Friday, 4 July 2014

Alliance Viewpoint Dr Graham Kramer - community collaborations


Via ALLIANCE Scotland 

Our latest viewpoint post comes from Graham Kramer, the Scottish Government's Clinical Lead for Self Management and Health Literacy and reflects on a story of "missed connections" identitified in a recent speech by Tommy Whitelaw, Programme Engagement Lead for the ALLIANCE's Dementia Carer Voices project, during a recent ALLIANCE and Royal College of General Practitioners event on the Improving Links in Primary Care programme.

There is no one better at telling it how it is than Tommy Whitelaw. His story is a powerful one in which he describes the struggles of caring for his mother Joan as she became increasingly lost to dementia. He no longer had her to put an arm round him when he needed it most.

I've listened to Tommy speak several times and it always triggers something new in me.

I am struck by two contrasting tales of humanity and compassion. The first, how, in desperation , he finally took his mother down on the bus,  to the GP practice to get help, only to be turned away as he didn't have an appointment.  The other, when bathing his mother, (a hugely discomforting experience for any son) a district nurse arrived for the first time, put her hand on his shoulder and told him he was doing a good job.

Tommy wasn't asking for much. He wanted to do things himself for his mother, but was struggling to know what was best and lacking someone to put a hand on his shoulder and tell him he was  doing a good job. The loss of his usual deep and loving maternal support made that need more acutely felt.

Maybe that is what we all need when we are struggling to cope with a significant change to our life circumstances.  Most of us want to get on and deal with it but need the support and affirmation of others. Perhaps in our complex lives and communities there is  less time  and less hands for putting on each other's shoulders and we increasingly turn to services and professionals.

What if these services are struggling to cope with the demands for help and support in the way that was evident in Tommy's GP practice?  Those hands end up pushing away rather than comforting. Maybe they were struggling to cope much in the same way that Tommy was. Who is there to put a hand on their shoulder and tell them they are doing a good job?

None of us can do it all ourselves and the more we struggle the worse it gets. The answer lies in supporting each other. Just as the community needs each other and the help of its health and care services, these services increasingly  need the help of the community. Problems shared are  problems halved.

The challenge is how can we build  collaborative relationships between people, community and their services that promote mutually supportive partnerships? Is it about integration and personalised health budgets?  It might be, but mainly it's about  developing a shared understanding of who we are, our problems and capabilities, and working together to help each other to do the best we can. This for me seems to be at the heart of Tommy's story and at the core of compassionate, collaborative care.

Graham Kramer, Clinical Lead for Self Management and Health Literacy, Scottish Government.

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