Dr Andrew Dayani Introduction

Hello from the new Chair

As the newly elected Chair, I thought this may be an opportune moment to introduce myself and lay out a little of my vision for the Institute, given all that is happening within the West Midlands.

So, Hello! My name is Dr Andrew Dayani. I am Executive Medical Director at Birmingham Community Healthcare NHS FT and was a GP for 21 years before moving into an Executive Director role. That gives you a flavour, but doesn’t tell the whole story, as I have also been an Occupational Physician, Community Hospital doctor and trained in Dermatology and Cardiology, whilst being involved in commissioning and medical politics. I like to keep busy!  Until last year I lived and worked in Somerset.

The most frequent question I get asked is ‘why have you moved?’ and answering that may allow me to start to tell you about what makes me tick and consequently the vision for the IAH. The answer is that I was born and grew up in the West Midlands. The further one gets from direct, patient facing care, the more important it is to have a strong link to the population served. For me that link is about feeling part of the community and the imperative to address health inequalities and consequently improve health outcomes. The changing demographic means that older persons care is a vital part of the puzzle to make the system work.

It is a sad reflection that across the West Midlands, there are many areas in which life expectancy remains well below national average. Of course length of life in itself is nothing without there being quality and enjoyment to be experienced. The statistics for many older persons shows that coming into contact with Health services is a life limiting event. Attendance at A&E results in admission to hospital. Emergency admission to hospital leads to dependency, core muscle wastage, loss of mobility  and increasingly failure to return home. 

The 1 year mortality rate in Care homes is 26 per cent (Age and Ageing, Volume 42, Issue 2, 1 March 2013, Pages 209–215)

Within the Sustainability and Transformation Boards there is recognition that admission to hospital is not the answer. We need to be more agile and pro-active rather than waiting for a crisis to intervene. Partly, this results from the inevitable stretch on primary care and community services, where funding has been largely static with consequent impact on staff recruitment and retention. But that isn’t the whole story. There has been a lack of change in the way care is delivered, failing to truly recognise the potential of multidisciplinary working or to recognise fully the expertise that exists. 

So, how do I want to see the Institute develop? I feel that this is an opportunity to bring together all parts of the multidisciplinary system to demonstrate positive leadership and publish what works well. We should be supporting small quality improvement projects as well as large scale research. I also feel that we shouldn’t be afraid of holding the system to account. The Institute was formed by a group of geriatricians in the 1970s. Times may have changed, we have learnt a lot and treatments certainly have improved in the last 40 years, but sadly there remains a lot to be done to improve outcomes. 

The Birmingham and Solihull STP are developing models of care based upon localities and neighbourhoods. As part of this work there will be a pilot to change the way in which older people are assessed and treated to make home the first choice for treatment. This requires a major change in the way in which organisations and teams work, across both health and social care. Fortunately, there is recognition that we cannot continue as we have been and collaboration and co-operation finally seem to be winning. 

In the 18th Century the Lunar Society brought about the Midlands Enlightenment. Perhaps the time has come for a similar movement in older persons health care.