It seems incredible that I am now writing this up at my desk back here in Nottingham. The time away seemed to go at a much slower pace whereas since I've been back it has flown. I think it was also due to the fact I hadn't realised how exhausted I was and have needed that time to recuperate.
So, last Tuesday - 12th June. The theme of the conference was "Ageing patients: Ageing healthcare workers". This was the theme we were supposed to have looked at during our time in our respective countries. There were 121 participants in 20 countries. For the first day we were to be addressed by keynote speakers and then the second day was given over to our respective presentations. We spent the morning in the Saphir room below:
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| Team Finland assembling |
Because the conference was in Berlin several of the speakers gave their presentations in German so we had headphones to listen to an English translation. It was quite strange when there was the occasional joke and hearing after everyone else had laughed and also when they finished often the clapping had started before the translation ended. However, it was better than not understanding a day of German!
The conference opened with the President of HOPE - Georg Baum. Then we had greetings from Daniel Bahr, the Federal Minister for health in Germany. He stressed that although we all represented different healthcare systems within that diversity we needed to work together. Most countries share the same demographics - an ageing population overall and specifically an ageing healthcare workforce with a need to try to maintain the same services but with a lack of skilled workers. He pointed out that extending older peoples' working lives and allowing for family caring time were all good ideas but these were buffers not solutions. He referred to a paper "Active and healthy ageing" 2012 which challenge us to not only lengthen lives but also to promote independence, health and fulfilment. One issue he raised was the increasing number of long-term residential care homes. This should not be left to unqualified, uncaring and unmotivated staff. Rather he pointed to the German education system where they are trying to recruit young people still at school into vocational training. He also stressed the need to link the practical and the theoretical to ensure this care was delivered at a high standard.
John Dalli, the EU Commissioner for Health, then gave a presentation via a video clip. He stressed that the EU was trying to establish a partnership to work together to extending a healthy lifespan, reducing chronic diseases and integrating care systems. The EU were also committed to maintaining an increased workforce.
A response was made by Tom Dolan, the President of the International Hospital Federation. He stated that in America 25% of the population now have one chronic condition and of these a further 25% have two or more chronic conditions. These two groups between them account for 75% of the health budget with 10,000Americans turning 65 every day. This did stress that this is a global problem.
We then had the first key note speaker - Professor Rita Sussmuth, the former President of the German Bundestag. The title of her presentation was "Healthy ageing - challenges and potential of increased life expectancy". In summary her main message was that by active participation in a healthy life it works! People will be more healthy and so have a better quality of life. She emphasised that despite all the technological advances we have made what makes the most impact was talking and sharing a relationship with healthcare workers based on trust. A very simple but quite powerful message. She stated that we must recognise the diversity in the workforce but also look to maintaining the standards, competencies and responsibilities too. There is increasing decentralisation but this level of care can only be achieved through a co-operative approach. Dr Sussmuth warned of the risk of burnout especially amongst the middle-aged workforce. She made reference to the co-operation that is occurring in the Netherlands between specialities such as maternity and gynaecology and even more diverse branches of medicine. The professor also referred to this concern that so often the least skilled people were working in elderly care.She made several references to the "young old ones" - those who were aged 50 years plus. I suddenly felt very old and not "young" at all! I started to realise that I was definitely a part of this ageing workforce and indeed ageing population! I did feel slightly more encouraged when she closed saying that elderly people still had an important contribution to make to society!
Josep Figueras, Director of the EU Observatory on health systems gave the next presentation entitled "Population ageing and the challenges for hospitals in Europe: Myths, realities and responses". Somehow he managed to link the concerns about the healthcare systems to the 4 horsemen of the apocalypse! He spoke quite quickly and whizzed through his slides. I shall have to revisit the HOPE website and look again! The first one was Famine - where he likened the ageing population and chronic disease burden. He pointed out that is could be seen that chronic disease was not a fiscal failure as it had been stated by the Czech government that each time a smoker died they saved $1,227 so there was the question as to whether increased life expectancy was actually desired. He showed figures for the whole of Europe about old age dependency and interestingly in the UK we were not as high as the rest of Europe. He had lots of really interesting statistics (I can't quite believe I just wrote that!). For example, 86% of deaths are due to chronic disease. At present this accounts for 1-6% of the GDP of most countries overall, but specific diseases can account for much higher amounts - Cardio-vascular disease 7-15%, Diabetes 2.5 - 15%. These figures will continue to rise at present rates. However, Mr Figueras claimed that if people managed their health better this figure could drop to only 0.7% so the key is health promotion.
Mr Figueras referred to a piece of research by Salisbury et al, 2011 which points out that hospitals now are predominantly managing patients with chronic conditions yet are still being run as surgical units. He introduced the concept of mortality compression. At the time it seemed really clear but I'm not so sure now. Basically there is a premise that if we live longer we will suffer longer but what we all want is to live longer, suffer less and die quickly. However, research suggests that in fact the former is not automatically true, that in fact people do live longer and that often their suffering is shorter and the is the mortality compression factor. People are living longer and the level of mild disabilities is increasing but the numbers of severe is decreasing so actually this does not have such an impact on hospital beds as we predicted. However, these factors he described as "known knowns" - the facts. Then there were the "known unknowns" - for example in dementia care. In 2010 there were 14.5 million people with dementia and it is expected that this will double by 2050. The problem is the "unknown unknowns" - the issues that we either know little about or haven't even appeared on our radar yet.
