Patient Stories – Will we learn?

Today the Patients Association published a report ‘Patient Stories’ (PDF). It focuses on thirteen different stories. These are stories directly about the experiences of patients through hospital systems and discharges. Some are told by family members when the person involved and some are told directly.  Some are anonymised and one is from a doctor who received treatment herself.

The format of ‘telling stories’ is a good one because it makes for interesting reporting. It personalises tales that we know about poorly managed hospital discharges which take place before they should because we hear the voices of those directly affected and it is easy to see the lack of humanity in some of the systems that exist in acute health care.

Sometimes what is remembered is a single comment which may have been made by a busy member of staff in an offhand manner, for example, in relation to Margaret Allen, her sister writes

‘my (other) sister called the hospital to enquire after Margaret’s health before her death. The answering nurse replied that Margaret was ‘screaming away nicely’ and held the phone out for my sister to hear her cries’.

There are some shocking details in some of the stories of miscommunication, arrogance and rudeness of staff, basic care not being given but sometimes it is these snippets of language which are telling in terms of respect and attitudes of professionals towards staff.

While it may be possible to write these off as ‘individual stories’, I think that would be an massive error because there is an enormous amount of learning and themes which can be traced – not just through these stories but through the similar ones that have emerged over many years.

There is a consistent lack of flexibility and a lack of listening in these processes.

An example would be in the story of George Robertshaw who was admitted to hospital and was discharged in a way that his GP felt was ‘unsafe’ due to it being so rapid and was discharged in thin pyjamas in the winter – so that when carers did arrive to him he was cold, hungry, very thirsty and still not well.

His daughter writes

‘Following my father’s death, I again spoke to someone to inform them of my father’s demise and that I would be making a formal complaint re procedures. She told me directly that she would ask a nursing director to phone me back in a day or two, This never happened. No call, no communication, no nothing. I again rang and I was told that they had informed whoever it would be and that they would remind them. I got the impression that the relevant person was present but did not wish to speak to me and was telling the person on the phone what to say

Again, this could be claimed to be an isolated incident but as a rule of thumb and as someone who takes quite a lot of verbal complaints about the services that I provide, I tend to assume for everyone one person who complains or whose family complains, there are far more who will not have the confidence, strength or understanding to do so. It is important that systematic errors are challenged and improved but it is also important that clarity of information and respect are given to those who use services.

I wonder if that same Nursing Director would have been so slow to respond to her own manager? No? Then treat the people who use the services, particularly if they have a complaint with at least enough respect to contact them in the same time frames – even if it’s a matter of updating them with no additional information.

An organisation which is not willing to take or deal with complaints, cannot be a ‘learning organisation’ which is willing to improve.

I don’t have time to identify the issues in all the stories but it is worth reading as a snapshot of some of the care which is being given in hospitals in this country.

Of course there are good stories, and there are fantastic staff. The very first section of the report is based on positive feedback but we cannot ever become defensive about the systems as they exist and must treat each of these experiences as areas of learning. Sometimes it isn’t always about resources, it’s about respect and it’s about listening and responding.

Yes the NHS is wonderful and many of us have personal stories of gratitude, I have many myself, but if there is anything that can be done by any one of us to make things better, we absolutely must.

The main lesson I will take from these stories is to make sure that every interaction is bounded in dignity and respect. Mistakes happen but they can be resolved by listening and learning from those who experience them.

Defensive organisations that won’t encourage criticism are dangerous organisations. These lessons are just as important in all social care organisations as it is in health care.

The saddest thing about these stories is that we have heard similar before. There have been commitments between increasing ‘compassion’ in nursing and care staff but the systems need to become more compassionate too and far more responsive and flexible.

This is a series of awful stories and experiences but they must be learning experiences so that some positive may come amid the extreme pain and grief caused.

Advertisements

Social Work and Moving On

soraya nulliah goodbye perfect

In a couple of weeks I will be leaving social work. Or will I? I am moving into a job where my social work qualification is not an essential requirement. I am moving away from ‘frontline’ practice in the way that I have always understood and defined it.

Being diligent, I remain registered as a social worker by the HCPC (Health and Care Professions Council) and there is no doubt, therefore, that I can continue to  legally be entitled to call myself a ‘social worker’ but the job I will be doing is not ‘social work’.

