I was 36 for my first Christmas period as a consultant. In 1980 Christmas was taken very seriously even to the extent of admitting the occasional lonely person for management so that they would not be on their own at Christmas. All ward staff helped to decorate the wards and on Christmas Day the consultants (and often their families) went in at lunch time. My elder colleague would carve the turkey. Such largess from the NHS did not survive Mrs Thatcher’s financial crises!
After lunch on the ward, I and our family would visit one or two of my housebound patients, usually with multiple sclerosis (MS) and the children usually ‘enlivened’ their house for a few minutes. One such lady was actually a patient in one of my beds on the first day of the job. When I went to do my afternoon clinic I was surprised to be intercepted by a general practitioner who wanted to tell me about this patient who was having repeated hospital admissions with bed sores. She lived at home with a daughter aged less than 10. The community nurses were at their wits end as the patients’ social care needs intruded on valuable nursing time.
A conference was arranged with social services and I am embarrassed to report that I had never attended such a conference during my training. The conference was chaired by a senior social worker from Harrow Social Services (HSS). I prudently kept my mouth tightly shut for most of the conference which was really about the potential for the appointment of social service-based care workers who had the skills of a ‘competent caring relative’ ( this was a new concept for HSS but had been tried out successfully elsewhere – I think in Derbyshire). They were subsequently appointed as HSS Care Attendants. I was able to persuade the hospital to produce some funds (from joint funding sources available at the time for joint health/social service projects) which enabled these competent caring women to look after social need thus enabling the nurses to concentrate on skilled nursing tasks for this and other patients 1. The only drawback was the behaviour of the patient herself who was demanding and difficult.
It fell to me to have to point out to her that if we were unable to care for her at home, then she would be cared for in a ‘young disabled person’s’ unit and her daughter would be cared for by social services (foster care) . To every ones surprise, her behaviour (which had been attributed to her MS) changed dramatically. HSS put in a lift which could take her in her large wheelchair up to her bedroom where a ‘high tech’ pressure relieving mattress was provided on a hospital bed.
Close Working Relationships
This illustrated to me the importance of being able to have straightforward discussions with patients despite the difficulty of the emotionally loaded nature of the topic. However, I also remember this individual for a number of other reasons:-
- The close working relationship developed with HSS not only enabled this individual and her daughter to remain at home together, but also the good social care probably helped to prolong her life. I had estimated – for the purposes of procuring funding – that she had a life-expectancy of about 2 years when I first met her. She lived at least 8-9 years.
- After her death, I was asked by her daughter, by then a mature teenage, to say a few words at her funeral – the only time that I was asked to attend the funeral of one of my patients. This I did, commenting on her Mother’s resilience and fortitude.
- After my few words, the lead social worker also spoke at the daughter’s request. Tears rolled down his cheeks as he spoke. I was sufficiently surprised by this to comment on it to him afterwards. He responded by saying that doctors are trained to withhold their emotions but social workers find it best to let them flow!
- The close relationships which evolved from working so closely with social services – at a high level – facilitated my professional life enormously to my benefit and that of my patients.
- Some years later I was able to develop close working relationships with disability employment advisors and with Harrow Association of Disabled People – but these relationships disappeared when the Department for Work and Pensions (or its predecessor department) destroyed the local networks by giving contracts to large outside organisations.
I am happy to discuss any of the issues raised in these reflections with colleagues who can contact me via the VRA.
Trustee and Past-Chair, VRA.
(1) Ellis PF, Frank AO. Care of a severely handicapped person over eight years: implications for the future pattern of community care (case report). Br J Gen Pract 1990; 40:383-385.