NO CARE

It was a darling tiny little pup, very much wanting to chew anything it could get into its little mouth full of pointed baby teeth.  It had lovely markings, picture book markings for a Jack Russell dog. He was happily bounding around on an area of grass at the feet of the girl holding his lead.

One girl in the group with the pup did not know what kind of dog it was, the other did not know how old it was, another youngster plucked an age out of thin air and so it went on. Another girl arrived who knew a bit more. The puppy was born on a local farm, he was one of six.  The pup arrived with them two weeks ago aged six weeks.  She thought he ate about three times a day puppy meals from a sachet.  As for inoculations,  what would they be for.....rather than go into it, I gently suggested the pup not be allowed to run around too much on the grass and not to go for walks  for now, explaining her puppy might become ill without have had protective injections first.

A year ago, I saw a family with a four weeks old Labrador  puppy in a park. It had been with these people a week already. The adults were very coy in talking to me about it and no wonder, they knew fine well the dog was too young to have been taken away from its mum.

There are, without a doubt, some disreputable people breeding animals. They have no care about early separations, no care about what kind of home an animal is going to, nor about what kind of care it will receive.

...IT WAS THE PLUMBING

We were expecting a tradesman this morning.  At 08.50 sharp, he phoned to tell us that he would arrive in ten minutes. Two minutes later the man phoned back to let us know he would be a bit later, his wife had phoned and he had to return home. The tradesman started work on our job about an hour later.

"How's your wife?" I asked.
..."It wasn't the wife, it was her plumbing".

With the matter-of-fact way he said it, my imagination took a turn into the musical hall and I stifled a laugh.  Hubby also turned away and 'cleared his throat'.

"At work I only do what I am expert at.... at home," said the man, "it's another story, I do everything." 

Time to change the subject.

Customer care was very good, in fact it was highly commendable.

COMMUNITY CARE - LET'S TALK.

The deaths of a number patients in the community led to fatal accident enquiries,(FAI's) during which a number of community physicians were cross-examined about their practice and abilities and their patient care. These enquiries are similar to those of the Coroners' Courts in England and Wales. 

The clear message that came out of the FAI's was, the communications between hospital specialists and the community physicians was totally unfit for purpose. The term 'woefully inadequate' would have been too gentle a criticism of the virtual blank wall between hospital knowledge patient requirements for effective care in the community. 

The standard discharge from hospital letter that followed a patient's movements, was inadequate and it relied, in the majority of cases, on someone handing this outline letter to a GP practice reception. G.P's had difficulties contacting specialists and obtaining information. It was a sorry state of affairs. 

Sadly, the patients who died had special medical needs or rare conditions understood in some depth by specialists and not by general practitioners. Some of the consultants would have been based in the regional hospital and others would have been out of region. The latter offered follow-up out-patient services in the regional hospital. This system still pertains. GP's started to tell patients with special needs that the hospitals, sometimes hundreds of miles away, had to continue their care, they, the GP's could not.  Since the FAI's and the GP 'work to rule', there have been changes to practice.  There has been a major overhaul of information technology and consultants are more readily accessible to the G.P's, BUT, only within region. 

The General Practitioners can now obtain reports of consultations and diagnoses, also the medical care required, all at the press of a computer button. This arrangement does rely on the individual at the hospital uploading the information and doing it promptly.  Blips occur, though in my limited experience, they have been rectified relatively quickly, once noticed. 

Likewise, and this relies on good practice pertaining within hospitals, essential community G.P. practice information about a patient can be accessed through the I.T network, for example, about drugs intolerances. 

It is a big improvement on what happened in the past and the technology can work. The I.T. systems seem to be up to the job. The weaknesses though, are obvious, the system is not infallible, but then nothing is. The access to information is dependent on timely recording onto the computer systems; it is dependent on hospital staff seeking community information and also checking on in-patient medical history, all being good medical practice. 

One of the largest weaknesses is that the sharing of vital information is limited to the hospitals and community medical practices based in the regional health authority. A major communications gap exists, fraught with old dangers because a range of specialist expertise is based outside the health authority. 

The regional I.T. system is, to a large extent, doing what it was set up to perform, to share important health care patient information, so, community health care professionals in theory, can provide appropriate care in the community. I say in theory, because the other major weakness lies in what resources are available to continue supporting specialised care requirements in the community.

WHO SAID THAT THE FIRST CUT IS THE DEEPEST.......

From time- to- time I post about current social issues.   The myth of free personal care for the elderly and vulnerable people  in Scotland was constantly peddled.  A few people spelt out the truth. It did not suit either the media or politicians of various persuasions to examine the truth of the matter.

Scottish elderly and other vulnerable people, who needed residential care, had certain benefits clawed back by the authorities, that their counterparts in the rest of the British Isles were able to keep. By this means, there was a major chunk of contribution being paid to that mythical free personal care. We worked out that a relative was left with a really tiny sum of benefits from allowances that other British people retained. We did not complain or moan about inequities; we did complain about the iniquity of the claim that there was free personal care. 

With the straightened fiscal times we are in, there will be, I am sure total clawback of certain types of state support, and with it, very little personal care, even for people trying to remain in their own homes, (an economic option) will exist.

Various social care organisations and charities now spell out the dreadful scenarios for the elderly and vulnerable individuals of all age groups in the community U.K wide.  Local authorities, who have severely restricted budgets, will no longer be able to provide home-help and arrange for such invaluable support like respite care for carers, (if any is left). The worrying picture painted, is likely to be so. 

There have been limitations of service by changing the definition of what constitutes 'severe or critical need' for a very long time.  It is more commonly known as moving the goal posts.  Re-defining needs is likely to be played with much more. 

