Sunday, 28 September 2014

A holiday full of promises, promises, promises, and erm, chickens!

Today is day 1 of my holiday. I am sitting writing the blog at the House in Scotland. Its dark, but the early morning sky is already showing signs of the days awakening. I have been looking forward to the weeks break, and to be frank, I was ready for it too. The last week was a real mixture in terms of issues, news and points to ponder. For example, Tony Blair, former Labour Prime Minster was named as being one of the top gay icons of the last 30 years by Gay Times. The German National Ethics Council voted to end the criminalisation of incest between siblings (the Max Planck Institute estimates that 2 - 4% of Germans have had an incestuous experience), and the week was also dominated by the aftermath of the resounding No vote in the Scottish Independent Referendum.

It’s also the UK Political Party Conference Season of course, which doesn't help. Yesterday UKIP, who the Guardian newspaper described as having a 'raw energy' that is missing from the main establishment parties, finished their conference. As well as the demands to leave the EU (we love Europe, but not the EU) scrapping tax for those on the minimum wage, there were calls for a revival of the coal mining industry, a better deal for ex-servicemen and women, and for NHS nurses. I am sure it pure coincidence but the UKIP conference was held in Doncaster, the Labour leader, Ed Miliband's parliamentary constituency.

Last week he led the Labour Party Conference, held in Manchester, thankfully without the 'ring of steel' that protected the Conservative conference when that was held in Manchester last year. Like UKIP, the Labour Party was also setting out their plans for the NHS. It was a £2.5bn 'time to care' fund which could result in 20,000 more nurses, 8,000 more GPs, 5,000 more care workers and 3,000 more midwives by 2020. It’s an interesting ambition. Currently the NHS educates and trains some 22,000 nurses a year. Universities are currently calling for a major review of the funding model underpinning the education for health care professionals. The current model is not financially viable. It’s likely that to get 20,000 additional nurses the UK will once again have to go out to other countries and recruit overseas nurses, with all the potential impact that has for their own health care systems. To become a GP will take 5 years for a medical degree, 2 years of foundation general clinical practice and 3 years specialist GP training = 10 years.

So we shall have to see what they are able to do – of course Labour need to win the next General Election first. The Conservative Party have gone to Birmingham for their conference. The Council Tax payers of Birmingham will be pleased to know that this has cost them a mere £1.48m. The conference is due to start later on today. Like UKIP and Labour, it’s likely that EU (in particular the Court of Human Rights) will feature, as will the NHS, and post the Scotland question, the possibilities for greater devolution and independence for other regions across the UK.  

The other main party, the Liberal Democrats are due to hold their party later on in October – in Glasgow (an independent Scotland Yes stronghold) which is about all I can tell you about their conference. I did read of the recent study undertaken by psychologists in the US who suggested that Liberal Democrat party members are a much unhappier than Conservatives. The paper was published in the American Psychological Association’s Journal of Applied Psychology, so it must be right.

And last week we heard the sad news of the death of a fabulous character whose life was jammed packed full of differences, contradictions, excitement, great highs and lows and above all else, chickens. Deborah Cavendish, Dowager Duchess of Devonshire died aged 94. Visiting her wonderful home (Chatsworth House) and reading her books gives you a glimpse of her life, but I would have really liked to have met her.

One of her sisters married Oswald Mosley; another renounced her privileged background, becoming a communist before eventually becoming a civil rights activist in the US: sister Pam, lived a quiet life in the countryside, and brother Tom was seldom mentioned. Deborah herself published her memoirs in 2010 (Wait for Me) – it’s a great read and full of detail. Her Father didn't send her to school because he disapproved of over educating girls and he thought that hockey would make their ankles fat. She was close to JF Kennedy, was a familiar of Churchill, attended the UKs Queen’s coronation, and apparently had tea with Hitler when she was a teenager. Her husband struggled with alcohol misuse. She is reported as being very relaxed about her husband’s many infidelities saying that 'although he could be difficult at times, he was never boring'. However, her overwhelming interest, right from a young age, was chickens. In my eyes, as the No 1 contender for having the worlds greatest collection of all things chickens (Guinness Book great) she was special. So carry on politicians one and all, me, I am getting off the merry-go-around for a week, and intend to sit in my garden in the House in Scotland and re-read Deborah’s books. 

