Older Mind Matters

Fashions and whims in health and social care

Is the NHS at the mercy of fashion? We talk about evidence based practice but many changes introduced into the system are the result of managerial and political fashions rather than a response to evidence. We’re also quite good at ignoring the evidence we don’t like.

One example of a fashionable change is the introduction of the so-called functional model in mental health which involves (amongst other things) a move towards splitting inpatient and community care. This means that the team which looks after someone in the community changes completely if they need to be admitted to an in-patient bed.  Not surprisingly this raises problems in relation to continuity of care and the therapeutic relationship – but fashions are repeatedly introduced into the system without testing them out. In fact a cynic might wonder whether the failure to test some of these fashions out is deliberate as piloting some of these changes might lead to them being abandoned.

The so-called single point of access is another example of a change which managers rushed to implement without testing out what its consequences and knock on effects might be. It seems to have grown out of the need to integrate health and social care services and has taken on a life of its own. The idea is that all referrals (or even contacts) go through a single point and are then processed and passed to the people who need to deal with them. I know of areas where this has meant that service users and their families have become obstructed from contacting the people who are dealing with their care and where it has introduced a considerable delay in getting a response. In fact it can result in a whole new layer of bureaucracy. That may not have been the intention – but unfortunately it can be the result. (I quite like the honesty of NHS Scotland’s statement ‘integrated services with a single point of contact will make best use of a limited workforce (e.g. OT, rehabilitation)’ see here.)

Do fashions and whims affect dementia care? I’d love to know what other people think...


PS you might like to look at:

Singhal A, Garg D, Rana AK, Naheed M. Two consultants for one patient: service users’ and service providers’ views on ‘New Ways’. The Psychiatrist 34: 181-186 - abstract here

and this open access literature review on integrated teams.




1 comment (Add your own)

1. Dave J wrote:
I thought, or maybe hoped, that this would be about the clothes we wear and some amusing whimsies on encounters across the spectrum of agencies.
(What we were (scouse word play) is vintage clothes: Macca - Memory almost full (2006))

In a way perhaps it is. I am sure the way we present ourselves is import, just as is the manner in which we address patients, family carers and colleagues.
'I doesn't cost any more to be polite.' My mum from her store of wise and whimsical sayings probably borrowed from earlier versions, the pulpit or Bilston market
Being properly dressed for the job is a basic essential for any professiona encounter

Remaining polite requires seeing the person as an individual who persists as an entity through periods of health and illness, marriages, childbirths and so on.
Cutting people up into slices (sections?) is not polite: it hurts. Salami publications are frowned upon as cheating. Multiple episodes are a similar device which stacks up numbers for the be_an accounters, fragments the individual and breaks the bond between therapist and therapised. Transference and counter-transference have meanings now more appropriate to the too and fro of the transport industry than the feeling world of psychiatry (mental health).

The thing about fashions is that they come and go and then are rediscovered: hemlines up, hemlines down; hairlength long, hairlength short; pink in etc. But it is a tiresome business

Wed, July 13, 2011 @ 1:52 PM

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