• A question of size 06 February 2018 | View comments

  • 6th February 2018 | By David Jolley

    This is just me musing – no statistics or web links – but maybe they will follow.

    I am on the small side, so maybe I am prejudiced. It starts with my seeing a huge/very big refuse vehicle riding up a small road just below our park this morning. It comes every day. Through the day many more very big, very heavy vehicles will come to and fro along that little road which has a slight incline. Most are taking and fetching materials to a building site where hundreds of new homes are being built on land which was, until recently, a neglected post-industrial wilderness. New Homes: Good. Damaged Roads: Bad.

    I wonder why the contractors don’t use smaller vehicles.

    I wonder if we could legislate for maximum size and weight of vehicles on our roads.

    Many of us have an inner mantra: ‘Small is beautiful’. Most of us are comfortable within a network of the relatively few people that we know and love best, straying beyond it for interest and additional experience, but returning to put the new knowledge into context.

    Hospitals become bigger and bigger. Cardiac surgery for children cannot be provided in Manchester – because the expertise and training is congregated in Liverpool. Specialist beds are declared to be insufficient for the need. People are inconvenienced, disappointed and left fearful.

    When the pattern of services for the mentally ill and older people was changing from institutional care towards care in local communities through the 1970s, mental health was included as a component of District General Hospitals, servicing populations of about 200,000. There were four such hospital in Manchester and at least one for all the towns clustered round it: Stockport, Ashton under Lyne, Oldham, Rochdale, Bury etc. The big advantage was being near to where people live, liaising easily with families, faith communities, Social Services, Primary Health Care – and other hospital specialties.

    Homes for older people were provided mostly by the Local Authority with a mix of purpose-built and converted property. There may have been some limitations to their structures, but they were OK and better than what came before. The encouragement of the private sector and punitive discouragement of direct Local Authority provision saw, at first, a plethora of small homes run as family businesses. They may have had their limitations but many were loved. Most have now disappeared and have been supplanted by bigger homes, some owned by chains run by international organisations. The average size of nursing homes is 40+ beds, care homes 30+ beds. Even at these levels companies find it difficult to provide quality care within the budgets supported by Local Authorities. The number of homes has reduced and so the availability and affordability within communities have been reduced. A smaller home has the virtues of residents, staff and families getting to know each other. Local homes make it easier for friends and family to visit and to contribute to the life of the home.

    I am still in favour of a return to small.

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