Sunday, 29 April 2012

Communication, Consultation, and a Cunning Couple

I was sent an email this week telling me that the College (of Health and Social Care) has a new Facebook site. This phenomenally successful social networking service is still only 8 years old. Today it has more than 900 million members and makes US$ 4 billion a year in revenue. The name comes from a more traditional form of social networking; it derives from the popular name given to the book given to students at the start of their studies in US Universities to help them get to know each other.

Surprisingly, I found I could have a quick look at the CHSC site without having to register, and I have now added this link to the blog. I say surprisingly, as I once a Facebook member, and as a consequence, have a user name and password, but these are long forgotten. I gave up membership on the basis that there are only so many things you need to know about what your children, nephew, nieces, brothers, sisters and work mates are up to.

I recognize the power such social networking has to bring people together, and as a form of communication, while not as good as F2F, it can be very effective in mobilizing large groups, something as a School we are hoping to do to celebrate International nurses day soon. And last week there was a fantastic example of just how effective such communication can be. From a Facebook call last Monday Norwegians flocked to town hall squares across the country to lift their voice in song last Thursday. Shocked by the lack of remorse shown by the far-right fanatic Breivik, whose rampage killed 77 people, many Norwegians appear to have decided the best way to confront him was to demonstrating their commitment to everything he loathes.

Driving home on Thursday I listened to a recording of the 40000 people in Oslo who singing along with Norwegian artist Lillebjoern Nilsen sang their version of the American folk music singer Pete Seeger's My Rainbow Race’, a song cited by Breivik as an example of how cultural Marxists had brainwashed Norwegian young people. As the voices of the Norwegian people filled my car with this beautiful song, I was both enthralled and totally captivated by the emotionality and effectiveness of their protest.

Of course Pete Seeger, now 92 years old, has long been associated with creating music and songs that have been central in many social justice issues that range from civil rights through to the environment. He sang out against the Vietnam War, and more recently with the protestors of the Occupy Wall Street protest in Manhattan. I guess many people will, like me have, learnt how to play and sing his most famous song, ‘where have all the flowers gone’.

With such proof positive of the power of mass communication, I was amazed to see those somewhat self important people at the RCN announce that they were ‘hosting’ a commission to review nurse education in England. And it seems they are doing so without first obtaining a mandate from their members that this is a good and appropriate use of their resources. I am not a member of the RCN so I didn’t expect to be consulted, but I guess there might be a number of people, in what has been described as the worlds largest nurse trade union, (many who pay an almost £200 annual membership fee), who might justifiably have thought it would been appropriate to have been asked.

RCNs Pete (Carter not Seeger) asked Lord Willis to be the independent chair for this hosted commission, and he has agreed to do so. Of course it is our Phil, long term supporter of Burnley Football Club (Champion not Premier League) and retired MP, who thought it might be good for research in the UK to concentrate all our efforts into no more than 30 Universities. he felt all other Universities should merge with Colleges of Further Education to deliver the high quality skills’ training the UK is desperate for. This sounds like just the man to lead a review into the education of the graduate only profession of nursing.

Now our School was one of the first in England to gain approval from the NMC to run an all graduate programme of pre-registration nurse education and training. The first cohort started in September 2011, the second in March 2012. And I am very happy to speak out on what is right about the way we prepare nurses for practice, but actually I am more inclined to do so to the Nursing and Care Quality Forum whose work was announced on the 17th April. If you feel you would also like to make a difference you can by going to:

The cunning couple? Well not Pete and Phil, but two juvenile foxes who have kept Cello almost on constant fox watch last week. The pair have been seen cavorting on the front lawn in the early evening. However, Jemima, sitting on her nest of 19 duck eggs, remains safe from the intentions of these 2 unwelcome interlopers. Not so sure about the future of nurse education though.

Sunday, 22 April 2012

Third Time Lucky in finding New Ways to Walk the Talk

It's been a very wet start to the day with heavy rain showers since 03.30. It does not bode well for an outdoor type of day. However, I am not that bothered, today I won't mind staying indoors. Yesterday after  a great deal of procrastination on the part of a high street supplier of electrical goods, who I will call Computer Universe to protect their anonymity, I finally took delivery of the new iPad.
With its breakthrough Retina display, 5-megapixel iSight camera and ultrafast wireless, this new machine is said to be more immersive than ever before. And I have to say I am impressed. From opening the box to sending the first email took just 5 minutes. All the files, apps and emails were instantly downloaded from the iCloud. The battery was 94% fully charged. This new machine allows me to do more things than any other computer I’ve owned. Given the migration issues I and colleagues have recently endured at work, this personal IT transformation was absolutely remarkable.
Of course what I was part of is a technological revolution that even the greatest names in communication have found hard to keep up with. It was the Finnish company Nokia who were one of the key developers of what we now all take for granted, GSM (Global System for Mobile Communications). GSM came to dominate the world of mobile telephony in the 1990s, in mid-2008 accounting for about 3 billion mobile telephone subscribers in the world. The first mobile phone I ever owned was a Nokia.

