tonywarne

Symmetry, Slovakia, and the Impact Factor of Snowdrops

2012-02-19T05:41:00.004Z

This week I was pleased to be able to write an Editorial for a new nursing journal, the Journal of Nursing: theory, research, education which is published by a group of my colleagues working for the, Jessenius Medical Faculty located in Martin, Slovakia. This is part of the Comenius University of Bratislava. The Editorial was for the 2nd edition of the journal, due out in March this year.

I have been part of the group that developed the idea of a journal for Slovakian nurses and was delighted to be asked to become a member of the Editorial Board. For me, it is a real privilege to be part of what I believe will be a contributing force for change in the way research can be used to improve nursing care for patients, their families and the communities they come from.

I first went to Slovakia in 1996 to present a paper at what was the 2nd International Conference on Education in Nursing, This was the first paper I had ever presented. I have been going back to Slovakia every other year since then! My first paper was entitled The changing nature of the UK nurse education system: concerns and challenges and explored the impact on UK nurse education of the internal market system in the NHS. And last year, at the 9th conference, I presented two key note papers: Thoughts in Search of an Evidence Based Thinker, and Bricolage: The importance of context to nursing research and practice.

Whilst the conference is a modest affair, no more than a hundred delegates, I really enjoy being a part of these events. They provide a much needed showcase for research and other scholarly activity that has been undertaken by academics, practitioners, those responsible for managing services and for those involved in developing health care policy in Slovakia (and the neighbouring countries). The presentation of nursing work is well received and for some, the congress provides a first opportunity to share their work with a wider audience of peers. Unfortunately my knowledge of the Slovak language is still limited, but many of the presentations use English and there is always expert simultaneous translation available. From the first time I went there, I have been made to feel very welcome my Slovakian colleagues.

Martin was, and to some extent remains, a tortuously difficult place to get to. On that first occasion, I had to fly to Prague, and then take an overnight train to Slovakia. This was at a time when passports were checked at every border and the train journey was punctuated by border guard and police checks every few hours. It was a very interesting experience. When I arrived (at 06.30) in the morning, I was offered breakfast by my very hospitable hosts. It was at this point that I discovered Slovakia didn’t quite know how to deal with vegetarians. The plate, piled high with fatty bacon and sausages was gently declined, and after much discussion the bacon and sausages was unceremoniously removed, and more eggs and mushrooms added. This seemed to be the solution at all those early meals, remove the meat, and double the potatoes and cabbage – thankfully, things have got a lot better these days and most restaurants offer a few vegetarian options on thier menus. Sadly, the large tumblers full of very fine Slovakian apple cognac served with each meal (even breakfast) have largely disappeared.

That the conference has spawned a new journal is brilliant. The journal provides a place for both empirically based research papers and for papers that present the changes made in practice around treatments, interventions, the organisation of services and the care that can be provided. Importantly for me the journal welcomes papers that present new ideas on how nurses can be prepared for practice or how they can improve their knowledge and skills. There are now some 35,000 nurses working in Slovakia, and the number of graduate nurses has risen by some 1500% since 2000 whereas the numbers of every other health profession has remained static. In Slovakia, and elsewhere, this change in educational achievement should give an increasingly powerful voice to nurses. As the provision of health care is affected by the wider international economic problems facing nations, using this voice to ensure that new ways of working (often with less resources) does not impact negatively on the provision of high quality nursing care and treatment becomes increasingly important. I am committed to making sure the work of the journal helps in this regard.

Back at the ranch, I am embroiled with discussions about the Research Excellence Framework (REF), journal papers and the importance (or not) of impact factors. The impact factor was devised by the founder of the Institute for Scientific Information, Eugene Garfeild. It is a measure that reflects the number of citations that papers published in academic journals achieve. As such the impact factor is used to note the relative importance of a particular journal in relation to another. Journals with higher impact factors are deemed to be more important than those with lower ones. The Journal or Nursing: theory, research, education is unlikely to attract an impact factor for a number of years if ever – but does it mean that as academics we should avoid trying to get our work published in this journal. I think not!

Interestingly, and contrary to many popular beliefs the current REF exercise (a process that adjudges the quality and power of recent research on a national and international level) which is predominately concerned with the published outputs of academics, will not take into account the impact factor of the journals within which papers are published. This is a long overdue stance that perhaps recognises that the impact of published work does not rely entirely on how often a particular piece of work is cited in the work of others. I am passionate about getting my ideas and those of my colleagues, published. Since that first conference paper presentation in 1996, I have published my PhD, 83 peer reviewed papers, book chapters and research reports, 96 conference papers, 26 non- peer reviewed papers and 133 blog postings. In all of this time I have only published 2 single authored papers, preferring instead to write with others.

And driving home on Friday night, after enoying an evening of wonderful conversation and friendship, I turned onto my drive, and my headlights picked up the naturally seeded drifts of snow drops lining the drive. These tiny white flowers standing tall and proud in the cold night air were perfect reminders that whatever we do Mother Nature will always find a way of providing the impact we need to remind us of what is really important.

The Art [Deco] of Figure Skating in Morecambe, the NHS and Beyond

2012-02-12T05:46:00.000Z

Last week was dominated by finance, numbers and the exploration of consequences. Following some considerable preparation work, I found myself once more on the way to the seaside town of Morecambe for this year’s University Financial Planning Conference. However, getting to the venue was a trial on its own. Early morning rain falling on frozen roads created sheet ice and led to hazardous roads and pavements. Cumbria and Lancashire police forces reported more than 100 road accidents between the hours of 05.00 and 09.00 am, in and around the M6.

The venue for the conference was the Midland Hotel, a renovated Art Deco style hotel, well past its once glorious heritage. I didn’t like it last year when we went there, and my desire for being there again hadn’t grown over the intervening 12 months. My deep joy reached a new low when I got out of my car and slipped on the icy surface. But at least this year I was aware of the toilet hidden in the bedroom cupboard (I kid you not) and I got a double bed (complete with an explicable cuddly toy) and a view that was handy for keeping an eye, overnight, on my car in the car park.

However, my comfort, well being and sense of the atheistic were not the reason I was there. The Senior University Leadership Team were gathered together to address the severe economic and financial situation impacting upon our future as a University. This situation is caused by a number of interrelated issues. Overall, there has been a 2.5% reduction in the Higher Education Funding Council England (HEFCE) grant made available to universities which is down to some £6,507bn. A new fee system has been introduced, and students starting in September 2012 will be impacted by this, with fees for programmes rising to some £9000 per year in some Universities. Student applications are down by some 30% on this time last year, and changes brought in by the UK Boarder Agency for overseas students has dramatically reduced the number of overseas student coming to the UK.

In addition recurrent research funding has decreased by 1.1% and HEFCE have reduced the weighting given to the quality-related research funding away from activity rated 2* with only that research rated at 3* and 4* receiving any quality related payment. It is these payments that in part, allow for the development of high quality research, and research capability at a School and College level.

These overall funding reductions have resulted in a challenging situation for many Universities, and for many Universities, (Salford included) there is a growing need to find ways of increasing income and reducing costs to deal with this situation. Some Universities seem to have come up with imaginative approaches. The Guardian last week published the Top Ten Universities raising the most in library fines:

University of Leeds – £1,869,340

University of Manchester – £1,299,342

University of Wolverhampton – £1,252,253

King's College London – £1,197,715

University of Hertfordshire – £1,147,238

University of Birmingham – £1,114,863

University of Plymouth – £1,058,777

University of Nottingham – £1,025,560

Kingston University – £1,020,753

University of Durham – £1,005,426

Thankfully, our University does not feature in this ‘top ten’ list and our Financial Planning Conference took a different approach to what could be done at School, College and University level in addressing increasing income and reducing costs. In terms of increasing income, we discussed the development of new integrated interdisciplinary programmes focused on emerging markets, how to substantially shift the strategic focus and quality level of delivery for our CPD portfolio, and further leveraging the Media City advantage. These proposals are in the processes of being translated into financially relevant targets and commitments. Reduction in costs included continuing the work on reducing the non-staffing budgets, but also we considered the need to address the skill mix and size of the current workforce. Again these discussions are to be given a financial, temporal and spatial framework over the next few weeks.

As a School I believe we are well placed to maximize the opportunities that arise from changes in our operating environment. Last week the Department of Health announced the predicted funding for the NHS. £65bn will be available for local doctors, nurses and other health professionals to to spend in the development and provision of local health services. In addition, around £5.2bn is to be spent on Public Health Services. Of this, at least £2.2bn will go direct to Local Authorities to help local communities stay as healthy as possible and to reduce health inequalities. These figures were developed by mapping PCT spending in 2010/11 on to the future structure, subject to the passage of the Health and Social Care Bill, and uplifting these to 2012/13 levels. And whilst it is not yet possible to find the funding allocation for Adult Social Services, (some £16.1bn was spent in 2009 – latest figures available), it is likely to be around £25bn.

The size of these investments in health and social care, alongside the re-organisation of service providers, new technologies and a changing workforce provide the School with enormous opportunities to change and further develop our educational, research and service development portfolio.

And it would be good to do so. In my own field this week, the launch of a National Survey of Investment in Mental Health Services in England was announced. This is the tenth national survey and aims to provide detailed analysis on spending for mental health services which will help the Department of Health and Local Authorities in formulating policy for the provision of mental health services.

This might also be a good thing, as last week it seemed that a lot more people might be at risk of being labelled mentally ill due to behaviour most people would consider normal. But not necessarily what American psychiatrists and psychologists might consider normal judging by what is proposed to be included in forthcoming Diagnostic and Statistical Manual (DSM-5). Thankfully powerful voices in mental health care in the UK are speaking out against the publishing of DSM-5, an updated version of the ‘psychiatrists bible’ that attempts to categorise every type of mental disorder, including some that are clearly difficult to accept as disorders. For example, among the anxieties to be labelled mental disorders in DSM-5 are shyness in children and uncertainty over gender. Loneliness could attract a diagnosis of chronic depressive disorder, and so could unhappiness following bereavement. A serial rapist could be classified as mentally ill, and given a diagnosis of paraphilic coercive disorder. Under the DSM-4, last revised 12 years ago, children who argue and refuse to obey parents can be classified as having oppositional defiant disorder.

Thankfully I didn’t get to the page that described the diagnosis of middle aged men who have an acute dislike of visiting art deco hotels, where toilets are hidden in cupboards; lunch largely consists of bowls of severely charred chicken pieces and to be asked do so during the cold British winter – but I bet the page is there.

[M]ice at the V+A, 30 something’s for the over 50s, Me and My Mate Billy, and Wit[tering] on about Sircumcision

2012-02-05T05:28:00.000Z

Last week not only were the NMC back, but I was back in the V+A. The NMC were back to assess the quality of our mentorship programmes (Nurse and Midwives). The review team approved the programmes and commended the team on their relationship with practice colleagues evidenced by the high quality of the mentorship provided to students, and the shared understanding of the learning outcomes and NMC standards by colleagues in practice and the School.

I was at the V+A for a College Planning Meeting. Now as regular readers will know, the V+A is not my favourite place in the world to stay. And whilst I do have some good memories of past stays there, it would not be my first choice of an overnight venue. I was there with my colleagues to develop the College response to the changing HEI environment and in particular to consider the fitness for purpose of our strategic plans in meeting the new economic realities facing all Universities.

After a long days work it was good for the team to enjoy a meal together, and catch up on non-work issues. The chef had been told I was dining (the food is one of the reasons I don’t like staying there) and he came out and I was able to negotiate an off menu meal that was surprisingly good. So in mellow mood I even considered whether I might have been a little harsh in my criticism of the place when much to the surprise of our table, we were joined in the dining room by a tiny little mouse.

The mouse ran around for a bit and perhaps like me had issues with the menu, turned and dissappeared. Now where there is one mouse there are likely to be many others. Mice become sexually mature in 8 to 10 weeks and a pair can produce 8 litters each of 16 young, in a year, so you are never likely to be far from a mouse or two!

The following morning I took a short walk around a cold and crisp white early morning Manchester. The canal that runs into the River Irwell was completely frozen over and yet the river just the other side of the lock gates ran freely. And it seems my gentle walk around the grounds of the V+A was typical of people my age. A recent GlaxoSmithKline (GSK) study revealed that people over the age of 55 do 30 minutes more exercise per week than people aged 18-25.

GSK in association with NHS London and supported by the Royal College of General Practitioners, the Royal College of Nursing, the Chartered Society of Physiotherapy and 7 patient groups across the UK launched the Your Personal Best initiative last week. This initiative aims to promote lifestyle changes among the 7.8 million Britons in the 50+ age group who have long-term health problems. Inspired by the London 2012 Olympics, it encourages people to undertake regular light physical activity, such as gardening or walking the dog. The scheme highlights the role played by nurses, GPs, physiotherapists and other health workers in promoting a healthy lifestyle among patients.

Being a keen gardener, a daily walker of Cello my Australian Labradoodle, and a Nurse, I thought the YPB initiative ticked a lot of boxes for me. This week however, I won’t be out walking with Cello every day. Cello is currently on holiday in Scotland and there is just Billy the Parrot and me rattling around in Château Warne. Which is a bit of a shame as the snow came yesterday and the ground is covered in about 4 inches of the stuff and despite trading the Tractor for other more manual and eco friendly snow clearing equipment, Billy is not that handy with a shovel.

And my thanks go to Sarah and James who with great cutting wit made me smile in what I thought was the defining comment following the news regarding Fred Goodwin last week:

@sarahtaylor: @mrjamesob - Sircumcision = having your knighthood removed.

And yes, I survived my alcohol free week, and that glass of heart protecting red wine tasted so good on Friday!

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

2012-01-29T05:43:00.000Z

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!

Saluting Foucault and Our Access to Information

2012-01-22T05:49:00.000Z

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 25—39 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 35—44 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.

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

2012-01-15T05:24:00.002Z

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.

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

2012-01-08T05:49:00.000Z

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.

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!

2012-01-01T05:40:00.001Z

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.

Family, French Hens and Friendships

2011-12-25T06:30:00.000Z

Last week was a difficult one and I was really glad to get to Thursday, where at the close of play I decided ‘that was it’ for the 2011 academic session. It wasn’t and I spent many hours on the 23rd sorting out problems and it was late on in the evening that my Christmas break started. Yesterday was Christmas Eve, and it was a day that started dull and cloudy. I went up to High Rid with Cello, and unlike last year there was no snow, and spookily, no people.

Later on, Christmas Eve was to be transformed into Christmas Day as some of my children came to celebrate their Christmas. By 14.00 there were ten of us sitting around eating a wonderful Mushroom, and Cashew Nut and /or Turkey Roast meal – and yes the sprouts were cooked to perfection, the roasted vegetables were heads held high in a rosemary herb sauce and the mash was horseradish infused. There were no prisoners and no leftovers for the chickens to enjoy.

Today is to be a repeat performance, but with a completely different set of members of the extended family– this time with eight people sitting around the table. However, a relaxed day is envisioned as we are not planning to eat until 16.00 hours. There is a chance for Cello and I to go for a walk, and put the world to rights as we do.

And today is the first day of Christmas. I am always reminded of the song the Twelve days of Christmas on Christmas Day. January 6th is the Twelfth Day, and the Twelfth Night is defined by the Oxford English Dictionary as ‘the evening of the fifth of January, preceding Twelfth Day, the eve of the Epiphany, formerly the last day of the Christmas festivities and observed as a time of merrymaking’

Of course (well maybe) it is the Third day of Christmas that interests me the most. This is the day that ‘my true love’ gives three French Hens which, in a biblical sense refers to Faith, Hope and Charity. Given the high degree of uncertainty there is for many people in the world at the moment, these are virtues that we are going to have to draw upon again and again over the next 12 months.

Yesterday, thanks to Mr I Pad (and don’t say anything to my little Brother Mark because he will become impossible in a I told you sort of way) I was able to speak to family and friends from around the world. Amazingly clear images and conversations all of which were achieved at a press of the button. I will speak to my little sister in Australia later on this morning but she did send me a photo of her outside Christmas tree decoration.