Sunday, 21 September 2014

Staying the Course: 549 days done, 549 days to do

I was sent a tweet last week from one of our students. She reminded me that 549 days ago I had welcomed her to the School at the start of her journey to becoming a nurse. She said she has 549 more days to go before that ambition is achieved. I am sure, like many others, she will get there and join a profession that continues to develop its knowledge and skills base. More than ever, greater numbers of students complete their studies.

It is inevitable, and probably desirable that there is some attrition, but there are good reasons to see retention of good students as a high priority. According to the Nursing Standard, in 2006 the national attrition rate was around 26%. Back then, this was estimated to cost the NHS some £29 million a year. By 2011, the Nursing Times was reporting some improvement however, with a national attrition rate calculated to be 18%. Calculating the actual rate of attrition is complex, partly due to the fact that students can take up to 5 years to complete a 3 year programme. And some will take this long – for example, stepping off because of pregnancy or perhaps because they have failed to progress academically.

What is easier to calculate is the number of students who never start their second year. In 2011 this was 1.6% (compared to 4.5% in 2009). I think there are many reasons for this reduction. It reflects the level of qualifications we now expect applicants to have achieved before they start and the enhanced recruitment processes we use. Like other Schools, we have adopted a values based approach and we involve colleagues from practice, and service users and carers in the recruitment of our students. With over 6000 applications for 700 places, it is true to say that we have been in the businesses of selecting our students rather than simply recruiting.

Since 2011 we have sought to deliver our new all graduate curricula in creative and challenging ways. We have introduced the 'flipped classroom', and perhaps most importantly have focused on the degree of support students receive from colleagues in the University and in practice. This has included offering enhanced pastoral care, and financial and health support to students. The majority of our students are not your average 18 year old undergraduate, but mature students, often with families and having to juggle studies with a range of other responsibilities.

Robert Francis investigated the concerns of the quality of care available to patients in many hospitals and at Mid-Staffordshire Hospital, in particular. He drew attention to the fact that there were not enough nurses in the NHS, and not enough nurses who were committed to providing compassionate care. Leaving aside that health care is usually provided by a range of different health professions the response from the UK Government was to look at how best to increase the numbers of nurses in the workforce and how to make all nurses more compassionate.

 The Secretary of State for Health, Jeremy Hunt response to the ‘apparent’ shortage of nurses was not to provide additional commissioned student numbers, but to blame Universities for not keeping enough of the student’s on their programmes. At the same time, the Chief Nurse for EnglandJane Cummings set out her 6 C's stall. She advocated that all nurses underpin and inform their practice with: care, courage, competence, communication commitment, and compassion, and that these 6 values should be embedded in University curricular.

Additionally, there was the highly contested ‘spend a year in practice’ idea. This approach suggested that all would be student nurses should spend up to year working as a health care assistant or an equivalent in a care setting. According to the Nursing Times, the pilot of 165 such potential students was costing around £11,000 per applicant. If this cost was rolled out to the nearly 20,000 students who start their nurse education and training every year it would cost the NHS some £225 million. Likewise, in May this year the Minster of State for Care and Support, Norman Lamb suggested that new recruits in to social care settings would need to achieve the so called ‘Care Certificate’

Whilst of course it might be a good thing to enable potential nurses and care workers of the future to gain some hands on experience before they start their training, neither of these approaches has an evidence base that might suggest they will either increase an individual’s sense of compassion or indeed, result in higher rates of student retention. I think that being and caring for others is what brings people into nursing as a profession. It’s a range of other factors that are more likely to contribute to students making the difficult decision to leave their programme. Tomorrow I will welcome another 1000 students to the School as they embark on their own personal journeys. Hopefully like the student who tweeted me last week, for many of them there will be at least 549 reasons for staying the course. 