I am incredibly proud of being a social worker so it is a shift for me. Of course, as I will be remaining in the sector, my experience will be crucial in the new role but I will no longer be building that same types of relationships on a personal level that I do (or at least I hope to) now. I will be working in a different way.

The next few weeks, then, will be filled with reflections. I am saying a lot of ‘goodbyes’. I have been in my current post for many years and the current council for even longer. I am saying goodbye to the people who are on my ‘caseload’ – some of  whom will be reallocated and some of whom will be discharged from the service. I am trying to get everything done but I know the way life works isn’t about neat closures.

I’m also saying goodbye to a local area I have worked in for many many years. Familiar streets, blocks of flats, estates which have so many faces and memories entrenched in them. There are roads and buildings I can’t walk past without remembering some of the people that lived within them and gave them the flavour and character of a neighbourhood.

I think of some of the people I worked with who had no one else to remember them. Isolated, detached from families by distance, ill-health or circumstance. Then I think of the families I saw, the warmth and kindness and hope within some of the depths of poverty and the tragedies that life can fling at people without recourse to ‘fairness’ or ‘equity’.

I’ve had the honour to work with some immense people who have opened up to me and allowed me to share some of their most difficult moments and I have worked alongside people who have struggled so long and hard with such dignity or pain.

I have put in services and tried to offer suggestions but – increasingly, I have also removed and denied services to those whom I felt would have an improved quality of life if they were provided.

I’ve learnt a lot about the value of good health and knowing ones limits. I’ve learnt enough about the effects of alcohol to turn me near enough teetotal (not entirely mind!). I have learnt enough that even the best planning can’t protect one from accidents or fate.

Ill health affects across all social classes, cultures and belief systems. I have walked into houses which have made my jaw drop, some through opulence and some through squalor. I have tried not to judge but to listen and respond – sometimes it can be predominantly about listening and hearing.

I have had good and not so good managers and feel so fortunate in my current role to work in a very supportive team and organisation so it is with sadness that I see how the cuts over the past couple of years have ripped the heart out of a service and professionals who really were, even if it didn’t always look like it from the outside, trying to do their best.

‘Doing our best’ will not be sufficient anymore. While a government talks of parity of esteem between mental and physical health and further integration or establishing the ‘dementia challenge’ which focuses on better diagnosis, it’s important that we do not allow those who spread the cheap and hopeful words around freely to believe that parity of esteem will not cost. Establishing good and supportive dementia services which focus on what happens AFTER diagnosis will cost and that integration has to involve more change that asking everyone to sit in a room together and do team building exercises.

When I look at adult social work and mental health social work, the two areas I have worked in and I see how things have changed, it is not only this government I look at with despair, it is the previous government too.

Ed Balls played political games with social workers and bought into the Sun criticism in the wake of the tragic death of Peter Connolly. All main political parties have backed the privatisation of care services without building in sufficient protection and until the personalisation agenda actually offers the same benefits to someone with dementia without a supportive family as it does to an independent adult with a physical disability I will see that it is not yet a success.

So I’ve seen a lot of changes but not all bad. I see a great hope in the profession as we can work harder on developing an independent voice that doesn’t need a battling professional organisation which can’t stop its bickering and pettiness or a ‘Chief Social Worker’ chosen by civil servants with no knowledge of what the heart of social work is to ‘speak for us’.

Let us speak for ourselves and find more ways of doing so. Social Work is a profession to be proud of – we just need to make sure more people know about it – and we need to put some more fight into it. Fight politically, fight against cuts which affect those whom we work with, challenge within the organisations in which we work and remember that we need to create and build a profession to be proud of for ourselves – because no one else will.

Not a ‘media officer’

Not a soap opera

Not a fly on the wall documentary

Not a professional organisation

Not a ‘college’

Not a Trade Union

Not a government-appointed ‘chief’

We have to claim the profession back from the narrow definitions that successive governments seem to be forcing us into. Social Work happens outside local government – something I am about to have a far better understanding of.

It’s going to be a weird few weeks for me as I grapple with my own professional and personal identity. I rather feel I won’t give up the fight wherever I go – I hope not. There’s still a lot more to be done.

pic by soraya nulliah @ flickr

Dementia Friends

The Department of Health has, today, launched the Dementia Friends scheme.

