The sad result of gaps in services

I would like, if you all don’t mind indulging me, to reflect on the often present problem of gaps in services. This is an issue, which I think has the potential to become more profound as services continue to be stretched and the country begins to feel the long-term effects of the last few difficult years.

I am prompted to write this, after reading the PFD report published on the mental health law online site concerning the death of Sean Kay.

It is a short report, but one that very much caught my attention. Sean had sought help from local mental health services, but discussions were ongoing about which service would be able to meet his needs. Before that decision was made, Sean was found dead in circumstances ruled to be a suicide.

The report concludes that if the model adopted by nearby Suffolk had been in place where he lived in Norfolk and Waveney, Seanwould have been assessed by mental health services and the same ‘gap’ through which Sean fell would not have existed. Hopefully, by now, the services have been reviewed and the same circumstances will not recur.

It would be easy to see that as the end of it, but I think this is, potentially, just one symptom of a pervading issue that can rear it’s head in many health and social care spheres. I have experienced it often in my professional career, and more than once as patient accessing NHS support. I have no personal experience accessing social care support, but am fairly confident that the issue exists there too.

I am thinking here about those ‘difficult’ cases where the answers are not easy to come by.

I’ve spoken before about the difficulty with patients who are not co-operative with support packages as a symptom of their illness being treated as if they are refusing support here and here. And that is a symptom of the same issue, I think.

Of course, I am only going off the very limited information in that report, but it appears that the issue came about after Sean was considered ‘too complex’ for the team that initially received the referral.

In my own experience, I have seen cases where this issue of being ‘too complex’ resulted in less tragic, but nonetheless damaging consequences for the individual concerned. It is easier to respond to a clear issue of slipping between two services. But what about those cases that are accepted by a service, but then sit in someone’s metaphorical desk because the complexity requires more time than that person has today, and the next day, and the day after that…

Then there are the cases where the individual is bounced from service to service because no one is quite sure what to do.

And the ones for whom short term solutions are always proposed that never act as much more than a sticking plaster. The long-term plans will be drawn up once this crisis is under control, but there’s always another crisis somewhere. There are an awful lot of plates in the air for every single front line health or social care service.

I am thankful that I have not had to become involved in a case as tragic as Sean’s, but when I read the report, it was a sobering reminder of a number of ‘close shaves’ over the years.

I don’t really have any answers to this problem. I think it will pervade as long as public services are under pressure, and as long as accessing these services has more in common with a factory floor conveyor belt than it does the individualised support we all aim for. I do hope though, that professionals will always feel empowered to question these problems, and to intervene in such cases before irreparable balance is done. And I like to think the problem would have been spotted, it just that for Sean Kay, it was too late.

In case it isn’t obvious from the fact I still haven’t identified the authority I work for, the views expressed on this blog are my own opinion and not the opinion of that local authority

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