Sunday, 27 December 2009

Just like Freud, books are not just for Christmas, they're for life!

One of the last emails I received before we broke for Christmas was from a colleague enquiring about my presentation at the last School Staff Development Day. My colleague had seen a number of book covers flash up on the screen, but had missed the point of my slide. She wondered if I could send the full reference please. Of course the details of all the books referred to will appear in the University of Salford Institutional Repository in due course. The presentation was just me stealing a cheeky moment to advertise Creative Approaches to Health and Social Care Education.

This is the latest book edited by my colleague Sue McAndrew and myself. The book further develops our work exploring the relationship between knowledge, knowing and not knowing. The final chapter, ‘Thoughts in search of a Thinker’ provides the springboard for our work in 2010. It is a book brings together some of the brightest and most creative thinkers in the world of nurse education. The aim in what is a series of works is to explore some of the opportunities to think differently about how and why we educate our students. I think I was rather tongue in cheek, suggesting that the books might make great Christmas presents. So I was amused to see that despite the Creative Approaches book only being published on the 10th December, by the 12th of December it was possible to purchase this (as a new copy) at £2 less than the publishers listed price.

In any event, I took a copy to my parents when I went to see them last Sunday. My Dad enjoys reading everything I write, including the blog. So I was surprised when between the nut roast and Christmas pudding he asked who I wrote the blog for. It was an interesting question to ponder. I said, possibly my ‘alter ego’. However, on further reflection perhaps the blog is really an example of Freud’s Psyche Theory and the relationships between the Id, Ego, and Super ego.

Freud described the id as being is responsible for our basic drives and basic impulses. The id is regarded as the reservoir of the libido or the ‘instinctive drive to create’. The id is unconscious by definition. The Latin term ego refers to ‘the I’. Contemporary meanings of the term ego include a sense of one’s self-esteem, an inflated sense of self-worth, or in philosophical terms, one’s self. According to Freud, the ego is the part of the mind that contains the consciousness. Freud revised his original meaning (a sense of self) to mean a set of psychic functions such as judgment, tolerance, reality-testing, control, planning, defense, synthesis of information, intellectual functioning, and memory.

The Super-ego on the other hand, aims for perfection. It comprises that organised part of the personality structure, mainly but not entirely unconscious, that includes the individual’s ‘conscience’. It is this conscience that criticises and prohibits our drives, fantasies, feelings, and actions. Thus the Super-ego strives to act in a socially appropriate manner, whereas the id just wants instant self-gratification. The Super-ego controls our sense of right and wrong and guilt. It helps us fit into society by getting us to act in socially acceptable ways. Not quite QED, but perhaps QEF (Quod erat faciendum) which appeals more to my notion of being the good enough blogger!

Anyway, I hope you all had a great Christmas Day. I was lucky enough to be able to get out early and walk for an hour around the hills and reservoirs of Horwich. The sun shone, the snow glistened, and for a short while, all was peaceful. This is the last blog of the year. I look forward to seeing you all in the New Year. I hope it will be a year where you are able to achieve all that you aim for. All the very best wishes to everyone for 2010.




Sunday, 20 December 2009

A Tale of Five Dinners and Cello Discovers Snow

It has been another busy week and a week that has added to my already expanding waste band. One downside of my job is the numerous lunch time meetings I attend at which sandwiches and other similar convenience foods are provided. I have stopped eating these, partly out of boredom and partly as a silent protest against the institutional promotion of such unhealthiness. This week, has also seen me out every night on University related business. On Monday I was a guest at the University of Leeds annual meal to celebrate all those members of staff that had retired in the last academic year. I was there with two colleagues who had decided to put their chalk in the desk draw for the last time.

The meal was hosted by the VC, and we ate in wonderful hall at the University House. There were cabinets full of silverware, wooden paneled walls and a graceful air of elegance. Whatever happened to those days of the Senior Common Room? The meal was served by immaculately dressed waiters in a highly coordinated approach to getting all the diners fed at the same time. I had a wonderful goat’s cheese, pear and spinach starter, followed by a equally delicious leek and cheese strudel. Outside, the rain lashed down and I got soaked getting the train station. However, unlike the previous occasion I was a guest at Leeds, I did manage to stay awake on the train home and got off in Manchester and not somewhere in the wilds of Merseyside.

Tuesday I attended the first of a revised University of Salford professoriate. I have made my feelings known about this professoriate before. It was an interesting experience. I have to say that whilst the vast majority of participants were male, and over 50, there was not much danger of being overwhelmed by a testosterone fuelled debate! The meal was an evening variation of the usual lunch time offerings, so I left early and was home by 9pm.

Wednesday was hectic from 7am. Much of the day was given over to working with the School Executive – and it was good to see so much excellent work emerging from the Whole School Project work groups. As a School we are developing a robust evidence base upon which to improve our approach to enhancing the student experience. In the evening, the School Executive went out for a Christmas meal. Smiths in Eccles. The food was good, a cauliflower cheese starter, with a delightful leek and cheese strudel as the main course. The conversation around the table was a mixture of funny nostalgic stories of times past (we were just across the way from Peel House) and good humored commentaries on the changes we and our university had gone through in the last year.

Thursday was a colder day. There was sleet at lunchtime and by the time we were all making our way to the VC’s house for an informal cocktail party, it was snowing heavily. The VC had invited about 60 colleagues from the School to attend what he described as ‘our house’ for an evening of conversation, drinks and nibbles (some would say canap├ęs). About 40 colleagues were able to make the evening. The house was quickly filled with people eating, talking and occasionally having a glass of wine. As at the Leeds event however the service was impressive and unobtrusive.

There was much speculation around ‘that painting’. Some colleagues recalled that ‘our house’ had in times past, been a nurse’s home for those nurses working in nearby Pendlbury Hospital.

Oh and George, in response to your email about missing the last train home, I don’t think the VC meant you could kip down on the sofa when he was talking about it being ‘our house’. By the time we left it was well below freezing and the roads were treacherous. I abandoned all thought of continuing the celebrations in Manchester city centre. The finger food had left me feeling full but not with the sense I had actually eaten anything substantial.

Friday morning revealed the snow that had fallen during the night. Cello who has never seen snow before, reveled in the experience as he rushed around outside.

I on the other hand, was less impressed, it was 05.30, dark and still well below freezing. The day included the judging of the best decorated office. I thought the ‘Credit Crunch Christmas’ theme was a good one, but perhaps not as well designed and executed as the ‘Black Forest’. The results are to be declared next week.

That evening many of us were at the Faculty Christmas Party at the VA Hotel in Manchester. Despite the freezing temperature outside, there was more naked flesh on display than can be seen on a Newquay beach on a hot bank holiday weekend. Perhaps I am just getting old. I should have had a goat’s cheese, pear and spinach starter, but it never arrived. The main course was what by now had become the ubiquitous leek and cheese strudel. As the DJ turned up the music even louder, and the bright young things got up to dance I knew it was time to go home.

I had baked beans on toast when I got in, and boy did they taste good!

Sunday, 13 December 2009

Understanding the Message and a Magic Malaysian Duck

I noted that whilst Twitter has triumphed in ensuring freedom of speech (for an up-to-date example, just Google Trafigura); Facebook has had its problems this week. It seems that in how we chose to communicate with others personal privacy and agency might become hareder to protect.

Who we intend to communicate with and to what end we engage in such communications, have all featured strongly in my experience of the last week.

For example, a colleague sent me an email this week (more of emails later). This particular email came complete with an attached copy of the latest policy statement released from the Department of Health setting out its vision for the future of the NHS: Prevention, Person Centred, Productive.