Nokia is a company dear to my heart. When I first went to Finland to work with nursing students undertaking their degrees in English, Nokia formed the key stone of Finland’s economic, sociological and technological prosperity. Sadly last week Nokia’s share price tumbled more than 3.5 % (to close at €3.63) on the posting of yet more losses. It has been losing the battle against rivals such as Apple's iPhone and mobile phone makers using Google's popular Android software such as HTC. Last week Nokia confirmed plans to cut 3,500 jobs worldwide, including 1,000 out of 1,700 factory jobs in Finland.

Now one of the apps (Mother, an app is short for application software designed to help the user to perform a specific task) I downloaded onto my new iPad (sorry Nokia) was the iFootpath. This app priced at just 69p (and there is an almost tantric symmetry to these numbers) enables you to download free walking guides, complete with photos and landscape directions, background information and so on. The coverage of walks from your front door to the rest of the UK is fantastic, but it’s not always been like that.

This weekend hundreds of walkers will be retracing the steps of those who took part in the Kinder Scout mass trespass. On April 24th 1932, about 400 ramblers set off from the Bowden Bridge quarry on intent on trespassing on to the Duke of Devonshire’s land to reach the Kinder Scout plateau. Half way up they encountered the Duke of Devonshire’s gamekeepers who, after a brief fight, turned the trespassers back. 6 of this group were tried and sentenced to between 2 and 6 months imprisonment.

Their arrest and subsequent imprisonment was a catalyst for a huge wave of public sympathy, and a few months later 10,000 ramblers – the largest number in history – assembled for an access rally in the Winnats Pass, near Castleton, and the pressure for greater access became unstoppable. However it took until 2002 before the Rights of Way Act opened up the countryside completely and absolutely to walkers. And over the past 10 years I, like many other walkers have enjoyed this freedom.

However, the fact that I can use my newly downloaded app to fully enjoy these hard won freedoms to roam brings with it other problems. This week the Daily Telegraph reported the story of a coffee seller in Norwich who refused to sell a customer his single latte because the customer was using his iPhone. The Nursing Times also ran a story about the series of articles this week in the Independent on nurses most of which were fair handed in their analysis of contemporary nursing. But there was one story that picked up on the number of student nurses who have to be told not to text while they are attending their patients. The availability of new technologies, particularly those around communication, raises new issues for us to find answers to, in terms of how we build and sustain our relationships with others. My belief is that in nursing relationships are everything.

And in a week where new communication technologies have been understandably contested in Norway, I took my hat off in respect of the quietly spoken but brilliantly effective prosecutor Inga Bejer Engh. This week she has so refreshingly reminded us all that the spoken word, simply and confidently used, is far more powerful than any form of evil can ever be.

Sunday, 15 April 2012

Not so Much Care in the Community as Care in a Cubicle

Well I enjoyed my holiday at home week. Although the weather wasn’t always kind, some much need TLC was lavished on the gardens, the long list of outstanding household jobs has been reduced to a very short list, pub lunches were consumed, books read, Cello had his hair cut, friends and family visited, first ducklings of the year seen at high Rid and all the Easter Eggs finished off. There was also no excuse for me to not catch up on attending to neglected health issues. Of course I admit to contributing to the evidence base that shows men, in general, are 20% less likely to visit their GP than women. In fact ‘50 something’ men are the worse culprits. But if my experience this week is anything to go by, it is not surprising that men maybe reluctant to seek help.

My appointment, made on line some 18 days before, was for precisely 10.10am. And although my reasons for the appointment were not life threatening, just an irritating flare up of a form of eczema, caused by a chronic and longstanding circulatory problem in my legs, at 10.40am I was still waiting to be called in. The man sitting next to me had been waiting for 60 minutes (but in fairness he didn’t own a computer and didn’t realise that these days an appointment was required). He was still sitting patiently when 6.5 minutes later I left the practice clutching my 2 prescriptions.

In that 6.5 minutes my GP told me I couldn’t have the treatment I wanted as (1) it wasn’t advocated in the best evidence to date, (2) the NHS was running low on funds and we all had to do our bit. So much for consumer and patient choice, especially so when I thought of what I had done to help prepare a generation of doctors to treat such a condition.

