Ways of Being, The Inner World, Reflective Practice

Thoughts from a Sportive- service provision

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There a number of things one wants on a long bike ride. A good bike, a comfortable saddle, dry weather, not too many hills. The list is long. But along with these one wants good nutrition. We always carry a certain amount of stuff with us  when we ride- unlike those riders one sees in the tour de France who have domestiques to fetch and carry for them. We become like camels. So I had three litres of sports drink in my bottles. Enough for three hours riding. And seven cereal bars. Enough for one an hour. Plus some gels for those “I can’t go on moments.” This is fine but what happens when the water runs out? We don’t always drink at a uniform rate. The pre ride blurb highlighted six feeding stations fairly evenly spaced along the route. “Great,” We thought. “That should keep us going.” Then we looked more closely .Each stop was either a pub or a Social Club. Whose aim was to make money. Not serve hungry and thirsty cyclists.

We use strange shoes for cycling. They have an incredibly rigid sole that has no give in it whatever. They also have a raised cleat in them. Thus one walks pigeon-toed and carefully across any smooth surface. Like tiled floors. Or lino. Or any floor such as one might find in a pub or social club. One does need to be drunk to find walking across these surfaces difficult when wearing cycling shoes. the other thing one doesn’t want is white table cloths and “polite” cups of coffee at an exorbitant price. We want some water. And the option of tea or coffee. Some Flapjack. Or a slab of fruit cake. Preferably served on tressel tables and in a lay- by or grassy turn off. Toilets are convenient but not essential.For women this is not quite so true. A convenient tree is fine for a man. More comfort is needed for women. But the general principle is the same. A loo. Some carbs. And easy access when wearing cycling shoes. Not a great deal to ask. Particularly when we had already paid our £30 entry fee.

When we did stop and only wanted a comfort break, we got annoyed looks from the owners. Why weren’t we buying a steak sandwich with fries? And a bottle of Red to chase it down? They had put out tables with cutlery for us. Did we not appreciate the effort they had made? (No! We didn’t. Because we hadn’t asked for any of it!)

 

I have recently encountered the idea of Clusters in Mental Health care.The idea seems to be that one is given a rating for the severity of one’s distress. This number will then equate to a pre formulated “package of care” Thus if I score 20 /20 I am a Red patient who gets a Red Care Package. When I score 12/ 20 I become an Amber patient and get an Amber Package of Care. (I assume there are no shades of Red. No light Red. Or strong Red. Or Red shading into Pink. That would spoil the fun!) These clusters are linked to Payment by Results. (Does this mean that If I haven’t used up all my Reds this week I get a refund? Or that I can vire my Red savings to my Green pot? It all sounds worryingly Orwellian to me. But I’m an old-fashioned Liberal who thinks that care by numbers doesn’t work. That care by Need is a better slogan.)

So, how do these ideas fit together? It was obvious on the ride that nobody had actually thought about what would work for us, the cyclists in terms of refreshment. The pubs and clubs saw 1,000 cyclists and added up their profit. fine. I am quite happy to sit down with my steak and red wine if I’m going out to dinner. I want white tablecloths. Cutlery and a question about how do I want my steak cooked? When I’m riding 100 mlles, I want something different. Something that meets my needs then and there.

I have been around the NHS for nearly 30 years one way and another. I am still amazed at the gap between what patients want “on the ground” and what is provided for them. Successive governments, committees and focus groups have all come up with a variety of solutions. Many of which fail to work in practice. Current provision for so-called mild to moderate depression is via Healthy Minds, essentially centrally funded. There is a  waiting list of at least six months. That is a long time to be depressed. Then there is no choice of therapy. It is CBT or nothing. This sounds too akin to my lack of flapjack and tea. CBT may well help some people. But to paraphrase Jeanette Winterson  “CBT isn’t the only fruit”. People want provision that suits them. Not a Procrustean bed of a service where the patent fits the service and not the other way round.

I will be doing more rides this summer. One of the things that will determine which ones I choose will be the service stops. Any suggestion of white tablecloths and I’m not interested. But flapjack- now we’re talking!

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