It's an ill wind...

Thank goodness for the snow. I didn’t expect to find myself saying that – with our yurt still not ready, because of the weather (mostly), two months after it arrived. But how odd it is the way things conspire to change the perspective.

Today, David (our greencare man) was told, when he turned up at the nursery, that the whole place was being sold off for development. Shutting in April with maybe a bit more access for us until June. A consequence, of course, of the heavily squeezed local authority budgets.

Our first thoughts were for the staff there, who have been so kind and helpful with our rather unusual requirements – and some who have been working in a shrinking island of public-spirited tranquillity for several decades: helping very disadvantaged and socially excluded groups to find self-respect and compassionate employment by working there, and clearly running an efficient organisation for filling the parks, verges and roundabouts of Slough with and ever-changing floral display. But it seems that that is not enough to guarantee sustainability in these globalised days.

I think with sadness how some of their staff, often with profound learning disabilities, have helped us with much appreciated wheelbarrowing and digging for our yurt project on Saturday afternoons – and became temporary members of our ‘community community’. And they – as the rest of the staff - will probably be rather bewildered and disorientated at the pace of ‘modernisation’.

The managers usually call it ‘change management’, but I do wonder just how much it takes account of basic human needs for things like dependability, trust and continuity – especially in those who are most vulnerable.

And what about our own project? Very small, indeed, by comparison – but, being somebody who is remorselessly optimistic, I immediately count up the benefits:

·         We won’t need to do that cob floor, which would have been so lovely, but is now only a project for the future.

·         Learning to put up and take down the yurt is just what the Mongolians would do. And now, we will learn how to do it faster.

·         The next place we find will be more secure and permanent, so we can really build things up with a ‘several years view’ of what we need.

·         We did not spend lots of effort, which would have been wasted, making it warm, welcoming and comfortable.

·         At least we didn’t get settled in, only to lose it. ‘Enjoy the struggle’, as a colleague implored me many years ago.

I just hope that the others working with us - particularly the members of our programmes - can see it without despairing that this is ‘yet another kick in the teeth’. But no doubt we will discuss that in our group therapy sessions. 

Still locked out

Large organisations do have an inflated view of how much control they can impose on individual human agency without undue consequences. This seems to especially true of those in the public sector, who do come up with some rum things.

On Friday I was told that our 'patients' (not a word I usually use myself) were not going to be allowed back to the yurt, and yesterday (3 days later)  we were told we couldn't use our usual 'therapy' room in the hospital, as a basic life support course was double-booked into the room. So we had one perfectly suitable therapy space in shared ownership with staff and members - which we were't allowed to use, and five minutes was our unsatisfactory room in which mandatory staff training was said to take priority over intensive therapy, and we were asked to leave. This is a programme for some of the county's most excluded and anguished people, and this is about the seventh time we have been 'evicted' since the three day programme started there last Summer. The administrative staff nearby are all lovely, and as helpful as can be - but there is nothing they can do to change these perverse priorities.

The 'managerial decision' is that members of the programme cannot go to the garden centre, and therefore to our the yurt, during therapy hours. Presumably this means 10am - 3.30pm on Mondays and 10am - 12noon on Wednesdays and Fridays - although it is a fundamental clinical principal of this sort of programme that 'therapy is 24/7' and 'everything that happens here is part of the therapy'. The managers will consider revoking this order when I have supplied:

• indeminty forms
• insurance certificates
• confirmation of criminal records bureau checks on all the greencare staff
• adverse incident policies
• medical indemnity cover
• risk assessments

...and then a decision might be reached, and hopefully communicated back to me. I have no idea how long that might be.

So much for a 'service user partnership' programme, where members of the therapy group are empowered to make their own decisions about engaging together in various supportive and therapeutic activities.

And, indeed, so much for our Mind-National Lottery funded project to provide an 'adjunct' to fill the gaps where the NHS can't go. I am still awaiting a response to my recent email to the Mind legal department.

Know a laundrette nearby?

