Newsletter December 2008

Dear Colleagues

Welcome to our winter newsletter. Another year has flown by and we have had a busy autumn. It was encouraging to see the excellent attendance and high standard of presentations at the recent autumn scientific meeting. Gillian Mead and I were delighted to host the meeting in the University facilities at the new Royal Infirmary of Edinburgh site. Following on from the successful meeting on Care Home Medicine, Willie Primrose and Paul Knight met with representatives of the Care Commission to discuss future collaboration and Susan Brimelow has kindly written a short article for this newsletter. Council has also been considering other ways to promote the development of community geriatrics and encourage additional training posts in geriatric medicine as part of wider concerns over manpower planning. Meetings continue to be held with Scottish Government representatives.

We continue to be in a satisfactory financial position and we are anxious to fulfil our obligations as a charitable body by awarding more start up research grants or travel grants to attend scientific meetings. Please encourage trainees to apply.

We were delighted when Professor Mary Marshall was awarded the Society's Award for the Relief of Suffering Amongst the Aged and we are looking for nominations of other non-medical individuals who have made a major contribution to the care of older people.

2009 will be the year for improving Scottish – Irish relations. We are looking forward to a joint meeting with the Northern Ireland branch of the BGS at Aberdeen in May while the Irish Geriatricians have offered to host us in Dublin in autumn 2009. The date and venue will be finalised shortly.

On behalf of Scottish Council may I offer you best wishes for 2009.

Brian Chapman, Secretary

The Care Commission “Who We Are and What We Do” by

Susan Brimelow, Director of Healthcare Regulation

There are about 15,000 care services in Scotland and the Care Commission registers and inspects them all. From the very young to the very old, these services care for some of the most vulnerable in our society – and it's up to us to make sure that these services deliver care consistently, and to a high standard.

Almost everyone in Scotland is affected by the Care Commission in one way or another. We regulate childminders and nurseries, care homes for older and younger people, independent healthcare services, and many more. We make sure that care service providers meet Scotland's National Care Standards and work to help them improve the quality of care. To do this, we have 582 employees, including 320 Care Commission officers who inspect services, and an annual operating budget of around £30 million.

Scotland's National Care Standards are set by Ministers and are important because they list the things that a service must do or provide for people to experience good quality care. They also tell people what they should expect from a care service. Copies of the National Care Standards are available from Blackwell Bookshops free of charge or on-line.

We also investigate complaints to protect people who use care services and can take action to force a care service to improve the quality of their care. If they don't improve, we can close the service down.

We also help develop and inform social and healthcare policy, working in partnership with local authorities, health boards, and other representative groups interested in care such as Scottish Care, Age Concern, the Mental Welfare Commission and the Scottish Partnership for Palliative Care.

Although the quality of Scotland's care services is generally good, it still needs to improve. In April 2008, we began grading the services we regulate. Each is awarded a grade from 1 (unsatisfactory) to 6 (excellent) across four areas: quality of care and support, information/environment, staffing, and management and leadership. To get good grades, providers need to make sure people who use the service are involved in its evaluation. Grading gives everyone ‘at a glance' information about what we, the regulator, think about the quality of a particular service, and should give reassurance that we are demanding improvements where the service is not good enough.

There seems to be strong agreement that grading is the right way forward. It is exposing even more clearly the small number of poorer services, which means that we can focus on helping them to improve.

By November we had graded 30% of services and recently published the results for the first 6 months on our website. The majority of services scored satisfactory or good. 19% achieved grades of very good or excellent. 2% were found to be failing and received grades of unsatisfactory and weak. We will report the full year results with more detailed information and conclusions in 2009.

We publish about 13,000 new inspection reports every year and if you are concerned about the quality of care in a service we regulate, we want to know. Don't just assume others will let us know.

All of our inspection reports are published in the care services list on our website at www.carecommission.com

Practice Development Unit, NHS Quality Improvement Scotland

Prevention and Management of Falls Programme

NHS Quality Improvement Scotland (NHS QIS) is currently undertaking a two year national, multiagency Falls Programme to raise the profile of falls and fracture prevention and support the development of related services in Scotland.