Sunday, 14 September 2014

My Dog Day Thoughts of a Spirograph Dame in Estonia

Last week turned out to be a bit of a Spirograph working week. I would normally say at this point that younger readers wouldn't know what I was talking about. However, as Spirograph was re-launched as a toy in 2013, I guess all will know what a Spirograph is. It was Toy of the Year finalist in 2014 nearly 50 years after it won this accolade in 1967. This was the year my parents gave it to me as a birthday present. I can remember being fascinated by the cogs, wheels and little pins with red plastic caps (now replaced with H+S compliant sticky putty) which when used with care, could produce fascinating line drawings.

The drawings were created by having a circular fixed point, around which one could rotate different size wheels with offset holes drilled in them which produced pictures where the connecting lines formed the most amazing hypotrochoid and epitrochoid curved pictures. It was these happy memories that came to the fore when I was thinking about the lifetime connections that featured in my week’s experience.

It was a week of travel. From Scotland to Manchester, Manchester to London and back to Manchester before going to Frankfurt and then Tallinn. It was then off to Brussels and then back to Manchester. And today I travel to Dundee before returning once more to Manchester on Monday evening. I was in London for a meeting of the Health Education England Transforming Nursing for Community and Primary Care; Workforce Project Steering Group. This is an exciting group to be part of, a group committed to changing the face of community and primary care nursing and importantly for me, open to rethinking the educational preparation of the future workforce.

The spirographical connection here was in the discussion around community mental health nursing – where data underpinning the workforce planning trends appeared to suggest a possible reduction of such nurses in the future, something that was counter intuitive to the way in which many international mental health services are developing. Some great examples of which I came face to face with in Tallinn. I was there for the 3rd European Conference on Mental Health. It was a good conference, made more so by the number of colleagues and friends of many years who also attended.

There were papers on the rhetoric of recovery, the use of technology in mental health care, and mental health care education, what makes for effective child and young people’s mental health services, nursing in the Caribbean (which did seem a little different from Salford). There was one paper I particularly liked. It was a paper presented by a geneticist who seemed to suggest that the reason I like to have the occasional glass of wine in the evening was all down to my Mother and her genes J

I enjoyed a number of papers of how we perhaps need to rethink our approach providing services to military veterans – and these papers were not all about Post Traumatic Stress Disorders by any means. Several of the speakers provided valuable insight into the culture and personal/shared context of those who have served in the military and may now be living with mental health issues. I am glad we are engaging with this work in the School.

There were papers on forensic mental health but I didn't get to these. There was a spirographical connection to forensic mental health nevertheless. I picked up on Twitter that a fire had taken the lives of 60 dogs at the Manchester Dogs Home, and that a 15 year old had been arrested (and subsequently released on bail) in connection with the fire. Whatever emerges about the involvement or not of this this young man, it's a sad fact that arson is the single largest cause of fires in the UK. On average 3500 fires a week are the results of arson, with arson related fires costing us all over £1.5 billion pounds a year, and resulting in over a 1000 deaths a year. Children and young people aged between the age of 10 – 19 are responsible for over 50% of all arson related fires in the UK. A high proportion of these fires are fires started in Schools.

In 1984, spirograph in hand, I started working at the Gardener Unit, the only NHS forensic mental health service for adolescents. One of the early patients we cared for had been sentenced for the offence of arson. It seemed the offence was related to the young person’s response to a life threatening condition that was acquired through no fault of their behaviour, or action on their behalf. The desperation of that young patients experience came to mind when I thought about the young man somehow connected to the Manchester Dogs Home fire.

