Quality care for older people

Exploring staff education needs to provide quality care to an ageing population.

The Dunhill Medical Trust wanted to understand the extent to which health and social care staff are equipped to provide high-quality care to older people. We considered whether there might be certain professions delivering care to older people that may benefit from enhanced education and training, and the impact this could have on the quality of care.

Our research identified a lack of consistency in approach to recruitment practices, training standards and requirements. However, the foundations for change were shown in the passion and dedication among participants.

Our research found that for older patient care to have good clinical outcomes there needs to be continual training across organisations and sectors, so that patients receive effective treatment by professionals they can trust. In many cases, this relies on continuity of care and smooth transitions between departments as well as emotional support, empathy and respect by staff who are fully trained in the necessary care competencies of geriatric medicine.

Challenges

Picker’s systematic review revealed that there were no integrated training programmes to equip staff to better look after older patients. If training did exist, then its impact was usually not measured, but where it had been assessed, it revealed that staff training was the key intervention into improved patient experiences and clinical outcomes.

The review identified gaps in training for older patient care that started at the earliest levels of training, for example, some undergraduate medical courses included only five weeks of ‘care for the elderly’ in a five-year curriculum. And, once graduate students are working within the NHS, then training programmes between sectors and organisations differed widely. Lack of resources and lack of motivation (for example no financial support) were real barriers to education and training.

Staff felt that ‘siloed’ working between different sectors and specialisms was particularly problematic in the care of older people. Caring for older people is multifaceted and having the skills to manage across system and organisation boundaries requires a more holistic approach.

Actions

In response to these challenges, the Dunhill Medical Trust has up to now:

• Sponsored a new award category at the 2019 BMJ Awards ‘Care of older people team of the year’. The award went to the multi-disciplinary, multi-agency team, which has consistently demonstrated a person centred approach to older people’s health and social care, and measurably improved healthcare outcomes for older people.
• Introduced an annual, joint student competition with the Medical Schools Council offering prizes at UK Medical Schools. The objective is to design a teaching session that will engage and educate the students’ peers on the topic of providing care for older people. The session should enable students to develop skills or knowledge that will help in their future practice.

Impact so far

The Dunhill Medical Trust sponsored the British Geriatric Society’s new course ‘Quality Improvement in Healthcare of Older People’, which enabled more nurses and allied health professionals to attend than would otherwise have been able to do so.

In 2019, 15 Medical schools took part in the competition; engaging their students in sessions to increase awareness of the care of older people. Three entries were shortlisted from the following Medical Schools: Barts and The London Medical School, Brighton and Sussex, and Bristol, to go forward to the “Winner of Winners” competition.

The 2019 winner was from Brighton & Sussex Medical School. The winner had taught his session, which aims to break down the barriers to good communication, at his school, with overwhelmingly positive feedback. He’d also been using pre- and post-session questionnaires to understand changes in students’ confidence, competence and opinions on conversing with older patients.

His next steps are to conduct further work to validate his questionnaires and to investigate whether the intervention has a longer-term impact on students’ approaches to communicating with older people. He’s hoping his teaching session will be incorporated into their curriculum more widely.

Future

The Dunhill Medical Trust is using the evidence from the research to help organisations enhance their training programmes. At the moment, they have the following plans in place:

• They will grow the student competition to include more UK Medical Schools and therefore further enhance the training of doctors in the care of older people.
• In response to a call for more research, they have agreed to fund a fellowship at the University of Bristol. The study is entitled “Innovating undergraduate geriatric medicine training: A training fellowship to develop, test and refine a novel undergraduate medical curriculum using mixed methods, evaluated within the wider framework of national and international medical training”.

“We were really pleased that through this research we have identified some great initiatives to improve the quality of care for older people, and are delighted to be doing our bit to encourage the systemic change that we think is needed.”

Susan Kay, Executive Director, The Dunhill Medical Trust.