Ann Murray, the Programme Manager, is working in partnership with nominated Falls Leads from each Community Health and Care Partnerships. The work programme will focus on priority topics including data capture, multidisciplinary assessment and multi-agency training, with a view to improving the prevention and management of falls and fractures in older people.

To date, a resource, “Pathways for the Prevention and Management of Falls and Fragility Fractures in the Community” has been developed and aims to focus attention on the key steps along an individual's journey of care. It presents, in one document, an overview of the various aspects of fall and fragility fracture prevention and management and articulates how these aspects link. It is underpinned by the best available explicit evidence, tacit and organisational knowledge, and the experiences of older people and their carers. It is based on the model for rehabilitation featured in the Framework for Adult Rehabilitation for Scotland (2007). This document is currently out for consultation.

In April this year NHS QIS, in collaboration with NHS Education for Scotland, launched an online Prevention and Management of Falls Community of Practice ( www.fallscommunity.scot.nhs.uk ) to promote the exchange of knowledge, ideas, experience and good practice to improve the quality of care for older people at risk of falling. All disciplines and professions working in falls and fracture prevention in Scotland are welcome to join and contribute.

This work is closely aligned to the Framework for Adult Rehabilitation in Scotland, which focuses on the rehabilitation of older people as well as long term condition management and vocational rehabilitation.

For more information or to contribute to the Pathways consultation, please contact Ann Murray, Falls Programme Manager at ann.murray3@nhs.net

Ann Murray

October 2008

A Trumpet Call from England: BGS Retired

Calling all retired Scotsmen and women. Were you there when we were building a better world? Do you remember from the armchair, the battles fought and lost, and those days when BGS Spring meetings involved afternoon visits. If so BGS Retired may be for you. This year Morag Insley has organised a great deal. Five nights, half board, £35 a head, May 11th - 15th Pentire Hotel, Newquay, Cornwall, at the other end of the island.  Sounds too good to be true? Luxury break at low price - check it out at www.pentirehotelnewquay.co.uk/
A mail out to all Retired BGS members will be sent out from BGS central later this month. More info email Morag ages@finsley.dircon.co.uk

Peter Millard

The Society's Medal for the Relief of Suffering Amongst the Aged

The BGS Scotland was asked to nominate potential candidates for this award and we identified Professor Mary Marshall as a very worthy recipient. Professor Paul Knight presented Mary with her award at the autumn meeting.

Mary was a non-medical member of the BGS who, after running Age Concern Scotland

for a number of years, was appointed as the first Director of the Dementia Services Development Centre at Stirling University, a position she held from 1990 until her retiral in 2005. This was the first such centre in the world and it played a pivotal role in both raising the profile of dementia worldwide and promoting better care of older people with dementia.

She encouraged the Department of Health in England and the Australian Government in establishing similar ventures.

She was a member of the original Royal Commission chaired by Sir Stewart Sutherland into the funding of Long Term Care (1999) and a member of an Independent Review of Free Personal and Nursing Care in Scotland (2008).

Her work was recognised by the award of an OBE.

Trainee update:

We had a very successful trainees' meeting in Perth on September 19 th , with 47 trainees attending. Thanks again to all the speakers and sponsors. We are keen to have feedback and suggestions for next year's speakers.

Following a well-attended BGS (Scotland) Autumn Scientific meeting in Edinburgh on 8 th October the trainees met to discuss ongoing concerns. The new Knowledge Based Assessment (KBA) will be held for the first time on March 4 th 2009. SpRs are not required to complete the KBA and none who attended this meeting intend to do so. ‘New style' trainees remain troubled as to when the best time to sit this exam would be. It seems that very few, if any, of the current ST4s intend to sit the exam next March. This is mainly driven by lack of confidence in the on-line examination system that is planned (having previously experienced MTAS problems), lack of curriculum and guidance for the assessment, and cost. Although guidance is limited it appears the KBA is aimed at ST5 trainees, when trainees will have enough ‘on-the-job' specialty experience.

