The sequel to my PPlog post of 11th October, "Circuitous Circus" is I eventually got to see the alternative consultant on 24th November. That consultant was Dr Willie Nottcutt, a leader in the field of pain management and someone for whom I had full respect, having known his work for many years. At the end of an hour and a half's frank discussion, he told me the kind of disorder I had was the product of natural wear and tear combined with scoliosis, osteo arthritis and calcification. Essentially I have an absence of disc material between the lower vertebrae and "...a very degenerate L3/4 disc with a massive left sided osteophyte (a huge bony spike growing out of the spine - my parenthesis)." The vertebra there is also out of place. He said: "We spent a long time discussing the nature of his problem and what can and can't be done about it. Unfortunately there isn't a solution to this type of degenerative change in the lumbar spine. There are people who put new discs in but he would certainly not be a candidate for that and anyway, this type of surgery is still very experimental."
So, all they can do is fill me full of very strong painkillers for the rest of my puff. But, having, at unpredictable times, used a wheelchair borrowed from the Red Cross, I asked the consultant about this. He said he would ask my GP to order one for use when it is needed. My GP duly did this.
Last Thursday I had an unsolicited phone call. The caller announced she was from the County wheelchair service (which, incidentally is 18 miles away off public transport routes). She did give her name but with the call being out of the blue, I wasn't able to make a note of it. She asked me, in that bureauspeak tone of voice people adopt at these times, when I use the wheelchair I have borrowed. I told her I use it outside when I have to: when I take the dog out and I can't stand or walk and when I am at meetings or conferences (I told her I did a lot of voluntary work) and the same conditions applied. She asked when I last used it. I told her "A couple of weeks ago." She then told me their 'Eligibility Criteria' - which, she said, were on the application form "And the doctor should have known that."- say that you have to use a wheelchair at least twice a week before you can have one.
I didn't have chance to say the times I need one are unpredictable and, at times would be more than twice a week and that most of the time I can't walk I am just confined to a chair at home, the house being unsuitable for wheelchair use.
So this is personalisation! A five minute phone call from someone of whom their credentials are unknown - such is the 'assessment' I've
Norfolk is one pilot area for the Personal Health Budgets Pilot Programme. In this, Norfolk's remit is in: "NHS continuing health care; dementia; learning disabilities; mental health; long term conditions." (Department of Health)
The Programme leaflet: "Understanding Personal Health Budgets" says: "Care planning is a discussion that looks at all your needs to make sure you get the most appropriate care. Everyone with a long term condition should have a care plan, if they want one."
Personalisation is a process "with a focus on supporting individuals to live as independently as possible, have choice and control over the services they use and to access both wider public and community services and employment and education. Rather than fitting people to services, services should fit the person." (SCIE Rough Guide to Personalisation) and "Independent living is one of the goals of personalisation. It does not mean living on your own or doing things alone, but rather it means "having choice and control over the assistance and/or equipment needed to go about your daily life having equal access to housing, transport and mobility, health, employment and education and training opportunities" (Office of Disability Issues 2008).
The Norfolk Community Health and Care website says:
We are Passionate...about providing the best services we can for our patients so it is important that NCH&C develops in order that our patients choose us every time.
To make sure that NCH&C provides the best service we have developed a strategy which ensures we will:
- Embrace advances in service delivery
- Be flexible and creative
- Treat each patient as an individual
- Provide personalised support for patients
- Making sure patients are at the centre of planning and service delivery
- Supporting national policy and guidance; and
- Treat each patient as an individual and develop unique packages of care tailored for them and co-ordinate the delivery of that care from a range of providers
Mike, 19th December 2009.