A Call to Arms and Knowing the Power of CTRL X C V to Change Things

Two weeks ago, I wrote about the difference the computer, and the opportunity to use it for word processing, had made to the world and writers in particular. What I didn’t know then was that it was a certain Larry Tesler who provided us with possibly the greatest innovation for contemporary writers, that was the ‘cut’, ‘copy’, ‘paste’, ‘find’ and ‘replace’ commands. More of which later. Ironically, I probably would not have found out who he was and that fact that he died aged 74 last week, had it not been for today’s virtual world. Like many computer geniuses of his age, he was poached by the legendary Steve Jobs, and worked for Apple for nearly 20 years. He was their Chief Scientist. And again, like many successful computer scientists, after he left Apple, he set up an education start-up organisation. Thankfully, it seems to be a familiar ‘Silicon Valley’ tale of making lots of money, and upon ‘retirement’, using that money to help others develop their own dreams.

Of course, here in the UK we have our own successful technology entrepreneurs. James Dyson (of vacuum cleaner and hairdryer fame) set up a foundation to award young people who are able to ‘design something that solves a problem’. Part of its mission is to get young people excited about getting involved with design engineering. In 2015, Joel Gibbard won the UK’s James Dyson Award for Engineering. Along with Samantha Payne they co-founded the company Open Bionics. Two years later their company was awarded the UAE AI and Robotics Award for Good, which came with a $1 million prize!

What they did with this money is very interesting too. They developed what has come to be known as the Hero Arm. You can read their story here. It’s a great one. Now, anyone who was a child in the 1970s probably played at being the Six Million Dollar Bionic Man or Woman. They both had limbs replaced by robotic prosthetics (I think the Bionic Man also had a replacement eye that could see clearly for miles). What Open Bionics have achieved won’t cost folk the six million dollars of the original bionic man’s arms, but their products are beginning to transform the lives of many folk across the globe. And yes, if you want, you can have these wonderful prosthetics in your favourite superhero colours.

They are 3D-fitted and printed, which makes them much less expensive and much faster to produce, than other prosthetics. The arms cost around £2,500 each, but compared to other makers in the market, who usually charge up to £75,000, they are really good value. Which is perhaps why the first person to receive one on the NHS did so last week. Darren ‘Daz’ Fuller lost part of his arm in the Afghanistan conflict in 2008. He had served in the Parachute Regiment for some 20 years. He now works for Blesma, the limbless veterans charity. His new Hero Arm was funded by the NHS Veterans’ Prosthetics Panel, and paves the way for other veterans to receive similar prosthetics. There is currently a clinical trial being undertaken and Darren is part of this.

When I read about his story, I had just read about Larry Tesler’s death, and for a moment, a very irreverent thought popped into mind in conflating the two different stories – CTRL, X, C, V – for those of you who weren’t around then, this was the way you once cut and pasted words using your key board before highlighting and using menu commands came to be the standard. You had to press the CTRL key, whilst at the same time pressing either X (for cut), C (for copy), and V (for paste). However, the reality of replacing a limb is somewhat more complicated then replacing a word.

The Hero Arm works by picking up signals from muscles in the residual limb. Special sensors detect these muscle movements, allowing control of the bionic hand with an almost intuitive and life-like precision. In addition, haptic vibrations, beepers, buttons and lights all help to provide intuitive notifications. See what I mean about being complicated – I didn’t even know what haptic vibrations were until I looked it up – if you don’t know either, you can find out more here – interesting to see that Apple are once again at the forefront of this using this technology.

However, what I do understand (well a little more than haptic vibrations) is mental health nursing. Last Friday was Mental Health Nurses Day. This is a fairly new innovation. Actually, this year marked only the second celebration of the day. There are perhaps lots of reasons why marking mental health nurses’ contribution to research, practice, education and the wider nursing profession is important. You can read about some of these reasons here.

For me the day was a special one. It saw the publication launch of a new research monograph edited by two superstars of the mental health nursing world Charlie Brooker and Ted White. It is entitled ‘Mental Health Nursing; from the outside, looking in’ and it can be found here. You will need to register, (a 10 second job) but I think you will be rewarded by a great read. Why am I so confident you might ask? Well I was one of 11 contributors who provided the ‘data’ for the monograph. I was asked to produce a short paper on my recollections of the last 20 years of mental health nursing with a view to looking forward to the future. None of us knew who else had been asked, and we continued to be ignorant of the identities of the other contributors until the final draft was ready for sharing.  

