• People or Paper? 30 November 2015 | View comments

  • 30th November 2015 | By David Jolley

    Firstly an apology in that I am told the link I gave to the Lancet article about the Goodmayes service for old people did not work: Here is a link which does work this morning! http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(70)90357-0/abstract

    This gives only the abstract so that people will need institutional access to read the full article. This is a shame because it means this classic contribution, which is the cornerstone of all that is good which has followed, will be unavailable to many who would like to read it. After all these years I would hope it might be made openly available.

    The essence of the service created by Tom Arie and his colleagues was to start with what was given – staff and wards in a large, overcrowded and poorly resourced mental hospital – and to make progressively better use of them with minimal additional funds. Tom led from the front, seeing every new referral at home himself in the early day, taking responsibility for a well-informed assessment and agreeing a plan of what to do with the individual and their family and other carers. In many instances it proved possible to make matters better by the exhibition of sound medical skills in the context where they were most needed. The involvement of others and identification of local sources of help and support followed on. Other agencies devoted to the welfare of older people were pleased and receptive, for they found that they were helped in understanding and by therapies – there was a new dimension to the force.

    Tom continues to help people think ‘out of the mental hospital box: recruiting good practice, good sense, intuition and mutual trust and respect – ‘be available, be responsive and flexible and see people through.’

    Next week I am invited, with others, to discuss DoLS and Protective Care with people from the Law Commission.



    The contrast with Goodmayes could hardly be more stark: grubbing around to make do with whatever we could lay hands on against a paper-based, legalistic pursuits of Rights regardless of expense.

    Deprivation of Liberty Standards have been required in response to poor practice which led to a European Court ruling. A sequence of Court Judgements has produced, by accumulative precedents, a bizarre situation within which millions of pounds are being spent on people with dementia to no obvious practical benefit. To the contrary people with dementia and their families feel oppressed by the legislation, stigmatised by the label, disadvantaged and currently deemed ‘Detained by the State’ and so requiring referral to the Coroner for Inquest when they die of their well understood terminal illness. This harm to individuals stands alongside the harm to others as resources are syphoned away from practical care to feed the demands of Law. No other country in Europe or anywhere else is behaving in this way. The Law Commission’s thoughtful and elegant Protective Care’ proposal as an alternative to DoLS has much to commend it. Unhappily the costs estimated in misleadingly exquisite detail in the impact assessment would almost certainly be as great as those of full implementation of DoLS. The consequences in terms of stigma and disadvantage would probably be as great and spread to almost the whole community of people with dementia. While requiring, by law, better services, the process would take away resource which might otherwise be available to provide care, should Central Government allow Local Government the where-with-all to spend.

    There are splendid people in our small group which will assemble next week. We are not alone for this matter is exercising more and more discussion in politics as well as the care community.

    The task is difficult. It requires, as did the Goodmayes initiative, a brave, clear headed return to a consideration of what is important, what we want to achieve and how this can be done with creative and well balanced use of what we have.

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