Graduation, Olympics and the Sea

It’s that time of the years again. The Graduation ceremonies have come and gone, joyful, colourful and fantastic occasions this year as any year. There was a great turnout from colleagues across the School to all 3 ceremonies. Many congratulations to all the students and their families in achieving all their ambitions with us.

And today the British Olympics commence. I wish all those athletes who have been training and working hard for many years all the very best in their endeavours.

I will not be watching the games. I am off to spend a week watching the sea come in and go out again on the South West coast of Scotland. No TV, no phone and no internet connection.

Normal blog service will be resumed on the 4th August.

The Hot Tub Edition

I was thinking about writing my blog around the publication this week, of a new toolkit. It was developed by Leeds University to help doctors and health service manager’s more effectively work together in improving the quality of patient care in the NHS. The tool kit appeared to consist of different activities that essentially got doctors and managers to talk to each other – which seemed to me to be a good starting point. Strange no one has thought about suggesting this before. However, I was in West Yorkshire for a workshop meeting this week and my thoughts started moving in a different direction after reading a story in the York Post.

The story was of a 63 year old man from North Yorkshire who had been found dead in his hot tub by his female gardener last Friday. Now I don’t know a great deal about hot tubs, but I never imagined they were particularly dangerous. How wrong could I be! Last year the National Water Safety Forum reported that out of the 420 water related deaths in England, 24 were the result of incidents in hot tubs. Apparently there are at least 100,000 hot tubs in the UK, with around 6,000 sold every year. The most popular models seat up to 5 and cost from £2,500 to £25,000

The trend for having a hot tub in your back garden has spread from the US and Scandinavia. The benefits of hot tubs are well known, for example, physical relaxation, hydrotherapy and massage. But there are a number of hidden dangers of hot tubs that people are unlikely to be aware of. For example, hot water is a necessary part of the effectiveness of a hot tub. If the water temperature rises above 40ºC the heat can cause sleepiness, and in some cases, this can lead to accidental drowning. Likewise, raising one’s body temperature to a high level can also cause heat stroke, heart attack, skin burns and even brain damage.

Another hidden danger is the so called ‘Hot Tub Lung’ caused by bacteria getting into the steam of the hot water, and a skin condition called ‘Hot Tub Rash’ caused by the bacteria found in water that has not been changed very often. Other hidden dangers include the type of drain cover fitted. Drain covers prevent long hair from becoming pulled into the drain, and in so doing, trapping a person’s head underwater resulting in death through drowning. The strong suction of the drain can also entrap limbs, causing injury and also death.

In a related study published last week, hot tubs have been deemed almost anti-social, having entered for the first time the top 10 list of the causes of ‘garden rage’. Whereas other entries on the list, such as power tools, barbecue smoke and faulty burglar alarms, are familiar annoyances from many a summer, the hot tubs are a relatively new phenomenon. The BBC’s Gardeners’ World magazine interviewed more than 800 readers about the things that most annoyed them in the garden.

Top of the list were late-night parties, with specific complaints relating to ‘students acting like 3 year-olds’ and ‘groups of middle-aged women shrieking’. More unusual sources of irritation included the smell of fabric conditioner, the sound of wind chimes, stray chickens and model aircraft. Hot tubs featured at number 8. As well as their perpetual ‘bubbling’ sound many hot tub owners also have a tendency to hold noisy late-night parties while taking a dip, the survey found.

Clearly despite their popularity hot tubs are in need of a makeover in terms of being seen as health promoting and socially desirable. Perhaps instead of purchasing a conversational ‘tool kit’ maybe every hospital should take a leaf out of Microsoft’s approach to facilitating good human interactions at work, and invest in a hot tub. Once a week, the hot tub could be fired up and doctors and managers could sit and have their conversations over how to improve the quality of care they were providing to patients. Wind chimes and free range chickens would be banned of course.

Not Sitting Around but Doing My Bit for Health Promotion

My office is located on the 1st floor of the School. It doesn’t have much of a view, but it is good enough. I took some time and spent some money (my own) on making it feel comfortable and a creative space to be in. Some days I seldom move from it so having a pleasant working environment is important. Early in the morning I did like to fire up the i-pod and depending on the mood or what I had to tackle that day, my choice of music might range from the Rolling Stones, Pink Floyd, Leonard Cohen, French Cafe music or something from my Euphoric Garage days. I say did, as someone (person(s) unknown) has stolen the i-pod from my office docking station. I doubt they are reading this blog, but if they are, thanks for the inconvenience and it’s to be hoped you like my taste in music.