When I saw my fellow contributors, I felt really privileged to have been included. And in constructing my contribution I was absolutely thankful that someone somewhere had made it possible to move my words around so easily and construct what I think is one of my better pieces of writing. The ‘Brave New World’ that I hoped would provide the backbone to future mental health nurse education in my concluding paragraph was certainly one that Tesler embraced, so thank you Larry. 

     

Lads and Gentlewomen, Care in the Community Needs Women of Conviction to Succeed

I first went to Hungary in 2005. One of the people I met there was a psychotherapist who specialised in working with troubled children. She was one of the most peaceful people I have ever met. Possibly in her late 60s (and I know, it’s always dangerous to try and guess a woman’s age) she was the gentlest women I had met in a long, long time. She worked with the most difficult troubled children and their families. She was modest, quietly spoken and so skilled. I spent only an hour with her, but she touched my inner being in a way that not many others have managed. Our encounter provided me with a lasting memory of something good.   

And last week I met a couple of other gentle women of conviction. The first was Ethel. I met her at our local walk-in centre. Having failed to get an appointment at my GP’s, I took myself and Kindle down to the local Urgent Care Centre, presented myself and settled down to wait. I had been suffering with an ear infection, and being a man, I had of course not sought help until the pain and irritation was so bad it was keeping me (and certain other people) awake at night. Anyway, no sooner had I settled down and found my place in my book, when a little older lady sat down beside. There was a pause before she asked me if I happened to know what the day was. I said I did, and would she like to know? She paused for a moment and said she thought she would. It’s Monday I said. She thanked me and I turned back to my book. I suppose you don’t happen to know what date it is she said, poking me in my side. I gave her a smile and told her it was the 10th February 2020.

She pulled out a rather crumpled yellow appointment card. That’s good, she said, looking at it. I am supposed to be here today. I closed my Kindle down and decided to have a conversation instead. She had a fascinating range of stories to share and we got on like a house on fire. The Queue God must have been looking down on her, as she disappeared to see the nurse way before me. I was still sitting there when she came to say goodbye and that she hoped to see me again, and I swear there was a distinct twinkle in her eye as she said this. Ethel was 92 years old.

The second woman was Reverend Deborah Prest. She is the Vicar who is reading the Banns for my forthcoming wedding. I had gone to meet her at the round church, a church a mere 61 years old whereas the church I’m to be married in was built in the 16th century. However, I believe you can be close to God wherever you might find yourself, although the quietness of a church can be something special. Deborah was a remarkable woman. I had only spoken to her on the phone, and didn’t know what to expect. In real life, she was a warm and welcoming lady. I clicked with her straight away.

We got all the wedding business out of the way and then had a brilliant conversation about our local community. She was committed to making a difference to the lives of those living around the church and beyond. Deborah was also a Chaplain at the Blackpool Victoria Hospital and told me of her hopes for the development of truly integrated health and social care services. I very seldom talk about my professional background or work experience to others. Having lived in our new house for just over a year now, most of my neighbours, who I am slowly but surely building relationships with, would not know that I was an Emeritus Professor or previously a nurse. They just know me as Tony, keeper of chickens and goats, driver of a bright orange GT sports car and guerrilla gardener extraordinaire.

Strangely I was drawn to the calmness and conviction of Deborah and shared with her my work at the University, my research interests, and work with Wrightington, Wigan and Leigh (WWL) NHS Trust. It was a lovely conversation and I left with a renewed spring in my step. I’m sure there will be plenty of opportunities for us to work together in the future. I hope so, as parts of our community need all the help they can get.

In my professional life, I was involved in the resettlement of many folk back into the community from the mental health and learning disability hospitals they had been incarcerated in for so long. Whilst many folk probably associate ‘care in the community’ as being a Thatcher innovation, the desire to treat, help and care for people closer to their own homes, or even in their own homes, has been around since the early 1950s. In 1956, it was the Guillebaud Committee that best captured the underlying ambition of creating a system of better care in the community:

‘Policy should aim at making adequate provision wherever possible for the care and treatment of [old] people in their own homes. The development of domiciliary services will be a genuine economic measure and also a humanitarian measure enabling people to lead the life they much prefer.’

Leaving aside the language of the 50s (which is rather quaint), it was a great ambition, but such a shame we are still so far from achieving it. Last week the Equality and Human Rights Commission launched a legal challenge against the Secretary of State for Health and Social Care for the failure to move people with learning disabilities and autism into more appropriate accommodation. As I write this blog there are more than 2,000 people with a learning disability being detained in secure hospitals, often far away from their families, and for many years.