This is my first blog at Christmas that is actually written on Christmas Day - so it only remains to say a Merry Christmas to all my many French Hens, Family and Friends, and whereever you are and whatever you are doing, I hope it’s really good for you.

Another Six Hours Travel, but its Plymouth and not Dubai before its Red Shoe Time and an End of Week Surprise

2011-12-18T05:58:00.001Z

Last week I spent an extraordinary amount of time sitting in railway carriages, waiting at train stations, searching pockets for wayward tickets, but also meeting some amazing and at times, unusual people. I am coming to the end of the Christmas Party season, and I have found it’s much easier and safer to imbibe the occasional tipple and then travel by train rather than get in a car and drive home. However, in the middle of the week I travelled down to Plymouth to take part in a PhD examination.

On the morning of this journey BBC News 24 hours started their broadcast from Plymouth Hoe. The report was about the storms and the winter weather that had engulfed the UK. We were due to have our first snow of the winter. Of course with the storms came the usual disruption of everyday life. The journey down to Plymouth took some 7 hours. The Hoe was just a collection of some distant unconnected lights seen from my hotel window. In the morning it was just possible to view the Plymouth Hoe through the buildings.

The students study was on how service users might best contribute to the acquisition and development of interpersonal skills in student mental health nurses. I was privileged to sit with another external examiner who had Hildegard Peplau as her own PhD supervisor. Peplau was possibly the first nurse theorist after Florence Nightingale and her life’s work was devoted to exploring the importance of the nurse - patient relationship and its primary importance to nursing practice. Unsurprisingly perhaps, her area of focus was on mental health care.

The journey back to Manchester was another 7 hours of disrupted travel. I will be happy if I don’t see Birmingham New Street Station for a long time to come. The last time I traveled 6-7 hours to and from Manchester the destination was Dubai – and Plymouth, as attractive as it may be, wasn't Dubai. Thursday was a second PhD viva – strange, like waiting for trains at BNS, nothing arrives for a while and then two come together.

Friday was the last School Development Day of 2011. Traditionally, (in my 5th year as Head of School) it is when the Red Clogs come out. These are my Christmas Clogs, worn only from the School Development Day to Boxing Day – then they go back into storage. As those readers who have met me know that black is absolutely the colour of the day. I got my Red Clog inspiration not from my friend, colleague and Professor of Mental Health Nursing, Phil Barker (who habitually wears red clogs, and once claimed that Hildegard Peplau would be one of the six people he would include in his personal life boat) but rather from the 1948 film the Red Shoes. This is a film of a ballet dancer (Vicky) and the dilemmas she faces in choosing between love and a career. There is a wonderful conversation between the ruthless but charismatic impresario of the ballet Lermontov, who questions Vicky at a critical point in her career:

Lermontov: Why do you want to dance?

Vicky: Why do you want to live?

Lermontov: Well, I don't know exactly why, but... I must.

Vicky: That's my answer too

Of course the film is loosely based on the Hans Christian Anderson fairy tale in which a young woman sees a pair of red shoes in a shop window, and which are offered to her by a demonic shoemaker – of course after she accepts the shoes her life is cursed as wherever she goes and whatever she does the shoes refuse to stop dancing and the young women eventually dies from dancing exhaustion.

Dancing exhaustion is a state of being that I do understand. Unexpectedly I found myself at the MEN in Manchester on Friday night dancing to a band called Duran Duran. How I got there is a tale almost as complicated as the ballerinas and the shoe makers. Duran Duran is a British band, formed in 1978. At which time I had two children, and despite my other three children still being just a twinkle in my eye, this was a band that didn't feature on my musical radar even though the band initially were part of the New Romantic scene.

The band became popular for their music and some fairly controversial videos, which featured partial nudity and suggestions of sexuality. In the early 1980s these were shown on what was then a new music video channel on the television called MTV. However, it was another film from the mid 1940s that was the start of this revolution. Brief Encounter (1943) tells the story of housewife Laura who meets a doctor called Alec at a train station. Although she is already married, they gradually fall in love with each other. They continue to meet every Thursday in the small café at the station. This passionate pair, who don't ever exchange a kiss during the film, eventually decide to part. When Alec puts his hand on Laura's shoulder at their final meeting in the station café, it's as erotic and far more touching than just about every sex scene you'll ever see in a Duran Duran video .

But enough of such musings, Cello, who has loved the snow of the past week, is awaiting his first walk of the day and its time for me to get up and make a start. As I appear to have acquired a cold from somewhere, I can only think that walking is definitely better for my health than train travel.

Enduring Migration, Some Information, and Christmas Beckons.

2011-12-11T08:41:00.004Z

Those of you who are regular readers of this Blog will have noticed that today’s blog was posted some three hours later than normal. I have been temporarily forced into a new Sunday morning regimen through something called Migration – and I have to say I am not a happy bunny!

Migration in the context of IT is the movement from one system to another. Strangely in a world that I assumed to be constructed around certainties and formula based approaches, it is unsettling to be told that the people managing this migration cannot tell me when I will be migrated. So until I am migrated, I have to turn off my computer at 18.00 and not turn it on again until 07.00 the following morning. This procedure has to be adhered to for the next seven days – so it will make for an interesting time I think. Still it could be worse. Our IT systems migration and hopefully improvements might have been undertaken by the same people as those involved in the failed NHS IT system.

According to the Times this week Margaret Hodge (a Labour MP), and chair of the Public Accounts Committee, described the American firm in charge of the failing NHS IT project as ‘cowboys’ who should be ‘run out of town’. Incredibly it seems that Computer Sciences Corporation was looking to increase its contract by a further £2bn even after it failed to deliver any fully functional software to the 166 NHS trusts in England. Margaret’s outrage is interesting given that way back in 2008 it was known that Labours £12bn NHS It project had run into serious trouble. Launched in 2002, the Labour Government NHS IT project was supposed to revolutionise the health service. A report published by the Public Accounts Committee last week reported that the scheme has fallen behind schedule and costs have escalated.

The cost of the electronic record element of the NHS IT project is estimated at around £7bn. To date, the Department of Health has spent £2.7bn on it. Last week the Government announced they were cutting their losses and intend to spend the remaining £4.3bn on better systems that have been proved to work and offer more value for money. However, not everything is to be lost. Spine, which stores patients' care records, the N3 Network offering a broadband network to health workers; NHSmail a unified, secure email system for the whole service, and the Choose and Book system, an appointment booking service are to be retained and developed further. The NHS has partnered up with Intellect and the Technology Trade Association to take the NHS IT improvement forward. These organisations mainly work with small to medium size companies and for me it’s great to see an antidote to one-size-fits- all approach in action.

And talking of which, this weekend the Christmas Branch went up. Now over the years this alternative (Rainbow Warrior style) approach to cutting down Christmas trees has been both ridiculed and loved. A long time ago, I would supplement my income by working in the Welsh plantations cutting down and dragging hundreds of Christmas trees out of the woods for this once a year extravaganza. I earned pence for each tree, and I knew back then that one day I would not cut any more trees down. I don’t do artificial Christmas trees, so the alternative for me at Christmas has been a Christmas Branch. In my current home I am fortunate to have a number of big mature Beech trees in the gardens, and every October I select a branch and cut and store in the garage until this weekend. Then in it comes to the house and accompanied by Sherry and Mince Pies, the branch is dressed.

In compensation for my personal and perhaps reckless deforestation of Wales, every year I also buy a ‘Christmas’ tree with roots and plant this outside, sometimes in my gardens but sometimes on the hills that surround the house.

And wandering around my garden yesterday looking for somewhere to plant this tree I couldn’t help but notice just how well Mother Nature does in dressing her own trees. For example, both a Crab Apple tree with its miniature bauble like fruit and a Silver Birch with its funky fungi looking splendid in the autumn air.

Information Bubbles and the Search for the Perfect Red Wine Continues

2011-12-04T06:06:00.006Z

Last week I came face to face with someone who in the words of Eli Pariser, described the way in which at any particular time, we create, enter and inhabit a bubble that allows us to make sense of the incomprehensible, the inexplicable, the exciting but unknown aspects of the world we live in and in doing so, we are able to retain some sense of ontological security. OK Eli doesn’t say all of that, it is of course my interpretation of his work. In his book The Filter Bubble, Eli argues that why we might all live in the era of personalization, our world views are being distorted by the change in the way media is being consumed by internet users.

In a week where I explored with a group of new Masters students the impact of what I call a Focauldian governance of the UK Public Sector, I find Eli to be an intriguing online organiser and disorganiser. He has been a long term critic of the way in which in the new information age algorithms, code and robots curate search engine result – amid as such, can we ever be sure were seeing the whole picture? Some would answer yes, resoundingly.

Last week I dealt with two Academic Misconduct cases, where through Turnitin, colleagues were able to say, and say categorically, that students involved had extensively copied from other peoples work and presented it as their own. I also waited with two colleagues for life changing information to filter through and reach us. And when it did, the information in itself did not help make sense of what, up to that point might have seemed a perfectly rationale world.

Importantly, for me and perhaps all of us, (with the possible exception of those asleep on the train to Preston) is the growing need to get to grips with the way in which the so called information age is changing human life profoundly. Arguably an almost unfettered access to information is changing culture, language, and it has even changed the thought process – legitimisation by Wikipedia rules OK.

This week the UK Secretary of State for Health, Andrew Lansley observed that many patients will benefit directly from Governmental efforts to make health data transparent and easy to use by the medical research community. Allegedly such free access will fuel advances in treatment, as well as positioning the UK as a centre of excellence for research. Of course this access to personal data is a good thing, but I wonder where all this information has come from, where it is stored and who is using it for what other purposes. Whether any of this prolific collection of data and information will make a difference to patient care or patient choice remains to be seen.

Also this week I have been involved in looking at the work of colleagues in the College and the wider University in relation to the forthcoming Research Excellence Framework (REF). It was good to see that in the main we are already in a good position. As I have noted before, UK research papers attract 11% of the world’s citations and make up 14% of the world’s highly cited output, including 17% of the world’s research papers with more than 500 citations and 20% of those with more than 1000 citations. The average research impact of UK publications now surpasses that of the US and we manage all of this on very limited State support. The UK spends 4% of the world’s Gross Expenditure on research, and the UK boast 6% of the world’s researchers who are authors on 8% of the world’s research articles and reviews published in internationally influential journals.

And as my research mentor enters his last couple of weeks with us the search for the Perfect Red Wine continues afoot. Finding and drinking the right amount of red wine is of course, as the research evidence suggests, crucial to our health and well being. This week in an attempt to contribute to this knowledge base, I have imbued some very indifferent Italian, some superlative Australian, and some excellent, if somewhat overpriced Chillan red wine. The wine from Chile was a Syrah Mouvedre from the Maipo Valley. The taste was of elegant aromas of dark fruits such as black cherries and redcurrants with rich chocolaty notes, with hints of toffee and nutmeg. So far the Chillan is winning – although of course, a little more empirical research is required.

And for all those Rainbow Warriors out there - sorry but yesterday I had to ditch the solar powered Christmas Tree lights on my Weeping Birch tree. They never got past 7.5 minutes of feeble illumination. So I rejoined the National Grid and now enjoy warm whitel lights glowing brightly in the darkness. However, unlike my neighbour with his unattractive grey plastic junction box, I utlised a blue tit nesting box to bring the wires, transformers and so on together in a totally eco friendly way.

Pipelines, but a very Different Landscape to Basra, Opening Minds in Openshaw, and a Birthing Centre in Bolton, and Cello loses his Ginger

2011-11-27T05:50:00.000Z

In what felt like a very packed week it was still possible to find the odd oasis of amusement and fun. Waiting for me on Monday was a copy of a letter from Ian Dalton, Senior Responsible Officer, FT Pipe Line (what a job title!). In this letter Ian sets out the NHS plans for an all Foundation Trust Provider Landscape by 2014. The letter is a delight of metaphorical ambitions, there is much talk of tough journeys, challenging journeys, the amount of the work the journey will entail, next steps, steps to be taken as organisations start off on their journey – a journey to establish a FT pipeline across the English Landscape. It’s wonderful stuff and the letter is a delight to anyone remotely interested in doing some content analysis.

It was on the 3rd October 2011, that the NHS North East, NHS North West and NHS Yorkshire and the Humber - the three strategic health authorities in the North of England - were placed under a single management framework now known as NHS North of England. And Ian is, of course also the Chief Executive of the NHS North Strategic Health Authority. What some people might not know is that while working for the Department of Health, Ian was seconded to the Foreign Office and posted to Basra. There he oversaw the reconstruction of health services following the Iraq war.

Tuesday night involved a Silver Service Dinner at the Bistro East, at the Manchester College, Openshaw. The meal was a celebration of some early successes with the Single Ticket project. The Single Ticket programme was developed by Manchester College, and a number of high profile partners from health and social care, inckuding our School. It aims to give the residents of Manchester and Salford an opportunity to gain experience of working in health care and gain a BTEC Health and Social Care qualification. The students on the programme gain experience in mental, adult and children’s health care through varied work placements. The first of the successful students to gain jobs were guests and hearing their stories was a real privilege.

Colleagues from Solleftea in Sweden were also guests and dinner provided the opportunity to hear of their experiences in delivering similar projects and to explore where we might work together in the future. The food was prepared and served by the College’s catering students. Whilst the food wasn’t entirely my taste the presentation was absolutely awesome and there were some fantastic food creations.

Last week saw the closure of the traditional maternity services in Salford. And on Wednesday evening I attended the opening of a new Birthing Centre in Bolton. Champagne and canapés were the order of the night. This was a private birthing centre offering a range of services from fertility advice through to birth. The opening of the centre coincided with the first reports of the Birthplace in England research programme. Birthplace is an integrated programme of research and is made up of several interrelated studies designed to provide evidence about important childbirth outcomes for women, their partners, and health professionals. This information will help all those involved take informed decisions over chosing where baby might be born. The research outcomes will also help policy makers and service providers to provide the highest quality and most cost-effective maternity care services.

However, some of us don’t have any choice over certain aspects of our lives. Despite the colder weather arriving, this week Cello was taken for what I am sure he hopes will be his last hair cut of 2011. His coat had become long, curly, slightly unruly and absolutely ginger in colour. After having a Christmas Trim, he does look smarter, can run and swim further, and his coat has returned to his original and lovely chocolate brown colour. However as I write this post there is a gale blowing outside and the rain is lashing against the windows. I can see it might be difficult to get him out of his bed for a walk this morning!

Conversations, Journeys, Susan Sontag, and French Wine!

2011-11-20T05:40:00.001Z

Whilst the previous three or four weeks have, for me, been characterised in part by travel and meeting some very intresting and exciting people along the way, last week was different. The closest I got to travelling was to say goodbye to a friend on Platform 13, Piccadilly Station. However, this week I have found myself in conversation with a number of other people, who in lots of different ways, were starting life changing journeys of their own.

Some of these journeys were the result of choices they had made, others were not. For some the journey will involve them having to deal with potentially life threatening illnesses. Reflecting on the conversations, some of which I felt were undoubtedly difficult, I recalled the words of one of my favorite writers, Susan Sontag. She said ‘silence remains, inescapably, a form of speech’. Silence has been something, in a therapeutic context I have been very comfortable with. However, in other kinds of conversations, it is equally important to sit and listen, in order that others have the space within which they can speak.

Susan Sontag, was a writer, critic, feminist and gave a voice to a generation of diverse academics that lives on way after her death, she sadly died in December 2004 from uterine cancer. Two powerful works, Illness as Metaphor, (1978) and later, AIDS and its Metaphors (1989) were written while she was being treated for metastatic breast cancer. I used some of her work in my PhD, drawing upon her explication of the use of metaphor in professional and personal accounts of illness and treatment, and what the concept of truth in the transactional aspects of relationships might involve: 'The truth is always something that is told, not something that is known. If there were no speaking or writing, there would be no truth about anything. There would only be what is'.

And ‘what is’ featured in other conversations about relationships last week. Some of these conversations were about professional relationships. I met with all the School Directors to talk about the outcomes of conversations that were held the previous week. As a consequence of those conversations I asked some of the Schools Directors to take responsibility for areas of the Schools business that they might consider took them out of their comfort zones. However, ‘the truth’ is that they all have shown great skill and application over the last two years in ensuring the School has continued to make progress towards its strategic ambitions. I believe that in the taking the work of the 'new School' forward, these talents needed to be refocused to fully take advantage of the opportunities open to us.

