Sunday, 28 March 2010

Becoming a Doctor: But let’s be careful what we wish for.

Way back in the early 1970s Sainsbury’s, the supermarket company, taught me how to bone a side of beef, cut up huge blocks of cheese and master the concept of JIT ordering and stock control. At that time I was part of a very good management trainee scheme. It was my youth and impetuosity resulted in my leaving the scheme prematurely. I wanted to travel. However, I convinced myself that what I perceived to be double standards in the way in which the managers were treated compared to the checkout operators and shelf stackers was unacceptable. I thought that leaving was some form of powerful protest (I was also idealistic and unable to easily accommodate compromise). And there was of course, an element truth in my belief and feelings over the perceived inequalities. At that time it was a lot more difficult for women to gain the same benefits and opportunities as men. Today, ensuring equal opportunities exist for all employees is something most companies strive hard to achieve.

Despite such improvements, it appears a lot harder to achieve is any significant move away from the stereotypical views we have around gender related roles both in the home and at work. I was interested to note this week that Sainsbury is to withdraw children’s play outfits which have been described as sexist. After receiving complaints that doctor, solicitor and pilot outfits were labelled for boys and nurses’ uniforms for girls, the company said it would remove these items from the shelves as soon as possible. These stereotypes, although hackneyed, still appear to persist despite much evidence to the contrary.

At present, women account for 40% of all doctors, 42% are GPs and 28% consultants. By 2013 most GPs will be female. By 2017 females will make up the majority of the medical workforce. But according to the report Equality and diversity in UK medical schools, only one in seven successful applicants are from the lowest economic groups, despite this group making up just under half of the UK population. Six in ten students entering medical school still come from the middle classes.

Likewise, in a separate report published by the British Medical Association last year it was revealed that the traditional image of the British family doctor as a serious, besuited white middle-aged man is out of date. For most patients the perfect GP would be someone diametrically the opposite: young, female and Asian. Female doctors under the age of 35 were judged to have a preferable personal manner, superior technical skills and more effective powers of description.

White, male doctors over the age of 50 were the least preferred group of GPs.

Paradoxically some might say and in a almost Cluedoesque coincidence Prof (Dr) Carol Black, president of the Royal College of Physicians, once said that breaking the dominance of male consultants and ‘feminising’ the medical profession will result in it being less influential in society. She noted that: ‘medicine has been a profession dominated by white males, what are we going to have to do to ensure it retains its influence?’

She also noted: ‘Years ago, teaching was a male-dominated profession - and look what happened to teaching. I don’t think they feel they are a powerful profession any more, and look at nursing, too’

Prof Black recived hate mail for making these comments. Whilst I think the inference was that nursing has suffered as a profession because of being a predominately female occupation, I don't accept this view. I consider the development of the nursing and midwifery professions has been hampered by a largely conservative desire to expand our knowledge and skill base and demonstrate strong leadership. I believe this situation is changing and changing rapidly. Nurses are responsible now for a ever increasing number of nurse led service provisions, and the Advanced Practitioner role illustrates how the exponential growth in professional autonomy, practice knowledge and enhanced skills for nurses and midwives can provide new solutions to the problems in medicine and health care. These developments need to continue. Across the NHS, 43% of all women doctors are under the age of 35, so many will not yet have started families. Many of the women choosing medicine will opt for specialties with more predictable working hours and/or work part-time. In hospitals, 8% of men and 21% of women are on part-time contracts. Women tend to specialise in less high-status areas of medicine, because the hours are more compatible with having a family. Now is the time for nurses and midwives to step up a gear and really show their leadership in finding new way to safeguard the NHS of the future.

We can worry about what Sainsbury’s puts on its shelves later.

Sunday, 21 March 2010

Reg 8.8.2 is Outnumbered by a Dad running backwards dressed as a Chicken

What a great end to the week last Friday turned out to be. Not only was I able to participate in a wonderful School Development Day, but it was the start of Sports Relief Weekend, more of which later.

First of all, I want to say well done to everyone who presented and provided such thought provoking ideas and possibilities at our School Development Day. For those readers outside of the School, we have these days four times a year. The everyday life of the School is suspended so all staff can attend and participate. It is an opportunity to grow our awareness of issues impacting on our performance and plans. I tend to start the day with a personal analysis of our external operating environment and the options we might consider in responding to the issues identified. Tim and Mrs J provided a superb guide through the complexities of Reg 8.8.2. – a hugely complicated change to the regulations which can result in students not being able to complete their studies if they fail to submit work as required. Martin, Ann and David provided much food for thought with their presentation on End of Life Care. I was very interested by the way that colleagues ran with this idea and immediately expanded a somewhat one dimensional view into something the School could embrace in so many ways. The end of a life can occur at any stage on the life cycle, not just in old age, and the point was well made by colleagues. I think the work could provide us with a much larger are to embrace with the Schools research and teaching and learning than perhaps was presented. I believe that it’s the kind of thinking we engaged in on Friday that will help us move from the confines of silo thinking into a more productive place, a new nursing research zeitgeist.