Last night, as Storm Dennis raged outside, I sat immersed in a wonderful documentary of Woodstock – three days of peace and music – maybe rather than the combative nature of a legal challenge, we would be better to look for solutions from within ourselves and listen to the quiet voices of those gentle people of conviction who wait patiently for others to find the calmness they have achieved.

Healthcare Innovations: which came first, the chicken or the egg?

Last Friday, we were helping one of our neighbours write an important letter to his employer. J got a pen and pad of paper out, whereas I wanted to use my laptop. When I suggested capturing her thoughts on the computer she very sternly replied, ‘No, I like to think when I write, and can do that better when I write my thoughts out on paper’. I have learnt that in such situations, discretion and keeping silent is always the best option to choose. But it made me think.

For me, the keyboard, computer and Microsoft Word have been revolutionary. For writers, they have been a real boon. I can capture my thoughts, write them out, review and change where necessary, cut and paste a line or two, or even whole chapters, and no ‘Tipp-Ex’ is involved. For younger readers, Tipp-Ex (first produced in 1965) was a wonderful thing for poor typists like me, and for poor students who wanted to change a word or two in their papers. These days, I can’t imagine anyone using the stuff. The computer has, like many things, made my life as an academic and writer so much easier. In fact, it’s possibly the world’s greatest invention, or is it?

The Nobel prize-winning Economist Robert Mundell once famously declared that the most important invention in the 20th century was the chicken. Now regular readers of this blog and followers on Twitter might think I am somewhat biased when I say I have to agree with him, but bear with me. However, as a vegetarian and an avid collector of chickens of all sorts, I’m not sure I agree with his reasoning. Mundell observed that modern farming production methods had since the mid-20th century (between the end of World War 2 and the 1970s) so dramatically reduced the price of chicken that it was essentially, for all practical economic purposes, an entirely ‘new good’. In 1900, most people had to work two hours and 40 minutes to be able to buy a 1.5kg chicken. By 2000, they only needed to work 14 minutes to buy one and today it would be a mere three minutes! It’s perhaps not surprising that what was once a luxury Sunday dinner is now an everyday source of protein. Indeed, in the UK, 2.2 million chickens are eaten every single day!

As an economist, Mundell was making the point that innovation is always as much about price, as it is about creating ‘new goods’. The same is true in healthcare, as it is in food production. Innovation has seen the development of cures for some cancers, successful organ transplants, state-of-the-art diagnostics, hip replacements and so forth – there is a long list of such innovations, and the good thing is that they continue to be developed. But, our (that is Wigan Hospitals) Quality Champions initiative has shown that there are also many smaller changes that can be made that make even the most familiar of treatments much less expensive and more effective.

There are pitfalls, of course. Telemedicine has oft been cited as an example of how new technology can move services forward, but frequently has only resulted in people getting the same old services but perhaps more rapidly and at a reduced cost. Its real benefit would come from early detection of potentially serious health problems and avoiding expensive ‘upstream’ interventions. Electronic health records (EHR) are another way where new technology, for example digital technology, has the potential to make both the patient experience much better, and save a great deal of time and money by reducing the number of times the same information has to be entered by different professionals and administrators.

When I changed GP practices last year, I had to fill in a nine page form that not only asked me for the same information on many occasions, but was actually asking for information that my previous GP already had. Ironically, I get text messages at least once a month to tell me I can look at the information my GP has on my health file. So yes, new technology is beginning to revolutionise the way we live, well at least it certainly has the potential to do so, but have you ever considered what life might be like if that technology was suddenly not there – if it were literally turned off?

Well, last week, that is absolutely what happened to our hospital. Last weekend, starting with radiography, various technological systems started to fail one by one. By Monday morning, things were looking pretty catastrophic. Monday lunchtime came and we declared a Major Incident and set up a Command and Control centre. All the hospital technological systems had failed. Patient care was now reliant on the return of a purely paper-based system for capturing diagnoses, treatment plans and so on. The Emergency Department was shut to all but the most serious of cases, and these were stabilised and then transferred out to other hospitals in the area. All elective and out-patient work was cancelled.

The problems persisted until midday on Thursday, when the systems started to be restored. As I write this there is still no indication as to the root cause. The Trust was supported during this dreadful time by so many people and organisations – Bolton Hospitals, North West Ambulance service, Wigan Council and CCG to name a few - all provided fantastic support and helped ensure compassionate and high quality care continued to be provided. And of course, colleagues working in the hospital deserve the highest praise for their determination to ensure they continued to provide the best possible care for our patients.