It’s a lovely scheme to promote greater awareness of Dementia by recruiting an army of  volunteers. These volunteers will be trained to have an ‘understanding of dementia’  As the website itself says, if you become a ‘Dementia Friend’

We’ll equip you with an understanding of dementia and how you can help, and the rest is down to you. We want Dementia Friends in every community – in every hospital ward, post office, place of worship, and on every street. Our target is to reach a million people by 2015, and we’re confident we’ll not only meet this target but will beat it

Wow, that’s great. Really it is. I’m (for once) not being sarcastic. I work with a lot of people with dementia and having to explain it to them and their family members, I see the fear and lack of understanding and I wish that there were a greater knowledge in dementia in the community and this seems to fit the bill.  In my social work training course, over two years, I had one lecture on older people – I can’t even remember if dementia was mentioned. That’s plain wrong. It needs to be a meaningful part of every training programme and on many courses.

First I thought Dementia Friends would be like a massive new befriending scheme for isolated people without family and friends and excluded by community  as the site says

Alzheimer’s Society research found that nearly two thirds of people with dementia feel lonely, and almost half reported losing friends following their diagnosis. With one in three people over 65 developing dementia, it’s vital we change this picture.

But reading more I see its  about encouraging people who are Dementia Friends not to abandon those of their family, friends and social circles who have dementia and  not to ‘drop’ them as the illness progresses. Which is also a very good goal.

I guess I just see a disproportionate amount of people who don’t have family/friends/social networks or maybe I’m seeing them after their networks have abandoned them.

Early Diagnosis

One of the aims of this scheme is apparently to encourage earlier diagnosis of dementia. Again, a very laudable aim. The Guardian previews Cameron’s announcement

Cameron will say: “Through the Dementia Friends project, we will for the first time make sure a million people know how to spot those telltale signs and provide support. There is still a long way to go in fighting the disease, but together we can improve the lives of millions.”

The scheme will provide free coaching sessions on how to spot the signs of dementia and provide support to people with the condition.

Each Friend will be awarded a special “Forget-me-Not” badge once they have completed their training, so that they can be easily identified as being able to assist people with dementia.

So when the dementia (and remember there are lots of causes for forgetfulness and confusion other than ‘dementia’)  is ‘spotted’, I imagine the hope is that the Dementia Friend will encourage the person they have potentially ‘spotted’ to get screened.

All good. Again back to the Guardian which says

The rate of successful diagnosis is expected to double from 42% at present to 80% – a target set by Cameron earlier this year when he launched his challenge.

Healthcare professionals will also be required to ask all patients aged between 65 and 74 about their memory as part of their standard health check. Simple diagnostic tests will be expected to be done on site, cutting waits that at present can be as long as 18 months.

Post Diagnosis Support

So we are able to identify and diagnose dementia earlier. Really that’s great. It allows people to have more time to adjust and to make plans regarding their needs in the future. We have more people who are aware of the needs of people with dementia in their own social circles and prepared, we hope, to be more tolerant and supportive.

However we can’t allow the happy clappy Department of Health talk to get away with the fact that dementia services and provisions have been slashed to bare bones. There is little left to provide to people who have early diagnoses, particularly if they don’t have that family support because the resources just are not there.

I’m all for early diagnosis if people want that (and not everyone does but that’s an individual thing) but if this is the same government that has launched a savage attack on local authority social care services which were barely fit for purpose at the best of times then I can’t help but be cynical about some of these provisions.

I’d like to see more research and provision of different types of care both in residential settings and at home so we aren’t at the mercy of large private companies creating ever larger residential and nursing homes in suburbs where the cost of property is low that house up to 80+ residents with dementia in places that are difficult for family to access without cars.

I’d like to see some of this ‘dementia challenge’ money put into allowing local authority assessments to build cost of non-directed advocacy into support planning – that would make an immediate change in the quality of life of those with dementia.

I’d like to see some honesty around the poor quality care for people with dementia currently in social care and hospital settings. Maybe some of that money could be invested in paying care staff better and more importantly improving training.

Big Society

This is very much a ‘big society’ volunteer type role. Good luck for those who participate. I’ll likely join up myself but lets not forget that this means distribution of volunteers may not be equal and those who have no community as such will not have the same benefit of access to these who volunteer.

So a good initiative and well done but lets not forget that if the government aim is to increase diagnosis, they have to be prepared to put more money into improving what happens and what support is available after diagnosis.

