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  • Still water 11 February 2019 | Comments (0)

    11th February 2019 | By David Jolley

    Wolverhampton does not have a river of any significance, but it does have canals. One of the pleasures of life there was to live on the bank of the Staffordshire and Worcester Canal at Newbridge. The Midlands has a network of canals, Birmingham bizarrely boasts a harbourmaster. These man-made channels were constructed to ease the transport of freight in the 18th Century. After many years of disuse and neglect they have been reinvented as a leisure facility for boaters, walkers and others; and affordable homes for more and more people. Currently there is real interest in returning freight to the canals of Salford, London and Leeds.

    The problem is that while bodies of water mean there is the possibility of floating along in one dimension, there is a block to those who want to cross to the other side. In some instances the lock system allows passage for people on foot, but for bigger canals such as the Manchester Ship Canal, something different is needed: Hulme’s Ferry continues an ancient tradition to help people across from Irlam to Flixton – at some times in the year https://irlamandcadishead.net/locations/hulmes-ferry/ . Cars and other vehicles need roads and bridges for their journeys. Traditional canal bridges are almost always narrow – not allowing the passage of larger vehicles and requiring their drivers and Satnavs to find another route.

    At Warburton a toll bridge crosses the Manchester Ship canal – using this cuts out many miles of main road and motorway travel when heading from Altrincham towards Warrington, Wigan, Liverpool and other North West towns. The cost is wonderfully 12p for a single journey and 25p for a day pass. I love the interruption of the flow to be part of this ancient ritual – but not everyone feels the same: https://www.manchestereveningnews.co.uk/news/greater-manchester-news/warburton-toll-bridge-queues-complaints-14817403

    So what is all this about? Well I think it is about finding your way – as in Pathfinders rather than Pathways. For there are some routes which suit some people and others which suit others. There are recent and modern routes, older and ancient ways. Beyond roads and canals there are railways, rivers, tramways and so on. Individuals will often want to go ways which use different modes in sequence, rather than stick to one. Sometimes you have to go a long way round to get where you want to. Sometimes you can use an older way and get there – but it may take time and research to learn about it.

    So it is with trains of thought or feelings – what is causing puzzlement, confusion or fear just now may be based in old times, old losses or mistrusts. Know about them and proceed gently. There will be a way.

     

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    Rant Control 04 February 2019 | Comments (0)

    4th February 2019 | By David Jolley

    Through the week we have exchanged thoughts about the learning from Gnosall’s successful memory service in Primary Care. That service, successful and sustained after more than 12 years, has generated international interest and added to enthusiasm for care of people with dementia and their families within Primary Care. Unhappily three attempts to extend the principle to other Primary Care services in Staffordshire and Shropshire have foundered.

    During this month we have been told that greater use of electronic technology for and by patients will make for much better use of resources and knowledge https://www.england.nhs.uk/2019/01/long-term-plan/ . This is something which one of our discussants has supported strongly. The problem is, I might venture, that much of healthcare need is amongst older people, some with dementia, and many of them are not computer-savvy.

    The Gnosall models brings clinical expertise directly to patients and families and that expertise remains available in the Practice throughout the life of individuals with dementia. The experience of the roll outs has been that everyone has liked the principle but that organisations have been unable or unwilling to accommodate them within gigantic, rule-ridden protocols which do not want to know about continuity of clinical responsibility or clinical freedom.

     ‘Large organisations cannot allow autonomy as it may affect the integrity both of the organisation as a whole but also the individual divisions.’

    And in that we have the essence of the problem: the health and wealth of the large organisations such as NHS Trusts or private sector providers has been allowed to become the first priority. What is best for patients, families and the health and wealth of the nation as a whole has been set aside.

    So we have an understanding. So we rant. Can we please regain control!

    Better use of technology may have advantages for some, but old-fashioned, person-centred good practice has so much more to offer.

