Sunday, 29 January 2012

Fishy Goings On in Belfast, and Move over Midwives the Three School Boys are Back.

It was a slightly hectic week last week. Monday was a back-to-back meeting crammed day which ended with a quick flight across the water to Belfast. I was there for the CoD AGM (Council of Deans). I was last in Belfast a couple of years ago so it was good to be able to get back there. It is an ever changing place to visit, although I have to say that the hotel stayed at was one I would personally avoid (with the possible exception of the Beetham Tower in Manchester) – why in this day and age the Hilton Hotels and Resorts Group feel the need to charge people £15 a day to access the internet is beyond me.

The CoD AGM was important this year as changes to the constitution were on the cards. However, at the end of the day the AGM was a rather damp squid of an affair. It felt a little like I was located in the time capsule stored inside John Kindness fantastic sculpture called the Bigfish, which was but a short walk away from the hotel. The meeting was South East dominated and seemed completely out of touch with the many changes affecting the University environment. For me the agenda for the AGM simply did not address the very real changes and challenges facing educationalists engaged in preparing the future health and social care work force.

I did take an extended lunch break, BUT although seen in passing, I did not tally at the ornately decorated pub the Crown Liquor Saloon (just down the road from the hotel). Designed by Joseph Anderson in 1876, it is the only bar in the UK owned by the National Trust! For those readers of a certain age, you will recall seeing it in the film Odd Man Out.

And one man who for many appeared to be the odd one out at the AGM was Peter Carter. He was the first speaker of the day and his speech fell flatter than a Dover Sole being run over by a steam roller. Peter Carter is of course the General Secretary and Chief Executive of the nursing trade union, the RCN. Since he took up post in 2007 his tenure has been somewhat a mixed bag. Yes the membership has grown to 420,000, but there have been some high profile PR gaffs as well. Allegedly there were some misunderstandings around what one needs to do to get a Knighthood in the UK, a poorly timed good news story released immediately before the Staffordshire Hospital scandal hit the news, and most recently, a story about the notion that nurses are too posh to care. Not helpful for someone promoting the nursing profession.

Peter started his career as a mental health nurse. Peter is not the only former mental health nurse working at the RCN. Janet Davies, (the RCN Director of Nursing and Service Delivery) who started her nursing career in 1975, (in Manchester), was also a mental health nurse. She has gained a well deserved reputation for her work in how to achieve effective partnership working across health and social care organisations, the police, and the wider community. And judging by her recent photos on the RCN web site, Janet clearly has a better PR company to advise her than the one used by Peter.

But there are some people who appear not to need PR companies. Later on today I shall be recording the entertaining Call the Midwife (watched by 8 million viewers last week), and described by yesterdays Times as a warm hearted, family friendly and gentle nostalgic programme. I am recording it tonight as showing at the same time is the start of a new series of Top Gear. The three presenters, Jeremy, Richard and James, behaving like three over-aged school boys having the time of their lives, test drive three cars collectively worth £500,000, (and all capable of achieving speeds of 225 mph) around the Nardo Ring test track (so big it can be seen from outer space). In a world of PR and professional smoke and mirrors it’s good to see there are some people with their feet firmly grounded on the tar macadam of life.

But I won't be enjoying a glass of wine as I watch. Inspired by all those friends and colleagues I know who are still not smoking, who have taken up walking and jogging, or have kept to their weight watching diets, I decided to have a completely alcohol free week starting tonight - I will let you know how I get on!

Sunday, 22 January 2012

Saluting Foucault and Our Access to Information

Possibly Foucault will have turned in his grave this week. At the very least he might have considered adding a further chapter to his work The Archaeology of Knowledge. I can imagine his despair might have resulted from the stories regarding gaining access and using information or not that made up much of the news this week. One story that dominated was of the arrest and seizure of assets of one Kim Dotcom, also known as Kim Schmitz, the flamboyant entrepreneur who founded the site Megaupload. The site had some 150 million registered users, and was one of the biggest file-sharing services in the world before it was shut down this week. It was reportedly the 13th most frequently visited website in the world. Megaupload is now the subject of one of the largest cases of copyright theft ever, after the US authorities ruled that it violated a host of piracy laws. The closure sparked retaliatory protest attacks by hackers focused on US government sites.

