Creating a fairer Britain
Paul Mesner and his wife Dorothy show off their album of holiday snaps: Paul smiling on a cable car in Madeira; the beautiful sea view from their apartment in Majorca. They tell anecdotes about visiting Palma Cathedral and Valldemossa, a monastery where Chopin went on a retreat. The Mesners have particular reason to be proud and excited about their travels; Paul is tetraplegic, with very limited movement from the neck down. Ordinary activities like getting up in the morning can take an hour and a half. Leaving the house is a major undertaking - and as for holidays, he says with a weary smile, they are a “military operation”.
Before a road accident that nearly severed his spinal cord in July 2005, Paul was a successful chartered engineer who enjoyed ballroom dancing, gardening and rambling in his spare time. Another of his great pleasures was travel; he and Dorothy would go abroad three or four times a year. Most of those activities are now impossible, but they have been determined to keep travelling – and their determination has prompted their local health board to adopt a rights-based approach to enabling others in similar situations to holiday abroad.
"You have to find replacement activities, reasons for living," says Paul. "I was so angry after the accident - I felt it had ruined everything. I knew the only way I could carry on was if I managed to get some vestige of my old life back." In the Mesners' elegant bungalow in the small village of Pwllmeyric, near Chepstow in Monmouthshire, it is striking how much they have done to make their new life not only bearable, but enjoyable. The house has a large garden, which has been landscaped so Paul can get around it in his wheelchair.
It is no substitute, however, for the freedom of movement the couple lost after the accident. "Many tetraplegics are confined to their homes," says Paul. "When something like this happens to you, your ordinary human rights are no longer possible."
The Mesners approached Torfaen Health Board, the NHS trust that provides Paul's care, to see whether it would be possible to incorporate a holiday into their care plan. This was a complex task, as Paul needs 24-hour care, provided in his home by a team of seven nurses working shifts. "We hadn't commissioned healthcare abroad before," says Tanya Strange, deputy director of nursing at Torfaen. "When Paul approached us about going on holiday we wanted to accommodate his wishes, but clearly we were concerned about the risks involved."
The Board decided that they had to balance the risks involved with travel against Paul and Dorothy's rights. "The human rights-based approach allowed us to make the argument that we should do what we can to accommodate their wishes," says Strange. "We have to consider health and safety, but we also have to consider their right to a family life, and their right not to suffer from discrimination. The rights-based approach allowed us to show that there were positive reasons for us to do this, and not just negative reasons not to."
Following legal advice, the Board devised a risk-assessment procedure, which enabled them to demonstrate that they were able to provide the same standard of care in the holiday setting. "We had to do a lot of research into nursing agencies in Spain, where Paul wanted to go, to ensure that they met the right standard," says Patricia Hapgood of Monmouthshire Local Health Board, which worked alongside Torfaen on Paul's case. "It was a lot of work but now we have the procedures in place for others."
Paul and Dorothy have now been on holiday three times since the accident, to Majorca, Madeira and most recently back to Majorca, where they have found excellent disability-friendly accommodation. "It's never going to be the same as it was before the accident," says Dorothy. "Organising it all and getting there is so difficult, but once we arrive I can see the difference it makes being in a new place. Paul just never stops smiling."