Patience and perseverance; the art of diplomacy in repositioning normal

I didn’t know until last week, that there are still two people who are expected to walk backwards when leaving the presence of the Queen. In times gone past, everyone who met the Queen was expected to do this, but Health and Safety regulations kicked in and the backward walk requirement was discreetly dropped. These days, it’s just the Queen’s Equerry and the Marshal of the Diplomatic Corps who still do this. I only know this as I met Her Majesty’s Marshal of the Diplomatic Corps last week. In these days where Covid-19 is still foregrounded in much of what we do, I of course mean I met him on Zoom. There were 284 other folk in the Zoom room, mostly diplomats and ambassadorial staff from over 100 diplomatic missions across the world. It was quite a party, although one had to provide their own canapes and champagne.

Actually, it wasn’t a party at all, but the inaugural World Economic webinar series, which focused on rebooting the world economy. I’m not certain we did. But we made a start and that’s the important thing, and when all is said and done, someone has to do it! It was a fascinating discussion to be a part of. Alistair Harrison is the 28th Marshal, a position originally introduced by King James in 1603. He started the discussion off with an absolutely perfectly balanced account of the old and emergent relationships between diplomacy, politics and economics. In his calm, measured and very reassuring approach, he noted that whilst the economic fundamentals haven’t changed; how politicians responded to the pandemic crisis would shape the economic consequences. He reminded us all of the disastrous response to the 1929 Wall Street Crash, which led to the global great Depression.

He very skillfully (and his use of language was brilliant) took us through some of the consequences of the pandemic, having to rethink supply chains, the need for countries to find ways of working together and not in competition with each other and above all else the necessity of rethinking what, perhaps up to this point, we had always thought of as certainties. He was confident we would find a path through what he describes as the “most challenging crisis facing the world in recent times”. He reminded us that the two greatest virtues good diplomats possessed were patience and perseverance. Both would be needed to successfully negotiate the ‘repositioned normal’. I liked this term much more than the so called ‘new normal’. A repositioned normal speaks to the notion of thinking what should be changed, and what preserved.    

I also liked the two virtues he ascribed to effective diplomats. Patience and perseverance seem to me to be something health and care professionals have in common with diplomats. Helping someone to learn to speak again, or walk once more, or reduce anxiety and restore confidence, all require both patience and perseverance. Likewise, I think it would be very difficult to be a truly compassionate leader without possessing both these attributes. In the current phase of the pandemic, there is another virtue to be seen, and that is resilience. And in order to safeguard our health and care colleagues in the future we have to find ways of ensuring their resilience store is well topped up. Failure to do so now will undoubtedly lead to a great depression of a different kind to that seen in 1929.

Taken action now for a better future was another strand in the discussions last week. The almost irrepressible Inger Anderson was also on the call. She is Danish, an economist and the Executive Director of the United Nations Environment Programme. I have never seen her speak without her having a hugely reassuring and infectious smile. In her contribution she talked about the four entwined crises facing the world at present: health, climate, nature and pollution. It was a passionate plea for change that, like effective diplomacy, will require patience and perseverance in taking forward the actions needed to restore trust and confidence across the globe. Not just economic confidence, but trust in our politicians, in our health and care services, in the science, and in the emergent repositioned normal.

Whilst Black Lives Matter, I would argue, so do Green Industries. The United Nations have estimated that 24 million new jobs could be created through investment in green industries. We have seen, until last week at least, how well Mother Nature can do in healing the harm caused by humankind – over the past few months, our beaches have become once more pristine, our air cleaner and skies free from aircraft vapour trails. And while the young may be keen to get back to the office, older folk in the workforce have realised that a better work life balance can be enjoyed through the adoption of working at home practices. Why would we want to go back to long, unhealthy and often expensive commutes?

I say that, fully aware that for some, particularly women, there can be real challenges when trying to work at home. Some of my children have really struggled with home working, home schooling and general childcare. And as I keep asking J, ‘who is paying for heating, broadband, electricity and so on?’ That said I have also seen what I would describe as a ‘sharing economy’. Volunteers fetching shopping, or making contact with lonely folk. I have read stories of shared PPE supplies, when things were particularly tight, and such an approach has been evident in the way our NHS has responded to the pandemic. In order to reposition our healthcare services in the future, we are all going to have to continue to have patience, embrace new ways of seeking and receiving help and care and finding ways to support each other.

