Care in the Community - Been There - Got Nothing

The sudden burst of posts might lead you to think that I have suddenly become more agitated of late but you'd be wrong. It's just that the year end in public accounting is when we all get inundated with requests for "stuff" - I won't bore you with the trivia that is much of my working day. The worst of the storm has passed, so I can attempt to benefit from the catharsis from shouting at the world-wide webosphere.

The current DH obsession with "moving secondary care into a community setting" brings back both some sad memories from my own childhood and also my own view of the last time we heard "care in the community". This was a dominant mantra of the Thatcher years. Why sad?

Well, my elder sister was born brain-damaged and remained a young child for the twenty one years she spent on the planet. At the age of twelve, in the early fifties, she was sectioned and sent to St Lawrence's Hospital in Caterham. She wasn't a danger to herself or to anyone. It was simply because my parents couldn't care for her due to my mother's failing health. Every other Sunday, we visited for two hours (having to queue outside the main gate until precisely 2pm). The journey was bus, train and then bus again and it took two hours each way. The wards were crowded and the nurses were amazing. Most of the inmates were there because that was the only structure in place at the time to provide such care. Once admitted, the "patients' " chances of leaving alive were almost nil since there was no rehabilitation; just detention. You might think then that I would be "Care in the Community's" greatest fan? If only!

The reality was different to the hype. Who can argue that my sister and most of the other 2,499 prisoners would have been better off if the vision of Care had been delivered?

Instead, the whole strategy was used by central and local government to leech money from the system to meet their short-term financial imperatives. St. Lawrence's was closed the government pocketed the proceeds of selling prime Surrey commuter belt development land. Local authorities were left with inadequate budgets and insufficient experience to absorb a wholesale shift to them of people who had spent their lives in such institutions with complex health needs and no clue of how to even help in their own care. It was ten shameful years of waste, unnecessary bewilderment and confusion.

The problem was not the intention. it was its implementation. If I could lay my hands on the mandarin that executed this appalling act, I would cheerfully throttle him.

Polyclinics - An Elegant Summary

George Monbiot writes for The Grauniad. his article on polywotsits is a standard of writing to which I can only aspire with little confidence of achieving.

Do read it here

Don't Confuse Me with the Facts

In our neck of the woods, "polysystems" are the flavour of the moment. They are the result of Lord Darzis's major review that in far too many words and way, way too much money, concluded that:

1. London has too many hospitals;
2. Lots more care should be delivered "locally" (which is healthspeak for "not in hospitals");
3. GPs should work in polyclinics (but we'll call them something else because polyclinics don't work).

I attended a meeting last month at which I said (yet again) that the wholesale disruption of existing referral processes can only work if the communications infrastructure is in place.

The director chairing the meeting agreed.

I then said that this would be especially true if the Darzi model is implemented (it is happening right now).

The director chairing the meeting agreed.

Then says I, but the current infrastructure is not in place; it's years behind schedule and billions over budget.

The director chairing the meeting agreed.

So, I went on, if you agree that it will only work if the comms are in place and you agree that the comms are not in place, the only logical conclusion is that it won't work???

The director said it was too early to say that!

Mmmm... now there is a good idea. let's wait until the system isn't working and patients are transferred from here to there, and then somewhere else, whilst their notes move from anywhere to nowhere.

Makes perfect sense to me.

Just Who Is This "Public"?

I live in a small rural village. It's lovely. It has a post office but not for long. Following a "public consultation" our post office will close at the end of the month. A lot of our neighbours submitted their opinions to the Post Office. Every one of them said "please keep it open". The only person I know who wants it closed is the man who owns the shop and post office in the next village five miles away. His post office is closing too! I can't imagine any sane individual saying: "close my local convenient post office (even though I only use it on 'high days and holidays')". Can you?

At the moment, the NHS is spending millions of taxpayers' money on a public consultation of the "Darzi report" on the future of NHS services in London. The big change in primary care is the idea of "Polyclinics". The consultation is about to be completed but no findings have been published yet our PCT has now published its plans for the first two polyclinics. The tenders are going out soon. Six more are in the second stage of detailed planning.

I hope the consultation agrees with Lord Darzi but somehow I don't really think it matters. Do you?