A Cutting Tale about Older Folk, and a Tale of Two Twitties

Many people today are not only growing older but stay fitter for longer than ever before. This was one of the factors we considered last week at our College Strategic Thinking Day. The day aimed to consider what our priorities should be over the next 5 years. The aging population was a recurring theme in understanding what these might be. For example, the number of people aged 65 and over is expected to rise by 65% (to almost 16.4m) over the next 25 years. Life expectancy when the NHS was created was 66 for men and 70 for women. Today it is 78 and 82 respectively. At aged 65, men will live an average of 18 more years; women 21.

According to a report published last week by the Royal College of Surgeons and Age Concern, (thank you Norman and Michelle) the NHS has not always kept pace with these changes and there have been a number of concerns raised over the quality of care offered to older people. In the UK age discrimination is illegal but the report suggests that decisions over whether older people are put forward for surgery might still be subject to the age of the patient rather than actual need.

For example, whilst the incidence of breast cancer peaks in the 85+ age group, the surgery rate peaks for patients in their mid-60s and then declines sharply from the age of 70. People over the age of 65 make up the majority of recipients of joint replacement surgery. However, the rate of elective knee replacement and hip replacement surgery for patients in their late 70s and over has dropped sharply and consistently over the last 3 years. 10000 men a year die from prostate cancer and the incidence of the disease increases with age. Overall 50% of men who develop the disease will die as a direct result of it. But surgical treatment rates for the disease do not match the number of new cases being diagnosed amongst the older population. Emergency surgical procedures are increasing for hernias in older people, while the planned surgery rates fall sharply once a patient is aged 75 or over.

Of course there are many reasons why these apparent discrepancies might be occurring, and it’s clear the fault does not lie with surgeons per se, other decisions makers might also have a role to play, particularly those responsible for primary and community care services. Likewise, the older person themselves might want to exercise some choice as to whether they want surgical treatment or not.

People need information to make choices however. It has been said that the rise of social media has led to the growing empowerment of us all, and the 'nowhere to hide' culture of the Twitterati has raised expectations of quality, and growing intolerance of poor service. And there are many people like my parents (older people in their own right) who regularly use their iPads to access information about all aspects of their life. However, such access can be a mixed blessing. The instant access to others offered by Twitter, Skype and FaceTime is the new technological tyranny. Orwell probably had it right.

At the other end of the age spectrum I was interested to read last week that university students in classes that use Twitter average 10% grade points higher than those who don’t. 98% of students own some kind of digital device, and 8% of students use social networking sites to contact their lecturers. 50% of students believe that tablets will replace text books completely within the next 5 years. When at our College Strategic Thinking Day I shared this information and asked who, that morning had used Twitter and tweeted someone – there were only 2 of us who had, Moira and me. Made me think.

The other thing that made me stop and think last week was the publication of the challenging report from the Prison Reform Trust and INQUEST entitled Fatally Flawed. This report used the the story of Joseph Scholes to explore the way in which the UK criminal justice system treats young people. Joseph was just 16 when he died at Stoke Heath Young Offender Institution in 2002. Despite much public outcry, no public inquiry was ever undertaken. Since Joseph died on 24 March 2002 to the day this report was published last week on the 24 October 2012, 9 children and 191 young people aged 24 and under have died in prison.

We have to do better for both the older and younger people in our society.

One for the Oldies, One for the Road and One Too Many?

I tripped over a guitar yesterday. I have 5 (although 1 is in my office). I hadn’t had a drink, it was just as I was clearing something away in my study, I stepped back and knocked one over and as I reached to rescue it from falling, I tripped over. Surrounded by guitars, I picked one up, tuned it and began to play. Now I don’t have a great repertoire, but I have some songs I know from the 1980s which was when I last played in earnest.

Like every wannabe rock star, I eventually I got to my Bob Dylan song selection in what (in my mind at least) is now an imaginary concert played in front of 1000s of fans at Wembley. ‘Knockin on Heavens Door’ is a favourite, a great standard, possible made more famous by Guns N’ Roses. It was one of their tracks on their debut album ‘Appetite for Destruction’ released in 1987. Axl Rose I am not, but yesterday I had fun nevertheless.

One of the other songs from this album was a song called ‘Nightrain’. It’s a song that was a tribute to an infamous brand of cheap Californian wine, 'Night Train Express', which was extremely popular with the band during their early days because of its low price and high alcohol content. I mention this fact as last week I was in Birmingham at the autumn meeting of the Council of Deans for Health. I travelled there by train and as I was travelling early evening, I purchased a lovely young Pinot Grigio from M+S (there are other retailers selling wine at train stations) to sip occasionally as the journey progressed. I saved some for the hotel room, which when I got there, had a panoramic view across the city.