Interestingly this statement was released after the Pre-Budget Statement. Is the first message being communicated here that the NHS is safe in the Governments hands. Predictably, being a DoH document, it was rich in rhetoric:

Although this will be the most difficult challenge it has ever faced, we believe that the NHS can approach it with confidence, building on the major improvements of the past decade. Improving quality will continue to be at the heart of everything the NHS does. Improvements will be led by NHS clinicians at the local level, based on what is best for the public and patients in their area. There will be no ‘blueprint’ imposed by the Department of Health and no top-down reorganisations of the NHS.

Again it appears the message being sent out is about ensuring that the ontological security of the great British public is protected – the NHS will always be there for you whatever your needs. The rhetoric continues:

Our commitment to encourage and foster innovation in the NHS, and particularly the diffusion of innovation, is clear. We have created a £220 million Regional Innovation Fund to support quicker innovation and more universal diffusion of best practice across the NHS. We have developed NHS Evidence, a pioneering system to improve access to information, providing clarity on what good looks like. This will lead to better clinical and commissioning decisions and increase diffusion of best practice.

The message here perhaps, is that although other parts of the public sector may have to make massive cuts, Universities for example, who face £600 million cuts which are predicted to hit at the range and amount of research undertaken and the breadth of taught programmes, the NHS is different. Research, education and development will continue to be important and protected in the new NHS. Two and Two might not make four when added together.

And there are still further beguiling messages, including:

There should be early interventions for staff with musculo-skeletal and mental health conditions, to help minimise the time staff must spend suffering with these problems and to support early return to work.

A good sounding message, well at least in away that Talcott Parsons might have recognised.

Parsons will always have a special place in my heart. I drew on his work in constructing my PhD. For me, he successfully brought together sociology and psychoanalytical thinking in his exploration of our relationships with each other and with the institutions of the State. For Parsons, ‘being sick’ was not simply a condition, but something imbued with the customary rights and obligations based on social norms. His theory presented two rights of a sick person and two obligations:

Rights:
The sick person is exempt from normal social roles
The sick person is not responsible for their condition

Obligations:
The sick person should try to get well
The sick person should seek technically competent help and cooperate with the medical professional

For the individual, organisation and the wider society, clearly, these rights and obligations can give rise to problems, and there are many critics who over the years have rehearsed the problematic nature of Parsons contentions. However, it seems that some 60 years after publishing his ideas, both Parson’s theories and our privacy are still in danger of being challenged by those interested in exerting social control. The effects of social control can be experienced at an individual organisational and societal level. Perhaps it is because the many new technologies, particularly ICT, allow us unprecedented opportunities for communicating that these tensions are beginning to emerge.

This week I was confronted with the tyrannical (and perhaps cynical) nature of the way we unthinkingly use email to communicate. Emails can be both anonymous and attributable, helpful or hurtful. Hence my new year’s resolution is to break the almost Pavlovian response to email requests for information, meetings, opinions, actions and so on. In future I intend to ask people to pick up the phone and talk to me and or come and have a chat, face to face. Whilst this approach might not be as Productive, it will be Person-centred, and might better Prevent misunderstandings.

That duck, well yesterday, Bernama, the Malaysian state owned news agency reported that an Imam and his wife were rendered spellbound after one of their ducks, this week, laid three black and three brown eggs. Apparently the shells of the black eggs bore an image of a man in a white robe, a pretty woman and Chinese characters. I am afraid you will have to work out for yourself what the hidden message might be here!

Sunday, 6 December 2009

The Lambs of Silence, Keira Knightley and a Cocaine Chicken.

Amongst other things I had scheduled into my diary for the past week was a quick trip down to the Eileen Skellern Award Ceremony in London. I thought this was to be a relatively straightforward affair and quite good fun. The award evening is jointly hosted by amongst others the Journal of Psychiatric and Mental Health Nursing. This Journal is special for me, and I have been fortunate to have many of my papers published here. The annual award celebrates the contributions individuals have made to mental health nursing and the field of mental health care. The Lifetime Achievement Award celebrates a sustained career contribution. Whilst previous years winners have all been deserving and hugely influential in the field of mental health care, the 2009 award winner was a very special person. She is Helen Bamber. Her evening brought the souls of 100s of people into the room, and in so doing, she was able to demonstrate the importance of bearing witness as a therapeutic endeavour.

Standing in an auditorium full of people she quietly and in the most dignified way imaginable, told us of some of her life work. She studied psychotherapy as an undergraduate at Essex University and at the age of 20 she joined one of the first rehabilitation teams to enter the notorious Belsen concentration camp.

"When we passed through the gate of Bergen-Belsen, we dropped out of life and time."

"We had nothing to go by, no point of reference, not even a 'doctor' who selected those of us who were to be murdered straight away and those who were to be murdered somewhat later."

"Anyone who came to Bergen-Belsen dropped into chaos, into nothingness."

These are the words of three survivors of Bergen-Belsen.
I am ashamed to say that I did not realise that following the liberation of the prisoners, many remained there for a further two years. Like modern day political and economic refugees, they were viewed by their Governments as being a nuisance. It was in her work at Belsen, that Helen first encountered what she called ‘grotesque death’ an experience so dreadful that most people cannot deal with the emotional trauma however much their outward appearance and demeanour belies this. For example she talked of the children who were forced to clear up the mess in the gas chambers. Helen told of the way she and colleagues were many times taken in by the overt optimism on display (often seen in the way these former prisoners participated in competitive sporting activities). However what Helen and her colleagues couldn’t easily do, was to understand their silences.

When our students join the School, I meet with them in the first week and talk about the importance of learning to hear what it is that people say, the importance of understanding how and why they might say things and to recognise the individuals personal zeitgeist. I ask the students to also try and be aware of what is not said. The silences are as important as the words that get spoken, but harder to deal with and sometimes more difficult to understand.

But back to Helen. In 1961, shortly after its inception, she joined Amnesty International. In 1974 she helped establish the Medical Group within the organisation. In recognition of the Medical Group's work within Amnesty International, the British Medical Association established a Working Party on Torture. The BMA's publication on the findings of the Working Party resulted in its first Torture Report and the publication Medicine Betrayed. She continued to work with the Medical Group until 2002 when she stepped down to continue to treat her large caseload of seriously traumatised people. In April 2005 she established the Helen Bamber Foundation to offer support to people who had suffered human rights violations. Helen ended her talk by making us aware of what she was currently involved in. She has since 2008, been a member of the Women Leader’s Council of the United Nations global initiative to fight human trafficking. This work is aimed at positively influencing action in the fight against human trafficking by providing a high-level of professional outreach, with a wealth of knowledge and experience in the areas of women’s issues and human rights.

This work is important and thankfully for all of us, others are now coming forward to carry this work forward. Keira Knightley, the world famous film star, is the new face for Amnesty International’s human rights campaign. The actress is backing a new short film celebrating the 60th anniversary of the UN Universal Declaration of Human Rights.

And that chicken, well a man from Guatemala is today under arrest after US customs inspectors at Dulles International Airport discovered he was carrying a cooked chicken stuffed with cocaine worth more than 4,000 US dollars (£2,404).

His intention was to sell this life wrecking drug on the streets of America. I find it hard to believe that often it is still human beings that continue to be responsible for bringing misery to other human beings.

Sunday, 29 November 2009

Green Plastic, the renaissance of Thalimide (?) over 50, the old ones are the best

The magic figure of 50 has featured large in my life this week. My wonderful PA Jennie celebrated her 50th birthday this week and it was great to see all her colleagues help in this celebration. Congratulations Jennie!

This week’s blog is a crowded one. Like yesterdays Times, I am starting with all things green. One third of yesterday’s front page was given over to the story of Chanel’s Jade nail polish. It was described as an interesting shade of medicinal mint. Originally sold for just £16, it was quickly fetching £64 on Ebay. I thought it was a bizarre choice of story given concerns over global warming, Afghanistan and solving world poverty. And as for good old Dr Foster and the reports of his excursions to Gloucester and hospitals all over the UK this week, that story will have to wait for next time.

