Review - Sinclair.

Lingham; Sinclair


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The Inquiry p19 reports that " Until the late nineteen eighties each Consultant had attached to the team a Community psychiatric nurse and a Social worker . These three professionals worked closely together ; for example, in the out-patient clinic they occupied adjacent rooms, and would be in constant contact with each other about both new and established patients " .

Here, one particular observation is a 'sine qua non' - a vital one which should underpin any revision of mental health working practice and govern the consequences of any future policy and strategic change :-

" ... that as a result of reorganisation by the separate managements, the Local Authority Social work Service and the NHS Health Authority and local HealthCareTrust, developed mental health services which were distinct and away from each other.

The success of joint working for the benefit of the mentally ill was overlooked.... "

The NHS management changes put community mental health nurses in an attachment to family surgeries , and broke the supervisory position of the consultant hospital psychiatrist in that relationship. Although the community service received referrals from both hospital and family practice, the family GP practice had 'purchasing powers' which meant that the community nurse caseload and lead function was at the bequest of the family practice rather than the hospital service. It is not clear that the policy of first priority to the severe and enduring mentally ill was in place .

In fact the Social Service mental health team had collapsed and was composed of one social worker new, to the area , and to the local NHS system. Her supervisors were missing or also newly in post.

The community mental health nurse team had no supervisory structure. The community nurse with RS was new to the area and never received any supervisory guidance from her nursing hierarchy. There was no such access. She reported to the family doctor service to which she was attached. There was no working arrangement with the psychiatric service which was regular enough for her to call upon it in doubt or difficulty. Her view of the patient was from less formal grounds than that available to the Consultant at Out-patients. His rank meant that his view prevailed .

At a crucial time all were out of touch with each other. This had been what prevailed during all the care of RS .

( ! )

Afterwards NHS and LA Social Service rearrangements everybody went their own way. The natural mutual support and supervision that previously had kept up standards of behaviour and allowed mutual anticipation of the consequences of anything untoward, were dissipated by misunderstandings arising from separation .

Although the family supporters were seen often, what they knew and were experiencing, how they were living, did not surface in the preoccupations of the professional support.

This difficulty in 'one side' not fully appreciating the limits of the predicaments of the 'other side' is a general happening throughout all the Inquiries. It is hard to describe this as just failure of communication. There seems to be a mindset which keeps each side in its own boundaries. Not knowing enough about the lives of the others, they canot conclude on what to say, in a manner which crosses those boundaries.

This site editor believes strongly that an 'interpreter' is needed in the first years of introducing a policy such as care in the community. It may be called family support worker , or community support worker , or carer support worker ; a person who has a relevant background experience -perhaps a general social worker background - backed by a managership with independent clout , who will 'go into bat' ; something like an active ombudsman broker for the community carers ( the cocoon ) where hesitancy or ignorance is felt as an obstacle to getting a viewpoint across . Both ways .

It is outside the remit of an Inquiry to challenge policy. It is hard to see in the Inquiry any criticism of the effects of management changes on the ability to deliver care to those that depended on that care. The weight of blame is placed upon those who were obliged to work within the constraints that management had imposed . Where those conditions - planned , purchased , and provided by management -the landlords - under which professionals have to work, are unsuitable, then the blame is properly placed upon NHS management changes at all levels - national, regional, authority and trust . Failure in care is not the responsibility of patients nor the individual professional, but is the responsiblity of public service managers , and on the public who do not hold them accountable , nor insist they change their ways .

Again -

Landlords get the tenants they deserve .

 

 

 

 

 

E-mail reaction is welcome

mica@didgy.freeserve.co.uk

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