A vision of..

photo by michaelangeloew	via PhotoRee

The past?

So, I’ve been writing about joined-up thinking and how we need to change the current system, but what does that mean? It’s easy to sit in a frosted glass tower, looking down at the world passing by, but actually working within the system that you have created is another thing entirely. Ask anyone in healthcare if everything works well and the answer will be long, complex and involve real situations.

It is always easy to look back with rose-tinted spectacles and enthuse about how things used to be, but is that really the case? Were we better off when your GP was your GP, instead of being slotted into any free appointment space? Were we better off when there was a cornucopia of nurses, of different grades, attending to people on hospital wards? Were we better off before millions of pounds was wasted on IT systems and streamlining? Were we better off before waiting targets forced the current paperwork shuffle that takes place now?

In fact, were we better off? I don’t know, but what I do know is that there is a better way. A way that is easy to implement and costs virtually nothing.

The present?

In the following ramblings I will probably upset some people and cause a little insult, but that is not through intention, it is merely a statement of facts. Just remember, I am not talking about you, and I am making a sweeping generalisation about how the system is broken; not highlighting the few good examples out there, that is for later.

We are currently in the midst of near chaos. The system is broken and the people in the system don’t know which way is up. I almost said that most people don’t know their ass from their elbow, but I refrained. If a person goes to see a doctor, hoping for some compassion and help to heal, they are sadly disappointed. What they actually get is a diagnostic machine that is plugged into a computer and doesn’t have the time to investigate or care about anything – see, told you I might cause offense.

Here is where the problem lies, our doctors are not given the time or resources to be what they need to be. Not only that, but most of them don’t know.. I refrained again. Unless there is a quick fix, they don’t want to know. ‘Got indigestion? Well take this then.’ ‘Feeling depressed? Well take this then.’ There is no compassion or knowledge in being a doctor anymore. Gone are the days of the family doctor who used to know you all by name and probably delivered your second cousin.

There have been great strides in medicine in the last few decades, which has saved lives and prolonged others, but has there been a cost? A doctor is no longer a holistic health practitioner. Instead, they are medicine machines, programmed to go for the quick fix and the cheapest option. Why? Because healthcare is expensive.

Now, I have a lot of sympathy for the local doctors, they are trying their best. But I wonder if they could do better, perhaps they could even do great. If only they were a vital part of society (that was sarcasm) who could stand up and in one clear voice say ‘Stop! this is not right!’ I mean, they seem to do ok when their standard of living is in question. The key players and the ones who can begin to make a change are those whom everyone trusts, respects, and who hold the purse strings.

There needs to be a leading voice for people to follow, one that will echo the sentiments of all the people who work in healthcare. You would think that is the job of the unions or the various societies and membership organisations, but they seem awfully reluctant to stick their collective heads over the parapet. Instead, like everything these days, the betterment of our healthcare system is a highly politicised and top-down vote catcher; rather than being a service focusing on being good for the general public (I hate that term, but what else could I use?).

We all need to realise that when we need the services that we are not making better, we will reap what we have sown.

Next…part 2

Salut

Holistic

 

photo by tourist_on_earth	via PhotoRee

 

A couple of decades ago I was introduced to a word. This word was to become a banner over everything that happened in health care. It was the question that we had to ask ourselves and the mantra that we had to repeat, in fact this word was the ‘thing’ that everybody had to concentrate on. That word? Holistic.

Meaning: to take into account all systems and view as a whole.

In health care this is very important, seeing a person as a whole being rather than a collection of symptoms or problems to be overcome. If you meet a person who has one defined problem it is best to look at them as a whole being to determine if there are any other factors involved, because there may be an underlying cause that is not apparent. It is especially important to involve a person’s mental state and thought process, which means empathising and trying to understand their situation as a whole.

Likewise, when deciding the best strategy with a person for their future, you must take into account their whole being. You must try to understand the problems they face and to empathise with their thought process. People are complex. There is more to a person than just what you see or, what the piece of paper says that is put in front of you. If it was easy to prescribe a course of action then health & social care would be an easy job; but it is not.

How often do I hear the word used now? Not very much.