If I sound irritated, it is because I am. Green has been the source of much of my irritation this week. I blame this state of being partly on the Canadian Harry Wasylyk. He was the guy who thought green plastic was cool, and was something we all needed in our lives. It was Harry who invented the ubiquitous plastic rubbish bag, which was originally only supplied in bright green plastic. Interestingly (for some) the bags were first supplied only to the Winnipeg General Hospital. Whilst rubbish bags now come in a range of colours, other plastic objects have stubbornly retained the luminosity of a frog on steroids. Thanks Harry. To see an example of this contemporary art form please visit floor one in the Mary Seacole Building. That is two floors below the Midwifery art exhibition, (which thankfully is presented in tasteful terracotta) and one floor above the Clasp, rusting gently outside in the piazza.

Thinking about it, perhaps green plastic objet d’art is not so bad after all.

Making a choice between buying nail polish at £64 a bottle, owning art and/or having enough money to buy food is something most of us don’t need to worry about, we buy the food. When the former British Prime Minister Harold Macmillan told the British people that they had never had it so good he was spot on. A comparative study, published this week, exploring our spending habits then and now, shows that although 50 years on we earn more, own more, and travel more, our lives are pretty miserable. These days most of us have big mortgages and endless bills, and a sense of having to work harder just to stand still.

In the 1950s once families had paid the rent, they concentrated on spending their income, mostly it seems on smoking, drinking and having fun. Cigarettes were the second most important item on the shopping list. Eating out was also popular and they liked a drink or two. Families in 1959 were spending 3% of their income on alcohol. Interestingly despite the media reports to the contrary, this was a greater proportion of the 1950s families’ income than we spend on alcohol today. However, the dominance of factory farming, supermarket price wars and cheap food has brought about some changes that some might consider progress. In 1959, when eating a chicken was considered a luxury (always considered barbaric by me), 30% of spending each week went on food compared with only 15% today. Today’s essentials (mobile phones and televisions) didn’t even feature back in 1959. However, all our spending on new technology also means bigger phone bills, mobile phone bills, car insurance and satellite and cable rental.

Sadly the report shows that, because of our increased wealth, we are now much more divided as a society than in the 1950s. For example, and perhaps somewhat critical to our ambitions for Media City, nearly every household in the richest tenth of the UK population has a computer and internet connection compared with just 21% among the poorest. I have the sense this societal imbalance is a never ending problem. I have been disheartened this week to read of the outcome of a clinical trial on the use of thalidomide in the treatment of Small Cell Lung Cancer. At the end of the trial researchers found no evidence of a survival difference between the two groups involved, although those who took the thalidomide drug had a higher risk of thrombotic events. Thalidomide is an anti-angiogenic drug. It targets and suppresses the formation of new blood vessels that tumours need to survive and grow. However, and particularly for those readers under the age of 50, thalidomide was used in over 46 countries following its launch in 1957, but its dreadful side effects led to over 10000 children being born with birth defects and the drug was subsequently banned in 1962. However, the drug is now experiencing what has been called a ‘worldwide renaissance’. Unfortunately, this renaissance is occurring particularly in many parts of Africa and South America where new cases of thalidomide-induced limb defects are increasingly being reported.

We know of these things because from a communications point of view, the world is becoming an ever growing (but smaller) global village. For example, 50 years ago the first transatlantic flight (from London to New York) took 8 hours 53 minutes (actually over 10 hour’s journey time) whereas today, the same journey can be done easily in less than 6 hours.

Indeed, this week it took Jennie just a few minutes to book flights, a hotel room, get the tickets and have everything printed off for my forth coming trip to Budapest. She tells me its all about organisation and planning. And so it seems. I heard the story this week of two older ladies meeting for the first time since leaving high school. One asked the other, You were always so organised in school, did you manage to live a well planned life?”

Oh yes,” said her friend. “My first marriage was to a millionaire, my second marriage was to an actor, my third marriage was to a preacher, and now I'm married to an undertaker

Her friend asked, “What do those marriages have to do with a well planned life?”

“One for the money, two for the show, three to get ready and four to go man go!”

Anyway, Jennie many thanks for all your help I hope the next 50 years are wonderful for you and yours - and in a back handed compliment sort of way, I want to say, as this joke shows, the old ones are always the best ones!

Sunday, 22 November 2009

Decisions, distances, dementia and Damsons

I have been told that last weeks posting was a little obscure in places, particularly at the beginning. Apologies, it was a simple message. I think a professoriate should be made up only of professors. For me, anything else defeats the point of having a professoriate. There, story re-told.

Two colleagues have, during this week, had to come face to face with the realties and consequences of having to make decisions about providing care for their elderly parents. This is something many of us of a certain age have to face. Often these decisions are made more difficult because of the geographical distances involved in where we might live in relation to our parents and other family members. Trying to make arrangements for the care and accommodation of parents at a distance is always going to be difficult.

Likewise, entrusting our loved ones into the care of others is also not an easy decision. Stories such as those around the neglect of many older people do not help either. For example, this week I was drawn back to the story that reported on how many people with dementia have been receiving anti-psychotic medication in order to keep them quiet and ‘controlled’. This is a distressing story of abuse of our older people. Especially as this is abuse said to be carried out by those responsible for providing un-conditional care and treatment of the highest order. Abuse of the vulnerable in society is typically hidden, and as well as being hidden in the hospitals and care services of society, much abuse is often hidden within the family. For example, the NSPCC have recently reported that:

• 7% of children suffered serious physical abuse.

• 6% of children suffered serious neglect.

• 6% suffered emotional abuse.

•11% suffered sexual abuse from an unrelated but known person; 4% suffered sexual abuse within the family.

Child abuse causes 1-2 deaths per week in England - possibly more.

Ironically, perhaps, there was also a report this week from US researchers that made the tenuous connection, but a connection nevertheless between childhood emotional and physical abuse and the premature aging of the body. This premature aging brought with it a range of physical problems including cardiovascular and cancer illnesses. I don’t know if these problems also include mental health problems, but I suspect they probably do. My colleague Sue McAndrew and I have, for many years, been looking at the relationship between childhood abuse and mental health problems in adulthood. As part of this work we produced the first structured review of the literature that identified the large number of nurses who were unprepared to work with those who had been abused as children. This lack of preparedness was both from a knowledge perspective as well as from an attitudinal point of view.

So I was also a little concerned this week to read the story about nurses clamoring for further education and training to enable them to provide better care to patients with dementia. That the story came out at the same time as the chemical straight jacket story noted above was one level of concern. Another concern was in thinking about what it was these nurses wanted in terms of further training and education in order to be able to care for these people. Being with a other, establishing relationships and helping others with their daily activities of living where they cannot help themselves, are and should always be fundamental aspects of good nursing care.

Thanks, I think, to Sue MacDonald (Royal College of Midwives), for her support on nursing becoming an all graduate profession. Midwifery, which has had an all degree entry only since September 2008, embraced this approach to ensure the continuing development and high standards of midwifery. Sue MacDonald’s comment was to welcome this approach as it would improve nursing care and the status of nursing.

Last night ended with a glass or two of home made Damson Vodka. It was many years old and had matured to a fine drink, which inspired introspection and philosophical debate amongst the dinner party. Given, what might happen to us in childhood and older age, much of this debate seemed to revolve around whether life was, in fact too short to remove the stones from Damsons when cooking with them or not. Although of course, I always follow the drink aware code of practice, this morning I cannot recall what the outcome of the debate was. So answers please, on a postcard or as a comment to this blog would be more than welcomed.

