2012 - A Year in Numbers!

This is the last blog posting for 2012. It has been a good year for readership numbers. There have been some 23,154 page views this year. My thanks to all of you who, week on week, take the trouble to read my words and thoughts on the world. Your support is much appreciated. As regular readers might have surmised, I quite the like numbers that underpin many of the stories commented on. So I thought I would over indulge myself in this last post with some of the numbers that have caught my eye this year. In no particular order of importance here they are:

Team GB won 29 gold, 17 silver and 19 bronze medals during the 2012 Olympic games. The games were watched by 90% of the UK population. A total of 51.9m people watched at least 15 minutes of the London games on BBC TV. The population of England and Wales is 56.1m, 4m more than a decade earlier. We are an ageing population with 1 in 6 of us are aged 65 or over. There are 10.6m children in England and Wales.

Russia has barred couples from the US from adopting Russian children - 60000 of whom have found new families in the US since 1992. However, there are currently 23,000 American children waiting to be adopted, most of whom are aged between 5 and 16.

$6Bn was spent this year on the US presidential election campaigns, which works out at about $18 (£11) per person. The last general election in the UK was 50p ($0.80) per person and the last Canadian election was about $8 per person. However Americans also spent $7bn on crisps this year and about $8bn on the Halloween celebrations.

The US and the UK has been at war in Afghanistan for 4,012 days. Troops arrived less than a month after the terrorist attacks of 9/11 The war in Afghanistan has cost the US $1.2Tn (the UK £2,5Bn) since 2001. It is an incredible amount of money to have spent with so few controls or plans, so little auditing, and almost no credible measures of effectiveness.

According to the United Nations, more than 13,000 Afghan citizens have been killed between 2007 - when the UN began reporting such statistics - and June 2012. Since 2001, 2,000 US and 425 UK service personnel and have been killed. In 2011 the number of people killed in road fatalities in the UK was 1901.

25% of the UK population say they have no religious beliefs, with Norwich being the place the most people report that they have no religion. Italy's former Prime Minister Silvio Berlusconi (aged 76) has agreed to pay 36m euros (£30m) a year to his ex-wife Veronica Lario. Forbes estimated his wealth at almost $6bn (£3.7bn) in March 2012. A study of 2012's most read Wikipedia articles reveals that Facebook topped the English edition, Hua Shan - a Chinese mountain featuring ‘the world's deadliest hiking trail’ topped the Dutch list and in Germany, cul-de-sacs were the German site's most clicked entry.

Fifty Shades of Grey was the most borrowed book from the Caterham Library in Surrey. Caroline Warne, 31, of Croydon Road (and no relative as far as I am aware), said ‘the book had been a real bestseller’ among her friends and acquaintances. It has sold over 65m copies in 2012. Scouting for Boys (a similar book allegedly, in that it involves the use of ropes, scarves and woggles) has sold 150m copies since 1908.

More than 800m chickens are raised and killed for meat yearly (about 2.1m per day) in the UK. The average consumer eats 170 eggs per year. I mention this as I also keep chickens, and although I eat the eggs, being a vegetarian, I don’t eat the hens. But foxes do. And there are 2 living in the evergreen bank in the garden. I saw one in the orchard only last Thursday morning while out with Cello. The chickens are safe and sound in their winter quarters however.

Last but by no means least; we were the only School in the University to reach our student target numbers in 2012. In September we registered some 980 undergraduate students and are on line to also take 340 more students in March 2013. It is a time of great turbulence in the UK University sector. According to UCAS, the UK admissions body, nearly 54,000 fewer students started courses this autumn than did so last year. I think this reflects on the student experience that we have collectively worked so hard to enhance. Well done to everyone and I wish you all a very happy and satisfying New Year - 2013

Christmas 2012

I wish all readers of this post a very happy Christmas and a wonderful New Year!

Back to normal next Sunday!