Holism should be the way that we all work, not because it is a trendy term or the latest idea, but because that is how people need us to be. Phrases and new terms come along all the time, changing the focus of our work and causing our thought processes to change. What we need to do is focus on the basics and get them right first though. It seems that a lot of icing and decoration is placed upon the health & social care services, but the cake underneath is not even cooked yet; leading to the soggy mess we have now.

I know that time is money and that money is tight, but is that really the problem? If more people worked holistically and to a framework, wouldn’t more money be saved? For example: An older lady visits the local hospital with a broken leg, which is plastered and she is sent on her way. Six months later she is back again with another broken leg. She is plastered and sent on her way. Six months later… and so on. It turns out that the lady – who lost her husband a year or so ago – is now responsible for putting out the milk bottles in the morning. The trouble is, the front step is too high for her, because of arthritis and she can fall off easily.

The reason the lady was returning after six months is due to the time the plaster cast was coming off, which meant she was putting the milk bottles out again. All the while the lady couldn’t put the milk bottles out, she was being visited by a home carer who would do that for her. When the home care ended, she was back to what caused the problem in the first place.

This is a simple story and most likely doesn’t happen so much these days, but I think it highlights the importance of taking a holistic view of a person. What happens to people when the service ends? Will the cause of the problem be fixed or merely the symptoms?

Holism & Holistic Care

Whilst they are not trendy terms or the latest buzz words, the idea of holistic health care is still as important as baking the cake. Yes, it’s nice to have the icing and all the trimmings, but you don’t decorate a cake before it is baked – do you?

Salut

Loneliness

photo by Frederic Poirot	via PhotoRee

Apologies for not posting in a while. Recent events have kept me rather busy.

Feeling alone

As our population ages and mental health issues continue to trend upwards, people are facing an increased chance of being alone.

Visiting various places and individual people, it is clear to me that the community has gone from community services. You may find pockets of people who do have a group to which they belong, but it seems that many are isolated because they don’t feel anyone understands their situation; which is especially relevant in mental health.

Once a person reaches a stage where an obstacle is put in their way, they are unsure as to what to do about it. People, in general, do not understand the services that are available nor are they prepared and informed of how to cope. Don’t get me wrong, the information is out there and there are people who know how to help, it’s just that they are not used in the correct way.

We seem to be mired in the catch 22 of our social services (meaning services that deliver community services): They don’t have the money to fund everything and if they make one service widely available others suffer. They want to improve services, but if they become too popular then others suffer. Social services have become a balancing act, driven by the need to follow whatever crazy ideal policy makers and budget holders come up with.

Now I’m not one for buzz words or catchy phrases, but one does spring to mind: Joined-up thinking. It has been mooted recently that social and health care are to be re-merged, making the two halves of healthcare joined-up; putting them back where they were in the first place. This would mean that the individual budgets would also become ‘sort of’ joined, perhaps making it easier to follow and commission services for a person with continuity.

What people need is information and clear guidance – and perhaps a sense of direction from their healthcare professionals – to help them cope with life as a whole, rather than disperate chunks of services that don’t work well on their own, let alone together. This brings me to the point: What people need is to understand how our services work and to be able to easily access them, with a joined-up range of services to support their needs; and perhaps a focal point to manage their individual case.

And before anyone gets annoyed – this doesn’t happen now, even if you as an individual are doing a great job. We need to look at the big picture to see where the faults lie.

I saw a person on the news the other day talking about the recent troubles in some cities, they were making the point that there is no one-size-fits-all approach and that each community knows what’s best for it. I agree with the sentiment, however, I don’t agree with the idea. Each community does know what is best for it, but that doesn’t mean there isn’t a basic framework to build from. If you have a standard template from which to work, you will then be able to innovate and try things out; finding out how much deviation from the template works in certain areas will also help others to create a better service.

I am finding it increasingly frustrating the more I see and hear. There are obvious solutions to the current problems, yet people aren’t listening. I can see big piles of money being wasted, all the while cuts are being made and services are suffering. I can see the people who are on the receiving end of all this nonesense and it makes me.. sad.

The very services that are supposed to serve people are the ones making their lives worse. This has to end and it can only end if people are willing to make a difference, and make a change.

Salut

A quick thought about construction

I have been a bit busy the last few days with one thing or another, which has left me little time for blogging. I was thinking about my next post when I realised that a lot of my thoughts are kind of negative. This is not a deliberate intention, but I guess it’s the idea that things can change that drives me.