Sunday, 15 November 2009

A story so big I almost missed it!

This week I was invited to book a place at the forthcoming first meeting of the Universities new Professoriate. All professors in the University were. The invitation made me ponder, and that is something we should do more in the increasingly ever turbulent world environment of Universities. University’s everywhere have to find new responses to the problems resulting from the need to respond to the new knowledge society/economy, globalization, and the massification of higher education. At times the responses prescribed can be uncomfortable and challenging. So I found the opportunity to re-engage with something familiar was somehow reassuring and comforting. Likewise, receiving the invitation also promoted a reaffirmation of my sense of identity, which is of my professional self, and the relationship I have with the University. It was Basil Bernstein who in his amazing paper The Divorce of Knowledge from the Knower (1996) warned of the inherent dangers of Universities, and the professoriate’s that make up these, losing their pedagogic identity. He argued that the relationship of knowledge production to is utilization and the value accorded to knowledge creators was critical a factor in ensuring societies continue to have access to the knowledge required for economic growth, physical health and sustainability of its moral fabric.

He worried that the very concept of knowledge and its relationship to those who create and use it, was being changed irreparably. He warns that the very concept of higher education is in danger of being lost to processes of economic commodifcation and demand. What has now become an internationally universal process of educational massifcation illustrates the worst aspect of this shift in how higher education is increasingly being conceptualized. Massification essentially refers to the actions taken in fulfilling the desire to increase the scope of participation in higher education. Paradoxically, this concept is said to be located midway between the notion continuing to provide both elite higher education and higher educational opportunities for all. This is a somewhat flawed conceptual model, and its pursuit has unintended consequences. For example, we know from UNESCO (reported in THE July 2009), that internationally, the range and level of qualifications possessed by many academics is reducing. This is a direct consequence of needing to increase the number of teachers required to satisfy the spiraling global demand for higher education. Up to half of the world’s university teachers may lack postgraduate degrees because of the pressures of massification. The UNESCO report also warned that “in terms of accountability and assessment, the professoriate has lost much of its autonomy. The pendulum of authority in higher education has swung from the academics to managers and bureaucrats, with significant impact on the university”.

I hope as our professoriate engages in its own renaissance that we ensure the pendulum swings back to a more balanced view of the value of engaging with a professoriate that is comprised of appropriately qualified academics. I mention this as the really big story I nearly missed was the announcement that all new nurses will need to be educated to degree level from 2013, in what was said to be one of the biggest changes in medical education in the history of the NHS. Talk about losing ones identity.

I was sent many copies of how this story was reported all the major British press, and almost without exception, the changes to medical education featured prominently. The Government claimed this change is designed to raise the status of nursing and to end the stigma of nurses being the doctor’s handmaiden. Where have Government Ministers been these past 20 years? I think it was Stein who wrote about the Doctor-Nurse Game – but that was in 1967 and was not based upon any kind of an empirical evidence base!

It was not a good day for the largest single profession within the British health service. It didn’t end there. Critics claimed that these planned changes will create an elitist profession and scare off recruits with the prospect of a long and expensive period of study. There are also concerns that some nurses would be too clever to care and refuse to carry out duties such as washing and feeding patients and helping them to the lavatory. A criticism that yet again would seem to play into the hands of others. For example, Alistair Henderson, Deputy Director, NHS Employers noted that: Employers will need consider the implications of the change and look at how they use all their nursing staff, both registered and non-registered, ensuring they have the right skills mix appropriate to the task required.

This last observation is very apposite given the latest report published by the Kings College London Policy Trust this week. In a study that looked at the relatively scarce evidence on the relationship between skill mix, patient outcomes and costs, they found there was no simple relationship between either numbers or skill mix of nursing staff and either outcomes and cost. Helpfully, the study essentially reinforces the benefits of a degree qualified nursing workforce and rejects the notion of the reinvention of a second level nurse, akin to that of the previous Enrolled Nurse, as being a simple solution to current workforce challenges. However, you can bet there will be NHS Trust managers out there somewhere working out the cost benefits of the employing the latter over the former. As with the modern professoriate, the dilution of experience, qualification and knowledge is likely, in the long term, to be a step we will come to regret.

Sunday, 8 November 2009

Sadness, stigma, suicide, and having the blues for Levi Strauss

This week I planned to write about my thoughts of an extraordinary example of an administrative fiat that I  stumbled across this week. It was a relatively simple thing, nothing more than an attempt to ensure that people turned up on a regular basis to a series of important meetings. When I read the missive I was reminded of that old saying about taking horses to water but not necessarily being able to make them drink. I felt the approach was almost certainly doomed to failure because it was essentially aimed at the heads and not the hearts of colleagues in bringing about change. I have published about this subject before, but as important as these issues might be, other events drew my thoughts somewhere else and I want to leave this discussion for now and perhaps return to it in a future blog.

The first and most significant event that changed my mind about what to write about was what occurred at Fort Hood this week. The tragic consequences of the army psychiatrist Major Hassan attacking his fellow comrades at the army base in the US reverberated around the world. It is too early to know if his actions were a consequence of religious extremism, psychological problems, a mental illness or a combination of all three factors. It is clear is that there were a number of behavioural changes and out of the ordinary occurrences to Major Hassans everyday life that might have alerted others to the fact he was having problems. From across the Atlantic, reading about the story, it seemed incredible that nobody noticed anything. But then I thought again. In reality there would of course have been enormous difficulties for anyone to make an appropriate intervention if and when they noticed something was wrong.

He was after all a psychiatrist and a doctor. Doctors hold a privileged position in most societies. As individuals most of us will listen and take note of what doctors have to say. What they have to say is often perceived as being inviolate and unchallengeable. Indeed, for many nurses, being able to appropriately challenge their medical colleagues in the course of their practice is still a very difficult thing to do. The hegemonic power doctors enjoy is often strongly institutionalised and supported within and outwith the many organisations of health and social care. We may have come a long way since Steins original thinking around the Doctor – Nurse Game, (others might say we haven’t) but it can still be difficult for the nurse to be seen as a equal professional in a system that is very clearly weighted in favour of medicine.

So perhaps it is not surprising that other colleagues in Fort Hood did not or could not do anything. Challenging the very embodiment of society’s number one sanity assessor would be an almost impossible thing to do. For me, the situation takes me back to the age old question of: Quis custodiet ipsos custodes? (who guards the guards?). Plato talked about them (possibly doctors, but certainly the professions) looking after themselves, and they would be able to do so because of a heightened sense of vocation and desire to serve others. It is certainly true that governments all over the world have struggled to deal with the countervailing power relationships between the State and Medicine in resolving these dilemmas. More regulation is not the answer, arguably, more and better education probably is.

The desire for education can be found everywhere. I received a request this week to facilitate an educational conversation with colleagues who were struggling to understand how best to respond to another colleague who was experiencing mental health problems. This approach appeared to me to be entirely genuine and well intended. I will have the conversation, and I am pleased to do so. I believe it will be as much about helping others better understand themselves, and to do so in relation to understanding the mental health of their colleague. Such a conversation can only be a good thing. Mental illness still brings with it a stigma reaction, usually born out of ignorance and unfounded perceptions. For example, people with a mental illness are likely to be murderers and violent, or that if you talk to some who might be contemplating taking their own life it will make them more likely to commit suicide.

