More possible questions than I've answers for: and the joys of growing [up/older/vegetables]

One of the great things about being a grandparent is the sheer joy of sharing the way in which the grandchildren discover the world they live in. I am fortunate to have 9 grandchildren of varying ages. I love the natural persistent curiosity young children have, the sheer exhilaration they can experience when achieving something after much practice, and the endless, often challenging questions they pose. I am sure most of us at some stage will have been asked by a 7 year old 'who is God's Mother?' or 'if you had a choice of having your arm chopped off or your leg chopped off, what would you choose?' or 'where does the wind come from?'.

They are the kind of questions that keep you on your toes, and for me, make me smile with sheer happiness. Likewise the energy they have inspires. Last week I took my eldest daughters 3 children to the 'Cream o' Galloway', an organic ice cream centre that has an adventure playground as part of its attractions. The number one thing to do, other than eat the delicious ice cream, was to ‘Go Boing’. These were a cluster of connected trampoline nets suspended amongst the trees which the grandchildren loved and my 60 year old legs didn't!

And my youngest daughter eldest child was given a bike by a neighbour last week, which was stabiliser free. He isn't quite there yet with his balance, but he’s learning and having fun at the same time. Many studies have shown that the most formative years are those between birth and the age of 8. About 90% of a child’s brain develops by the age of 5, and 85% of a child’s intellect, personality and social skills are developed by that age. Whilst supporting, stimulating and encouraging a child during their early years is a parent’s responsibility, increasingly others, like grandparents are involved in the child's early life care. There can be many reasons for this, but most often it is economic concerns that top the list with many families caught in a net of both parents having to work and in order to do so, source and pay for early year’s childcare.

The costs of childcare have spiralled in recent years. According to the Family and Childcare Trust the cost of keeping a 2 year old in full-time nursery education is around £918 a month or around £11,000 a year.  All my children except my youngest son (he hasn't started yet) have at least 2 children each and the cost of trying to provide full-time nursery care is completely prohibitive. Of course there might be some readers who might wonder why, given the known expense, couples don’t just have one child. Looking at the '4-2-1' problem China is now experiencing, makes me glad that in my own families case, they chose and were able to have more than 1 child.

The '4-2-1' problem has given rise to a situation where the only child potentially becoming responsible for their 2 parents and 4 grandparents. If pensions and savings fail to provide adequate cover in later life, responsibility for the care of the older person might be beyond the only child's resources and increasingly care become the responsibility of the State. So it was good to see last week councils, employers and childcare providers in the England being asked to come forward with innovative and flexible ideas of how to deliver 30 hours of free child care every week from September 2016.

The UK Government already spends £5Bn a year supporting childcare provision, helping parents to return to work and when working, keeping more of their income to spend on things other than childcare. More than 80% of all parents surveyed in a national survey undertaken by the Department of Education said they would take up the offer of free child care if it was available now. Sadly, even within the existing provision, 50% of families (some 113,000 children) from the most disadvantaged groups in society are not using their free places, particularly those families with 2 year olds.

As OFSTED's Chief Inspector, Sir Michael Wilshaw noted last week, children from poor families don't always do as well as those from better off backgrounds – there can be a 19 month achievement gap by the time children start school reception class (4-5 years old) between those children who attended good quality pre-school child care facilities for part of the week up to starting school and those that didn't.  This is a gap that can severely disadvantage a child's chances and opportunities in later life. Watch this space for those innovative ideas to emerge – in the meantime, I'm personally glad to do a bit of child-minding. Its an 'awesome' experience as my one of my 2 year old grandsons is pleased to say!

And last Friday I was privileged to see something else that I thought was equally awesome. I was invited to the Crossmichael Community Garden Open Day. This is a South West Scotland Gardening Project that uses gardening in therapeutic ways. On the side of a wind swept hill, the garden, tended by those recovering from an alcohol or drug related mental health problem was full of fruit, vegetables. There was even an Enchanted Secret Garden for the children who visited, so they could also learn how to grow their own food and cultivate flowers however old they might be. I cant think of a better way to spend a Friday afternoon - Brilliant!