Opportunities lost and promised, featured in other conversations. An evening meal with a friend where the conversation included how difficult it can be to witness the relationships of others (dearly loved) sadly coming to an end. But I also had a delightful lunch (in a very noisy Café) with a good friend on the cusp of great things, who I hope will continue to believe in themselves. And Thursday evening’s conversation surprisingly involved French wine with something to eat and good company (surprising only given my love of Australian wines).

And I am starting on my own little journey, and one that involves an Apple. After years of steadfastly refusing to entertain the notion of buying an I-this or an I-that, I succumbed and purchased one of those new fangled I-Pads yesterday (it’s still in its shiny box). I will see how I get on with this particular journey. The I-Pad, I am told, will replace my book and CD library and allow me access to information anywhere. Susan Sontag described books as being 'funny little portable pieces of thought' – I wonder what she would have thought about the I-Pad.

Tracey meets Liz, Outrage in Amsterdam and Chicken Pox Lollipops

2011-11-13T05:37:00.001Z

Eccentricity, difference and even a little quirkiness have been on my mind this week. As those readers familiar with my published work will know, the drive towards universality, homogeneity and coercive specification is an anathema to me. Unfortunately, it is often these approaches that organisations seek to impose in a countervailing attempt to address organisational adversity. Such adversity usually arises from changes to an organisations economic, political and or professional wellbeing. However, as I have said many times before ‘the more precisely you specify a professional performance, the easier it is to measure and the harder it becomes to motivate’. For whatever reason, this week I have been more than usually aware of such approaches. It may well be that I have been playing catch up with emails and the concentrated reading of these might well have resulted in a heightened perception on my part.

So imagine my dismay on learning that the bad girl of art, Tracey Emin had met the Queen for a cosy chat last week. Dressed in a Vivienne Westwood suit (but it was highly tailored and grey !?!) Tracey met the Queen at an art gallery in deepest Margate, Tracey’s birthplace. The gallery was exhibiting a diverse collection of works depicting youth. Tracey, whose work includes installations that feature amongst other things used condoms and blood, even gave the Queen a curtsy upon meeting her. It seems the once somewhat eccentric, angry and outrageous Tracey has finally become part of the establishment.

I was in one of my favourite cities on Thursday. I first went to Amsterdam some 40 years ago, and for me it has retained an almost magical quality and appeal. I was there for a meeting with colleagues to plan another European project aimed at finding ways of improving the preparation of nurses for professional practice. Although the schedule was busy there was time to also walk around the city and to see how it had changed. The magnificent central train station had been cleaned up and was a fantastic testament to Dutch architecture, faith in the future, and economic prosperity.

In the city centre was a large anti capitalism protest camp against. These camps are becoming an almost ubiquitous feature of many cities. They have grown in number over the last couple of years and are to be found all over the world. The protest camps have as their inspiration the work of Stephane Hessel and in particular his essay, published in 2010, entitled Time for Outrage. Indeed the early protest camps (in Spain) were named the Outraged. Hessle’s concern has been on the increasing gap between the rich and poor in society, particularly where this impacts upon the provision of health, social and welfare services in society.

For me the most bizarre manifestation of this gap was the story last week of the so called Lollipox. These are the products of an online business in the US that sells second-hand licking lollipops from children who have recently had Chickenpox. The lollipops are sold through Facebook. Anyone who knows anything about Chickenpox knows that buying these lollipops is a complete waste of money. Chickenpox is caused by the Varicella zoster virus and is usually spread through the air and/or through direct contact with the fluid from blisters.

And blisters are where I end this week’s blog. Yesterday I spent a couple of hours blowing the leaves off the drive. Despite having a big boy’s toy of a blower, the task involved muscles not used for a while, and gave rise to blisters to both hands.

Another Sunday Morning in Dubai – But it was a Great Busman’s Holiday

2011-11-06T02:00:00.000Z

This time last week I was sending my blog from the Business Lounge at Dubai Airport. One week later, and I am once again sending my blog from the Business Lounge. In between I have been to Adelaide on a bit of a busman’s holiday. And it has been a wonderful week. I was hosted by the School of Nursing and Midwifery at the University of South Australia. They looked after me as if I was royalty.

The Qantas problem was overcome with a stopover in Melbourne – lovely to step out into the city and have lunch by the river – it brought back fond memories of previous visits. The evening was spent with a group of trainee Air Hostess. They were the most competitive group of people I have come across in many a year. I was appointed official judge for the best doughnut hair style. I have to say I was fascinated by the way those who knew how to do it did it – and did so effortlessly. I didn’t realize there was an actual material doughnut involved.

One day later than I planned I arrived at Adelaide. Two hours after landing I was having lunch at a Rundle Street pavement restaurant. Lunch proved to be a great opportunity to start the process of finding out what similarities there might be between the School of Nursing and Midwifery at UniSA and the School of Nursing, Midwifery & Social Work at UoS. And there are many. Although the School at UniSA only taught nurse and Midwifery programmes, the numbers of students for these programmes were comparable to the UoS School. Amazingly from a UK context, each student has to make a contribution of up to 5000AUD toward the cost of their education and training – and some 90% of applicants to the School had UniSA as their first choice.

The next day I had an escorted tour of the city which touched each of the four quarters of Adelaide – so it was possible to experience the inner city, with its fantastic mixture of old and new architecture, and its bustle – epitomized for me in taking a coffee in the Central Market – the hill district, which of course had to include a visit to a small boutique winery, and then the old part of Adelaide with its fine old buildings set in huge plots, before going to the coast. When I first came to Adelaide in 2001 it was to a service led mental health conference. The coast with its sandy beaches and shallow warm water were the memories I have kept in mind ever since.

After a fine lunch at Lofty Peak, a lunch taken with a panoramic view of the city, it was back to the University to see the practice simulation laboratories. These were superb. Every clinical context was catered for and they were ‘staffed’ by colleagues from practice. It was an impressive set up that brought together new technology, the best from contemporary clinical practice and an approach to skills acquisition that was comprehensive and realistic. And it didn’t stop there as some of these facilities were so realistic and well equipped that the plan is to run real life clinics from them.

The following couple of days were a mixture of great conversations with some interesting and enthusiastic colleagues. I had a breakfast meeting with Nicholas Proctor and was able to identify a range of shared mental health research interests that I will follow up on. And by a strange twist of fate, this week I have also been attending a week long virtual Editorial Board meeting for the International Journal of Mental Health Nursing – many of the Board, including the Editor, are resident in Australia. But Australia is a big place and trying to get everyone together for a meeting is next to impossible. This week I was able to contribute in real time and not as is normally the case, some 10 hours behind the conversation.

So many thanks to Alun, Alan, Kelly, Roger, Mary, Nicholas, Peter, Carol, Joanne, Geri the driver (who had an encyclopedic knowledge of Adelaide’s history) and especially Michelle whose unremitting attention to detail made the whole trip a very successful one. Qantas got its act together and delivered me to Sydney airport, where Emirates once again took over That A380 is a great plane - but you have to travel on the upper deck to understand why.

After travelling for the best part of 17 hours already I am just 7 hours away from Manchester – I wonder how the little Arctic Tern manages the same journey on just an occasional swoop down for the odd fish along the way. And just how does he know whether to turn left or right?

Back to Marmot, a Foot in the Door, and Dubai Airport at 03.45am

2011-10-30T04:09:00.000Z

It was Lord Marmot who in his publication Marmot: A strategic review of health inequalities in England post-2010 set out the six main policy areas that required action to be taken if health inequalities were to be reduced. These policy areas: (1) Give every child the best start in life (2) Enable all children young people and adults to maximise their capabilities and have control over their lives (3) Create fair employment and good work for all (4) Ensure healthy standard of living for all (5) Create and develop healthy and sustainable places and communities (6) Strengthen the role and impact of ill health prevention provide the strategic framework for developing a fully integrated public health policy for England.

The UK Government’s Health and Social Care Bill 2011 introduced the new Health and Wellbeing Board which is charged with improving local health and social care, and reducing health inequalities. It sits within the local authority, although responsibilities for delivering many of the Boards functions will have to be shared between agencies. The Health and Wellbeing Board have a statutory responsibility for the delivery of a local Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy in order ensure joined up commissioning across health, public health, social care is achieved. What’s exciting about these changes is that the Board will need to think more creatively for innovative solutions and draw upon wider services in order to more effectively promote health and wellbeing, and for delivering value for money.

So I was pleased this week to read the publication from the Northern Housing Consortium entitled A Foot in the Door. This publication is both very informative (in terms of describing the emergent health and care structures and organisations) and a useful and useable ‘tool kit’ for those working in the housing sector to use when looking at developing more collaborative relationships with health and well being commissioners and providers.

The NHC Chief Executive, Jo Boaden is enthusiastic about tackling some of the complex issues that result in such persistent health inequalities. The toolkit reminds the housing sector that they already have an invitation to get involved and that the agenda for change is clear. Poor housing conditions are implicated in up to 50,000 deaths in the UK; cause 0.5 million injuries and illnesses that require medical attention; and contribute to increased risk of cardiovascular diseases, respiratory diseases and depression and anxiety.

There are huge economic issues associated the provision of poor housing. The estimated costs to the NHS in England each year is around £600m to provide treatment for health problems arising from poor housing. In 2010 the average cost of a fractured hip is £29665; five times the cost of an average adaptation and 100 times the cost of fitting hand and grab rails for older people. Research shows that investment of £1.6bn in housing related support generated savings of £3.41bn to the public purse including £315m of savings to health service in a year. The NHC note that investment in specialist housing could result in savings to the public purse of £639m each year, including an estimated saving of £11751 per person to the NHS for those experiencing a mental health problems.

The challenges for the School in responding to these opportunities are fantastic. Developments such as these in the Schools operating environment present us with a much wider range of opportunities to bring our combined expertise to bear in developing new programmes of education, research and engagement. However, I will have to leave such thinking until later. Instead of sitting in my bed with a cup of tea at 05.00 am on Sunday morning writing this blog, I am in the Business lounge at Dubai airport on my way to Australia and its 07.45 am 03.45 UK time, some 7 hours after leaving Manchester last night. And I’m just a little tired to be thinking about anything other than the next 14 hour flight to Melbourne. The really good news is that Qantas (the internal carrier for Emirates) have gone on strike. I am not sure how I get to my final destination, Adelaide!

Three Weeks Early and One Week Later.

2011-10-23T05:41:00.001+01:00

Two hours after writing my blog last week, grandchild number six was born. Heavily pregnant Rebecka was staying over to meet older sister Jennifer who was visiting on the Sunday. Just as I finished my blog Rebecka announced that her waters had broken and it was all action stations. At 06.50 little Jack was born – three weeks early. Conceivably [sic] the midwife who delivered Jack would have been trained and educated at our School, more of which later.

As Rebecka has yet to return to her own home, preferring to stay here all week, it has been a somewhat busy week. It’s been more late nights and early, early mornings. The West Wing resembles a maternity unit, and the number of visitors arriving during the week has made Amsterdam Airport on a busy Bank Holiday weekend look completely tame. Yesterday it was the Lincoln contingents turn. Now Saturdays are meant for doing the chores and starting the relaxation promised by a weekend away from work. Yesterday turned out different. I got to understand where the ninth century Bishop Aethelwold of Litchfield was coming from when he commissioned the manuscript The Book of Cerne. The work is famous for its inclusion of the Harrowing of Hell, possibly the earliest surviving Christian drama script. This play describes Christ’s decent into hell. Spookily the story is depicted in a wonderful stone frieze high up on the walls of Lincoln Cathedral.

Tuesday was an interesting day. The morning was about dealing with what turned out to be in-appropriate behaviour by a student towards other students and staff in the School. A difficult meeting to have and unfortunately it was a meeting with a very sad outcome. Unlike the afternoon which involved a PhD viva. As regular readers will know, I think that taking part in PhD viva is a huge privilege. I tend to treat each viva as a chance to have a conversation rather than simply facilitating an examination. And so it was on Tuesday - it was a great conversation and the outcome was a good one.

Thursday was slightly stranger day. I was lucky enough to be part of a group visiting Keele University to explore partnership opportunities. So 08.30 saw me sitting in a mini-bus travelling down the M6 motorway alongside the VC and other assorted colleagues from across the University. My day at Keele was hosted by Professor Andy Garner, an internationally renowned academic and practitioner from the field of Pharmacology. He is the Dean of Health and Pro-Vice Chancellor at Keele University, and introduced me to the first virtual ward I have ever seen.

Imagine walking onto a ward that is there, but as you try to touch anything, a bed, a patient and so on, it’s not there. Yet you can pick up the patients notes, flip the pages, and read everything that has been written. You can talk to the patients and be with them while they vomit (yes into a bowl that you can see, but can’t touch or smell), and you can intervene and provide treatment – if it happens to be wrong it might kill the virtual patient, which of course is much better than doing so in real life. The experience showed me what might be possible at Media City, and possibly what it is I don’t yet know about what it is I don’t know in terms of using such technology.

And as we enjoy a slightly warmer and brighter weekend than at first thought possible I am sending envious glances to those colleagues who this weekend are able to walk in the hills or on beaches, but I am also sparing a thought for those colleagues who might be busy preparing for their viva on Tuesday, or making a start with sorting out their expressions of interests for the new Director roles.

And those midwives – an interesting experience. Clearly they are very good at doing what they do, but I found the juggling between what is offered as official advice and guidance and that gleaned from practical experience an interesting cultural manifestation of what appears to be contemporary midwifery practice. I won’t say anything about the quality of the written comments the midwives make when reporting on what they have encountered at each visit, but I do intend to write a paper about the obscurity of succinctness in such records.

Old Feet, Insularity, and is it Time to Change

2011-10-16T05:45:00.001+01:00

Last week was another busy week which by the time I got to Friday night left me feeling exhausted. I think I may be getting to old for the late night - early morning combination – and this week there have been a lot of both. It may also be due to having been at the V+A twice in one week – which as regular readers of this blog know, is not my favourite hotel in the world. I have also been to London to meet the Chief Nurse, Chris Beasley on a day when a stalled train outside Milton Keynes meant a 40 minute delay at the end of a very long day. Foolishly as I walked around London, I forgot I was wearing new clogs and without socks (it’s a long story) and of course ended up with feet that look as if they have been wrapped up for a week in barbed wire. But none of these experiences accounted for my sense of it being a strange week.

And this week as I was attending the opening of the Salford University International Life Centre (well done Liz!) I also read the news that the Health Professions Council's Welsh Language Scheme (an interesting notion in its own right) was approved this week. The Welsh Language Act 1993 established the principle that in the conduct of public business and administration of justice in Wales the English and Welsh languages should be treated on a basis of equality. The HPC is committed to offering services to the public in Wales in the language of their choice. Apparently, this is a great step for the Welsh language, which not so long ago was in real danger of becoming obsolete. As well as preserving the heritage of the country, this move could encourage more people to learn Welsh, and for the language to receive greater public use. It seems that learning Welsh can provide you with more than just another way to speak. I am not sure what exactly, and before all you Celtic Warriors write in, four of my five children were born in Wales and it’s a place I have some super memories of, and of course you were robbed yesterday in New Zealand…

Closer to home, it was good to see the announcement that Comic Relief and the current UK Government will be joining forces to help tackle mental health stigma, Between them they have pledged funding of £20 million for Time to Change, the leading stigma and anti-discrimination campaign, run by Mind and Rethink Mental Illness. This is the first time that the long-standing campaign has received Government funding: up to £16 million over the next four years. It will also receive £4 million from Comic Relief. Love the coincidence of corporate colours.

This new funding will allow Time to Change to reach 29 million members of the public and increase the confidence of 100,000 people with mental health problems to challenge stigma and discrimination. So far so good you might think. Perhaps it was when the Care Services Minister Paul Burstow commented on this announcement that I again experienced a slight sense of the bizarre. He was visiting Dukes, a gym, this week, and noted how young people with low self confidence have this boosted by attending the gym and learning to box and the other people at the gym get to see that people with mental health problems are no different to the rest of us, Ouch – this is from a man who in February, with Deputy Prime Minister Nick Clegg announced the No Health Without Mental Health strategy.

