A long time ago I was part of an undercover squad that would move beds around at weekends and in the evenings.
These weren’t ordinary beds. These were the sort of beds you see in hospitals (the really expensive ones), with mechanical parts that allow you to lie down, sit up or position yourself in about 40,000 different ways. There were also the mattresses, equally complicated.
They were very technical, very heavy, and awkward to move up steps, through doors and around the corners in small houses. On one occasion I think we even removed the glass from a front window to get a bed in (and out). But it was all quite necessary and helpful, especially if you were planing to eventually die in your own home, surrounded by the people you love, on a specialist bed.
None of this seemed unusual at the time. It was just part of helping out the District Nurses that operated in the Community.
A Community Going Above and Beyond. Basically the District Nurses had ended up going ‘above and beyond’, to provide nursing care for people who were terminally ill. Somehow they had acquired bits and pieces of equipment that helped people live, and eventually die, more comfortably at home. Eventually this escalated into one of these incredibly heavy but extremely comfortable beds. From what I remember, some of the people who had passed away would leave donations in their Wills to a Community Nurse Fund, to provide this sort of equipment to help others.
Within the Community word got around and District Nurses eventually had control of 3 beds which could be placed in the homes of terminally ill people.
Did I mention the beds were incredibly heavy? This is where the ‘secret bed transportation squad’ came in. Moving these beds around a hospital is a reasonably straightforward activity, you just push them along nice flat surfaces and stick them in a lift to move between floors. Unfortunately the ‘role description’ and ‘scope’ of the people who do this doesn’t extend beyond the hospital front door.
Out in the community things are a bit different and the District Nurses just got on with it, and formed a ‘bed transportation squad’. The squad comprised:
- A mate with a van. He was actually a proper removal man, used to shifting heavy awkward equipment, so he doubled up as the Brains of the operation.
- The ‘Technician’ someone good on the mechanical stuff who knew how these beds worked, and
- The Donkeys. People who were quite strong, willing to work, and did as they were told. I was a Donkey.
A Secret Bed Transportation Squad. The ‘secret’ part of the squads work was due to our operating hours. We all had other occupations and activity was determined by when the van was available, usually weekends and evenings. This was all done voluntarily and no money was ever exchanged, even the cost of fuel for the van was politely refused.
Another ‘secret’ element was the fact that this wasn’t really ‘officially approved’, it was sort of ‘under the radar’. I’m not sure what was known or understood at Health Bureaucracy Headquarters, but that didn’t really worry the ‘bed transport squad’. We were just happy to be doing something that was helping out the District Nurses and the Community. This was helped by the fact that generally we all had some sort of connection (family, friend, colleague) with the people in whose homes we were scuffing the paintwork and wallpaper (collateral damage, a small price to pay….).
Those were great days and on occasions, even many years later, people would insist on buying me a beer in the Rugby Club; to say thank you for what we’d done. If I’m honest, I used to struggle to remember some of the people / events, but I was happy to accept the beer, particularly as it made them so happy……
The Abominable NO Man/Woman. All good things come to an end, and so did the ‘secret bed transportation squad’. I’m not sure of the exact circumstances but there were the usual rumblings about ‘policies’; Health and Safety Assessments, Risk Assessments, Procurement of Equipment Requirements, etc etc.
The Abominable NO Men (and Women) in the Heath Bureaucracy Headquarters had started to get their teeth into in what the District Nurses were doing.
I’m sure that many of these ‘policies’ were very necessary for very good reasons, like patient safety, but looking back I do think we’ve lost a lot, not just for the individuals who used the beds, but more widely:
- The engagement of a wide range of people in helping the Community to fix it is own problems,
- Being part of the ‘secret bed transport squad’ felt like I was doing something really useful in my Community,
- The ability of a team of District Nurses to manage themselves, and the resources of the Community they worked in – for the benefit of people in that community – seems to have been diminished,
- The ability of people to spend the last days of their life in their homes, surrounded by the people they loved. Having watched a relative die in hospital fairly recently, I know where I would rather spend my last days, and it’s not hospital,
- Finally – I’m making a guess that the costs of spending your last days in hospital are significantly greater that what used to happen in the days of the ‘secret bed transport squad’.
What’s this got to go with Buurtzorg? This slightly ‘rose tinted spectacle’ reminiscence, has been prompted by a blog post Annie Cooper wrote about her visit to Netherlands to look at the Buurtzorg model of District Nursing.
In a brief discussion with Annie and Matt Wyatt, it did strike me that some if what was being described in the Buurtzorg model, was similar to what I’d experienced with the ‘secret bed transportation squad’. A smallish group (6 minimum ,12 maximum) of District Nurses, having the power and autonomy to ‘do the right thing’, with limited interference from above.
25 years ago one of their actions had been to create the ‘secret bed transportation squad’ (before the Abominable NO Men / Women got their teeth into it). In her post Annie talks about the fact we are frequently operating from a ‘brownfield site’. I agree and sometimes we might need to think about going ‘back to the future’?
So, What’s the PONT?
- People and Communities have considerable resources and the abilities to do great things.
- Sometimes, well-intentioned rules and regulations, imposed by well-intentioned public services can diminish what is possible in those Communities and People.
- We’ve done this sort of thing before. We can do it again, it might not be easy, but it’s worth a go.
Links: Annie Cooper’s blog, ‘Why can’t we be more like Buurtzorg?’
The Royal College of Nursing ‘observations’ of the Buurtzorg model. Interestingly this sums up by saying that yes, the model has many merits but picking it up and replicating it in the UK isn’t straightforward. There are lots of complicating factors. A similar sort of point to what Annie is making about ‘brownfield sites’.
Finally. I could not resist this. Here is the finest instructional video ever on how to move heavy, difficult bits of furniture around a domestic home. Courtesy of A.Shifter and Sons.
Have you seen Barry Schwartz’s TED talk on practical wisdom?
If not, I think you’ll like it. Very much in the same spirit as this post.
Thank you Charles
I will finish watching it this evening
Makes me FURIOUS stories like this. I certainly wouldn’t be sure that policies have very good reasons at all. No policy has a very good reason. It’s a documented abstraction, distanced from real life by actual geographical distance and time, and by the very fact that it’s a piece of paper and not real life. No need to presume good intentions, look at the results. I couldn’t give a shit about people’s intentions in these cases. No need to be nice, none whatsoever, they weren’t. They spoiled something good through piss poor thinking and made many people’s deaths worse. It’s filthy.
This is a very good blog post I enjoyed it immensely.
I’ve been having a think about what you’ve said here.
You are right.
The point that the policy and the decisions to make the District Nurse Team ‘conform with policy’, happened at a distance is absolutely true.
A geographical (not that far) but most importantly a distance from reality.
I think that distance from reality is what allows so many decision makers to make wrong (and often cruel) decisions.
Not having to experience the consequences of your decisions is a dangerous place to be in my view. Spending time ‘on the tools’, on a regular and frequent basis, is something all the people in charge should be doing – even those who label themselves ‘Leader’ – in fact, particularly them.
I must admit, I felt guilty for not being as furious as you were reading the post.
I suppose I have had 25 years to calm down, I was furious at the time, not as furious as the District Nurses though. Imagine what that did for ‘Team Morale’ and trust in the leadership…..
Unfortunately I suspect that there are many examples of this sort of thing happening every week.
Sometimes I think the tide might be turning, sometimes not. At the end of the day all we can do is keep pushing at the forces of petty officialdom.
Thanks for the comment.
I’ll try not to raise your blood pressure too much in the next one