• Eight Days a Week 01 November 2016 | View comments

  • 1st November 2016 | By David Jolley

    Eight days was the time the Beatles were devoted during every week. Every day needed 36 hours for the carers of people with dementia, captured in print by Nancy Mace and Peter Rabins 1981 and still selling and still true to life today.

    In his regular feature in the BMJ this week David Oliver picks up on one of Jeremey Hunt’s phrases from a speech at the Conservative Party Conference: ‘Let’s not argue about statistics’. Mr Hunt was pushing the case for ‘improvements’ to the Health Service – changes which are thought to be popular and justified by ‘evidence’ that current patterns of service are not efficient and may be responsible for poor outcomes for some people. One major focus is the press for seven day services. Hunt cites studies which say that people admitted to hospital at weekends have a higher mortality during the admission than people admitted during the Monday to Friday working week. David Oliver and others question the validity of these analyses, for the comparisons are almost certainly not of like with like. Oliver’s point is that we need to use statistics respectfully, listen to expert interpretations and perhaps always have a pinch of salt and our own experiences to hand before being railroaded along an uncharted track.

    Health care is available every day of the year and through every day. So is care from Social Services, the police, the fire service and others. Time, experience and an awareness of limitations of finance and personal resources lead to a delivery which is the best we can do and afford. We have become accustomed to do as much as we can during normal working hours, Monday to Friday 9am to 5pm but to have emergency cover available at all other times. That has been a tidy and accepted way to ‘cut our cloth’. The more generous and efficient the work 9 to 5, the less the calls for help at other times. Services which concentrate on emergency services are less satisfactory than those which put maximum effort into routines.

    We found it useful to have an answer phone associated with our Memory Clinic in Wolverhampton. The recorded message was the voice of a known and trusted senior nurse. She asked people to leave a message and their contact details and the promise, and reality was that she would be in touch with them at the first available opportunity. Not 24 hour everyday availability of full force service, but enough reassurance to make the situation bearable for most people. The Alzheimer Disease Society Branch provided a telephone help line which was available continuously. Someone to listen and share difficulties, and to point the caller with confidence and from a base of personal knowledge and familiarity in the direction of emergency services of they were really needed.

    I can go shopping at any time of the day or night on almost any day of the year, but the choice of shops is limited and even in supermarkets the choice of goods tends to be restricted out of hours. Banks, solicitors and other professionals have their defined hours of business, with emergency arrangements between times. I am not convinced that there is overall advantage in having shops open on Sundays. A little planning ensures that supplies are at home by Saturday lunchtime. In its own way this frees us all from the need to use up every day with basic activities to the denial of the time for rest, reflection and time for each other.

    Maybe we are being lessened by the lure of 24 hour access to instant gratification which is alternatively to be seen as unending pursuit of profit for a few by the exploitation of the weak.

    This is not an issue of numbers but one of values.

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