The ‘Red Tape Challenge’ does Health and Social Care

Red Tape

We all knew it would come in time. This wonderful government idea to slash all that awful ‘red tape’ that stops people doing what the government otherwise would stop them doing finally arrives at Health and Social Care.

I had a brief look at some of the provisions detailed as ‘red tape’ for which the government is asking for comment and quite frankly, I am horrified.

What I might see as essential protections, they are presenting as ‘red tape’ and asking for feedback about potential abolition.

This is a consultation so it’s really important that as many people as possible to contribute and in the joyful spirit of openness, the website allows up to see the live commenting on others. I wonder how those with less technological access or knowledge are able to comment quite so openly about some of the provisions up in the air.

But openness and accessibility only seems to go so far and for the government departments responsible they seem to be after whipping up public distaste of ‘red tape’ although actually, we really do need to move from the idea that bureaucracy is necessarily bad.

There is a separate website entirely to focus on ‘ regulatory enforcement’ and where it might be unnecessary.I feel robust regulation (and thus, enforcement which has to follow as a result) is essential. The big problem with social care and health regulation since the CQC was established was the ‘light touch’ type approach which had been taken and the ‘back office’ regulation and not enough enforcement.  I really really hope that it is not cut back further. I want to see more regulation and stronger enforcement, not less of it.

But back to the ‘red tape challenge’. I want to share some of the provisions ‘up for discussion’ that the government has classed as ‘red tape’.  I’m solely concentrating on what is up under ‘Quality of Care and Mental Health Regulations’ as I felt that was the area I knew best. The numbers refer to the list of these ever so demanding provisions in the Excel list here.

39 is that oh so burdensome (!!!) regulation that requires the Care Quality Commission ‘to monitor and access for monitoring purposes, people who are deprived of their liberty’ and necessity to report this to the Department of Health.

40 is a nice one about requiring people ‘who assess Deprivation of Liberty’ to have an enhanced CRB.  – clearly unnecessary because.. er.. people who lack capacity and may potentially be subject to DoLs aren’t likely to be vulnerable, right? I think there’s an issue about effectiveness of CRBs in general but a bit worrying that that’s considered ‘red tape’.

43 is much more worrying as it is the obvious ‘red tape’ which introduced IMCAs as a safeguard for ‘those who have noone to speak on their behalf’ making them mandatory in abuse and review situations. RED TAPE??

55 is another ‘good one’ which ensures that IMHAs are ‘of an adequate standard’ because clearly, that is unnecessary (!?!)

Obviously there are many many more – I’ve just, for reasons of time, picked out a few that interest me personally but do have a look at them and COMMENT.

I’m frankly insulted that some of these provisions are even considered to be ‘red tape’  but as there’s an open consultation, it’s important that as many people as possible who know and understand the implications of removing them, to contribute.

If the government want to know what ‘red tape’ is in terms of adding unnecessary burdens, I’ll gladly explain about how useful (or not) it is to spend time recording how much time I spend on ‘smoking cessation’ work or time spent ‘clustering’ people according to diagnosis into tiny little tick boxes which are, clinically, unhelpful in order to get the ‘Payment by Results’ systems which will never work well, up and running. THAT’S red tape.

But it seems to be red tape that potentially infringes on the rights of those who might be least able to protect their own that they are classing as ‘red tape’ here.

Contribute to the consultation and let’s tell them how important some of these provisions are.

Oh, and someone should tell the Department of Health that the GSCC doesn’t exist anymore as they seem to have forgotten on their Professional Standards page (published this week!) but we know how much interest the Department of Health has in social work and social care so shouldn’t really be surprised.

Pic by Martin Deutsch@Flickr

Two Chiefs are Better than One?

or the Saga of the Chief Social Worker (s )

On Friday came a somewhat mystifying announcement from theDepartment of Health that two chief social workers will be appointed. The position of ‘Chief Social Worker’ had been advertised earlier in the year but no appointment had been made and the somewhat oblique decision was made that two would be better as no one person would have sufficient knowledge and expertise to be able to adequately respond to the needs of social work with adults and with children and families.

I was never particularly enthralled by idea of a Chief Social Worker  as I didn’t see what it would add to the voice of the profession. Some see links with medics or nurses but there is no ‘Chief Teacher’ – a ‘chief’ position doesn’t mean a profession has a better representation and personally I’d prefer the voice of the profession is somehow accountable to the profession either through a role in BASW, the professional association or the College of Social Work.