Paul and his wife Mary, a Liberal Democrat councilor, are of course famous for their saving the Cheque Campaign. Younger readers might need to ask their parents what a cheque is. And is it just me, or does Paul bear a striking resemblance to a certain Asst Directors of Commissioning and Education working in the former NHS Northwest? Unfortunately I couldn’t find an image to compare, but Google did offer up an image of a lovely cuddly kitten on the search page.

Finally, just in case we forget, one in four of us will suffer a mental health problem. Many individuals will experience some kind of discrimination as a result of others finding out about their mental health. However, aaccording to data from the Institute of Psychiatry, King’s College London, there has been a 4% reduction in discrimination since the start of the campaign in 2007, which equates to 23,500 more people living lives completely free from discrimination.

Cod and Alphabet Spaghetti, Outcomes and Abstracts, and Cello has a Rest

2011-10-09T05:23:00.003+01:00

Thursday I spent the day in Liverpool. At the Hilton Hotel which has to occupy the windiest and coldest spot in the whole of the City. I was there to take part in the Council of Deans of Health full meeting (CoD). This is a group that represents nurses and allied health professionals and ensures these professions have a voice at the political table. On this occasion, there were 119 members in attendance, a record number of Deans and Heads of School from each of the four countries of the UK. The agenda was a packed one and although there was some time to network, our noses were firmly held to the grindstone.

I enjoyed the discussion and exploration of the recently announced Education Outcomes Framework (EOF) consultation. This is an extremely important work for all educational providers, and colleagues across the UK are encouraged to respond. The framework supports the integrated healthcare workforce in meeting the clinical outcomes set out in the NHS, public health and social care outcomes frameworks – the overarching policy within which the education framework is nested.

From a educational perspective the EOF identifies what Health Education England (HEE) is likely to expect in terms of outcomes and how these outcomes would monitored by the Department of Health, HEE, and HEE and the Local Education and Training Boards (LETBs) and the LETBs and providers such as our School. Perhaps somewhat closer to the Schools ambitions the EOF provides a direct line of sight between education and training we provide and how this impacts upon patient experience.

Colleagues in the School are resurrecting a bid to see how we might best involve service users in articulating a view as to how we are preparing nurse for practice. I expect we can also transpose this to social care, and I would love to be able to do something similar with social policy! The EOF is being promoted as a catalyst for driving quality improvement and outcome measurement throughout the NHS, and I am sure in the fullness of time, a series of Key Performance Indicators (KPI). One way or the other the EOF is an important piece of work that needs commenting on – so go online and make your voice heard.

This week has also seen me writing a series of abstracts for next year’s NET/NEP conference in the US (you either know these abbreviations or not, and life is too short to write out every full name). Writing abstracts is one of my favourite things to do. I love the challenge of ‘selling’ an idea or an outcome in 300 words or less – I also like the challenge of finding a title that will stand out from the rest. Last year NET/NEP received over 900 abstracts and so it can be difficult to make sure your abstract sticks in the mind of the scientific committee. I hope to have achieved this with the abstracts sent in.

This week the weather changed here in the UK – for the worse. The sunshine and heat of last week was replaced by rain, high winds and cold. The cold has turned the green leaves of my blueberry plant crimson – amazing. Wednesday morning at 05.00 am, it was very dark, close to freezing, but with a sky filled with bright stars. As romantic as this sounds, taking Cello out in the morning has been rather like going for a walk dragging a reluctant soggy brown paper bag behind you – but as this week marks two years of getting up at 05.30 for a walk maybe he is entitled to the odd lie in.

And Alun, thanks for the good news, Keith a healthy diet does not usually come out of a polystyrene container, Sue, Happy Birthday – life begins at 50, Karen, Olga and Jurate, thanks for the wonderful company at dinner this week, well done Ieuan, it couldn’t have been easy, Dean and Sam, you’re a perfect pair, Stewart, remember there is usually no gain without a little pain, especially when trying to stand on your own two feet, Ghassan, well done, and I am glad I hold a Gold Card with Emirates, Sarah, keep the emails flowing, and many congratulations to Nancy, Jane, Nick and Jill, all of whom secured Associate Head roles in the School, against some stiff competition.

Falls, Man Flu, and Talking with Psychologists

2011-10-02T05:38:00.001+01:00

Two of my relatives fell over last week and injured themselves – one is 84 and the other 4 – and neither could account for themselves or why they had fallen over. Thankfully apart from some bruising, grazes and possibly hurt pride, no serious injury resulted from the fall. My relatives are not alone. In a report published by the NHS Information Centre last Thursday, it was reported that 20,800 hospital admissions in England over the last 12 months have been for people having a fall involving a bed, 12,000 admissions were for people who had falls involving chairs; 6,400 admissions for people falling from ladders; 1,200 admissions for people falling out of trees; and 170 admissions for people falling from cliffs.

Today sees the start of the Conservative Party Conference (held in Manchester). Given the Government statistics about falls, and the somewhat risk adverse society we have become, I would not be surprised to see calls from the conference floor for legislation that saw people being advised to sleep on the floor, all trees other than bonsai trees to be cut down, all chairs to be fitted with three point safety harnesses, ladders to be no taller than one metre, and all cliffs to be fenced off.

On top of having to deal with these risks to our health and well being, we have had an unprecedented heat wave to contend with in the UK this week. Not that I have noticed. Following my trip to Lithuania, I went down with a cold and cough and have been enduring high temperatures all week.

Monday I was at the University of Cumbria first thing, and this was for a meeting at the Lancaster Campus. It was the first time I had visited this campus. For those of you who have not been there the campus is made up of a collection (yes that is the correct word) of some very different (and again that is the correct word) buildings, in terms of styles, ages and architecture. The meeting was of the Council of Deans North West.

Sadly, the solidarity that had been evident throughout the last year across the group representing the 11 Universities in the North West, and which had provided us with so much influence at a regional and national level was challenged by the actions of one University seeking to unilaterally exploit a business opportunity that we had collectively been working on for the last few months. In 1850, one Frank Edward Smedley from Great Marlow in Buckinghamshire, UK said that that all is fair in love and war and maybe, just maybe, it is also true for business relationships too.

And relationships, as I have said many, many times are all important. Last week saw the publication of the Personal Social Services Adult Social Care Survey. This User Experience survey is an annual survey that seeks to gain an understanding of service users' views about the care they have received rather than simply measuring the quantity of care provided. The survey aimed to learn more about whether or not the range of social services provided are helping individuals to live safely and independently in their own home and what was the impact on their quality of life. Some 61,000 people took part in the survey and of these:

62% said that they were extremely or very satisfied with the care and support they received, but only 42% said they had as much social contact as they want with people they like, and only 57% of those asked said the way they were helped and treated made them think and feel better about themselves. So maybe there is some way to go yet!

And for me, last week was equally full of such contrasting experiences: the best meal eaten was that taken with my Head of School colleagues at the Café Istanbul, the worst moment was opening up my email after a 3 hour meeting to find I had hundreds of new emails, the longest phone call was with a colleague in Australia, the best cup of coffee nearly drunk was at Wednesday's catch up meeting, and the most relaxing walk, was with Cello, early Saturday morning, up to High Rid, and finally, the most unexpected but welcome conversation this week, was with my favourite psychologist of all time, standing at the top of the stairs in Allerton late on a very hot Friday afternoon.

Making a Start, Making Progress, Making Time

2011-09-25T05:43:00.000+01:00

The week was a busy one and one that was rich in experiences, emotions and challenges and opportunities. Monday was the start of the new academic year and some 900 nurses, midwives, social work, counselling and social policy students joined the School to begin their studies. At times the noise and movement resulting from these students exploring for the first time their new campus, was fantastic and a real fillip after the somewhat quiet days of August. I really enjoyed welcoming the students and it was great to see the 300 seats in G21 filled to capacity on each of the three occasions it took to deliver my talk this year.

Tuesday was the last day I was at the University before leaving for Europe – so was crammed with planned meetings and those ‘can I just have 5 minute ones’. However, I did manage to get to talk to the one person I missed talking to the previous week, which allowed the silence to be broken and conversation to recommence. Sadly, Tuesday also brought the dreadful news of the untimely death of one of our valued colleagues working in another College. For me, the news reinforced the fragility of our lives and the need to ensure we find ways each day to live the lives we want to live.

Wednesday started at 03.00 and by 04.30 was at Manchester airport on my way to Lithuania. Wednesday became a 22 hour working day. Lithuania is a wonderful place - and one full of contrast. New modern buildings stand next door to buildings crumbling away through neglect. I was there as part of the EmpNUR project - a project aiming to empower nurses through mentorship. University’s for seven European countries have come together to develop a mentorship programme that will transform nurse education across Europe. And the good news was we had made progress in achieving this aim.

Working on a project that aims to work across a multi cultural consituency is always going to be difficult. However, our group has succeeded in finding a way to embrace difference and recognise the cultural, political and organisational challenges facing each of the participant countries. We have established an evidence base for the benefits of mentorship as a way of improving learning in practice.

Our hosts in Lithuania were brilliant. The hotel was the most laid back place I had ever stayed in. Cool seemed to run through the veins of every employee. They really delivered on making staying with them a wonderful experience. During the trip we were able to visit colleagues in practice and spent a great afternoon with students and tutors exploring their experiences of becoming a nurse or a midwife. Afternoon tea included a range of cheeses served with a thick honey – sounds strange but actually it was very tasty.

Friday was a bitter sweet day. On this day four years ago my little brother Christopher died. He endured a whole load of health problems throughout his life but always remained optimistic, and enthusiastically embraced life. He never had a bad word to say about the doctors and nurses who provided for his care. He never tired of singing my praises, most of which was undeserved. It was really good to spend the journey travelling between Lithuania on Friday afternoon trading stories of childhood experiences, good and bad, with my friend and colleague Karen. Christopher died the day before my interview for the Head of School role.

The four years since then have passed very quickly. They have been four rewarding years, and thanks to the contribution of my colleagues, as a School we have been able to move forward in achieving our strategic aims at an exponential rate of progress. And as a new School, we will need to continue to find time to ensure that what we do is what we need to do. Just like the project group in Europe, all my colleagues in the School will need to remain open to new ideas, be prepared to be brave enough to try something different and creative, and have the confidence in our collective abilities to continually find innovative ways of developing and delivering our programmes.

Kilts, Saris, a Jacob's Feast, and Conversations

2011-09-18T05:21:00.001+01:00

Last Sunday I attended a Scottish/Asian wedding held in the Ashton Memorial located at the highest point in Williamson Park in Lancaster. The folly is visible for miles around, and most people will have seen it from the motorway on their way to the Lakes or Scotland. The day was bitterly cold with strong winds and lashing rain. The under floor hot air heating kept the space warm and the Indian spicy food warmed people up from the inside.

All the men wore kilts and the women saris, which made for a colorful, noisy and wonderfully cosmopolitan gathering. The conversations around the room with people known and new were often fascinating and always great fun.

Monday I took part in a Readership/Professorial interview at the University of Bedford. It is always a great privilege to be part of such events. You get to hear all the issues (good and bad) that colleagues from a different University are dealing with, and of course you get to have conversations with the candidates. On this occasion one of the candidates was from Maastricht University, famous for its approach to internationalism and of course, Problem Based Learning. It was fantastic to hear about both these activities during the interview process. I came away with some great ideas for our School to consider, and these ideas made the three hour drive there (and three hours back) worthwhile!

Tuesday saw the first of our new College Research and Innovation Committee meetings. New faces, new agenda and the first conversations with some of new our colleagues joining the College as part of the University Transformational Programme. Wednesday’s work included an afternoon spent at Senate – and conversations around ourTeaching and Learning, Research and Innovation, and Engagement and Partnership strategies.

Thursday was my granddaughter Evie’s 4th birthday and it was delightful to be able to talk to her and hear just how exciting her day had been. I also had the discharge conversation with my nursing colleagues at the Clinic. And later on that evening the phone rang, and it was a colleague from Australia. He and I were at opposite ends of the day, and whilst he had sunshine and light, I had darkness, rain and high winds to contend with. It was an interesting conversation nevertheless.

Friday was the first Development Day for the new School. I am not sure standing in front of 240 colleagues from the School presenting my analysis of the external and internal environment and the changes we need to address really counts as a conversation, but it was a fabulous start to what turned out to be a creative, productive and fun day. Next up, colleagues worked in small groups to develop a sense of the kind of School they wanted to work in and what as a new School, we need to do as ensure we can successfully create this. The work continued as the groups turned to addressing some specific issues around enhancing the student experience, and developing our research activities.

Lunch was a Jacobs’s Feast and it was a veritable self created banquet – we also tried out the refreshed University catering offering and this got positive reviews from everyone. We had an extended lunch break and it was great to listen to the conversations going on the rooms and corridors, often between colleagues who were meeting each other for the first time. The day ended with a plenary session at which the group work outcomes were presented. I don’t know whether it was Friday, or that colleagues felt relaxed, but the presentations were thought provoking and at the same time the mood in the room was jubilant. Great fun was had by all. The last couple of hours of the afternoon passed quickly, easily and very enjoyably.

Friday ended with a meal out with my Magistrate friends. We have been together as group of Magistrates for nearly 20 years. As always, the dinner table conversations were rich with tales of our collective experiences of sitting in Court over those years, and of course, ambitions achieved and those that didn’t quite come off.

It has been a week of interesting, rewarding and sometimes challenging conversations. However, due to my not being particularly thoughtful, I made it impossible to have a conversation with the one person I really needed to talk to this week. Sadly, as the week has gone on the silence has stretched out between us.

Clearly I need to more carefully reflect and act upon the advice of Mahatma Gandhi’s - happiness is when what you think, what you say and what you do, are in harmony. Today is the start of a new week, with hopefully plenty of new opportunities to work towards achieving such a state of harmony.

A Duty of Candour, Depressive Women, and Friends in Finland

2011-09-11T05:44:00.000+01:00

The first two days of last week were spent at the University Strategic Conference. Unfortunately due to still having treatment at the clinic each morning, staying over was impossible. Experience tells me that it's the informal getting together in this way that are the most valuable and enjoyable aspects of such events. However, the two days were very good and I came away with a sense that the University had somehow changed gear in working towards achieving its strategic aims. In the last session we were encouraged to raise ‘taboo’ topics. Ironically, the rules of confidentiality don’t allow me to say whether anyone did or not.

But arguably such sessions are important for any organisations health. How many of us have been party to a meeting where the 'Elephant in the Room' is completely ignored as people feel for whatever reason unable to voice their concerns. It’s sometimes easier to simply convince oneself to be a team player and not rock the organisational boat. It can be hard to stand up and be counted for what you believe to be right. I believe that it is important for organisations and the managers who lead within them to learn how to listen carefully to what is being said.

Last year the UK Department of Health signalled its intent to introduce a ‘duty of candour’ for all health care providers, making them contractually obliged to publicly reveal mistakes made. This month the Health Select Committee recommended that the ‘duty of candour’ will need to be a condition for licensing (by the Care Quality Commission) for any qualified provider wishing to contract for the provision of health care services. Even without the moral obligation to enact a duty of candour there are important economic drivers to consider. The cost of settling legal claims against the NHS for clinical negligence was £807m in 2010, a rise of £146m on the previous year. Each of these claims represents something going wrong, a patient harmed or killed. Being a current user of health care services and the fact there were just under 6000 claims last year is enough to make me feel quite depressed.

And I am not alone. The journal, European Neuropsychopharmacology last week published an updated report on work originally undertaken in 2005 which looked at the size and burden of mental illness in Europe. The report showed that almost 165 million people or 38% of the population suffer each year from a mental health problem such as depression, anxiety, insomnia or dementia. Professor Hans-Ulrich Wittchen, who led the systematic review of empirical based studies, noted that the rate of depression in women was 2.6 times higher than for men, particularly for those women aged between the ages of 16 to 42. These researchers attribute this higher rate of depression in women to the burden of balancing the demands of marriage, family and a job – although I am not convinced this link is clearly demonstrated in their paper.

