Sunday, 28 July 2013

Basingstoke Booze, Belle de Jour, Boris and his Blue Cock

Our VC came to spend some time with colleagues at last Fridays, School Congress and School Development Day. It was good to see him, and he had warm words of thanks to share with colleagues for the way in which the School delivered consistently against all our performance targets. The School Congress usually begins with me presenting an analysis of our internal environment (changes we need to consider as a School brought about by changes in the College or wider University) and of our external operating environment – our world as I like to describe it. The latter is usually the consequence of spending time scouring the latest policy documents, thinking about notes I've made at ‘ideas meetings’, Twitter chatting, and Google searching contemporaneous words or phrases to see what is being said about health, health care, social care in a post-modernist society.

This type of search throws ups many interesting bits of information, some I can use and others that for various reasons wouldn't be as appropriate for a School Congress presentation. But I keep it all, just in case. This week’s blog draws upon some of this 'just in-case' information, and as my Mother is in hospital recovering from an operation, and unlikely to read this week’s blog, I don’t need to warn her that you might need to be over 18 to read it.  

Now it appears that Basingstoke Hospital, (part of the Hampshire Hospitals NHS Foundation Trust) are considering making wine and other alcoholic drinks available to their private patients between the hours of 10am10pm, 7 days a week. Whilst this wouldn't appeal to my Mother, who is in Welsh hospital (no not the one said to be dangerous by its own consultants this week Dad), and whose annual intake of alcohol usually consist of a small sherry on Christmas Day, but I guess it might appeal to many other patients. Donna Green, the Trust Chief Operating Officer, apparently quick to reassure critics, notes that patients would only be served alcohol if it was medically appropriate. You can see the guys at DSM5 licking their lips with yet another medically determined disorder to add to their growing list of the bizarre.

However, it was a non-medical Doctor who caught my eye last week, one Dr Brooke Magnati, to be precise. She has studied anthropology, and mathematics and has a doctorate in forensic science. She was also once known as Belle de Jour, and if you haven’t read her books, you may well have seen her TV programme staring Billie Piper. Regular Telegraph readers will of course know her writings, and it was an article last week that caught my attention. She was responding to David Camerons declaration of war on internet pornography. It appears he wants internet companies to ban all porn from their sites unless individuals opt in to view such sites (presumably at a cost).

In her article, Dr Magnati successfully challenged the assumption that it was likely to be only men who would want to opt in to these sites as its only men who watch porn. Using statistics from Google, she was able to show that women seek out such material too. Although the search terms used are slightly different and men slightly outnumber women in making searches, what the statistics clearly show is the way in which the internet has helped remove the stigma for women who seek out erotica. However, whilst having to provide ID to access such sites is unlikely to deter men, Dr Magnati suspects it will put women off, and they will simply go back to the lo-fi option: the paperback shelves.  

Thanks to all those who sent me links to the chicken story of the week – much appreciated as I did not pick it up on my radar – the story was about our favourite Mayor- Boris, who last week presented the latest exhibit of the fourth plinth at Trafalgar Square‘it’s a ginormous blue Hahn Cock’ he said after promising no ‘double entendres’- and it is too. The 5 metre tall vivid blue cockerel represents regeneration according to the German artist Katharina Fritsch who created it. I thought it was stunning, however, Boris like me, thinks that unfortunately, if you were to try to Google it in the future, Cameron’s new internet porn policy would probably stop you from finding it!  And Mum, I know you will have read this post, so get well and feel much better soon. 

Sunday, 21 July 2013

Walking the Great Wall of China and Other Ambitions

I was once given a book for Christmas that had a title something along the lines of 500 things to do before you die, I recall leafing through the book and being mildly surprised at the number of things I could already tick off: flying down the Grand Canyon, coffee at the top of the Eiffel Tower, riding a Japanese Bullet Train on the way to Mount Fuji, hearing the cry of your own peacock in the early morning; seeing the onion shape topped buildings at the Kremlin, taking a smoke sauna, riding on the Maid of the Mist under the Niagara Falls, seeing the big five animals in the Serengeti; paragliding in the Lake District; making my own goats cheese and so on.

