Saturday, 24 October 2009

Job Clubs in the ‘80s recession, now in the Noughties, welcome the Leg Club.

While trawling the web, in yet another busy surgery waiting for work, we decided to have a look at The Comic and found an interesting article here that caught our eye.

Those of us old enough to remember the 1980s were reminded of “Job Clubs” where unemployed people were meant to meet up, exchange ideas and get advice to try and help them to find work (when there was actually very little or no work to be found).

We remember them well. We walked past people with no jobs in groups, usually of men, smoking lurking around the Job Club doors spilling out on to the street and looking like a posse you would try to avoid at all costs often funded by local councils.

We thought given, our memories of the former Job Clubs of the Eighties, we would have a look at the Comic’s “Resource Centre” where there is a new form of club, the Leg Club.

In summary it is “social model to manage treatment such as ulcer care”.

Sounds a little vague. Leg Clubs: a social model to manage treatment such as ulcer care? Can a “social model” manage other “treatments” such as coronary artery bypass surgery in a CABS Club?

We read on.

It tells us that leg ulcers affect people mostly over 65. Well nothing there new to your average Northernshire GP, district or practice nurse. “Evidence” shows this is expensive with slow healing rates and a high incidence of recurrence”.


Does “evidence” reflect the team here at ND Central’s experience that it is usually little old ladies whose only source of social contact is their ulcer?

If they complied with treatment their ulcer would get better but instead they remove dressings, develop multiple allergies to all known dressings and let their favourite pussy rub up against their festering ulcers and then complain it never seems to get better. And they sit with their leg down to “improve” circulation and “facilitate” healing and still they never get better.

OK rant over that description was just our own Grandparents over whom we had a degree of control and who mimicked every other geriatric leg ulcer patient we see. Patients, however, are more manipulative. For example ringing nurses after they have just put a new dressing on to tell them it has “fallen off” with no patient helping hands whatsoever honest guv.

Yes, ulcers heal slowly, and they do recur but if your ulcer is your only source of social intercourse then there is no incentive to get better.

It is also usually a pre morbid condition caused mostly by poor circulation which gets worse as you get older but we digress. These were just some thoughts from those on the frontline based on years of experience.

We were only on paragraph 2 just wait for paragraph 3 and its little “QUIP” and being “referenced” whatever that means by the Department of Health. So it already is doomed to failure or care on the crap sorry cheap.

The Leg Club idea was apparently developed by a former nurse of the year who goes on to say that “Collabrative working (comrade) is the bedrock of each Leg Club”.

Fourth paragraph and a good Party phrase or two already mentioned for the comrades in NHS management to absorb in their working week off.

The next two paragraphs, with lots of Partyspeak (if you want more of this check out this inpiring link on Leg Clubs) describe how they work which to our slightly cynical eyes at ND Central sound very like the current dressing clinics and tissue viability clinics held at local surgeries and dermatology clinics.

Further on GP involvement is kept to a “minimum”.

Excellent idea! Keep the idle educated GPs away from patients.

Next paragraph starts to shed a little light on where this might be coming from as:

“Established and run by volunteers in partnership (excellent Party word!), they are self funding (cheap), with patients finding ways of raising the money for the rent and equipment (remember care free at the point of need?). The cost to the Commissioner (ah ha the important one in the equation the new force of Darkness in NHS management) is in the nursing time and dressings.

True Party Central Utopia no cost!

Hmmm. Could we perhaps re write that paragraph to describe the current system as such:

“Established and run by district nurse, practice nurse and GPs they are cost neutral to the patients as the care is delivered in their own homes. The cost to the Commissioner is the nursing time and dressings. There may also, unfortunately, be GP and dermatologist involvement but at no extra cost to the commissars.”

Have they forgotten the additional costs for genuinely housebound patients like “Vera”, the case study, who will no doubt be volunteering to self fund taxi services to mosey on down to her local Leg Club shin dig in the same way that Vera does not now come to surgery so no cost there comrade commissar in you needing to provide transport to the Leg Clubs via the ambulance (free taxi for OAPs) service.

Read on dear reader for things are getting worse.

It turns out that clubs are supported by the Lindsay Leg Club Foundation which presumably is the new version of the Rotary Club devoted to charitable good causes?

Now it really starts to get interesting.

Click on the Leg Club Foundation link > Useful documents link and download the Leg Club brochure.

Just look at how a “Leg Club” will transform your patients.

Take Mavis Thistlewaite, 30 stone, five foot nothing, 60 a day lifetime smoker and a bottle a day of Scotch for good measure in her farmhouse high on a moor some 10 miles = 25 minutes drive to any social centre, with ulcers for 10 years as she watches day time TV with her legs massaged regularly by her 5 cats surrounded by their droppings and see how she will be transformed into a Leg Club brochure babe of the month.

