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  • 19th March 2018 | By David Jolley

    I have been able to attend the Association for Public Service Excellence (APSE) Parks seminar at Mere Golf and Country Club. It proved to be an impressive and informative day, making us aware of a range of facts and statistics and several examples of good practice.

    The day was chaired by Wayne Priestly – principal adviser on parks. He introduced the day with reference to the political and economic situation and let us know that Paul O’Brien (CEO of APSE) is included in the Parks Action Group https://www.gov.uk/government/news/government-pledges-500000-for-new-action-group-to-grow-future-of-public-parks

    They welcome suggestions for questions to be asked. They ask for comments on priorities for funding by the Heritage Lottery Fund.

    First main talk came from Councillor Peter Golds of the Local Government Association. He is a councillor in Bethnal Green and referred to its history and origins in the Old Nichol one of the grimmest areas of Victorian London https://en.wikipedia.org/wiki/Old_Nichol . It now has become Boundary Estate, one of the first developments of social housing https://en.wikipedia.org/wiki/Boundary_Estate. A recent survey found that residents’ greatest wish is for a bandstand!

    The message was that cities need parks and green spaces. He told us that there will have been a 75% reduction in spending on parks by 2020 (from 2010 I think). This equates to a reduction by £5.8 billion (not sure over what period – per annum or per decade – whatever – it is a lot!)

    He believes that if parks are left to deteriorate there will be a public outcry. (Seems to me that some parks – eg Stamford Park – have been allowed to deteriorate. People are upset and there is need for action).

    He drew attention to impressive innovations, which demonstrate how improvements can be achieved despite the economic and political gloom:

    Newcastle upon Tyne: www.newcastle.gov.uk/news/future-newcastles-parks-decided

    Knowsley: http://knowsleyparksboard.co.uk/proposals/

    Councillor Golds warned that some major and well-meaning social housing initiatives have gone badly wrong. He cited new towns created after WW 2 – some were badly sited and lacked a balance of amenities: in addition to houses, towns and cities require schools, libraries, museums, open spaces, transport, lively shopping areas, restaurants, police and other ingredients.

    A final throw away was to be flexible and responsive to new ways of living: one specific example of providing for barbecues might be something we could consider www.clinkhostels.com/london/guide/barbeque-parks-london/

    He also mentioned his own experience of work with the Green Candle Dance Company which involves young and old, including people with dementia http://www.greencandledance.com/

    Paul O’Brien, CEO of APSE spoke next and shared the statistics from their annual survey of parks, which was published on the day

    http://apse.org.uk/apse/index.cfm/members-area/briefings/2018/18-11-state-of-the-market-2018-local-authority-parks-and-green-spaces-services/

    This catalogues the decline in funding and the consequences which had been trailered by Councillor Golds. As a proportion of GDP, spending on Local Government is now lower, at 6%, than it has been in 80 years.

    He referred to The Graph of Doom www.theguardian.com/society/2012/may/15/graph-doom-social-care-services-barnet. This traces the increase of need for care within society with greater number of frail older people, and sets it against falling budgets to provide all services, including parks – parks being vulnerable, as they are not a legal requirement for local authorities.

    Despite this 72% of parks’ services are delivered in-house. He told us that where authorities have outsourced parks, most have taken them back in-house after a short time. 56% of park services are integrated with street services and 91% of authorities now have Friends groups for parks.

    There is greater public satisfaction with parks than with other local authority services.

    Telford and Wrekin are pioneering a £2m venture linking parks with Public Health (I have not found an internet link to this)

    Income generation: highest from sport pitch hire

    Strong case for direct provision: Look before you leap. TINA (There Is No Alternative!)

    Future for success:

    Parks champion on the council

    Parks more flexible

    Parks with community involvement

    Parks using crowd funding

    Parks linked with health initiatives

    Next was Nick Grayson a ‘sustainability manager’ from Birmingham. Nick is a scientist/researcher/guru and with colleagues has helped Birmingham to be Global leading Green city https://www.theguardian.com/cities/2014/apr/03/birmingham-san-francisco-oslo-global-green-biophilic-cities-club

    He too told us some history – with local authorities being ‘allowed’ to create public parks from the 1840s under Public Health legislation. NB ‘allowed’ rather than required to and this is still the case.

    He then warned us that all our prejudices were about to be challenged and debunked.

    ‘Human beings – only 10% of our cells are human’: That surely has to be nonsense – but apparently there are nine times more bacterial cells within the framework of an individual human being than there are human cells! http://bigthink.com/amped/humans-10-human-and-90-bacterial

    He took us on then to consider how we can lobby successfully for more and better parks and green spaces in cities. One problem is that decisions are made by gut feelings rather than logic thinking. https://www.telegraph.co.uk/finance/businessclub/management-advice/10874799/Gut-feeling-still-king-in-business-decisions.html

    I don’t think he told us how to get around this.

    He confirmed that wealth is made in cities and went on to introduce the notion of five forms of capital, following ‘Forum for the future 2013. www.forumforthefuture.org/project/five-capitals/overview

    Natural capital, Social Capital, Human Capital, Financial Capital and Manufactured Capital.

