A new vision for the care of elderly people is taking shape in the region. PETER BARRON talks to the hospital consultant leading the drive for change

A LIFELONG interest in the care of the elderly can perhaps be traced all the way back to David Bruce’s carefree childhood trips to the Scottish borders to visit his grandmother.

David was growing up in Glasgow and Grandma Bruce ran a residential care home for the elderly in Peebles. It was a successful business but she had a vision that was seen as revolutionary in those days – she wanted to develop a high quality care village for the elderly which, for various reasons, never got off the ground.

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Nevertheless, it gave young David an insight into caring for the elderly and that early interest has stayed with him throughout his distinguished career with the NHS.

After two decades working as a Consultant Elderly Care Physician in Hartlepool, Dr David Bruce is now leading the management of elderly care for the County Durham and Darlington NHS Foundation Trust. Care Group Director For The Integrated Adults Care Group is his proper title but it boils down to making sure the growing elderly population gets the best care possible.

And, just like Grandma Bruce, he has a vision for changing the status quo by bringing care teams together to form a partnership between hospitals and community services. He sees it as the creation of a “virtual centre of excellence for the elderly”, although he’s convinced there is scope for the philosophy to be underpinned by a physical centre, or centres, where the specialist care needs of the elderly are focused.

Talks between those involved in primary care, secondary care and social care are continuing to finalise the most effective model. However, the vision is taking shape with the development of what have been termed TAPS – Teams Around Patients – which bring together hospital consultants, GPs, district nurses, community matrons, and social services.

The fundamental idea is that there is a greater level of interaction, co-operation and understanding between the various care professionals, with old demarcation lines being overcome and less risk of duplication. Thirteen of the teams have now been set up across the county, working around GPs’ practices and health centres, but with rapid access to hospitals, where “front of house” teams are ready to make assessments. The objective is to give older patients the best care but to restore them to independence as soon as possible.

It is a philosophy backed by Dr James Carlton, GP at Bishopgate Medical Centre, in Bishop Auckland, who said: “We’re finding that bringing professionals together into one team, focused on a local area, is working really well. For example, they’re sharing some of the practical, day to day activity, in a more efficient way.

“They also have more opportunities to discuss patients with complex needs or whose needs are changing. These interactions and collaborations are less formal but much more effective than before, which can only benefit our patients and feels better for the staff as well.

“The boundaries between services are reducing as the focus on getting the best outcome for each patient, is shared. Having both healthcare and social workers on the team is having particular advantages. They’re identifying and discussing individual patients earlier, so as the support that is required for a patient to stay in their preferred place of care changes, issues can be addressed before they become a crisis.”

The change has not been easy. Indeed, Dr Bruce, who has been in his current post for three and a half years, says it has been a case of “deconstructing and reconstructing community teams into a better model that delivers improved care”.

“There is plenty of evidence that elderly people prefer to be looked after in their own homes,” he says. “Hospital is often the right place for an elderly person but often it is not. It’s all about what gives them the best quality of life.”

“I’ve been involved in elderly care since I graduated in the 1980s, and I’ve seen a lot of changes,” he adds. “But by far the biggest cultural change we need now is to move away from the idea that it’s all about the bricks and mortar of a hospital. Instead, we need the main focus to be the people working as part of an integrated team.”

By being closer to the community, Dr Bruce believes it will be easier to identify those at greater risk of coming into hospital and he sees communication between team members as key.

“It’s really important to get health professionals working in partnership for the greater good of the older generation,” he says. “The elderly don’t actually ask for very much and I absolutely hate to see elderly people getting poor quality care. What we should be striving for is the kind of care we would want for our own loved ones.”

That passion to find the best way forward for the older generation may have been stimulated by those boyhood visits to his grandma’s care home, but it has never left David Bruce throughout his career in the NHS.

And, ultimately, he’s convinced it all comes down to teamwork.