Patients (sorry well looking geriatric models not real patients) wading in the sea, worshipping the Leg Club, practising martial art manoeuvres, smiling holding hands and not an ulcer or bandage in sight. Please look and see how Leg Clubs have been so successful.

Instead of just looking at the pictures of ulcers “transformed” try reading and see what the bottom line is. If you are just a tad cynical and bored by now just read the “Setting Up a Leg Club” section on page 8. Is this a possible Third way model for funding ulcer care?

Oh Lordy we are reading this and seeing our patients transformed by this new Messiah. Like St. Paul we now see the light and will start following the guide word for word. Tell us how do we get the handbook? Will there perhaps be a small donation to the Leg Club’s Messiah’s charity? (We couldn’t find that bit).

Still Resistance work at the café Michelle is hard. So after another trip to the Quartermaster for some top up rations we sat down for some more self directed learning from their website.

We looked at the “Corporate Partners” a few names we recognised and we are sure none would have any vested interests in this particular field of medical and nursing care except the one which had “wound care” in its name. Still 1 out of 16 may just be allowable.

This can’t be a public private initiative via a charity? We can’t be that cynical given our recent religious conversion to the “Leg Club” creed? But it is “referenced” by the Department of Health which we know likes care on the cheap and lots of private sector involvement to save money ( = pay more for less) a good Prudent “socialized medicine” policy (we do like that phrase here at ND Central it sounds so much better than incompetence).

But then we noticed, after more rations, and this Resistance meeting was after an early and a late Gordon shi*t for some of us, the link “Information for Motorcyclists”.



Well you can imagine the imagery that came to our collective minds at this stage in the evening.

Poor old housebound Mavis Thistlewaite on the back of a Harley being whisked to get over to her Leg Club by the local Hell’s Angels Chapter perhaps? A Community Partnership?

Will there now be a Northernshire Chapter of the Angels called the Leg Club Ulcer Seniors, the LCrUS Seniors for short, using a “social model” to help their leg ulcers? Nora Batty on a motorbike anyone?

We fell apart laughing at this point it had been a long day.

(For our overseas readers Nora Batty is a comic character from a long running gentle humoured comedy called Last of the Summer Wine set in southern Northernshire who was the love interest of a rough geriatric scruff who yearned after her wrinkled stockings. The picture here is not too dissimilar from your average Northernshire leg ulcer patient although Nora was a lot more mobile even on motorbikes).

A few more mouse clicks and we found a picture. Could this possibly be of the new “Messiah” mounted astride a Hog?

Well you can imagine that any more serious critique had long since evaporated at that point.

We do not know if Leg Clubs work. The nearest one to us in Northernshire would be about an hours flying time to reach such is their obvious success up North and we here at ND Central certainly have no axe to grind with Ms Lindsay but we do thank her and the Comic for inspiring this irreverent piece.

After a long hard day at the coal face and a few top up rations you do need a bit of light relief. It will take a while to get the imagery out of heads.

We really must get back to 5 minute appointments it will stop us trawling the Net in our downtime but the Party has decreed 10 minutes good = pay but 5 minutes bad = no pay.

Bored minds do mischief make. And we ain’t teenagers on a street corner.

Praise be to the Party and NHS Innovation. Heath Robinson’s ideas seem workable in comparison with some of theirs.

Those of us old enough to remember grants and UB40 cards as medical students here in the UK will be off to the Leg Clubs in the same way that we went to Job Clubs in the eighties. They were such a good idea. Some Job Clubs may still be here today? None locally but GPs and district nurses are still here so are the leg ulcers.


Nikita said...

Due to our ever changing world, the almost absence of community spirit, the fragmentation of the family unit - for diverse reasons -and other factors, you are correct.
Little old ladies leg ulcer may be her only means of social contact.

Some little old ladies may have a network of friends, but will manipulate as their leg ulcer is seen as important to them and regular input will add credence to this and will be their main topic of conversation.

Most little old ladies however, I suspect, will manipulate as they are so goddamned lonely and their leg ulcer is indeed their only means of social contact.

Perhaps it would be helpful to address this mental health issue as extreme lonliness is such and refer little old lady to a befriender organisation. If she has a weekly visitor, perhaps she may not feel the need to rip her dressing off as a means of engaging in social contact.

I have always assumed that you are based in Newcastle and if so, there is a befriender organisation located in the west end. If not, I am sure there will be a similar organisation near you.

Northern Doc said...

Thanks for your comments. Nice idea but our experience is that these too are manipulated and then disgarded. The term no win situation comes to mind because of the patient.

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