Tuesday, 17 November 2009

Depressingly un-sexy

Every morning I set my radio alarm to wake me up with the Radio 4 Today Programme. I know I have become like all those bitter and twisted 50 somethings I remember working with, who are counting off the days until retirement, but the news today was depressing. A survey by the Alzheimer's disease society found that people with dementia get a poor deal when they are admitted to medical wards. They often spend longer in hospital than people with similar conditions without dementia and when they are finally discharged their dementia is often worse. This "news" was met with instant condmenation from all political parties (rightly so, but then there is an election approaching) and plans for action.

 I say "news" because to me this is sadly not news. Fifteen years ago when I was last working as a clinician this was the situation and in fact it was the topic of my colleague's PhD thesis. The reasons cited at the time were the same as the reasons now; lack of training and skills from staff in knowing how to manage people with dementia, unsuitable environments, lack of resources. There were outcries, plans, policies (I can remember going to a few meetings and consultations in various organisations) and, as I'm sure there was an election then, there were statements that this would change and a lot of guidelines produced. Obviously they were effective!

As I see it, there are several problems:
Training is rationed in the NHS and expensive. Over the last years training budgets have been cut. Training for unqualified staff is carried out on the job (a good thing)  by senior staff who also have little basic knowledge about care (not a good thing).
There is a high staff turnover on these wards due to the unrelenting pressure of the job (and poor pay and conditions, especially for the lowest paid who have the most patient contact). Even if staff have training they usually leave before they can put anything into practice.
Medical wards are usually under-staffed.
Dementia is still not 'sexy'. The majority of people with dementia are frail and elderly and Terry Hatchet, Ronald Regan and Iris Murdoch are the exceptions (and can or could afford proper care).
Solving these problems is not difficult but does require money and as there are an awful lot of people with Alzheimers it requires an awful lot of money.

So instead, governments prefer to spend money on cheaper but higher profile things that seem more trendy. Also on my local news this morning was the story that our local NHS  Trust is opening an walk-in health centre at the railway station where people can "see a GP or nurse from 8am to 8pm, seven days a week".
 A statement from the chairman of the local trust said

" the centre will also be able to look after anyone else who needs to see a GP or nurse, whether they live locally or are simply visiting Eastbourne or working in the town. It is all about making it easier for people to get the care they need at a time and place convenient to them."

I can't help wondering why we need such a place. Do you get off the train in Eastbourne and say "Ahh. on my way to the seafront I'll just pop in and ask this nice doctor (who knows nothing about me and my medical history) about the stomach ache I've got this morning" 

Given the population profile of Eastbourne the money would have been better spent on the former problem but a GP and a nurse in an office at the train station is cheaper than the cost of ensuring that your basic services are up to scratch and a lot more trendy (just like on Street Doctor).

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