I sometimes think, when reflecting on the past, how things could have been different.
I appreciate this is a waste of time, but I can’t help myself.
This takes me back – I think, probably, to 1997 when I had just qualified as a doctor, and was thinking about my future direction.
Some of my early experiences hadn’t been great – to the extent that I was seriously considering as to whether I should continue in the profession. This was close to the time my grandfather died in a hospital in Glasgow; I was over in Northern Ireland at the time.
Something about what happened, my sense of impotence or frustration at the treatment he received, my lack of understanding of the minutiae of his care, ultimately, led me to becoming a physician – specialising in medicine and subsequently, for many reasons, as a doctor who looks after older people.
Where I am now, having grown to understand the system inside and out, as well as gaining a greater knowledge of health and disease, is to discover that the problems we face, that is, me, you, your family and friends, which are all tangled within the jumble of systems and pathways that is the modern NHS, are not something that can be remedied by a new career or gaining a better understanding, but, actually, taking hold of where we are and changing the system.
How to change the system?
Over the past twenty or thirty years, we have become fantastic within the health service at seeing the world through a lens of ‘health’ or, perhaps more ominously, through ‘disease’ – when things go wrong, there is a physiological, anatomical, pathological basis; things wearing-out, inadequate or excess blood supply, degeneration, immunity, infection. We have created a language of clinical certainty that says that everything in health can be explained through medicine and, that which cannot, is squeezed-out. Cure, cure, cure and treat has overtaken our approach to life. All of this, at the expense of care, care and care.
Our system is perfectly designed to obtain the results it gets. When an old person falls, becomes confused or has pain, our explanations and actions are often ascribed to clinical conditions – urine or chest infection, arthritis, delirium, and so on. Within all of this is an urgency to arrive at an explanation, or diagnosis.
Sometimes we are best not seeking a diagnosis, sometimes we are better not asking the question, sometimes we are better relying on our own innate knowledge, understanding and sensitivity to determine what to do next.
Medicine is powerful – it is a force to be reckoned with in today’s world – it is backed by powerful lobbies – drug companies that are worth more than many nation states, organisations and reputations are based upon the model of disease which has become dominant.
I am not dismissing the achievements of modern medicine, nor the importance of cutting-edge health research or science; If the meningococcus invades my blood stream, I will be the first one to value the utility of polymerase chain reactions, third generation cephalosporin antibiotics and magnetic resonance imagers. Instead, it is the balance that I want to redress, the balance that sees the bogey man around every corner; think George W Bush and the War on Terror – by demonising people we can come together and fight the enemy – unfortunately, this mentality makes enemies of potential friends and alienates everyone else.
And here we come to the solution as I see it, the solution that I hope to explore with my colleagues Helen Sanderson and Greg Bamber, bringing together the talents, resources, imagination and creativity of others in my network. A new way of seeing the system of care. A new way of imagining how we can support one another and, in particular, older people without engaging in a clinical witch-hunt, without adopting lazy thinking and going down the medical model, the expressway to diagnosis and treatment, interventions, escalation and disempowerment.
By reimagining something that is at the core of care and, the core of independence, helping people to live enjoyable, fulfilling lives amidst the busyness of the 21st Century, amidst the chaos of family networks that are strained by work, commitment and getting-on.
Older people, particularly those who are 85 and older, are amongst the section of our society that is growing fastest. Most live lives of independence, many do not; the needs of the latter being outstripped by our ability to support them and, in many instances the assistance we provide, the network or framework which maintains them is rickety, uncoordinated and inadequate.
Although people entering their ninth decade are different to those who are younger, inside, most of them are bursting with life and a need to experience and love, to engage, connect and collaborate, a need to remain part of society, not within a needs-assessed model of health and social care, but within an organic family of growth.
How do we do this?
I don’t see us going back to an earlier time of extended family networks living together, multigenerational families sustaining one another – sure, this happens across much of the world and remains a cornerstone of society in many communities in the UK, yet, it is likely to be of diminishing feasibility as time moves-on.
Many more older people are now living alone – this is one of the realities facing our society. Mostly, older women, with men dying younger; let alone, the increase in single occupancy households, what of them?
As humans, we have evolved to live in close, tight-knit communities, in families; the trajectory of society is now very much against this; more of us are living in cities, perhaps closer together, but less are within communities, less within families that are able to reach-out and support.
Only by connecting, but forming networks of families and friends, volunteers, neighbours, faith groups, young and old, through traditional means but also utilising technology – social and mobile media, can we start to think of a different way. By recasting these relationships, modelling them along different lines, seeing the strength inherent in coming together, can we see a way ahead.
We want to take the model and reformat it.
This means looking at the relationships between all of these different partners – firstly, the structure of the system needs to be new – teal, that is, the new way of organising described by Frederick Laloux and others, through self-managing teams who come together to work, not for monetary gain or reward, but for meaning, for respect and growth; looking at how people can combine their resources and imagination to support one another.
This is, redefining roles – indeed, taking away the roles that often get in the way (in my case, the ‘doctor’ title). Engaging and interacting as people, from a position of mutual appreciation and support.
Remodelling our vision, changing what is often construed as ‘disease’ into ‘life’ – unravelling the complexities of modern medicine that weed-like tend to dominate. To do this, doctors are critical – they have more knowledge of the care system than anyone, and a supercharged doctor – one that works in a multidisciplinary way, with social workers, nurses, therapists, families and friends is best placed to help overcome the ‘disease’ niggles.
At the centre of much of this change is the role of the lost tribe of those who sit alongside our older people, who provide the care, who help them to wash, dress and eat, who provide support and engagement, who can see when someone is up or down, when they aren’t right or things are going well.
Home care in the UK is a neglected, sometimes abused and disregarded sector of our workforce. Career progression, support, development, opportunities to grow and learn are not considered important to the role. Indeed, the minimum salary, plus, mileage is often all people receive. Zero-hour contracts have cast a further pall over the people who put themselves forward for this work.
Home care is the linchpin that we want to help develop, through using the principles of teal that I have mentioned above, we want to elevate their position, support the development of this group, acknowledging their value, their importance and ability, seeing the role they are able to play in acting as go-betweens, navigators of the health and social care system, who, when supported through networks, are able to contribute in ways that most of us have yet to consider.
Layering on top of this team, the combined, networked, resources of an extended multidisciplinary team, held together by Community Circles, that is coaches who in turn can help support the carers and families, is the way we see the system needing to grow.
Through an appreciative process of mutual respect, built on a non-hierarchical model of interdependency and support, we believe that the system which most of us see to be struggling, can be saved, can be turned-around and brought back to life.
Here to the launch of a new way of work – the Teal Partnership!
Helen has written a blog from her perspective; demonstrating the diversity of opinion that is critical to any form of evolutionary development – you can read it here.