Shades of Ivan Illich, In Gearing up for Uganda and New Ways of Working

I have long been a fan of the work of the philosopher Ivan Illich. Many people don’t like his writing, which has often been described as polemic, challenging and rhetorically intoxicating.  Part of his appeal for me is not just in the subjects that he chose to write about, but also in his use of words. Like my artist friend Urpu Sellar, Illich liked to use words outside of their normal context and generally accepted meanings.  Whereas Urpu uses words to produce tongue in cheek ceramic sculptures, Illich produced trenchant accounts of his analysis of many of societies social institutions (education, medicine, the law and so on).

In his book the Limits to Medicine he argued that the medicalisation of so many of life’s vicissitudes (birth and death for example) often caused more harm than good, and introduced the wider public to the concept of iatrogenesis. He described the concept in both its strict sense of the word – harm that comes from direct medical intervention and also in its wider sense, a cultural use where as a society we become, over time less reliant on ourselves to look after ourselves and others, and more reliant on the state (in this case medicine) to look after us.

I was prompted to recall his work by a couple of things last week. One was being asked to choose which antimalarial medication I wanted prescribing for a trip next weekend to Uganda. Anyone traveling to Uganda is advised to take precautions against malaria including taking antimalarial medication. It makes sense, as there are approximately 750,000 deaths a year from malaria, most of which occur in sub-Saharan Africa. Some 3.2 billion people worldwide are at risk of malaria. Despite the news last week that the pharmaceutical company Glaxo Smith Kline, after nearly 30 years work, had developed a malaria vaccine, preventative and control measures are still required to reduce the number of deaths.

Antimalarial medication is part of these preventative measures. However, the side effects of the medication can be pretty awful, ranging from a sore mouth, headaches, diarrhoea through to unusual bleeding, and mental health problems – however unpleasant, all of which are obviously better than death.  I am going to Uganda as part of a team from the NHS Health Education England Global Health Exchange. I will write more about this trip and what the initiative involves in future posts, but is both important for the School, communities across Uganda and the wider NHS.

The second Illich memory prompt came from reading the publication ‘the art of the possible – what role for community health services', published by the NHS Confederation. I found this a rather archaic paper. Aimed at meeting the needs of people with long term health problems, it appeared to state the obvious. For example, that practical support from community health services those with chronic conditions would enable primary care to work faster and at a larger scale.

To be frank, I was more inspired by my Friday morning meeting with Jim Taylor and Charlotte Ramsden. Jim is the City Director, Salford City Council, and Charlotte is responsible for children and adult services in Salford. They were both a breath of fresh air. Totally switched on when it came to integrated care, new future for social work and how we might look for the added value in initiatives such a ‘devo manc’. I was really pleased at the range of opportunities we discussed for working more closely together, particularly so as last week I was sent a ‘storify link’ which showed the contributions our social work colleagues made at the recent Joint Social Work Education and Research Conference (JSWEC). The range of papers on their research, new approaches to teaching and service development they presented was fantastic. See for yourself here.

The Naked Professor: 644 Robed Students, and a Midweek Congress

Last Friday should have been a duvet day. Apparently, many organisations in the UK and the US provide for duvet days as part of their terms and conditions of employment. Having conducted an exhaustive search of our University HR web site, it appears I work for an organisation that doesn’t do duvet days. However, it didn’t matter on last Friday. Last Friday was my summer holiday. My dear wife decreed that I was to stay in bed beyond 05.00, with computers, iPads, and mobile phones banned from the bedroom. 

At 03.21, I awoke shiveringly cold, with not an inch of duvet covering my naked body. My wife, on the other hand was completely wrapped up in the duvet, and resembled a cocoon on her side of the bed. She looked like the silk cocoon the duvet had been made from. I'd brought the silk duvet on a visit to China, the original home of silk fabric. I'd been to a store that showed the entire silk making process. The part I recall best is the way 4 or 5 women pulled out a gossamer thin sheet of silk which when layered with others formed the duvet. It was a fascinating sight, an expert technique undertaken like an art form. It provided a wonderful image for my memory bank.

Likewise, last Monday, at 10.30 I walked onto the stage at the Lowry Theatre, Salford Quays, for the first of our 2015 University graduations ceremonies. The stage was packed (130 colleagues) and the auditorium was filled to the rafters with the student’s families and friends. It was an awesome sight, and I could almost taste the electric expectant atmosphere. Truly it was another wonderful image for my memory bank. Regular readers of this blog know that graduation ceremonies are often a bitter sweet experience for me. I am ashamed to say that I find the pronunciation of some names a real challenge.

