MINUTES of a meeting of the EXECUTIVE COMMITTEE and REGIONAL REPRESENTATIVES of the FACULTY OF THE PSYCHIATRY OF OLD AGE held on 1st March, 2006 at The Corus Hotel, Glasgow.
1.06 /PRESENT
Professor Susan Benbow (chair)Dr Sarah Black (honorary secretary
Dr Yong-Lock Ong (finance officer)
Dr Carmelo Aquilina, Dr Mark Ardern, Dr Andy Barker, Dr Barbara Breitner, Dr Roger Bullock (delayed), Dr Peter Connelly, Dr Jane Garner, Dr Deborah Girling, Dr Jonathan Hillam, Dr Paul Hogbin (delayed), Dr Dave Hunsley, Dr Rob Jones, Dr Claire Lawton, Dr Donny Lyons, Dr Gill McLean, Dr Peter Metcalfe, Dr Ross Overshott, Dr Anand Ramakrishnan, Dr Shelagh-Mary Rea, Dr John Starr (delayed) and Dr Andy Tarbuck.
In attendance
Gill GibbinsOn behalf of the executive committee, Professor Benbow welcomed Dr McLean on her first attendance as co-opted member from the Scottish Division executive committee.
2.06 /APOLOGIES FOR ABSENCE
Received from: Dr Anderson, Dr Connolly, Dr Devakumar, Dr Dhariwal, Dr Devakumar, Professor Elliott, Dr Gilbert, Professor Howard, Dr Ivbijaro, Dr Jackson, Dr Katz, Dr Larkin, Dr Leonard, Dr Neville, Dr O’Cuill, Dr Series, Dr Shanks, Dr Sibisi, Dr Sorby, Dr Talbot, Dr Tyre, Dr Waite, Dr Williamson and Professor Wilson.3.06 / PREPARATION FOR BUSINESS MEETING DISCUSSION WITH THE PRESIDENT
Professor Benbow reported that Professor Hollins had had to cancel her attendance and it was agreed to invite her to attend the 29th June meeting at the College instead.
Action: SBenbow, agenda
4.06 / CONTINUING CARE: STANDARDS FOR OLD AGE PSYCHIATRY UNITSThe committee considered email correspondence from Dr Peter Simmons and from Dr Hilary Nissenbaum about the shrinking pool of knowledge within the faculty about the continuing care of patients with a severe dementia, and what steps the faculty could take to redress this.
4.06 / There was broad-based discussion across the legislatures about the discontinuance of long-stay beds, the transfer of services to means-tested private psychiatric provision and the transfer of funding to other services, and the implications these factors had for training in addition to their effects on patient care. The committee recognised that the assessment of who should receive continuing care has been fragmented and devolved and that although the Department of Health had commissioned an evidence-based framework for continuing care, this had been held up – it would be difficult to establish ‘standards’ for continuing care when the conditions for assessment were very variable and blurred by the lack of distinction over what was health care and what was social care.
Professor Benbow undertook to relay this discussion to Dr Simmons and to suggest that he might usefully contact Dr Amanda Thompsell, working in a multi-agency service providing care to homes.
Action: SBenbow
5.06 /FOLLOW-UP WORK FROM NOVEMBER 2005 STRATEGY MEETING
It was agreed that Dr Aquilina would include the boxed text from the strategy meeting notes on the faculty, encapsulating the faculty’s aims, on to the faculty web page, and that Dr Hillam would place this on the front page of the next faculty newsletter.Action: CA, JH
With regard to the three-year strategic targets, the following was agreed:A. Setting the boundaries. Dr Black reported that there would be a workshop at the conference on job planning, which will replace the consultant/population norms. A paper from this workshop would be circulated with the June papers.
Action: SBlack, agenda
B. Stating our case: gaining a fair share of the resources. Professor Benbow reported that this area fitted well with the user/carer meeting discussions about experience of patients with dementia in a ‘general’ hospital bed and that she would be discussing a possible seminar on these issues with Harry Cayton, to arrange a date and venue with Gill Gibbins.Action: SBenbow, agenda
D. Collaborating with other bodies. It was agreed that this could in part be dealt with by inviting specific groups to attend faculty seminars.6.06 /
CHAIR’S REPORT
6.06.1 /Report from E&F
There were no matters to discuss not raised elsewhere in the agenda.6.06.2 / Meeting of faculty and divisional executive chairs on 24th January, 2006
Unfortunately neither Professor Benbow nor Dr Black had been able to attend this. Professor Benbow reported that a working group, led by the Registrar and comprising two faculty and two English divisional executive chairs, had been set up to propose a resolution of the questions over faculty representation on English divisional executive committees.
Action: agenda
6.06.3 /Proposed meeting with the Dean on ‘Modernising medical careers’
Three papers were tabled: on the CCT, on post-CCT and on education committee structure at the College.The paper on the CCT proposed that the College should move to the ‘long-discussed’ option of two recognised psychiatric specialities. There was some uncertainty about whether the decision would be made in August 2007 or whether the case for the decision would be reviewed in August 2007; however, a decision not to adopt two CCTs was understood to have been made some time previously.
