Sunday, 31 January 2010

Cardiff, Emma, Cars, Chickens and Does MH really read this blog?

There has been a slight delay in getting this week’s blog out. An inch of snow overnight required clearing off the drive before it was driven on and compacted to ice, making the drive un-passable again! Anyway, last Monday afternoon saw me on a two carriage train trundling its way to Cardiff. The train driver took great pride in stopping at every train station between Manchester and Cardiff. It was a long journey. But a worthwhile one. I was on my way to the Council of Deans of Health. This is a organization that grew out of a group Head of School and Deans of Nursing coming together to provide a concerted and considered voice of reason in order to challenge the many governmental polices and plans that threatened to slow the progress of the professionalisation of nurses. These days the Council of Deans is a broader church, and now represents many health care professions – except, of course, our colleagues in medicine. All four countries of the UK are represented. This is a group whose influence extends not just to the UK Government, but to health care systems world wide. The collective ability to deconstruct and critically analyse health care policy is incredible. However, nurses and midwives have a long tradition of being able to shape the course of health care practice. This week two midwives working both in clinical practice and in our School received a prestigious award from the Department of Health for their work in developing further the skills of midwives. Their success was underpinned by a research based approach and is a great example of how research can have a long lasting impact upon the experiences of others. This achievement clearly reflects the contributions to health care made by nurses and midwives down the ages. I came across a brilliant web site this week that captured the contributions of Walt Whitman, one of the all time great contributors to nursing - - have a look and remind yourself that actually the biggest differences to the quality of life of others sometimes come from the smallest acts. And small acts repeated over and over again.

This week I also sat in awe of a young lady courageous enough to tell the story of how she had experienced her mental health problems over the last eight years. She was 19 years old. Throughout al this time it was her GP who had provided the time, presence and therapeutic relationship to enable this young lady to move forward and recover from her problems. What she described in her account was receiving a form of talking therapy that was about her GP always being there for her, (providing the unconditional positive approach that is usually a characteristic of nurses and midwives relationships with their patients). Over all the years she was troubled, this GP was her constant rock. It was both a humbling and exhilarating experience.

Friday saw me picking up my new car, black and sleek. Enough said.

Saturday morning was given over to Jason. He is a ace photographer and a real artist. He has previously taken photos of colleagues that have been truly amazing. With me it was slightly different. He maintained an almost constant refrain of 'look happier, even more than that', dominated the couple of hours shooting! Some 150 photo shots later he drove away leaving me wondering what images he was going to send in for use. A clue is that they all included chickens.

On the other hand, our VC appeared to know what shots I was using. At a professoriate dinner with the VC and a dozen other professors this week, Martin Hall, observed that I had taken a photo of that picture’ and he understood it now appeared on my blog. So if you do read this weekly offering Martin, just for the record, I think you are doing a great job.

It is a increasingly turbulent world at present. I am very aware of the huge efforts being made by all my colleagues in the School under what by any measure are very difficult circumstances.

Just for the record, I want to say thank you, I think you are all doing a great job too.

Sunday, 24 January 2010

Suicide, Durkheim, Foucault, and the Joys of Teaching

In the main this has been a great week. Highlights included facilitating two teaching sessions with mental health students. These were students half way through their third year of study, more of which later, and the fact that the central heating got sorted. Makes washing my hair much easier.

But I have to start with an apology – to the many people who took the time to ask me whether I had eaten ALL the Swiss Chocolate… …and not brought back any to share?... …well yes, sorry, but it was sooooooooooo good!

There were some things that weren’t so good however. When I first arrived in Manchester I liked listening to Piccadilly Radio (for young readers, this was the precursor to Key 103) – all except programmes from a full of himself DJ named Steve Penk. It came as no surprise to hear that on the 14th Jan 2010, in response to a request from a listener sitting in a traffic jam on the M60, he played the song Jump by Van Halen. Four lanes of the motorway were closed while police attempted to deal with a woman who was threatening to throw herself off a bridge. He told listeners he was playing the song to empathise with frustrated motorists. Moments later the woman jumped from the 30ft bridge.

Fortunately, the women involved only received minor injuries.