The Rebooting the World Economy discussions reinforced that, in order to rebuild a better future, our mental and physical wellbeing will be key to developing and sustaining a healthy economy and a resilient and supportive environment and likewise vice versa. Whilst we didn’t solve the global economic questions entirely in the meeting, it was certainly a step in the right direction and one which I am certain would have royal approval.

Beware the Temple of Zoom, but remember that kindness matters (as do sunflowers)

I exchanged a thought or two with folk last week about how depressing it’s starting to feel with the ever increasing number of Zoom and Microsoft Teams meetings I’m taking part in. Over the last few weeks, it has felt like most of my days have been taken up with such meetings. Globally, the use of applications like Zoom and Teams has grown exponentially since the start of the Covid19 pandemic. I was originally a great advocate for using this technology, and wholeheartedly embraced the opportunity to communicate and interact with others in this way. Several months in, I’m thinking that the increased use of such platforms, whilst being great for shareholders, might not be so good for our mental health and wellbeing.

Whilst not having to travel to our places of work has admittedly been a time (and petrol) saver, it has meant that those corridor or water cooler conversations, the quick ‘have you got 5 minutes?’ informal meetings, the chance encounters with different folk have been lost. These everyday interactions appear to me to have been replaced with a growing number of often lengthy online video meetings. My calendar and email inbox are crammed full of ‘Join Microsoft Teams Meeting’ and or ‘Zoom Invitation’ requests. I’m not a technology dinosaur but managing these requests is rapidly becoming a bit of a stealthy thief of my time. Of course, I know, I could be like Indiana Jones, and when I'm asked to join a meeting, could respond with a ‘Maybe. But not today’ – but somehow in the absence of those informal opportunities to meet up with others, saying ‘no’ feels a little harder to do. And so, the busyness continues.   

However, sometimes in the midst of our everyday busyness, an oasis of calm can appear. A week ago, one of my colleagues from the fabulous #earlyrisersclub - Tina South, contacted me to ask if I would speak with her students about a recent blog I had posted. I was happy to. The World Health Organisation has designated 2020 as the International Year of The Nurse and Midwife, and this seemed a good way of acknowledging the contribution both professions make. After arranging a date and time and using Collaborate (like Zoom and Teams) I was able to meet with Tina and her students last Friday. In a week of intense online meetings, it was a fabulously different encounter.  

The students on the call were all Midwifery students. Tina had asked me to share some of my experiences of being a student nurse, becoming a qualified nurse, my NHS career journey and my transition to academia as Dean of a large health professions School. Interestingly for me at least, I felt very comfortable describing my journey and the many wonderful midwives I met along the way.

It was a journey that touched upon the first midwife I ever met, someone who assisted at the birth of my eldest child, which was a long time ago now. It continued through to stories of some of the midwives I had come into contact with over the past 25 years in Higher Education. My earliest and one of my fondest memories of this time was of two midwives who worked for an NHS Trust in Greater Manchester; one of whom was Val Finigan. They both undertook a distance learning degree which had face-to-face study days. Every assignment Val wrote focused on breastfeeding. I learnt more about breastfeeding than I ever needed to, However the work she and her colleague did led to their NHS Trust gaining the UNICEF Baby Friendly Accreditation, and possibly one of the first in the UK to do so.

Interestingly, many years later, the midwives in our School did exactly the same thing, and again were one of the first universities in England to gain this accreditation. That work was led by our Director of Midwifery, Lesley Choucri, a remarkable woman who provided exemplary leadership to our midwifery team and the wider professions and was someone who was always willing to take on a challenge; one of which was to take the counselling and psychotherapy colleagues under her wing. She did well, and in the words of Donald Winnicott, she was absolutely a ‘good enough Mother’ to 100s of students.

