Driving improvement in difficult times

This year, the annual congress of the Association for Perioperative Practice (AfPP) focussed on the theme of Managing perioperative care within changing environments – reflecting the major changes currently taking place in the healthcare landscape. Professor Jean White, Chief Nursing Officer (CNO) Wales/Nurse Director NHS Wales, addressed this theme in the Daisy Ayris Lecture, at the start of congress. “We are being presented with unprecedented challenges – not just in the theatre environment, but throughout the public sector. These are difficult times for all of us,” she commented. Prof. White outlined some of the challenges ahead – including those posed by demographic changes. Improved life expectancy is to be celebrated, she commented, but it also presents some major challenges. People are living longer and the average life expectancy for men is now 77.2 years and 81.6 years for women. Many will have a reasonable period of health past retirement age. However, the gap between the higher and lower socio-economic groups is widening. “People in the lower socio-economic groups are having longer periods of ill health – while those in most need have the least access to care... This is a real problem in our society that must be addressed,” she warned. Prof. White went on to stress the importance of tackling health inequalities. In Wales, over a 5th of the adult population are smokers. She explained that this presents an issue for theatres, as these patients are more likely to experience complications. In addition, 57% of adults are obese or overweight – leading to problems such as diabetes and other comorbidities. 1-in-3 children are also overweight or obese. “When I first started out in perioperative practice, in 1982, I hadn’t heard of bariatric surgery. Today it is extremely common. There will be consequences arising from these public health challenges – Governments across the whole of Europe are currently struggling with these issues,” said Prof. White.

Dementia: impact on the acute sector

Due to an ageing population, theatre teams will encounter an increasing number of patients with age-related health conditions – including diabetes and COPD, which will need to be given consideration, she warned. However, of particular concern will be the ‘Tsunami of dementia’. Prof. White explained that there are currently 35.6m people with dementia worldwide, but, as people live longer, the numbers are set to double by 2030 and triple by 2050. “As more and more people live to an older age, we are going to have to get a grip on how we care for patients with dementia in the acute sector. What are the requirements of dealing with a patient with dementia who presents with a chest infection for example? Dementia is going to be a ‘background’ factor that we will have to deal with – along with the consequences, such as falling, or patients not caring for themselves. The burden on carers is going to be very substantial,” said Prof. White. This trend is emerging at a time of changes to the benefits system and coincides with an economic crisis, she pointed out, adding: “How we deal with these challenges is very important. There is a great danger that money will become the only issue that we worry about. We have seen far too many instances in which organisations, health boards and Trusts have focussed on money at the exclusion of other things. Of course we have to ensure that every penny counts, but we must ensure that we do not lose sight of why we are here – we are here for patients.”