In what seems like a very long time ago when I trained as a nurse, and later nurse tutor and nurse director, I experienced the extraordinary change in the NHS which the introduction of market economics and business models to NHS management created. I well remember the arguments between clinicians and economists, and the inevitable pain suffered by our patients who were caught up in the middle of it all. Certain things stand out, but none more painfully than when someone decided that we should stop buying nice soft flexible catheters from reputable suppliers, and replace them with a far cheaper option which turned out to be as flexible as the average drainpipe. For the uninitiated that meant that it was agony going in, uncomfortable to have in place, leaked and was agony coming out! Of course, those insisting on what would have appeared to them to be saving the public purse considerable amounts, had no clue as to the implications of their decision beyond the sheer economics.
I was tragically reminded of this again just recently when I heard of the deaths of two young women who had previously used our services but who had gone on to become two more numbers on the shameful Scottish drug deaths history. You see, so many of the services which are commissioned for vulnerable people have time limits placed upon them, because of course commissioners are very reluctant to maintain any sort of open-ended approach which could be a blank chequebook. This inevitably means that there is some sort of expectation that services or programmes will have an end point at which the person is ‘fixed’. Such a medical or illness model fails to take into consideration the fact that people rarely suddenly recover from anything which involves psychological trauma or is a recognised chronically relapsing condition, as is the case with most dependencies or acquired behaviours. Applying business models to human nature just does not work because people are people – not widgets – each person being complex and unique in their experiences and needs. Only a person-centred approach can hope to adapt to the ever-changing needs of anyone, let alone those especially vulnerable in our society.
Our contracts may define how long we should work with someone and what we should do with them, but these are inevitably based on the premise that we work with a homogeneous group, which of course we do not. It is our values that define how long we should care for someone, and maybe we need to think more about ensuring that the support networks available in the community are there as and when people need them, rather than insisting that those needs must align with what we decide to set up. If we continue to insist that people conform to our services, rather than insist that our services actually meet the needs of those who call out for them, then we will continue to see people happily complete courses and provide good outcomes for statisticians but find themselves with nowhere to turn when inevitably things go wrong again. That is why Apex tries to ensure our ears and hearts are always open even if our doors cannot always be. It is why every wasted life or personal tragedy hurts every one of us deeply, and it is why the third sector is so vital for Scotland’s communities.