Now despite its attractions, the one disadvantage my office has is that it is located below 2 of our Skills Laboratories. Nearly every day when students assemble in these rooms for sessions, they drag their chairs across the floor, and for what can often seem like a lifetime, this dreadful intrusive noise goes on and on. Not one of our students appears capable of lifting a chair in order to move it. But I now have the perfect solutionto this problem. I am going to remove all chairs from the Skills Labs and classrooms. In so doing I will be doing my bit for health promotion. There is an evidence base to support me.

This week in BMJ Open, an US study reported that restricting the time spent sitting down every day to less than 3 hours could add a 2 year extension onto a person’s life. The study drew on data collected for the National Health and Nutrition Examination Survey (NHANES) for 2005/6 and 2009/10 on the general health and lifestyle of 167,000 US adults. Basing their findings on 5 population studies, the researchers estimated deaths from all causes linked to sitting time were around 27%. While the study was unable to predict individual risk associated with time spent sitting down, I think that in terms of promoting health and wellbeing amongst the student group all chairs will hence forth be removed. It’s a win win situation.

And so it seems is the UK Governments Healthy Start Scheme. Until last week I was completely oblivious to this fantastic scheme. Last week the Department of Health published a report on how the scheme was working. It was a very positive report and the scheme is making a difference to many people’s lives. The Healthy Start scheme is designed to help low-income pregnant women and families with children under 4 years of age buy liquid cows milk, fresh and frozen fruit and vegetables and infant formula milk (sorry Midwifery colleagues). Over 15,000 retail businesses (across 30,000 retail outlets) are registered to accept Healthy Start vouchers. Every 4 weeks 2.6 million Healthy Start vouchers are issued to 450,000 vulnerable families across the UK. Around 91% of these are spent and returned to the Healthy Start retailer reimbursement unit. 70% of vouchers are used with supermarkets the remainder are spent at pharmacies, independent shops, market stalls and door stop milk rounds men. Healthy Start vouchers are worth £3.10 and voucher misuse is rare.

Unfortunately, Jemima, the duck who thinks she a hen, is not entitled to the vouchers, even though she has 2 chicks that are only 10 days old. However, they do get a healthy diet every day, including corn on the cob, Cos lettuce, scrambled eggs (I know, strange but true), whole meal bread (crusts left on) and fresh corn. Yesterday Jemima had them outside in the run for the first time and they seemed to be doing well, and I've never seen a chair in the Hen House.

China Tweet, tweet to Boltons Cheep, cheep

At one of the meetings I attended this week, there was much talk about how we might best market our School to ensure that students in the future make our School and the University of Salford, their first choice when considering a career in nursing, social work, midwifery, social policy or counselling. The discussion was creative and ideas around using social networks were the one most people favoured. In an Emperors New Clothes moment I asked how precisely we would use Twitter to take our campaign forward. There was a pregnant pause (more of which later) and it soon became clear that the dozen people sitting in the room had no idea and had never used Twitter.

The good things to come out of this discussion was the recognition that we should be setting up a series of interactive workshops where colleagues can gain hands on experience of using such digital media to enhance our own communications with students and promote the Schools achievements more effectively than we perhaps can do now. The reach and influencing power such social media is huge.

For example, this week Sina Weibo the Chinese version of Twitter, has been used to bring to people’s attention the hidden atrocities arising from Chinas strict 1 child-policy. The discussions on Sina Weibo were around two maternity service scandals. The first followed the online posting of gruesome images of a young women who had been pinned to her hospital bed and forced to abort her 6 month old foetus. She later died. Her only crime appeared to be that she already had a child. The 1 child-policy is strictly enforced.

The second scandal, reported on Friday on Chinese television, was the operation to break up a baby-trafficking ring operating in 15 Chinese provinces, in which 802 people were arrested. Infertile couples or those wanting a male child to carry on the family line have been paying up to 80,000 yuan (£8,100) for a child. 181 babies were rescued from the gangs that made up the baby trafficking network. Courts usually give out very harsh punishments, (including the death sentence to convicted traffickers.

However, the discussions on Sina Weibo identified a range of culprits responsible for this trade: corrupt officials, the baby traffickers, and the couples who commoditise newborns. The potential for social unrest appears to be growing This week’s examples of the perverse (albeit unintended) consequences of 33 year old 1child-policy seems to have unleashed a national discussion on what is usually a very taboo subject – the challenge to the ruling Communist Party. As one Sina Weibo user tweeted yesterday ‘between killing babies and selling them, we need to ask what this policy has turned us into’.

And closer to home, I also read this week that women in London will be able to access a free emergency contraception ‘just in case kit’ during the next few summer months to prevent unwanted pregnancies. The reason for this, well it seems that wide spread and significant disruption is likely to result from the Olympic Games making it more difficult for women to access health care services during this time.

