After the excitement of allowing our 1-year old child to open his Christmas Stocking and getting the turkey in the oven, the family got into the car and went to Northwick Park Hospital (NPH). Christmas Day was taken very seriously by all the staff. A turkey was delivered to the ward and the senior consultant – not me as I was the new boy – carved the turkey in front of all the inmates well enough to get into the meeting room. The ward staff was supported by a small dedicated group of ex-patients or their relatives who added to the festive atmosphere and came in every Christmas Day to support the Ward Teams. It was possible that one or more of the patients would have been admitted especially as it was Christmas and they would otherwise have been on their own. Such practices were soon disbanded as the harsh economics of the early Thatcher era hit the abilities of the hospital to deal with its inpatient workload!
On our way home we dropped in to see one or two of my community-living individuals with multiple sclerosis who were on their own – 1980 was before Harrow Social Services (HSS) had appointed any care assistants to provide personal care – a development that was soon to come and with which I was closely involved.
The most memorable person has been referred to previously (Reflections of a Rehabilitation Professional of December 2018). I have previously recalled to her multiple admissions to hospital with major pressure sores. She (Mrs A) lived with her young child and cats. The latter created a problem for the district nurses who were the only support staff going into the home and who didn’t feel it was their job to feed the cats although they were always prepared to assist the child if needed. The problem was that Mrs A was becoming more dependent as her illness progressed and if she could not be supported at home then she would need residential care which was not available in Harrow and would result in the child also needing residential care of one form or another.
The situation would be greatly improved if care assistants could be appointed but where would the money come from? I was dispatched by the head of HSS to find out whether there were any NHS funds which might be utilised – and amazingly there were ‘joint funding monies’ which were available for such cases where there was both health and social need. After a period of time the monies would ‘taper’ to social services. My estimate of her survival was grossly out – I was too inexperienced to know that life expectancy could be expected to be extended with good social support! My stock with social services went up enormously when the money was forthcoming and care assistants were able to be appointed. There was capital expenditure to fund a hi-tech pressure-relieving mattress from the NHS, a lift to get her upstairs to her bedroom and extra support to strengthen the bedroom floor funded by HSS!
Eight years later she died peacefully and to my surprise I was asked to attend her funeral by the adolescent ‘child’ and the head of HSS also attended and we were both asked to say a few words – the first and last time that the family of a patient asked me to go to the funeral of a loved one. I said my bit and then my colleague from HSS said his piece amid floods of tears! I commented on this to him afterwards to which he replied ”doctors keep their emotions well hidden but us social workers are trained to let our emotions loose!”.
Fortunately, I was able to utilise these close NHS/HSS relationships when we set up a scheme to utilise our locally trained care assistants (with the skills of a competent caring relative) to assist elderly individuals on discharge from hospital – a very successful scheme which saved the NHS a lot of money 1. After the conclusion of the trial, the scheme was totally disbanded! The same old story: that the savings accrued to one department but at the expense of another!
I hope you all have a fantastic Christmas and a very successful 2020! I am happy to discuss any of the issues raised in these reflections with colleagues who can email me at andrew.frank1 at btinternet.com (excuse the spam filter) and head the email VRA – rehabilitation professional reflections.
Trustee and Past-Chair, VRA
(1) Townsend J, Piper M, Frank AO, Dyer S, North W, Meade TW. Reduction of hospital readmission stay of elderly patients by a community-based hospital discharge scheme: a randomised controlled trial. BMJ 1988; 297:544-547.