The ‘Chief Social Worker’ seemed to me to have a quasi-civil service position to rubber stamp rather than challenge government agendas and that has pretty much been confirmed by the way the appointment has been handled.

Yes, social work needs voice but I am under no illusion the voice of the chief appointed  would be different from voice presented by ADASS/ADCS .  The ‘Chief Social Worker’ would likely be someone coming from the top management positions who had proved their worth within local government systems and would be a mouthpiece for management interests rather than social work interests having been unlikely to have been engaged in frontline social work for many years. If that’s the case, I don’t see the purpose but many were in favour so I could be wrong! (It’s known and I don’t always claim to be right – just opinions!).

I was also particularly concerned that with the appointment of a Chief Social Worker, adult social work would be sidelined further. It was clear to me that any single Chief Social Worker would focus on children’s services because that’s where most social work takes place. I was worried that adult social work would be further marginalised.

So I’m not completely against the move to split the role.

What next for Social Work?

However, the announcement does have a number of implications.

1)   Dividing paths of social work into streams of ‘adult services’, ‘childrens services’ and to some extent ‘mental health services’ is irreversible.  As social work students, graduates and practitioners we  are streamlined by sector earlier and earlier with even qualifying programmes asking more for specialisation earlier  and the post qualification programmes encourage this.

Entry to social work ‘Step up’ type schemeswhich focus in pumping out ,children’s social workers encourage this. Local authorities (with government ministers backing them up) are seeking ‘practice ready’ social workers as graduates from universities which means that placements in statutory children’s services have a disproportionate value. I think that’s terrible shame. A local authority wanting a social worker from university should be prepared to accept a generically trained graduate with any placement experience and GIVE THEM the experience to make them ‘practice ready’. There is a mismatch between local authority expectations and universities ability to deliver and I’m 100% behind the universities here.

Employing organisations need to invest in training their workforce from graduation to get the workforce they want.

There are fewer people around who will have substantial experience necessary to cover both children and adult services. That’s a failing of government interference in the profession, the splitting of social services departments and separating agendas.

2)  Equally worrying is that this decision was seemingly taken ‘behind the scenes’ in the Department of Health.  Both BASW and the College of Social Workhave published statements opposing it. There was no broader consultation with social workers so who made the decision?

Why was such a significant decision taken without any consultation and who was responsible for ‘signing it off’. I’d wager it wasn’t a social worker.  This is frankly very insulting to the profession. Unsurprising but it shows how much the government listen to the College they set up and the professional association when it comes to making crucial decisions. It makes me realise more that the Chief posts will be government mouthpiece posts that will not speak for the profession. The government knows what it wants and it knows ‘what’s best’ for us without consulting or telling us until the decision is made.

Two heads of two professions?

We seem to be  moving inexorably towards two professions. This is sad for people like me, who have always passionately supported genericism as being important. While I think there are positives in having separate chief social workers for adult and children’s services, I am desperately concerned about how the decision was made.

What do you think? Do leave messages as I’m very interested.

Familiarity Breeds Contempt

Over the course of the past months, who could help but feel a plethora of emotion as the horrors of Winterbourne View have unfolded before our very eyes: Absolute disgust that an organisation could get to the point where such blatant institutional abuse becomes a part of daily life, anger at the systems in which we work as they are revealed as insufficient to protect the most vulnerable in our society or perhaps a heart-wrenching empathy towards the vulnerable and a passion that things have to change and something done… but what?

It will hopefully have challenged us all as a professionals.  Is it just possible that as we go about our business there is a very real danger of becoming complecent unless we keep on out toes and remain true to our professional standards and ethical practices?  I’ve been reminded how very important the role of those who commission services and the need for greater accountability when choosing services for individuals who can’t choose for themselves.   Are we pressured into choosing the cheaper option even when we know in our heart that it isn’t the most suitable?  Do we sigh a sigh of relief and accept without question when we find a service that will accommodate the individual with particularly challenging behaviour knowing that the option will be limited? Do unrealistic case-load sizes prevent us from spending time to think outside of the box and identify the very best service and then think how it might be achieved? Do we have a professional relationship with providers when a less formal relationship can be so much easier? If we become too familiar those so important boundaries can become distorted and increase the risk of poor practice or even abuse going unnoticed or being excused.