The Golden Gate Bridge opened in 1937, and since this time, one person every two weeks has gone there to commit suicide. I mention this sad fact, partly to start the conversation about the nature of suicidality, and partly in addressing comments made in response to my thoughts last week about conference attendance. I hope we can develop the debate about conference going further. We need to think a great deal more about how we engage with new technology particularly in rethinking about such activities as attending conferences. However, parking that debate for one moment, there was a good point made last week in the response. This was around continuing to ensure we find better ways of sharing experiences, whatever this takes. This may continue to be through conferences, publications, or educational conversations, or blogs like this one, and I hope I didn’t imply anything different. As was noted in the comment, sometimes it can be difficult to predict the impact of attending a conference and meeting others in a different place. Finally, and with a somewhat sad symmetry to these thoughts, I note it was announced this week that Claude Levi-Strauss had died.

Levi-Strauss, was widely considered to be the father of modern anthropology. He was born on Nov. 28, 1908, in Brussels, Belgium. He studied in Paris and went on to teach in Sao Paulo, Brazil, and conducted much of his research from there. Levi-Strauss was awarded honorary doctorates at universities, including Harvard, Yale and Oxford. The very first overseas trip I went on as a new member of MMU was to Sao Paulo. This was part of an EU funded project that required meetings to be held in South America and Europe. During what was an immensely exciting trip, my subsequent interest and passion in anthropology was born. The life work of Levi-Strauss helped me (and I am sure countless others) with my studies of human behaviour and thinking. He also was a great believer in how conversations help all of us better understand each other.



Sunday, 1 November 2009

Faster than a speeding bulletin from up here in the frozen North.

I was interested to read this week of the way in which we are tending to use web based search engines. It appears that 60% of us use search engines for navigational purposes, trying to find a particular website like Salford.ac.uk for example. The remaining 40% of us tend to use search engines for informative reasons like finding your GPs telephone number for example. Whilst the use of the internet for these purposes continues to grow, it is other forms of real-time web use that are really pushing the boundaries of how we communicate and keep abreast of the news. Twitter, for example provided real time of the minute narrative of the riots as these occurred in Iran with information literally coming direct from the streets themselves. Our VC recently asked for colleagues to comment and make suggestions on his plans for teaching and academic developments using his blog. This is a trend that is set to grow and is a way of communication that will ensure as many people as possible are able to contribute to decision making and future developments. However, I am not sure we are all ready to take advantage of such opportunities, and the challenge will be to find ways to make such developments attractive to individuals and something they can gain a benefit from as well.

It’s clear that such developments in communication and dissemination of information are likely to shape the way we do many other things in the future (and perhaps not always for the better). For example, this weekend I am in Finland pulling together a research bid that I am developing with colleagues from Estonia, Lithuania, Czech Republic, Croatia and Finland. Whilst it is good to travel, I might possibly have been able to achieve what I have done, and in real time, simply by using Skype to video conference. It wouldn’t have been the same experience, although it would have been much cheaper. But I am not sure we need to keep having the same old experiences. I think it will be interesting to see which big name conference moves to virtual participation rather than encouraging people to travel half way around the world to present their work.

Anyway, it was great being back here in Finland. It is one of my favorite places to visit. It was minus 7 when I got off the plane, but during the day the sun has shone and transformed the landscape. Thanks to Mikko for his hospitality and it was great to meet Leena and Heikki as well. We looked at photos taken when I first came here some 11 years ago. It was an amazing look back in time. Not sure quite when my hair turned silver.

Finally, please feel free to comment on this blog – its takes a few short steps to register an account and then you can let me know what you think. After all, I am trying to keep in touch with the way new communication technology is going!

Sunday, 25 October 2009

Temporarily parked on the hard shoulder of life

Last weekend I was unable to bring you my blog due to being ensconced in a cottage in Scotland that had no internet access. It is strange how unthinking we become in our assumption that we will always be able to communicate with whoever, whenever and wherever we happen to be. Knowing that I was going to struggle to communicate once at the cottage, I had meant to send out a blog on Friday morning, but events overtook me and before I knew it the opportunity was gone.

This was unfortunate as I wanted to congratulate all my colleagues working at Greater Manchester West Mental Health Trust on their achievement of an Excellence rating on both the quality and financial management criteria in the recently published Care Quality Commission Performance tables. I am not keen on performance tables as a way of driving up organizational performance, but given that only 15% of all Trusts nationally achieved an Excellence rating for quality and 26% for financial management, the achievement of GMW is simply awesome – and well deserved.

Staying in a cottage in Scotland, isolated and disconnected, in itself reduces the inspiration for writing a blog. I can tell you about the otters, tame pheasants, and spectacular sunsets and so on. These were all wonderful distractions. However, within 24 hours of getting there I succumbed to a cold, which has, ‘gone to my chest’ as my Mother would say, and ever since I have suffered with a racking cough, fever, sleepless nights and so on. The consequence has been a lack of energy to get on and do what I would normally be doing! My inability to get going I found difficult. I could not concentrate to read, I didn’t put pen to paper at all, and even gave up shouting at the radio like the grumpy old man I can be when I hear something outrageous.

Finding myself temporarily on the hard shoulder of life has been a difficult place to be.

A balancing factor in this uncharacteristic week for me, was hearing the very sad news of my colleague Professor Deborah Bakers untimely death. Her contribution to improving our understanding of what makes for good health and wellbeing is internationally recognized. On a personal level she provided me with great support and enthusiasm. I shall miss her wise words and capacity for thinking differently. My thoughts are with Deborah’s family at this very difficult time.

Sunday, 11 October 2009

Willie Nelson and Rod Stewart come together for the nurse genome project: Ob-la di, Ob-la-da – life goes on

Yesterday was the last day of the first Cochrane Nursing Care Network. The day started with a inspirational presentation from Alison Kitson, who now works at the University of Adelaide, although, of course she has a strong track record of innovative work in nurse education in the UK. What made her presentation interesting for me was that it was an update on where the International Learning Collaborative had got to; looking at what we understand the fundamentals of nursing to be. This is not new work, nor is it innovative. In the UK, the essential skills cluster initiative was aimed at ensuring the fundamentals of nursing were embedded into the curriculum, and similar initiatives can be found in the US, Australia and beyond. The collaborative were modeling themselves on the Human Genome project approach where scientists from all over the world worked collaboratively at trying to understand and unravel the big questions of human life. The collaborative are adopting a systematic review approach, the first stage of which was a meta-narrative analysis of what key texts (from Florence Nightingale onwards) to see what key terms were evident. This stage of the work had thrown up a number of terms that has then been tested out in data bases such a Medline and CINAHL to see what published studies would be highlighted. Intriguingly, there were many differences in the way these fundamental terms (elimination, activities of daily living, safety, communication and so on) were used in nursing theoretical and research based papers. Whilst this is very much work in progress, it was a fascinating update. The rest of the day was spent in workshops looking at how nurses could become more involved in the CNCN project. There were some easy wins to consider, particularly as some of these could fit into our preparation for the 2013 REF.

In the evening I went to eat at one of the many riverside restaurants and bars that have live music. I joined a table with a wonderful Singaporean family, who thought I was Willie Nelson, despite my protests to the contrary. We agreed a kind of truce, I think I admitted I may have once owned a Willie Nelson LP, and we got on and enjoyed a Beatles celebration night. The live band were very good, the music extremely familiar and in the end, we were all singing along – which was a sound to behold. The father of the family group was an expert on the Beatles and got all the pop quiz answers right, although he was equally impressed that I knew Alex Ferguson (he stated his allegiance to Manchester United rather than Liverpool!). It was a little difficult really to have a straightforward conversation as outside of the Beatles lyrics no ones English was easy to understand. The taxi driver on the way home was convinced I was Rod Stewart – something to do with the hair – couldn’t see it myself.

Anyway, tomorrow is a day off, and then it back to the mountain of emails, and a long return journey home to Manchester and the start of what promises to be a busy few days of work – as Paul, Ringo, John and George might have said Ob-la di, Ob-la-da – life goes on!

