Well it looks like Florence Nightingale was right after all when she subjected her patients to a regime of sunshine and fresh air. An item in this week’s New Scientist cites research confirming the bacteria-killing qualities of these two commodities. The value of sunshine and fresh air is receiving greater attention at a time when the classic antibiotics are becoming less effective. As the article says, “.. perhaps we can prepare for the looming post-antibiotic era by taking some lessons from the pre-antibiotic age.” One of the researchers writes, “Hospitals of the future should be designed to allow windows to be opened and perhaps patients to be pushed outside in their beds.”
The reality for thousands of people in care homes, nursing homes and hospitals is something rather different. Thousands of older people in particular spend most of their days in stuffy, stale, airless environments. It seems to show up a lack of interest in the quality of the physical environment once a person finds themselves ‘in care’. CQC’s Essential Standards of Quality and Safety runs to 274 pages but says little about environments that support physical and mental health. Perhaps it’s time to look at the scientific evidence and revise our view of ‘good care’.
The Royal College of Speech and Language Therapists has just issued ‘Five good communication standards .. Reasonable adjustments to communication that individuals with learning disability and/or autism should expect in specialist hospital and residential settings’. It is a helpful document that has relevance beyond hospital and residential settings. Standard 4 is about services creating “opportunities, relationships and environments that make individuals want to communicate”. Here they recognise that ‘communication problems’ derive not just from individual characteristics but also from how people relate to each other: “Good communication needs to be considered broadly. It is about social interactions – greetings, sharing stories and fun. It is the quality of interaction that contributes to overall emotional and mental wellbeing; providing a sense of belonging, involvement and inclusion.” One of the ways in which services will know they have achieved Standard 4 is when “Staff are observed spending time with an individual for no purpose other than interaction and communication.” Continue reading
The appeal of standardisation
In human services there are often good reasons to standardise activities. For example, sticking to a standard checklist for operating theatre staff, including checking the identity of the person on the operating table and the procedure that person needs, has been shown to improve the success of operations. There is no reason to quibble with the standardisation of that activity.
In recent years politicians and administrators have been enticed by the idea that almost everything can be standardised allowing them to assess the value and quality of a service in terms of the service’s compliance with set standards. Continue reading
Martin is recovering from a stroke. He now needs help with activities like dressing, washing, shopping and cooking. Some activities like going to work and driving are right off the agenda. His mobility and communication are impaired and at times he feels useless. But worst for Martin, he feels he is no longer the husband, father, grandfather, friend and colleague he used to be. Continue reading
People’s surplus time is something we can make much more of, particularly with regard to the needs of older people who are isolated or who feel vulnerable. To capitalise on this resource we have to tackle those obstacles that reduce people’s propensity to offer their surplus time. The solutions may be many but include technologies that allow people to identify where their surplus time, however marginal, can be used to good effect, achieving a better connectedness between formal care, informal family care and other community support, enabling organisations and groups to increase mutual support within existing structures, changing the perception of what older people have to offer, and supporting people to create their own systems of informal support. For each of these proposals there is a practical agenda. Continue reading
Getting to grips with the Adult Social Care Outcomes Framework (ASCOF) is no simple matter. We’ve just been given access to some of the outcomes data on a new website: http://ascof.hscic.gov.uk/Outcome . The technology behind it is impressive and it’s clear that the effort behind the whole ASCOF exercise is substantial.
We’re told by DH that “The ASCOF measures how well the care and support system achieves the things we would expect for ourselves and for our friends and relatives. People who use care and support, carers and the public can use this information to see how well their local authority is performing, helping people to hold their council to account for the quality of the care they provide, commission or arrange.” This sounds good but it’s a claim we have to look at with some scepticism. This is for three main reasons: Continue reading
Watching Dispatches on Channel 4 about the failings of surgeon Ian Paterson, we have to ask again why more people didn’t speak up about something that plainly was going wrong. There must have been many people involved in his operations and their aftermath. Clearly, intimidation is an issue and fear of reprisals. Also, there is the way in which a man with such authority, power and self-confidence can make others doubt their own judgement. We’ve proposed on this site that the web app Care Comments could help. Through Care Comments people submit their observations in a low-risk way to service commissioners. In the Paterson case we might suppose that observations would have been submitted from .. fellow surgeons, theatre colleagues, ward staff, referring GPs, Macmillan nurses etc. With such a volume of data that cross references and triangulates to confirm a problem, the imperative to take action is strong. It’s not the only solution, but it is worth consideration.