Redesigning Health and Social Care

I’m just pondering over the news that Simon Duffy, the founder of In Control, has quit the organisation after an alleged Boardroom clash. Simon Duffy will be closely associated in many people’s minds as a major driving force behind the introduction of personal budgets. Many have listened to him speak passionately on the topic at various events over the past few years.

Simon Duffy’s departure from In Control – a social enterprise at the forefront of self-directed support – comes at a critical time for social care. Local authorities across the country are working to implement the personalisation agenda, and In Control has provided many with a model of good practice. The widespread introduction of personal budgets represents a significant shift in the way that services are funded and delivered, and it’s in the these times of change that calls for strong leadership are heard.

Simon Duffy is somebody who many would consider to be a strong leader: he challenges the status quo; provides a strong voice for people who may otherwise struggle to get their views heard; and speaks with conviction about the principles and objectives of personalisation. However, today’s report suggests that this positive side of leadership may also trigger discontent and clashes with others. Successful leadership seems to involve striking a balance between persuading and directing people, whilst enabling them to participate and share in the process of change. Ultimately, I suppose it’s about managing complex and messy human relationships. Is it really fair to expect all leaders to be all things, all of the time? 

If you watch BBC TV over the next two weeks you will not escape the
Wimbledon phenomenon, where even the most dedicated couch potatoes in the viewing public become obsessed with fine physical specimens like Andy Murray throwing themselves around the courts. Meanwhile, if previous years are anything to go by, the public tennis courts in my local park will suddenly be full of people not looking anything like so fit trying to emulate their sporting heroes.

Some months ago, quite by chance, I used tennis as an analogy for life in some materials I was writing on health and wellbeing for the Open University’s forthcoming new 2^nd level health and social care course.

“Not surprisingly health and social care services tend to focus on what is going wrong in the lives of their service users, as they have to try to find ways of tackling their problems. However, in order to recognise what constitutes a ‘problem’ it is useful to have some understanding of what a good quality of life might look like, as this provides a point of comparison between what might be and what is. To use an analogy, if you wanted to improve your ability to play tennis it would help to know what a good game of tennis is like, what makes for a good tennis court and for your coach to know how successful tennis players operate, as well as having an understanding of the circumstances under which people play tennis poorly. Knowledge of quality of life and the factors that contribute to an individual’s wellbeing can similarly be useful to those who provide and use health and social care services.”

What I didn’t consider at the time was that, in comparing ourselves to the likes of Andy Murray or Venus Williams, whilst we might be inspired to greater things we could also become dissatisfied with our less than perfect bodies and with our less than optimal performance. The balance between inspiration and desperation is a delicate one. How do you react to this week’s Radio Times cover?

It was reported yesterday a woman has died, marking the first death in the UK from Swine Flu. Although it has only been reported for around 12 hours at the point that I write this post, I have to say I have been impressed with the reporting of it that I have seen on the 24 hour news channels and online. Gone is the sensationalism of the a few week ago, and in has come a bit more rational reasoning.

But I’ve been thinking…. does this rational reasoning downplay the situation? Will it make people more vigilent about personal hygiene? I am constantly amazed when I see people not wash their hands after using the toilet or before they eat. Why is the message about hand washing simply not getting through to some people? Perhaps we need a bit of drama in the media to get the message across about the spread of infectious diseases and the importance of basic principles about hygiene?

I suppose the question is how to get this point across without either being melodramatic about the person who has died (or those who are ill) or causing a mad panic. Certainly, journalists and their superiors are in a powerful position when it comes to providing information and gudiance about health and illness to the general public. But is this right that we have ended up being so reliant on them?

“If it was me, I’d have given you such a slap.”

How would you feel if that was said to you?  I was watching a care worker say this to a service user.  They’d known each for years.  Certainly, the exchange had warmth to it.  The service user was giving as good as he got.  But is it appropriate to tease and banter in professional worker-client relationships?

On one hand, in many health and social care relationships, the workers need to build intimate and supportive relationships.  A little bit of teasing and bantering suggests affection and attention implying that ‘we are close enough to have this sort of relationship and enjoy shared laughter.’  Banter is a social lubricant.  Perhaps it builds bonds.

Health and social care work can also involve embarrassing, awkward and unusually intimate situations.  Humor can lighten the mood and drain uncomfortable feelings.  This may also be particularly important when the worker, dealing not just a difficult situation but a difficult person wants to comment on inappropriate behavior.  Teasingly pointing out that someone is out of line stops anyone from losing face. 

But is it appropriate?  When does it become bullying?  Research suggests that the teaser can enjoy the interaction more than the teasee.  Is teasing and bantering a misguided way of building relationships and dealing with the sometimes awkwardness of practice?

What is the solution to the NHS? Our MPs are making over-indulgent  expense claims for duck islands and toilet brushes – whilst the European Working Time Directive threatens to choke hospitals by reducing over-work for doctors. Looks like a summer of political belly-ache ahead. How will you be spending yours? I’m sure you’re all waiting in eager anticipation for one event. It has come round every summer for the past decade, and no I’m not talking Big Brother – but National Gut Week! Or perhaps you have been lucky and it passes you by unnoticed? Maybe a little flatulence after an impromptu barbeque, a hiccup or two after an ice-cold beer, with not so much as a ‘pass the Rennie, please’?

A couple of years ago this week of gastric celebration saw me doubled up in agonising abdominal pain, and I was rushed to A&E by my GP. This was my first experience of hospital but given the range of performance targets thrust at the NHS I had high hopes. My GP knows me as a level-headed, capable adult, who faced with most experiences can reel with the punch and get on with life. Once in the hospital ward however, I became a 30-something woman (oh no, not one of those!) presenting with non-specific symptoms (i.e. they can’t see it on an x-ray), and they very quickly had me down as an awkward hypochondriac with an extremely low pain threshold.

The first diagnosis was consumption of suspect barbeque food, despite my assurances that I was vegetarian and hadn’t managed to eat anything, least of all raw chicken, for the best part of a week. National Gut Week passed in a blur of bodily invasion by tubes, needles, x-rays and scans. I was never told a test result and when I attempted to ask my consultant, he immediately became defensive, claimed there had been ‘a breakdown in the doctor-patient relationship’, and promptly passed my case over to a colleague (together with a referral to the hospital complaints department which I hadn’t requested but was my ‘right’).

Meanwhile fellow patients were dutifully consuming ‘celebrity chef inspired’ hospital dinners and silently watching the news on brand new television sets. At the time the government was announcing the scrapping of hospital ‘star rating’ in favour of another concoction of targets based on managerial goals and ‘customer choice’. I had ‘breeched’ by spending longer than four hours in casualty before admission. This may have cost my hospital a third star, but quite frankly, I would have been happy to spend four days in casualty if they could have made me better. With or without celebrity food and flat screen TVs.

So my first experience of hospital and of National Gut Week become a painfully slow and drawn out process, as staff tried to reach targets and I failed to tick any box. One morning on Channel 5, viewers with stomach problems were invited to ring in for a live on-air consultation. Dr Mark Porter beamed down at the ward, oozing bedside manner, charm and confidence, and I was momentarily convinced he held the key to unlock my suffering. Even the nurses were egging me on to make that call. There’s a celebrity, surely he could get me out of there? Pass the telephone trolley, nurse…(or have they phased those out now..?)