A terrible thing to have to write...

In the last 24 hours a couple of  social media interactions have linked together to cause me to write. One is ongoing and concerns the care of a dying person; having worked in Hospice and palliative care  for a couple of decades I can claim to know something about this. Added to this is my experience of end of life care that started on my first ward as a student nurse, that was even longer ago.    Follow @nursemaiden on Twitter to see the story unfold, in real time.
The other link was made this morning as I read @RoyLilley and his blog piece of today, see It's all going horribly wrong

As a service provider I am dealing with several commissioners, except there don't seem to be any out there. There are well intentioned folk in positions that have no decision making power; there is no-one in place in their organisation who can negotiate or decide what to do about the current financial year let alone the next one. In the meantime services go on being poor inequitable and not joined up. Commissioning is getting a bad name through this; as Roy Lilley points out the layers of interference and in my view obfuscation are causing serious problems;  in particular I find in creating change on the ground. 

We are not seeing a new dawn of person focused services - despite the efforts of providers to work that way; we are seeing a shuffle of the layers of control - a shuffle in inexpert hands that will be a whole lot messier than 52 card pick up. It is leading to a dying of the light in which the rules and regulations over reporting and numbers will lead decisions on the provision of care. I'm not convinced that concerns about the money (spending or saving) are behind the decisions; only being in a place where having control counts.

All around us though the dying, frail and vulnerable of all ages are only being supported by dedicated on the ground staffs day by day. Often they are kept from doing the right thing by the 'rulers' or vacuum and this is leading to provision of poor, less than best services and no sign that things will improve soon. That is a terrible thing thing to have to write in 2012.

Aftershocks and fallout

Having not written too much of late I was keen to get back into the rhythm of making a comment; the last week has been dominated by human tragedy. The ongoing tragedy of humans treatment of one another - as evidenced in the Arabian North Africa region, as well as the devastating effects of a natural event as we've seen so well demonstrated via all sorts of media, from Japan.
My links with the Middle East as we in the western world refer to it are pretty tenuous; I had visited Israel for sight seeing over 20 years ago; I have looked across the Straights of Gibraltar at the coastline on the other side. I have little feel therefore for what normal day to day life is like, as I suspect many westerners do, despite it's proximity. It occurs to me as a politically naive person, that oppression must have been going on a long time. Yet it's taken til now for governments to realise that the relationship we've had with such countries is complex and double edged. If we weren't so dependent on oil would we have had the same relationship? I'm sure political and economic experts can and have argued about that, and will continue to do so. However it would seem where economic interests are less complex, we are happy to ignore dictatorship and oppression; Zimbabwe and Mugabe being a prime example. I think the UK government is afraid to tell the Saudi and Bahrain leaders to stop attacking hospitals, and shooting their people. Oil and economic principles really get in the way of a positive ethical stance - that's political life I guess, but makes it no less acceptable. The end to this situation is not in sight yet; it may get bloodier before it gets settled.
In Japan we have more contacts and have visited the country; I understand why there is no panic at present, yet there are some political and practical difficulties. The relationship of government to the nuclear power industry is being questioned; how much this has this led to the situation at Fukushima will debated long and hard; the lessons must be learnt globally too. In the context of difficulties over oil prices and supplies the debate itself on nuclear energy becomes critical.
In the meantime we have now been able to establish contact with all those we know in Japan; they are alive and saying they are ok; however we hear of young children so traumatised by events they are not eating. That leads to the question of the priorty the Japanese government seem to be giving to getting food and water distributed. Are things much worse and they are saving face by downplaying this?  The long term psychological effects of the earthquake and tsunami are going to be with us for a couple of generations at least; any serious radiation leakage will be with us much longer.

NHS frontline cuts - coming to a hospital near you... a BS Bank

So, unsurprisingly, the impact of budget squeezes imposed by the current government are having an impact on front line NHS services. See http://www.guardian.co.uk/society/2011/feb/17/nhs-hospitals-axeing-frontline-staff
These may seem to a disinterested detached politician modest changes to services; where will those women who won't be able to give birth at St George's go?
An electorate who are already being squeezed by rising food and fuel prices will see further erosion of the familiar as libraries, local clinics, schools and other institutions close or at best move away. Despite the attractiveness of local targeted services (this is a presumptive interpretation on my part of the Big Society idea) the drive to save money is simply removing established local services, making them impossible to restart by volunteers and charities as the costs will be too big. So, with no one capable of bearing the initial financial burden of running these local services the Big Society Bank will have no one to lend to. That will save more money, though not before the costs of setting up the BS Bank have been spent.
Did I say BS Bank? That takes me to another thought... the BS could stand for something else?
A headquarters in Westminster perhaps?