The next point that Josep Figueras made was that we do not cost the social contribution of the elderly but actually this is a key factor in social cohesion and well being. He made the following bullet points which I thought were all worth capturing here:
- we need more flexible working patterns
- integrated health, social and economic services
- strengthened health promotion
- patient involvement - but not the patronising way that much of this is done at present
- moving funding from hospitals as the elderly and chronic do not need this type of care
He then drew on the World Health Organisations social determinants of health:
- focus on primary prevention - tobacco, alcohol, diet
- improved screening and control - hypertension which would then reduce the numbers of stroke, dementia
- promote healthy diet and nutrition
- promote physical activity
- co-ordinate structured disease management programmes
- increased involvement of non-medical staff
- need for e-health to take a central role
- need more geriatricians and more health workers trained in geriatric care
- focus on multidisciplinary care, not carry on in the blinkered specialist manner
- improve medication adherence
- promote personal health management
- integrated care for chronic diseases including remote monitoring
His conclusion was that increased expenditure in the short-term will be cost-effective in the longer term. This was all music to my ears - it is what I have always believed and it was so good to hear it being said in such a prestigious forum.
This inspiring presentation was followed by a podium discussion with the morning's speakers. Some of the main points raised were that there should be routine screening of the elderly for prevention and also early detection and management; the need for keeping citizens active and independent not just focusing on patients; that we need better leadership that is not disease or financed focussed.
An very interesting fact was stated - in Germany 1:5 people go to hospital each year and yet 4:5 do not so why do we not put all our efforts into keeping those 4 out?
After lunch I went to the "Ageing Patients Workshop". It was not really a workshop but 3 further presentations. The first was by John Cachia, the Commissioner for patients' rights in Malta speaking on "Requirements and entitlements of ageing patients - the Maltese example". He again stated the need to recognise the role of older people in society and their value in terms of paid and voluntary work, transmitting their experience and knowledge, helping families with their caring responsibilities. Malta has a high rate of elderly people and they are aware that their current services do not meet the needs of the existing population. For them the challenges are around polypharmacy, diet, falls, long term conditions, ageism and the environment. By addressing these challenges people could be helped to be healthy, independent and autonomous and have a high quality of life in their old age.
Throughout the conference the message was clear for me - people must accept responsibility for their own health and be prepared to live a more healthy life in terms of their diet and exercise specifically. This was not a new message and all of the problems raised are ones that we all share. The key is getting people to take that ownership and I do believe that the work we have been doing regarding motivational interviewing and the course I did in behavioural psychology give insight into how to at least try to achieve this.
The third speaker, Professor Elisabeth Steinhagen-Thiessen, presented the Berlin Ageing Study. This is a piece of research which tries to address the typical problems of geriatric patients in hospital. In Berlin they have ensured that all their general medical wards have rehabilitation facilities - looking at mobility, dementia and continence. They have recognised that they cannot have separate budgets for health and social care. They have set up a service which runs from 8am - 8pm to support the elderly in their homes. This is a telematics system which allows patients to interact with specialists via a computer to monitor and advise on their conditions.
The Professor gave a great example of adapting to ageing. The ageing pianist, Rubenstein, was asked how he still managed to perform at concert level. He remarked that he Selected fewer pieces to keep at that level; Optimised his practise - focusing on those few pieces and practising them more intensely; Compensated - played the slower parts more slowly so that the faster parts would be relatively faster. Dr Steinhagen-Thiessen stated that this is how all elderly people adapt to function well as they age.
We then reconvened in the main auditorium and had a feedback from the other workshop - ageing workforce. Unfortunately they did not summarise the speakers only the discussion afterwards but this seemed to be saying that workers needed to have a good work environment, be satisfied with their work to enable them to work more productively and well. A happy workforce + happy environment = happy patient.
We then had quite a quick turn around to be ready for the Gala dinner. I went to see my friend the concierge who had found the suitcase from lost property that he said I could have to put in some of my luggage for Steve's wife Jane to bring back to the UK on Saturday. He said they had had a really enjoyable day cracking the code on it to open it - but they have succeeded and so I collected my case. He had also been trying to obtain a piano for me but it was going to cost 230 euros so we declined. Dian and I met to look through the presentation as there had been various points during the day when I had remembered points that we needed to include. As we sat in the hotel lobby Lars arrived with a gift - a toy gun. I had decided to make out second slide as it we were starting off on the Marathon and so was going to say "take your places on the starting blocks, get set, Go!" So Lars had the brilliant idea of me firing a gun. He also had brought some balloons to pop one by a microphone to make the bang louder. Do read tomorrow's blog though as this caused some fun later on in the day!!!!
We met for the dinner and sat with Debbie and Franck who had been in Slovenia. the food was very nice and the evening very pleasant. The only problem was the background (well, not so background at times!!) music. It was the same loop and it came round very frequently. It was mainly Beethoven's 9th "Ode to Joy". By the end of the main course we were really fed up with it!
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| The Slovenia team |
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| Cesar Dian and Lars |
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| Dian, Lars, Steve and Lorraine |
The pudding almost made up for it - it was beautifully presented:
I just had the most awful few minutes. I thought that I had lost this blog. it has taken me all afternoon to write and I made a wrong click and then it was gone! I had a few seconds frantic searching backwards and forwards. I called Helen, my daughter but she wasn't' there so I left her a desperate message. I then called our IT department but he told me as it was web-based there was nothing he could do. Emma, my line manager emailed me and I sent this very woeful email so that she had to reply telling me to breathe! However, then I called Helen again and she found it - she really is a genius and I am so grateful to her!! Time to go home now and carry on with the second day of the conference tomorrow!
