Watch out! - for the little things

I’m into week three of my induction period after joining an NHS acute trust. These days we’re all in a uniform of some kind or mufti; a big change since I was last working in such an environment is being bare below the elbows. Brought in as we became more conscious of infection risks ties have largely gone too.

So after several decades of wearing a wrist watch that habit has had to change too. “You can get the time from your phone” I hear you exclaim; but I’ve worn a wrist watch for much longer that digital timepieces were available, when analogue meant winding up the watch or clock yourself. And to get time from the phone meant dialling the speaking clock.

Why is this worthy of mention? The watch I’ve worn for some years now belonged to my late dad, and it was given to him after many years work as a teacher and head teacher in inner London. It’s served as a reminder of his commitment to education and those in his care; whose learning and development were so important.

It’s also reminded me of him as a person and father and of his love of public service and doing good things through that service. It’s been a little disconcerting not to have it handy to refer to. It’s meant I’ve had to develop a new ‘check my phone for the time’ thing though I still go to my wrist and wonder why there’s a gap. It’s made me reflect on loss and grief; another step away from him. It’s chipped at the inspiration the watch has provided as well as a sense of time. I always like to be just a little early and a watch is a quick way to check times progress. Now I have to rely on my phone, or the occasional wall clock, to be sure I’m timely.

Not having the watch has been a distinct loss that I wanted to mark through speaking up about it; it’s about the difference little things can mean to people. This was emphasised to me again this week listening to Chris Pointon speak about Dr Kate Granger and the build up and progress of the #HelloMyNameIs campaign. Do look the campaign up if you’ve not heard of it; even if you know about it, remember little things when left out or ignored can have an impact much bigger than we can ever realise.

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.

Creaking care market

I've seen a report today that says the UK's leading residential care provider is having to restructure its finances, Southern Cross Healthcare. Refinancing is a fashionable thing to do - Ireland and Portugal spring to mind. Not surprisingly the Department of Health are said to be watching the situation and are concerned that standards of safety and quality are maintained in the care the residents receive. I suspect too they are concerned at how a potential market leader collapsing would look for the current health care reforms.
I have had a look at the Southern Cross website http://www.schealthcare.co.uk/News-and-Events/2011/Message-from-Jamie-Buchan-Chief-Executive-of-Southern-Cross-Healthcare/ and the message from their CEO; it is the closeness of SCH to Local Authorities and their finances that is the real problem. If Southern Cross are struggling who else is? Are we going to see more care providers struggling and those without sufficient critical business mass go under? Where will residents end up? At the end of the day what would happen if there was no local capacity in the sector - is the UK ready to have residents shipped about the country as there is nowhere locally to house them?
Is this the kind of result the government expected from market reforms? Markets have to allow for failure - are we prepared to accept this kind of failure in the care sector? Failure here is not an option - not if we are to avoid a return to a workhouse scenario.
It sounds like Southern Cross have a plan; indeed have been working on their plan for some time and I wish them well; not just for those with a financial stake in the company (I wonder what my bank has lent them?) but mainly for their people - the staff and residents and their families who will need to have faith that the system will sustain them.