Teaching, a New Take on Phone Sext, and Being Peer Reviewed

Last Friday I was able to get into the classroom and do a bit of teaching. Fabulous, and such a rich counterpoint to the rest of my day job at the moment. I was contributing to a new optional module for our BSc Nursing students, now in their second year. There were a number of things about this experience that I found interesting. The first was the requirement to get my learning materials up on the virtual BlackBoard site 3 days before the session so the students could read and start to think about this – an interesting concept. I tend to use lots of images rather than words to literally illustrate my points. This year we had introduced a policy of if you are not there at the start of the session you don’t get to come in late. Every one of the students was there. And not one mobile phone rang during the whole session.

The latter phenomenon I found fascinating, particularly as I read earlier in the week, about a recent study undertaken by Vodafone on peoples phone habits. They wanted to find out if everyone really was constantly on their phones, texting, tweeting, checking emails or playing Angry Birds. There were some interesting results from the survey which polled 2000 people, not least of which was that over a third of the men said they would answer the phone during sex. 62% of all participants revealed that they would answer the phone on a date or the toilet, at the dinner table rather than wait and call back later. 25% of people said they had been given a job offer, nearly 15% said they had been told about the birth of a child and, in London, over 4% of the survey population had been proposed to over the phone. So I was impressed that not 1 phone went off.

My teaching session was a quick canter through some of the philosophical ideas that might underpin the informal carer contribution made to the lives of so many people in the UK. 6.4 million people provide informal care. As noted last month, caring for another can be a 24 hour, 7 days a week commitment, often with very little support. This is despite the fact that such informal care saves the State some £119bn a year in costs.

The session covered the work of Foucault, drawing upon his philosophical writings and his own life and the care he benefited most from, touching base with Durkheim and suicide and society, through Marx, and to Etzinio. And of course it was possible to see how these philosophies had been transposed into political ideologies so we also talked about Thatcher’s Conservatism, Blair’s Third Way and Cameron’s Big Society.

On my mind during the session was that 2 of my colleagues had elected to stay in the lecture theatre while I taught. We had recently agreed as a School to introduce peer reviews of the quality our teaching, but I hadn’t thought it would be me who would experience this first. As I write this I am awaiting the results of the student and peer feedback. Now let me tell you what this feels like, well, excuse me my mobile is ringing, I'll get back to you....

...Hello... ...yes?...

Pipped at the Post, Panic, and Plato

This week saw our new students arrive. If any of them are reading today’s posting, I say once again welcome to the School and the University of Salford. Despite many months of planning, we were pipped to the post by Student Life who took over the large purpose built auditorium we have in the Mary Seacole Building (the name kind of gives you a clue as why the building was built in the first place). So my first meetings with these students were in our Allerton Sports Hall. Now this is not a building that forms part of the GB Olympic Legacy. It is a cold, slightly past its best, Sports Hall. 350 chairs had been set out and at 10.00 on Monday the first 300 students came in. Some 30 minutes later we had a slight log jam as 300 students tried to get out of the same doors as a different group of 250 students who were trying to come in. We soon had it sorted and by the time we got to the fourth transition we had the exchange down to a fine art.

I was already busy last week and that was before the problems of students accessing our IT systems emerged. There were many very concerned students to attend to. All of whom seemed to be in a state of mild panic as timetables and where they needed to be and so on were not readily available on-line. We had to resort to good old fashioned paper, and hand distribution. Colleagues across the School were magnificent in rising to the challenge and they deserve great credit for dealing with so many issues as well as trying to get on with the day job.

I was mildly amused by a panic of a different kind set in train by the Nursing Times last week. Their shock horror headline was that nurse training places have been slashed by more than 2,500 in 3 years. The trend is in contrast to medical training, with has seen an increase in numbers. Nationally, 12.7% fewer university places were commissioned by the NHS for the new academic year. This follows on from 2 previous years of reductions – in the North West we have seen our commissions fall by 16% over the past three years – but there was no panic, we worked with the Strategic Health Authority to ensure that the local health care and higher education economies were not destabilised.

