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  • 9th April | By David Jolley

    We thought we had quelled all this hoping for a cure and settled for a sensible use of the evidence we have that what works for dementia are preventative approaches and care, so that expenditure on research into possible cures should be rationed internationally and more resources directed to care and health promotion.

    Yet the Guardian carried ‘Humans keep making neurons for learning throughout life’ on Friday. The article and the references it drew on had the virtue of reminding me of the existence of the dentate gyrus, but reading the references I could not be convinced that they were describing the development of new neurons in adult life or old age – to the contrary most of the research seems to confirm that lots of neurons are established at birth and very early life – the number decreases with age. Somehow the alternative story has taken a grip.

    At our weekly seminar we learned that much time of very great men and women is being devoted to consideration of how the NHS will cope when (when) a cure for Alzheimer’s disease via monoclonal antibodies becomes available – at vast expense and with expansion of the need for therapy into decades before the possible/probable emergence of the clinical syndrome.

    I remember being glad that I had not been required to spend my creative years planning for what this country should do in the event of a nuclear war. By comparison this seems a positively reasonable expenditure of a life. The zombie keeps on walking! https://www.researchgate.net/publication/5059675_APOCALYPSE_NO_population_aging_and_the_future_of_health_care_systems

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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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