For some reason this year was different. I felt at ease and really enjoyed myself. It was the 8th graduation ceremony for me to present our students, whereas for our Chancellor and VC, and for many of our students, it was their first. Our School had 2 ceremonies during which 644 students received their awards. Grandson Jack watched the first ceremony on-line and got a wave from the Chancellor in ceremony 2 when I made a speech as a Council member: ‘Chancellor, Vice Chancellor, Distinguished Guests, Ladies and Gentleman, and Jack, my 3 and a bit year old grandson who wanted a wave’… …and Jackie Kay, our new Chancellor, very kindly obliged. He was pleased and has plagued his mum to watch the Youtube version over and over again. 

Midweek saw our Summer School Congress. There were a number of serious challenges in our external world we needed to explore as a School, and I was pleased given the time of the year, that 75 colleagues turned up to take part. It wasn’t all about the challenges we face though – my colleagues are very creative, highly motivated and fully committed to making a difference. So it was great, in a week of celebration of our student’s achievements to also acknowledge and celebrate our colleagues many achievements. Unlike the start of my Friday Duvet Day, I was left feeling warm all over. 

Needing to Change a Few Things Around Here!

Last Friday I was talking to some of our mental health students who were on placement at Greater Manchester West Mental Health Trust (fondly known by many as Prestwich Hospital). The conversation took me back to my time there. I arrived at Prestwich Hospital in June 1984. I was there to commission and manage the first and only NHS Forensic Adolescent Unit. I stayed at the hospital for the next 11 years, leaving to go and work at Manchester Metropolitan University. It was great to be able to talk about the many changes in service provision that I had been part of – and it was somewhat sobering to stop and think that some of these students hadn't even been born when I started working at Prestwich. Made feel slightly old.

A bit like my faithful Toshiba Portage Lap Top computer. I really liked my little Toshiba. It had accompanied me all over the world and has served me well, and has never let me down. It was light and easy to use, had a fantastic memory and was almost grandchild proof. It just fitted onto those fold down tables in trains and planes, and sat snugly in the space between the front seats of my car, turning all into a mobile office. However, it reached computer old age. The battery started to run out after 45 mins, and many of the letter keys were blank, the letters long gone, worn away through many hours of use. So reluctantly I had to start the journey to replace my wonderfully compact computer.

The University are trialling the Surface Pro tablet (there are other tablets to available) and so I chose to go with one of these. It arrived last week and was set up while I was out of the office, a week ago last Friday. I didn't have time to get to grips with it then so last Monday there it was sitting on my desk ready and waiting to be used.  And so it stayed for 2 days. It was a busy start to the week and I simply didn't feel I had time to learn how to use a new computer. Day 3 I felt I had to make an effort and tried to log on, only to find the computer said No!

However, by Friday I was beginning to feel better about the new computer, but although it does more than my little Toshiba, I really missed the old machine. I guess like many of us, I was stressed out by the unfamiliar and the comfort of my habitas. In my heart of hearts I knew it was the right thing to do, but taking a step into a new digital world, and with it a new way of working, was a little daunting. Some of us can find managing and / or coping with change very difficult.

And so it seems might also be the case for some of those who often exhort the rest of us to change – change our life style, what it is we eat, drink or smoke – I'm talking about doctors, who can often find it difficult to change their own lives despite advising others to do so. Last week, Steve Miller, a qualified hypnotherapist called on the NHS to get tough on overweight GPs as part of his campaign to help the UK resolve its obesity crisis. He was proposing that NHS doctors should have an annual health MOT to see if they are maintaining a healthy body weight themselves.

Miller suggested that if any NHS doctor fails the test they should be put on a regime to lose weight. If they refuse he also suggested they should face disciplinary action including being sacked. With the NHS facing a shortage of some 10000 GPs and with 25% of GP places not being filled each year, I am not sure this is such a great solution. The Chesterfield Royal Hospital NHS FT had what I thought was a much better approach. Over the last year they have taken part in the Global Corporate Challenge which challenged organisations to get staff to take 10000 steps a day for 100 days. They ended up being the 4th highest performing health care organisation in the world with 75 teams across the Trust taking part and improving their health, weight and wellbeing.