Professor Green vice-chancellor of the University of Worcester sees it differently however. He said: ‘We are heading straight for a national disaster in two to three years’ time’. He claims that the number of places commissioned by SHAs is based on projections by Chief Executives who were trying to save money. He said the commissioned numbers were ‘divorced from reality’ and not based on the actual need. ‘There is going to be a shortage, that’s plain to see,’ he said. But is there?

The impact won’t be felt in any event until 2014/15 and then if nothing else changes, mainly by acute providers. But of course we know that there are many aspects of health care that are changing and the acute hospital of the future is likely to be a very different place, treating different kinds of health care problems, harnessing new technologies, with much greater resources being used to promote better population health through health promoting activities – see http://www.gmahsn.org/news/blog-prof-tony-warne/ for more thoughts on these changes.

I think the challenge is in knowing how we need to change the way in which nurses (and other health care professionals) are prepared for the future. And that’s the rub. Yesterday I was clearing some files (really fed up with paper these days) and came across that brilliant paper Plato, sociology and nursing, by Christopher Lambert published way back in 1993. His first line captures for me the problem: Nurses have a tendency to entrap themselves in webs of their own creation. Drawing on the epistemological exploration classically espoused in Plato’s Republic and his story of the people in the cave, Lambert brilliantly deconstructs the problems nursing as profession face when they inhabit a cave constructed of well established and traditional ways of thinking that are highly resistant to change.

My younger brother Christopher would have been more succinct in his analysis however. He would have told me ‘Tony for goodness sake (or words to that effect) just get on with it, get it sorted’ – Christopher died 5 years ago today. This buddleia was planted in his memory from a small cutting taken from his garden, like my brother Christopher, it’s beautiful.

Bikes, Profs, Goodbyes, Designer Conferences and Carers

For the first time in a long time, well at least as long as I can remember, this morning I over slept. Simply put, my internal clock did not wake me up as usual at 05.00. This has not happened for many a year. Maybe its because last week my long awaited bike arrived. I had wanted one of these for a while but the makers had stopped production. Fortunately I found a company that could bring one in from the US, and last week they delivered it – in a brown cardboard box! It took a while to assemble and then I realised I had no way to get it home. I live some 18 miles away from the University and that seemed like an awfully long first bike ride to me. So it was disassembled and taken home in parts. The inaugural bike ride happened yesterday and I was instantly transported back to my early teens, and so enjoyed the experience.

And another enjoyable experience was to hear that two of my colleagues in the School had been given their personal Chairs, Paula Ormandy and Nick Hardiker both became Professors this week. Many congratulations to them both, well deserved and great for the School and University. I also completed the internal considerations of the applications made from colleagues moving from Lecturer to Senior Lecturer. The final outcome is embargoed until tomorrow, but there were some cracking successful applications that showcased the enormous breadth of talent in the School.

Last week there were congratulations to be celebrated in a different context, as it was time to say goodbye to our 2009 students. We had two big celebration events both of which were a great success. At one event there were some 300 students in our large lecture theatre. The warmth the students displayed to my colleagues for the support and help they had unremittingly received from them was fantastic. In the second event I was presented with a pair of authentic bright yellow wooden clogs. I thought this a fun and really lovely gift, although I am not sure if the students were perhaps slightly amused that I only ever wear clogs.

On Friday I opened our Dementia Design Conference. In the UK, there are currently 800,000 people with dementia with some 17,000 being young people. It’s estimated that by 2021 there will be over a million people living with dementia. 33% of people with dementia are women, and 60,000 people die each a year from dementia. This year dementia will cost the NHS some £23bn, and that’s despite the fact that family carers of people with dementia save the NHS £8bn a year.

Last week Carers UK and the University of Leeds published a report on the contribution carers make to societies well being. Based on the 2001 Census, it is estimated that there are some 6.5 million carers in the UK, some 10.5% of the total UK population. The care they provide is worth an estimated £119bn per year (more than total spending on the NHS). Carers are more likely to be women than men - 58% of carers are female and 42% are male. 58% of carers look after someone with a physical disability; 13% care for someone with a mental health problem; 20% for someone with a sensory impairment and 10% for someone with dementia.