It also brought to mind, with great fondness. the formidable Professor Dame Sue Bailey (who until recently was the president of the Royal College of Psychiatrists) who still works a Consultant Psychiatrist at the Gardener Unit. She is an amazing mental health professional who has campaigned tirelessly for the UK government to spend more money and resources on the areas that might ensure children and young people don’t development mental health problems in the first place.

And for me this thought was the final spirographical connection. Yes it is sad that 60 dogs died in the fire, but what kind of society are we, where because of our actions we still need dog homes. In 2011, the Stray Dog Survey (undertaken by the Dogs Trust, the UKs largest dog welfare charity) reported that 126,176 dogs a year were being taken into Local Authority care a year. The Manchester Dogs Home takes in 7000 dogs a year. Most of these dogs are dogs that have abandoned by people who for whatever reason can't or don't want to look after them any more.

Perhaps not surprisingly, since the news of the fire hit Twitter last Thursday over £1 million has been raised in response to the fire. I am sure much of this money will be used to re-build the dogs home, but wouldn't it be great if we could create a society where young people don't need to experience mental health problems and we don't need a home for abandoned dogs – that indeed would be a perfect Spirograph picture. 

Sunday, 7 September 2014

You can do anything once you stop trying to do everything

My parents, who live in Cardiff, escaping the Obama et al circus, arrived last Thursday to spend a couple of days at the House in Scotland. Later on today we will go back down to Bolton where we will be joined by 13 other members of my family for a meal, hopefully outside if the sunshine holds! I am so looking forward to this down time. These days I treasure my weekends and try very hard to leave work behind until Monday morning. It’s my way of trying to achieve a healthy work – life balance.

Achieving a healthy work – life balance sometimes feels impossible. It’s taken me a long time to realise that you can’t put a good life on hold. Likewise it’s a fallacy to think that if you have enough time you can get everything done, you are never done! Twice last week I had days where I had back to back meetings for 10 hours each day. It is a situation that was immensely frustrating in many ways. Research undertaken in the US by John Robinson, Professor of Sociology, suggests that the happiest people are those that have little or no excess time yet seldom feel rushed.

This is something I am sure many of us can identify with. My frustration last week was caused in part by the sense that the constant meetings, one after the other, robbed me of any control over my work load and how I might best meet the demands being made of me. It is not true that as Head of School I can easily determine who I will meet and when. I have learnt over time the effectiveness of delegation but on occasions I have to do what only the Head of School can do. I try and practice what has been described as transcendental leadership. I am here to serve others in ways that enable them to more effectively make their contribution to our endeavours.

Like most people I can sometimes fall into the trap of simply getting started on dealing with whatever happens to be on the top of my pile of 'must do' things. But proximity does not equal priority. Of course it would be foolish for anyone to think that its possible to be able to do everything. I am constantly asking myself what it the most important thing for me to be doing right now, what is it I need or want to prioritise. Just because something (usually a request from someone else) is deemed urgent, it doesn't make it important and vice versa.

Most of my working life I have wrestled with making the choice between something being urgent and important. At times this dilemma has resulted in my taking decisions which throw the healthy work – life balance into complete disarray. Often it’s been the 'life' part of the equation that has come of worse and I am sure that family and friends will have suffered as a consequence.

Jeremy Hunt the current UK Health Secretary last week proclaimed that patients should expect the same standard of care regardless of the day of the week, and more doctors and nurses should work weekends. Currently many contracts for doctors and nurses do not state they are required to work weekends, and when they do work at the weekend they are paid an enhanced rate for working so called un-social hours. The consequence is that there is fewer staff working at weekends. The evidence points to this lack of staff being linked to higher death rates and complications at the weekend. As a consequence Jeremy Hunt is trying to make 7 day working the norm. All of which I applaud and support. However, ignoring the potential impact this ambition will have on health professionals work – life balance is likely to come at an even greater cost. For me, well I am trying to get into the habit of saying each and every day that I can do anything I want to do once I stop trying to do everything.