An access to information story of a different scale,was the news on Thursday that all NHS and social care staff in England will now have open access to the online version of The Lancet, thanks to an agreement between NICE and Elsevier to fund a national subscription. Such a move will save the NHS time and money. NHS organisations, and individual members of staff, will no longer need to take out their own subscriptions. The Lancet was founded in 1823, and is one of the oldest medical journals in the world. Access is via use of an Athens password – and as I have one, I thought I would see what was available.

There were some surprisingly interesting papers, although I felt there was a bit of 'my RCT is bigger than your RCT' feel to the journal at times. A number of what were very serious papers appeared to have very creative titles, and there were some papers where I found the content amusing, not because the focus was in itself funny, but because of the possibly unintentional juxtapostion of topics. My eye was drawn for example to the paper: Mortality in relation to oral contraceptive use and cigarette smoking which reported upon a study undertaken by the Oxford Family Planning Association study, which compared mortality in relation to contraceptive use and smoking. This was a big study (17032 women, aged 2539 years at entry) which ran for some 32 years (now there’s research funding for you!). The findings were interesting, as it appeared there was no harmful effect of oral contraceptive use on overall mortality. By contrast, death from all causes was more than twice as high in smokers of 15 or more cigarettes a day as in non-smokers. The harmful effect was already apparent in women aged 3544 years. 

However, it seemed to me that the authors had missed a unique health promotion opportunity. And of course where there is a market niche someone will come forward to fill it. Possibly without the benefit of a free subscription to the Lancet, the Swedish company Pharmacia Latex, have developed a condom that has a nicotine infused lubricant. Their claim is that as nicotine is a natural stimulate, in using these condoms smokers will feel less inclined to light up after sex. Now I bet such covert population control would have made Foucault smile!

I wasn’t smiling at my colleagues from the Nursing Standard who once again were using the Freedom of Information legalisation to gather information about University nursing lecturers involved in pre-reg nursing programmes. They chose to send out the request at late on the afternoon of the 23rd of December, starting the clock ticking just as everyone left for Christmas. The deadline for compliance was this week. I am sure in the fullness of time an article will appear that reports (almost predictably) a negative view of nurse education today. As someone from the DoH (possibly a kindred spirit) said recently for the important things in life we have credit cards. For everything else we have the Freedom of Information Act’.

Of course our access to information that is presented in many different media can be a cause for good. I was pleased to learn that Paul Burstow the Minister for Care Services reaffirmed the Government’s commitment to 3millionlives at a parliamentary reception this week. This event celebrated the work of the Whole System Demonstrator Programme (WSD). The WSD programme is the largest randomised control trial of telehealth and telecare in the world, involving 6191 patients, 238 GP practices across three sites in the UK (Newham, Kent and Cornwall). The research aims to explore the cost effectiveness, clinical effectiveness, organisational issues, and effect on carers and patients of the use of telehealth. The study has focused on 3 conditions, diabetes, COPD and coronary heart disease. Outcomes to date show that if delivered properly, telehealth can substantially reduce mortality, reduce the need for admissions to hospital, lower the number of bed days spent in hospital and reduce the time spent in A&E. Its estimated that in the UK at least 3 million people with long term conditions and/or social care needs could benefit from using telehealth and telecare. Not sure what Foucault would have made of this modern day intrusion by the state into our everyday lives, but I bet he would have preferred to it to what is going on in the US with Megaupload.

Sunday, 15 January 2012

C'est la vie, Rubber Chickens and the Normality Test, and Where the Dickens Weir Hughes is the Regulation of Nursing?

It’s funny how things happen. In the middle of last week, catching up on Christmas reading, I came across a report in the British Medical Journal which claimed that brain functioning can begin to deteriorate once we turned 45. The study found that mental reasoning declined by 3.6% in both men and women aged 45-49. The study involved over 7,000 male and female civil servants aged between 45 and 70 and was run over a 10-year period. Participants were tested on their memory, vocabulary and aural and visual comprehension skills. A faster cognitive decline was recorded in older individuals with a 9.6% loss in men aged 65-70 and 7.4% in women of the same age. The study highlighted that adopting a healthy lifestyle helped in slowing any cognitive decline. The research was led by Francine Grodstein, an Associate Professor of Medicine at Brigham and Women’s Hospital, Harvard, Boston. Her research focuses on healthy aging, particularly in women. Interestingly, her primary research base is the Nurses’ Health Study (NHS), where she leads the study of cognitive function among the oldest participants.