Some 33 years ago I had been stood on a table in a room full of medical students, my legs covered with felt tip pen tracks that traced my veins. For the next 40 minutes I endured the medical students taking turns to inject my varicose veins before each leg was tightly bound with compression bandages. I can recall not being able to take a bath for weeks and having to walk 5 miles each day until the bandages came off. These days the preferred approach is steroid cream for the eczema, and compression stockings to be worn daily. And unless the legs become infected that’s all my GP would do. So I dutifully took my prescriptions to Tesco’s to get both filled. The steroid cream was no problem, but the stockings had to be ordered.

The pharmacist was apologetic on 2 counts – that she had to order the stockings and that I would have to pay for each item (1 pair of stocking do not 1 item make). The current prescription charge is £7.65 (but this equates to £15.30 for a pair of elastic hosiery). As my GP had helpfully prescribed 2 pairs of stockings (presumably so I would always be able to wear a pair even when a pair was in the wash) the total bill came to £38.25. However, included in this price was a private consultation and personal measuring session in a made to measure state of the art health care cubicle. I was impressed.

During the week I had read a PhD thesis on 'compliance and coercion in mental health care', and my experience did make me think of the impact on treatment compliance of such a high total prescription bill. England is the only one of the 4 countries in the UK to make such a charge. The Department of Health says that scrapping the charge in England would result in a shortfall of some £460 million a year (I can see where my GP was coming from now with his cunning approach to prescribing). In 2011 prices this money would buy nearly 18,000 nurses, or 15,000 midwives, or over 3,500 hospital consultants. I don't know how many Tesco employed pharmacists the money might also buy.

And these numbers, more so than the cost of my prescription, made me think of what the potential loss of that number of health care personnel might mean in terms of health promoting opportunities. Those working in the health sector (which increasingly has to include supermarket provided health care) have an unique access to the general population. According to the Institute of Health Equity (who last week launched a consultation on the role of the health care workforce can take in positively influencing the social determinants of health and tackle health inequalities) the NHS deals with 1 million patients every 36 hours. That’s 463 people a minute or almost 8 a second.

Each week, 700,000 people will visit an NHS dentist, 3,000 people will have a heart operation, and each of the 40,000 GPs employed by the NHS will see an average of 140 patients a week. There are some 1.4 million people working directly for the NHS. Additionally there has been a 60% increase in supermarket pharmacies in the last 12 months, and 20% of all prescriptions are filled at supermarkets. Such supermarket provided services offer an increasingly diverse range range of health care advice and services.

Like the Institute of Health Equity, it seems to me there is huge potential to influence health inequalities through the contact health care professionals have in both their direct patient contact at key points across the full life course (before, during and after birth and at times of illness). Despite Shipman, and Allitt, most health professionals are highly trusted and every encounter is an opportunity to promote good health and well being and take action on addressing the cause of cause of health equalities.

And I haven’t always been a '50 something' male statistic, health promoting health care professionals is a cause dear to my heart and if you want to know more see:

Holt M., and Warne T., 2007 Pushing at an open or closed door: Training Pre Registration Student Nurses as future Health Promoters. Nurse Education in Practice 7 373 – 380

Carlson G., and Warne T., 2007 Do healthier nurses make better health promoters? A review of the literature. Nurse Education Today. 27 506-513

Warne T., and McAndrew S., Health promotion and the role and function of the nurse. In: D. Whitehead & F. Irvine (eds) 2009 Health Promotion and Health Education in Nursing: A Framework for Practice. Palgrave MacMillan, London
And I am sure, like me you will all start to see BOGOF ‘care in the cubicle’ offers at a supermarket near you soon.

Sunday, 8 April 2012

Being on Gardening Leave and the Mystery of the Big White Egg

I am writing this blog posting on Easter Sunday 2012. The Easter bank holiday weekend marks the start of a week’s Gardening Leave. And don’t worry; I am talking semi-agricultural and or maybe botanical and not anything organisationally sinister and terminal. Thus this is a very short blog as I am itching to get outside and continue what I started on Friday and Saturday, albeit that Mother Nature seems to be doing a grand job without any help from me.

But the green house is cleared and cleaned, the grapevine that has permanent residency in it, has already started to bud up, ready to burst into life. The raised beds are cleared ready to be planted; the seeds have germinated and survived last week’s frosts. The lawns have been scarified and already the summer green is beginning to show through the winter lack lustre look. The slightly shaggy end of Winter beginning of Spring look that has typified the hedges these last few weeks has gone. They are now trimmed to perfection and stand as proud guardians against unwanted visitors whilst at the same time providing luxury homes for the gardens bird life.

