vogue for passing care onto day centres, whilst still maintaining a strong medical role and identity. Old fashioned quality elements such as social care and meal provision are not deemed cost effective in the current economic climate, especially with rising pressures on acute hospital beds.

In Lothian, we are fortunate to be able to operate 5 day hospitals. They cover a wide geographical area and each is unique having developed to suit local needs.

A working party was set up by NHS Lothian last year to examine our day hospital practices to see if the health board was getting value for money. The agenda was to try and utilise them primarily to avoid acute hospital admissions. This has been controversial as how can it be proved that an admission was avoided by day hospital attendance? We know for example that many of our patients are frail, at risk of admission and a proportion are admitted either during attendance, despite our best efforts. Consideration has been given to using SPARRA data to identify particular individuals whose targeted attendance may be useful.

However what has become clear at least in our locality was that there was no standard model of care even within one health board and it was impossible to make comparisons or even judge performance. This is because no benchmarking for staffing levels exists locally or nationally and there is no guidance about numbers of patients who should or could be assessed or standards for services. Data collection is inadequate and usually performed internally and informally by enthusiastic nursing staff or ward clerks.

In an attempt to quantify the work which is currently being done avoidance, we aim to start standardising the collection of data on all 5 sites. We aim to start small with simple agreed outcomes. However as in all areas of geriatric medicine many of the scales used to measure functional change such as EMS or Barthel are insensitive, and don't reflect the real value to an individual elderly person who attends.

We would be interested in hearing from other day hospitals that have meaningful data sets in particular about any models which have proved particularly successful to help those outside geriatric medicine understand the value of day hospital care.

Contact myself please – Kath Anderson, Royal Victoria Hospital, Edinburgh

Trainee update:

The 2007/2008 trainees are delighted their dual accreditation can now be reinstated –they are advised to follow guidance on the JRCPTB website to allow this to take place at their next ARCP. The new GIM curriculum is up and running, however there remains teething problems. Consequently all trainees are advised to use a logbook for GIM. There remains a lack of training and guidance regarding eportfolios for trainees who are switching over to this system.

The Specialty Certificate Examination (previously called Knowledge Based Assessment) will take place for the second time on March 24 th 2010. Candidates can now register (from 4 th Jan to 8 th Feb) on the MRCP website ( www.mrcpuk.org/SCE ) –testing centre locations in Scotland appear to be limited so we encourage early registration! The exam remains at £800, despite efforts to ensure the exam is run at cost only. However, free resits have now been confirmed for unsuccessful candidates (sitting the exam in 2010 only). There is still concern that there is only one ‘diet' per year.

The BGS is running a sponsored ‘ National Geriatric Medicine Trainees Weekend'. This ‘Educational and Social Weekend for StRs/SpRs' will be held in Manchester on 27 th - 28th February 2010. It's a first of its kind aimed at SCE candidates (but also includes consultant interview workshops and CV tips) along with looking to be a great social weekend.

There are as yet no other courses/books specifically for the SCE. There is a free online resource set up in Dundee –this is a useful knowledge-based assessment tool with references and further reading recommendations.
( http://www.dundee.ac.uk/learning/era/eraindex.htm )

There will also be a ‘Continence in Geriatric Medicine' training day in Perth on 24 th Feb 2010 which would be suitable for those sitting the SCE.

If you have any comments or concerns about issues relating to training in Scotland, please get in touch with either of us. We will continue to update the website, including presentations from this years trainees' meeting. If you have anything you feel could be added to the website please let us know.

Angela Wilkinson ( angelawilkinson@nhs.net )

Claire Steel ( claire@steelworks.me.uk )

Joint Meeting BGS Scotland and Ireland society of Physicians in Geriatric Medicine – November 13th -14th 2009

About 25 hardy Scots braved the trip to Kilashee House Hotel for the first ever joint meeting of BGS Scotland and the Irish Society for Physicians in Geriatric Medicine – quality if not quantity. We had an excellent meeting with some very good clinical papers and the hospitality was first rate. We were particularly grateful to Shaun O'Keeffe for acting as local organiser. All agreed it was a worthwhile experience with a return meeting to be held in Scotland.

Kate Johnston Prize for best presentations at Dublin meeting

Congratulations to Michael Alcorn for his interesting paper on "Skin Ageing In A Narrow-age Cohort of Older Adults: Scottish Women Are More Wrinkly".

Edinburgh Meeting and BGS Scotland AGM

Although we will not have a BGS Scotland spring meeting because of the National BGS meeting in Edinburgh, Council has decided that it will still have an Annual General Meeting. The plan is to meet on Friday April 24 th 2010 at 1300 in the Edinburgh International Conference Centre. This will allow election of new office-bearers and regional representatives as well as approval of the accounts.

This should also encourage you to attend the national BGS meeting in Edinburgh. Please note to separate letter inviting nominations for vacant positions on Council.

BGS Scotland Autumn Meeting November 19 th 2010

This year is the fiftieth anniversary of BGS Scotland and to commemorate the occasion we are planning a ‘special meeting' in Lanarkshire on November 19th hosted by Brendan Martin and colleagues.

The exact format has to be finalised but already we are planning an extended lunch break with a sit-down three course lunch, some speeches and other surprises. We will be encouraging retired members to attend and, although it is a one day meeting, there will be a special rate for those wishing to stay over in the Hilton Strathclyde Hotel. Please make a note in your diary now and encourage others to attend.

Meetings:

•  UK National BGS April 22-24th 2010 Edinburgh

•  Autumn meeting, Hilton Strathclyde November 19th 2010

Newsletter Articles or News of Consultant Appointments :

All correspondence should be sent, preferably by email, to:

Dr Brian Chapman

Royal Infirmary

Edinburgh EH16 4SA secretary@bgs-scotland.org.uk