The mental health organisation SANE note that perhaps one reason we believe that women are twice as likely to suffer from depression than men is more to do women being more prepared to talk about it, whereas many men can find it more difficult to describe their feelings of anxiety, depression or loneliness and may even lack the language to express their inner feelings.

However, maybe the depressive woman doesn’t need to be, well completely depressed. Dr Sabura Allen, a clinical psychologist at Monash University published, in 2007, her now famous piece of research which looked at the recent sexual experiences of depressed and non-depressed married and single women who were both in relationships or not. Her study found that depressed women had more sex than their non-depressed counterparts. The study concluded that depressed women were likely to be seeking out sexual intimacy more often to help make them feel more secure. I am not so sure her research really proved this is the case. But it is known that sexual activity provokes a release of endorphins which elevate our mood and can make us feel ‘happier’ and increase our sense of wellbeing.

And finally, it is likely that this weekend will be a difficult one for many people. Each anniversary of 9/11 provokes in me a sense of deep contemplation of the human condition. I was in Finland when 9/11 happened and with friends of many years. We sat and watched the dreadful events unfold together. And Mikko, Leena, and Heikki remain good friends all these years later. They have, and continue to bring much happiness to my life!

Black and Blue Bodies, A Red Letter Day, and Purple Prose

2011-09-04T06:25:00.000+01:00

In my opinion, and I know I am making a rather sweeping generalisation here, nurses becoming patients is never a good thing. Disclosing that one is a nurse to other nurses when one is a patient is possibly also not always such clever thing to do.

I was surprised, therefore to find myself telling a nurse armed with a needle poised above my vein, ready to draw blood, that I was a nurse. The somewhat unfortunate result was getting two bruised arms before any blood was drawn. It was unfortunate that the drawing of blood came immediately before the administration of a deep subcutaneous injection into my abdomen. The injection was painful and bruised me. But it was just the start, my belly was turned black and blue during what was a week of daily injections.

I was at a clinic I last attended in December 2007. On that first visit I came across a very caring health care assistant. I remember her well. Seeing my bewilderment on that first day at the clinic she kindly offered me a welcome cup of tea – which duly came, served in what my Mother would call 'a proper tea cup'. Nearly four years later, we were both there again. This time there was no tea, and she was the one looking bewildered. The waiting room door was locked. It had a numerical lock which defied all her attempts at guessing the code. So we stood outside talked about the advantages of a Kindle versus paper books and whether I knew who had 'done it' in the TV series the Killers – and despite my repeated protestations that I had never heard of the programme she insisted I must know who the villain was. I was saved by the arrival of the Clinic Sister. The painful injection was a small price to pay for being rescued.

I think the Clinic story is likely to run for a bit yet, unfortunately. What I also hope gets to have a long run is our new School. September 1st, 2011 was a Red Letter Day for the School. It was the official beginning of the new School of Nursing, Midwifery & Social Work. The creation of this new School, bringing together for the first time a much wider range of health and social care professions in one school, is what I believe to be one of the most exciting and significant developments in the Schools history. The opportunities to deliver our programmes differently are limitless. There are many opportunities for new research and to further contribute to the development of health and social care services of the future. I am really proud to be part of a newly formed team of colleagues who will take these ideas and opportunities forward.

Of course at one time in British Universities, there really were red letter days (often referred to as scarlet days) where the full dress gowns were worn. These days such academic dress is usually only worn on graduation days. It is such a shame that it doesn’t these days. I would love to be able to wear of our gowns everyday!

However, it was only the Doctors who got to wear the Scarlet Robes! That is real Doctors (those with a PhD). But it was not surprising to read the outcomes of the 2011 Ipsos MORI Veracity Index which revealed that 88% of adults in the UK reported that they trust medical doctors to tell the truth. It was an annual poll carried out for British Medical Association. The results revealed that doctors were the most trusted profession measured. The least trusted profession were politicians. It was teachers who were the second most trusted profession (81%). Interestingly, since 1983 at least 50% of those taking part in the survey have also said they trust the ordinary person in the street to tell the truth (in 2011 it was 55%).

And finally, many congratulations to our NJL, who also had her own Red Letter Day on Thursday – she got married - well done and best wishes!

A Hopeful Resurrection, Contemplating Suicide and Saying Goodbye

2011-08-28T05:43:00.000+01:00

With so many colleagues on holiday last week (and next) it has been a week for taking stock, getting all those things done that have slipped down the 'must do list' in favour of addressing the latest crisis or meeting yet one more demand generated by others. That said, the week felt, for the most part, a relentless task orientated one with little time (or energy) left for blue sky thinking.

So I was glad to get to the weekend (a long one) and enjoy a chance to step of the merry-go-round for a few days. Whilst the weather yesterday was pretty mixed it didn’t prevent me from going out to the annual Bolton Food and Drink Fair. This year’s event appeared bigger than ever. It really was so good to see so many people crowding the Town Hall Square and the surrounding streets. The last few times I have been into Bolton it’s been dead, no noise, no action and not attractive at all. This weekend has clearly provided a boost and I hope it will be the start of Boltons resurrection so that once more Bolton will become a place to shop, visit and enjoy at a weekend.

This week I came across a newly published research study that examined the relationship between physical illness and suicide. The report, Hidden data provide new insights into life at the end: the truth about suicide was published by DEMOS. DEMOS are a highly regarded independent think-tank focused on power and politics. During 2011, DEMOS focused on five programmes: Family and Society; Public Services and Welfare; Violence and Extremism; Public Interest and Political Economy

And as the report notes, suicide continues to be an extremely important public health issue here in the UK. In the UK there is one death by suicide every two hours. Nearly four times more men than women die from suicide. Although over the last decade the overall rate of suicide has fallen, in the last two years there has been an increase. Indeed, data included in the Coalition Government’s recently published Consultation on Preventing Suicide in England suggest that the 20 per cent reduction target set by the previous Labour Governments National Suicide Prevention Strategy is unlikely to be achieved. Suicide rates tend to rise during periods of high unemployment or economic uncertainty. Some of the key risk factors for suicide are well known and include gender, unemployment, drug abuse and mental illness, the latter being considered as the most significant risk factors.

Of course this is not new. In 1897, Emile Durkheim, the French sociologist, published what at the time was a paradigmatic shifting thesis on the prevailing view of suicide. He described four subtypes of suicide: Egoistic; Altruistic; Anomic; and Fatalistic. For me it is the egoistic and anomic subtypes that are of most interest – both deal with the individual sense of self and self in relation to others, and perhaps more particularly the impact of perceived expectations of others on self.

Durkheim established through his work that generally suicide rates are higher in men than women, for those who are not married, or for people without children, for soldiers rather than civilians, and are higher in Scandinavian countries. This new study by DEMOS adds to our understanding of suicide and is definitely worth a read by all those interested in this aspect of mental health care and the care of people with long term conditions.

Friday was both the end of the working week, and unfortunately the end of a fabulous relationship. Lunch was spent saying goodbye to a wonderful colleague and friend who was moving on to a different place. Although I found lunch a very sad occasion, I was reminded that like all good relationships that involve hard work, there had also been plenty of fun along the way as well.

And fun it was yesterday – my grand niece was staying for a sleep over and although she is only four, sometimes she behaves as if she was 40 - and she certainly reminds me I am 56! When I asked her if she wanted to have some music on as she ate her dinner, without hesitation and in all seriousness she said she would rather like to listen to Coldplay! So that’s what we played and in truth, it was lovely to hear such fine music again.

Strategic Thinking in Cheshire and Cello gets a new Soul Mate

2011-08-21T05:35:00.002+01:00

Monday wasn’t the best day of the week for me. It was the start of what turned out to be an exhausting week, and the day ended with unexpectedly finding one of my female colleagues (and friend) had taken up smoking again. So I was more than interested in reading a piece in yesterdays Telegraph newspaper reporting on some recent research involving women’s belief about the seriousness of lung cancer. Lung cancer is the cancer that kills most women in Britain. The survey revealed that most women thought that 40% of sufferers would live for 5 years after diagnosis, whereas the real figure was only 9%. Smoking remains the biggest cause of lung cancer. That so many women are still smoking is amazing. This study appeared to suggest an almost state of denial being adopted by many women of the consequences of their choice to smoke.

And smoking was still on the agenda by Thursday when I drove to Cheshire to work with a group of mental health service providers on helping them to think more strategically about where they wanted to be. I went to work with the Executive part of their Trust Board. Two of this group smoked, and the time spent together was definitely punctuated by many so called ‘therapeutic smoking breaks’. While all staff are banned from smoking on any part of the Trust premises service users are allowed to smoke in designated areas. This approach sparked an interesting side debate about what message this sent in terms of promoting health and wellbeing across the Trust.

However, it was a lovely venue to hold a retreat and the group worked well over the two days in developing their understanding of the difference between strategic thinking and strategic planning – the latter activity was one they were very good at doing. Unnervingly (for me) it was my analysis of the mental health world that was up for scrutiny – presenting an expert veiw in this kind of context is always a difficult situation to find oneself in. The conversations were, however very interesting. And as a group, they reached a consensus over what the strategic direction and intent was, only late on in the afternoon. But they got there and that made the second day a very productive one.

For me it was a real privilege to work with such an interesting and informed group of practitioners. Some definite opportunities for further collaborative work between the Trust and the School were identified. Driving back on Friday afternoon, although very tired, I felt in a very good place, and once again thought how fortunate I am to have such opportunities. It has made me more determined to try and ensure that others have similar opportunities to both grow and develop personally and contribute to the development of the services we prepare others to work within.

Yesterday, my youngest brother arrived. He and his family were to spend Saturday and today here before returning to the lost city of London. His two children were a delight and in turn, delighted Cello, who as always, is always up for as much attention as he can get. By late afternoon, my brothers daughter had formed a real bond with Cello and they were inseparable.

The children went to bed asking for the 100th time when were they going to get a dog. I certainly don’t envy my brother the drive back to London!

Sitting in the seat of the armchair anthropologist once more

2011-08-14T05:35:00.000+01:00

Last week was hectic! The first day back from work came and went at an almost bewildering speed.

The oasis of calm on Monday was a PhD viva – the second time for the student and this time such a better experience for all. There is something very special in spending that couple of hours having a conversation with someone passionate enough about a particular question that they spend three, four or more years studying it. And for me, once that door has closed and the viva starts, the outside world cannot intrude – it is an almost self-indulgent activity. For this candidate it was a successful conclusion to five years work, allowing a welcome return to his family and friends.

My new office, started on Saturday, was welcoming but not complete – somehow it didn’t quite work for me. It was Tuesday before I began to feel a creative certainty over what to do – chairs were exchanged, pictures placed on walls and at a stroke the room delivered on its promised magic. What I had been missing for a while now was a space that would allow me to think, write and converse with others. By the time I had got to Tuesday going home time, I felt I was getting somewhere, and the new office was starting to feel like a place to centre ones thoughts in. Just as well perhaps, as it took me two hours to get home that night.

The riots, sparked by a death of a young man in London had spread north. Starting in Salford, the dissent and mindless wanton destruction quickly spread to Manchester city centre. The result (coupled with an accident on the M60) was gridlock and the inevitable long journey home. All comparisons are odious, and I was particularly put out by the way in which the media kept cross referencing the behaviour of rioters in Manchester with the street protests there were in Thatcher’s early years. It was strange watching the old archive films of the anti Thatcher protests on the news programmes, and for me, a little sad.

Later on in the week I started the task of preparing for a two day workshop next week aimed at trying to consider what the future holds for mental health care providers and service users in the North West. My approach to such tasks is to search for, download and print off, everything I can find to read on the question being addressed. It is an activity akin to that sense one gets with the ethnographic immersion into the field that typifies the work of anthropologists. In this case it is a form of anthropology, sometimes called armchair anthropology that sees the ‘anthropologist’ using and relying upon the work of others to provide the ‘data’ for analysis. For me it is an approach that inspires huge amounts of creative analytical thought.

It was Edward Tylor who is considered to be the greatest armchair anthropologist. Tylor’s first and only field trip was to Mexico in 1856. He never traveled anywhere again to collect data, although he continued to study the customs and beliefs of many different tribal communities, both existing and prehistoric. His work, Researches into the Early History of Mankind and the Development of Civilization, published in 1865 was based entirely on the studies and information collected by others. His most influential work however was, Primitive Culture published in 1871. This work set the foundations for what we know today as cultural anthropology.

This week, I have trawled my way through over 45 separate pieces of policy, governmental guidance, white and green papers to try and gain a sense of where it is we have come from and where it might be we are going to in terms of new directions for mental health care. It is a process that involves first deconstructing the [policy] rhetoric in order to be able to re-construct a new view of a possible future.

In dealing with all the day to day turbulence of change that has characterised much of my work over the past six months, I had forgotten what a pleasure it is to sit in the seat of the armchair anthropologist once more. Now I have a new creative space, it is a seat I intend to occupy a lot more in the future.

Two Weeks and 100s of Emails Later - it’s back to work!

2011-08-07T05:39:00.000+01:00

Well the last two weeks have been a wonderful break. The sunshine, sea and isolation of Scotland were fantastic, a real tonic and totally relaxing. Last week was more unreliable weather wise but there were plenty of sunshine filled days nevertheless – but it was a week of chores and getting things done that are more difficult to do during the weekend.

The tree surgeon came for his annual visit – trees are lovely things but certainly need looking after. Cello went for his regular check up, as always an absolute star and of course loves being the centre of attention. I spent an hour or two choosing new shelves for my office at work, and thought I am possibly becoming too much of a grumpy old man to tolerate IKEA any more. But many thanks to our caretakers who took the flat packs out of my car and up to the new office. Jennie and I have swopped offices in preparation for the new enlarged School and although I am sure it was a pain to organise my thanks also go to Jennie and colleagues for getting things sorted while I was away.

Yesterday I called in and assembled the book cases – I really am becoming a grumpy and impatient old man, who should stick to buying ready assembled furniture. I abandoned the project after a few hours, and I guess it will take me some late evenings this week to get things sorted and comfortable.

Following on from a conversation I had a few weeks ago at a wedding reception I was invited to go and meet some colleagues at a mental health service in the West of what our new NHS SHA Cluster refers to as the NHS North. Whilst some might some think this a strange thing to do on holiday, it was partly business as well as pleasure. The morning was very bright and the sun shone. It was gorgeous walking around the grounds of a relatively unspoilt and slight old fashioned mental health hospital. Someone clearly had spent time, love and care on the grounds, and the space and quietness was soothing.

Today I will have to turn on my outlook account and start to look at the emails – 100’s, but hopefully, many of these will have already been looked at and responded to by colleagues – so it will be more a case of me catching up. A bit like Cello, who has been trying every night for the last two weeks, to catch Henry our resident hedgehog - every night he waits for Henry to walk across the front lawn, at which point he becomes beside himself with excitement - until last night Henry has always disappeared by the time Cello has gone out for his last walk - but last night he hadn't and Cello managed to catch him - Henry of course rolled into a ball leaving Cello completely flummoxed! Just as well...

...and now I am off to enjoy the last few hours of my holiday.

Week Two, Sunshine and the Return of the Beard

2011-07-31T05:39:00.000+01:00

On Friday I returned from a week’s holiday in Scotland, and I brought the sunshine back with me. Little did I know when I wrote last week that I was hoping for some sunshine that the week would be so gorgeous weather wise. All week, I have enjoyed blazing sun, temperatures in the mid twenties and some very lazy days walking, reading and simply sitting and watching the world go by.

Foolishly, I decided on day three of my holiday to shave my beard off – not sure why, it just seemed a good idea at the time. Then after shaving for just two days, and with a face as sore as anything, and cut to ribbons, I decided to let the beard grow again – hopefully normal service will be resumed by the time I get back into work!

I felt incredibly guilty thinking about all those early years of my nursing career where it was ‘normal’ to shave the male patients every morning – I cannot recall anyone asking the patients if they wanted to shave or not.

I have a little time to re-grow my beard as unusually (for me), I am having two weeks annual leave back to back. Whilst the first week was total self indulgent relaxation the second week is destined to be spent catching up on all those jobs that simply don’t get done at the weekend. It will be a hectic week but rejuvenating nevertheless.