And just like some people might buy their value chicken breasts from Tesco, (yes there are other supermarkets) and others will still go to Waitrose or directly to the actual farm to get their organic corn-fed bird, new technological innovations will inevitably change how healthcare is provided. Hopefully the more traditional hands-on, personal interaction between healthcare practitioner and patient will still be there for everyone. Just as when J had written her thoughts down on a piece of paper, I dutifully copied them on to my computer enabling our neighbour to have his own printed copy to take away.

There’s something in the air – and I’m hoping it’s authenticity and respect

Speedy Keen died of heart failure just 17 days before his 57^th birthday. One Life, Live It. He once shared a flat with Pete Townshend of The Who. He also acted as a driver for the band. He wrote the only song The Who have ever performed at a live concert that was written by someone outside of the band. He was a session musician for Rod Stewart and The Mission. However, possibly he will be best remembered for writing (and performing) the song Something in the Air for the group Thunderclap Newman, released in 1969. 

Now none of the above is unlikely to make any sense to anyone under the age of 50 years old. For me, the 70s happily coincided with my mid-teens and the beginning of my journey of finding my ‘self’. Something in the Air was one of the first 45s I ever bought. Let me come back to the song in a moment, but first, a slight diversion. For younger readers, back in the 1970s, the only way you could hear music was by buying a small vinyl record, a 45 or an LP. 45s had an A and a B side and were usually released as the most popular songs from a group’s album. CDs were still a decade away, streaming was something associated with a heavy head cold, and Alexa wasn’t even a twinkle in Amazon’s eye. 

OK, what has this to do with the price of eggs, you might be asking yourself? Well I was whizzing through the brilliant resource that is the BBC Worklife web site (and if you haven’t found this resource yet, have a look here) and came across a wonderful article on Japan in 2020 which focussed on communication and situational awareness. And I also learnt a new descriptive phrase – kuuki o yomu – ‘空気を読む’ – which is pronounced kuki wo yomu. The phrase means ‘reading the air’, which when I saw it, immediately made me think of Speedy Keen’s song. Once I had thought about it, I couldn’t then get the tune out of my mind – listen to it here and you will see what I mean (and it’s so good to share). 

Kuuki o yomu is an important part of Japanese culture and a key part of how people there behave in social situations. People are expected to think about the situation and the people around them, before acting or speaking. Sounds simple, but actually, understanding the unspoken rules that govern social life requires one to have a fairly comprehensive understanding of the environment in which you find yourself. I recall, when I was having to make regular trips to Abu Dhabi, that I spent a great deal of time being taught what ‘unwritten but important’ rules might apply while I was there. I found those lessons to be so important, both when I was in the formal management meetings, and the social settings. 

It was a culture I was unfamiliar with and so the ‘normal’ social cues I used in everyday life back in the UK only had a limited use. However, what the lessons did provide me with was a little cultural knowledge that at least allowed me to better navigate situations. In Abu Dhabi, like many places around the world, respect is an important element in all interactions. In cultures such as Japan or Abu Dhabi, kuuki o yomu, ‘reading the air’, is a critical skill, as communication is not always about what is said, but what might be implied or inferred.   

I have for many years asked my students to learn to listen not just to what is said, but also what is not being said. In the therapeutic encounter hearing what is not said is as critical as those words spoken aloud. As are non-verbal forms of communication. I once worked for a boss who rubbed the side of his nose every time he lied. He didn’t know he was doing this; it was an unconscious outward manifestation of his inner conflict and perhaps anxiety. Some folk have described this as an involuntary emotional leakage, which actually is a good way of describing such behaviour. So, whilst the words my boss used were often very convincing, the non-verbal cue revealed he may well have been communicating something very different. Thus, understanding non-verbal communication is an important skill when it comes to ‘reading the air’.

It is also a skill many compassionate leaders have. What such people use in every interpersonal interaction is attentive listening and observational skills. Not only will the compassionate leader be demonstrating they are interested in what the other person is saying, but that other person is likely to be able to see the respect demonstrated in the words used and the non-verbal cues involved in attentive listening. Both these behaviours can provide a degree of psychological security in others that makes effective and authentic communication possible. 

For me (and for many I hold dear), authenticity is all. Whatever the situation, or context, being authentic trumps everything else. And perhaps that’s the rub. Being able, and skilled in ‘reading the air’ might appear to be somewhat Machiavellian to many people. However, I believe it’s possible to be both authentic and respectful at the same time. Speedy Keen’s song was all about there being something the air; that something was revolution and change. As we enter the second day of finding ourselves once more outside of the European Union, I hope we can find it in ourselves to be both authentic and respectful to all those we meet as we start on this new journey.