People will read what they want into articles. However, I do find David Jolley's response bewildering.
Do I know the origins and history of the speciality of geriatric medicine? I am the current President and former Secretary of the British Geriatrics Society and as such am fairly steeped in the history of the speciality and have written and spoken on these themes, for instance in two articles cited below [1, 2] I was also trained by senior geriatricians who had been in the speciality since the 1970s and who would often speak about how the work had evolved. I am also the son of one of the earlier specialist old age psychiatrists in England and frequently visited his wards and discussed his work with him.
More to the point, as I made pains to say in the column, I used to work on long stay wards at the start of my medical career and throughout my training and consultant career have lived through the various changes to continuing care legislation - Ii have seen writ-large, how things have changed for patients and their families and for practitioners working in the system. And as a former National Clinical Director and a current King's Fund Fellow I have spent several years working in the areas of health policy development, analysis and implementation. It beggars belief that I would need explaining to me what I have already explained and referenced in the article.
Am I blaming patients for a predicament not of their own making? Quite the reverse, as should be patently obvious. I called the article "NHS Continuing Care is a Mess" because it is the very antithesis of a person centred system and puts patients and their families through a depersonalising wringer that leaves them trapped in acute hospital beds they don't need to be in. I have written about this before in the BMJ making it very clear who my sympathies are with [3, 4], and I have argued at some length in a major King's Fund paper for a radical change in approach to ensure modern health and care systems are fit for the largely older people who use them [5] and repeatedly written about the need to stop ageism and age discrimination in our services [6,7]
Am I some kind of sap who "swallows" government propaganda or policy lines (as opposed to studying and understanding them)? Well regular readers of my BMJ column or Kings Fund Blog can judge for themselves but I would be surprised if many came to that conclusion.
I have precisely argued the case for a system that is fairer, more person centred, less complex and less bureaucratic, and I am pleased to see that the response from colleagues in Scotland to this column confirms that this can still be a good thing for patients and their families.
In trying to discern what may have "riled" Dr Jolley - about what I actually said in my 450 words - I can only imagine it's
1. Saying that local people often feared long stay wards as places you would never leave alive and those long stay wards not offering particularly personalised care. Well I stand by that. Wherever possible people would prefer to be in less institutional environments, which is not to say that there were not skilled and caring staff working on those wards. Even back to the time of Marjory Warren - effectively the UK's first geriatrician and the doctor after whom the British Geriatrics' Society's HQ is named - she described systematically asssessing and treating large numbers of patients who had effectively been written off as beyond recovery and inevitably dependent [1] and not accepting that a long stay ward was the only environment they could ever be in.
2. Saying that in our current system some families of older people appealed continuing care decisions when they have no realistic chance of overturning them and that there are financial implications for families if they enter the means-tested social care system is demonstrably true. It's understandable that it happens but they are victims of the system.
I find it quite bizarre that a column I wrote, firstly, to explain the history and complexity of our current arrangements and, secondly, to criticise it or indeed as one respondent has said "blow the whistle" on it is somehow interpreted as my supporting the system, not knowing its history and blaming patients trapped in it.
David Oliver
[1] http://www.britishgerontology.org/DB/gr-editions-2/generations-review/th...
[2] http://www.bgs.org.uk/pdfs/2016_rcp_future_hospitals.pdf
[3] David Oliver BMJ Values statements are not worth the paper
[4] David Oliver BMJ Why I let patients stay longer in hospital
[5] Oliver, Foot, Humphries. Making health and care systems fit for an ageing population. King's Fund 2014.
[6] Oliver D. Older people in hospital. Physicians Need to embrace the challenge. Clinical Medicine 2012
[7] Oliver D. Acopia and social admissions are not diagnoses. Why older people deserve better. JRSM 2008
Rapid Response:
Re: David Oliver: NHS continuing care is a mess
Editor
People will read what they want into articles. However, I do find David Jolley's response bewildering.
Do I know the origins and history of the speciality of geriatric medicine? I am the current President and former Secretary of the British Geriatrics Society and as such am fairly steeped in the history of the speciality and have written and spoken on these themes, for instance in two articles cited below [1, 2] I was also trained by senior geriatricians who had been in the speciality since the 1970s and who would often speak about how the work had evolved. I am also the son of one of the earlier specialist old age psychiatrists in England and frequently visited his wards and discussed his work with him.
More to the point, as I made pains to say in the column, I used to work on long stay wards at the start of my medical career and throughout my training and consultant career have lived through the various changes to continuing care legislation - Ii have seen writ-large, how things have changed for patients and their families and for practitioners working in the system. And as a former National Clinical Director and a current King's Fund Fellow I have spent several years working in the areas of health policy development, analysis and implementation. It beggars belief that I would need explaining to me what I have already explained and referenced in the article.
Am I blaming patients for a predicament not of their own making? Quite the reverse, as should be patently obvious. I called the article "NHS Continuing Care is a Mess" because it is the very antithesis of a person centred system and puts patients and their families through a depersonalising wringer that leaves them trapped in acute hospital beds they don't need to be in. I have written about this before in the BMJ making it very clear who my sympathies are with [3, 4], and I have argued at some length in a major King's Fund paper for a radical change in approach to ensure modern health and care systems are fit for the largely older people who use them [5] and repeatedly written about the need to stop ageism and age discrimination in our services [6,7]
Am I some kind of sap who "swallows" government propaganda or policy lines (as opposed to studying and understanding them)? Well regular readers of my BMJ column or Kings Fund Blog can judge for themselves but I would be surprised if many came to that conclusion.
I have precisely argued the case for a system that is fairer, more person centred, less complex and less bureaucratic, and I am pleased to see that the response from colleagues in Scotland to this column confirms that this can still be a good thing for patients and their families.
In trying to discern what may have "riled" Dr Jolley - about what I actually said in my 450 words - I can only imagine it's
1. Saying that local people often feared long stay wards as places you would never leave alive and those long stay wards not offering particularly personalised care. Well I stand by that. Wherever possible people would prefer to be in less institutional environments, which is not to say that there were not skilled and caring staff working on those wards. Even back to the time of Marjory Warren - effectively the UK's first geriatrician and the doctor after whom the British Geriatrics' Society's HQ is named - she described systematically asssessing and treating large numbers of patients who had effectively been written off as beyond recovery and inevitably dependent [1] and not accepting that a long stay ward was the only environment they could ever be in.
2. Saying that in our current system some families of older people appealed continuing care decisions when they have no realistic chance of overturning them and that there are financial implications for families if they enter the means-tested social care system is demonstrably true. It's understandable that it happens but they are victims of the system.
I find it quite bizarre that a column I wrote, firstly, to explain the history and complexity of our current arrangements and, secondly, to criticise it or indeed as one respondent has said "blow the whistle" on it is somehow interpreted as my supporting the system, not knowing its history and blaming patients trapped in it.
David Oliver
[1] http://www.britishgerontology.org/DB/gr-editions-2/generations-review/th...
[2] http://www.bgs.org.uk/pdfs/2016_rcp_future_hospitals.pdf
[3] David Oliver BMJ Values statements are not worth the paper
[4] David Oliver BMJ Why I let patients stay longer in hospital
[5] Oliver, Foot, Humphries. Making health and care systems fit for an ageing population. King's Fund 2014.
[6] Oliver D. Older people in hospital. Physicians Need to embrace the challenge. Clinical Medicine 2012
[7] Oliver D. Acopia and social admissions are not diagnoses. Why older people deserve better. JRSM 2008
Competing interests: No competing interests