Friday, 9 October 2009

World Mental Health Day, Cochrane Nursing Care Network and the Lost Thursday

The news this week has been full of reports of Psychiatrists paying people diagnosed with a serious mental illness £15 each time they agree to have their medication via a injection, those suffering with Alzheimer’s Disease reported to being kept quiet and submissiveness through the use of a chemical straight jacket, and three suicides amongst young people, three of which are three too many. All of this has occurred during the lead up to World Mental Health Day (9th October). As a Professor in Mental Health Care I can’t emphasize enough the important of mental well being, and as Head of School that prepares people to become mental health nurses, I would iterate the importance of our students and staff looking after their own mental health and well being so they can then better enable those who ultimately seek their help back on to the road of recovery.

As I write this I am attending the inaugural Cochrane Nursing Care Network in Singapore. Interestingly nurses are the biggest group of health care professionals (including all types of medical staff) to access the Cochrane Library for evident to underpin their practice and delivery of care. Whilst the concept of a Cochrane Review is predicated on RCT’s and largely big quantitative type studies, the importance of the Nursing Care Network is the realization that we need to use these approaches more effectively in order to better demonstrate the efficacy of our interventions and the power of our knowledge base in shaping future health care services. There are over a 100 delegates to this event and a further 600 attending the more general Cochrane Colloquium that follows. The theme for this latter event is increasing the involvement of service users in the development of the evidence based Cochrane Library.

The missing Thursday – well I got up at 05.00am on Wednesday and started work in my office at 6am. After a day spent at a special session of Senate I got on a plane to fly to Singapore. By the time I got to my hotel room some 33 hours had passed, 20 of which were Thursday. However, coming back next Tuesday, I leave after breakfast Tuesday morning and get into Manchester in time for a late evening meal, still on Tuesday. It’s a strange world at times.

Sunday, 4 October 2009

Conflict, Commercial Reasoning and the Appearance of Cello

Perhaps like me you found the Little Ted case disturbing. As a parent I can empathise with the parents involved. As a nurse with a research interest in the impact on adults of child abuse I can imagine the fears and anxieties of those parents whose children attended Little Ted's. I think it will take some time for the parents to accept that their children are safe. The case perhaps highlights the fragile sense of safety we construct when we see our children left to be cared for by others. Another disturbing aspect of the case, and there were too many to discuss here, was the knowledge that once Vanessa George has served her sentence, she is entitled to a life free from vigilante attacks or intrusion by the media – The Telegraph, this weekend estimated that this was likely to cost the tax payer £1 million a year. Like some of the parents, I found this information a little unpalatable.

This week I also heard from a colleague who had recently been involved in taking a decision about the future of an employee in his organisation which was to be based upon something called sound commercial reasoning. In a nutshell, this apparently refers to when an organisation has to consider the cost of say fighting a claim for constructive dismal versus the cost of fighting the case or where simply to ‘get rid’ of an individual it is worth agreeing a price for them to go. This seemed an equally unpalatable set of consequences.

The issues in both these situations reminded me of the somewhat old fashioned notion of the psychological contract – (see David Guest’s work – what is the value of the psychological contract?) - whilst this notion generally refers to the unspoken but powerful dynamics that bind individuals to an organisation, its vision and culture and the consequences for the individual and the organisations when this trust is abused. Arguably we all have a psychological contract with the State. We expect the State to look after us, to protect us whilst not intervening too much in our lives. When such unconscious perceptions are challenged as in the Little Ted Case the damage is likely to be long lasting and not helpful.

Many thanks to my film going friend who weekly updates me on what I should be going out to see. This week it was ‘The Soloist’, an interesting coincidence as the film is about friendship and trust. I am led to believe that it is a film about befriending, starting out with a simplistic view of friendship and going on to demonstrate the many subtle complexities involved when two very different lives come together. Like the psychological contract does the value of real friendship lie in its ability to provide a sense of containment that promotes mental well-being?

My mental health and well being has been severely challenged this week. So it was a surprise to find some light relief, and from such an unexpected quarter. Cello, a 10 week old Australian Labradoodle arrived this weekend – don’t ask - and has been a source of great joy.

Puppies, of course start from a position of unconditional positive regard, it’s humans that have the ability to change all that.

Sunday, 27 September 2009

The Case for Crown Courts, Squirrels and Being a Nurse

Apart from having to pay £8.50 for a glass of an ordinary red wine at a hotel this week, one of the many strange and unusual things to have happened to me was to find myself on the other side of the Bench in Court, giving evidence at a Crown Court Case.

It was a day of much waiting around, where jovial conversations eventually dry up and you can’t remember how you managed to get into the position in the first place. The conduct of the case was interesting. When I was finally called it was to be asked a series of questions that focused on a very narrow aspect of my relationship and involvement with the individual in the dock. Clearly the barrister had a strategy he was following, and the information I gave, limited and sharply focused as it was, was aimed at him realizing this. I felt as if I was simply a means to an end – and this was, for me, an uncomfortable feeling.

I believe that as nurses we are trained and educated to take on board a wide range of information as we work with others in helping them to help themselves. We listen to what is said, and hopefully also consider what is not said. We watch and observe, we comfort and we suggest. We give individuals room to express their feelings and hopes, and find ways to contain anxieties. We provide a shoulder to lean upon – both physically and metaphorically, and in a general sense we are at our best when we are able to be there for our patients. We do all of this because we learn to become good at ‘doing’ nursing as well as ‘being’ a nurse.

I emphasized these thoughts in my welcome address to all our new students when I greeted them last week. Like many Schools in the University, we had a bumper number of students starting their studies with us. Whilst this large number of student’s poses many challenges for us as educators, it was also reassuring to see so many people, of different ages and backgrounds who wanted to become a nurse. Of course, I know that some will quickly change their mind, and do so for a variety of reasons, some of which we will understand easier than others, but I thought such a large number was a good endorsement of how far nurses have come as a profession.

This brings me to a further strange or rather sad thing to have happened to me this week. I and many other colleagues from practice and education, met with the CNO for England to get an up-date report on a range of ongoing issues currently affecting the profession. Meeting with Chris Beasley was not strange, indeed she was in a feisty and confident mood, and very inspirational, no it was a report from a public focus group undertaken as part of the Prime Ministers Consultation that disturbed me.

The outcomes of this data collection and analysis revealed a much distorted view of nurses being shared across a wide and diverse representative group of the general public. People were reported to have been very surprised that nurses were educated to degree level, that they could be autonomous practitioners, prescribe medication and didn’t need to wait for a doctor to tell them what to do before intervening! I found it strange that such stereotypical views still exist yet the opportunity of becoming a nurse was still demonstrably a very attractive choice, if the numbers starting their education and training with us was anything to go by.

Finally, two story’s about hands, one about biting the hand that feeds, and the other about the hand that cares. The first story is about being attacked (twice) by a very angry squirrel. I have many mature trees and bushes surrounding my house. There is a large colony of grey squirrels that live in these trees, and indeed, for much of the time I enjoy watching them scamper and climb around. They get porridge oats and monkey nuts every morning. So I was very surprised to be attacked by one of these little fellows – and it was a determined attack too. He really was tenacious in his attack (of me and my car). I was eventually able to drive him away and can only suppose the poor little thing was ill as they normally steer clear of any contact with humans. So of course having driven him away I immediately felt guilty that I was unable to do more to help.

The second story was the sight of a nurse comforting one of the children involved in the dreadful accident in Suffolk. As the TV commentator’s spoke of the accident an off duty nurse could be seen gently stroking the child’s hand and arm. Perhaps sometimes we forget the power of touch in our work.

Sunday, 20 September 2009

Station Waiting rooms, the PM’s Commission on Nursing and a Chance of Stardom lost.