Part I would be years ST1 and ST2, knowledge-based.
Part II would be OSCIs before sub-specialty was achieved, between years ST3 and ST6.
The old age psychiatry faculty should think about selection into specialties, Pt I and Pt II. Trainees would be given grades for how they did for various sub-specialty modules – that result would be part of the selection process. There would then be two years in old age psychiatry and one year in general psychiatry, both competence-based. It was thought that although there might be increased flexibility in some years, there would be less in others, which could deter people from certain specialties. If there were to be time-limited training, what would establish the pass rate in Pt I and Pt II? Would there be a lowering of standards?
The committee asked what status an endorsement would have when it came to a consultant appointment, and whether trusts could ignore the needs of old age people, for example, or any other endorsement area. There was no indication as yet of how trusts might treat this issue.
One key factor was the point that it might be difficult to have enough psychiatrists trained in each specialty to match the service needs; if trainees were allocated NTNs only in adult and child and adolescent psychiatry, the mechanism for ensuring that adequate numbers of psychiatrists were trained in each of the existing specialties might be lost. A second major concern was that everyone would effectively be trained as a working-age psychiatrist.
6.06.3 / It would be necessary to point out that the paper had missed out the competences for general community psychiatry and to remind the College that general psychiatry was also a specialty: if there were only three years’ training for general psychiatry this would not produce better trained psychiatrists but less well trained psychiatrists. It was thought that the general and community psychiatry faculty should advocate having its own CCT recognised as a specialty.
However, if all competences were considered equal, why should people do only general psychiatry in the first year, and why was the academic part delayed until Years 4 to 6? There was a need to find out whether people were good at what they were doing, then they could concentrate on clinical developments that would still make them good psychiatrists.
The question of age cut-off was getting more blurred. There was a need to re-define roles eg in nursing homes. Two CCTs might be more managerially attractive but with an ageing population there would be more people with the complex needs of old age, so there needed to be more definition of why old age psychiatry was different and needed more complex medical skills.
Dr Starr set out the background of what happened in geriatrics in the 1980s/1990s, with joint training in acute general internal/geriatric medicine. As soon as that happened the balance of geriatric medicine shifted to become that of general physician - so old age psychiatrists would de facto become general psychiatrists, and other areas of psychiatry would be more difficult still.
In the last five years there had been a realisation that there should be community geriatricians, but all trainees had trained in acute medicine so that this caused problems, although there was an improved situation in general internal medicine overall.
There was no understanding of why this College had committed itself to replicate the same problems about a lack of preparation of trainees with one-third fewer people who were being lost to foundation years.
This was seen as increasing the conveyor-belt mentality of the NHS. There was no mention of quality in the paper – this was not part of the NHS agenda any more, so what were the faculties to retain? The new modern NHS was not about what the current consultants were trained to do. The new proposal would be in line with European uniformity but that was not seen as a criterion for adopting it – Europe should be brought up to the levels of UK training, rather than the UK training being brought down to current European levels.
The general view was that old age psychiatry needed to remain a specialty and to train as a specialty, not as a sub-specialty or an endorsement.
6.06.3 / It was agreed that Professor Benbow would write to the Dean to convey these views and to ask for a meeting with faculty officers; it was also agreed that a separate meeting of all faculty chairs as stakeholders would be advisable in the near future.
Action: SBenbow, agenda
6.06.4 / Action on Alzheimer’s drugs; and guidance group for the use of anti-dementia drugs for non-Alzheimer’s dementiasProfessor John O’Brien had co-ordinated the faculty response to NICE, for which Professor Benbow expressed the excutive’s appreciation. It was agreed not to issue any other advice before receiving the NICE response; updated information was on the faculty web page.
6.06.5 / Feedback from the seminar on 14th February, 2006 on alcohol-related dementia and cognitive impairment
This had had good attendance and had gone very well. Information was awaited on whether NIMHE might set up a working group on this with the faculty.
6.06.6 /
Faculty of academic psychiatry
All academic old age psychiatrists were encouraged to join and to stand for election to office.6.06.7 /
Faculty elections
The committee were reminded that nominations for election to the posts of chair and finance officer, and to nine executive committee places, would close at the Glasgow business meeting.Action: agenda
6.06.8 /Data protection issues
The College has changed its arrangements for members to ‘opt out’ rather than the present ‘opt in’, which should make communication a lot simpler. The faculty was very pleased that its comments on the problems associated with data protection issues over a long period had contributed to this change. It had been agreed that no one should be elected to the executive committee, or become a regional representative, without consenting to the use of their email address for faculty work.6.06.9 /
Faculty ACCEA process
The College paper on changes to the process and timescale would be circulated to the executive immediately and Professor Benbow undertook to prepare a version for the faculty’s May mailing, which Dr Aquilina would put on the faculty web page as soon as possible. As very few names had been put forward for the previous meeting to rank-order nominations, it was agreed to ask regional representatives to identify outstanding people in their region, following which the chair would write to individuals suggested that they apply. It was likely that the London division rating scale would be used to ensure objective rating.Action: SBenbow, CA, regional representatives
6.06.10 /Faculty representation on the Public Education Committee
As no one had put themselves forward for this, it was agreed to ask for expressions of interest at the business meeting later in the day. Subsequently, Dr McLean expressed interest in the role.6.06.11 /
Faculty representation on the College ‘virtual’ library committee
Dr Ramakrishnan undertook to serve.Action: ANR
6.06.12 / Nomination for the William Farr Medal of the Worshipful Society of the Apothecaries of LondonIt was agreed that Dr John O’Brien’s name would be put forward to the President’s office as the faculty nominee.