I started my social care career working in a residential home for children with autism and it must be said that in my experience the majority of carers are decent caring people who go the extra mile.  Most don’t get paid heaps, have to work shifts but still turn up at work asking how they can make the next 8 hours the best they possibly can for those they have come to work for.  However, there are some for whom that isn’t the case and over the past couple of weeks we have seen 11 photos that will probably remain imprinted on our minds long after the media frenzy has died down.

I’d really like to hear how recent events have perhaps challenged you as a health or social care worker as you strive to help deliver the very best services to those who need them. I also look forwards to hearing how the Department of Health is going to drive service commissioning, delivery and safeguarding forwards.  What is agreed upon is that there needs to be a radical overhaul of social care; what doesn’t see so clear is what that will look like.

 

What I would say to Norman Lamb

Norman Lamb MP

Working in dementia services at the ‘frontline’ I often consider what messages I’d feed back to the local and national policy makers if I ever had the opportunity. Of course, I don’t have these opportunities as I’m not a manager so I thought I’d imagine I were at an important meeting with Norman Lamb, the minister for Care Services.

This is what I’d say.

Make policy practical. Making the right noises about setting up a wonderful plan to ‘challenge’ dementia is all well and good but I see nothing of that at the ‘frontline’.

What I see are cuts. I see respite narrowing in terms of ability to access. I see provisions which had been helpful, closing. I see a lack of beds in the local hospitals when they are needed and I see people who need support being denied it because there are no provisions left.

So take your pleasantries and policy ideas and come and spend a day with me in the community and you’ll see why I am impatient and unbelieving about the platitudes that emerge from those who don’t seem to understand what is happening ‘out there’.

I’m tired. I’m tired of saying ‘no’ to people whom I see need services because the provisions are so tight. I’m tired of saying ‘no’ to people at the early stages of need when I know it will prevent higher costs in terms of pain and suffering but also in terms of money in the longer run. I’m tired of logging targets that have no meaning in the lives of those whom I work with. I’m tired of jumping through artificial targets so I can ‘prove’ I’m doing my job when neglecting visits to actually talk to people because I have to catch up on the paperwork.

I have waited for years for a fair system of implementing personalised responses to care which include people with dementia but am still waiting because the entire focus on the programmes developed through personalisation have been on those who are more able to be involved in the processes or those who have involved family members to help them. I’m tired of wading through appallingly designed forms, self assessments and RAS (resource allocation systems) that focus entirely on physical health needs and marginalise mental health needs thereby ignoring equality legislation.

I want action and yes, sometimes, action includes money. I know what the people I work with ask for and I know I can’t deliver it – not through a lack of will – I want to be able to go home thinking I’m doing a good job and doing my best – and for the most part, I think I do – but the best I can offer is very sparse. The best i can do isn’t good enough.

We have few residential homes locally and are placing people further from their families. We have nothing ‘creative’ left to offer as those agencies which are helping with ‘support planning’ aren’t trained to offer support in non-directed advocacy and therefore if someone doesn’t ask, they don’t get.

So what would I do? I don’t have a budget and it’s probably for the best as I’d steam through it in five minutes – one of the many reasons I’m not and will never be a manager – but I would focus on trying to create a system of social care which offers equality of access to good and creative support planning.

I’d commission more non-directed advocacy into support planning. I’d roll out Individual Service Funds for people with dementia and I’d allow more time for carers – and for social workers to work with people who have dementia because honestly, that’s what’s needed.

However all we get is platitudes about how wonderful services will be without extra money being provided. Yes, I’m sure early diagnosis is important. It is. But please, please can the Department of Health and local government concentrate their minds on what is happening now and the poor services we are providing now and do something, anything to make them better.

I want to do my job well and I want to support people but all the tools I had available for doing so are being ripped away from me. It’s sometimes hard to keep the motivation up when you don’t believe you are helping anymore.

I’m the person saying ‘no’. Me, not the Head of Adult Services, not the Ministers responsible, not the councillors responsible. I sit in people’s homes and tell them what they are not entitled to anymore. I want those who make these decisions to take responsibility for that and to listen to us who go out there and who see.

That’s what I’d like.

picture by Liberal Democrats at Flickr