Although this whole episode in itself was distressing, I think I was more upset by the various reactions to this news. For example, Daily Mail readers flooded the online comment section on the web with huge numbers of responses that were generally really difficult to accept. These ranged from the uninformed:

I think it's funny. These people who climb bridges at rush hour aren't serious about suicide… …to the smug: It's irresponsible - this woman could have overheard it on someone's car stereo… …but unlikely, more likely she had been listening to Chris Evans' new breakfast show!!... …to the uncaring: it’s a free country and Some people need to get a sense of humour!... …and the grounded: I had totally forgotten about this has been, his short-lived TV career crashed and burned some time ago… … nice to know he is now bringing the same low standards to radio!

Although I didn’t hear the actual programme, like Mind and the Samaritans I complained to Ofcom about the show. It was not an easy thing to do – and I mean it literally was not an easy thing to do – Ofcom didn’t recognise Penks radio station on the list of stations broadcasting.

There was a sustained but somewhat muted response from mental health groups. And I guess, given other world concerns, not least of which the dreadful events in Haiti, perhaps the subdued response is understandable. However, the World Health Organisation estimates that each year approximately one million people die from suicide, which represents a global mortality rate of 16 people per 100,000 or one death every 40 seconds. It is predicted that by 2020 the rate of death will increase to one every 20 seconds.

Over 100 people a week take their own life in the UK.

We did talk about the story in my sessions with the students. However, it was interesting that I discovered none of the Students had ever come across Emile Durkheim and his ground breaking sociological work on suicide. This work was first published in 1897. One of the things he noted all that time ago was the higher than average rates of suicide to be found in Scandinavian countries than elsewhere. Something as unfortunately true today as it was then. I was also surprised that the students hadn’t come across my most favourite philosopher and sociologist, Michel Foucault. Particularly so given his huge contribution to our understanding of society, the relationship between individuals and the State, the importance of social institutions and his work on knowledge, power, psychiatry and human sexuality.

He also suffered with depression for long periods at different times during his life. He first embraced psychiatry and psychology, only to reject these and seek asylum (in its truest sense) as the way to finding his own road to recovery. For me it was a great joy to be able to discuss with these ideas with the students and to consider the impact that these great thinkers and writers had on the way in which mental health care, the policy, practice is understood today.

For me the teaching was entirely positive for my own mental health and well being, which in a demanding week, had been sorely tested this week.

Sunday, 17 January 2010

Stories of Schizophrenia, Science, Swiss Chocolate and Mob Rule

I have for a long time now complained loudly whenever I have come across some one being referred to as a Schizophrenic. Schizophrenia is a disease not a person. Last week I sent another email to the BBC when they announced that a Schizophrenic mum, who we now know is called Aisling, stabbed her daughter, Chloe, 52 times. Aisling was suffering from Paranoid Schizophrenia at the time. This is a tragic story told of events that occurred some 7 years ago, but which, for a number of reasons, has only now been reported on. There were the usual accusations levied at individual professionals, a social worker and psychiatrist in this case, and the various agencies involved were found to be wanting in a number of respects. Refreshingly, the Manchester Evening News, in their coverage of the story, steered well clear of referring to Aisling in any other way than as a Mother. No condemnation and no reductionist and patronizing personal pathologising. In what was an account about a very sad and tragic occurrence, this approach was at least a one that properly reflected the sensibility and humanity of all of those involved.

It is a shame that the same cannot be said about the governments Scientific Advisory Group for Emergencies. I am talking of course about the latest twist in the Swine Flu scandal. It beggars belief that over half of the SAGE group (11 out of the 20 members) have done work for or have a link to the pharmaceutical industry. Many of these people have long established links through the research they have undertaken as part of their work at a University. Many of these people have been paid sums of money ranging from £500 for a lecture to £100,000 for a directorship. No wonder Mandy is stamping his foot and threatening to stop funding much University research. GSK are likely to be the greatest beneficiaries of the preparations undertaken for swine flu. In July 2009 the UK Government was predicting up to 65,000 deaths from swine flu. To date there have been some 251 deaths. Unsurprisingly, the Government is now busy trying to off load nearly one billion pounds worth of unwanted swine flu vaccine.