    The most essential of these is Natural Capital and we need to work on this with long horizons – 25 years rather than short term projects, which focus on finance.

    He gave us references to books, which will help us understand all this and turn out own city environments into Biophilic Cities:

    His own book (he gave us a printed copy)

    http://liveablecities.org.uk/sites/default/files/outcome_downloads/littlebookofecosystemservicesinthecity.pdf

    What has nature ever done for us? By Tony Jupiter

    www.amazon.co.uk/What-Has-Nature-Ever-Done/dp/1846685605

    Happy City by Charles Montgomery

    https://www.penguin.co.uk/books/177643/happy-city/

    Fascinating – but we have a lot of work to do to understand it and then find colleagues who can help us interpret it.

    This was a day for opening eyes and for putting flesh to fumbled notions of what needs to be done and how it can be approached.

     

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    12th March 2018 | By David Jolley

     

    Wednesday proved to be a surprising day. We met at a church on a hill near Werneth Low. The church has an extension, which was built only five years ago – sponsored by a donation with vision, supplemented by the church itself. This is good news and at odds with the picture of decline in church membership and perceived relevance. Five years on the extension is comfortable, busy, well used and well equipped: looking good.

     

    This day was ‘Action on Dementia’ and was to consider what churches can be doing.

    The Archdeacon set people at ease with his personal ownership of the dementias community. ‘Seeing the change which occurred to my strong and able grandfather in his last months, as he became frail and unable to hold a conversation, was shocking and has never left me’.

    The very best of local GPs ran through the basics of what dementia looks like and what pathologies underlie the clinical symptoms. People responded warmly to his trusted exposition. One lady shared her observations of a relative who had Fronto-Temporal Dementia and progressed to Motor Neurone Disease. This way learning comes naturally and with real meaning.

     

    There were contributions from a man who thanks God for his faith and for the love and support of friends and family as he continues life with a diagnosis of dementia. New staff from Willow Wood Hospice pledged themselves to pick up the threads of good work there, which has established the power of a palliative approach toward dementia wherever it is encountered and however advanced it has become.

     

    We all joined the reminiscence tunes of Oldham’s ‘Singing for the Brain’: from Daisy, Daisy to Que Serra Serra. This was thoroughly enjoyable and brought us into the afternoon in lively spirits. This was just as well for we were then privileged to hear about two more local initiatives:

     

    The Moravian Church at Dukinfield provides a dementia café which it calls Dementia Warriors. http://www.moravian.org.uk/index.php/uk-congregations-list-for-the-moravian-church/lancashire-district/dukinfield. This offers a range of activities and generous fellowship. The enthusiastic description of how money was found to fund this and then spread wonderfully thin, we heart-warming and even entertaining.

     

    Deb’s Fidler is a young woman who came to Mottram as a youth worker. http://www.mottramec.co.uk/index.htm. She is good at this and has been effective and successful but she knew, and her pastor appreciated, that her unfulfilled wish was to develop more activity for older people, including those with dementia. The result is a vibrant visionary opening up new ideas to actual practice: mixed age activities including a café, trips to places of interest, big nights out and ‘Mottram Monday Matinee’. MMM is a regular recreation of cinema, as it was with red velvet curtains, ices at the interval and films which are classics from years gone by.

     

    People are drawn in and benefit physically, emotionally, socially and spiritually.

    You have to believe it – It happens in Mottram (which was the adoptive home of L.S. Lowry for his later years).

     

    Debs is studying spirituality amongst older people at Cliff College: http://www.cliffcollege.ac.uk/students/shortcourses/cliff-certificates/certificate-in-ministry-among-older-people/

     

    Follow that with a dementia network meeting at Willow Wood Hospice and the sharing of great practices there: Public Health are leading on Dementia Action Week – which will include music from a Sax Quartet. There is a concert later this week. Several new dementia cafes have been established. Willow Wood is offering a new counselling course for carers of people with dementia.

     

    Quite marvellously the two relatively new Admiral Nurses who are employed within Tameside general have support for several pioneering ideas for people with dementia and their carers. They have attracted interest from a trainee anaesthetist who developed activities for patients with dementia at his previous hospital and wants to help here too.

     

    A day like this. A week like this. What more can we ask for? What can I say?

     

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    5th March 2018 | By David Jolley

    Time to look forward to the Dementia UK Congress in Brighton in November. It is good that the congress has moved around the country during these 12 years but, even though the series started in Bournemouth, Brighton has become its natural home. I’ll not forget my first Brighton Congress – walking down the hill from the station past relaxed pairs who were playing chess on the pavement. Playing chess on the pavement! It is a message which we can all take as our own: whatever the mad, mad, wicked world is up to – I will find time and a place to do life well.

    What I am wanting to do is to celebrate good things which have developed in recent years – and prospects for even better – but also to pay respect to where we came from and how improvements have been achieved. Learning from the past gives sound direction for the future.