On Catching a Cold, but not Air France flights, and catching up with Colleagues

I wasn’t sure I would be up to writing this week’s post. My eyes are watery, my head is pounding, throat is very sore, my chest congested and my nose is redder than Rudolf’s! Yes, I have got a cold and I am feeling extremely grumpy, irritable and grouchy. Unusually for me, I even left work on Friday at lunchtime, took to my bed and didn’t re-emerge until late Saturday afternoon. Not sure where I caught the cold from. 

Studies conducted by Cardiff University have shown that close personal contact is necessary for the virus to spread, although the common cold viruses are not spread by contact such as kissing but appear to be spread by large particles expelled at close range by coughs and sneezes, and by contaminated fingers that pass the virus to the nose and eye. The incubation period for a common cold is usually around 2 days before the symptoms start. You are most infective when you have the early symptoms of sneezing, runny nose and cough. Travel to foreign countries can increase the risk of viral infection.

I mention the last point as last week involved 4 flights getting me there and back to Brno, the 2nd largest city on the Czech Republic. The airline was Air France (my least favourite airline ever), and flying through Paris Charles De Gaulle Airport (in my experience the worst airport in the world). The Cardiff studies also showed we are more likely to catch the cold virus while travelling by plane. So I guess I might have caught the cold going out and then unintentionally passed it on to other passengers on the flight home – Sorry...

I was in Brno as a Visiting Professor to the Department of Nursing at the Masaryk University. I was there with my colleague Karen Holland, Visiting Fellow. A fantastic new University campus has been under construction in Brno Bohunice since 2002. The last stage of development should be completed in 2015. We were wonderfully looked after by our host Andrea Pokorná. Both Karen and I have known and worked with Andrea for a large number of years so it was a real pleasure to spend some time working with her again.

And it was a full on few days. After 17 hours of travel (thank you Air France) and a disturbed night for me, we found ourselves standing at the gates of Brno’s long term psychiatric facility – the Brno-Černovice Psychiatric Hospital. Even in the snow, and minus 10 temperature, I was transported back in time to my days at what once called Prestwich Hospital (now Greater Manchester West Mental Health NHS Foundation Trust). What followed were a couple of hours of really stimulating discussion and interaction with service users and the nurses.

The rest of the morning was devoted to a workshop with MSc nursing students exploring the realities and rhetoric’s of evidence based nursing practice. In the afternoon we were hosted by Professor Tomis Kaspaek, Professor of Psychiatry. One of the services we visited was an Intensive Care Unit – not what I had expected, which was a highly staffed unit able to look after those going through mental health crisis and perhaps at risk to themselves or others. This unit was for those who had attempted suicide. It was very small, (5 beds), and the patients looked extremely physically ill. For some reason I have not yet got to, I felt a little emotionally disturbed on visiting this Unit.

The following day was just as hectic. This time at 08.00 Karen and I found ourselves all suited up ready to observe a total hip replacement (total hip arthroplasty). Interestingly, this pioneering technique for hip replacements, devised by a British surgeon John Charnley, marked its 50th year of use in November this year. Sir John Charnley, a surgeon with a love of engineering, developed his artificial hip joint and surgical technique at Wrightington Hospital in Lancashire. It revolutionised hip replacement operations and became the 'gold-standard' procedure, which is still carried out on patients across the world.

I was fascinated by watching the operation although the whole procedure left me having to rethink how surgical nurses are enabled to consider the dignity and care of an individual undergoing this procedure. The afternoon was devoted to a workshop on writing for publication with staff and PhD students. There was enough time to visit the local Christmas Market to stock up on Christmas gifts.

The following day we headed home, and by now the cold was making its presence felt. I fell asleep on the way to Prague – again not like me. We used the couple of hours we had in Prague to visit the city centre. I decided to deal with the minus 8 temperature by purchasing a hat and partaking in a hot toddy. Despite my cold discomfort and Air Frances ineptitude (yes we struggled on the return journey as well!), sitting there under an outdoor heater, sipping the warm spiced fruit drink, I felt the trip had been worthwhile. We have established a process to take community care research forward, and we will sign a MoU to offer places for student exchanges, and best of all, we had reinforced our good working relationship with Andrea and her colleagues – catching a cold along the way is a small price to pay. And now I am closing the computer down, and will go back to sleep.

