• Small World 20 January 2016 | View comments

  • My wife is an enthusiast for low tech approaches to getting things done without burning fossil fuels. We are both enthusiasts for being respectful to ordinary people and realising that we all have abilities which can be fostered or crushed.

    This month’s issue of Small World caught my eye, especially the quotation from Dr Fritz Schumacher:

    ‘The gift of material goods makes people dependent, but the gift of knowledge makes them free – provided it is the right kind of knowledge of course’

    He was thinking of developing countries where people lack basic resources including clean water and sanitation. But the ideas have relevance more widely.

    In Manchester and no doubt other towns and cities there is controversy over decisions and ‘consultations’ which are requiring cessation of some sorts of surgery in local hospitals and their relocation to other hospitals which are designated expert. From Ashton under Lyne you go to Oldham for eye problems and Stockport for genitourinary disorders. The most recent upset will see general abdominal surgery removed from Wythenshawe hospital (University Hospital of South Manchester) to concentrate resources at Stockport. Colleagues quote figures which say that outcomes in these specialist centres are better. I wonder quite how ‘outcomes’ are being defined. I do not like a system which sees me as a collection of organs rather than one person who may have a number of pathologies but wants to be treated as someone.

    How often are we to say: ‘The surgery was successful, but the patient’s life was ruined’?

    My post-Christmas reading is: The Shepherd’s Life’ by James Rebanks. He accounts for the resilience and success of his family farm by their return to old fashioned systems which do not rely on subsidies or supplements from outside agencies. Old fashioned is good to me.

    I am unhappy with the way that agencies in support of older people and people with dementia have lately gone to a central model providing handouts and commissioned services rather than a grass roots multiplex which feeds ideas and strength to a central liaison and information-exchange hub. I suspect that the experience of – Rose-Marie Droes from Holland which we heard about at Telford can help us. She began to encourage local people with dementia and their carers to come together and decide what they most needed. They found a meeting place and looked for resources which would work and that could be afforded. Thirteen centres in Holland, maybe more by now, are doing this. Other countries are picking up this the model: http://www.meetingdem.eu/. The extraordinary Dawn Brooker in Worcester is the UK lead.

    I wonder if we might join this movement through our ‘Conversations’.

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