During her tenure, I appointed our first professor of Midwifery, Caroline (CJ) Hollins Martin. This inspirational woman and I got off to a great partnership (and friendship) from our first meeting. She is the only person I know who attended and conducted her interview with a magic wand in her hand. She is now working at Edinburgh Napier University, and doing great things around maternal health. CJ was as passionate as I was about the Birth Rites art collection we were privileged to house in the School. This was a magnificent collection of art (in all forms of media) that depicted and explored the notion of who controls the process of childbirth and early motherhood. It was a Marmite kind of collection. Some found the images too provocative, while others, me included, found the work powerful and evocative. Sadly, after I left the School, the entire collection was moved to Kings College in London, where it can be found today – well worth a visit if you happen to be down that way.     

My last midwifery story was of a visit to our student midwives on a clinical placement in Uganda – I was so proud to see their professionalism, compassion and care, in what can only be described as very primitive field hospital conditions. What also impressed me was their acknowledgement that they were able to use ‘basic skills’ acquired early on in their training, and use them to good effect. It was something they thought had been lost in a more technically and governance-structured NHS.

I finished the session by taking the group through what is involved in becoming a blogger, and gaining a voice on social media. There was some practical advice, but I used the particular blog to share how writing in this way can help in resolving personal confusion over sometimes very complex issues. The session was somewhat of a soliloquy, but goodness did it give me much to reflect upon. In particular what I/we in health and social care might be doing to deal with the issues surfaced so powerfully by the global #BLM protests. But that will have to wait for a different blog posting.

Finally, I want to say a huge thank you to Tina. Not only did she provide me with a unique opportunity to speak with the next generation of midwives, but at the end of her very long day, took a huge bunch of flowers around to my elderly parents. Like her, they also live in Cardiff and J and I have not been able to visit them since lockdown. It was her way of saying thank you – and it was a wonderful act of kindness that cuts right across the virtual world of communication in such a positive and powerful way. My Mum and Dad were knocked out by Tina’s kindness. Thank You Tina.

Has Downing Street become the new Bermuda Triangle?

There were two stories last week that caught my eye, both about nurses, but first, here is a Zoom Quiz question for you. From what animal do umbels come from? Well it’s an old fashioned word for offal, which actually can come from any animal, but the Zoom Quiz answer (according to Samuel Pepys in 1663), would be deer. The offal was used to make an umble pie, for the huntsman, whilst the Lord and Lady got the good stuff, and ate the venison. The English courtier and philosopher, Kenelm Digby, is credited for first describing Humble Pie with an H in 1665. Today, it is a dish that has been dropped from many menus, but if you want to try it, here’s a recipe, and if you don’t eat meat here’s a vegetarian version.

This week I’m having to eat a rather large portion of a slightly different type of Humble Pie: the one that’s about making public your apologies, or in my case admitting that I got something wrong. Back in April I wrote a blog about heroes, and in that blog I gently reproached the Chief Nursing Officer for England, Ruth May, for appearing on TV at one of the Covid-19 daily briefings wearing her uniform. I was concerned about the obvious infection, prevention and control implications of this decision, and I thought she was playing into the hands of all those who have such an old fashioned and inappropriate view of nurses. In my eye she was lowering the perceived value of nursing as a profession – none of the doctors have ever appeared wearing their scrubs, complete with stethoscope slung round their neck, nor have any of the scientists worn white coats and carrying a handful of test tubes.

Yes, I was a tad frustrated and annoyed at whoever had advised her to appear in uniform. And there would have been someone doing just that. Despite the protestations to the contrary that the briefings are unscripted, and the press and public questions unknown before the programme is aired, it’s clear that this is unlikely to be the case – we can see evidence of prepared responses, and responses that contain a great deal of detailed and contextual information. The espoused story has to be consistent and agreed. However, yesterday, the media was full of stories of the disappearing experts from these briefings. If these stories are to be believed, it’s because they have expressed a view contrary to the one the Government wants told. In my lighter moments, I imagine there is a house somewhere where they are all being stored until the ‘new normal’ is bedded in and stops being the new normal, and they can all be freed once more. We learnt from these media stories that the so-called Special Advisors take all those appearing at a briefing through a series of ‘practise questions’ before they go live.