Off to Australia: in the mourning, we think of Jacintha.

It’s not a good time of the year to be a turkey. I mention this as today I am celebrating Christmas with my youngest son and his lady friend, my wife, my eldest daughter, her husband and my granddaughter. They are having roast turkey with all the trimmings; I'm having a mushroom and cashew nut roast, baked at Château Hoboken, This meal is no minor occurrence it is the first time I can remember my son cooking me anything let alone a full Christmas dinner. They are off to Australia and New Zealand next week and will spend Christmas out there with brothers and sisters from both families.

Australia has played a part in my thinking this week. The first was a piece I read in the Observer about grief and loss and how different people deal with this. The story used the Nicole Kidman’s 2008 film Australia as its starting point. At the beginning of this film there is an on screen warning that urges caution when watching the film as it may contain images or voices of deceased persons. The warning of course, is for the benefit of Aboriginal Australians, for whom it is a taboo to name or encounter representations of the dead.

The naming taboo is said to make people more aware of the person whose name is being avoided. As a form of remembering through non-remembrance, it is a psychological mirror image of more familiar UK traditions where creating and cherishing a representation of the deceased is considered necessary for healthy ‘normal’ mourning. Like so many others life events, mourning has been framed as a problem, pain as something to be cured.

The Swiss psychiatrist Elisabeth Kübler-Ross, is possibly best known for her ideas that mourners pass through stages of denial, anger, bargaining, depression, and eventually acceptance. The fact that Kübler-Ross was talking about adjusting to one’s own impending death, not to the death of someone else, seemed to pass most people by. Her so called theory doesn’t have an empirical evidence base.

In contrast, the psychologist George Bonanno has studied how people deal with grief. His research involved following people from before they were bereaved to months and in some cases, years afterwards. He was unable to evidence that there is some kind of movement or progression through specific stages of adjustment, and even the belief that most people are plunged into despair and gradually ‘get better’ appeared to be little more than a cliché.

This is not to say that sadness isn't a common response to loss. It is, however, only about 10% of people suffer what is sometimes called ‘complicated’ or ‘prolonged’ grief, where the feelings of loss are intense, long-lasting and cause significant impairment, potentially needing help from mental health professionals. However, the loss of a loved one is not the only ‘loss’ that people can experience deep sadness, and despair over. Loss might involve losing a job, a limb, or a reputation.

I don’t know what Jacintha Saldanha must have been feeling last week. Jacintha was the nurse who was found dead in her home on Friday. Her death followed her involvement in a hoax phone call made last Wednesday that involved two Australian radio presenters who were pretending to be the Queen and Prince Charles. Jacintha was the person who accepted the call. During the call information was given on the condition of Kate Middleton who had been admitted with severe morning sickness. The radio station called it ‘the prank call the world is talking about’ before playing clips of news programmes reporting on the original call.

There was much support for all those involved and both the King Edward VII Hospital and the Royal Family were at pains to support the nursing staff involved. However, in contrast it was only after international condemnation following Jacintha’s death that the two presenters were suspended from the station. The Sydney based radio station, 2Day FM, is owned by Southern Cross Austereo.

In a somewhat bizarre coincidence, and although there is no actual connection, you might recall that Winterbourne House, whose vulnerable clients were the subject of much physical and emotional abuse by those who were there to care for them was owned by a company also called Southern Cross. We are still waiting for the Francis Report following the inquiry into the Winterbourne abuse. Let’s hope for Jacitha’s family sake that finding out what happened doesn’t take as long. They are in my thoughts and I am sure many others too.

Hey Ho, Like a Rolling Stone, it’s Back to Work I Go!

