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  • 11th April 2016 | By David Jolley

    Retirement from clinical practice was designed to free more time with home and family. So it is proving but there are growths which I had not predicted. These include deeper appreciation of John Leigh Park: http://roundhoundcouk.ipage.com/index.html

    We have a grant to erect a chestnut paling fence around the garden of the bowling green: the grant money gives us the palings, stakes (need some more because my sums were embarrassingly wrong!), stretchers and struts. You can see the technicalities. Putting the fence in place requires effort and some expertise from our volunteer group. We are about one third of the way round the 600 feet so far – and the result is quite as thrilling as anything I have ever done.

    Being there and being identifiable as ‘parkies’ meant that mums alarmed by the presence of bees in the playground:

    ‘Bees in the Playground’ – rekindling memories of Dog in the Playground http://poetry.clusterup.com/poems/dog-in-the-playground-837. Many happy bedtime readings.

    Bees in the playground – with help from experts in Trafford - were recognised to be Tawny Mining Bees https://www.buglife.org.uk/bugs-and-habitats/tawny-mining-bee which are harmless and charming. Reassurances to mums and a notice made up to inform others who might be unsure.

    All this in the open air and within five minutes’ walk of home.

    Opening the box labelled ‘Dementia Conversations’ at Bowdon Vale means finding out more about services in Trafford – This is where we live and have lived for over 30 years but though I have worked in Manchester – South, Central and North, Salford and Tameside – I have not worked in Trafford. It is a new world. With a little help from friends I will get to know it better.

    In amongst rummage I found references to the dementia component of the Greater Manchester Health and Social Care Devolution – or ‘Dementia United’.

    I am puzzled and taken aback by some of the statements and aspirations:

    ‘Greater Manchester currently spends £221m per year on dementia across health and social care. If we diagnosed everyone on GM who we think currently has the disease this would raise to £320m per year. From these data we can estimate that the predicted cost to the taxpayer for health and social care currently provided for people with dementia across Greater Manchester will be £376.7m per year by 2021.

    Surely the logical response is to stop doing it – all it does is increase costs.

    ‘Develop a measure for Greater Manchester of the lived experience which can be tracked over the 5 year period and used to inform the effectiveness of changes.’

    A unitary measure of lived experience for people of either gender, age band, social settings, race, faith, previous complex personal experiences over many years! This will take some doing. Emperors and suits of clothes come often to mind and here is another instance.

    ‘Every person living with dementia will have access to a key worker 24 hours per day, 7 days per week who will support them to live well with dementia.' 

    'Every person living with dementia will co-produce a package of support and care which meets their needs and wants which is reviewed and updated at least once per year’.

    During the time I was a trainee with Tom Arie he was approached by a Public Health colleague who wanted us to extend the pioneering Goodmayes service to include everyone who might have dementia, depression or other mental health problems. The wise man said:

    ‘Let us do what we know how to do for those people whose needs become declared. This is a realistic ambition’.

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    4th April 2016 | By David Jolley

    Where are we now? 

    How did we get here?

    How will we move on?

    You would think it is easy to know where we are and the journey which brought us to this time and space.

    Reminiscing during the week, a social science colleague reflected on the poverty of thought amongst present day psychiatrist and remembered with affection and awe, conversations with clinical phenomenologists of the past. 

    Manchester was the centre of phenomenological psychiatry during the late 1960s and into the 1970s. Working from the small unit housed in the Manchester home of Elizabeth Gaskell, Professor Anderson and his colleague Dr John Hoenig championed the approach based in the works of Karl Jaspers and others from the University of Heidelberg http://www.britannica.com/biography/Karl-Jaspers

    Anderson had retired and given way to Neil Kessel, and Hoenig had just departed for Canada when I came to Manchester 1970 as a trainee. Their teaching and tradition lingered on and was inspirational in the depth and value we discovered in listening to patients’ experiences as we sought to understand them as a first requirement to providing help.

    The hierarchy of values placed clinical activity and expertise at the pinnacle, to be supported by teaching and research. Somehow, somewhere in the intervening years, despite the massive increase in funding and the number of professionals working in mental health, this order of values has been changed and respect for individual experiences given less weight.

    Understanding the present and future from the past can be helped by mapping and I have enjoyed and recommend the series of historical maps produced by Alan Godfrey of Gateshead: http://www.alangodfreymaps.co.uk/. Whether it is to review the places where you have lived, or to learn more about a new work territory or holiday destination, these humble gems bring added depth to every street walk.