If there was ever a need for some constructive criticism then it’s now, perhaps just some construction full stop. I have seen the care industry take some interesting twists and turns, the passing of buzz-words and the changes in policy direction. There was holistic and now personalised, care in the community and now putting people first.

Where is it they say has a road paved with good intentions?

There is just too much messing around with the system, too much emphasis on changing the less important things. It seems that there is a lot of good talk, but not much walking the walk. Everything sounds good on paper, but in practice nothing really happens the way that it should.

Even if one person or part of the system works, the rest of it falls over broken. All I hear are new ways of saying the same thing and a lot of pretty marketing material, but where are the results?

By now, we should have the best healthcare system in the world, but alas we do not. There needs to be a concerted effort to turn all of the fancy re-branding into real results. Ask yourself, how much time do you spend reading and preparing for the next big change or implementing new paperwork because of terminology changes?

Then think about your training, how much of it is about the real practical work and how much is about fulfilling the latest policy goals? There was a time when health & social care was about the health and social care of people, rather than making sure that the right part of the budget is spent on just the right niche idea.

Health was split from social care, but now they are being sown back together. What was the point of the seperation in the first place? All of this messing around preoccupies people who should be focusing on the provision of a service to people. The forgotten part of the equation – the people. How does the constant messing around really affect the people? What do they care if they are rehabilitated, reabled or just plain cared for. All these terms probably mean different things to you, but is there really any difference? Does the person receiving the service really see a difference?

Shouldn’t the focus be on the training and skilling of the workforce and providing the people with health & social care that does what it says on the tin? Let the construction begin!
Salut

Are people still at risk?

photo by romkey	via PhotoRee

I was chatting to someone today, someone who is older and vulnerable. You wouldn’t have thought this person was vulnerable when you speak to them, but it soon became clear that they were ‘at risk’ of being too nice; some might say easily taken in. I’m not going to tell the whole story, but I will give you a brief idea of what happened.

A lonely person in need of some assistance was conned by a person who took advantage of the situation. They ended up paying way too much for a shoddy service that took far too long and some other things that I shan’t go into. The person providing the service was someone operating on their own with no regulation or monitoring by a company, nor were they legally self-employed.

Thankfully, the person at risk is now receiving a proper service from a regulated and vetted company, but this does highlight something about the current policy approach: people in receipt of personal budgets are encouraged to purchase the services of unregulated individuals.

Within all of the ‘personalisation’ stuff that has been going on for a while, there is a lot of safeguard dropping going on. After a number of years chasing the safeguarding extreme, we seem to be reverting towards another extreme of no safeguards at all. I’ve no doubt that there are some great people out there working for other people who need a little help, I have met them, but there are also people out there who are not so nice.

It seems that there is intense regulation and monitoring of certain types of service and very little for others. There are people who are given the choice of purchasing their service themselves – something that I think should be a given for anyone – but they are open to engaging someone who will take advantage of them.

Don’t we have a duty of care for people anymore? A person at risk should be given the choice of which service to engage, but shouldn’t they also be choosing from services that are regulated and monitored? Shouldn’t there be safeguards in place to ensure that our industry is as safe as it can possibly be?

After the shocking revelations (sounded a bit tabloidy there, sorry) of late, hasn’t anyone learned any lessons? There is a need to take the health & social care industry seriously and to ensure that it operates well; as it is this industry that may look after your parents or yourself one day.

Health & social care delivered correctly is a skilled and valuable work, making people’s’ lives better and happier. H&S care ‘done wrong’ is a sad state of affairs indeed. It’s about time that someone took the figurative bull by the horns to ensure that we are all headed in the right direction. Enough of changing goalposts and enough of the political vote-winning headline-grabbing sounds-good-but-isn’t nonesense. We need a skilled and respected workforce on whom we can depend for the future, because I don’t know about you, but I’m not getting any younger.
Salut

Slight of hand

photo by Carly & Art	via PhotoRee

Magicians have a good trick, they make you look one way whilst making the magic happen in the other direction. This is called misdirection, the art of making you do one thing whilst something else is going on that you don’t notice.

There is also another trick called compartmentalisation, which is the act of seperating things and making them independent of one another. Magicians don’t use this trick as much, but there are people who use this to good effect every day.