My Weeks Magnificent Seven

There were a record number of views of my blog last week. I don’t know the reason why, but I was very pleased albeit just a little surprised. My Dad often asks me who it is I write my blog for. He's getting into his silver age so can be forgiven for forgetting my answer, but it is a good question. I tend to write for myself, like doing the Times Crossword, and I just like to write. I don’t do polemic so much these days, unlike those blogs written by the Gilded Lily. I think that kind of blog is ultimately unproductive. And whilst I am sure the number of readers he has is much greater than me, as they say, size isn't everything. 

Whilst I have also been accused of blogging about the poor service I have received from restaurants, hotels and airlines I feel slightly more justified in doing so in that these are services are I'm paying for directly and being a customer in such circumstances is different to being a consumer of health and social care services. But in any event, this week I wanted to write a different kind of blog, one where I can take the opportunity of acknowledging those who last week made a difference to my world.

My colleague Andrew, and frequent traveller to Abu Dhabi, knowing that I was off to the city last weekend whispered the magic words 'Club Rotana' into my ear. Now out in the UAE the Rotana hotel group is the kind of ubiquitous Holiday Inn level chain accommodation, comfortable but nothing particularly special. However 'Club Rotana' was described to me as the hidden gem. So in for a penny, in for pound, last weekend when I was staying in Abu Dhabi I thought I would give 'Club Rotana' a go.

Now before any of those of you who like to send me FOI requests, there was no additional charge for using 'Club Rotana' but it does need to be booked in advance. The accommodation was fantastic, located on the 9th floor with corner window views over Abu Dhabi. There was a state of the art control system, lights, air conditioning, TV, room service. It was magnificent. The shampoos, soaps, mouth wash were all 'l’Occitane', the towels were as soft as a baby's skin, and the fruit replaced fresh everyday. 

The rooms come with their own dining room and lounge facilities. Queen of the afternoon/evening shift was Zineb. I met Zineb when stepping out of the lift on the way to my room for the first time, she looked up from her desk and said 'hello Professor Tony'. Now these days wherever I travel in the world I have become used to putting my card into an ATM and the machine saying 'Hello Tony', but stepping out of a lift in Abu Dhabi and having someone greeting me by name was just down right spooky!

Zineb turned out to be an absolute Godsend (sorry Mother), and I said I would mention her in this week's blog – you made my stay really easy and hugely pleasant. Zineb hails from Morocco, and there was another lady, Sandra, who also made my weekend in Abu Dhabi a good one, but who hailed from a very different place, Germany. 

Sandra is our new Project Director for the criminal justice system project we have out there, and she was just starting her third week in role. I was there for the monthly Project Board Meeting, and it was a very productive one. Sandra led on the progress with Work Stage 3 – the 'training the trainers' programme. This is pivotal stage of the programme and the news of progress to date was very encouraging. It really felt like we were working as a partnership with colleagues out there and making progress at achieving real change in how the juvenile justice system was better able to work with young people and their families.

Although my time in Abu Dhabi tends to be very short in terms of days, each day can be very long. For me last Sunday, the first day of the Arabic working week, started at 05.00 and ended at midnight. It wasn't all meetings of course. I spent some time last Sunday working on a book chapter drafted by my long term writing partner Sue Mc. Sue is a very generous co-author and had spent considerable time crafting the first version of a chapter we are submitting for a commissioned book. She had sent me away with strict instructions to work on her first draft. Something I was happy to do, not that it needed much changing.

And generosity has been the golden thread throughout last week. There have been 2 more heroes in my world, who during a period of my contemplating change have stepped up to the mark and have unhesitatingly been there for me. Thank you Ged and June. Watch this space – let’s see where the ambition takes us! 