And the wine was a good one too! As was the Council of Deans meeting. One of the many things we discussed was how each University was responding to the changing educational needs that were emerging as new (and often long term) health conditions are being identified. Some of these new health problems also have a long lead-in times before the disease becomes evident. For example obesity related diabetes, smoking related lung disease, and of course, health problems related to alcohol use over a prolonged period of time. For example, alcohol related dementia is a silent epidemic that could affect up to 80,000 people in the UK.

So it was good to see that last week Alcohol Concern published a so called 'alcohol harm map' which reveals the harm and cost of alcohol misuse across England. The map, which can be accessed at http://www.alcoholconcern.org.uk/campaign/alcohol-harm-map provides an interactive guide to your area highlighting how many people are drinking at harmful levels, the number of alcohol-related hospital admissions and alcohol-related healthcare costs for your local authority area.

According to the map, more NHS money is spent treating alcohol-related hospital admissions for the 55 to 74-year-olds (over £825m) in 2010/11 than that spent on the 16 to 24-year-old age group (£64m). According to the Office of National Statistics it is estimated that 6% of the population in England are dependent on alcohol, of which 9.3% are men and 3.6% women.

As I live in Bolton, I thought I would look to see what the statistics said about my neighbours and I. The information was very interesting. For example, alcohol-related admissions in Bolton cost £16.9m in 2010/11 which equates to £80 per adult. £3.6m was spent on the cost of A&E admissions, £10.7m on inpatient admissions, and £2.6m on outpatient admissions. In Bolton the number of deaths attributable to alcohol (all ages) in 2011 was 110 (74 men and 36 women). The statistics made sobering reading. I guess there must be a lot of people in Bolton already knock-knock-knockin' on heaven's door.

Talking About the Money, Old Age, and Hen Parties with a Difference.

Last week I was sent a letter by my bank to let me know that an endowment policy I had taken out many years ago was due to mature on the 1st November. Of course given the current economic situation and despite many years of faithfully paying the premiums, the plan has not performed as well as expected. Nevertheless a decision is required over what to do with the Money.

Amongst the conversations over what the money could be spent on, (new car, cruise holiday, replacement kitchen, deposit to allow one of the children to buy a house and so on) the one thing I hadn’t considered was spending the money on a Social Insurance Policy. Bear with me. You might remember back in July the Dilnot Commission reported on its ideas for funding social care in the UK.

Led by Andrew Dilnot, an economist and Swansea comprehensive school boy done well (he is now Warden of Nuffield College, Oxford), the Dilnot Commission undertook the first review of social care funding in the UK since 1948. He suggested a social insurance scheme – where people could pay premiums to the State so as ensure costs for care and accommodation would be paid for up to a capped limit. He recommended that such care cost should be capped at £35,000 and so-called ‘hotel costs’ – to pay for food and beds in residential homes – would be limited to £7,000-£10,000.

I guess like many people I read the proposals and was genuinely interested in the merits of paying now to reduce cost of care in the future, but possibly lost interest when the Collation Government refused to run with Dinot’s ideas. Well that was until last week when the NHS Confederation published their analysis of the issues in a paper called: Papering over the cracks: the impact of social care funding on the NHS

This paper reminded us of the demographic reality facing the UK. A huge and growing number of people need a large amount of care from both the NHS and social care providers. It is generally accepted that the demand for care will continue to increase, particularly with the growth in the very old and for adults living with multiple and complex conditions. The population of over-65s is projected to grow by 50% over the next 20 years. In 2011 there were over 430,000 people aged 90 and over in England and Wales (compared with 340,000 in 2001 – a 21%). The current figure of 820,000 people who are living with dementia in the UK is expected to increase to 1.7 million by 2050.

The number of emergency admissions among patients aged 75 and over has increased by 18% between 2006/07 (1.231 million) and 2010/11 (1.453 million). Current services are already stretched. Delayed transfers of care already cost the NHS £545,000 per day (approximately £200 million per year). A situation that can only get worse unless significant funding is found to ensure high quality social care is more readily available than at present.

And that’s where we all come in. It is vital we face up to the true cost of providing social care. I think the Dilnot Commission’s proposals are the most practical and credible way of achieving this. So sorry one and all, no new car, or cruise holiday, or deposit for a house, it’s a Social Insurance Policy for me.