Like all good things my brief sojourn in Kippford eventually came to an end and it was back to downtown Bolton, and a house completely re-wired, but with every surface covered in what appears to be self replacing dust, a leaking roof, no central heating, and during what was the coldest spell of the year. It was so cold in the house that the first night seriously contemplated sleeping in front of the lounge fire. I can remember when my children were young, living in a house without central heating, where if it was freezing outside, the (single glazed) windows would freeze on the inside. It was a case of putting another blanket on the children’s beds, but there was never a queue for the bathroom in the morning!

Children and families were the focus on my partial return to work on Thursday. Although not back until the Friday, I popped in to open our Midwifery Conference, which took as its theme, ‘Supporting Mothers, Supporting Families’. It was interesting to reflect for a moment on how things were changing in parts of the UK. For example, I knew that the UK birth rate has continued to rise year on year, but I didn’t know that 25% of births in 2011 were to women who were originally born overseas but had moved to the UK. Poland remains the most common country of birth for immigration mothers but China is now also in the top 10 are Pakistan, India, Bangladesh, Nigeria, Somalia, Germany, South Africa, and Lithuania.

So while the number of births in 2011 rose to 723,913 the number of babies born to British women fell  the increase in births resulted solely from a rise in births to non-UK born mothers. Foreign-born females now account for 19% of the population of women of child-bearing age in Britain and according to the Office for National Statistics; they tend to have higher fertility. Having said that its strange then that the Total Fertility Rate for immigrant mothers (the average number of children a group of women is likely to have over their lifetime) dropped slightly to 2.29 while that of British women rose to 1.90.

This not so for all British women though. Britain’s biggest family, the Radford’s, got a little larger 6 weeks ago when baby number 16 was born! Mum Sue, (aged 37) gave birth to baby Caspar in just 16 minutes, bringing her total number of children to an impressive 16. This self sufficient family (they don’t live on benefits) live up the road from me in Morecambe in a 9 bedroom home.

They spend £250 each week on food, consuming 3 loaves of bread, 2 boxes of cereal and 18 pints of milk per day. This already large family has also been joined by their first grandchild after Sophie (the eldest child) gave birth to baby Daisy. Mind you The Radford’s are nothing compared to the Chana family from Baktwang, India, where father Ziona Chana has 94 children by  different 39 wives. Mr Chana, says he is a ‘lucky man’ lives in a 100-room, 4 story home with another 14 daughters-in-law and 33 grandchildren.

Sadly, the Chana family children are unlikely to be around as long as the Radfords children. 33% of babies born in 2012 in the UK are expected to live to 100, according to a new report also published by the Office for National Statistics. They suggest that more than 95,000 of those who turn 65 this year can expect to celebrate their 100th birthday in 2047. Indeed, the number of centenarians has steadily increased - from 600 in 1961 to nearly 14,500 by the end of this year. And more of these will be women than men. In 2012 there are 826,000 babies aged less than one year. Although more are boys - 423,000 compared to 403,000 girls - the survival odds are greater for females. Women have higher life expectancies than men at every age.

And as for me, well I am the eldest of 7 children. And I have 5 children of my own (3 girls, 2 boys) and 6 grandchildren (4 boys and 2 girls) all of whom I love to bits! And as Sir Michael Phillip Jagger, might say,  Monday will soon be here, and goodness it’s great to be alive!

A Glimpse of Sunshine, Forest Tales, Mushroom and Asparagus Risotto, and no Regrets!

Last weekend I arrived in Scotland amidst storms and some of the highest tides of the year for a 10 day autumn break in my favourite costal village of Kippford. I love coming here at any time of the year, but late autumn is wonderful. The weather is what I call emotional. The wind blowing off the sea can howl one day and the next gently whisper. The rain can be monsoon like but can also provide the autumnal colours with a shiny gloss, and the sky can be transformed in an instant as the suns rises, shines and sets.

