Saturday, 15 November 2014

Still feisty after all these years...

I come from a long line of feisty women. No surprise there I hear you mutter. And mostly it serves us well. My Grandmothers lived through two world wars, deep recessions, losing babies and teenage children even and then widowhood. These were such tough times.
 My own mother in some ways had it easier; better times and better medicine eventually made her life more comfortable, her own babies safer. But she too lived through her teenage years in a town that was relentlessly bombed during the war and that left its scars. Her evident fear during a storm a testament to those early years spent in bomb shelters.

This week has found me in deep reflection about the past. November 12 was the anniversary of my fathers death. Twenty years have passed and perhaps it's juxtaposition to the Remembrance ceremonies, with that 100 years commemoration of the start of the war that was to end all wars,that made it so poignant. We came upon this wonderful tribute from his home village on return from serving in the war. 

So many lives changed by that war and others. This of course was the stimulus for our welfare state, people no longer willing to accept the status quo. Are we really willing to stand by and allow it to be dismantled with all it stood for? He for one would be very, very angry if he were still here to witness it.

The twenty year anniversary of course is also of my mother being windowed. And although over the years she has spent many holidays with the family, all celebrations shared together, weekends with us all and so on, nonetheless each time she has returned to an empty house. Of course she had her routine, punctuated by time with friends, reading, favourite TV programmes, hobbies and the like. But in the last few years Alzheimer's has robbed her of those and of her fragile peace of mind. The time had come that being home alone was jeopardising her wellbeing and safety. Of course that feistiness served her well but it was no longer enough. And so this weekend she went to try out a care home to see if it would help. The family achieved a remarkable changing rooms transformation on her room. Creating the familiar around her. It was overwhelming at first but she has quickly adapted and is thriving with having company. All fingers are crossed that may even help her regain some of her dramatic weight loss but if not at least she will be feeling safe and be celebrating her regular quiz and dominos success! It has taken support from the family to enable that and it also takes real courage to face the kind of change she has. 

Much of the drive in health and social care is to keep people out of hospital, to stop admission, to enable early discharge and of course that's right. No one really wants to be in hospital. But we are social beings. We need the connection of others. Especially when we are unwell. The milk of human kindness is part of healing and wellbeing. I fear for our future, where single households are the norm and in general we are a more disconnected society. Can we start to find ways to respond to this now?

We do need however to ensure that health policy and personalisation approaches connect rather than isolate people. Prescribing a pill may lift a low mood but it won't stop loneliness. We prize independence but do we also need to relearn interdependence, how to share, collaborate and create together. As family units change so can social units maybe? The answer doesn't need to lie with institutions but within communities too. Of course there will always be a need for increased support as our frailty increases. And our own experience reminds me that we shouldn't fear modern care homes who offer person centred support and kindness when we need it.

Courage comes in many forms, keeping going through the hard times and also knowing when to accept help. The public services role is to support our personal and community assets, not undermine them. If we keep remembering to ask what matters to them we are more likely to respond accurately to the need, not making assumptions that can threaten wellbeing. Yes we need to keep people out of hospital but that doesn't mean the only answer is to be at home alone at any cost. Is there a creative answer to this I wonder?

Sunday, 2 November 2014

People powered reform of health...thats got me singin.

Yet again I have had to engage with the NHS recently and I have been treated with respect, compassion, taken seriously and supported with clinical competence. I'm so grateful to all who play their part. In many ways the system works well for me, especially as I  have a good level of health literacy, given my nursing and public health background. But when it comes to my Mums needs, frankly, its poor. Frail both physically and mentally now she is so vulnerable and without my sisters nearby support, coordinating her care, advocating for her, plugging the many gaps and lack of joined up thinking I really find it hard to see how she would have survived, and certainly not at home.
Aged 86 and well until recent years she has done well, but its heartrending to see her decline now. She is typical, not unusual. Thankfully she and my father saved for this rainy day and it is helping her afford the care she needs but my sister has the finger in the dyke of her need and lives with the constant anxiety of what will happen next.
It's no surprise to me therefore that we have had reports of the pressure on the system, on waiting times, on recruitment, on burnout of staff. I have suggested in the past like others we need to decouple health and social care from politics but let's be honest that's not likely to happen. But the pressures on our health and care system is echoed across healthcare systems in the developed world. The combination of us living longer and therefore developing longer term and more complex needs for care and treatment of course are part of this. So too is the development of expensive treatments that extend and improve life in a way we couldn't have imagined a generation ago. We look on and expect others to make decisions on which drugs to fund, to play God or a kind of Russian roulette to decide who can have the life extending drugs and which we can't afford.
We expect targets to be met at the same time as politicians in Westminster are saying austerity measures cannot be avoided. It's not sustainable to expect both and we all need to be part of the conversation to decide how we improve and sustain things in the longer term; as well as what we are willing to pay to achieve this. There is no doubt that health will become the political battle ground of the next election but I fear that will serve nobody in the longer term.
We need a vision that enables a greater wellbeing for all, that works with individual and community assets not their deficits,we need to bring love and humanity into the whole process of care, and have honest conversations about what we prioritise and what we don't. And we need to stop thinking that changing structures or organisations will solve things, they won't. The best thing our politicians of all hues and nations could do now is get around the table with representatives all of those who work in and experience the service. Then commit to working with them, to really listen and to learn from them to work out the best way forward and indeed what that will cost.
Let's also have the wider civic conversations like we had in the run up to the referendum here in Scotland about our health and care system and recognise that we all have our part to play to support the services of health and social care to thrive. 14,000 people in Scotland did submissions to the Smith Commission, can we harness that engagement around our health and care service and shape together the future service we need?
I think we can, I think we need to. We know this matters to people, let's trust them to understand the issues and  to help shape the future.   
I leave you with the words of that well known optimist Leonard  Cohen for all you who feel concerned that the opportunity for positive change wont come," Youve got me sininging."