Sarah Mistry is Chief Executive of the BGS. She leads the organisation and works closely with BGS officers, the wider membership and BGS staff to deliver its vision of the UK as a place where all older people receive high-quality, patient-centred care when and where they need it. She tweets @SarahMistryBGS
This pre-Christmas blog was to have been a round-up of key BGS publications and activities for 2022, but it will now have more of a personal bent, if you will forgive the indulgence. On the 10th of December I fell off my bike on an icy patch (ironically on the way back from not playing tennis, as we had deemed the courts too slippery), breaking my leg. So the last two weeks have been coloured by my direct experience of the NHS, something we BGS staff are normally only exposed to through your day-to-day work as clinicians and BGS members. I thought I would intersperse 2022 BGS highlights with personal reflections of being a patient.
As we come to the end of another immensely challenging year in the NHS, the workforce crisis shows no sign of abating. In September, the BGS published an analysis of RCP Census data, highlighting shortages and workforce patterns across the UK for geriatricians and higher specialty trainees. This report is part of the BGS workplan, where we seek to influence recruitment, retention, development and support of the specialist and generalist workforce caring for older people. The BGS will be recruiting members of a formal BGS workforce committee in January, building on the work of the existing workforce sub-group, in line with the new priorities set out in our Strategic Plan 2023-26, which members approved at the AGM in November.
Underinvestment in the workforce lies at the heart of many of the current problems of the health and social care system, predating the COVID-19 pandemic but also exacerbated by it. Our #BGSTimelyDischarge blog series and our more recent #BGSInvestInCare campaign highlight how such underinvestment stores up problems for older people, meaning they present later with more advanced frailty and comorbidities. The result is worse health outcomes and more costly treatment. Investing in the community workforce has the benefit of population health management approaches which can identify those at risk of decline and offer proactive interventions. The BGS has been supporting the long-delayed development of anticipatory care in England, which was one of the original components of the Ageing Well programme. Following on from our 2021 report on urgent community-based care, this year we published a guide to hospital-level care at home, building on the important work done across all four countries through Hospital At Home and the NHSE-funded virtual wards. These are important initiatives aimed at reducing avoidable hospital admissions and delivering care closer to home, which is what most older people want if they have sufficient family and other support available.
I was very glad to have been speedily and efficiently processed when I had my accident, with a well-established pathway. But I was an ‘outlier’ on three different wards, as managers struggled to find any available bed. Each time someone moved on, the bay was swiftly cleaned, new linen put on the bed and a new patient installed within half an hour. With the help of excellent physiotherapists, I managed to pass the test of hopping up a step on my new crutches, but I could see how their expertise was in such short supply that few people had in-hospital rehabilitation. Older people decondition rapidly once admitted, and so rehabilitation is vital prior to and after discharge. The shortage of a rehab workforce directly affects older people’s chances of recovery after an admission, and is one of the reasons, along with a shortage of social care, for older people being stuck in hospital when they are medically stable to be discharged.
2022 saw the launch of the BGS QI Hub, a great resource for anyone using quality improvement methodology to enhance the quality of their service. Joining the BGS Frailty and Delirium Hubs, and soon to be followed by a Research Hub, the QI Hub provides a one-stop shop for everything you might need on the topic with examples, guidance, tips, and helpful links. A couple of months earlier, the BGS had helped to launch the World Falls Guidelines. Co-produced by more than 90 experts from across the globe, the guidelines were published in Age and Ageing during its 50th anniversary year, and launched at the EuGMS Congress, which the BGS co-hosted in London. Achieving a global consensus on the prevention and management of falls was a terrific feat of collaboration. There have been many other examples throughout the year where BGS members have contributed to consultations, guidelines, policy statements, research, and practice to improve the clinical quality of care.
When in hospital, I was struck by the absolute commitment to professional standards and first-class care of all the healthcare practitioners I encountered. Despite the immense challenges of a difficult working environment, long hours, and an overstretched workforce, I was so impressed by the quality of care I received, with pride in personalised care and attention to detail evident across all professions. A couple of examples: I enjoyed eavesdropping on the 95-year-old lady waking up in the next bed to me after surgery for a hip fracture and broken arm. At first, she seemed incoherent, but with the warm and respectful coaxing of the Filipino post-op nurse, it soon became clear she wanted her teeth in to be able to talk more easily. She then proceeded to reel off her three sons’ 11-digit mobile numbers, and within ten minutes was cracking jokes with the porters. It was abundantly clear to all that she had quality of life and that surgery was beneficial, regardless of her age. Another time, I listened to a nurse compassionately supporting a woman who had broken her ankle, and who was full of sadness about missing a long-awaited trip to India to see her family. As I listened through the thin blue curtains at 2am to that kind nurse gently helping her patient to get used to her situation, I felt awed by her unhurried empathy.
You, the BGS members and officers, continue to prompt the admiration of the staff team. We know you are exhausted from the unrelenting pressure of the pandemic and its aftermath. We captured ten lessons from COVID in a recent report, but we know the so-called winter pressures are year-round. Despite the challenges, you continue to advocate for older people’s right to high-quality joined-up healthcare. You generously volunteer your time to work with the BGS community as trustees, committee members, peer reviewers, representatives, organisers and authors, and you help to share education and knowledge. As a recent patient, I can see the value of the multidisciplinary team and have heightened respect for the skills and perspectives different professions bring. Please take some time for yourself this festive season. If you are working - thank you! The staff team and I are proud to support you in your vital roles. Thank you for all we have achieved together as BGS this year, and we look forward to continuing to improve healthcare for older people in 2023 and beyond.