Likewise, the surroundings meet other needs. The tide comes in and goes out, leaving pristine beaches to walk upon, the forests and hills are deserted, open and full of life and excitement. On one walk I came across Ginger, a highland cow wandering through the woods. Not sure who was the most surprised. This trip I discovered the craft and art of dyke building. These are low stone walls, made without mortar, that mark out property boundaries. Neither fences nor gates are used to contain or confine, just the dykes. 

Kevin, a bike riding Master Carpenter with a disturbingly large number of missing fingers, introduced me to one such craftsman called Alan. He had just seen a group of wild boars in Dalbettie Forest and was very excited. I found it interesting that long after the last bacon buttie has been eaten his handiwork will be seen in and around the village for a long time to come.

Unlike perhaps those Kippford folk who continue to smoke cigarettes. Unbelievably, while having a glass of real ale in the local pub (The Anchor – more of which later), one of the bar room conversations was about Speedboat Norm (aka Norman who is married to Fifi). Norm is recovering from a recent triple heart bypass surgery following a major coronary. It appeared that on the day of his coronary when Norm first starting feeling unwell, he first mowed his front lawn, and then went on a bike ride to see if that would make him feel any better! He smoked for much of his adult life.

So it was good to hear, last week, that the supermarket Sainsbury announce that it would stop selling tobacco from a further 6 of their supermarkets in Scotland. Sensibly, the Scottish government has introduced a health levy on the business rates paid by large stores selling cigarettes and alcohol. Sainsbury's already operates 3 supermarkets and 1 convenience store in Scotland which do not sell tobacco. The public health levy will contribute towards the costs of preventative programmes that are being taken forward jointly with the Scottish government, local authorities, the NHS and the third sector to tackle smoking and alcohol related health problems. I cannot understand why we still sell cigarettes to our students from a shop located in the College of Health and Social Care – but I have an appointment to discuss this with the VC on the 4th Dec, so watch this space.

Back in Kippford and the local village pub, The Anchor, has often been an oasis in times of emotional weather - offering a warm welcome, real ale, roaring log fires, and good gastro pub food. The Anchor serves a wonderful Mushroom and Asparagus Risotto, one of my favourite choices when eating out. This week, despite it being on the menu, there wasn’t a chef in the kitchen to prepare it until yesterday. The risotto was delightful, as were the tales of the deer seen grazing in the fields surrounding the village, and of the Red Kite seen soaring on the thermals. There were stories about Lindsey’s dilemma over making house building plans or holiday taking plans, and of Emma, described as a single generation hippie, now working in the Krueger National Park in South Africa, and whether she would be coming back to Kippford.

Finally, huge thanks to the Blackwater Bistro in near by Castle Douglas, whose free WiFi has made sending this post possible. Kind of ironic, that last week Dr T, (after Miss Otis regrets she is unable to dine tonight) is at last, now able to connect to the web in a fine dining establishment. So this posting is a little early this week, but better an early blog than no blog at all. Things will be back to normal next Sunday morning.

Dr T Regrets

Dr T regrets he's unable to post a blog today

Going Dutch, the Morning After Breakfast, and the Magnificent 7

Last week was an interesting one. For the first time in 5 years I had an interview for a job. Usual preparation undertaken, hair trimmed, suit dry cleaned, the one tie located and sponged cleaned, bright smile practiced in the mirror. Tuesday dawned and it was Lights, Action, and Camera. I really enjoyed the interview process. For me, it was a little like being on a stage, albeit it was a rather small and somewhat intimate audience. I thought I had done a good job and felt things had gone well. There was the usual wait and then...

...well the then occurred while I was at Manchester Airport the following morning. My phone rings and a voice says ‘sorry not calling with good news I’m afraid’. Now at the time I was negotiating what a vegetarian Full English Breakfast should entail with an Italian waiter in a so called Italian restaurant priding itself on providing the best breakfast in Terminal 3. Whilst the news wasn’t particularly appetising, the FEB was FAB.