The past week was a whirlwind of train journeys; frantic emails from often distraught others, frenetic walks back and forth across campus and being witness to surreal and metaphysical musings by a former Secretary of State for Health. Monday started early with meetings with colleagues looking at the changes a foot in Midwifery, Phd’s and Strategic Planning. At 10am I got to meet one of the groups of students who have just completed their studies with us. This was an interesting meeting, which allowed me to hear from the students how they had experienced being with us. Whilst there was much spoken of what we might have done better, it was also great to hear of those areas where the student experience had been good. Then it was on to a meeting to hear some suggestions for a project that looked at different ways of working with those people who were homeless and living on the streets of Manchester and Salford. It was a humbling meeting to be confronted with tales of continued stigma and tales of such unwillingness to accept there was even an issue in a modern city like Manchester. The discussion provided an uncomfortable juxtaposition of certainty and uncertainty over my emotional location with the media city zeitgeist I am also a part of.

An extraordinary meeting of Senate followed, with challenging decisions being taken over future assessment processes for students. After a brief interlude that was the University Research Strategy Implementation meeting, it was off to meet participants in this years Education in a Challenging Environment. The setting was perfect, the Salford Museum and Art Gallery, and the company excellent. By all accounts the conference turned out to be a great success. Well done to all those involved.

Tuesday and Wednesday were spent at the NHS Institute for Innovation and Improvement with a group of other invited senior nurses from education and practice, many of whom were old friends and/or friends who were becoming old. This is not meant to be a flippant remark, but one that raises where such experience will be found once this group move on and retire. I was left wondering whether I was doing enough to mentor others so that they too might have the opportunity and motivation to influence and lead the future development of nursing. This was an underlying theme to the meeting as the two days were spent, amongst other things, looking at the progress to date of the work of the Prime Ministers Commission on Nursing – a feedback report is due out in the next few weeks, so I am unable to say too much here, BUT I was struck by the certain thought that we as individual nurses, as communities of practitioners needed to become a great deal more assertive. If we fail to do this, we will fail nurses everywhere. There are enormous opportunities to get our collective voice heard. If we don’t seize these opportunities then we our voice will be drowned out in the cacophony of sound that results from ill-informed perceptions, selfish and territorial professional attacks aimed at protecting and defending power and autonomy across the health and social care professions. Is it only me that thinks the observations and calls from the medical profession are becoming ever more strident and worried about what it is the nurse of the future might be engaged in, or more particularly how such activities might erode the medical hegemony. I heard a medical colleague lead a debate at a dinner party the other week where one doctor railed against the very concept of Nurse Led Services, and longed for the days where he knew what his nurses did on his Ward. Perhaps we gave ground too easily in our response to the implications of the European Working Time directive.

Part of the time during these two days was also given over to exploring the value of Experience Based Design (of health care services). This was an area very close to my own research interests, and of course is a major part of the Whole School Project approach. What was also interesting for me was the uncomplicated way non-academics described the process they were engaged in. Not for them the debates around the merit or other wise of ethnomethodology, for me, the conceptual rubric in use, but a straightforward and uncomplicated explanation - we go out, talk, observe, and then share with those same people what it is we found in trying to find explanations and possible new ways forward – very refreshing.

Thursday was a great celebration and showcasing of how far colleagues across the University had come in working together to grow our expertise as researchers. The energy and innovation was wonderful, and when the presentations are put on-line, I urge you to have a look at the many examples presented. It is worth considering that for every one example presented on the day there were at least three or four other examples of collaboration that did not get mentioned. It was a stocktaking opportunity that revealed a potentially bright future for research at Salford. When I got home that night and looked at my emails there was one from Jennie my ever present and superbly effective PA, reminding me there was a film crew arriving at 8am to film some footage for a forthcoming University DVD. I was at my desk at 6.30am, hair under control, newly dried cleaned suit on, looking good even if I say so myself (apparently earlier that week, in a poll to judge the best dressed male in the School, I had come third).

You can imagine my surprise when the film crew eventually arrived only to ask where these dolls and dummies were that they had to film? Cruelly, in what had been a long week, my chance of stardom slipped quickly and quietly away as I humbly showed the film crew the skills lab. As it happened, the day turned out OK, and colleagues and I able to appoint two highly respected and gifted colleagues to part time research fellow posts within the School. Perhaps in dosing so we were, in a small way able perhaps reverse the growing trend of losing experience and knowledge from the intellectual crucible of nurse education noted above.

And the Station Waiting room, Ah, well, I was patiently waiting in the business lounge at Coventry Station, reading the paper, sipping pretty good coffee, when the door at the rear of the room burst open, and two completely incognito plain clothes policemen rushed in followed by an entourage of what looked like blond bright young things, male and female, who fussed around a ruddy and somewhat familiar face. It was, I realized, none other than Alan Johnson (MP), the former Secretary of State of Health and now the Secretary of State for the Home Department.

I maybe wrong but I don’t think the current Government has set up a ministry to assist MPs to more carefully spend their expenses at John Lewis’s so the Department must mean something else.

I resisted the temptation to engage in conversation around the current state of the NHS and what might have brought us to where we are today. So I returned to my news paper with just one eye and ear tuned to what was going on. Whilst Alan Johnson’s stay in the lounge was only ever going to be brief there was an opportunity for refreshment, and he did get up to make himself a cup of tea from the grand looking coffee maker. After a few minutes of fussing, much noise, steam and no cup of tea he was heard to ask as if in wonder, ‘what am I doing here’ – to which one of his young aides earnestly asked, ‘if this was a literal or philosophical question’. As astute readers I can leave you to make your own minds up – but for me the question neatly summed up the State of British politics’ right now.

Sunday, 13 September 2009

Clogs, ladders, Witch-hazel and Making it Better.

This week has been a painful one. Last Sunday while up a ladder trimming a tree, I slipped out of my clogs, fell 15 feet to the ground, pulling the ladder down on top of me. The result was that whilst I hadn’t ‘popped my clogs’ I ended up being severely bruised, covered in grazes, and feeling very foolish. My youngest daughter, who had witnessed the accident, was so annoyed that she missed capturing the fall on camera (apparently its possible to sell such mishaps to the TV for a few hundred pounds) that she returned to bed. My dear wife’s best offer was to dab the afflicted areas with Witch-Hazel. Interestingly the areas which did not have the Witch Hazel applied to them, bruised more vividly, but were far less painful than those areas treated. Here the bruises didn’t come out as well but the area remained painful longer.

The incident stayed with all through the week. I endured a week of stiff limbs, multi colored bruising, scabbed over grazes and still have to finish trimming the tree. I was still very sore on Friday, when I attended a very interesting meeting of educationalists, service providers and colleagues from the NHS North West. The meeting was aimed at reviewing achievements to date with the implementation of the Making it Better initiative – this is an initiative aimed at improving Children’s, neo-natal and Maternity services – and much had clearly been achieved. What made the meeting interesting was two interrelated issues: the first was that the initiative was predicated upon the notion of shifting services closer to home and preferably into the home, and the other was the realization that we may not be any longer training and educating nurses to work effectively in these new service provisions. Like the use of Witch-Hazel on my bruises, I wasn’t very sure what the evidence base was for this shift in service provision, although everyone seemed to agree it was a good thing. The question as to how well we were educating and training nurses for these new service models was challenging. Already, parents of children with long term conditions were being trained as to how to make interventions that allegedly nurse fresh out of training would not be able to do – it was the fitness for practice and purpose argument writ large.