Interestingly, I find trying to understand what the spirit of the time might be is both entirely confusing and yet sadly predictable – something’s appear to have a transcendental quality. For example, having got held up in my home town of Bolton yesterday, by what appeared to be a huge mass protest of some sorts, I came home and Googled.

It seems that the Police have battled with thousands of demonstrators during a day of protest and clashes between the English Defence League and Unite Against Fascism in Bolton’s Town Hall Square. Some 4000 people from both sides took part. 67 people were arrested during the day of protest.

It is not my desire to comment on the political motives that might lie at the heart of such protests. However, the second web site I looked at in trying to and find out some information was sponsored by a dating company that specialised in arranging meetings for people who work in public sector services. The main advertisement featured Michael and Bethany:

Michael, Fire Fighter – Fights fires, rescues children from burning buildings, and makes a killer macaroni cheese – Bethany, Nurse - Saves lives and brings breakfast in bed

So it seems some things will always be a feature in society’s zeitgeist. This was a point well made by Ruth, our final and a very engaging presenter at the School Development Day, She guided us through the difficulties of promoting a fair and inclusive approach to Fitness to Practice processes for our students. Ruth reminded us of the difficulties we have in ensuring that our students understand that becoming and being a professional is a 24/7 responsibility. This is something I am acutely aware of in writing this blog every week. Balancing the personal with the professional is a task fraught with difficulties. For example, I am not entirely sure about wisdom of the current the article about my predilection for chickens that features in the latest US magazine.

This inevitably for me prompts my writing to return to the wonderful night of TV that was the Sports Relief coverage on Friday evening. My favorite item has to be Outnumbered! I have long been a fan of this excellently observed sit com. Anyone who has children will be able to identify with the story lines – the kids are just wonderful. For me the best line of the night was the conversation over what the family can do to support Sports Relief. They decide on running the Sports Relief Mile, Dad agrees only to find out the kids have booked him to run his mile backwards, and wearing a Chicken outfit. Good luck to all of you running the mile today.

Finally, most of you will know I am the least competitive person in the world. But I did get slight sense of satisfaction last Monday on entering the School of Nursing at University of Manchester. They were currently running at a NSS completion rate of 39% - our completion rate was 64%. Likewise, on Monday, this blog  received twice as many comments as the VC’s – thanks and keep the comments flowing.

Sunday, 14 March 2010

The ‘Good Enough Cook’ on Mothers Day

This week Toby Elles who lives in Salford fell asleep while cooking some bacon. When he woke up about an hour later, not only was his kitchen filled with smoke, but under the slices of burnt bacon he discovered the image of Jesus etched into his frying pan. I mention this lack of culinary skill as this weekend will see many families across the land celebrating Mothers Day. Mother's Day has been celebrated in the UK since the 1600. Mums with younger children will be blessed with breakfast in bed followed by lunch and or dinner lovingly prepared by children possibly unable to spell the word kitchen, but thanks to M&S, will produce a wonderful three course meal. In the UK, Mother's Day is the third-largest card-sending occasion. According to Hallmark cards, over 150 million Mother's Day cards will be sent this year.

Many countries celebrate at different times throughout the year, Canada, Denmark, South Africa, Finland, France, Italy, Turkey, Australia, Japan Sweden and Belgium all celebrate Mother's Day in May. Norway observes Mother's Day on the second Sunday in February, and Argentina celebrates it on the second Sunday in October. Lebanon celebrates Mother's Day on the first day of spring, whereas both Spain and Portugal celebrate in December.

Of course not every child will want to celebrate their Mothers in this way. For example, in California this week, Rebecca Stancil a typical 9-year-old all American girl, told a court about her desire to kill her mother. The story noted that that Rebecca had reported been haunted by images of wolves, men with monster faces, and shadows and shapes that scampered around her bedroom at night and had done so since she was 3 years old. The way that Rebecca responded to what might or might not have been hallucinogenic experiences was to behave violently towards her Mother. In 2008 Rebecca was diagnosed as having paranoid schizophrenia. Schizophrenia in children is extremely rare – internationally on average only 1 in 30,000 children are diagnosed with this disorder each year. The report made no mention of childhood sexual abuse, which will be the experience of many more children each year, and which could also result in such behaviours.

Some children have yet to grow up and learn about Mothers Day. Joanne Walters, 30, from Middlesbrough, will be celebrating Mother’s Day with her partner, her new baby son, Thomas and his two-year-old brother, Joshua today. Unfortunately, Joanne had contracted Swine Flu after declining the vaccination while she was pregnant. As a consequence she spent nearly a month on a ventilator in an intensive care unit with double pneumonia and kidney failure before giving birth to Thomas. All are well now.

