• BlogRSS

  • 13th November 2017 | By David Jolley

    I have enjoyed the 12th Dementia Congress organised by the Journal of Dementia Care at Doncaster Racecourse. There were over 800 delegates: people with dementia, family carers and professionals of many sorts. The programme was full and varied – from the Tuesday debate, via breakfast sessions, plenaries, parallel sessions and extras. There were people to meet and much to be learned.

    The whole thing worked so well because of the excellent signage. This had been advised by a group of people with dementia from DEEP http://dementiavoices.org.uk/.They had given time and expertise to attend the racecourse some weeks ahead of the event. We could see where rooms were situated, there was clarity about ways in and ways out. AND there were stewards at every level and at every corner, and at the tops and bottoms of escalators. They were attractively dressed and actively sought to help anyone who looked even mildly unsure or bewildered. Magic – a model for any service and proof if ever it were needed that what works for people with dementia, works well for everyone else. Let’s encourage this everywhere.

    In similar vein the support for speakers by the IT technicians was exemplary. There was someone around at all times, they knew what they were doing and simply picked up the pieces and made things work when fumbling anxieties threatened to wreck the day.

    Outdoors we could watch the staff who cut the grass of the racecourse – A huge and strikingly impressive swathe which is mown in patterns to be sure of its readiness for the next time the horses will come.

    Reminders that preparation and attention to the basics will make the best of clever and creative programmes.

    Read more ›

    30th October 2017 | By David Jolley

    First frost on the roof of my car at 6am today. This would have been 7am two days ago. Here I am at 7.05 ready to attend to the birds in the aviary – in daylight. This aligns us with farmers, school children and workers who walked to work at the mill – pleased to see the return of Greenwich Mean Time. It is a fabulous thing that time is manipulated like this.

    On clear days we are feeling cold – but exhilarated by the sun which shines through leaves – transparent, gold, orange, yellow and red, before they fall to be crunched underfoot or blown joyously in gambolling crowds to make temporary mountains. Warmer days come under cloud, with darkness and rain. Not so easy to get things done. Games for a rainy day.

    We had a book of tracing which came out only on such days. What was the point of that!

    Time to plant bulbs, given to bring colour in the springtime, by neighbours for the beds at the corner of the road. A triangle of peace beside a busy junction. Space in the day to be away from the buzz of the office, the gossip, the earnest pursuit of profit. To get to the ground we have to shift the leaves – and there we find weeds have grown on those rainy days that have kept us inside. Weeds give way easily enough from the damp soil, made richer this year by compost and attention. They will make new compost for next year.

    This way we maintain and improve the ground and favour those plants and creatures which we prefer. Left to themselves, those weeds would have their way and our hints of peace would be lost.

    An elderly preacher, musing as he worked his garden reflected:

    ‘I pay attention to the weeds and clear them away, but the more I remove them, the more they grow again. Sometimes I feel like throwing in the trowel!’

    Now this might be a parable applicable to any or every creative effort. If we want to make things better, we have to keep vigilant and take opportunities to identify and deal with poor practices which will ruin the design and take us nowhere or worse. We must not throw in the towel.

    Could be, as reflected last week, that this has been happening in our beloved NHS and related organisations. We need to be rid of the choking weeds.

    Could we please turn the clock back to a simpler system and leadership and direction from clinicians in association with patients and carers at grass roots who know what is right for particular locales.

    Read more ›

    23rd October 2017 | By David Jolley

    A friend has given me a link to the King’s Fund’s Animation which offers ‘a whistle-stop’ tour of how the NHS is at present and how it might be working: Here it is https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-england-work

    The essence has to be much as ever was: overall control and responsibility with the Government of the day. This leaves the organisation at risk of change motivated by political fashion, personal quirks and wishes to stamp their presence from ministers and others. The vehicle is the Department of Health: ‘slimmed down’ with delegation to NHS England and NHS Improvement.

