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  • Moving spirit 19 September 2017 | Comments (0)

    18th September 2017 | By David Jolley

    This week the Guardian carried a story of research which suggests that sitting for long periods without interruption is associated with early death and morbidities on the way to death https://www.theguardian.com/society/2017/sep/11/moving-every-half-hour-could-help-limit-effects-of-sedentary-lifestyle-says-study

    It is a long time since Professor Jerry Morris reported the different life expectancies of bus drivers (who sit) and bus conductors (who don’t) www.epi.umn.edu/cvdepi/study-synopsis/london-transport-workers-study/. It was a classic study which confirmed that being active is a powerful preventive medicine. The most recent study does no harm in reminding us of this.

    A very simple arrangement leads us to host a weekly walk on our park. We meet at the bowling pavilion and walk for about an hour, then have a cup of tea and simple refreshments whilst putting the world to rights and sharing news. Our walks attract about ten people most weeks. Most are ‘getting on’ and/or have some sort of pathology. These may include dementia – we are ‘dementia inclusive’, not ‘dementia exclusive’.

    We are part of a network of such walks loosely organised by Walk for Health: www.walkingforhealth.org.uk/ The initiative for this came from Macmillan nursing out of their understanding that walking improves life and life expectation for people with a diagnosis of cancer. As for cancer, as for dementia, as for life with or without any pathology.

    A marvellous development in Trafford, has been the initiative of one General Practitioner in Sale Moor. She invited all her most vulnerable/suitable patients to join a weekly walk from the clinic building. Over 100 came the first week – this has settled down to about 30 regulars – but how wonderful this is. The links between a voluntary initiative and our brilliant Primary Care services is a magic model for the future.

    The hope is that other Practices will follow her lead – We will try to monitor the success and the impact which this makes on the physical, emotional and cognitive health of the people – and their need for services.

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    Harvest Home 19 September 2017 | Comments (0)

    11th September 2017 | By David Jolley

    We planned it. The local paper ran a little story and we posted flyers to local homes. Lots of people brought fruit and vegetables as well as tins and boxes of food – to decorate the church and to use every sense to say – This is harvest!

    Saturday morning there was a gathering of willing helpers to ‘dress’ the worship area. We had apples and pears, bananas and grapes and oranges, a pineapple, two marrows, squashes, cabbage, cauliflower and all manner of salad things. There were flowers and specially made plaited bread – in pride of place and on the altar.

    A local farm provided two smallish bales of straw. (Quite big enough). ‘What a mess they make!’ But what a strong message of size, shape, colour and scent.

    That is how it was – We walked into a special place. ‘It’s like a barn’.

    With music to match and friendly closeness amongst people of all ages. This is timeless.

    Reverend Ros beams welcome

    Hymns and Psalms:

    355 Come, ye faithful people, come,
      Raise the song of harvest home.
    330 All things bright and beautiful,
      All creatures great and small.
    352 We plough the fields and scatter,
      The good seed on the ground.
    342 For the fruits of his creation,
      Thanks be to God.
    333 For the beauty of the earth,
      For the beauty of the skies.

    We knew the tunes. We knew (most of) the words. 

    The text took us to consider the seed and the soil. Matthew Chapter 13. There is quite a lot to be considered when you take in the accumulation of the ever circling years.

    So important. So basic.

    We can all be secure in this.

    After the service we were welcomed to a school-room prepared with refreshments – tea and coffee or juice – cheeses, bread, sausages, pies, chopped vegetables and salad, cakes and biscuits, fruits and crisps. All served with gentle joyfulness – and we talked for longer than we’d thought.

    There were children playing with model farm animals – and now more children and parents – The village picnic has to move indoors because of the threat and reality of rain.

    All creatures great and small – competent and less able – all at home in this.

    And you know afterwards the food and such was distributed, the tables and chairs and crockery were washed and dried and put away safe. The bales went back to the farm. The carpets were hoovered. No mess was left behind.

    But we knew we had been somewhere special.

    Celebrations like this were a Victorian invention – but they were extending and adopting festivals which have given thanks for the goodness of the Earth over centuries past.

    We will never stop giving thanks for this.

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    4th September 2017 | By David Jolley

    First mists on the park yesterday to join the cobwebs which tell us autumn is here. Apples and beans collected and shared with friends and neighbours – and next Sunday we will hold a ‘Traditional’ (old fashioned) harvest festival with special breads, bales of straw and unashamed fresh vegetables, fruits and salad. It will be ‘Dementia Friendly’ in an inclusive rather than exclusive sort of way.

    Schools will be back on Monday, with some children we know going to new schools. Our version of this is the recommencement of our Friday seminars. The introductory session says hello to new trainees and gives chance for others to catch up on summer adventures. We read through Don Williams’ piece from the Guardian – ‘the article that changed my view: Research – the enemy of scholarship’. The essence of his observations is that the pre-eminence of clinical work, support by respect for the wisdom of previous generations, with teaching firmly hung on case examples, has been usurped by academic research, supported by large grants. Involvement in research, receipt of multi-million pound grants and publication of multiple papers are the things which have greatest kudos and attract the highest salaries. It is a model which detracts from clinical work and clinical teaching. It drives services, via government and management interventions, from a paper base which often feels to be detached from the real world of patients and their need for continuity of care from mature clinicians in confident and secure teams.