One ambition I hadn't fulfilled when reading the book was walking on the Great Wall of China. I finally had the opportunity to do this back in 2009.  I can remember the sense of history that pervaded the wall, the stones worn smooth by the marching of thousands of soldier’s feet, the sheer size of the construction and the skill and imagination to both conceptualise and bring the project to fruition. Although these days parts of the wall are in disrepair many sections have survived well since it was first constructed in the 16th century. It was a fantastic experience and one that I can recall with great vividness, and that’s what realising ambitions should be about.

I mention ambitions as last Monday the Keogh Review Report was published. The review was commissioned in February this year following the publication of the Robert Francis Public Inquiry into the poor care provided by the Mid Staffordshire NHS Trust. The review was led by Professor Sir Bruce Keogh, a former Cardiac Surgeon and now National Medical Director for the NHS in England. His review looked at the quality of care and treatment provided by 14 trusts identified as having higher than average death rates in the 2 years prior to the start of the review. 11 of the trusts reviewed are to be put under ‘special measure’ in order to improve governance.

The report has been described as 61 pages of common-sense, truth, courtesy, concise and clear analysis, doable fixes, and ambition. And I would agree. It’s a great read and shows what can be done with the right data, commitment and conviction. There are 8 ambitions outlined in the report: a new national indicator on avoidable deaths; more informed (by data) commissioning; increasing patient and public involvement in the design and assessment of local NHS provision; increasing confidence in Care Quality Commission assessments; ensuring that all health care services are fully professionally, academically and organisationally integrated; nurse skill mix and numbers to more appropriately reflect the severity of the health care need in the patients being cared for; reposition medical leadership at all levels of clinical experience and knowledge; developing a culture that results in happy and engaged staff.

I welcomed them all, but perhaps like you might have felt when reading about my ambitions at the start of the blog, some of Keoghs ambitions resonated and some didn't – I am not sure, for example we are ready for any more medical leadership, although perhaps this ambition is about the medical profession benefiting from recognising and harnessing the energy and enthusiasm of some of its more junior member’s. Likewise, I am sure as a School we will be asked to take even larger numbers of students for pre-registration nursing programmes, although goodness knows where we will put them! However, I did like the ambition of creating a culture that resulted in happy and engaged people. Mind you if you want to see just how big an ambition this might be, spend a few moments looking at this happiness map 

Sunday, 14 July 2013

Yellow Fever Blues Vanquished

I am off to Nigeria in a few weeks' time on a University mission. We had been asked to help develop nurse education for Nigerian nurses. I was given a list of things that I was required to do and had to tick the boxes as each requirement was completed. One of these was to get a Yellow Fever vaccination and Certificate in readiness for acquiring a visa. Google said I could only get the vaccination at a special travel clinic, but fortunately there was one not far from where I lived.

I rang up and made an appointment for 08.00 and turned up on day 10 minutes early. I enjoyed a lovely early morning conversation with a wonderful pharmacy assistant who told me she had been preparing and filling prescriptions since 07.30. 08.00 came and went and there was still only me and the pharmacy assistant in the room. 08.10 appeared on the clock and finally the reception blinds went up and I was asked 'what I wanted'. I politely pointed to the clock, now showing 08.15 and said 'I had a 08.00 appointment for a Yellow Fever vaccination'.

After giving her my name she looked on her computer, which apparently said No, and she said 'I didn't have a 08.00 appointment'. It was a moot point really as the clock now stood at 08.18. After another few minutes of looking a scrap of paper was found with my name and details on it which appeared to confirm I did have an appointment and I was ushered into the treatment room to meet Sister Sandy. Her clock said 08.25. 'I'm off to Nigeria shortly and I am here for a 08.00 appointment to have a Yellow Fever vaccination' I said.

'Well fill in this form while I look up whether visitors to Nigeria require a Yellow Fever vaccination or not' Sister Sandy said. I was handed a form that asked for my temporary address and my permanent address. Now I don’t have a temporary address so used my office number and the name of the University building instead which seemed to satisfy Sister Sandy. At 08.32 she told me I didn't need a Yellow Fever vaccination to visit Nigeria. Now I am not someone who easily becomes exasperated but this was the second time in as many minutes a computer had said No.

I told sister Sandy that 'I had an instruction from my University that says get a Yellow Fever vaccination, I don’t want to end up at a border having goodness knows what pumped into my arm and being charged £500 for the privilege - so let’s do a deal'. Using my most persuasive voice I said, 'I will give you the £60 and you just give me the vaccination and we can all go our separate ways happy'. Glaring at me in silence she gave me the vaccination and at 08.40 I left her treatment room and went to pay for it.