The felt is damp, not wet through - and the cotton yurt lining is bespattered with mud.
So we reckon the felt will dry out if treated nicely and put in front of a roaring fire for a few days, and the cotton liner needs taking to a laundrette. That should be fun as a group activity...

Bad vibes

When we decided to just cover the yurt with the canvas till after Christmas, and store the felt and inner lining until we had time to put it up properly, we looked for somewhere to put it safe and dry. The inner lining spend some time with me at home, drying out, until I took it back once we had found a large disused metal container to put in in, with the felt, adjacent to our site.

So far so good - disappointing situation held and managed over the winter break. But our it was not to last - our green care consultant emailed me on Friday to say that the container had been moved and the people who had previously run a voluntary project on a different part of the site were angry at finding our bits and pieces in their container - so had thrown them on the muddy ground and left them there for the weather to do its worst.

Barely a metre away is the entrance to the broken polytunnel we are being kindly lent by the nursery staff, until we are establishe din nthe yurt. It might not have been as dry as the metal container - but was a great deal drier than being left in the open.

Thankfully, the weather forecast is dry over the weekend (during which time we do not have access). But the organisation in question, with whom we were hoping to collaborate on future bids for greencare work, has rather gone down in our estimation...

Third time lucky?

A few rather more abstract and random thoughts today. And they come from listening to the morning radio show about the health service changes, for which the NHS Bill is being presented to Parliament this week. I have an odd feeling of rather liking what they are up to,despite everybody from all corners shouting about what folly it is - particularly how they are abolishing the PCTs and giving 80% of the total NHS budgets to GP consortia, all at a reckless speed. Maybe it's just because I have always advocated 'creative chaos' as a therapeutic change mechanism, and prefer to trust the imagination and ingenuity of good people, than lumbering systems that have seem to have been set up to mostly serve their own survival and growth. Not to mention their rather irritating need to measure everything ('evidence based practice'?), predict everything ('there should be no surprises') and then control everything (which they call 'good governance').

Well I don't know. Is it really so fast? And don't we need to do it pretty fast to make sure that all the old hierarchically promoted ways of working don't just get replicated?.(I mean this in Tom Main's psychoanalytic sense, rather than as organisational hierarchies). I hear arguments that the expertise in the PCTs will be lost - but just how much of that 'expertise' serves to cause monstrous insititutional constipation - and actually makes spontaneous local innovation almost impossible? I'm probably just being a hopeless old romantic here, but I do believe that my GP colleagues might be 'feeling this in their bones'.

I was trained as a GP, and the one thing I remember my trainer saying to me (it must have been 1987) was 'Don't go back into hospital practice. You won't like it'. Being young and set on a career in psychiatry, I didn't understand. But I don't think he was talking about the oppressive nature of biomedical psychiatry I was soon to encounter, but the freedom to think. And to do so with all the non-specific skills, understandings and attitutes that you can't avoid picking up during a good medical education. Like what to say to people who are naturally frightened of what you are going to do to them, how to be professional and human at the same time, and how to be with somebody who is dying.

So the way I currently feel about the NHS reforms is that this is the third major relocation of power - and I have more confidence that it might be for the good than the others.
The first was before my time - when the NHS was formed, and power (in abundance) was given to the consultants. Sir Lancelott Spratt was still alive and well when I trained, and I think there are a few echoes of him left in the fustier more self-important medical schools.

The second relocation of power has been happening since the 1980s - and has been chilling my bones ever since. I remember meeting the chief executive of the newly formed trust, where I was appling for my first and only job as a consultant, back in 1994. He said that he felt a bit sorry for consultants, as they had been disempowered by the Griffiths Report, and several other things that were going on. Little did I know it then, but 'modernist managerialism' was going to change the world as we knew it, and not only in the health service. Modern management, with its ugly sisters of corporatism and risk aversion, was on the way in.