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    21st January 2019 | By David Jolley

    This little phrase may be one of my own creation – Googling doesn’t find it – but does give: ‘In the same boat’, ‘On the same wavelength’, ‘On the same Page’, and ‘By the same token’. I guess that is where it comes from.

    Wolverhampton is about as far from the sea as any other town, or city, in England so my experience of boats is limited. The Black Country does have its canals and some towns are based on rivers, but boats have not figured greatly in my life. Dawn Brooker has used the metaphor of a riverboat journey as an alternative to the ‘pathway’ analogy. I find both too deterministic and restrictive. Individual journeys are so complicated, variable and have so many dimensions.

    Buses I do know. We travelled by bus and counted the numbers on the tickets when shopping with mum and when travelling to school, often it seemed in a soaking gabardine raincoat. Modern buses are huge – Double decker plus bringing hundreds of young ladies and young men to or from local schools. We travelled in an ultra-modern, plush coach to Southport for the North West in Bloom Awards ceremony this year.

    Last night I dreamt of a big bus carrying teams of people who I have worked with. We were travelling to places which need help to produce and provide decent services for older people with dementia and other frailties. We travelled first in confidence, knowing that we had the skills, the resources and team loyalties which would see possibilities, and support a reasonable life for individuals with difficulties and those caring for them.

    But then in the way of dreams, we found ourselves without a driver. Down to me then. But this bus seemed to be powered by electricity. No matter how long we sat at the charging station, we never got the signal that there was enough power to carry on.

    I am not having that. We’ll get off and walk

    Medscape recently gave Charles Dickens claim to the having described the interpretation of dreams before Freud https://www.medscape.com/viewarticle/906730?nlid=126771_425&src=WNL_mdplsfeat_181226_mscpedit_psyc&uac=164450HY&spon=12&impID=1844188&faf=1

    I was not impressed because the bible told us long ago of the Joseph’s prowess in this matter. https://www.theologyofwork.org/old-testament/genesis-12-50-and-work/joseph-genesis-372-5026/josephs-interpretation-of-dreams-in-prison-genesis-3920-4023

    I think my dream is pretty transparent. Reliance on the latest technology and ‘systems’ leaves us flattered to despair.

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    ‚Äč18th January 2019 | By David Jolley

    Our Dementia Conversation this week included a young woman who provides a specialist service for people who have difficulty finding shoes which are the right shape, comfortable and maintain or improve their gait. One of the keys to her entering this field was the difficulty which a family member had, following a number of strokes and the emergence of dementia.

    Feet are so important to us and we know that some people neglect their feet for want of being able to reach them, lack of money to afford chiropody, or not noticing as things get worse and worse. Chiropodists love to show you bottled and preserved examples of overgrown nails from great toes – onychogryphosis www.healthline.com/health/onychogryphosis

    Strangely I have not found a study which looks systematically at the prevalence of such problems amongst people with dementia but it would be worthwhile. There have been such studies of dental problems https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1754-4505.2003.tb00283.x and I remember a project from the Salford Psychiatric Register which did this too. Difficulties arise in similar fashion at the two ends of the body – lack of awareness and loss of routines initially, complicated then by resistance to help which is too easily seen as an attack.

    We diverted to comparing stories and views on best practice when someone with dementia requires to be seen by a specialist – for help with feet, teeth, hair, clothing or whatever. Some people insist on seeing the individual with dementia just by themselves. This may be seen as confirming their personhood and individual dignity. There can, however, be problems if the individual with dementia is unable to describe their difficulties, and may simply deny that there is a problem. A supplementary ‘history’ from a carer is invaluable – as is the presence of a carer to take note of what is said so that the necessary action is understood and can be done, with feedback of the outcome to the professional. Everyone agreed that carers should not hog the discussion and we must avoid being lured into being the only one talking to the expert. As in most things, adjustment according to the circumstances will be best – rigid guidelines are not helpful.

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