    The experiences and thoughts of the trainees amongst us were particularly interesting. We learned that another northern university has lost or given up its academic department – It was deemed to be failing by the university as it was sufficiently successful in bringing in grant monies – no regard for its influence on the quality of clinical work or teaching. This has led to the perception amongst trainees that ‘nothing is happening here’, and an exodus to other centres which retain their professors etc. Recruitment to psychiatry, including recruitment of doctors who will work with older people, is difficult enough, but it is possible in the longer run that this will prove to be a healthy change. Perhaps the ambition for all centres to house an academic department has gone too far. Many of us would agree that the extension of university status to former technical colleges, colleges of art and such, is at best a mixed blessing. Some rethinking might be worthwhile.

    The perspective from a general practice trainee was that there is much less of a hierarchy. Certainly research is not given the dominant roll, with greater emphasis on guidelines, clinical teaching and audit. That too sounds a healthy arrangement, but we know that general practice, like psychiatry, has difficulty with recruitment. Tracing things back to source, we reflect that what is taught to medical students and how it is taught and by whom, is likely to mould the values of those being taught. So it is that increase in medical student numbers has not resulted in more opting for careers in the less fashionable disciplines of general practice, psychiatry and care of older people: more and more see themselves as high-tech wizards in the specialties of what was general medicine or general surgery. And though there are academic departments which shy away from their teaching responsibilities to free time for research, the teaching generally lauds their work. Who sets the examination questions? Who make the awards which give access to a career? So we have a range of thoughts on all this and are grateful to Don Williams for bringing the matter to the table. Our balanced view emerged as a wish to acknowledge the equal value of clinical work, teaching and research, maybe even management. Within this flatter landscape, individuals might give more time to aspects of their work at different periods in their careers. I wonder if and how we could get back to this.

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    28th August 2017 | By David Jolley

    A close friend and colleague was reflecting rather sadly on the changes he/we have seen in careers of 40 years. He was focussed on the failings which are still evident in attitudes, values and the quality and availability of services for older people and for others who are vulnerable and in need of help of one sort or another. Beyond that, the politics of this country and other countries, not to mention the local politics of trusts and universities are bewilderingly lacking in warmth or sparkle.

    But I would say, we take all this – but despite the disappointments – we have seen amazing and worthwhile changes. We have had a hand in these – We have changed the world.

    Amongst these changes the care of older people, including those with mental health problems (within which dementia is important but not alone), is taught to doctors, nurses, social workers and a long list of health and social care professionals and to people working in other fields. The reality of neglect and abuse of residents of large mental hospitals and other chronic sickness facilities, has been recognised and action taken which has closed the mental hospitals and sponsored more supported care at home (not enough) and in care homes (not enough and not sufficiently funded). We have seen the emergence of novel arrangements of ‘extra-care’ and strengthening of charitable organisations, patients and carers to have a say in what is being done. It is not enough but it is a far cry from what we knew in the 1960s.

    Don Williams has helped with his contention that ‘Research is the enemy of scholarship’ The article that changed my view … of how research affects medical training

    He quotes Dr Walter Gratzer’s article in the Guardian of 1979 which questioned the growing belief in research as the great and only source of all good:

    ‘research is bad for teaching and teaching is bad for research’, ‘research is the enemy of scholarship’. Gratzer had cited Benjamin Jowett who wrote in the nineteenth century that ‘research is merely an excuse for idleness’.

    Don’s career has been that of a great clinician, scholar, teacher and researcher. His research has been generated by his clinical observations, and entirely relevant and practical. His unhappiness comes from the distortion which has reversed the previous hierarchy: ‘If you can do good clinical work – you are golden. Them that can’t – teach. Them that can’t teach – do research’. Research accompanied by grants and publications are now seen as most highly regarded, and most likely to attract additional financial reward.

    More than that, the pole position that management now assumes, was not dreamt of in the 1960s. Frontline – hands-dirty – nous, tuned by an apprenticeship and respect for the scholarship of previous generations, is all-but set aside.

    Products of this change include brilliant and comprehensive reviews like the Lancet Commission on Dementia http://www.thelancet.com/commissions/dementia2017

    This covers 62 pages and cites 665 references – you know there could be many more – several are meta-analyses of multiple funded studies of particular topics. It is impressive and it is useful, but does it thrill you to commit your life to this sector? Can it be translated into a coherent clinical practice which rides the subtleties and changes of real-life with dementia or a related condition? Will it make life better for people with dementia and their families?

    It takes my breath away. I want it back again. (Travelling Wilburys). 

    I think we should be pleased with the progress which has been made within the world which we have been able to influence. It is right, however, to say that there are aspects of the worlds around it which we would wish were different – and have again some features which allowed us to move forward in the 1960s and for some years afterwards.

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