The receptionist said she would prefer it if 'I paid by card', but when she tried to connect, for the third time that morning a computer said No. So I paid by cash, got the certificate stamped and at 08.55 finally left the surgery. Being a man, I hadn't looked at the instructions for Yellow Fever vaccination before having it done and it was only after spending 24 hours feeling nauseas, enduring a pounding headache, aching limbs and also generally biting everyone’s head off, that I went n-line and discovered these were fairly common side effects. 

Much to my horror I also discovered that 4 in every 1 million vaccination doses given results in a neurological condition known as yellow fever vaccine-associated neurological disease (YEL-AND), a particularly nasty disease. The risk for those who are 60 years or over is much higher, 1 in every 50,000 people. This represents the highest risk of any vaccine currently in use. But I wasn't going back to see Sister Sandy to discuss this.

Thankfully, as I write this, some 78 hours after having the vaccination, I am feeling much better. Apologies to anyone whose head I might have bitten off since the middle of last week. Normal service is resumed. 

Sunday, 7 July 2013

Forget CBT, What’s the Story Morning Glory?

I was going to write this week’s blog around Cognitive Behavioural Therapy (CBT). I have been questioning the absolute mainstream support for the power of CBT in all its forms to resolve all our mental health problems. I have always argued that it has its place, but the almost panacea status afforded it could not be right. But I am afraid that if you want to find out why I was going to write about CBT, you will have to attend my teaching session on the 19th July at 14.00  - but what I can say is that is sometimes great to be right! It was sitting in the sunshine on Friday evening playing catch up with my week’s emails that changed my mind.

A noticed a number of re-occurring themes in many of the emails. They were often being sent by people in the University that I simply did not know, and yet these people all felt empowered to tell me that ‘I had do this or that’, and ‘I had do this or that’ by ‘such and such’ a time. Although often there was not an ‘or else’ concluding statement, the tone of many of these emails conveyed that what was being asked of me was not up for negotiation. 

Perhaps the authors of these emails are the aspiring managers of the future. I know not. I do know that my first ‘managerial’ position was in 1972, as a management trainee for JS Sainsbury. I was 17 years old and of course knew it all, in fact I knew everything there was to know. Of course, the ensuing 40 years have shaped my approach to working with others. I long ago realised that organisational position didn't count for much. Yes you can tell people to do things and they will because you hold a higher position in the organisational hierarchy than they do. But this approach often does not result in effectiveness. I am more interested in how people do things and what I can do to enable ensuring we get the best from others.

Last week, I came across a wonderful paper in the Harvard Business Review, by Amy Cuddy, Mathew Kohut and John Neffinger entitled Connect then Lead. It’s a paper I strongly recommend is worth reading. They explore the notion our old friend Machiavelli possibly had it right, OK, partly right when he said we judge others, in particular our leaders, by first looking at 2 characteristics: how loveable they are (their warmth, communication or trustworthiness) and how fearsome they are (their strength, agency or competence). Of course we can argue about how such traits are best described, but I like the notion of warmth.

And why are these traits important you may well ask? Well in many organisational situations they answer 2 fairly critical questions: ‘what are this persons intentions toward me?’ and ‘are they capable of acting on those intentions?’ – I think that together, these questions underlie our emotional and behavioural reactions to other people groups and organisations. For me, warmth will always trump fear.

Fear can be psychologically constraining, and how we respond to a fearful challenge can be equally constraining. Unfortunately, we often don’t realise this and can be seduced by other elements. I was reminded of this yesterday morning when out walking with Cello. I came across an absolutely stunningly beautiful example of a Convolvulus arvensis or in layman’s terms ‘bindweed’. This is a species of bindweed in the morning glory family (Convolvulaceae) which although producing very attractive flowers, is a most unwelcome inhabitant of our gardens.

Bindweed competes with others for sunlight, moisture, and nutrients. It chokes out grasses and those plants we love to cultivate in our herbaceous borders. It is one of the most serious weeds of our agricultural fields, and food supply. Wearing my public health hat, a good healthy food supply is essential in ensuring a healthy community. I don’t do analogies, so reader, please don’t read anything untoward into my morning story of bindweed...