I can only hope that the current upheaval will preserve the best of both those power bases, the traditional and the modernist if you like, with something that is less one-dimensional, dogmaic and brutal. Perhaps it will be complex, reflective and post-modern; better able to tolerate and cherish differences, and to understand underlying layers of meaning. I would have described it in therms of 'the unconscious' once upon a time - but that word seems to have become rather tainted in the last decade.

But if the authotitarian days of Sir Lancelott Spratt were traditional, the micro-managed days since the 80s have been times of high managerialism, and perhaps we're now moving into a new era of openness, plurality and web-based life!

Funnnily enough, I said something very similar at one of the first 'big talks' I every got invited to give, in 1996, as the invited lecture to the 'closure conference' of an Essex therapeutic community, Greenwoods. At that time I called the three different ways of running things 'traditional', 'administrative' and 'therapeutic'. I've been waiting fourteen years since then - but I do just wonder if number three is finally coming round the corner.

The first sign of SERIOUS trouble

Just a short post today - I had better not say too much.

I received an email from my employers this afternoon, insisting that I do not set foot in the Slough Council Nursery, at Wexham, where the greencare project is based. It will be difficult to meet the targets we have agreed with Mind and the National Lottery, if the leader of the project is not allowed on the site!

Naturally, I am very unhappy about this, and will make a fuss - but while I am under such instructions, I had better write no more about it.

It's funny, but today is the first time I have ever read all the legal statements at the end of our NHS emails - where it says it is strictly prohibited and might be unlawful to disclose, copy or distribute information in it or take any action in reliance on its contents (whatever that last bit means). I often think of myself as the absolute opposite of a conspiracy theorist - but this feels quite sinister, and even menacing to individuals who get on the wrong side of it. It's all rather frightening, in a way.

Anyway, I hope that I will live to tell the tale after all these strange times, odd attitudes and whatever lies behind them have been dealt with...

So - unless put in prison or otherwise legally stopped - I shall keep posting something here on this blog every week. If it goes deathly quiet - send out the search parties!

Thanks, Freegle - but not much thanks to Heathrow Airport

Apparently, the good people of Slough (those who wanted to give away their old stuff on the internet) fell out with FreeCycle, and set up on a separate outfit called Freegle.

So we joined up with Freegle a couple of months ago, and barely a week goes by without something useful coming up which - as long as we're fairly quick to respond to the emails  - we manage to bag for the greencare project. So we now have three sofas, a large desk and various other donated items including a three-ring camping gas stove, wheelbarrow, assorted chairs, patio set and numerous other bits and bobs. I suppose not surprisingly, it's a very nice way to meet people and tell them what you're up to. And they all seem to love the idea of greencare - one person we met like this was an ex-high flier who had a breakdown many years ago, and now has nothing but thanks for the NHS therapy services she then received. But greencare would be even better, she could see. If only her stigma-free view of mental health problems could be spread around to other people - so many of whom are frightened by the very idea of 'mental health' and dare not think of how it might apply to them.

We had been galvanised into action by the fact that one of the Freegle donor people was about to move, and needed the stuff out of their house. Yesterday was the allocated day - 14 year old Dominic had volunteered to help his less-than-athletic father to do the heavy lifting. First, we had a small sofa to collect from High Wycombe, and a small 5-door car to collect it in. Problem number one. Sofa diagonal = 130cm; hole to put it in = 115cm. At least the cushions fitted in the small car's small hole - 'we've got a bigger family car - we'll be back tomorrow', I cheerily said as we hauled it back into the house. Wrong. Big car does not necessarily equal big hole in which to put a small sofa. Big car's small hole = 120cm.