In terms of high performing organisations I was very pleased to see that Wrightington, Wigan and Leigh FT was the Acute Trust runner up in this years Best Companies Group 120 top performing NHS organisations awards. They were 2nd in the 'Top 10 Places to Work' category. I’m a Non Executive Director in the Trust and I’m immensely proud of the way WWL has worked hard at gaining staff engagement focused upon constant improvement in providing safe, effective and caring services. Likewise I felt really privileged to spend some time with colleagues last week who were working through what our new nursing programme will look like this time next year. Hearing the passion in the way the many suggestions, questions were presented around how to better prepare our nurses to be competent, compassionate and caring practitioners filled my head and heart with great confidence and pride. 

I wasn't feeling very caring on Friday evening, however. Arriving at the House in Scotland, it was like a scene from Watership Down. The rabbits that have taken up residence in the front garden, and who gave birth to baby rabbits a couple of weeks ago, were all laying on the lawns enjoying the early evening sunshine. Things will have to change, and this is one change I won’t worry about at all!

Hypocrisy has no place in Remembering the Death of the Innocent’s, Even in the Heat of the Moment

For a few days last week here in the UK we had weather that reminded me of the heat in Abu Dhabi. It was lovely, and unlike Abu Dhabi, we also got to enjoy some absolutely spectacular thunderstorms with sheet lightening and torrential rain. I was also reminded of Abu Dhabi by the visit last week of His Highness, Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi. During his visit he expressed his sympathy to the families of those killed and injured in the terrorist attack on the beach in Sousse, Tunisia the previous Friday. 

And many people across the UK also expressed their solidarity and respect when they observed a minutes silence as part of the official day of mourning for those killed. Flags flew at half-mast on official buildings and people stopped what they were doing at midday last Fridays to think about all those innocent people killed in the worst terrorist attack on Britons in a decade. 30 of the 38 people who were killed were British.

When I say many people, I exclude the so-called comedian Russell Brand, who in what I consider to be an obnoxious display of ignorance declared the one minute silent tribute as 'an empty, futile gesture'.  His comments made in the year in which many marked the 70th anniversary of the Victory in Europe (VE) Day reveal more about his lack of respect for all those who sacrificed so much for his and our freedom. But then he has often been accused of being a hypocrite: living in a £5000 a month apartment while protesting about affordable rents; 2 days after hosting the 2015 Comic Relief telethon that raised nearly £1Bn condemning charities as being part of the problem; and just last month, the Daily Mail revealed that Brand was selling sweatshirts stated to be British made, while in reality they were being made in Bangladesh by workers earning under $1 per hour.

Death has featured a great deal this week. My Fathers sister Pauline died after what was a long battle with ill health. She was the only Auntie I had on my Father’s side. Her death was a peaceful one in her home with her husband and one of their daughters being there with her. The last occasion I got to spend time with her was at my Mothers 80th birthday in April 2014. And Mum, I know every birthday you tell your grand children you are 21 again, but most of them don’t read this blog so your secret is absolutely safe.

Last Friday I was an Internal Examiner for a PhD Viva. This was a study that looked at the withdrawal of treatment in an Intensive Care Unit, and so something else that also featured death. I have to say it was a beautifully constructed ethnography. The candidate defended her thesis really well and so it was with great pleasure that we were able to recommend the award of PhD be made. I learnt so much in the reading of her thesis. I was humbled by the descriptions of the care and dignity afforded to patients and their families at a time of great trauma and challenge. Once a year, those working in the unit held a memorial service. It was a simple but powerful way to remember all those people who didn't survive being in ICU. I felt proud to be a nurse.

Paying tribute to those who have died in the service of the rest of us or as in the case of the Tunisia massacre, to reflect on the death of innocent victims killed for some perverse cause, is a British attribute, and I am proud to be British too.  As were others this week and this could be seen in many ways. For example, seeing the enthusiasm for that most traditional of British sporting events, Wimbledon. Andy Murray gets through – shoulder therapy mid match seemed to do the trick, and of course there was Heather Watson’s tremendous tussle with Serena Williams, a magnificent match.  But for me, it was a German that captivated my attention – Dustin Brown, ranked 102 in the world, and someone who spent 3 years travelling around Europe in a VW camper van in order to play tennis. He convincingly beat Rafael Nadal (someone who has won 14 grand slams). I was so envious of his dreadlocks, but I so loved his unorthodox approach to life and playing his game. Unlike Brands jaundiced view of the world, Dustin was grabbing the opportunities with both hands – and I am sure, unlike Brand, Dustin will make a difference.