In their seminal proposal for an ageless society Life after work Michael Young and Tom Schuller discuss the impact on its workforce of closing a south London maternity hospital in the late 1980s:
‘There is very little to say about what the women did after the closure. The main reason is that they themselves had so much more to say about their time at the hospital than they did about their current lives, and wanted to say it and go on saying it.’
More than thirty years later the death from coronavirus of my colleague enrolled nurse Sophie Fagan, who was still working at Homerton Hospital in her mid-seventies, is a poignant reminder of the continuing loyalty felt by many caregivers to their work and to the NHS. In a long career Sophie moved to the Homerton when it took over the day hospital from St Leonard’s in Shoreditch. Then, during the nineties she was a carer first to her mother, who had dementia and lived nearby, and then to her husband Jack who would go on to die of cancer. She served on committees, first for the TLC Care Attendant Service and then at the City and Hackney Carers Centre, for which she was a long-serving chair and as her colleague Mary Julian put it still ‘a fierce advocate for carers’. From 2000 she worked part-time as Homerton’s carer support specialist until her death. Her involvement with supporting carers had begun when the Deputy Medical Officer of Health for City and Hackney, Dr Jane Leaver (who also, sadly, died last year), asked her to administer the use of two respite care beds at St Joseph’s Hospice in Mare Street. Leaver had been rightly concerned at the limited provision and worse management which so often alienated family carers. The beds at St Joseph’s became a benchmark.
Sophie and I were alumni of the certificate and diploma in gerontology which was launched at the University of London Centre for Extra-Mural Studies in 1984. Sophie was in no way academic nor even a highly-qualified clinician: she was opinionated, determined, improvisatory and entirely solution-focused. In 1997 TLC started a stroke support group partly because of Sophie’s frustration at being unable to discharge her day hospital patients: people with aphasia were so often put in a corner or left at home for want of transport. Earlier, we had formed the Respite Care Action Group, a campaigning scrutiny group. Sophie had been one of three carers I persuaded to work together on a super-complaint against a Hackney-run care home. The manager was dismissed and the respite service reconfigured in an eight-bed unit at a new built facility. Alongside a seven-year case investigation known as the Coombes Review this became the foundation of the direct engagement of older carers in policy development in Hackney. We aimed to break down what Mike Nolan characterised as ‘obstructive practice’ in service delivery.
Sophie was much admired and loved by her colleagues. For a serving health professional her engagement with advocacy and complaints was unusual. Her willingness to step out of line was recognised by geriatricians like Anthea Lehmann and by some of her managers as a vital contribution to a real-world engagement with family carers – so often then, as now, subject to condescension or erasure. Homerton’s decision to appoint her as a carer support worker was thus an inspired rationalisation of a role she had been playing for a decade or more. Born into a Jewish family in Mumbai she had converted to Catholicism after coming to Britain and marrying an Irishman. She identified strongly with her multi-cultural childhood. Her ability to speak Hindi, her familiarity with Jewish and Asian cultures and her religious convictions gave her practice enormous versatility in serving families in east London. I remember how she teased out the reluctance of one family to accept the return home of a bedbound stroke survivor, resolving the situation with a deft proposal that a number of icons and sacred objects could be moved to a different room from the one he would have to occupy. She knew how to neutralise the sensitivities and power relations working beneath the surface.
I wonder how many people at Homerton knew that Sophie in her 40s studied gerontology to degree level. The course, with Anthea Tinker and Tony Warnes among its founders, ran for twenty years, first under Andrew Blaikie and then – until the demand tragically faded away – Anne Jamieson at Birkbeck. Who now in health and social care gets to study the processes and dynamics of ageing for four years part-time? It would be a fitting tribute to Sophie, her colleagues and patients to re-establish such provision.