Care

So here I am, sat in my office and reading through some blogs from people who work in the healthcare sector. Pausing to reflect on why people don’t see the big picture. In fact, I had a discussion with a colleague the other day about why the whole system is in such a broken mess.

What we worked out is that after a number of years where the government spent all of the money, there is nothing left to pay for all of the healthcare bills. There is nothing left to pay for new doctors, nurses, qualified carers, pensions, literally no money for anything.

On top of that, there is no one person who can see the healthcare system as a whole. The system is broken into little departments and a multitude of various projects, each taking a small share of a very limited budget. None of these departments really talk to each other and are in a continual struggle to fight for their budgets; and wages.

The most important aspect of care of any kind is the person. Whilst all these various departments work on various projects and nonesense, the people at the centre of it all are being let down. There are many stories that I could relate about how the system actually treats people, but there are already too many other blogs about that. Instead, I shall tell you why it is happening.

The very basics of care have fallen by the way-side, it is no longer about the care of people, but more about the care of budgets. In the financial books of government there is a number, a number that represents the total amount of money allocated to the care of the nation. This number is then allocated to each county, divided by the number of people and their apparrent need for care.

That number is then broken into two halves, one for healthcare and one for social care. With me so far, well those numbers are then broken down into more parts, making up the departmental budgets for various services; the x-ray department in the hospitals get some, then the social services get some and so on.

Straightforward so far right? Well, that’s not exactly how it happens, as each budget also comes attached with conditions. For example, perhaps the budget for the department who carries out hip operations has to also account for helping rehabilitate people after their operation. But not all of the money comes from their department alone.

You see, the GP of that person having the operation will have to pay for some, the rehabilitation service will pay for some and probably other departments involved in the after-care will also pay for some – an accounting nightmare. Ah, but that isn’t all. If the policy is to help people rehabilitate after a hip operation and make sure to cut re-admissions, there will be a chunk of the budget that is only allowed to be spent on that.

So, once a person has had the operation they will then be allocated a certain amount of the budget to help them afterwards, provided by the rehabilitation and home care department. The person (regardless of their needs) will be allocated 6-8 weeks of help to get them back on their feet. Once this time has been completed, the various departments have adhered to the policy and can leave the person to fend for themselves, regardless of whether their treatment is complete or not.

This person is then left with no information, no assistance, no guidance about what to do next. All of the departments have followed the policy and can tick their respective boxes, according to the policy they have done a good job. Everyone is happy.

Now imagine that scenario for all the various departments, services and policies. Each overlaping and each fighting to access the extra money to carry out various projects. Each department becomes focused on whatever the policy idea is for that year, neglecting all the other things that represent the good practice of care.

Also, imagine the accounting nightmare that comes from dealing with these budgets, imagine how many extra people are employed just to manage the books. Not to mention the positions created to manage and run the various projects that come along. If a department doesn’t join in and complete the numerous projects attached to policy ideas, they don’t get the extra money; which isn’t extra at all, it is just taken from the existing pot and earmarked for a particular purpose.

Care

This is a very simplistic way of describing the healthcare service commissioning system, it is actually much more complicated. There is a raft of rules and regulations surrounding how it must be done, not to mention the bribery and corruption that takes place when the public sector deals with the private sector.

All these people are compartmentalised in their seperate departments, fighting over money to make sure that they can justify their jobs. Money, which in the end is taken from the budget and earmarked for various projects that in reality don’t achieve what they need to. If you troll through the various health websites you will come across a whole load of policy information and failed (or long forgotten) projects that came and whent.

Some of the ideas last a few months whilst some last years, but in the end, all that is achieved is a few reams of notes on how certain amounts of money were taken out of the services and used for something else. This is the misdirection, you take a nice idea that sounds good, make people run around doing it for a while and then pull the plug.

You see, no matter what the idea or how you attempt it, there is only so much money in the budget. No matter how you split it up or allocate it, the first number stays the same. We are in a situation where there are too many people wasting too much money on projects that will only end up as reams of paper gathering electronic dust.