    I am led somewhere new by a recommendation from our first ‘Conversations’ at Bowdon Vale: ‘Words for a journey’ from Takashi Iba and Makoto Okada. Takashi Iba is a management guru who writes and researches patterns in words and other systems http://web.sfc.keio.ac.jp/~iba/.

    How he has come to apply his philosophy to living with dementia and related disorders is a new area of exploration for me.

    Heidelberg, Manchester, Gateshead, Keio – Listening and learning


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    Hopeful 29 March 2016 | Comments (0)

    28th March 2016 | By David Jolley

    Monday saw me complete my last ever clinical work as a registered medical practitioner – 47 years on from qualification via Guy’s Hospital Medical School in the University of London: MRCS (Eng), LRCP (London) and to take up my first post as House Physician at St Mary’s Hospital on the Isle of Wight. We have much to thank the Beatles for and I was not for waiting until the age of 64 before taking up temporary residence.

    It has been a huge privilege and I will write it down.

    The last clinic was beautiful – with one person seen with her daughter at the clinic base and five seen at home, all but one with a family member being present. So I saw the people, learned of their lives and current difficulties, felt their homes and knew their locality. One of the warmest hugs of the day was for the A-Z of Greater Manchester. What a friend you have been.

    Tuesday gave time with Ros Watson to reflect on our first session of Dementia Conversations and to look at where this has pointed us. It is important to keep listening and to remain flexible but we want also to make best use of the steers which came from that first session: Sharing experiences, gathering and sharing information, obtaining training, considering carers, perhaps adding to the range of activities which are inclusive of people with dementia, looking at the practicalities of appointing Admiral Nurses.

    But people also identified BIG AREAS: Primary Health Care, General Hospitals and Faith Communities, where we might begin to review local realities and make contributions to improve matters.

    Primary Care and Faith Communities are perhaps the closest to us and there are things we might do without too much delay. Work is afoot. Excitingly the potential of the Dementia Roadmap to help us in Primary Care is there for the taking. So one component of Pathfinders is already finding a niche within another. If we can make this work – we might help others to use a similar approach. Only 17 CCGs currently using the Roadmap: people with dementia in another 194 might benefit.

    Wednesday was a dream as we celebrated Easter on John Leigh Park with the pupils, staff and PTA of Altrincham Church of England School. We had a total school Easter Bonnet Parade – every hat sponsored to make a donation to the Marie Curie Foundation: daffodils on the park will always bring back the knowledge of cancer and the work of the Foundation – Ladies dressed in yellow came and charmed us and shared their knowledge and commitment.

    We shared joy at the facilities of the park as the pupils paraded in their bonnets and they swarmed to park to hunt for Easter Eggs – everyone was successful.

    The expert horticulturalist from the council reassured us that the daffodils we had hoped would be in bloom for this day will be in bloom for next and subsequent years: ‘They are shy and sulk for the first year at the insult of transfer and new planting.’ They are the native bulbs which Wordsworth so enjoyed and wrote of: www.poetryfoundation.org/poem/174790

    We are in this for the long game :)

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    Hoping 22 March 2016 | Comments (0)

    21st March 2016 | By David Jolley

    We are having an Easter Bonnet walk in the park on Wednesday with children from the local school sporting sponsored hats – Sponsorship for the Marie Curie Foundation. This is to rekindle a relation between the school, park and Marie Curie Foundation which began 20 years ago when the mother of children at the school became terminally ill.

    A Field of Hope – thousands of daffodils – was planted and bloomed magnificently for a few years but has latterly waned. We want to see hope re-established and sustained into the future.

    We planted 2000 daffodil bulbs in the autumn, 1000, snowdrops and 1000 bluebells. The yield is disappointingly sparse. Maybe we chose the wrong part of the park, maybe the very wet season has drowned the bulbs.

    Nothing to be done though other than to press on – We can celebrate Spring and what daffodils we have this year and photographs of the most successful years. We will wear hats and make a donation to Marie Curie and learn something from them about cancer and their work. We will be thankful for new picnic benches and hear something about the history and natural history of the park from a local expert. We will walk the park together and talk of realities and hopes.

    Perhaps there is more to be learned about hope and coming to terms with the wonders and frailties of biological systems, including human beings, when things do not go quite as we wish. Living with bad news and finding a new way will see us through.

    We are wanting to learn more about The Dementia Roadmap. Salford is nearby and has one and has a good reputation in dementia services. Their Roadmap is fronted by a scene featuring a tram! Perhaps there is less flexibility in Salford than the A-Z might suggest.

    It seems such a good idea – but who does what and how are the maps actually used? Can we see evaluations? Why are there only 17 maps registered to date?

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