As some of the more astute readers among you will have gathered, I have been reading the Daily Mail again. It was the only free English language newspaper on the Swiss Air flight I took this week to get to Budapest. There was little snow in Budapest, but it was minus 7c for much of the time. I was there working on a bid with colleagues for a £300,000 project from the life long learning EU funding stream. We were interested to build upon previous work a group of us had done looking at the role of academics who facilitate learning in and from clinical practice. It was a fascinating discussion. There were many differences in approach across Europe. For example, in the Czech Republic, nurse tutors worked for up to 6 hours a week with their students in practice, maintain clinical loads, and despite being employed by their university, are very much part of the clinical team where as in Romania, university lectures seldom met with students when they were out in practice – perhaps has something to do with many of these lecturers were doctors. They may well have been busy sorting out the swine flue pandemic.
Another really good thing about Swiss Air is those mini bars of Swiss chocolate they bring round at every opportunity, its lovely stuff. One needed a good blood sugar level upon arrival at Manchester airport on Saturday. The airport had chosen to upgrade the arrivals and passport hall this weekend. There were only four desks open, instead of the normal 14. I arrived to join a queue of 2000 other passengers. It took an hour and 15 minutes to get through passport control. The flight from Budapest was one hour 45 minutes. What I found frightening about this experience was the regular wave or anger and frustration that swept through this mass of people. People were hot, tired, needing to get their luggage, go to the toilet and so on. It was the constant apology for the delay that seemed to particularly anger people. Clearly people wanted their cake today and not tomorrow. And although I don’t intend this blog to be focused on food, if anyone has been to the newly renovated Pitcher and Piano (now called Barbirolli) – I hear it now features jazz, blues and acoustic live music- perhaps they could let me know if it is worth a visit.

Sunday, 10 January 2010

Mandy buys us all a drink, but there's still a shortage of Zimmer frames.

What a great week for the senses. No sooner had we got back to work after Christmas than many of us were confined to barracks by the extraordinary snow fall on Monday night, more of which later. Also on Monday, I received confirmation that one of my PhD students had got through the examination process and was to be recommended for the award of a Doctorate. Congratulations all round, particularly as this student is an academic member of our School of Nursing & Midwifery here at Salford. It is an unfortunate fact of life that despite representing the largest group of all health care professions, there are precious few Nurses and Midwives who have gained their PhD.

In 1950, my role model Virginia Henderson, decided to collect together all the published research undertaken by nurses. The collected works filled just two slim volumes. As a profession we have come a long way since, but there is a long way to go. For example, it was estimated that in 1997, there were less than 300 nurses in the UK who had a PhD. While this number has trebled the current number of nurses and midwives with a PhD has to be put into a context of some 600,000 nurses currently registered in the UK. We are looking forward in 2010 to having the first Midwife with a PhD in the history of the School.

However, if Mandy has his way nurses and midwives with a PhD might well be a thing of the past. At least 80 UK Universities face being forced to abandon postgraduate research as funding is concentrated on centres of global excellence. If the proposals are accepted,  Doctoral research would be restricted to about 30 Universities where there are centres of high specialist science based research. The proposals are expected in a review due to be published shortly by Professor Adrian Smith, formerly of University of London, and director of research in Lord Mandelson’s department. So I was interested to read yesterday that Imperial College, London, a likely ‘winner’ in these proposed changes, reported that a team of their researchers have developed an alcohol substitute that mimics the effects of drink, but doesn’t give rise to drunkenness or hangover (?!) and the effects of which can be instantly switched off by taking a pill. Hmm….

…Of course alcohol misuse is a big problem. Some 945,223 people were admitted to hospital with an alcohol-related diagnosis in 2008/09 - 47% higher than the 644,185 people taken to hospital in 2004/05. Although the figures include patients with alcohol-related conditions such as liver disease, some cancers and alcohol poisoning, they do not include those injured while drunk or the victims of drink-related violence.

But back to the snow. It came out of the early morning sky on Tuesday. I lay in bed watching it fall but by 5am I was up and outside busy clearing the snow from the drive, vainly hoping to get to work. However, by 9am I gave up and worked from home for the next two days. Well it was more working and digging. By Thursday morning I was exhausted, but at least could walk to the station and catch a train into Salford. It was good to get to work and meet other colleagues.