This sparked a particular stream of consciousness to draw upon for this week’s blog; unfortunately, life doesn’t always work out in the way you think it should, but c’est la via would be my simple existential observation. News of the unwanted kind intervened with my plans. I heard on Thursday, of the death of the wonderful mental health campaigner John McCarthy, who died aged just 61. John was the founder of the mental health organisation Mad Pride Ireland. He spent vast amounts of his own money trying to challenge the stigma around mental illness and organised happy, crazy Mad Pride family events. These were often massive outdoor parties where everyone who went was given a ‘normality test' by clowns using rubber chicken ‘normality detectors'. No one has yet passed the test.

I first met John at a mental health conference hosted at Dublin City University in 2007. This conference was the first in a series of Health 4 Life Conferences. The focus was on exploring critical perspectives and creative engagement in psychosocial health. The conference was very different from others I had been part of. The conference participants included the traditional mental health nursing academic greats, Phil, John, Liam, Dawn, Richard, Poppy, (me) and unbelievably Thomas Szasz (of The Myth of Mental Illness and The Manufacture of Madness fame), but equally half the audience were service users and carers. John was part of this group and his approach to challenge and questioning set the tone for a fantastic conference experience for all.

In life, John was slightly irreverent, passionate and hilariously rude. He wore his long, white hair in a ponytail, (and yes we were able to exchange hair care tips over the three days of the conference). John also had motor neurone disease —a cruel and relentless illness. He brought great awareness to the struggle of those facing the illness, but always maintained that mental illness was worse suffering. In August 2011 he wrote that:

"Having spiritual disquiet; depression is the most crippling method of destroying a human being. Pain in the body can be handled so much easier than pain in the spirit. I will take the last few years I have with creeping paralysis, but with my spirit growing, rather than 20 years with depression and my spirit dying. I have been there, that place of self isolation. That was truly awful."

Last week I was also due to be in London to meet the Nursing and Midwifery Council Chief Executive Professor Dikon Weir-Hughes. However, the meeting was cancelled, and last Thursday he resigned from his post for ‘personal reasons’ – not that there is any connection between the two events. Likewise, I am sure his resignation has nothing to do with the rather critical report on the way the NMC has undertaken its responsibilities for Fitness for Practice investigations and hearings published by the Council for Healthcare Regulatory Excellence (CHREC) in late November 2011. CHREC promotes the health and well-being of patients and the public in the regulation of health professionals. They scrutinise and oversee the work of the nine regulatory bodies that set standards for training and conduct of health professionals.

The audit report was less than complimentary about the progress made to date by the NMC in modernizing itself and its processes. Some would say (me included) that the audit report was not the most helpful of outcomes for the NMC at this stage of its restructuring. I guess John McCarthy, in his wise way, would have been more outspoken and direct and would have asked the question of old: 'if CHRE regulates the NMC, who regulates the CHRE and who regulates the regulator and shouldn't the regulator be regulated?'

And rest in peace now John, but I think the world is going to be a less colourful place without you.

Sunday, 8 January 2012

Sally, Terri, Penny and Viv on Alcohol, Cigarettes, Sex, and no Mischief

Its estimated that 7 million of the UK population will have made a New Year’s resolution last week and by the time you are reading this blog posting, it’s likely that the vast majority of these people will have already abandoned any attempt at being a Size Zero, Smoke-less, Teetotal Worshipper at the Church of Self Denial and Health and Well Being.

This week the NICE website main headline was: ‘New Year, new lifestyle, new you’. The narrative noted that making lifestyle changes like exercising more or cutting down on alcohol and cigarettes tend to top the list of New Years resolutions. Spookily, and in some clever fleet of foot use of evidence our Chief Medical Officer (Professor Dame Sally Davies) suggest that the just making one healthy resolution can result in individuals enjoying double the benefits – a lovely example of this is helpfully provided: allegedly those who quit smoking are more likely to eat fruit and vegetables. Conversely, people who regularly eat fried products are more likely to add extra salt to their food.

Smoking is the single greatest avoidable health risk factor. The WHO note that worldwide, tobacco consumption caused an estimated 100 million deaths in the last century and if current trends continue it will kill 1,000 million in the 21st century. Sadly, around half of all regular smokers will die from the habit, half of these in middle age. The NICE site does include guidance on the kind of self administered help that individuals can use to help them stop smoking.