Best of all, for the first time in a long time, I have finally managed to spend a week away from work and alone with my dear wife Wendy - she is patience personified. Having missed being together for our wedding anniversary this year and Wendy’s birthday because I was too busy working, some might wonder how I even have both hands left in place to be able to write this blog. Last week has been wonderfully slowed down, highly relaxing and rejuvenating. And apart from bumping into my colleague Sarah R on the sea front last Friday afternoon, it has also been completely University of Salford free! Last week has seen a magnificent 7 come to the fore, and for completely different reasons - so Andrew, Zineb, Sandra, Sue, Ged, June and Wendy thank you – and I don't even have to go back to work until Tuesday!

Contemplating the Metaphysical Meaning of Numbers

I flew back into Dubai yesterday morning. I was en-route to Abu Dhabi and this month’s Abu Dhabi Police Project Board Meeting. Although this meant the 4th weekend on the trot that I have been away from home, I was pleased to be coming back. The culture here means that face to face encounters are always the preferred ways of growing relationships than using new technology to try and communicate from afar. In terms of the project, things are really moving in the right direction and the training stage of the work is well under way. It will be good to catch up with the team later on today.

I was slightly amused on Friday to receive an email from Emirates (there are other airlines flying to the Middle East) that contained so much information I wondered just how many people there were involved in daily updating the data. Not only did the email tell me the details of my flight, but what the weather forecast was for the 4 days I'm in Abu Dhabi; there was a menu (for each level of ticket) and the wines being served. I could see the complete film list and what music was available to listen too. It was a trip advisor in words and numbers. And last week was a bit like that for me as well.

I got to see a preview of this year’s Key Information Set (KIS) information. KIS provides prospective students (and I guess their parents) with information on how the programme of study they may fancy doing compares with similar programmes in all other universities. So important and often critical decision making factors are reduced to numerical values – 90% of students were satisfied with the programme; 88% got graduate jobs in the 12 months following completion; the typical cost of accommodation is £XXX; you will spend 40% of your time in lectures and so on.   

The KIS data is assembled from a range of national performance indicators such as the National Student Survey (NSS). This annual survey is for undergraduate students in their final year. This year’s NSS outcomes were good for the School, with an average 5% rise in student satisfaction, with one course gaining a 25% rise. Nationally 86% of all students polled were satisfied with their experience, and for many of our programmes we were way above this figure.

Our Postgraduate Research students were also doing well in terms of their satisfaction. Nearly 83% were satisfied with their experience, way above the rest of the University, our nearest competitor nearly 10% behind us. We also came top in terms of research culture 71% compared to the University overall score of 58%. And for the third quarter in a row our School has topped the University research grant income league table and have now secured more research income than any other School for this year. On average we are securing 30% of all grants applied for.

Of course these numerical facts belie the contribution of individuals. Last month colleagues from the School made an incredible 89 deposits of their published papers into the University of Salford’s Institutional Repository (where all research outputs are stored). The nearest School to ours deposited just 25 papers in the same period. 

And I find looking at the numbers a fascinating way of trying to make sense of the world. There is lots of different ways numbers can be used. I really liked this infographic sent to me by a colleague in the US - see here which captures and presents a wealth of information about child mental health in the US in a simple and powerful way. But there are other ways that numbers represent how people make sense of the world. For example, Research Gate told me last week that there had been 970 downloads of my papers, 6032 on-line views of my publications, and my papers had been cited 675 times by other authors. Last year there were 117,000 views of my blogs and last week, for some reason, 8 people viewed a blog I had written in October 2011. These are not the most impressive set of statistics but nevertheless it makes me wonder what these numbers translate to in terms of the way people view our worlds.

Yesterday, there was one number that made it easy for me to understand my world. I went and sat out side to read. The temperature was 44C even in the shade. So after a very short while I was back inside, up in the confines of my room, which although very pleasant, doesn't really reflect the spirit of  a vibrant Abu Dhabi!