I was at the airport, en-route to a medieval town in Holland called Zwolle – pronounced Svolla. I was going there to take part in Workshop 5 of the EmpNURS project. http://www.empnurs.eu/ The EmpNURS project aims to advance the empowerment of nursing through mentorship. The EU funded project is made up of 11 partner organisations located in the Czech Republic, Finland, Hungary, Lithuania, Romania, the Netherlands and United Kingdom.

The workshop was attended by 21 colleagues drawn from all the partnership organisations - and we all pitched up at the Hotel Fidder. Just take a look at the pictures on this web site: http://www.booking.com/hotel/nl/hotelfidder.html?aid=330631;label=msn-VIqUy1jDwtPLuDssWIaucA

I was last at this hotel some 4 years ago and loved it then and if anything, the place grew on me even more this time. If you have a spare weekend and are wondering how to spend it, whizz across to Amsterdam, catch the train to Zwolle and have yourself a great time. And hats off to Collin, who was the most attentive host at the Hotel; absolutely nothing was too much trouble for him.

The Workshop was a successful one and much progress was made. However, there is 1 more year to go and now we must find the evidence to illustrate the sustainability of the projects outcomes. Not as easy as it sounds. With this many countries involved, there are many opportunities for differences in interpretation of ideas, concepts, the words used to describe experiences and so on. Our hosts, Ernia, Nicole and Valerie from the Windesheim University of Applied Sciences provided a perfect place to address these differences and plan a united way forward.

Whilst the trip was a very good one, there were a couple of downsides. No 1, we were given bikes to use to get from the Hotel to the University. This was a journey that was probably the most frightening of my life. No 2, well that was the train journey to Schipol Airport. I was travelling with my colleague Karen. Once on the train we found our seats were in the quiet carriage. So we said OK, lets not use our iPods or phones. We settled down to sandwiches and coffee and some catch up conversations. 3 times we were told, with various levels of anger, that we were in the quiet carriage and that meant NO talking. Silence meant silence. It seemed a strange, almost over the top reaction in country whose government legalised prostitution in 2000.

Interestingly, the World Health Organisation reports that sexually transmitted diseases are a major global cause of acute illness, infertility, long term disability and severe medical and psychological consequences for millions of men, women and children. However, the World Health Organization makes no comment about the health risks associated with talking on trains or riding on bikes.

Measuring Up to the Acronyms and Numbers

For many reasons, last week saw me preoccupied with thoughts of measurement. This stream of consciousness was started by the story that staff working at the Department of Health had racked up a bill for £331,644 on ‘refreshments’ for staff and visitors last year. This story is set against a back cloth of the NHS having to make £20bn of savings by 2015, with many hospitals reducing the numbers of nurses and other health care professionals. I wondered what was being measured here – after the entire overall budget for the NHS is nearly £110bn, give or take a million or so.

So my quest was on. The numerical metric is king, and these days it feels like we have Key Performance Indicators (KPIs) for everything. But as William Deming the great management theorist has reminded us, relying only on measurable figures without consideration of figures that are unknown or unknowable is one of the big 7 ‘deadly diseases’ of many organisations. Numbers can sometimes be verifiable, but as Universities have seen with the introduction of Key Information Sets (KIS). KIS is meant to provide comparable sets of information about undergraduate courses. It has been designed to meet the information needs of prospective students (or more likely their parents) when choosing a University. But a quick scan through the Unistats website shows that there is little uniformity in the way degree programmes are described.

And how does one truly measure ‘satisfaction’- a key indicator in the KIS and National Student Survey (NSS) metrics. What does 89% overall satisfaction mean? Is 89% satisfaction in Bristol the same as 89% satisfaction in Bolton, or Bradford? Likewise, is it  possible to ever measure happiness, being in love, or future success? Daniel Kahneman, the Nobel Prize winning economist and psychologist has had a go at measuring happiness. He said below an income of £37,332 a year, people are unhappy, and they get progressively unhappier the poorer they get. Above that, there is an absolutely flat line of happiness. Money does not buy you experiential happiness, but lack of money certainly buys you misery.