As my waist line will attest, Christmas can also be a time of overindulgence, and many of my colleagues I have talked to this week have noted the need to start the New Year by trying to lose the extra pounds we’ve gained. Obesity adds nearly £1.9 billion in costs to the NHS each year. Again NICE provides plenty of advice on how to maintain a healthy weight. But one has to say that the advice is not half as interesting as that to be found on the GoodtoKnow Diets website. This website notes that if you have sex every night for a week you will burn off just less than 5000 calories in a month. Unfortunately you need to burn off some 3500 calories in order to lose each pound of weight, but it sounds like more fun than going to the gym.

And the GoodtoKnow Diet outcomes apply to both genders, although having fun together might be a little difficult. Research undertaken by Dr Terri Fisher a Professor of Psychology at Ohio State University discredits the somewhat persistent stereotype that men think about sex every 7 seconds, (which would amount to more than 8,000 thoughts about sex in 16 waking hours). It appears that men also think about eating and sleeping too. The study found that whilst young men thought about sex almost 19 times per day they also thought about food almost 18 times per day and sleep almost 11 times per day. Likewise, women thought about sex 10 times a day, eating 15 times and sleeping 9 times a day.

A different but related study led by Penelope Phillips-Howard of Liverpool John Moores University (and colleagues) examined the link between wellbeing, drinking alcohol and engaging in sexual activity. Their cross-sectional survey using self-completed questionnaires was conducted with 3,641 schoolchildren aged 11-14 years. The strength of the association between alcohol use and the prevalence of sexual activity in 13-14 year olds, increased incrementally with the higher frequency of alcohol use. Penelope’s first degree was in Nursing.

And in a symmetrically interesting development this week, Professor Viv Bennett took up her appointment as Director of Nursing in the  Department of Health and the Government's Principal Advisor on Public Health Nursing. Viv was previously the Deputy Chief Nursing Officer. This is a new post which will enhance the role of nursing leadership and replace the current role of Chief Nursing Officer in the Department of Health. This new role will see Viv acting as champion for health improvement at all stages in the life course; providing nursing advice to the development of social care; and provide professional nurse leadership for nurses, midwives and health visitors and develop and extend the public health role of all nurses. However, this will not be an easy job. Given the evidence above, Viv will have to work hard to ensure our young people are kept out of mischief.

Finally, sleep and sex combined in another story that made me smile this week. The story was about the 40,000 women in the UK who received breast implants, filled with a silicone originally intended for bed mattresses. 95% of these women had the breast enhancement operation for cosmetic rather than medical reasons. These implants were manufactured by the now-defunct French company, Poly Implant Prosthese, or as Jon Snow described them on the Channel 4 News programme last Friday, the company that’s gone bust.

Sunday, 1 January 2012

2011, the year of Uprisings (or Peri, Peri Chicken), that Impossible Question, an ex Midwife called Brenda, iPads and What We Still Have to Learn!

Welcome to 2012, a year some five hours old. Political and possibly also economically driven uprisings dominated 2011. In a new form of pan-national contagion, the phenomena of revolution has so far touched Tunisia, Egypt, Libya, Bahrain, Syria, Yemen, and many other countries in the Middle East. Colonel Gaddafi lost his life after a civil war in Libya, and in Egypt, President Mubarak, like many other people across the globe, lost his job.

Given this global phenomena I was not surprised to see that Nandos, the Peri, Peri Chicken restaurant chain launched a 45-second TV advert, called the ‘Last dictator standing’ in South Africa. This really bad taste advertisement opens with a Robert Mugabe lookalike wistfully picking up a Colonel Gaddafi place card from an empty dinner table. In a dream sequence he is then met by the deceased Libyan dictator who starts a water fight with a golden AK-47. It gets worse; Mugabe is seen partying with Saddam Hussein, South African apartheid leader P W Botha and former Ugandan president Idi Amin before the dream sequence cuts out. Nando’s 6-pack meal is then advertised in its place. Thankfully, I have it on good authority that Nando's have no plans to bring the advert over to Britain.