    These layers pass on money and guidance to others, some directly within the public sector healthcare, some from social care, the independent sectors, voluntary sector and so on. There is ‘commissioning’ and there is competition. There are Vanguard sites demonstrating new approaches which are thought (by people upstream) to be more effective and/or more economic. Flashing through as one of these I see the development of memory clinics run by specialists within Primary Care. Hurray for that – people upstream have been listening – let us hope that one catches on.

    But it does seem complicated. One of the most memorable and chilling phrases in the video is: ‘the NHS never stays the same for long’. Trying to make progress on shifting ground is harder work than when you can be sure of your footfall and take the basics as ‘read’ – You can then get on with the business of caring, treating and giving priority to the individual patient and their family.

    I am not convinced that the series of management changes which have occurred since the first of 1973 have made for better care of better use of resources. http://navigator.health.org.uk/content/nhs-reorganisation-act-1973

    That system gave responsibilities to Regions from the Department of Health and Social Services (DHSS). Regions related to Area Health Authorities, and they to smaller units such as hospitals and community services. GPs were independent practitioners, often working in partnerships. It worked well. There was no ‘commissioning’, no competition: we were working together to get the best use out of resources given to us. We had planning.

    The wonderful quotation: “We trained hard, but it seemed that every time we were beginning to form up into teams, we would be reorganized. I was to learn later in life that we tend to meet any new situation by reorganizing; and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency, and demoralization."

    Comes – I am told – not from the Roman satirist Gaius Petronius Arbiter, but from Charlton Ogburn Jr in a passage in Harper’s Magazine January 1957. Less romantic for its recency, but satisfyingly true to our experiences.

    Interviews of applicants for senior clinical roles too often consist of determination of the candidates’ knowledge of the latest actual or possible organisational map, rather than their clinical competence and nous.

    We are grateful to the King’s Fund for their enlightening animation.

    Might it be possible to ask that: ‘the NHS never stays the same for long’ be challenged and be replaced by: ‘‘the structure of the NHS never changes, but within this there is flexibility of response to changing needs and possibilities’?

    And before we do that – Can we please return to something rather like 1973!

    Read more ›

    16th October 2017 | By David Jolley

    There is some dismay that older people, including people with dementia, are less likely to be referred for specialist psychotherapy than are people with similar problems who are of working age (younger).

    Should we be bothered? Sitting and sharing worries and thoughts has its attraction and a degree of power.

    One of the lines I remember from Robert Davis in his ‘Journey into Alzheimer’s disease’ is his plea to those who want to help when he gets stuck and frustrated:

    ‘Walk with me – Just walk with me’. 

    So it is in dementia, so also it is for many of us with or without other pathologies. Walking gives a good feeling. Walking with others provides for many an acceptable, even enjoyable, context in which to share of themselves and listen to others.

    Our beloved local park hosts a Health Walk every Monday morning. It is open to anyone who wants to come – but is aimed especially at those who have lost confidence in their physical abilities and so stay indoors where they sit a lot of the time. We are dementia inclusive and dementia friendly but it is not a dementia exclusive company. We walk for about an hour in the park or in the streets and alleys nearby. This includes conversations reflecting on the day, the views, the seasons and much more. After-walk provides tea, coffee or whatever drink and toasted teacake or something else which is good to munch.

    A GP in a Trafford Practice has taken an important lead in setting up similar walks – which she attends and to which she invites all patients on her list who might benefit. The letter from the doctor advising individuals to come on their first walk generated a massive 100+ attendees. I believe the regular turn out is now something like 40 per week – much more than our 10 +/- a few – She has shown what could be done by all practices. It will be a transformative moment if all the other GPs follow her lead.

    This is Therapy for sure – with physical, psychological, spiritual and social components to be accessed as suits you this week. It costs nothing! It does not discriminate. 

    I just hope it can catch on because it gives freedom and independence to people who find they have control over their own health – and can be helping others to find theirs.

    Read more ›
    First ... Previous 2 3 4 5 6 Next ... Last