As reported here earlier in the year an Australian mathematics professor, Tony Dooley at the University of New South Wales created an equation, nicknamed the ‘Fiancée Formula’ which works by factoring in the age at which you start looking for a long-term partner and the absolute oldest age you would consider getting married. However, his mathematical equation for love only has a 37% success rate.

Future success? Well Daniel Kahneman again, he notes we don’t choose between experiences, we choose between memories of experiences. Even when we think about the future, we don’t think of our future normally as experiences. We think of our future as anticipated memories. A notion, however, which relies upon developing a reference point which can be used to make judgements about what we have done without still being able to measure what it we might have achieved. In the KIS information this measure is the number of students who get a graduate job - which is like knowing the cost of everything but the value of nothing.

Health Education England, the new body responsible for spending some £7bn on educating and training the health care workforce has come up with a plan to do tackle this issue – perhaps borrowing from the Research Excellence Framework rhetoric, that want to establish a clear line of sight between education and service improvements and patient outcomes. Their Education Outcomes Framework focuses on 5 domains: Excellent education; Competent and capable staff; Adaptable and flexible workforce; NHS values and behaviours’; Widening participation. Each has metrics developed to a greater or lesser degree. It is the values and behaviours domain I am particularly interested in, and this is the area that is perhaps the hardest to measure. If anyone was going to ask me how I would address this area I would like to say it would be through my ability to create positive ripples throughout the whole School and beyond so that colleagues find inspiration for making nuanced and creative contributions to the lives of others – just how I would ever measure this though is the difficult part – all thoughts welcome.

A Cutting Tale about Older Folk, and a Tale of Two Twitties

Many people today are not only growing older but stay fitter for longer than ever before. This was one of the factors we considered last week at our College Strategic Thinking Day. The day aimed to consider what our priorities should be over the next 5 years. The aging population was a recurring theme in understanding what these might be. For example, the number of people aged 65 and over is expected to rise by 65% (to almost 16.4m) over the next 25 years. Life expectancy when the NHS was created was 66 for men and 70 for women. Today it is 78 and 82 respectively. At aged 65, men will live an average of 18 more years; women 21.

According to a report published last week by the Royal College of Surgeons and Age Concern, (thank you Norman and Michelle) the NHS has not always kept pace with these changes and there have been a number of concerns raised over the quality of care offered to older people. In the UK age discrimination is illegal but the report suggests that decisions over whether older people are put forward for surgery might still be subject to the age of the patient rather than actual need.

For example, whilst the incidence of breast cancer peaks in the 85+ age group, the surgery rate peaks for patients in their mid-60s and then declines sharply from the age of 70. People over the age of 65 make up the majority of recipients of joint replacement surgery. However, the rate of elective knee replacement and hip replacement surgery for patients in their late 70s and over has dropped sharply and consistently over the last 3 years. 10000 men a year die from prostate cancer and the incidence of the disease increases with age. Overall 50% of men who develop the disease will die as a direct result of it. But surgical treatment rates for the disease do not match the number of new cases being diagnosed amongst the older population. Emergency surgical procedures are increasing for hernias in older people, while the planned surgery rates fall sharply once a patient is aged 75 or over.

Of course there are many reasons why these apparent discrepancies might be occurring, and it’s clear the fault does not lie with surgeons per se, other decisions makers might also have a role to play, particularly those responsible for primary and community care services. Likewise, the older person themselves might want to exercise some choice as to whether they want surgical treatment or not.

People need information to make choices however. It has been said that the rise of social media has led to the growing empowerment of us all, and the 'nowhere to hide' culture of the Twitterati has raised expectations of quality, and growing intolerance of poor service. And there are many people like my parents (older people in their own right) who regularly use their iPads to access information about all aspects of their life. However, such access can be a mixed blessing. The instant access to others offered by Twitter, Skype and FaceTime is the new technological tyranny. Orwell probably had it right.