There is plenty of relaxation time built in to the week’s schedule and Cello certainly knows how to deal with the heat and truly understands the art of relaxation.

Anyway, as well as my beard returning next week, the blogs normal service will also re-commence next weekend!

Time to Sit and Contemplate

2011-07-22T08:08:00.000+01:00

Thankfully it’s time to take a step back, and to sit and contemplate.

I'm on my way to Scotland to enjoy the wide open spaces, the relaxing sound of the sea, and hopefully some warm sunshine – but I will be back to write the blog in a week’s time!

ECQ makes it a good week, even if the weather was a little wet and dry!

2011-07-17T05:45:00.001+01:00

This week the quality of our nursing and midwifery programmes were assessed by the NHS North West using the Education Commissioning for Quality (ECQ) framework of metrics. This approach is a Department of Health must do, designed to ensure that the provision of all healthcare education is reviewed, quality assured, performance managed and in our case, meets the requirements of NHS North West health care workforce. For those Universities providing education and training programmes for health care professions, the ECQ approach is a critical improvement process. The results ensure that all educational and placement providers are working against agreed standards of provision and providing value for money. The ECQ process also allows for the formal identification of areas where educational provision can be enhanced beyond what is currently accepted as the standard provision. However, if we get it wrong there are possible financial consequences for the School as the commissioning of programmes can be reduced or even moved to another provider entirely. However, the process is also an important opportunity to present any areas of exemplary practice, which we took to show case our work over the past 12 months.

The ECQ process is an evidence based one, using nationally agreed metrics. Each University is rated on a traffic light scheme (Red = unacceptable/high risk; amber = concern/areas to be addressed; green = no problems). I am pleased to say that we scored all greens! And just for good measure our Social Work colleagues had the results back from the General Social Care Council of their equivalent quality assessment process and again we scored all greens.

So the outcome was really good news. The results point to excellent team working across the School by all academic and professional support staff in continuing towards our ambition of becoming known internationally for the quality of our education and training programmes and the creative ways in which we prepare nurses, social workers and midwives for the future.

The week was a busy one all round. It ended on Friday with a day spent in the V+A hotel at the last College Executive retreat of this academic period. The conversations and discussion were productive and despite the sometimes powerful egos sitting around the table, the debate was nowhere near as dramatic as the weather outside the rooms’ big picture windows. All day there was sunshine followed by rain and hail in equal measure. I should have known Friday’s weather was a spooky portend for the weekend.

Yesterday started warm and grey, but after a quick burst of rain we settled into a warm sunny morning. By the time the chores were done and it was time to take Cello out the sun was shining and I strode out confidently dressed in sandals, shorts and t-shirt. However, after just 10 minutes, the blue sky, turned black, and we were engulfed in a monsoon like down pour. Both Cello and I were soaked to the skin. Thankfully by the time we got to the top of the hill on Joan’s Field, the sun came out and started to dry us off. Apart from some frizzy hair (mine not Cello’s) there were no ill effects. From this hill, it’s possible to see right across the Manchester Plain to Blackpool and Manchester (the Hilton Hotel is clear to see), and on very good days it is possible to even see the mountain slopes of Wales. Whatever the time of day or weather, it is one of my favourite local walks.

And my favourite quote of the week was to be found in this week’s Nursing Times (the online version): You have two things to offer a patient: humanity and technical competence. You are rarely much use to people without both and, if you lack one element, you probably won’t be able to do the other well. The quote came Professor Peter Griffiths Head of Health Services Research at the University of Southampton, and Executive Editor of the International Journal of Nursing Studies, and for me, the quote encapsulated our approach to what it is we are trying to achieve across the School in preparing our students for professional practice.

A Summer Conference, CPD, Cello, and Cheesy Chips

2011-07-10T05:32:00.001+01:00

There was a real buzz to the Mary Seacole Building this week. The Education in a Changing Environment Conference came for three days this week.

It was the 6th International Conference and this year the very best practice in teaching and educational research in higher education was explored and presented through themes of Social Media; Learning, Teaching and Assessment; Networking and Partnerships. Throughout the three days I only heard good things being said by the delegates, which when one thinks about the enormous changes affecting Universities at present, was very heartening.

The inner gardens of the Mary Seacole Building were transformed as a place to enjoy food, music and good company. Each day there was different food to try, and different music to hear. The smells and sounds were delicious and very tempting – I however, conscious of my ever expanding waist line, reluctantly resisted the temptation. The funniest moment of the conference was hearing about the highly embarrassed electrician, extension lead in hand, looking for a plug socket. Someone had forgotten that electric guitars and amplifiers need real electricity to power them. The situation was saved by our School Administrator, who heroically gave up her kettle plug so that we could all get to hear the music – Well done Angela!

There was no such problem for me earlier in the week when I attended NHS North West at 3 Piccadilly Place, Manchester.

I was there to take part in a discussion around the future arrangements for CPD commissioning in the North West. Now 3 Piccadilly Place is a relatively new building and bears no resemblance to the old SHA headquarters, which can still be seen from the 11th floor. It is all floor to ceiling windows, Terrance Conran furniture and furnishings and absolutely no detail has been left unaccounted for. Everything is automatic, you won’t get past the security unless your name has been lodged with them, the lifts take you only to the floor you select, and even the gents toilets have a vase full of fresh flowers!

The meeting was for the North West Deans and Heads of School to discuss how in the brave new world of a transformed NHS, continuous professional development of the workforce was going to be achieved. In the future it will be possible for each NHS Trust to use 30% of funds to currently given to each University in any way they see fit. 30% of this funding must be kept to ensure core CPD provision is available and 40% is to be used in more flexible ways – again determined by each Trust, but delivered by each of the North West Universities. Given that up to now all the money has come to the School, it really did feel like the dawning of a brave new world.

Cellos world also changed this week. He was transformed from a shaggy slightly overweight looking beastie to a slim, sleek, carefully coiffered handsome dog. Yes it was his ten week visit to the dog groomers this week. Unfortunately, the same cannot be said of his owner. Not only is my six weekly visit to the hairdresser overdue, I must confess that despite resisting the temptation of the ECE lunch time gastro extravaganzas all week, I was so easily persuaded on Friday that eating a large bowl of cheesy chips was a good thing to do. BUT it was a great bowl of chips, and a bowl of chips to die for. I know they were 100% full of carbohydrates!

And this morning’s blog posting is the 100th blog posted since I began. Many thanks to all of you who read the blog (now over 17000 hits a month a month), and I promise to try and make it easier for you to leave comments when the University moves to its new web system later on this year. But it is brilliant knowing that when I sit in the quietness of my house at 05.00 am on a Sunday morning, that so many people will later on in the day, read about my (sometimes strange) view on the world, and what I have thought of my week or my take on what has happened in the School of Nursing and Midwifery at Salford. I am humbled and pleased in equal measure. Thank you.

Informing Our Practice: Art or Technology?

2011-07-03T05:46:00.001+01:00

In 2005 the RCN published a research report on the information needs of Nurses. It made very sober reading and reflected a world within a world where access to information to underpin evidence-based practice seemed limited and unachievable. The usual suspects were to blame; employers not allowing staff time to find information, access to computers and the internet was said to be limited. A significant number of the respondents (15%) claimed to have no access to a computer at work. The recommendations were also interesting – provision of more information skills training, the provision of value-added information services which help nurses find good quality, up to date, relevant evidence in manageable amounts, and greater access to physical and electronic libraries, librarians and other online services.

Reading the report now it seems an astonishing tale and one that is difficult to understand. Back in 2005 a survey, conducted for the BBC World Service by Canadian pollsters GlobeScan, asked people in 27 different countries what event of global significance did they think was the most important in 2005? Whilst there was no disagreement as to what these events were: the war in Iraq, Asian Tsunami, Hurricane Katrina, death of Pope John Paul, London bombings, Pakistan earthquake, Bali bombings and Avian flu, in some countries these events were given greater significance than others.

So for example, the war in Iraq was the most significant event for 15% of all of those polled, although 43% of Iraqis saw it as the most significant whereas only 9% in the UK made it their top event. It was suggested by GlobeScan that the extent to which people in different countries perceive the same events as significant is a sign of how much the world has become globalised – I argue that it is access and movement of information that facilitates this globalisation. Street level capture and dissemination of information and events is now easily possible allowing for contemporaneous observation and comment on a huge range of occurrences worldwide.

I mention the RCN survey, because this week I opened the 6th International Evidence Based Library and Information Practice Conference hosted by the School. My thanks to Alison and Maria for having the vision and faith to make this conference happen. There were 170 delegates from 15 different countries, plus many more delegates accessing the conference through a real-time on-line programme. In my paper I presented my ideas around learning and working at the edges of knowledge, knowing and not-knowing, and I had great fun. It was one of those occasions where what I set out to do in a very serious way became a humorous and much more light hearted challenge to our thinking. I think the RCN probably got it right in 2005, but in a world where I now have more computing power and communication access in my smart phone than I have in my lap top, I think it will increasingly important that we help our colleagues not just how to better access information, but also develop new strategies for how that information can be used as an evidence base for our practice.

Nick, another colleague working in our School is Editor-in-Chief of Informatics for the Health and Social Care journal, and he does just that on an international stage, the journals impact factor has gone from 0.471 to a 1.000 this year. Likewise the journal I’m Associate editor of, the International Journal of Mental Health Nursing has this year just received its first impact factor of 1.427. But it’s not just words that can make a difference. It is also how and where the words are delivered that can be important. Like me, I am sure there is is somewhere you might have been to where the company, place and conversational focus all come together, and where the resultant experience is then so good. I think this may be the case for at least one of my colleagues this week.

Across the world this week, in Durban, South Africa, a midwife with more than 30 years experience in developing midwifery practice and service management, Frances Day-Stirk’s was confirmed as President of the International Confederation of Midwives (ICM). Her professional interests include the organisation of maternity services, homebirth, promoting normal childbirth, newborn care and safer motherhood. She is a widely published writer and in particular on her ideas about learning research and practice development.

Elaine one of our Midwifery team was also there in Durban and she was there to promote her work on using art to further our understanding of effective midwifery practice. The world is becoming a smaller place as a consequence of new technology and how we realise the potential of access to information, but it is enriched by the way in which we promote the creativity that’s there in all of us.

And without this blog becoming like a popular film title, I ended this week not at a funeral, but at a wedding. Which was a joyous occasion. I want to wish Samantha and Dean all the very best for their future - and can say the NHS is safe in your hands!

A Rich Woman and a Richman show that it’s not the Money but the Thought that Counts

2011-06-26T05:18:00.002+01:00

I found the story this week, of Hadassah Peri an interesting one. Twenty years ago, Hadassah, orginally from the Philippines, and working as a nurse in New york, was sent to look after Huguette Clark. At the time Huguette was an 84 year old millionaire recluse. She had inherited a quarter of a billion pounds back in 1927, money made from copper mining. When Huguette died she left £21 million of her estate to the nurse who had cared for her all this time.

In a statement released through her lawyers, Hadassah said she was ‘awed at the generosity Huguette has shown me and my family, and was eternally grateful’. She was with Huguette every day for the 20 years. She said ‘I was her private duty nurse but also her close friend. I knew her as a kind and generous person, with whom I shared many wonderful moments and whom I loved very much I am profoundly sad at her passing’. Huguette Clark’s family will receive virtually nothing from the legacy.

The case has sparked a growing debate in the nursing profession, both in the US and here in the UK over the ethics of nurses receiving gifts from those in their care. I predict it will run for some time yet. Spookily, the Health Service Journal, using the Freedom of Information Act last month revealed that Hospital Trusts in the UK still owed the Department of Health a quarter of a billion pounds, with most of the debt resulting from mass bailouts made during the financial crisis of 2006. Hospital Trusts had been given £778m in working capital loans by the DH in 2006-07 and £247m since then. By the end of 2010-11 Trusts still owed £269m and 11 trusts had £10m or more outstanding. However, I am willing to bet that this is a debate that will be as loud as the noise of one hand clapping.

The week ended for me on a sad note with the funeral of my friend, colleague and great mental health nurse Tom Mason. Tom was one of those very special people, who always put other's first, whatever the cost he was always willing to show he cared. Much of his work was in the field of forensic mental health and his prolific publications in this and other areas of nursing care helped shape the services we now have in the UK. In 1999, Tom was awarded the International Association of Forensic Nurses Achievement Award in recognition of his outstanding achievements. His work with colleagues all over the world was always given freely, and his leadership and scholarship will be greatly missed.

Tom was a humanitarian, a member of Amnesty International and active opponent of the use of torture. He was a gentle man but one passionate about promoting nursing practice, education and research – and to this end he succeeded very well.

During the celebration of his life led by his wife Elizabeth, Tom had been keen that his mentor and the man who had been a big influence in shaping his life course, should be acknowledged. This was a man who was possibly one of the greatest thinkers I have ever had the fortune to encounter – he was the late Professor Joel Richman. Joel was also my PhD supervisor, colleague and generous friend, as he was too many of the people at Tom’s funeral. And I want to add my voice in salute to the way both these extraordinary men touched so many of our lives in such a positive way.

However, I am sure like me, your thoughts are with Elizabeth and Tom’s family during this difficult time.

Competence, the Code, and Trying Aristotle Again

2011-06-19T05:49:00.000+01:00

This week has been an interesting and varied one. I spent an entire morning taking part in competency based interviews. Given my predilection for difference, those that know me will understand how bizarre my involvement in such a process might have been. MI5 use competency based interviews on the basis that, done properly, they can help the interviewer understand a person’s past behaviour, something said to be the best predictor of future behaviour. Competency based interviews are designed to assess a candidate against a standard set of competencies required for the role. The candidates are not assessed against each other, but against these competencies. Surrealy, I was interviewing my PA for a Head of School PA job, a job she has done excellently for me over the past four years, and hopefully will continue to do so.

I also took part in an event that sought to understand what is meant by inclusive teaching. The first task was to ask the participants to work in small groups aimed at developing just one definition of what is meant by inclusive teaching. An impossible and some would say redundant task, given that being inclusive, in this context, must mean embracing the individual and difference. Likewise power differentials, economic considerations and professional expectations will all contribute to the interpersonal dynamics of the teaching relationships we engage in with students.

Later on in the week I presented a case at a Fitness for Professional Practice hearing involving a student nurse studying in our School. There are currently over 660,000 nurses and midwives on the NMC register. If an allegation is made about a nurse or midwife who may not meet the standards set, the NMC will investigate and, where necessary, take action to safeguard the health and wellbeing of the public. However, less than 0.2% of nurses and midwives have allegations made about their fitness to practise. The vast majority work within their code and consistently meet the high standards expected by the public. The Code is the foundation of good nursing and midwifery practice. Competency based interviews don’t feature in these FfPP processes, thankfully.

And then Friday came and there was an opportunity to spend some time writing. A couple of my colleagues and I are trying to write a paper about the ethics of contemporary mental health nursing practice. It is not proving an easy task! The paper has already had two different drafts reviewed by the journals peer reviewers, and vastly different views expressed on the quality and standard of the argument in the papers discussion. We are using some of Aristotle ideas as the basis for developing our analysis, which is where the challenge comes from. Aristotle was a Greek philosopher whose writings were the first to create a comprehensive system of Western philosophy, encompassing morality and aesthetics, logic and science, politics and metaphysics.

I am pleased to say that much progress was achieved, and a third and hopefully what will be the final and successful draft is beginning to emerge. I enjoy writing and words fascinate me. More than anything words have the power to change things. While words can hurt, intrigue, inform, embolden, show care and love in equal measure, words can also cause great amusement.

I found a headline in yesterdays Times very amusing. The story was about Michele Bachmann, a woman tipped to be the Republican most likely to oust Barak Obama in the forthcoming US presidential elections. The headline was Bachmann turns on the overdrive as Palin teases. What a brilliant play on words I thought. But perhaps you need to be a reader of a certain age to understand.