And I have to say I am with Dave (from Bridgend) and his observations on our own Peri Peri Chicken institution – the OCR (Oxford Cambridge and RSA Examinations). This leading UK awarding body is committed to providing qualifications that engage learners of all ages at school, college, in work or through part-time learning programmes to achieve their full potential. Unfortunately in 2011, 6800 teenagers in 335 School in England, Wales and Northern Ireland, were set a maths question that was impossible to answer in an AS-level exam.The question carried eight marks out of 72 being awarded for the paper and the OCR said it deeply regretted the ‘unfortunate error’ claiming it has a range of procedures in place to ensure candidates are not disadvantaged.

Disarmingly, (for those mathematically challenged  - such as myself), the OCR released full details of the error - in their paper ‘Decision Mathematics 1’: The question as printed asked candidates to verify the shortest route, for two given conditions, giving values of 32.4 + 2x km and 34.2 + x km. These values should have been 34.3 + 2x km and 36.1 + x km respectively. The error was not to have included twice the journey between A and B (0.9 km) and the journey between F and G (1.0 km) in the values given… …Hmm, as Dave said “Can't see what the fuss is all about. The question is worth eight points from a potential 72. Don't re-run the test, ignore the question and mark the paper out of 64. It's basic maths, not rocket science, although some people do like making life needlessly difficult”.

And ex Midwife Brenda set the example of reducing difficulty from one’s life with her simple strategy to secure a bargin chest of draws for her 20 year old grandson Joshua. She spent her entire 2011 Christmas camped outside a furniture shop so she could buy a chest of drawers for just £10 when it opened for the sales. Despite having her walking stick stolen by a partygoer 75 year old Brenda waited until 9am Boxing Day to pick up a chest of drawers reduced from £200 to £10 for her 20-year-old grandson Joshua. It’s to be hoped that Joshua appreciated the effort.

For me I hope the people of Edinburgh appreciated the efforts made on their behalf to put on the best possible firework display to welcome in the New Year. The effort gave rise to one of my favorite photos of 2011, superbly captured by photographer Jeff Mitchell and included in the Guardian news papers images of the year (now there’s a surprise Karen and Sarah). It was a photo of the 5.5 tones of fireworks at Edinburgh Castle ready for the city's Hogmanay celebrations, which were fantastic, unlike the slightly more modest display in Bolton last night which was based upon the half a dozen fireworks I saved from our 5th Nov celebrations.

However, sometimes less can be more. Zheng, a Chinese teenager was so desperate to acquire the new iPad 2 that he sold one of his kidneys for just £2,000 to pay for it. The 17-year-old confessed to his mother that he had sold the kidney after spotting an online advertisement offering cash to anyone prepared to become an organ donor. Trading human organs online is a common practice in China, despite repeated attempts by China's government to stamp out the practice. Last year Japanese television reported that a group of ‘transplant tourists’ had paid £50,000 each to receive new kidneys in China. According to official Chinese Government statistics more than a million people in China need a transplant every year, but fewer than 10,000 receive organs, driving an almost unstoppable black-market organ trade that enriches brokers, doctors and corrupt government officials.

Finally, I could not write a blog about 2011 on the first day of 2012  without mentioning the series of natural disasters we witnessed across the world this year - the tsunami in Japan; an earthquake in New Zealand; famine in the Horn of Africa; and floods in Pakistan and the Philippines. In our April School Development Day we remembered our colleagues and their families in Japan by observing a two minute silence while we watched the almost unthinkable scenes of devastation wrought by the tsunami.

During such times of crisis and disaster it is the United Nations Central Emergency Response Fund that provides the resources in those crucial few hours, where delays and lack of resources can mean the difference between life and death. However, not all members contribute in a way that reflects their inherent wealth. For example, selected CERF donors in 2011 made the following donations:

• UK - 60m
• Sweden - £74m
• Norway - £68m
• Netherlands - £54m
• Canada - £41m
• Spain - £20m
• Germany - £16m
• Australia - £14m
• US - £6m
• Japan - £3m
• France - £720,000
• China - £500,000

As can be seen, Chinas contribution amounts to no more than 10 kidneys being sold on the organ black market, or 50,000 chest of draws purchased in Bath, and goodness knows how many firework displays in Edinburgh or 1000 iPads– maybe we still have some lessons to learn in terms of where to spend our money.

And on this first day of 2012, I hope that you are able to make whatever dreams, goals, hopes and thoughts you have for the year come true and work for you and those you care for.