Goodbye Kampala, and to all those doing health work in Uganda (and the goats)

Yesterday I walked around the Mulago Hospital in Kampala. It is the largest state hospital in Uganda. It was a very challenging end of my busy programme in Uganda which started, over a week ago with a breakfast meeting on the terrace of my hotel in Kampala. I was in Uganda as part of the Global Health Exchange placement programme and also and partly to scope out opportunities to contribute to the Uganda UK Health Alliance programmes aimed at establishing more generalised health partnerships and collaboration. After breakfast it was off in a small minibus to tackle the traffic on our way to Maya, a small rural community just outside of Kampala. The final mile of the journey was on an unmade and treacherously slippery road carved out of the red mud of a hillside.

I was travelling to meet John and to look around his Community Clinic that was emerging from the hillside, one brick at a time. John once lived in one of the shanty towns that are sprinkled around the city of Kampala. He lived there with his parents, his Father working as a servant to a wealthy Englishman. During the brutal terror reign of the tyrant Idi Amin the wealthy Englishman was exiled from Uganda, only returning on the end of Amin's presidency. Johns Father had kept the house in good condition and as a reward the Englishman agreed to send John to the UK to gain an education.

John studied first at St Davids College and Wales, and then took his degree at Liverpool John Moore’s University. He returned home to find his Mother now on her own, living in a one room shack in the same shanty town he had left. The first thing he did was to build his Mother another room and that 2 room brick built house still stands, and is rented out. The process of building his Mother another room inspired him, and he was able to raise enough money from his friends in Uganda and the UK to buy some land upon which the Community Clinic now stands.

He built the first consulting rooms himself, which now house a general clinical space and a dental surgery. He pays for a dentist to attend twice a week, and patients pay a contribution towards their treatment (£1 for a tooth extraction – something that costs £5 in Kampala city and £51 in the UK). The dentist equipment (drill, suction, lights, laptop for clinical notes and so on) were all powered by solar power, and the steriliser uses boiling water fired by gas from a biogas plant, fuelled from the waste from 2 cows.

I was truly humbled by his approach to sustainability. Last Christmas I had bought 14 solar panels for the House in Scotland, and apart from collecting the cheques from Scottish Power every 3 months don’t do anything as worthy as John. His ambition was to use his education to help the community from which he had come. He did so quietly and confidently. There was often the help of others, and sometimes this help was in form of money, others the forms of help were more unique.

He collects and stores rain water from the clinic roof. This water goes into a 1000 gallon tank buried in the ground, and need to be pumped manually up the hill to other storage tanks before it is fed by gravity back down to the clinics taps and toilet. Patients are asked if they would spend 5 minutes (or more if they are able) on a machine rather like a bike that pumps water up the hill. Not only does this improve their cardiovascular circulation, but in so doing helps reduce anxiety. It was a fantastic set up.

We also had 12 students from the University out in Uganda, and they were all starting their placements in different services, and so there was an opportunity to see them in action. They were all placed in different service provisions, regional centres, private hospitals, referral community services and missionary hospitals. They weren't there as volunteers but as part of their pre-registration professional education and training.

One of these placements was a referral centre outside of Fort Portal, again at the end of a red mud road. There I was able to meet 4 of our midwifery students, all of whom were busy putting their knowledge and skills into use working with mother’s pre and post-delivery of their babies. In some ways it was health care the raw, but I was impressed with the evident compassion and care being provided. In a resource challenged country, I felt we had a lot we could learn from the Ugandan approach.

The Goats – well everyone seemed to keep at least 1 pygmy goat if not more. For a goat lover, it was great to see so many at the side of the road everywhere I went – it was a added bonus that like so many things on the trip, was very unexpected.

Not least of which was the glass door in my toilet at one of the hotels I stayed at. I am not sure whose bright idea it was to provide the toilet with a glass door, I am sure there is paper to be written about this at some stage. I write this from Terminal 5 at Heathrow, and in a couple of hours I will be back into Manchester before driving up to the House in Scotland for a couple of days relaxation. I was glad of the experience of Uganda, but will be equally glad to get into my own bed and look out at the sea, watching the tide come in and go out again. 

