• We did change the world? Well it has changed 30 August 2017 | View comments

  • 28th August 2017 | By David Jolley

    A close friend and colleague was reflecting rather sadly on the changes he/we have seen in careers of 40 years. He was focussed on the failings which are still evident in attitudes, values and the quality and availability of services for older people and for others who are vulnerable and in need of help of one sort or another. Beyond that, the politics of this country and other countries, not to mention the local politics of trusts and universities are bewilderingly lacking in warmth or sparkle.

    But I would say, we take all this – but despite the disappointments – we have seen amazing and worthwhile changes. We have had a hand in these – We have changed the world.

    Amongst these changes the care of older people, including those with mental health problems (within which dementia is important but not alone), is taught to doctors, nurses, social workers and a long list of health and social care professionals and to people working in other fields. The reality of neglect and abuse of residents of large mental hospitals and other chronic sickness facilities, has been recognised and action taken which has closed the mental hospitals and sponsored more supported care at home (not enough) and in care homes (not enough and not sufficiently funded). We have seen the emergence of novel arrangements of ‘extra-care’ and strengthening of charitable organisations, patients and carers to have a say in what is being done. It is not enough but it is a far cry from what we knew in the 1960s.

    Don Williams has helped with his contention that ‘Research is the enemy of scholarship’ The article that changed my view … of how research affects medical training

    He quotes Dr Walter Gratzer’s article in the Guardian of 1979 which questioned the growing belief in research as the great and only source of all good:

    ‘research is bad for teaching and teaching is bad for research’, ‘research is the enemy of scholarship’. Gratzer had cited Benjamin Jowett who wrote in the nineteenth century that ‘research is merely an excuse for idleness’.

    Don’s career has been that of a great clinician, scholar, teacher and researcher. His research has been generated by his clinical observations, and entirely relevant and practical. His unhappiness comes from the distortion which has reversed the previous hierarchy: ‘If you can do good clinical work – you are golden. Them that can’t – teach. Them that can’t teach – do research’. Research accompanied by grants and publications are now seen as most highly regarded, and most likely to attract additional financial reward.

    More than that, the pole position that management now assumes, was not dreamt of in the 1960s. Frontline – hands-dirty – nous, tuned by an apprenticeship and respect for the scholarship of previous generations, is all-but set aside.

    Products of this change include brilliant and comprehensive reviews like the Lancet Commission on Dementia http://www.thelancet.com/commissions/dementia2017

    This covers 62 pages and cites 665 references – you know there could be many more – several are meta-analyses of multiple funded studies of particular topics. It is impressive and it is useful, but does it thrill you to commit your life to this sector? Can it be translated into a coherent clinical practice which rides the subtleties and changes of real-life with dementia or a related condition? Will it make life better for people with dementia and their families?

    It takes my breath away. I want it back again. (Travelling Wilburys). 

    I think we should be pleased with the progress which has been made within the world which we have been able to influence. It is right, however, to say that there are aspects of the worlds around it which we would wish were different – and have again some features which allowed us to move forward in the 1960s and for some years afterwards.

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