On Friday I was privileged to take part in a NUS sponsored event exploring how to enhance student union representation for students on professional based degree programmes. I took part in a very lively panel discussion that looked at how the university could better accommodate the typical student of today. These were students described as being over 25, often single parents and/or married and with young families of their own, and who might also need to work to supplement the house hold income while they studied. I came away with many ideas for the School to consider. The responses I heard are a long way away from how nursing students in 1940 were often treated.

For example, in the Hansard of April 1941, the Minister of Health was asked whether he was aware that many hospital authorities refuse to employ fully qualified nurses, or to train students, who have been, or are, unmarried mothers and, was he awre of the recent action of the General Nursing Council who removed the name of a nurse who was an unmarried mother from their register just because she had given birth out of wedlock.

Finally, I am spending today looking after a wonderfully diverse collection of Grandmothers, Mothers, daughters who have become Mothers, a daughter who is a  Mother but whose own Mother is far away and one Great Grandmother!

To borrow from Donald Winnicott, the English pediatrician, psychiatrist, sociologist and psychoanalyst, I hope I will live up to being the good enough caterer’!

Sunday, 7 March 2010

Three foxes and Pearl Harbour

Hilter was a vegetarian. He banned fox hunting in Germany in1934. Tony Blair on the other hand loved his steak. Under Blairs leadership, the UK Labour Party used up over 700 hours of Parliamentary time trying to ban fox hunting. Eventually the Hunting Act became law in 2005. Ironically, the League for Cruel Sports has reported that since the ban on fox hunting was introduced in the UK the number of foxes killed by dogs has actually increased.

However, in the interest of fairness, I need to mention the work of the Countryside Alliance who campaigned long and hard against the Hunting Ban. It’s possibly forgotten now, but it was one Sarah Bell who provided an engaging if somewhat controversial aspect to their campaign. Although often described as that ‘long legged blonde 25 year old’ she was, at the time of the campaign, a qualified children’s nurse of nearly four years. Famously she was pictured in a poster campaign wearing her full hunting garb with the slogan ‘now they hate her’ alongside her wearing her nursing uniform with the slogan ‘now they don’t’

That was then and here we are some five years later. Without disclosing where I stood (or rode) on the Hunting ban issue, I was somewhat surprised to read that it was chickens and not dogs that had killed a fox this week.

It is alleged (Mail, Telegraph and Radio 4 amongst others) that three hens and a cockerel named Dude (which gives you a clue to the story’s authenticity) pecked a fox to death. Hmm… The Essex family (another clue perhaps) claimed to have previously lost chickens to foxes, and that they were aware of the danger foxes pose, which is presumably why they had built such an insecure hen house.

Having kept chickens for the last 35 years I doubt very much that these chickens pecked the fox to death! It was reported that a little table in the corner of the coop, which the chickens perch on, had been kicked over and was lying next to the fox's head. I would imagine this is what had killed the fox. Apart from fogs, mice and so on, chickens are not equipped to kill, whether by pecking someone or something to death or in any other way.

However, most Foxes are the complete opposite. Killing is what they do.

Hold that thought. I was at the Oval this week as an assessor for the first Mental Health Leadership Challenge. I had joined a panel of leading experts, practitioners and NHS Foundation Trust Chief Executives to participate in the event run by the Health Services Journal and the Nursing Times and sponsored by Mental Health Strategies, Care Principles and Nottinghamshire Health Care NHS Trust.

Teams of mental health practitioners and managers from all across England were joined by service user and carers in addressing a number of organizational and professional challenges arising out of a simulation exercise based around what the NHS in England as it is likely to look during the next few years. The event was competitive and developmental. The teams had to work through a number of issues that became more complex and demanding as the day progressed.

My role was to judge the progress of each team. Each team had to demonstrate team working, leadership, multi-agency involvement innovation and improvement. The event ended with a number of awards being made against these criteria. The event was in part, an opportunity for mental health services to review and explore how they address the issues set out in the New Horizons Mental Health Strategy.

This revised mental health policy for England seeks to reduce demand on secondary health services as well as achieve better health outcomes, including higher employment rates and lower suicide rates.

Amazingly all though the day we watched a fox follow the sun around the pitch. He seemed completely oblivious to the ground staff working on the pitch and just very languidly stayed and sunbathed for most of the day. Apparently he and his family have been living there since the summer of 2009.

Interestingly, is was a certain Annie Fox, who as the Chief Nurse in the US Army Nurse Corps, was awarded the Purple Heart for her work during the Japanese attack on Pearl harbour. During the attack, Lieutenant Fox administered anaesthesia to patients during the heaviest part of the bombardment, assisted in dressing the wounded, taught civilian volunteer nurses to make dressings, and worked ceaselessly with coolness and efficiency. It was said that as a Nurse she was able to demonstrate calmness, courage and leadership in a situation of great danger and personal threat.

It is unlikely that the Essex Dude will ever be able to make the same claim.