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 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!