The weather is set to be sunny and Spring like again today, so one would think that all was well here. And up until yesterday morning I might have agreed. However, when feeding the chickens yesterday morning, I noticed that Jemima’s (as in Puddle Duck) huge nest contained a big shiny new white egg. Now I have a parrot, chickens, a little black bantam, and a Duck who thinks she’s a Chicken, but nothing that is capable of laying such a huge egg. How it got there is a mystery. But I am on holiday and I do like a good mystery...

...and if like you me you are also off for a few days over Easter, I wish you a very happy, relaxing and egg-citing time.

Sunday, 1 April 2012

H&SCB Becomes Law, Never mind Petrol, Stock up on Peanuts or Pasty’s, and That Red Bikini Again

Last week there was so much going on that at times it felt as if I was caught up in a whirlwind of change, and with some of these changes passing me by completely. One change I did notice as it occurred was noting that some 2 years after first seeing the light of day as Equity and Excellence: Liberating the NHS, the UK governments sometimes controversial Health and Social Care Bill was finally passed into law. Getting to this point broke many records. The bill had been in parliament for some 14 months, and endured 50 days worth of debates – this was by far the greatest time given to scrutinizing a new Act of Law. It took longer than the time taken to ban fox hunting with dogs, and like that Bill, at times, tempers often ran high. The Royal Colleges for the various Health Care Professions were universally opposed to the proposed changes. The Times newspaper ran a story that reported several Conservative MPs as saying Andrew Lansley should ‘be taken out and shot’.

Following the H&SCB becoming an Act, the man himself wrote to all the NHS staff thanking them for their hard work over the past year. In the one and half pages long letter, he reminded them that the Act ‘explicitly supports the core principles of the NHS’ – care provided free at the point of use, funded from general taxation and based upon need, and not ability to pay.

The letter also referred once more to the ‘no decision about me, without me’ principle. I am a member of the Citizens as Scientists Steering Group. This group aims to involve individuals of all ages from all communities, (that is the man, woman and child on the Salford Tram), in health and social care research. This group is not just aiming at involving people in large trials, but also in smaller more qualitative research projects. At last week’s meeting, we were looking at the website being developed, and I was reminded that we had adopted the Lansley NDAMWM to use as a principle for the groups work: no research about me, without me’.

One change that passed me by somewhat was the panic buying and stocking piling up on petrol. My daily routine means that on my journey into work I tend to listen to Farming Today, and most days reach work just as the 06.00 am BBC Radio 4 News headlines come on. This week, I must have been travelling slightly faster, because I missed the news. So on Thursday morning I was surprised to find the local garage coned off. However, listening to the news coming home that night, I became aware of the fuel crisis gripping the nation. Strangely when I called at my local garage I didn’t find any queues, and was able to fill up without problem.

The same news programme also talked about the other major news story gripping the nation, the new tax on pasty’s and other hot take away food. Yesterday I read an amusing story in the Guardian that speculated on how unworkable this new law was likely to be (the Pasty Tax not the Heath and Social Care Act), but it is too complicated to present here. Ann Muller has run a pasty shop in Helston, Cornwall, for more than 25 years. She claims this is basically a tax on the ‘working man of Britain’ (maybe women don’t eat pastys) and for the many elderly and unemployed people who come to her shop very lunchtime for a pasty. Mrs Muller intends to put a sign in the window proclaiming ‘hot for the rich, cold for the poor’. Interestingly I could not find any commentary on the potential positive impact there might be of the Pasty Tax on the UKs growing obesity problem.

The real ‘shortage’ story of the week was peanuts. I buy peanuts for the birds by the sack. Yesterday my local pet store didn’t have any, and advised even if they did, a sack would now cost £37! Off to the Tesco’s (yes there are other supermarkets that also sell pet products) but they only had 2 small bags priced at £10 each, Pets R Us had many even smaller bags of peanuts, but at £6.99 I thought these uber expensive. It appears that a combination of drought and failing crops across the world has meant peanuts are in very short supply. The price has tripled since October 2011 - which is just as unfortunate for people living in the US, where $800 million worth of peanut butter is consumed every year, as it is for my garden birds and squirrels. But again, in a perverse way, the shortage might be beneficial in terms of the world’s obesity problems.

Someone who clearly doesn’t have an obesity problem is Helen Mirren. Yesterdays Telegraph ran a story on the dispute she is having with a neighbour in Puglia, Italy. This revolves around renovations and a new garden wall being built to a house she has there. However interesting this story may have been in its own right, the Telegraph took the opportunity to reproduce that now iconic picture of Helen taken in 2008 when she was 63, wearing that Red Bikini. She later donated the bikini for auction as part of the Age UK’s Spread the Warmth campaign. This campaign aims to help prevent the deaths of up to 200 older people a day during periods of cold weather. And unfortunately, the wonderful sunshine of last week has once again given way to some bitingly cold days here.