The entirely credible and human face of modern day medicine, Professor Jonathan Van-Tam, England‘s Deputy Chief Medical Director has not appeared since being on the 30th May briefing. Then he was asked a direct question about that not-so-special Special Advisor, Dominic Cummings and whether he believed that those in authority should lead and obey the rules. Professor Van-Tam’s response was a brilliant piece of television. In a calm and measured voice, he replied: ‘In my opinion the rules are clear and they have always been clear’ – pause – ‘In my opinion they are for the benefit of all’ – pause – ‘In my opinion they apply to all’. If he is not locked away in that house of dissidents, I hear say that the University of Nottingham is a lovely place at this time of the year. I wish him well – he is my kind of academic, expert, doctor and person.

Likewise, although not a medical doctor, (although she holds a couple of honorary doctorates), and not an academic in the same sense as Professor Van-Tam, Ruth May is an expert, and as I found out yesterday, my kind of person too. Two things made me consume that large slice of Humble Pie – the first was that the uniform she wore at that briefing was an example of the ‘gender-neutral’ uniform she is advocating as part of her objective or challenging the stereotyping of nurses – so I got that wrong big time! The second thing was in the media stories yesterday, Ruth May was cited as being another one of those disappearing experts from the daily briefings. Her alleged crime? – well in one of those ‘practise sessions’ she was asked about Dominic Cummings, and after refusing to publicly support the Prime Minister’s Advisor, she appears to have been unceremoniously dropped from the briefing. She has not appeared since. Now if it were possible, I would like to shake her hand and say both thank you for her firm stance and apologise for calling her out. I was wrong. She has done much through her values-based approach to the Dominic Cummings debacle to promote the profession of nursing. I don’t think I will get to meet her, but one never knows.

For example, last week I took part in a webinar, during which Andrea Sutcliffe presented her thoughts about nursing and midwifery in the Covid19 era, and I was able to ask her a question. Andrea is the Chief Executive of the Nursing and Midwifery Council, taking over from Jackie Smith, an equally formidable and brilliant person. Andrea, is not a nurse, nor a doctor, but in 2015, she was acknowledged to be the third most influential woman in the NHS. My question was around whether the ‘new normal’ perhaps gave rise to a new way of thinking about nurse education and training, particularly, the EU- imposed requirement for 50% of time to be spent in study and 50% in practice. She was very positive about the opportunities, and as with Ruth May, I wish her well in her endeavours.

Andrea also talked about the role mental health nurses have to play in dealing with what she foresaw to be an emergent mental health consequence of those working in healthcare services dealing with the pandemic. This was the second nurse story to catch my eye. We already know that patients who spend time in intensive care (ICU) can also experience severe mental health problems, particularly post-traumatic stress disorder (PTSD). Last week, I read this paper ; it’s ‘open access’, so you can too. It’s a great paper, but not as good as the one written 20 years ago by my sadly deceased PhD supervisor, Joel Richman, see here (unfortunately this one’s not ‘open access’). Andrea recognised that the nurses and doctors are also likely to experience mental health problems as a result of their Covid-19 work. Whilst, (no pun intended) Ruth may have disappeared from our TV screens, I’m confident that with the likes of both her and Andrea and the teams with which they work leading the way, such needs will be acknowledged and absolutely met.

Black Lives Matter: continuing the Long Walk to Freedom

Back in 2004, I was privileged to be speaking at the first regional congress of social psychiatry, organised by the World Association for Social Psychiatry in Johannesburg, South Africa. It was the first time I had been to South Africa, and as well as attending the conference, I was keen to also explore some of the historic sites that I had heard about as a young man, more of which later. It’s fair to say that one of the two papers my colleague and I presented didn’t go down well with the conference delegates. It was a paper that looked at the early mother-daughter relationships as experienced by women who self-harmed. Indeed, the question section was very hostile and confrontational. The reaction wasn’t about the research methodology, analysis or authenticity of our results, but on the subject focus itself. It appeared that the pain of womenhood experienced by the study’s participants wasn’t what the conference delegates wanted to hear; perhaps reflecting the status of women in the world of psychiatry at the time. However, it was something I found strange given the conference was focused on social psychiatry, and stranger still (but maybe not so), we have never been invited back.

