A Statement of the Bleedin’ Obvious

In the midst of the current tumult, Scotland’s First Minister Nicola Sturgeon came on air to remind the nation that the Scottish Government was keeping its eye on the ball, and was continuing to govern the country with respect specifically to Health and Education.  She might have said “Keep calm and carry on”, or, more colloquially, “Keep the heid”.  Anyway I’m taking her advice and devoting this blog to an aspect of Health.

I got this invitation from the Royal College of General Practitioners to go on a course, entitled You as a collaborative leader.  This was “Cohort 2” I so guess it has already happened.  Here is a digest of the blurb:

You as a Collaborative Leader is part of the Leadership for Integration programme, which supports leadership development for health and social care integration…

You as a Collaborative Leader supports you to recognise your own leadership strengths and sources of resilience so you can lead more collaboratively and effectively in delivering integrated care.  It is completed over a period of approximately four months and involves:

  • Three 1:1 coaching sessions (one at the start, middle and end of the programme)
  • A 360-degree assessment and feedback exercise on your leadership capability
  • Two full-day workshops on 06 October and 10 November in Edinburgh, focusing on leadership capabilities for health and social care integration
  • A tailored personal development plan to help you sustain your learning in practice

I don’t think I would have understood a word of all this but for the fact that I had a little prior knowledge as to what it is all about.  The blurb reminded me of job adverts you occasionally see in the Situations Vacant columns of newspapers which describe in glowing – if somewhat abstract – terms the qualities a company is looking for in a candidate for a job whose specification is never spelled out.  What is the company called?  What do they do?  What do they make?  What values do they live by?  It doesn’t seem to matter, so long as you demonstrate that you have leadership strengths and sources of resilience etc etc.

I’m not going to embark on You as a Collaborative Leader.  I’d just be a spoiler, like Nigel Farage in the European Parliament.  I just don’t believe in the project.  The integration of health and social care – ever closer union if you will – is just a step too far.   It seems to me that behind the whole project lurks a series of misconceptions about the nature of life, aging, decrepitude, and death that could only have been formulated by people with very little first-hand experience of these phenomena.

When I was a junior hospital doctor there was in vogue a rather disparaging term – “social admission” – descriptive of a patient, usually elderly, brought on to the ward because, frankly, they had nowhere else to go.  Amongst ourselves – I shudder to think of it now – elderly patients with multiple morbidities were called “crumblies”.  We were supposed to be bright young people and yet it clearly never occurred to us that to call a patient a “crumbly” – or even a “social admission” – was nothing less than an abrogation of our responsibility to do all in our power to make their lot better.  The great skill – and compassion – of a consultant in aging and health (we used to call them geriatricians but the name itself now has a geriatric quality) is the insight that not all of the adversities faced by the elderly are irreversible.

There is huge political pressure on the Health Service at the moment that it do its damnedest to look after frail elderly patients at home.  This is the driving force behind the Leadership for Integration Programme.  If only we could get social services and health care workers to come up with a way of shoring these people up at home, we could free up x numbers of hospital beds and save y million pounds in the process.

It’s a fallacy.  Any experienced GP carrying out a home visit on a sick elderly patient can tell within a minute of entering the house whether the patient needs to be admitted to hospital.  Sometimes the decision to admit is based on a diagnosis, but more often it is predicated on the patient’s inability to cope at home, to move, to feed, to wash, to get to the toilet.  In other words, for the time being, they need nursing care.  It is theoretically – and occasionally practically – possible to provide such nursing care at home, on a one-to-one basis, but it is very expensive.  It is far more efficient and cost effective to have a small group of nurses looking after a larger group of patients in a single location – call it a ward – itself situated in an environment designed to do this sort of work – call it a hospital.

Most district general hospitals in the UK run close to capacity with near 100% bed occupancy – and sometimes beyond that.  Beds and trolleys line the corridors and patients awaiting discharge are lodged in the ward day room to free the beds up for the next occupants.  It’s almost “Cox & Box”.  Would it not be better to create more hospital beds, and train more doctors and nurses, rather than spending money on supporting me to recognise my sources of resilience with a 360 degree assessment of my leadership capability?  What a load of nonsense.

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