But, if you are thinking about other life decisions, and in particular, getting married, there is also some Positive News – last week I was given a copy of a newspaper so named. Brilliant idea, that is to celebrate what’s different and positive about our world. The story that caught my eye – Hens get back to nature. So not a story about my favourite feathered friends, but a story of how some women are trying to move away from the tradition (well last 10 years at least) of hen nights that consist of a debauched weekend where women in devils horns, and slogan daubed T shirts compete to see who can be the most outrageous.

No this was stroy about a return to nature, literally set in some woodlands, but with campfires and champagne. Favourite quote from the story – (talking about sleeping out under canvas) why have 5 star accommodation when you can sleep outside and have billion star accommodation. Mind you, without my having a Social Insurance Policy in place I could be sleeping under the stars in a few years time!



Making a Meal of the NHS Reforms, and 50 Shades of Middle Class

For all kinds of reasons, a prominent feature of my life last week was eating in restaurants of various quality and enjoyment. My lucky escape was in not being able to go to the somewhat strangely named Live Bait restaurant. It was a night out with my other Head of School colleagues. That wasn’t a problem. It was the fact that the restaurant specialised in fish dishes of every hue and type. Being a vegetarian, sitting next to colleagues eating their way through various fish dishes absolutely didn’t appeal.

Interestingly, cafes featured in a very interesting piece written by Professor Paul Corrigan, Director of strategy and commissioning for the NHS London Strategic Health Authority and former Labour Party adviser, and his colleague, Dr Steve Laitner, GP and associate medical director of NHS East of England. In an intriguingly entitled report - The Accountable Provider: developing a powerful disruptive innovator to create integrated and accountable programmes of care.

This report looks at why many people talk very highly of their experience of NHS services when speaking about a specific experiences of treatment, yet  have problems with their overall experience of the NHS. So patients’ feedback starts with  patients saying that each doctor, nurse, pharmacist and ambulance driver was really good., and that each aspect of the care was really well delivered, but the overall experience was not good.

For example, patients complain about: being asked the same questions over and over again; about hanging about between bits of the service; about having many people involved in their health care but not really sure who is responsible for what and who is in overall charge of their care; and of not really knowing what is going on. So it seems that whilst the bits of NHS care are reported as being very good, the overall service is often poor. This is not a new problem, and many professionals working in the NHS have struggled with the problems caused by the changes to the organisation of care. Likewise there are few models of integrated care that have been systematically evaluated.

What Corrigan and Laitner argue for is a strong ‘integrator’ who has the power to make providers of care provide single pathways of care. In other industries very complex supply chains come together to provide a simple output for a customer. The example they use is that when we walk into a cafe and order a cup of tea you do so without worrying about having to go to India to buy a tea plantation in order to enjoy a good cup of tea. The logistics and supply chain management will have been already sorted – you just have to enjoy the cup of tea. This has to be a new and sustainable approach to commissioning care to both improve quality and productivity.

And quality and productivity were on my mind yesterday when my eldest daughter and family joined my youngest son and partner, who having just moved into their first house together wanted to celebrate. So we went to the Mud Crab Cafe in Didsbury to have a celebratory meal. Not sure it would have been my first choice, but there you are. There were 7 of us, which was the first problem, but eventually we were all seated. Then it was down to selecting a meal. Mine was a cauliflower cheese finished off with truffle oil – however it was the accompaniments that caused the biggest problem and drew the largest laugh.

The French Fries came dressed with something called Chicken Salt. Being a vegetarian this was of concern. Not to worry. The French Fries seasoning was billed as coming from the USA, although it was actually manufactured in Australia and was completely meat and fish free. Corrigan and Laitner would have been impressed with the seamless supply chain that delivered such divine chips.

Finally, totally fed up to find I am no longer a possible member of the middle classes. The Times, yesterday presented the 50 attributes of being middle class. I failed the test. I don’t do Man Hugs, and my dog is called Cello because it suits him not because I ever wanted call one of my children Cello, I don’t drink water, tapped or bottled, either at home or in restaurants, never entertained the notion of having a trampoline, I do have a tattoo, but it’s a picture of a chicken so that probably doesn’t count, and making cheese, well I was making cheese 37 years ago, not because it might be a fun thing to do, but because it fed the family, and camper vans are for those who have never stayed in a 5 star hotel. 50 Shades of Middle Class indeed!