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  • Asylum 09 April 2018 | Comments (0)

    2nd April 2018 | By David Jolley

    This week I received a beautiful picture card from a friend who has sought refuge and peace in the beauty ruggedness of North Wales. It carries the sea and sky, land of an island and rain between.

    This is not the North Wales of beach, pebbles, running tides and friendly shops and cafes which I remember from our childhood. It is something more grown up and powerful. There are parts of the country where people find retreat, healing is a local industry. Generations of children from the North West and the Midlands spent days and months in the cold sanatoria which cared for them and their tuberculosis in North Wales. My first appointment as an SHO in psychiatry was at the North Wales Mental Hospital, Denbigh. Built a short distance from the town and its castle, its creation was to counter the disadvantage being experienced by Welsh speakers who were admitted to English Mental Hospitals http://northwaleshospital.btck.co.uk/

    ‘Denbigh’ is now closed, abandoned and its remains damaged by fire. I spent only three months there before moving to South Manchester. They were months which burned, maybe scarred, memories which I will never forget. The staff were impressive, caring, well-educated local people. Healing was a major local industry, alongside farming which was perhaps less dominant than had been. Doctors at the hospital base were an assortment of long-serving individuals with characteristics and limitations of their own. Consultant Psychiatrists ranged from the young and ambitious to the older ex-military, and were often away from the hospital at clinics dispersed across the wide territory of the whole of North Wales – as far down as Aberystwyth. Life and therapy in the attractive villas with in the hillside grounds was good enough and encouraging for recent admissions. Living and dying for old people within the bowels of the old part of the hospital was as dark as anything I have ever seen. Cot beds, contractures, reflex use of antibiotics, forty bodies to every single sex dormitory, a cockroach run at night time.

    A review of budgets told how little was being spent on people here in comparison to nearby general hospitals. There was less heating, less food and fewer staff. We did the best that could be done.

    This is a component of the changing scene which it has been my privilege to be part of. I look back in horror but not regret. This was the base from which marvellous changes have been made and we have been part of. Some of these advances have come from better medicines, but much more has come from greater awareness and wider involvement of caring people of all descriptions. Much of this has gone on and continues to be conducted, in the places where people live their working and family lives. Part of the movement saw mental illness become included within the general hospitals, first of the North West, and then throughout the UK. https://www.cabdirect.org/cabdirect/abstract/19702701868

    There is much more to be said about this and where it has led us. But for now, to reflect that even now we find help and therapy in the physical environment of North Wales and other blessed landscapes. Neither approach need be exclusive of the other.

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    27th March 2018 | By David Jolley

    Having gone through the final iterations to agree a version of our chapter on carers’ needs for George Tadros’ coming handbook on liaison psychiatry, I am saturated with the facts and arguments for good practice. It all seems so familiar, so much common sense and so widely known that I was wondering if it needs saying again.

    I met Marlene on Sunday. She was hardly recognisable for the anxious, thin, uncertain figure that I have known these past 18 months. She looked taller, fitter, and her hair a fountain of curls above a confident, smiling, caring face. George’s struggle through the last stages of dementia has been completed and she has her life, her home and her involvement with friends and the world outside to be lived again.

    She has memories of their long and happy years together, and reminders of them around her. Unhappily there remain the memories of the very last weeks which were spent in a general hospital ward where the regime and individual nurses were ill equipped or disposed to understand and provide for his needs and hers.

    ‘In those weeks he ate hardly anything. They gave him chips and sandwiches – things he could not cope with. I took him treats myself but they were not enough.’

    Then two new nurses came to the ward.

    They had worked on a unit which specialised in people with eating problems.

    ‘This is no good.’ They said out loud – and went off to their previous unit and obtained suitable supplements and preparations which he could manage. He ate and drank them all.

    ‘They took time with him – and in those last days I knew he would be OK. I thank God for those nurses’

    So it may be common sense to many, and it may have been said before, but it needs repeating over and over.

    Writing a chapter is all very well, but how widely will the handbook be circulated and read?

    Could we have a poster prepared which would be placed on every ward?  People with dementia and their carers are to be found on nearly every ward in every hospital.

    Can we worked toward a system where every ward is supported by/owned by a Friends Group – who will monitor what goes on – and contribute to the quality day by day by their presence and modest contributions?

    It would be a good thing to do but there is likely to be resistance in many places – Just the places where the arrangement is most needed

    I wonder if we can muster person-power to do this in our local hospital. Would it be the first priority for people’s time and energies? Mostly it would be something that needed experience of caring for a loved one living with/dying with dementia. It could not be taken on by current carers – they have more than enough to do already.

    Maybe it is something to think of in the life after the death of the individual who had dementia – for immediate carers or other whose lives were affected.

    We keep thinking, and saying, that if we get it right for people with dementia, it will be right for everyone else too.

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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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