Problem number two; we needed to book a van, on a Saturday night, for using on a Sunday. Easy - plenty of places on Google. Wrong. All shut until Monday. Tried phoning a couple of Slough taxi firms - to see if they would do it in a people carrier. No way. But one of them put me onto Brian in Chalvey, who had a pick-up truck and he might help. Indeed he would - but not for this side of a hundred quid. Time for supper - better give up and see if one of the others on the project could do it during the week. But - inspiration came during the chili con carne - Slough is just up the road from Heathrow Airport, and they'll surely be open there to hire cars. Correct - but they don't do van hire there, only shiny cars for people in suits. But it did include medium sized shiny cars with five doors and big holes, and I didn't really think they'd be too strict about the suits. So, credit card out, numbers typed into the website, both bits of driving licence ready to take in the morning, and all done.

Today was a beautiful day - not a cloud in the sky, as our 14 year old Dominic noted as we got into the car at about 10.30am for our run over to Heathrow, High Wycombe, Langley and Wexham - to collect the various things we'd been offered on Freegle, and get back for a late Sunday lunch. Not too cold either. We found the car hire place, no problem. Drove in, walked up to the desk  and hit problem number three: "Haven't you come on the courtesy bus from the airport? We can't have cars here you know, the security people are always round, you'll have to go in the airport car park next door or get here by public transport".  Drove round to 'next door' (about quarter of a mile away, with acres and acres of cars between it and the car hire), "Up to 24 hours: £17", the sign at the barrier said. A taxi from Slough would have been a third of that, Ho hum.

"Oh look, there's a row of shops over there", about half a mile further on. Let's see if we can park there. Yes - there was a lovely spot up off the road and off the pavement in front of a boarded-up shop. Dominic didn't like the look of it. "You're not leaving the car there. I'll phone mum at work. She won't let you." OK, we'll go a bit further. Soon found a nearly empty parking bay, beside the road, outside a newsagents. Just right. Off we walk, back to the car hire office. "Look - there it is - just over there - we can take a short cut through the car park". Wrong again. Short cut = long cut, not unlike Hampton Court maze, except the walls to the maze were eight foot high chain-link fences which you can't see from the other side of the carpark. Quite frustrating.


We got back to where we started after a healthy walk round a scrubby and dismal bit of the perimeter of LHR, confirmed the booking, all was fine.  Chose a very nice shiny new Renault with a lovely big hole. Drove off to Langley for our first item - a handsome and enormous desk in a tiny second floor flat. With an even smaller front door. We were on our way within the hour (or two), after not using a power screwdriver with a flat battery to take the door off and later replace it (we used a tiny electric screwdriver instead). Nice cup of tea and lots of support for the project, though.

Problem four: Sunday lunch. Dusk falling with two mouths to feed in a hired car somewhere near Heathrow and three mouths to feed about twenty five miles away. Eldest brother Ben was not amused, and made that very clear on the several occasions he phoned to find out how long we were going to be. Thankfully, very resourceful daughter Beth is at home from University this weekend, and she did the lot - fresh Yorkshire Puddings from eggs and milk and flour, various vegetables, and a nice half leg of pork. We later learned that she prepared the best crackling and crispiest roast potatoes ever. She needs to come home more often, clearly.

Well into the hours of darkness by the time we next saw the Northern runway - looking for all the world like those marvellously atmospheric scenes at LAX in the film 'Heat'. Dropped the car off - no problem. Walked a slightly short cut back to the row of shops for our own small car (the one with a small hole). Problem number five - Dominic was first back at the car, and was excited to find a sticky plastic envelope with black and yellow stripes on the car windscreen. I was less keen: I had misread the parking signs and it didn't say 'permits only except Sunday', as I thought. Inside the envelope was a not-very-cheerful post-festive message: pay £50 now, or £100 the week after next; we have taken a photo and we know where you live; don't argue, it's not worth it.

Oh well, at least we've got lots of useful stuff for the greencare project. The crackling was still good - but the rest was a bit dried out and sorry for itself. Helped a bit by some hot instant gravy.

Learning points (one from each problem):

• Car size is not proportional to the hole size of the boot
• Airports are for planes, cars and businessmen - not real people from nearby
• Teenage daughters are much better at cooking than they let on
• Keep your electric drill charged up - you never know when you'll need it 
• Freegle helps you meet some very nice people