Jeremy Hunt, the health secretary, recently criticised the previous government for setting policy in the NHS which caused staff to focus on targets and not on people… which is a bad thing. I’m sure this is not an issue that is unique to healthcare there are many examples we could cite, but this one felt exceptionally tough to take:
About 3 weeks ago I bumped into one of our service users in the evening. He’s on our caseload and his worker had been telling me about him. He had been in hospital and was seriously ill; he wasn’t expected to make it, but miraculously he did. When he left hospital with nowhere to live he posed a bit of a problem to house. He’s no angel and in the past has not been good at paying his rent and is therefore banned from council housing provision. However, as an exceptionally vulnerable individual the local authority did have a duty to house him. So he was put into a hostel for one night and some private rented accommodation was arranged.
This in itself feels a little like the wrong criteria are driving a decision process to me. We have a very vulnerable man who has many needs not just his poor health. I would like to live in society that would prioritise this man’s health and safety, that would house him somewhere that could offer some support with his numerous needs and had experience of and relationships with the specialist services that would play a crucial and active role in his recovery and opportunity for positive change. But I don’t, I live in a society that seems hell bent on punishing him for his past behaviour and not allowing a problematic case to blot the copy book… but that’s not why I’m so frustrated that’s just normal in my world.
So back to the night in question… he told me that he had been to a property that had been arranged for him to live in. When he found it he realised that it was in an adjacent street to where a few months earlier he had been the victim of a knife attack. He made the very sensible decision that he really did not want to live in that area as it frightened the life out of him. So he tried to call the hostel for advice but lost his money in the call box. He then hobbled back to the city centre, which is a massively time consuming affair for him; I have never walked so slowly as when I am beside him. This is when I met him. So I accompanied him to the hostel, he was very nervous about this.
As we arrived a worker was just leaving. The opening gambit to me in an angry tone was, “you’ve not brought HIM back here have you”. The volunteers we have just finished training would be able to tell you several things that are wrong with that statement when working with the people we support. So why is the state employing someone who seems to think it is acceptable to ignore, objectify, de-humanise and trample all over the dignity of not just a fellow human being but one who is so vulnerable and needy. But then I’m not in HR perhaps it’s me that is mistaken!
The worker then went on to tell this guy all the reasons he was a problem… it was what I can only describe as a soliloquy; it really didn’t seem to be for our benefit but a five minute relentless cathartic rant. It was bizarre; its purpose seemed to be for the worker to unload the burden, which is what colleagues and supervisors are for not the clients! What did strike me though in these shared thoughts and feelings was that the major problem cited with this guy was that the last time he had stayed in the hostel he had been there for over a year and their target to move people on is a few weeks.
I looked at the skeletal, hunched over, yellow, drawn, beaten man in front of me as he struggled for breath and wondered how a target could create a greater sense of motivation than the saving of a vulnerable life!
This chap is not known for his tolerance, but on this occasion he took everything that came his way. The worker stopped (not finished, stopped; I’m sure if the energy had been available the rant would have continued), we all basked in the silence for a moment and I asked if he could stay. The worker angrily agreed and we entered.
The arrangement was one night only. Every morning this guy has to go to the council’s centre and sign up for the following night to stay again in the same hostel. They have agreed to pay a bond for a private rented property but a month after he has been discharged from hospital it’s still dragging on. I bumped into him again last night. He told me that each morning they send him off to the council and when it’s arranged for him to stay again that night in the same place he is told he can’t access it until 9pm. That leaves him with nowhere to be all day long. When he arrives, as soon as he has opened the fold away bed which he puts up in one of the communal rooms (that is empty at night), they switch the lights out and won’t let him have them on.
He was telling me this as he shuffled down the street and I tried to maintain his dead-slow pace. He waved a Lucozade bottle in front of my face that smelled of cider, “I’m so pissed off,” he groaned, “I’m back on the drink.” I did my best to tell him how well he’d done to not ‘kick-off’ in such terrible circumstances and what a phenomenal achievement going from very heavy drinker to not drinking at for over three weeks was. In my head I was gutted that this guy who lacks motivation to change had found it and then been so let down by services that his motivation had escaped him and he was back on the drink.
We said our goodbyes and he struggled off towards the hostel. I’ve seen and heard a lot of stuff whilst working in this field but this really got to me. I had to be somewhere, meeting some people so a gulp of air, a deep sigh and moving on to the next thing was what I had to do. Through the evening the knot in my stomach kept tightening. When I got in the car on my own I cried. Some of it was just about how bad things had got for this guy, especially as he is so physically fragile. An awful lot of it was about how poorly some workers are prepared to treat some of the people we know because they believe they are ‘bad’ people.
On reflection I think I am truly embarrassed to live in a society that will sanction treating someone that vulnerable that badly. I hope this guy doesn’t die soon, I hope that about everyone but for him it’s a real threat. If he does I fear I’ll be consumed with the injustice of it all, the lack of humanity and compassion of those involved in ‘trying’ to move his case forward. That is appalling I should be allowed to grieve by remembering what a funny and charming man he is, on his story telling skills and on his ruthlessly blunt way of being that has on a number of occasions brought me back down to earth.