The sexual health charity British Pregnancy Advisory Service will post out the kit containing the morning after pill and condoms following a telephone consultation with one of its contraceptive nurses. The charity believes it ‘makes sense’ for women to keep an emergency pill at home and avoid ‘unnecessary difficulty and delay’.

Lead Contraceptive Nurse Tracey notes that ‘If you carry an umbrella in your bag or a spare tyre in your boot no-one would suggest you are hoping for rain or planning on a puncture. Having the morning-after-pill to hand is no different. It doesn't mean you’re planning on taking chances, it means you’re planning on protecting yourself when things don't go according to plan’. It all seems a long way from the baby traffickers in China.

And Jemima, the duck who thinks she’s a chicken, produced her first little black fluffy chick yesterday morning. By 10am there was one more chick and only 3 eggs remaining. It’s her second attempt at incubation this year. She is un-necessarily highly protective of her 2 chicks. I have told her she doesn’t need to be. This is not China and there isn’t a 1chick-policy in place. Cello just looks bemused that something so small can be fluffier than he is.

The Price of Keeping Quiet - Bristol to Baltimore

This week the UK Department of Health published its interim report setting out how it intends to improve the care provided to vulnerable people in the future. The report was prompted by the scandal last year involving people with a learning disability who lived at the Winterbourne Care Home near Bristol. They suffered physical, mental and emotional abuse at the hands of the staff meant to be there to provide them with care. The report drew upon a review by the Care Quality Commission (CQC) of learning disability services at 150 NHS, private care and social care services which found almost 50% were not meeting government standards.

The CQC review was ordered after the abuse at the care home in Bristol was revealed by the BBC Panorama programme in 2011. Some of the staff working at Winterbourne tried to warn of the abuse taking place but were ignored. The report on Winterbourne View itself will be published later on this year so as not to interfere with the ongoing prosecutions. 9 people have admitted abuse charges and 2 others will face trial at Bristol Crown Court this summer. While no abuse on the scale of Winterbourne was found at the sites studied by the CQC, the report showed that there is compelling evidence that some people with learning disabilities are being failed by health and care services. However, I wonder if anyone responsible for the systematic failure at Winterbourne and places like it will ever get to face the music in court.

Reflecting on this failure to speak up I was reminded of the highly evocative and emotionally challenging Baltimore Holocaust Memorial I had visited 2 weeks ago. The first thing one becomes aware of is the sculpture created by Joseph Sheppard. This is a statue which depicts the horror of the Holocaust by portraying emaciated bodies of the victims’ bodies contorted in a ball of flame. The base of the sculpture bears the quote from George Santayana:

Those who do not remember the past are destined to repeat it.

The attempted annihilation of the European Jewish population between 1933 and 1945, took the lives of 6 million Jews. The Holocaust was unique not just in its numerical magnitude. Gypsies, and those with a physical or mental handicap were also marked for death, homosexuals, Jehovah’s Witnesses, Soviet prisoners of war, Polish nationalists and resistance fighters were all tyrannized as part of the holocaust.

Many thousands of German citizens and nationals of other countries allied with the Germans were involved in the killing process either as guards at camps, members of mobile killing units, architects who designed gas chambers, engineers who built crematoria, railway personnel and bureaucrats who oversaw the distribution of the victim’s possessions. Although many of these perpetrators claimed they had no choice, there is no record of anyone being punished for refusing to participate in the killings. Many countries and neutral international agencies were aware of what was being done to Jews and other victims. Few, if any, were willing to speak out in protest.

At the back of the memorial are 2 walls bearing the words of Primo Levi from his book Survival in Auschwitz. Standing in the quiet and sunshine of Baltimore, I found reading these words a profoundly moving experience.

On both sides of the track, rows of red and white lights appeared, as far as the eye could see...

...with the rhythm of the wheels, with every human sound now silenced, we waited to see what would happen...

...in an instant, our women, our parents our children disappeared. We saw them for a brief while as an obscure mass at the other end of the platform

Then we saw nothing more

The full report into what went on in Winterbourne will be published in the autumn. The Department of Health interim report sets out clear actions which will be taken forward at a national level to help deliver the local change needed to ensure that people with learning disabilities or autism and behaviours that challenge can have the support they need to lead their lives like any other person, with the same opportunities and responsibilities, and to be treated with dignity and respect.

Whilst all parts of the health and social care system have a role to play in making this happen and every part of the system must work together to drive up standards, it will be equally important to ensure that individuals have a voice they can use and use with confidence and free from personal persecution if the horrors of the past are never to be repeated.