6.06.13 /
Strategy meeting in November, 2006: 15 Belgrave Square
It was agreed that this should be a full-day meeting, attended by outgoing and incoming executive committee members, and by regional representatives. The meeting will have an outside facilitator.Action: diary
6.06.14 /Honoraria for executive committee members’ secretaries
The College will only support costs requested for faculty officers’ secretaries. It was suggested that regional representatives’ secretaries might be elilgible for some divisional honoraria.6.06.15 / College consultation on association with the College without the MRCPsych
Following discussion, it was agreed that Dr Connelly would send a response on behalf of the faculty, with members enouraged to reply individually.
Action: PC, all members
6.06.16 /Department of Health’s older people’s specialist forum
Dr Forsyth reported that the first meetings of the forum, which would be chaired by Professor Ian Philp, would take place in September and December, with faculty representation requested. The forum intended to produce position statements aimed at influencing policy. Interested members should contact Professor Benbow as soon as possible.Action: all members, agenda
7.06 /REPORT FROM FINANCE OFFICER
Dr Ong reported a faculty credit balance in the region of £62,000, of which £10,000 was designated to the day hospital project.7.06.1 / Proposal for SpR and SAS members 25% discount on faculty meeting delegate fees
Dr Ong reported that this had been put in place from the 2006 residential meeting. Dr Ong will detail all present arrangements on faculty finances, including bursaries and criteria, to hand over to his successor later in the year.
Action: YLO, agenda
7.06.2 /Proposal to fund reprinting of the College’s ‘Partners in Care’ campaign leaflets
The cost of £1,266 was supported for a faculty-relevant leaflet.Action: YLO
7.06.3 /Administrative system for faculty prizes
It was agreed that the faculty chair should advise the names and addresses of successful candidates to Katie Hillman in the postgraduate education department, to Gill Gibbins and to the faculty finance officer, who would request cheques to be sent to the faculty chair to accompany a letter of congratulation. Katie Hillman will ensure that the candidates’ names are recorded and are read out at the College AGM.Dr Ong undertook to check the present faculty prize regulations and administrative details to see whether any change was required for the next edition of the College booklet on prizes, lectures and bursaries.
Action: YLO
8.06 /POLICY
8.06.1 /Cross-jurisdictional issues
8.06.1.1 / Services for younger people with Alzheimer’s disease and other dementiasThis report is in production.
8.06.1.2 / Revision of CR 103 ‘Psychiatric services for black and minority ethnic elders’, 2001
Dr Ong reported that the revision working group would meet in June and would present a report on what might be required.
Action: YLO, agenda
8.06.1.3 /Revision of CR 119 ‘Forgetful but not forgotten’, 2002
As this only became available in print in 2005 it was agreed to advise PPC that the faculty would review the paper in November 2007.Action: 11/07 agenda
8.06.1.4 /Revision of CR 126 ‘Covert administration of medicines’, 2004
It was agreed to advise PPC that the faculty would review this in March 2007 when the Code of Practice/Capacity Act might have been assessed.Action: 3/07 agenda
8.06.1.5 / Position paper on speech and language therapy provision for people with dementia: from the Royal College of Speech and Language Therapists (RCSLT)It was agreed that Professor Benbow would ask Professor Elliott to reply on the lines discussed, and to suggest that the RCSLT be involved in the faculty’s March 2007 residential meeting, and that the faculty be involved in the next revision of the paper.
Action: TE, RB
8.06.1.6 /Revision of CR 69 ‘The care of older people with mental illness: specialist services and medical training’, 1999
This paper will be re-titled ‘Raising the standard’. Professor Benbow undertook to circulate the final draft by email, following which production of 5,000 copies would be put in hand. Design costs would be £1,500 plus VAT. Dr Aquilina would place the final text on the faculty web page as soon as possible. Discussion on how the document would be distributed would take place at the June meeting.
Action: SBenbow, CA, agenda
8.06.1.7 /Faculty paper on non-pharmacologicals for web publication
Dr Jones tabled a paper; following wide-ranging review it was agreed that he would amend the text as discussed – any further comments should be sent to Dr Jones by the end of March, so that he and Dr Connelly could produce a final version for circulation.Action: all members, RJ, PC, agenda