Home help provision where I live, used to be means tested help.  If you were over a certain low income level, you contributed to the cost of the service.   That was generally accepted, until the calculation of the contribution changed to a vastly increased fixed hourly rate, irrespective of the individual's circumstances or personal means. The local authority service provision was in this manner, priced out of the pockets of those who needed it. It became more affordable to seek un-vetted home help support from private sources, if you could find it. 

In urban areas, agencies sprung up under contract to social service departments. This was economic outsourcing. Their service levels and quality of work were of concern. The same applied to care homes, whose services had mushroomed as private enterprise, since the 1980's. 

To counter the worrying standards of care, Care Commissions were set up in recent years, to inspect and regulate standards of practice training and qualification. They were always an imperfect tool, but their existence was preferable to not having any standards at all to work to. Their budgets are slashed too.

As a humane nation, we did get used to knowing that the vulnerable in our society would be cared for. We are uncomfortable with the growing truth that this is unlikely to continue to be so.

COULD YOU LOOK DOWN AT YOUR FEET?

I visited the GP with an eye problem under the upper lid. A locum was in situ, a nice person though not entirely confidence boosting. "I am not an expert on eyes", the doctor says.

Lying down on a couch to have my eye looked at was novel. And "could you look down at your feet?" I promise you, I tried.  On my back flat out, trying to find my feet was a bit too acrobatic for my eyes.  "It might help if I sat or stood up", I suggested......."No I want you lying down" said the doctor.

"Hm. Would you hold the torch and shine it in your eyes while I try something else, " requested the GP.  I dutifully did as asked.  I felt the lid being lifted; I screeched with pain and strained away, doctor jumped back, ...."that hurt did it, so sorry." 

No surprise I yelled, I saw that the doctor had been trying to poke around in my eye with a wooden throat spatula!!  

Should I make a quick exit...."I'm just going to put some drops in your eye....oops, sorry" as the orange fluid covered the whole socket and cavity.   The locum GP made a call to the hospital, for an eye specialist to see me as soon as possible. 

An hour and a half later, I am still in surgery reception - staff awfully sympathetic - waiting for feedback from the doctor, hospital, and a possible prescription, I decided to leave and wait in the comfort of my own home. 

Today, the eye specialist says I have an abrasion on my cornea.  No damn wonder.

JOINED UP WORKING

Slowly but surely, the hindsight investigation in to the death of a toddler is treading its way through a variety of professional enquiry systems. It strikes me, the disparate enquiries reflect the untidy mass of systems that have not, to date, worked in any coherent way with one another.

My belief is, that until there is serious joined up communication, a trust between the organisations and professionals, to enable them to work supportively with one another, child killing cases in the UK, such as the one of Maria Colwell, Victoria Climbie, and Baby Peter, will continue to appear. 

In times of austerity,  tougher times that will cause increased individual and family pressures, where a timely intervention could be a lifesaver, it is going to become even more imperative that services do develop broader interdisciplinary teamwork skills, outside their offices, clinics, surgeries and hospital wards. Egos have to be left at the door! 

Quality training and dedicated skilled leadership will go some way to improving community protection services for a whole range of vulnerable individuals.  These and the other service structures mentioned above, on their own will not. I know that recent practice and regulation manuals spell out what I have believed for a long time, (better now than  not at all).  Staff shortages, increased workloads for those who are left in the field, will dilute efficacy.

EMBARRASSINGLY GOOD CUSTOMER CARE

The trouble is, I cannot find a third book that I fancy.  After spending ages searching the American publisher's website,  the two books I selected as replacements for two large tomes that I was disappointed in,  were really all I liked the look of.  The lovely lady I spoke to in the USA, is mailing the two books I selected, and will leave me to let her know in my own time, what third book I want.  I feel bad about the fact that I am having great difficulty selecting a third book.  In turn, she is actively encouraging me to request one.  

The American publishing house is a highly specialised one, in the main dealing with computer sciences.  The majority would be considered academic books.  The few books I found that whetted my curiosity led me to the two books I tentatively requested. 

All this came about because I commented on the publisher's site on my personal view of the books I bought. I was asked to either contact the guy who replied to my views, or another named individual, to resolve my issues.   At that point, they did not realize I was in the UK.  I believe the intention was to offer a refund under a 100% satisfaction guarantee they operate.  The books I have, were originally purchased via online UK stores.  No money went through the American publishing house site.  Determined to instate goodwill, the company offered me instead, goods at no charge, to be mailed at their cost.  I am so impressed with the high standard of customer service I am unexpectedly receiving. 

AMERICANS SCARED WITLESS OF HEALTH CARE FOR ALL

The media portrays American society as scared witless about installing a health care system that gives access to all. Certainly, Hilary Clinton was soon removed from her husband's administration by the powerful anti-health care lobby. Now it is back on the agenda with the current President - Barack Obama - leading from the front.

The tales of how bad things could be, are accompanied by examples of the UK health system. An American who had positive experiences of British health care, felt people like him were having difficulty being heard.

What is breathtakingly awful is the level that scaremongering has reached, and I wonder if it is at its apex yet? To what depths will scaremongering plumb, what further so-called examples will it illustrate.....................

One tactic has been to say that if Professor Steven Hawkin did not live in America, he would not have the level of care he has. This blatant lie has prompted Professor Hawkin to issue a denial.

First, he states, he lives in The United Kingdom.

Second, he states, he is alive today and living the life we see, BECAUSE OF THE CARE AND SUPPORT OF THE BRITISH HEALTH SERVICE.

This disgusting level of campaigning against basic health care for a society, says much about a swathe of individuals and corporations that have much self-interest and benefits of their own to reap, which they are not inclined to lose or share.

Where are the basic senses of decency, social morals, Christian principles in a society that wears its religion on its sleeves? In my book, caring about ones fellow people is a humanitarian thing to do, and I for one have no compunction about it.