At the other end of the age spectrum I was interested to read last week that university students in classes that use Twitter average 10% grade points higher than those who don’t. 98% of students own some kind of digital device, and 8% of students use social networking sites to contact their lecturers. 50% of students believe that tablets will replace text books completely within the next 5 years. When at our College Strategic Thinking Day I shared this information and asked who, that morning had used Twitter and tweeted someone – there were only 2 of us who had, Moira and me. Made me think.

The other thing that made me stop and think last week was the publication of the challenging report from the Prison Reform Trust and INQUEST entitled Fatally Flawed. This report used the the story of Joseph Scholes to explore the way in which the UK criminal justice system treats young people. Joseph was just 16 when he died at Stoke Heath Young Offender Institution in 2002. Despite much public outcry, no public inquiry was ever undertaken. Since Joseph died on 24 March 2002 to the day this report was published last week on the 24 October 2012, 9 children and 191 young people aged 24 and under have died in prison.

We have to do better for both the older and younger people in our society.

One for the Oldies, One for the Road and One Too Many?

I tripped over a guitar yesterday. I have 5 (although 1 is in my office). I hadn’t had a drink, it was just as I was clearing something away in my study, I stepped back and knocked one over and as I reached to rescue it from falling, I tripped over. Surrounded by guitars, I picked one up, tuned it and began to play. Now I don’t have a great repertoire, but I have some songs I know from the 1980s which was when I last played in earnest.

Like every wannabe rock star, I eventually I got to my Bob Dylan song selection in what (in my mind at least) is now an imaginary concert played in front of 1000s of fans at Wembley. ‘Knockin on Heavens Door’ is a favourite, a great standard, possible made more famous by Guns N’ Roses. It was one of their tracks on their debut album ‘Appetite for Destruction’ released in 1987. Axl Rose I am not, but yesterday I had fun nevertheless.

One of the other songs from this album was a song called ‘Nightrain’. It’s a song that was a tribute to an infamous brand of cheap Californian wine, 'Night Train Express', which was extremely popular with the band during their early days because of its low price and high alcohol content. I mention this fact as last week I was in Birmingham at the autumn meeting of the Council of Deans for Health. I travelled there by train and as I was travelling early evening, I purchased a lovely young Pinot Grigio from M+S (there are other retailers selling wine at train stations) to sip occasionally as the journey progressed. I saved some for the hotel room, which when I got there, had a panoramic view across the city.

And the wine was a good one too! As was the Council of Deans meeting. One of the many things we discussed was how each University was responding to the changing educational needs that were emerging as new (and often long term) health conditions are being identified. Some of these new health problems also have a long lead-in times before the disease becomes evident. For example obesity related diabetes, smoking related lung disease, and of course, health problems related to alcohol use over a prolonged period of time. For example, alcohol related dementia is a silent epidemic that could affect up to 80,000 people in the UK.

So it was good to see that last week Alcohol Concern published a so called 'alcohol harm map' which reveals the harm and cost of alcohol misuse across England. The map, which can be accessed at http://www.alcoholconcern.org.uk/campaign/alcohol-harm-map provides an interactive guide to your area highlighting how many people are drinking at harmful levels, the number of alcohol-related hospital admissions and alcohol-related healthcare costs for your local authority area.

According to the map, more NHS money is spent treating alcohol-related hospital admissions for the 55 to 74-year-olds (over £825m) in 2010/11 than that spent on the 16 to 24-year-old age group (£64m). According to the Office of National Statistics it is estimated that 6% of the population in England are dependent on alcohol, of which 9.3% are men and 3.6% women.

As I live in Bolton, I thought I would look to see what the statistics said about my neighbours and I. The information was very interesting. For example, alcohol-related admissions in Bolton cost £16.9m in 2010/11 which equates to £80 per adult. £3.6m was spent on the cost of A&E admissions, £10.7m on inpatient admissions, and £2.6m on outpatient admissions. In Bolton the number of deaths attributable to alcohol (all ages) in 2011 was 110 (74 men and 36 women). The statistics made sobering reading. I guess there must be a lot of people in Bolton already knock-knock-knockin' on heaven's door.