Losing the person

I joined Sarah Mitchell of the Local Government Association and Liz Sargeant of the Emergency Care Improvement Programme, for a masterclass looking at solutions to ‘winter pressures’: the ‘delayed transfers of care’ issue which becomes particularly acute in winter, when more older people are admitted and the number of people who are so called ‘bed blockers’ (what a great way to blame other people for a service failure) rises, putting pressure on the NHS which hard pressed social care services increasingly struggle to alleviate by helping people to get back home swiftly and safely.

Liz talked about discharge planning meetings which had ‘completely lost the person’ in a discussion which was all about needs and services. Liz suggested that a good test for this happening was when nobody in a planning meeting was able to say what the person had been capable of before they came into hospital.

This struck a real chord with me. Losing the person happens in many care settings, but particularly those where people enter the service during a crisis. People with learning disabilities enter highly institutionalised, risk-focused Assessment and Treatment Units bearing all kinds of labels and information about what problems and risks they are considered to pose. Sometimes, a few months previously, the same individual has been living ‘well enough’ in their ordinary family home, with little or no support from paid professionals. But their capacity to live this way, and the potential for family and community to support that life, is lost in the crisis which took them in to service land.

Every plan and planning discussion should start with a discussion of what the individual can or has been able to do: what my colleague Sian Lockwood at Community Catalysts calls their ‘gifts, skills and assets’. If people involved in those discussions don’t know what those capabilities are and what the individual’s potential is, they have ‘lost’ that person, and will not build a plan which enables the person to be all that they can be.