Bachman Turner Overdrive was a super group of the 1970’s. Their most famous song was You aint seen nothing yet – a song about a man who meets and falls in love with a devil woman. His is an unrequited love, whereas she keeps the relationship going through promises of excitement and enjoyment, hence the songs title. It is somewhat ironic then that in 1983, Margaret Thatcher on a visit to the US famously quoted the songs title when making a speach to Ronald Reagan. She has just been elected for a second term, and her promise to the British people was of better times to come. History would seem to suggest that peole experienced those better times in different ways!
And for Fathers everywhere today, have a Happy Fathers Day.

A new School in the Making, Gardening and Making Black Champagne

2011-06-12T05:23:00.001+01:00

Last week was a long and, at times, a confusing week. There was one more panel to sit on – a ‘Any Questions’ type of panel focused upon the relationship between a supervisor and a student undertaking a PhD – the panel was part of the University’s Post Graduate Student Research Conference, where students get to present their work. The conference was attended by 180 people and was inspirational in its variety, vibrancy and sheer energy; it was a real privilege to be part of the event.

On Friday the School had its last School Development Day in its current form. From September this year the School will be re-born as the School of Nursing, Midwifery and Social Work. The new School will be the largest in the University with some 200 academic staff, and 4500 under graduate students, mainly studying on pre-qualifying professional programmes. It was the first time I had the opportunity to meet all the colleagues who will make up the new School. My passion for chickens seemed to confuse those who were hearing me present at School Congress for the first time.

However, apart from a lovely meal at the Mint Hotel with colleagues from the other Greater Manchester Universities, much of the week was unremittingly stressful. And yesterday was a wonderful opportunity to unwind and relax, to find a way of recharging my batteries. A good friend recently reminded me that: if you want to be happy for an hour, have a glass of wine; if you want to be happy for a year fall in love; but if you want to be happy forever, make a garden. So after doing the chores, it had to be a day in the garden.

Once the lawns were mown, hedges trimmed, trees pruned and weeds pulled, there was time to take in the changes. This year the Sambucus nigra is in full flower, with lots of blossom. Predictably perhaps, I prefer this black version of the popular elderberry. And I am not alone. Black elderberry has been used medicinally for hundreds of years. It’s even been known to cure ‘man flu’. More seriously, a 2009 study found that the H1N1 inhibition activities of the elderberry flavonoids compared favorably to the known anti-influenza activities of Tamiflu.

My interest is in the flowers is more esoteric – despite the fact the leaves, seeds, roots and flowers contain cyanide, I want to find out if I can make black elderflower champagne. I’ve made ordinary white elderflower champagne for years, but this is the first time I have enough black flowers to have a go. Watch this space.

The perfect end of a day in the garden yesterday was hearing Robert Miles ‘Children’ coming on the iPod as I cooked dinner. I have two 160 GB iPods each holding different sets of music – it’s a lot of music, and as the iPods are set to random play, it was serendipity that I got to hear this music again. I defy anyone to listen to the music and not start dancing – this music will make you move – even Billy was dancing up and down on his perch.

I first listened to this music some 16 years ago, driving across the Mojave Desert on my way to Las Vegas. From LA to Vegas it is one straight long long road, and putting Robert Miles Dreamland tape in the player made the journey such a good one. Ironically, Miles wrote the music in response to the number of deaths due to car accidents as clubbers drove across the country overnight, falling asleep at the wheel from strenuous dancing as well as alcohol and drug use. DJs such as Miles recognised the need to create and play slower, calming music to conclude a night's set.

And that quote about happiness, it was one David Burpee (he dropped out of University to look after the family business selling seeds), who is acknowledged as the person who made the original Chinese proverb famous. Interestingly, as a gardener, Burpee was more concerned in the nutritional value of flowers rather than the vegetables his family had traditionally sold. However it’s not known what he thought about drinking Black Elderberry champange.

ESRC reviewed, UCL revisited, and a Dry Wedding in Bewdley

2011-06-05T05:50:00.001+01:00

This week was the final shortened working week for a while, and I do like Bank Holiday weeks. It was a busy one though, with plenty of student concerns to resolve, the start of the transformational interviews, a Research and Innovation Away day, the VC colloquium on Arts and the Humanities at the University of Salford – for some reason I had been invited to be a Panel Member. Towards the end of the week, I sat on a different panel, a recruitment panel for a Professor in Midwifery – more of which in a later blog.

The week ended however, with a visit to Lancaster University to take part in the first Regional Event facilitated by the Economic & Social Research Council (ESRC). The event was hosted by Lancaster at their magnificent campus on one of the hottest days of the year so far.

The day was facilitated by Paul Boyle, Professor in Human Geography at the University of St Andrews and current Chief Executive of the ESRC. He outlined the changes the ESRC have made and which are introduced from June 2011. These changes have been driven in part by the reduced funding available for commissioning research, and partly because the number of applications has risen by 38% over the last 3 years, whereas the success rate for applicants has stayed at a stubbornly low 13%. Many of us have spent a great deal of time preparing bid applications, which are then sent for review and clearly the attendant time and cost involved in this is not worthwhile if only 13% of applications are getting funded. So part of the day was around discussing how this situation might be managed.

Interestingly, there was also an opportunity to hear about the existing and planned programmes. I was struck in particular by the longitudinal studies (and these really are life time studies) funded by the ESRC – this is the only funding body able to commission and pay for such studies. The most famous of which is possibly the British Household Panel Survey (BHPS).

Its longitudinal design means that the same individuals are re-interviewed on each successive year. Similarly, children from these households become eligible for interview as they reach the age of 16. Thus the sample has remained broadly representative of the population of Britain, and provides unique data on the dynamics of change in the UK population. The BHPS has been running since 1991, and now includes around 9,000 households and 22,000 individual members (target is 40,000 members).

The study collects data about each sample member and his or her household at annual intervals. Such panel surveys provide unique information on the persistence of such states as child poverty or disability, on factors that influence key life transitions, such as marriage and divorce, and on the effects of earlier life circumstances on later outcomes.

The latest project to be announced is the Birth Cohort Facility Project. This project has received a landmark £28.5 million commitment from the UK Government. The Birth Cohort Study will track the growth, development, health, well-being and social circumstances of over 90,000 UK babies and their families - from all walks of life – and will initially cover the period from pregnancy right through the early years of childhood. Recruitment of parents is due to begin in or around 2012.

The Study has been developed by a team comprising the UK’s leading biomedical and social scientists. Professor Carol Dezateux, Director of the MRC Centre of Epidemiology for Child Health at the Institute of Child Health, University College London and a consultant paediatrician at Great Ormond Street Hospital for Children, will lead the Birth Cohort Study Scientific Leadership.

Sitting there listening to the presentation I was struck by the rather wonderful Google Chrome advert on the TVs at the moment that is built around the emails a Father sends his daughter over time, with the aim to one day to sit and look at them together. Its a wonderful advert and one that both recognises and promotes the longitudinal nature of the bond between children and thier parents in an ever changing world.

This weekend I was witness to the dynamic nature of such relationships. I attended a family wedding. One of my nieces was getting married (I think I was that slightly eccentric Uncle from up North). It was a long over due opportunity to spend some time with my Mother and Father and some of my brothers and sisters. The marriage was held in the beautiful village of Bewdley, it was a lovely if somewhat over long wedding service (I am not sure I really like these new fangled hymns and the preacher man insisted on calling them songs).

The reception was held at Rock Hall – a wonderful example of an ecologically sound community venture. One side of its roof was covered in solar cells generating enough electricity to keep the building going at no cost.

The reception was great, but it was a dry reception, no alcohol allowed…

…but I guess each to their own.

30,000 miles, 15 flights, 4 trains, 2 buses and too many taxi’s!

2011-05-29T05:07:00.000+01:00

This week marks the end of a month long series of overseas trips for the University. I have traveled over 30,000 miles, been on 15 different flights, 4 train journeys (each some three hours long) and two bus journeys (also 3 hours long) and taxi’s too many to mention – I am so fed up with doing taxi therapy. And for those wondering about cost - only the Council of Deans meeting was paid for by the University!

In any event, this week I spent three days in Martin, Slovakia at a nurse education conference that I have been supporting for some 18 years. It was held at the Comenius University, a University renowned for its programmes in both Slovak and English, particular those in the field of medicine.

The University is named after Jan Comenius a 17th century Czech teacher and philosopher…

… as a theologian, Comenius was viewed as a mystic, a believer in prophecies, dreams and revelations. His legacy was the influence he had in educational work. Despite the fact that few people since his day have had a greater influence on health care education, there is little recognition of his relationship to the current advances in educational thinking and practice. His contribution was far reaching. He was originally a teacher and a manager of schools, in Slovakia, Sweden and Holland. In his Didactica Magna (Great Didactic), he outlined a system of schools which today is the exact counterpart of the current American system of nursery, primary school, secondary school, college, and university system.

Comenius was influential in formulating a general theory of education. He was the first person to formulate that idea of ‘education according to nature’ so influential during the latter part of the eighteenth and early part of the nineteenth century. The influence of Comenius on educational thought is comparable with that of his contemporaries, Bacon and Descartes.

None of which compares with the friendships I have enjoyed with colleagues involved in the conference over the past 18 years. Alzbeta (who first introduced me to Slovakia in 1993), Darja, who has shared the stage with me since 1995, Martina who has provided the best hospitality ever over the last ten years, and Stephan – the wisest man I have ever come across.

And of course the trip was a good one, great to be part of a new wave of intellectual debate and discussion – and then there were the medical students from UCL. Do they know how to hold a discussion? Interestingly they had decided not to drink the same drink twice while they were in Bratislava – so by the time I met them they were in mellow mood. And they were so much fun. BUT I have decided that I will not go out and have a drink with medical students again. I had to take two aspirin in the morning, and it took me a while to get going.

This is the last Bank Holiday weekend for a while - and today is for my children, grand children and celebration.

Deer in Horwich, Health Care in Jersey and if it’s Tuesday it must be Slovakia

2011-05-22T04:43:00.000+01:00

One of the highlights of what was a very long week was coming across a female fallow deer on my drive early Tuesday morning. There is a small herd of deer who occupy the slopes of Riverton, on the outskirts of Bolton. I live part way down from and Riverton Moor, and deer can sometimes be seen on the fields between my house and the top of Winter Hill, close by. I was taking Cello for his first walk at 05.20 and as we got to the Orchard, there the deer stood. She appeared calm and watched us for a short while before slipping effortlessly between the chestnut paling fencing and back into the surrounding woodland. It was a wonderfully calm interlude in what turned out to be a turbulent week.

Eight hours later I was sitting in Gatwick, en route to Jersey and this year’s Council of Deans of Health Annual General Meeting. The meeting was held at the Hotel de France. Behind its rather grand 19 century facade was a wonderfully modern and very comfortable hotel. For me, being able to stay in touch with the School and colleagues while away is vital, and the hotel had a fantastic WiFi internet system, accessible anywhere in the hotel, that allowed for this. Situated on the outskirts of Saint Helier, it provided a rare glimpse into a former era of splendour, luxury and hedonism!

However, we were there to look at the big issues facing Schools of Nursing and other Health Care Professions in the here and now and the future, of which there were many. The two days started with an introduction to health care provision in Jersey – and possibly what we heard provided a glimpse into the future for the rest of the UK.

There were some interesting facts however, for example, there are 92 GPs for the total 92,000 population of Jersey. In the US there are 247 doctors per 100,000 patients, in India there are 2200 patients to 1 doctor and in England there are 18 GP per every 100,000 patients. GPs in Jersey make their living from selling everyone of their services. So for example, it will cost you anything from £55 – 125 for each consultation.

It is no wonder that Emergency Departments are seeing an ever increasing number of patients turning up seeking treatment – all A+E treatment is free – at the moment. Current reviews of how the Jersey health care system needs to change are seriously considering charging patients for their A+E consultation in the future. Without enormous investment of capital to increase secondary care capacity, by the year 2016 current services will not be able to provide for the islands populations health care needs. The underlying drivers for this situation show high levels of congruence to those to be found in mainland UK – I think it is only a question of time before we will need to engage in similar debates – but one thing is for certain, comprehensive health care services, free at the point of provision are well and truly a thing of the past. It will be a hard road to travel.

And tomorrow, while not being completely straightforward in terms of what I am doing, it is likely to be both a busy and an important day to get through. Then Tuesday sees me yet again travelling (for the last time in a long while!) – I am off to Chair one of my favourite Nurse Education Conferences.

This conference is held in Slovakia, more of which next week. I have been involved with this conference for some 16 years, and for me it provides an opportunity to give something back to the nursing profession, and it is a conference based upon relationships that are long standing and which are very dear to my heart.

International Nurses Day, Bob Dylan,Football and Birthday's

2011-05-15T05:16:00.002+01:00

May the 12th was International Nurses Day. It is a day when nurses all over the world celebrate nurses, nursing services and nursing accomplishments while commemorating the anniversary of Florence Nightingale’s birth.

The international theme for 2011 was Closing the Gap: Increasing access and equity. Evidence suggests that effective access to health services can contribute to a person’s life expectancy and/or to the quality of life that they experience.

However health is not merely a commodity produced by health services. Health is socially determined, will be influenced by genetics and environment. It has long been recognised that the ability to achieve good health or, conversely, the risk of suffering ill health, is affected by socio-economic status, geography, employment, education, gender, sexual preference and a host of other elements that impact, both directly or indirectly on a person’s ability to achieve and maintain good health.

The International Council of Nurses believes that nurses have an important role in achieving health equity and developing a clear understanding of how the health sector can act to reduce health inequities. As the principal and, in some cases, the only group of health professionals providing primary health care in many of the most challenging settings, nurses are essential to improving equity and access to health care and adding quality to the outcome of care.

It was with these thoughts in mind that the School facilitated a conference to celebrate International Nurses Day this week. Led by Melanie, our ever enthusiastic International Lead, colleagues from across the School ensured that the day was a great success. Nearly 150 nurses from across the North West attended to share in the day, and speakers from around the world talked about both the history of nursing and nursing today as it can be seen in its many forms and focus.

Unfortunately, I could not stay for the whole day as I was also scheduled to participate in our College Executive Retreat. This was a two day retreat aimed at thinking strategically about the recent academic reconfiguration and the decision to move from three Schools to two Schools. The retreat was a productive one, and we were able to agree a way forward for each School and how these plans will be delivered over the next 12 months.

Dinner and bed was at the Radisson Edwardian Hotel in Manchester. This hotel stands on the site of the Free Trade Hall, indeed the original front facade of this building has been kept intact. The Free Trade Hall has a special place in the history of Manchester. The first hall was erected on the site where the infamous 'Peterloo Massacre' of 1819 took place.

The Free Trade Hall was the setting for important political events: the voices of Gladstone, Disraeli, Lloyd George and Churchill have all filled its cavernous spaces. It was also a place of entertainment. Charles Dickens, Oscar Wilde, Ella Fitzgerald the Halle Orchestra and Bob Dylan all played in the hall. For a fleeting moment, as I lay bed on Friday morning watching the surrounding Manchester City wake up and the sun rise, I wondered if Bob Dylan had also seen the city slowly coming to life when he was here.

Yesterday saw Manchester United secure their 19th Premier Championship a great day for all those who support MU – and for those who support Manchester City it was a great day for them too, MC gained the FA Cup - many congratulations to both teams and thier supporters.

And today I celebrate my birthday – imperceptibly but unremittingly creeping towards 60, Hmm!

EmpNURS, Seeing beyond the Panopticon, and some Blue Sky

2011-05-08T05:55:00.000+01:00

I spent much of yesterday travelling back from the Czech Republic. The journey took over 12 hours. I had been in Bruno, (known as the small Prague) since Wednesday night for what was the second workshop of the EmpNURS project. This is an EU funded project which aims to advance the empowerment of nursing as a profession through the development of high quality mentorship. The project is being carried out by 11 partner organizations from the Czech Republic, Finland, Hungary, Lithuania, Romania, the Netherlands and the UK. The Project Manager for this study is my long time friend and colleague Mikko. We have known each other for some 15 years and share both a common history and background and a desire to find ways of better preparing individuals for nursing practice.

Over the last 15 years Mikko and I have become increasingly interested (and a little concerned) over what appears to be some big variations in the way nurses are being educated across Europe. And this appears to be the case, despite the Bologna Agreement which sought to harmonise higher educational systems across Europe. We have written about our concerns, both with each other and with colleagues from other parts of Europe. It was from this work we went on to develop the EmpNURS Project.