Addressing the Rudeness of Receptionists and a Grumpy Old Man on his way to Uganda

It was a fairly busy week last week. When Friday came I have to say I was feeling tired. And certainly I was tired of meeting difficult receptionists. I had a consultation appointment with a trauma and orthopaedic specialist, an appointment held in a local community health centre. Walking in I was instructed by a number of notices telling me to report to reception. So I did, and was greeted with ‘name?’

 ‘Hello’ I said,

‘NAME?’ was the response.

I gave her my name. ‘Address?’ - I gave her my address. ‘Phone number?’ – I gave her my phone number. ‘It’s not the same number I've got’ she said with a triumphal smile on her face; how do I know who you are she declared…

 ‘Google me’ I said.

‘Upstairs and wait to be called’ was her final response.

 

I know, I know, I’m an adult and should know better… …but I do get so fed up with poor service from those that should be there to help others. Later in the week I went to pick up my antimalarial medication from a hospital pharmacy. Walking into the pharmacy I was greeted by a sign stating: ‘No medication given to staff without identification’. I thought not a problem for me as I wasn't a member of staff. How wrong could I be!? The prescription for the medication had been written by a doctor on the staff, and it appeared even though this was a NHS Trust I had nothing whatsoever to do with, as I was picking this medication up, by default I became a member of staff.

Yes you've guessed it, I was greeted with ‘name?’

‘Hello’ I said,

‘NAME?’ was the response. I gave her my name. ‘identification?’ – having been in this situation once before that week, I thought why not cut to the chase - ‘Google me’ I said.

‘IDENTIFICATION’ she said.

Thankfully I had my Wrightington, Wigan and Leigh (WWL) NHS Foundation Trust identity card on me and I was able to show that, collect my medication and get away.  Now some of you might be thinking ‘grumpy old man’ and you would be right. But in my defence, last week a paper published in the Journal of Ageing reported that the male menopause  is real (not that I doubted it for a moment), and of course one of the symptoms is grumpiness...

But of course, as irritated and grumpy as I might have been, both these receptionists, in their own way were trying to ensure I was being kept safe while receiving my healthcare. This was a theme that formed the focus for the two day Making Safety Visible learning workshop I participated in. Bringing together many of the Acute NHS Trust in Greater Manchester, along with many of the Clinical Commissioning Groups, the workshop was an opportunity to blend theory (of improvement science) with examples of practical service improvements aimed at improving the safety of health care services.

I was there as part of the WWL Trust Board team and during the 2 days we were able to celebrate the progress made in a couple of areas of safety improvement. One initiative was in addressing the processes that ensure people get onto the 60 day cancer pathway and the associated public health and health education measures that need to be put in place. This is work being undertaken with the Christie NHS Trust. The other initiative we were able to celebrate was the 7 Days, No Delays Project. This aimed to bring together all parties in the local health and social care economy / geography to ensure people were admitted and discharged appropriately with the right services being provided by the right people at the right time. Being the creative and fun loving team we are, we decided to present the work through a specially developed team rap song. Treat yourself to 90 seconds of pure celebration by watching here. 

It was long 2 days of workshop activity squeezed into what was a very busy week anyway. I had 10 professorial applications reports to write. Whilst this meant burning the midnight oil, it was actually a great joy to do as for me it was a real opportunity to respond to the ambitions being demonstrated by my colleagues working in the School. Friday I had my 1-2-1 meeting with our VC, always a great joy and there was much to discuss, particularly around some of the health innovation plans for Greater Manchester – something I am looking forward to being part of.

It was an opportune discussion as yesterday I spent the day travelling to Uganda with Ged Byrne and Laura Roberts. Ged is one of the 4 Health Education England Deans and Directors of Education and Quality, and Laura the Director of the Health Education England (North). It was a long day’s travel, (18 hours door to door) but there was plenty of time to talk, and talking is always a good thing to do. This blog comes from my bed in Kampala, and is posted by a very grumpy old man as it 02.12 Uganda time. Next week's blog will describe the work with the Global Health Exchange that brings me to Uganda.