Having got myself mobile again, I felt much better, but I did feel for the physiotherapy manager at Lancashire Teaching Hospitals NHS Foundation Trust. There is a shortage of Zimmer frames in Lancashire. Since the beginning of December there has been a 75% increase in the number of patients being treated for falls and injuries caused by the snow and ice. This equated to some 550 extra patients being seen, treated and discharged. The consequence of this increase in patient numbers was an absolute shortage of Zimmer frames to give out to patients. Pleas for the return of old Zimmer frames punctuated local radio programmes all week.

Despite the difficulties the snow brought and the forced changes to my plans this week, I have been amused by the endless mental images of what might have been the consequence of an early resolution of the Zimmer frame famine – especially as our car parks were, up until Friday afternoon, still covered by 18 inches of snow.

However, the last word has to go to the story I eventually resisted using for this blog. The news from Northern Ireland caught my attention, and made me think about one of my all time favourite films  The Graduate. For a short while I was almost seduced into thinking about weaving the various Mrs Robinson/young lovers/students/politics/older people story lines into a commentary on the state of the UK higher education system. But resisted. So here’s to you Mrs Robinson, there's no need of Zimmer frames for you!

Sunday, 3 January 2010

Pandemonium as Obama walks in the footsteps of the Head of School

I had one of those strange feelings today – you know it’s like the simple tickle of excitement that comes when you first fall in love or experience something totally unexpected and inexplicable. Partly this feeling came from reading the story of how the the Chinese government has announced that as a first step in the process of calling in the United State’s debt of approximately $800 billion, it will repossess the National Zoo’s giant panda cub. In a masterful and inscrutable sense of understatement, a spokesperson for the Chinese Ambassador in New York said:

“We will credit America $5 million dollars for the panda, which means the US only has $799.995 billion left to go.”

The US National Zoo learned that the panda, four-year-old Tai Shan, one of fourteen such animals living in zoos across the US, will be leaving for China asap. It appears that even the offspring are forever the property of China. However, it wasn’t the pandas that caused the excitement it was watching a film clip of President Obama gently strolling on the same part of the Great Wall of China I had been on several months before. Regular readers of this blog will understand where I am coming from here (for the rest of you, see my blog for the 29th August 2009). I know when I stood on the Great Wall, the sense of history of all those people who had been there before me was almost tangible.

Pandas aside, China will be a major feature of the Schools future, not only in the forthcoming year but for some years to come. 2010 is likely to be the first of what is going to be a number of challenging years for the School. The challenges will come from many sources both internal and external to the School. The most powerful of these drivers for change arise as consequences of the current economic recession. The notion of ‘flat cash’ has entered our lexicon.

An uncomplicated explanation of this phenomenon is that the very best the School is likely to receive in terms of its main income will be no more than we received last year. Against this static income, will be the inevitable rises in real costs for the School. Of course, the worst case scenario is that our income will be reduced because we either cannot recruit students or retain them. Against this backdrop of fiscal uncertainty are other changes, including a sustained reduction in the overall commission numbers for pre-registration students, the move to an all graduate profession and a move to National Bench Mark Pricing as the means of calculating the Schools income for pre-registration nurse education and training.

I remain very confident in our abilities as a School. Our collective knowledge, creativity and above all else, our commitment to what we believe in has set a high achievement benchmark for the many other Schools of Nursing. Our Institute of Nursing heuristic is alive and well in my heart.

In last weeks blog I wrote about a couple of books I have been involved in. Despite trying hard not to do anything except eat, drink and be merry over the past week, I have taken a couple hours to tidy up another chapter for a new book due out in the summer of 2010. This is a chapter that explores the notion of resilience, and whether such resilience can be taught or better caught. Resilience is a precious attribute. I believe it is better caught than taught, but we can learn how to better protect ourselves from the emotionality of what it we do in practice, in our contact with students, and in our dealings with the challenges posed by our University in these turbulent times. Individually, and as we work in our Directorates and the School as a whole, we will all need to develop our own strategies for staying resilient. Helping and caring for and with others is what we are good at doing – we just have to remember to include each other in providing this support.

The Financial Times in its report yesterday about New Year resolutions observed that those individuals who didn’t make any resolutions were likely to remain mentally healthier, as there was no danger of feeling a failure! As this is the first blog in the new year of 2010, and unlike the FT, I hope all the blog's readers are able to achieve whatever dream, hope or resolution they set out to do over the next 12 months.