    It is difficult to remember that, before Martin Roth performed his careful description of the clinical characteristics and outcomes of older people admitted to Graylingwell Mental Hospital, all serious mental disorders of late life were commonly pooled under the label ‘senile psychosis’. From then on we have known that depressive states in later life are usually recoverable with the use of ECT or antidepressants which were introduced during the 1950s, delirium may end in death but otherwise usually resolves, but dementia persists and progresses to an early death.

    Roth M. (1955) The natural history of mental disorder in old age. Journal of Mental Science, 101, 281–291

    There were few studies of the prevalence and incidence of dementia. Those that were known included Roth’s classical series in Newcastle upon Tyne:

    Kay DW, Beamish P and Roth M (1964) Old age mental disorders in Newcastle upon Tyne: 1 – A study of prevalence. British Journal of Psychiatry 110: 146-158

    There were at least five people living with dementia in ordinary housing for every one in any sort of institutional care: institutional care at that time would be a long stay hospital or local authority home. There were very few care homes or nursing homes within the independent sector. There were no major charities devoted to dementia. The legislation of the time made scarce reference to issue of capacity amongst the rising number of older people affected by dementia. Life expectation for someone with a diagnosis of dementia and entering care was short with hardly any surviving for more than two years.

    Our understanding of the biology of mood disorders and dementia has advanced considerably during the past 50 years. The pattern of care offered to people with dementia is radically different now from that of the 1960s – a shift determined in part by response to exposure of the scandalous regimes practised in some institutions, but also by issues of economy and political perspective. The funding of care has become complex and contestable, legislation has changed and will change further.

    Perhaps a reflection on these changes which have occurred during a working lifetime will be of interest and give thought for plans for the future.

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    Our Friday sessions are lively and informative affairs. This week was almost exhausting in the range of topics which required a least a mention:

    We had Von Economo neurons and Super Agers: www.theguardian.com/society/2018/feb/19/scientists-unravel-secrets-of-superagers The story is that a study of the brains of 10 people, who had remained lucid and exceptional in the preservation of their intellect until immediately prior to death in old age, found unusual concentrations of the large bipolar neurons which were first described by Von Economo and colleagues 1925. For most of us the name is just about recognisable but has no links. Earlier studies have remarked on reduced or increased numbers of Von Economo cells in subjects with Autism. They are present in the brains of all the great apes as well as human beings. What the significance of these reported findings will turn out to be we do not know – but it gives an alternative to confinement to the cul-de-sac which the Amyloid Hypothesis has become.

    We are reassured to find that a meta-analysis confirms that antidepressants are effective. It is particularly satisfying that this elegant study, which is free of drug house sponsorship, found that amitriptyline – one of the oldest tricyclics – stands out as the most effective: https://www.theguardian.com/science/2018/feb/21/the-drugs-do-work-antidepressants-are-effective-study-shows This paper will bear closer examination in the future. 

    We will need to return to Alan Maynard, whose obituary is untimely but reminds us of his contributions to the change in thinking and values which has occurred since the 1970s: www.theguardian.com/society/2018/feb/16/alan-maynard-obituary

    Mostly we were swept along by unexpected enthusiasms released by the report which begins: ‘It could, if the results stand up, be one of the most dramatic medical breakthroughs of recent decades. It could transform treatment regimes, save lives and save health services a fortune….’ https://www.theguardian.com/commentisfree/2018/feb/21/town-cure-illness-community-frome-somerset-isolation

    The project has been described more fully previously:

    http://www.swscn.org.uk/wp/wp-content/uploads/2015/07/Community-development-in-Frome-the-GP-perspective-Dr-Helen-Kingston.pdf

    and in a current issue of Resurgence and Ecology:

    https://www.resurgence.org/magazine/article5039-compassionate-community-project.html

    The essence is that one General Practice in the village of Frome determined to break free from a model of treating illness, preferring to get to know people and to help them see themselves as individuals who are part of a local community. They brought together information of activities which might be of interest and have some therapeutic value and supported people in joining where they had previously been shy or reluctant. In Frome people like it and have derived personal benefits and contributed to enriching their community.

    This is an example of approaches which are being championed, especially by the palliative care community: www.kingsfund.org.uk/sites/default/files/media/Catherine_Millington-Sanders.pdf

    Wonderful – but it will never happen around here. It is all very well in Frome and maybe in Gnosall and rural Norfolk, but it could never work in urban Manchester – could it?

    The amazing turn of Friday was that there was a flush of excitement at the possibility of doing just that. Wythenshawe is made up of a series of village-like communities on much the scale of Frome. General Practices could become centres of similar social engineering for health and well-being. It will need more thought and work but we made a start by listing activities which might be core elements of most community networks:

    • Dog walking (animal welfare)
    • Community bus/taxi
    • Shopping
    • Men in sheds
    • Park
    • Handyman jobs
    • Intergenerational lunchtimes
    • Allotments

    Would Tesco help? – We heard of models based on sharing ‘out of date’ food to provide food for people who are short of funds and food but can learn how to make use of unwanted cast-offs to produce wholesome meals. 

    We heard of models from Scandinavia – Norway https://www.ijic.org/articles/10.5334/ijic.2217/

    So there is literature to help.

    But could we really do something like this in Wythenshawe?

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