I did my training way back in the 1970s and then it was highly competitive. Trying to get to see everything that was contained in our red book (the precursor to today’s Passport), and to get each observation ticked off was what we lived for. Of course we could only see those problems that other people presented with. It took me a long time to shift my thinking from the problem (diagnosis) to the person sitting in front of me. At the meeting last Friday we talked about ‘neo-nates’, ‘trachies’, ‘pau’s’, ‘nicu’s’, ‘paeds’, so maybe nothing much has changed. Hmm, anyway, I was pleased to see a competency (yes its me being pleased to see a competency) that was about communication and understanding the other. Maybe there is hope we will change, and tall trees can look good as well.

Sunday, 6 September 2009

Robot Nurses and the Schizophenics, I don't think so!

What a week. We have management consultants telling us 1 in 10 health care workers will need to lose their jobs if the NHS is to achieve a balanced budget. My old friend and mentor Professor Joel Richman had some choice words to say about the NHS spending enormous sums of money on management consultants. I think he would have turned in his grave this week hearing the debate. Interestingly, The Times, this weekend was absolutely in his camp, claiming such profligacy was on a par with the payment of bankers bonuses. I agree, and I do get depressed about such blatant ‘let’s see what the punters think’ attitude to managing policy.

The other depressing occurrence this week was the BBC, (unfailingly it seems) referring to Peter Bryant as a ‘schizophrenic’. I hate this way of describing anyone. Despite what he may have done, and in no way dismissing the distress his actions have caused to others, he is suffering from a serious mental illness. He is not a label, and affliction, a disease. He is a person, albeit very troubled. I feel someone at the BBC needs to ask the question why, as a major news organization, they continue to persistently see only the illness and not the person.

My Mum has booked her first holiday on-line. This is maybe not a particularly newsworthy item on its own. However, this is a great leap forward in using new technology. Media City it’s not but its interesting how on the edge of becoming dependent upon others my parents have suddenly got a new lease of life that is predicated upon being independent.

Independence and dependence are such interrelated dynamics. Its something I wondered about when I first heard about the new Japanese invention – the Robot Nurse – this weekend. Having been concerned that we are educating out the essential emotionally of nursing the notion of a robot nurse is an anathema. It certainly made me think again about the huge investment we have made in our high fidelity manikins. In any event, if we need robot nurse who was it that thought it would be a good thing to give it the face of a Teddy Bear?

Saturday, 29 August 2009

Looking back, looking forward, but not being able to see over the backyard fence

This time last week, I was standing on the highest point of the Great Wall of China. Form this vantage point it was possible to see the wall snaked over the hills for miles around. It was an awe-inspiring site, and despite the thousands of other people on the wall at the same time, it was a very moving moment in my life. I was at the end of a long week in China, guests of the China Nurse Fund. The purpose of the visit was to start discussions over how the School of Nursing & Midwifery at Salford could meet the postgraduate training and education needs of Chinese nurses. During the week I was very proud to be able to represent the School at the Chinese Nursing Association Centennial Celebration. The history of Nursing in China, matched our own development as a profession here in Europe. I was fascinated by the fact that nurses and nursing had survived some very different political context in China, and the practice of nursing was still held in high regard by the Chinese people.

This week I have been engaged in trying to look into the future and consider what our student numbers might be for the next fie years, and what might be the range of programmes we will be providing. Whilst there is a wealth of high quality data and information available and I am being supported in this task by some great minds on the School Executive, it is a remarkably difficult task. This really feels like a task that puts colleagues and myself in that space between knowledge and knowing – that is, not knowing.
And finally, I awoke this morning to a news item on the TV that took me through a back yard in a small suburb in San Francisco where a kidnapped girl had been held and, its alleged, abused for the past 18 years by a known sexual predator. The pictures were provided by Google Earth. Watching the story gave me pause for thought. Once the Great Wall of China was a marvel because it was said it could be seen from outer space. Google Earth now makes it possible to look into everyone’s back yard. So why, with all this progress did the neighbours in this case find it so difficult to look over the fence and see what was going on.

Sunday, 16 August 2009

Meeting Bin Laden, Pigs and Badgers and leaving for China

It has been a while since I last posted a blog. Aplogies - I am determined to become better at posting in a more regular fashion. Part of the problem is the almost unrelenting stream of other distractions that I seem to have to contend with on an almost daily basis. For example the other day, I met a man, he was a defendant in the Magistrates Court I was sitting in as a JP, who insisted on being referred to as Bin Laden. This resulted in an interesting encounter (at least for me) – on one hand I needed him to acknowledge who he was (as per his birth certificate) so that the case could move forward, but challenging his insistence that he was not a world renowned terrorist proved futile and he gradually became more and more angry and excitable – to the point where he was taken back down to the cells and I was able to continue the business without him being there. I wondered why he felt that he wanted to be known by such a despicable name. There did not seem to be any evidence of a mental health problem, but he was clearly very angry at someone, something and perhaps this was his way of letting the world know. He was in court charged with two very serious crimes and as these allegations matched his previous history of offending, he was eventually remanded in custody with the matters all being sent to the Crown Court. His appearance in my court lingered in my thinking for some time afterward.

I could still hear him and see him in my mind for the first few days of holiday in Scotland. I am fortunate to be able to rent a cottage right on the edge of the Solway Firth at Kippford. There is little else to do but watch the tide come in and then go out. However, the badgers in the area had bred since I was last there and in the evening I was able to watch mother and three young cubs come out to feed in the garden. Given the time of the year it was still light at 10pm and out they would come and gobble up all the peanut butter sandwiches I made (and any leftovers from the evening meal). It made for a magical end to the day. I was there for six days and every night they came and ate.

I wondered what it was that concerned badgers.

Having read about B+Q considering selling pigs sty’s to cash in on the ‘lets get back to the good life’ craze currently sweeping recession struck Britain, I had to wonder at the number of pigs who would end up spending many a miserable hour before their owners eventually got rid of them. So far this year I have been asked to re-home three sets of chickens from people who thought it would be good to keep half a dozen hens for the eggs and then realized it was actually a little bit more difficult to do so then simply buying your free range eggs from Sainsbury’s (an interesting aside, Stephen Fry on Radio 4 this week: - the purpose of Sainsbury’s is to keep the riff raff out of Waitrose). Anyway, I asked if we could have a pig at home. I am still awaiting a response, I will keep you posted.

I am writing this in the waiting area of Manchester Airport – off to China to discuss how we might work together in the future to develop nurses in China and opportunities for UK nurses to practice in China. I am sure this will not be the last such meetings, China presents a huge opportunity for the development of new relationships and the extension of our community of practice. I will (hopefully) keep you posted.

Sunday, 2 August 2009

Welcome to my first blog – actually, it is my second blog. The first never got posted. I was asked to create a blog and describe a recent trip to South Africa. I was presenting a couple of papers at the ICN conference. In any event, I started my blog and soon realized that it was a lot more difficult than one imagines - so it never got posted.

What do you write about (is that the correct terminology?)?

There was plenty of material from the conference.

It was the largest conference I have ever been too, some 6000 delegates + our CNO… …sitting there every morning at breakfast…

…sometimes you can have too much of a good thing.

The first paper I presented was to a small select group of about 60 delegates. Well that was at the start of the paper – almost immediately another 30 delegates joined us – and yes of course I was pleased. 20 minutes later there were some 300 people in the room, nobody could move, the room was gridlocked.

Nobody was actually there for me and I realised that on this occasion I was rather insignificant and surplus to requirements. Those of you who know me will easily understand how uncomfortable this realisation would have made me feel.

So you can imagine my total relief to watch the Andrew Marr show this morning, (who was that woman and why does he need to take a month to find the sun?) and hear that Harriet Harmon, standing in for Gordon, passionately advocating the need for both men and women to be involved in managing any organisation.

I think she was reported in the Times to have said something like men alone were incapable of running any organisation. Our School Executive is made up of 13 wonderful individuals. There are 12 females and one male (me) – Phew a sense of equilibrium has returned.