The EmpNURS project is aimed at benefiting nurse educators, nurse students and qualified nurses across Europe. The project builds on our previous work and is focused around approaches to mentorship. With my colleague (from our School) Karen, I am undertaking an impact evaluation of the EmpNURS project which among other things, will assess the level of cooperation between health care service providers and educational institutions such as University’s in developing and implementing a mentorship programme. Already we are seeing that despite a common desire to achieve such a programme, there are cultural, organisational and political factors that challenge this work. So it will be an interesting couple of years work!

This week’s workshop was facilitated by my very good friend and colleague Andrea – and her hospitality was brilliant and so helpful for all of us. One of the activities Andrea arranged for us was a visit to the local health care services. These were situated on the same campus as the University – which was new, brash, modern and a huge testament to the investment the Czech government is making in its higher education system. However, when we walked into the main entrance of the hospital, we were confronted with a row of archaic trolleys.

What was unknown to us at the time was the fact that on the other side of an adjoining door was a state of the art major trauma centre – and when we were able to visit this centre I found it truly impressive in terms of not only the available equipment, but also the approach of the staff who worked there. Likewise, on visiting the ICU I found the highest possible care being provided to some very ill patients in a way that really demonstrated how important it is to balance the technical with the humanistic in using our skills and knowledge as nurses.

I found the entrance to the School at the University very interesting. It was ‘guarded’ by a modern example of what Jeremy Bentham (the philosopher and social theorist) described as a ‘panopticon’. This observational device was a somewhat a somewhat sinister presence in the entry foyer of the building. However, once one got past this silent sentry, the rest of the building was encouragingly welcome.

And the blue sky. Well my wonderful PA Jennie, who absolutely ensures everything I need is sorted for these trips, included a five day weather forecast for the Czech Republic in my briefing papers – this forecast showed wind, rain and cold temperatures. However, the reality in Bruno was blue skies, wall to wall sunshine and a barmy heat. The great weather contributed wonderfully to what was a productive and informative three day workshop. Back here in the UK writing this blog this morning, the sky is grey and its raining!

Pledges, Weddings, and Big Boys Toys

2011-05-01T05:39:00.000+01:00

This week saw an impassioned email debate in the School on whether we should instigate the practice of asking our students to make a pledge at their Graduation Ceremony. The suggestion originated at a graduation Ceremony two years ago, but was not taken forward because of the ‘Pledge’ contained in the last UK Prime Ministers Review of Nursing and Midwifery (The Front Line). In preparation for this year’s ceremony I was asked to raise within the School the possibility of our graduating students using the Declaration of Geneva as their prledge at the point of graduating.

It was way back in 1948 that the General Assembly of the World Medical Association adopted the Declaration of Geneva. Despite the wording being amended many times since then (the last being in 2006) it remains to many (within and without the medical profession) an anachronism. In its current form it reads as follows:

At the time of being admitted as a member of the medical profession:

• I solemnly pledge to consecrate my life to the service of humanity;

• I will give to my teachers the respect and gratitude that is their due;

• I will practice my profession with conscience and dignity;

• The health of my patient will be my first consideration;

• I will respect the secrets that are confided in me, even after the patient has died;

• I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;

• My colleagues will be my sisters and brothers;

• I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;

• I will maintain the utmost respect for human life;

• I will not use my medical knowledge to violate human rights and civil liberties, even under threat;

• I make these promises solemnly, freely and upon my honour.

Even for the medical profession, one can argue there are major problems in the terminology used and how the concepts these words reflect are incongruent with modern values and ethics. When I put this version up on the screen at our last School Development Day, I was (quite rightly) verbally shot down in a fusillade of emotionality.

This week’s debate was both on whether we needed to make a pledge at all (graduating students will already be bound in practice by the NMC Code of Conduct, the law and their moral duty not to harm patients), and if so what would it look like. The general consensus from colleagues and students (albeit a small number from those likely to graduate in 2011) was that a pledge was inappropriate and there were other ways to increase the significance of the ceremony for students, colleagues and the families who attend to celebrate the students success.

Last year, our Chancellor, Irene Khan, asked the students to keep their caps off until they had thanked their family and friends for supporting them over the course of their programme. The students also gave the staff a standing ovation. Many colleagues agreed that this approach had an authenticity to it that no pledge could match.

And of course this week also saw the wedding of Prince William and Kate Middleton. Being an unashamed royalist I of course every moment of the day, and could be found for long periods, sipping champagne in front of the television marvelling in the day as it unfolded. It was a fantastic spectacle and people all over the world witnessed the couple making their own special pledge to each other.

Strangely however, I was particularly captured by the trees used to decorate Westminster Abbey. Six field maples and two hornbeams, all of which were nearly 20ft tall were installed at the Abbey. These trees were English, natural, seasonal, ethical. The field maple symbolises humility and reserve, and was used to make loving cups in medieval times, while the hornbeam signifies resilience. I wish the happy couple well.

This long weekend is also remarkably different for me from the one I spent last weekend. Last weekend was spent at 33000 feet in the air travelling back to Manchester. This weekend like many British people I have stayed at home. What some have called ‘staycations’ – last year this meant people who stayed in the UK to holiday rather than travel abroad, this year, it means ‘camping in your own back yard’. So this weekend, I’ve stocked up with refreshing summer drinks and BBQ food, and have stayed at home and played with my big boys toys in the garden. The result is a garden that has its perfectly stark symmetrical lines once again restored against a backcloth of the irregularity and chaos of shape and colour that Mother Nature gives to the world.

ISCHP and a Good Friday for an Ethnographer to be in Dubai

2011-04-24T04:13:00.002+01:00

I am posting this blog before having breakfast and making my way to the airport to come home from what has been one of the best conference trips I have been on in a while. I am in Dubai now, after arriving from Adelaide where the International Society of Critical Health Psychology held their 7th Biennial conference. The conference was chaired by the indomitable Wendy Stainton-Rogers. She is a fearless lady and takes no prisoners.

There were some other influential colleagues in attendance as well, Professor Raewyn Connell who presented on the psychological dimensions of social transformation, often using examples of her own personal journey of transformation as a trans-gendered woman. This was the first time she had described publicly this journey. The openness and inclusion to be found in the presentations and discussions was unusual and made for some lively debates – it was these debates and discussions that are often missing in the busy-ness of our everyday academic lives, and yet are precisely what we, as academics, should be facilitating more often.

There was an extremely good Pecha Kucha session where the presentations were outstandingly brilliant, both in content and style of presentation. The use of images, voices and music was stunning. Each session was perfectly timed to 6 minutes and 40 seconds, and although some presenters had many more slides than the normal 20 slides, each were delivered within the automated time frame. It gave me renewed enthusiasm to try this approach again at future School Development days. In a similar vein, were two sessions that allowed individuals the platform for five minute challenges (again the sessions were timed). These challenges could be about current problems, aspirations for the future, or just to start a debate going. Again I will try and use this approach at future School Congress (or whatever replaces them in the new Governance framework).

And so it was coming back home that brought me once again to Dubai for a couple of nights. I arrived on Good Friday and once unpacked, thought about doing some work and enthusiastically took my lap-top to the pool. This is one of those so called infinity pools, three floors up and with a glass wall that perfectly merges the pool with the sea beyond – both of which were brilliant blue. It seemed churlish not to use the opportunity to consider developing an ethnography of pool behaviour. All was revealed (well nearly all in some cases), but it struck me that it was a great place to witness the behaviours of others and to try to make sense and understand the significance of these behaviours for the individual and families. – I made lots of notes and will write up – but that is for tomorrow.

In terms of human behaviour and the significance this has for our self and for others, two of the presentations from the conference stood out for me in illustrating this. One was from New Zealand and the other from Japan. Both used vivid, uncompromisingly graphic and emotionally moving images of the absolute devastation wrecked by the earthquakes and tsunami. Yet both these presentations were using the images to show what it was that people in both these communities and from across the world were responding to in terms of human kindness, generosity and in the facilitation of hope and opportunity for others.

Easter is traditionally the time of renewed hope for the future. Yesterday I was fortunate to travel 140 meters upwards in just 14 seconds in the Burj Khalifa tower. This wonderful building is truly impressive. It is the tallest building, and the tallest free standing structure in the world. It has the highest number of floors of any building and the highest outdoor observation deck in the world (Empire State Building you really need to get your act together) and the 140 meters travelled in 14 seconds – travelling in the longest single continuous elevator in the world was impressive. 10 metres travelled every SECOND! Spookily, you did not feel a thing until your ears popped at around floor 56.

The trip up gave me a 360 degree view of UAE and what appeared to be a huge commitment to how a new future was being successfully built against the back cloth or some very traditional ways of doing things (and the in a very inhospitable environment of sand and heat).

Likewise, in the UK, Easter will for some be embedded in religious celebrations, others will turn their attention to DIY. Such stores make a great deal of money as people start to redecorate, remodel the garden, and generally start on the repairs put off during winter. So for all of the readers of this blog who might be doing something like this over the Easter weekend, just spare a thought for those still grappling with the reclamation of their homes, communities and lives, and in so doing please just send out a message of understanding and support.

The Wizard is Back in Oz

2011-04-17T03:24:00.000+01:00

I first went to Australia ten years ago to speak at a conference on service user involvement in mental health. The paper - The Being and Doing of Mental Health Nursing: Users Perceptions became the basis for a book entitled Using Patient Experience in Nurse Education. The book inspired the hugely successful service user, student and carer conference we ask all student to attend at the beginning of their nurse and midwifery education and training with us. And 10 years later I was on my way back to Australia and where this story started. Despite the long journey involved, I was looking forward to returning to Adelaide to present my current work at a mental health conference.

Ten years ago I flew directly to Singapore, had three hours in a transit lounge and then flew on to Australia. These days, and one DVT later, my body isn’t so resilient or so forgiving. So it was a six hour flight to Dubai, an overnight stop and then a twelve and half hour flight to Adelaide. On this occasion I flew with Emirates, who have the most amazing collection of films and music to entertain passengers on these long flights. Interestingly, their 100 best albums mirrored my personal Ipod collection, so it was almost home from home, not sure why Leonard Cohen didn’t feature, maybe people these days don’t like his music.

I found it amazing that I could be in a plane that is travelling at nearly 600 mph, 33000 feet off the ground and all I had to do was press a screen and gain access to thousands of songs from my youth. I must confess to leaving my computer in the overhead locker and being totally self-indulgent for the twelve hours and listening to song after song that for me evoked so many good memories. I bought my first LP when I was 13 (1968) – Jimi Hendrix Electric Ladyland – and there it was on the menu of cd’s. I am amazed at how quickly (over the last 10 years) airlines such as Emirates have embraced new technology for the benefit of their passengers. I am sure we need to being do the same with our approaches to education and health care practice.

It is still a long journey and tiring. However, you do get to meet some interesting people along the way. When I first went to Adelaide, one of the people I met was Julia who in a different life became the Director of our Postgraduate Directorate when I took over as Head of School. This time, In Dubai I met Alli, who trains fighter pilots for a living. He chained smoked (no smoking restrictions in UAE) his way through an evening’s conversation where we discussed politics, his love of all things British, the state of the world economy and of course my relationship with the ubiquitous Manchester United football team. I have lost count of the number of people over the years who I’ve told that I really don’t know Sir Alex personally.

One of the albums on offer was the remarkable What’s the Story Morning Glory (by Oasis). As well as being a great collection of music, the title track always reminds me of 5am in the morning. Wherever and whenever I travel I always wake up just before 5am – even on trips like this where you gain and lose time as you travel. Interestingly, on the first trip to Alidade, some of the people I met presented work on the impact of circadian rhythms on people’s mental health.

I am writing this blog on the eve of the conference, which promises to be a very interesting one. This time I am presenting some work on risk and control in society and the impact this can have for some people with mental health problems. One of the issues I explore is Jeremy Benthams concept of the panoptican, and how sometimes therapeutic relationships are felt to be compromised by the sometimes bounded nature of care and containment. My new found friend Alli didn’t have any such problems. In an account reminiscent of Michael Moores’ Fahrenheit 9/11, he talked about how they trained their fighter pilots not to think about the fact they are killing other humans beings when they fire their missiles at targets. Partly this involved reinforcing the fact that the targets were selected away from the battle field, and the missiles guided by information relayed through satellites. Not a good use of new technology and it was somewhat frightening stuff.

A room with a view, but why is it sometimes difficult to see what’s there?

2011-04-10T06:06:00.001+01:00

Last week I was on a brief holiday, re-charging my batteries in the tiny village of Roosebeck, in the South Lakes. The house I stayed in looked out over Morecambe Bay. Roosebeck is up the coast from Ulverston, and when the view was clear, it was possible to see Blackpool Tower on the horizon. However, there weren’t many fair weather days!

On the first morning I climbed up to the Hoad Monument in Ulverston. This is a 30m tower that sits at the top of Hoad Hill (133m) and it is one of the most iconic symbols of this part of the North West of England. If the weather is clear, there are 360o panoramic views of the Furness Peninsula, Morecambe Bay and the Southern Lake District to be had. However, when I got to the top, these surrounding areas were shrouded in mist and they were all but invisible.

And so it continued, apart from one morning when I was able to lay in bed and watch the most magnificent sunrise I have seen in many a year, for much of the time Morecambe Bay remained obscured by low lying rain clouds. The vibrant world that I knew to be there was turned into an unyielding, impenetrable greyness.

Problems with taking in a view was a bit of a theme while away. I was taken aback by the very intrusive reporting on the M11 crash of Monday morning – I did not understand why we were given a bird’s eye view of the devastation brought about in this accident. A film taken by a helicopter flying up and down the crash site was repeatedly shown throughout the news bulletin. It was an almost voyeuristic view of what would inevitably be a life changing event for all of those involved (directly and in-directly). Of course it is possible to argue that as individuals could not be identified from the helicopter view, such reporting was acceptable. However, the report left me feeling very uncomfortable and my thoughts go out to all those who will be affected by the accident.

The piece on the accident was followed in the news by the announcement that the UK Government plans to reform the NHS would be temporarily paused so that additional views might be canvassed, and where necessary adjustments made to the proposals. What fascinated me about the piece was the way in which those interviewed regarding the proposals appeared to become more un-knowing (and less bothered) about what the proposals might mean for them, the further away from Government they were. So by the time they report featured patients (sitting in a GP surgery), the views being expressed were characterised by perceptions of powerlessness and a wearying sense of ‘what will be will be’.

The problem appears to be a familiar one – the inability to communicate what the changes involve, what the impact is likely to be and the reasons for making the change in the first place. In fact one could easily substitute University Fees for NHS Reforms and arrive at the same conclusion. I am more interested in the NHS Reforms however. Many years ago I started my PhD looking at the way in which GP Fundholders used various forms of relationships to negotiate and take advantage of Margaret Thatcher’s introduction of a quasi- internal market for the NHS.

Towards the end of my PhD journey, the Conservatives were removed from power and Tony Blair swept in with a large majority and hell bent on dismantling the NHS internal market. Out were to go GP Fundholders, and in were to come PCG and PCT’s. For six months or so, I had a very difficult time trying to avoid the thought that my study was now worthless. Thankfully, I had a very wise supervisor who walked along my path with me for for a while. And of course the reality was that whilst the language changed, and much money was spent on restructuring the NHS, the internal market continued and was possibly more successful than anything Margaret Thatcher could have ever hoped for. I also got my PhD.

I think the latest proposals to make further structural changes to PCTs and the Strategic Health Authorities do not appropriately reflect the contribution made by many managers and non-clinical staff in achieving the progress that has been made in the NHS over the last two decades. Whilst my own studies have shown that GPs will be able to commission the services required in the future, they will only be able to do so with the right kind of managerial support, leadership and infrastructure being available to them. Of course gaining access to these services might be just as difficult in the future as it can sometimes be now. I have been trying to get an appointment with my GP for nearly three weeks – without success. No matter, working on the principle that 85% of the problems that result in us consulting a GP are self-limiting, I have given up trying to secure an appointment and moved on.