The intensity of labour and supplies that goes into just one of these projects is astounding, millions of pounds being wasted every day.
“First we need a logo, then some headed paper or posters.”
“Yes, then we need some extra people to take on the various roles in the project.”
“Oh, and also an accountant or three to work out the numbers.”
..and so on

Instead of one person being responsible for a department there are several, each with their own project or focus. Instead of the focus of the department personnel being on the people they are providing a service to, they are wrapped up in a world of making sure they meet the policy requirements and providing evidence they have done so.

Care

The system is broken. There are people who think they are doing a good job, because they get more money for completing projects and reaching targets. Each department has so much to focus on, they forget about why they do their jobs in the first place. The money is spread around so many different ways that a lot of it is wasted in projects that go nowhere and staff that aren’t needed; whilst the real staffing issues are ignored.

If you are reading this and you are one of those people working in a department, I am not blaming you. You, according to your supervisors, are doing a good job. It’s just that you are doing good at the wrong thing.

All I can say is that we need to consider the big picture, rather than focus on the individual things that are wrong. Look at the system as a whole, day-to-day. How do all these things work in reality?

The answers are there, staring you in the face. It is time for a change. Let’s make care about caring, instead of wasting time and money on people and projects that just suck the money out from where it belongs.
Salut

Do you switch?

photo by Richard Holden	via PhotoRee

I often wonder how the provision of H&S care is seen by the general public. I get the impression that once people are purchasing a service that they stick with it, thinking that bad service is the norm. There needs to be more awareness of care and the fact that you purchase it like any other service. I mean, how many people will stick with the same company if they are unhappy with the service? Probably too many.

I also wonder if care is seen as a valuable comodity like a good builder or garage. Do people place a high value on a service that looks after them or is a care service like a utility; ‘bad service but it’ll do, I can’t be bothered to switch’. So this is the question that I am asking: Do you switch? If the service is bad and you are not getting what you want, are you going to try another company?

I think that many people do not realise what care is all about, so they accept whatever service is given. The public perception of care isn’t the same as inside the industry, not everybody knows what to expect from care. It seems that care has fallen into the medical trap – even if the service is bad, we still accept it because at the end of the day I came out alive. It doesn’t seem to matter that the whole experience was degrading and uncomfortable, and that I wasn’t treated like a human being; ‘they were busy and had much worse off people to deal with’.

A few years ago the government decided that we could ‘Choose & Book’ our own medical services, but when there is a monopoly on those services what choice is there really? Not many people can afford to purchase expensive medical services, so that choice is taken away from most people; It is the same with care. People don’t understand it and they don’t see it as valuable, which means that some services will remain poor at best.

I fear that until the profile of health and social care is raised and competition drives up standards, people won’t switch because they don’t know any better.

Now I’m not saying that there aren’t any good services out there, because believe me, there are some excellent companies around. It is just that, the people that I see and speak to don’t seem to be using them. Perhaps it is just the position that I am in or the people that I speak to, but there is a definite need for those people to switch to something better. In fact, there is a definite need for those people to value their own care at least as important as their car or house.

Come on people, you deserve better so make sure that you get it. Is it time for you to switch?

Salut

The other day…

…I was conducting a training session, which encompassed human rights, dignity, choice, safeguarding & abuse etc. A sort of intro into the world of care and it’s many facets. Anyway, I was going through the Universal Declaration of Human Rights and explaining what it means:

Article 25.

• (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
• (2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

We should take care of one another.

A little later on we were talking during a break and one of the group statred talking about what their friends work is like – they also work in care. It was the usual story of not having sensible travelling times between appointments, not being given enough time at appointments, blah blah.

I pointed out that our friend – UDo Human Rights – might have something to say about that way of delivering care, not to mention that big word ‘dignity’. A discussion ensued and I was asked: “Well, if they’re not doing it right, who’s doing something about it?” to which I replied “Me?”.

That’s the thing though, what exactly can one person do to change anything? Well, Ghandi said it starts with one person and one idea, and he did alright. Don’t get me wrong though, I’m not comparing myself to the great man, nor am I claiming to be able to make the situation better. All I am saying is that if we can pass on the ideas of dignity and human rights, perhaps one day the right people will listen.

So this is me doing my bit; along with my everyday work. I am saying to you “Stuff isn’t right, we need to change things. We need to remember that we are dealing with human beings, these people could be our familiy.” and what I want to know is “What are you doing about it?”

Salut.