Last year as part of my MSc. Module I planned and implemented a scheme to introduce open visiting in my Trust. The Trust agreed to pilot it as flexible visiting in its older people’s wards and we launched a new Visitors’ Code
The scheme was partly a response to evidence of Delirium prevention and Dementia care, but also to patient-driven campaigns such as John’s campaign ; a post Francis response to incorporate PPI, and to settle the demons from my own personal and professional experiences over the years. One year on it is proving successful with positive feedback from patients, visitors and staff. Relatives have told me with relief what a difference it makes with many positive examples such as some families saving money by using cheaper public transport from remote villages instead of expensive taxis.
However, I see that some staff remain resistant to open visiting and wonder where such entrenched ideas originate. The lack of a supportive ward infrastructure was always a problem, but not insurmountable. Historically, hospital wards were of a Nightingale design, long wards with rows of beds with the nurses’ station at the head to facilitate maximum surveillance with minimum staff. I suspect the idea originated from Bentham’s 18th century Panopticon or ‘inspection house’ and was an effective means of control. Foucault took the idea further, using the metaphor for modern day surveillance which led me to wonder if the real reason for the rejection of open visiting and PPI is because it dilutes the power base and hinders the ‘medical gaze’ so cleverly constructed by not only architects but also healthcare professionals?
The tables appear to be turning with the public now, quite rightly, staring right back and old hospitals demolished with modern structures to replace them. But are we merely replacing one form of surveillance with another and entering a postmodern dystopian Orwellian nightmare? Sanitised social quarantine is in danger of being replaced from the structural to the cerebral, from a panopticon to an oubliette, and has no place in care of older people with cognitive impairment. Coupled with sensory deprivation from necessary infection prevention measures and the omnipresent cultural hegemony in whatever era we find ourselves in, partnership working is a humanistic way to resist toxic organisational cultures and must be welcomed and embraced to promote excellence in the care of older people.
Photo credit: Memphis CVB via flickr