The exam remains at £800, despite efforts to ensure the exam is run at cost only. The KBA is expected to run at a loss for several years but the long term aim is to make a profit for the BGS and colleges. The BGS has promised to redirect it's 25% of the profit back to trainees. Unfortunately this cost is unlikely to drop significantly and is thought to be similar for other specialty KBAs being introduced. Cost implications are also the reason why the exam will only run once a year for the foreseeable future.

Other work based assessments such as MSF, mini-cex and case-based discussions continue to be completed and further assessment tools are being piloted by some Scottish trainees.

Susan Shenkin has stepped down from her two year post as Scottish trainee representative. Thanks to her for all her hard work. We are delighted to have Angela Wilkinson from Tayside replace her.

We are currently updating the trainee section of the Scottish BGS website and would welcome input from trainees. Please check the website and make suggestions!

If you have any comments or concerns about issues relating to training in Scotland, please get in touch with either of us.

Gillian Kerr ( gilliandkerr@hotmail.com )

Angela Wilkinson ( angelawilkinson@nhs.net )

Interested in Heart Failure?

The British Society for Heart Failure is arranging a training day for SpRs and STs on 22nd April 2009 at Paul Wood Lecture Theatre, National Heart & Lung Institute. Full details of the programme should be available in the New Year on the BSH website www.bsh.org.uk

The BSH is a multidisciplinary organisation which has an annual scientific conference in November, sessions at the British Cardiovascular Society annual conference and it has also had joint meetings with BGS CV section. The quality of the meetings is of a high standard and they provide a great networking opportunity. The BSH is keen to involve more physicians in Medicine for the Elderly and information on membership is also available on the Website Jackie Taylor

Start-up Grants

A reminder that the BGS Scotland is pleased to give start-up research grants of up to £1000 to assist in establishing a research or audit project. Congratulations to Sarah Henderson for achieving a recent publication entitled ‘ Do the malnutrition universal screening tool (MUST) and Birmingham nutrition risk (BNR) score predict mortality in older hospitalised patients?

Website

Why not have a look at the BGS Scotland website? We have been updating the content to make it a more useful site and previous editions of the newsletter and Scottish Council minutes are now available on-line.

We are particularly grateful to Gillian Kerr and other Trainee colleagues for revamping the trainee section to include much useful information including the presentations from the September meeting.

If any of you wish to advertise meetings or have ideas for other content let me know. Brian Chapman

Kate Johnson Prize

Congratulations to Fergus Doubal for winning the Kate Johnson Prize for his presentation at the autumn meeting on ‘When is MRI negative in mild strokes?'

Dementia Services Survey

Professor June Andrews of the Dementia Services Development Centre has asked me to thank those of you who responded to the study which aimed to identify current patterns and practices of information provision to people with dementia and their carers. This project was commissioned by NHS Quality Improvement Scotland in partnership with Alzheimer Scotland and has provided some very useful information.

College Meetings : meetings of interest to Scottish BGS members include:

•  RCPEd February 4 th 2009 Palliative Medicine in your hospital c.gray@rcpe.ac.uk

•  RCPEd May 11 -15 th 2009 Update in Elderly Medicine

c.gray@rcpe.ac.uk

•  RCPEd May 26 th 2009 Evening Update in Stroke Medicine- with video links c.gray@rcpe.ac.uk

•  RCPSG Sept 17-18 th 2009 EUGMS Palliative Care Medicine and End of Life Issues in Older Adults lynsey.mcnaught@rcpsg.ac.uk

Future BGS Meetings:

•  Aberdeen – May 14 th and 15 th , 2009 – Joint Meeting with N Ireland Branch

•  Dublin – Autumn 2009 – Joint Meeting with Irish Geriatricians

•  National BGS Edinburgh Spring 2010

New Consultant Appointments:

Congratulations to Dr Olayinka Ogundipe who has recently taken up post as Consultant in Medicine of the Elderly at the Royal Infirmary of Edinburgh.

Newsletter Articles :

Can you please inform me of any new consultant appointments?

Newsletter articles are always welcome.

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

Dr Brian Chapman

Royal Infirmary

Edinburgh EH16 4SA brian.chapman@luht.scot.nhs.uk

secretary@bgs-scotland.org.uk