The Dementia Design Conference was the result of work undertaken by colleagues from School of Nursing, Midwifery, & Social Work and the School of the Built Environment aimed at making a positive difference to those living with dementia. The multi-professional, multi-sector and multi agency approach was a great success. My favourite presentation was on the use of different smells to keep people health. Resulting from work undertaken by the Design Council this device can produce a different smell at predetermined times to stimulate appetite. Small trials have shown good results, and now a larger trial is underway with Anchor Care Homes. The final event of the day was the launch of the International Dementia Design Network, and this network is definitely going to be a case of watch this space!

Cranage Hall Reprised, Milton’s Paradise Lost, and the Hunt’s On

I enjoyed last week. There was plenty going on and finding the time to watch coverage of the Paralympics became more difficult. I am looking forward to what I am sure will be a fantastic closing ceremony tonight. As was the Last Night of the Proms concert yesterday. I have never seen such an enthusiastic Tambourine player as the lady from the BBC Symphony Orchestra – she was phenomenal. And the performance of Benjamin Brittens arrangement of the National Anthem was simply brilliant.

On Wednesday I attended a HIEC (Health Innovation and Education Cluster) meeting at Manchester Metropolitan University, my previous place of work before coming to Salford. It was really good to meet up once more with colleagues not seen for a while. Thursday and Friday were spent at Cranage Hall, in Holmes Chapel. It was the University annual Strategic Planning conference. Our University, like others has faced an extraordinary and unpredictable year, so it was good to know that we were being proactive in our deliberations of the actions we need to consider taking. The main focus of the conference was on improving teaching and growing our research capacity. There was a great deal of creative thinking evident over the two days, but it was also exhausting. 

Last week 'our Dave' had a bit of a reshuffle. Nursing Minister Anne Milton lost her job in his Cabinet reshuffle. Spookily I mentioned her in despatches just a few weeks ago, not sure that ‘our Dave’ reads my blog, but who knows. So far she has not been offered another post in the Government.

It was single Mum and former journalist Anna Soubry who has been appointed under-secretary of State for Health. Born in 1956, unlike Anne, Annas only connection to health care appears to be that her mother once worked as a radiographer. Yesterdays Times carried a story that appeared to set out Annas thoughts on end of life care. She said that people seeking help to die should be allowed to obtain assistance in the UK and said it was ‘ridiculous and appalling’ that Britons had to ‘go abroad to end their life’, and that ‘you have a right to kill yourself’.

The Department of Health rather predictably said the views were Ms Soubry's own. However, it was her first speech as under-secretary that really interested me. She addressed the House (of Parliament) about the NHS Estate. She described the creation of a new company called NHS Property Services Ltd which will own and manage buildings that are needed by the NHS. However, it will also be able to release savings from its properties that are declared surplus to NHS requirements and sold off. I’ve no doubt that the money raised by selling surplus buildings and the land they stand on will be used to improve services in the NHS. Now interestingly, Anna’s long term partner is one Neil Davidson, who amongst other things is a non-executive Director of Persimmon, the property development and house building company.

Of course the greatest re-shuffle surprise was the sacking of Andrew Lansley as Secretary of State for Health. He is off to become Leader of the House, which while still being a Cabinet post, is a relative political backwater. The work mainly consists of scheduling Commons business and a weekly all-comers’ question session. Andrew Lansley said yesterday that he didn't believe he was removed because of any dissatisfaction with his controversial reforms of the NHS. Of course everyone is entitled to their own opinion. However, no sooner had we all taken a deep sigh of relief when it was announced that Andrew Lansley’s replacement would be one Jeremy Hunt.

This was a stunning decision, and unfortunately a clear indication that the reforms would continue apace. It is worth remembering ‘our Jeremy’ will be responsible for a £100 billion of NHS resources. This is a man that earlier on this summer was staring into the political abyss over his alleged ‘cosy’ dealings with the Murdoch empire. His journey from the brink of disaster to one of the Cabinet's most important posts is remarkable. Time will tell if Lord Justice Leveson agrees. The crowd at Fridays Paralympics medal award ceremony didn’t. He was booed as he presented the cycling medals. Enough said.

