Last week I asked for help with an area of grass at the road junction near to our park. The flower beds had been abandoned by the council 2015. They became neglected and weed-dominated. A local political group sought publicity by their public-spirited attempt to rescue the beds, but gave up in the second year. Since the our Friends group has quietly got on with the job, attracted a grant for replanting, used in part to donate to The Alzheimer’s society. The grassed area around has been maintained by the council, with the men taking pride in producing regular cuts. This year has been different – a man we do not know, with a machine we have not met before, has appeared to cut the grass. His machine is too big to get to the edges and fiddly bits – so they were growing apace. We asked if the man could not get off his machine and use a strimmer. Ah – No. But the strimming team will be asked to visit!
My personal journey through NHS secondary and tertiary services in the investigation and possible treatment of illness has revealed similar frustrating, costly and inefficient, ineffective fragmentation – everyone doing their job as described in some sort of contract – and passing me on to someone else with the real needs only partially met – Clinicians not allowed to follow up patients where their knowledge would be made best use of and they would gain satisfaction by seeing the individual through. Too many investigations, not enough reflection. Not person-centred – utterly organisation centred – but not able to achieve good outcomes. Outcome becomes – home at the end of the day, job list ticked, pay packet guaranteed – but we would like more money.
In creating effective and happy psychogeriatric services from the 1970s to the 2000s, one of our not-so-secret weapons, was to merge services at the edges: long-stay care linked with day care, long-stay NHS care linked with Local Authority and independent sector residential care, shared staff between Psycho-Geriatrics and Geriatric Medicine, social workers employed by the Local Authority but working with the NHS team, a Punjabi speaking member of the Sikh community leading as a CPN with the NHS team, Consultant Psychiatrists working within Primary Care. Hey presto – there are no boundaries. People are respected as people, they do not get lost of forgotten. They are the centre of everyone’s efforts. We share the learning, rejoice at successes, acknowledge the problems and do our best to correct them. There is trust, respect and satisfaction.
We do need some money, but we value love and humility more highly.
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