So, there was lots of time to actually go out and take in the sights. We hired a taxi driver who took us to all the famous sights of this sprawling city. One of which was to see where Nelson Mandela had lived. His former home is now a museum and although a tiny little house, the tour of the rooms was accompanied by a rich history of his time there. I sat on his bed, which was a very surreal experience. As was standing at the memorial to those killed in the 1976 Soweto Uprising. The latter was sparked by the law that required all black South African school children to be taught half of the time in Afrikaans and half in English – Afrikaans was thought to be the language of the oppressor. On 16th June, around 15,000 children walked from their schools to the Orlando Stadium for a mass protest rally. The police set a specially trained dog on the young people, who managed to kill it. The police then opened fire with live rounds into the crowds of children and young people. 23 people were killed and many more were injured.

One of the first to be killed was Hector Peterson, aged just 12 years old. A picture of him being carried away moments after he was shot, and taken by the South African photographer, Sam Nzima, became the iconic image of the uprising. Much later Time magazine claimed it was one of the 100 most influential images of all time. Sadly, this week we have seen other similar challenging images from across the water in the US following the death on 25th May of George Floyd, an unarmed black man already in handcuffs, after a white policeman knelt on his neck for over nine minutes.

His death has sparked mass protests across the world in recognition of not only the awfulness of his death, but also in acknowledging that racism and oppression are still as virulent globally now as they were way back in 1970s Johannesburg. I have not joined in the protests, but I share the outrage and outcry over what George Floyd’s death represents. Whilst this blog is not the place to explore some of these important issues, I have struggled at times with some of the narratives, more specifically I think, some of words used to convey people’s anger and concern. Like pictures, words are important.

Way back in the 1970s, it was the words of Angela Davis that captured my attention over the degree of oppression and racism experienced by many African-Americans. Her book: If They Come in the Morning was first published in 1970. It was on my bookshelf until last year, when I downsized and had to reduce the number of books in my library. It is a classic work written by someone I considered to have a powerful voice in championing black rights and radicalism. The book has not lost any of its prescience or power in the intervening years since it was first published. It can still be bought (yes try Amazon), and it is worth reading.

It tells the story of her trial and imprisonment following the so-called Marin County Courthouse Rebellion. It is one of those stories that feels like a great work of fiction, but the events told are real and still challenge our sensibilities even today. Indeed, one of those caught up in the events of that day is still in prison. Ruchell Magee, is said to be the longest political prisoner in the world. Despite having helped many other inmates over the years to mount appeals and gain justice, he has never been able to secure parole and remains incarcerated. He has been in prison since 1963, when he was originally given a prison sentence for attempting to steal $10. Black Lives Matter, All Lives Matter, Ruchell Magee’s Life Matters.  

George Floyd was suspected of using a counterfeit $20 bill in a nearby grocery store.   

I have used more images than normal in this week’s blog – partly because as I have been thinking and writing this blog, I have come to a point where I think at this time, I can’t find the words to express what I feel, and others have used images to more powerfully evoke what many of us have been feeling. The word ‘photograph’ actually means ‘light writing’. As a really good example of this, and one which actually does use words as well, have a look at this work of Jammie Holmes. He is a US artist who used George Floyd’s last words in a very unique, powerful and poignant way.

Likewise, Banksy has produced a different type of image that I think many of us will recognise and share the feelings behind it.

However, it is the words of Barack Obama that I will use to end this blog:

‘I recognise that these past few months have been hard and dispiriting - that the fear, sorrow, uncertainty and hardship of a pandemic have been compounded by tragic reminders that prejudice and inequality still shape so much of American life. But watching the heightened activism of young people in recent weeks, of every race and every station, makes me hopeful. If going forward, we can channel our justifiable anger into peaceful, sustained and effective action, then this moment can be a real turning point in our nation's long journey to live up to our highest ideals. Lets get to work’