Planes, Peahens and Pills that go Beep

As I mentioned in lasts weeks posting, instead of spending the Bank Holiday weekend here in the UK, I travelled to Sweden to present a paper at a nurse education conference. I was slightly annoyed that I had been asked to arrive at the airport 2 hours before my flight was due to leave. My tickets had been booked on-line, I had an online confirmation on my phone. At the airport, I placed my passport in a brightly coloured machine, which felt immediately able to address me, and the proceeded to ask me a few questions, I pressed a couple of touch buttons on the screen, and my two boarding cards were printed off. Card is possibly the wrong word, as they were printed on what felt like the toilet paper we had at School when I was a child – grey hard, thin, slippery and useless for the job in hand being my recollection.

I never travel with luggage that has to go in the hold, a consequence of reading every book Lee Child has written. Perhaps it was my Jack Reacher persona that allowed me to then slip through security in a whisper. Spookily the rules had changed yet again, and while my laptop had to come out, this time my iPad could stay nestled deep inside my rucksack. The security people took exception to my comb, and so in the end everything had to turned out and repacked. But some 12 minutes after arriving at the airport I was through all the hurdles and still had 108 minutes to wait before my flight was called. Clearly reality had not kept pace with technology.

I found the conference very interesting - the focus was on how student nurses were being prepared for practice though learning in practice. My long term friend and research partner Mikko was there and between us, drawing on opposite research paradigms we were able to provide backcloth that allowed for debate and challenge. Strangely the hotel I was staying at was still using the same type of toilet paper as I recalled using in my childhood, and what’s more, the same toilet paper was to be found at the conference venue, the Karolinska Institute at the Sophia Hemmet University.

However, the venue was well equipped with state of the art technology making the presentations and discussions a smooth and enjoyable process. The organisers had apparently forgotten I was a vegetarian. 

Fortunately, at the official Conference Dinner, a vegetarian option was available. The dinner was good, and the conversations interesting. The venue was one of the oldest buildings in Stockholm, with a commanding view of the sea and ports. Big cruise liners came and went as we ate. I was fascinated by the peahen who sat on one of the balcony railings. She didn’t move even when I got very close to photograph her. She just looked disdainfully in my direction. What I didn’t see at first was that she had laid 4  eggs in the corner of the balcony, and was clearly not going to move and abandon these. Although it’s a bit late in the year, I hope she is successful in hatching them.

Flying back, Stockholm Airport kindly allowed me to use their free wi fi system. All I had to do was send them my mobile phone number, and in a nano second, an activation code was texted back to me. Booking in was the same procedure coming home as going, so I had just under two hours to kill. As I had been asked to write a blog for the greater Manchester Academic Health Network website (see http://www.gmahsn.org/ ) (great video), I thought I would do some search for ideas. The all dancing singing, walking, talking pill was the first to attract my attention.

California -based Proteus Digital Health have developed the digital techongloy to embed tiny ingestible chips into pills for all kinds of conditions from the common cold to cancer that allows for tracking of whether a patent has taken their pill or not. The pill technology can allow carers to prompt patients to take their medication, or even ask patient sto take a walk if they have been inactive for too long.

Whilst some patients might not like their pill-taking being tracked the system can help manage patients' complicated medicine routines, such as diabetes or heart conditions. The swallowed sensor is linked to a skin patch worn on the patient's body, which captures the report sent by the sensor. About the size of a grain of salt, the sensor has no battery or antenna and is activated when it gets wet from stomach juices. That completes a circuit between coatings of copper and magnesium on either side, generating a tiny electric voltage for a few minutes. The skin patch records the digital message, along with the patient's heart rate, body angle and activity, and sends the data to a bluetooth-enabled device such as a phone or computer. The data is then uploaded to a computer network for viewing by patients, caregivers and physicians.

Of course some people might argue that this extends the clinical gaze in a totally unacceptable way, there are clear opportunities here to think very differently about how we begin to treat long term and chronic conditions. I just hope the same kind of different thinking can be applied to air travel.