Once again I have proved to be rubbish at this blogging lark, having posted nothing since 18 June. As the NHS celebrates its 60th birthday this week, I am going to turn over some kind of leaf and get back into blogging. I also intend to try to blog daily during July.

The last couple of weeks have been busy in different ways, but I haven’t been to work for just over a week, as I have been on leave. I have been for a great weekend to Barcelona (more about that later) and have had a few days generally chilling out at home, shopping for clothes in the sales and doing as little as possible.

So if anyone still calls by this blog to see if I have written anything, I promise to apply myself to blogging much more in the coming days. For today though, I have one last day off, a cat to get jabbed and a son to buy some summer clothes for.

I seriously doubt it, but the Guardian online has used part of my post on compassion in a round up of blogs as we approach the 60th Anniversary of the NHS. It is interesting, and this happens when I read papers I have written at work in the past as well as some of the academic essays I wrote for my masters, that sometimes you re-read a passage and feel pretty pleased with yourself.

My own organisation is celebrating the great diamond jubilee (I think 60 is diamond) by holding a family fun day. I hope it is successful, though have a good excuse for not going (really I do), because next weekend I will be in Spain. Those who work in the NHS, and my own trust in particular still struggle to feel valued, but I guess events like this one may help. The problem I have with the NHS right now, is wondering how much longer it will be fit for purpose and affordable. The trouble is that we are far more discerning than we were in 1948, we expect more from those who provide services for us, we know more about what we should be able to expect and it is much more expensive. We are often told through the media that there needs to be a public debate on a particular topic, but if there was ever an important subject to be informed about and to get talking to others about this is it. Meanwhile I and my colleagues, clinical people now working in management will continue to try to challenge services to prove to us that what they do is the best value and most appropriate for the needs of the patient. Free this treatment might be but quality and value are what are important. What is more, going back to the compassion debate, we need to value each other and be caring of everyone who comes into contact with us.

J	Judicial
U	Unusual
L	Light
I	Intense
E	Exhausting

Name / Username:

Name Acronym Generator
From Go-Quiz.com

A long absence from the blog is always going to require more than one shortish post to catch up, so in the absence of a great title, this is part two. My other interesting encounter of the week was a day spent at an event to do with teenage pregnancy and the government target to halve teenage pregnancy by 2010. This is a complex area of work for those who have been part of this whole thing for the last 7 or 8 years. Many areas seem to have had good success, but others are struggling. We are living in a culture where sex for young people seems pretty much the norm and where despite the publicity and availability of various forms of contraception plenty of girls still don’t use them. This means not only pregnancy but also sexually transmitted diseases like chlamydia.

Interesting as the actual conference was (and as I am only just getting involved in this area of work so it was very informative) that is not really what I want to talk about here. Instead my focus is about the extent to which some people lack insight into the way in which they behave and are prepared to allow people to see their behaviours towards others, and the long running arguments they are involved in where ‘partnership’ is meant to be happening. We were sitting on tables together with people from our own geographical area, alongside others from neighbouring areas. As the new person, I was keen to find out as much as possible, but what I found out was fascinating. Two particular colleagues spent much of the time engaged in what appeared to be a long running dispute about the sharing of information, the lack of engagement of one party, the unwillingness to work together and the feeling that they should tell and dictate rather than share and collaborate. Sadly the main aggressor (and I choose that word with care) was from my own organisation, and sadly also other people sitting nearby were party to what i can only describe as the washing of dirty laundry in public. Sadly also this is going to have to result in me getting involved in areas I would rather not do when I get back to work. My take on such disagreements is this, say what you like to each other so long as the doors are closed and people from outside don’t know how much you despise each other. But please don’t act in a way that demonstrates that you are in turn aggressive and then defensive and which appears do demonstrate something quite unpleasant about the way in which you work in your organisation.

I am sorry to see this morning, that Mousie has taken down her blog. in the context of that, I have thought long and hard about the above post, and have been as vague as I can without it not making sense (I hope). It seems our colleagues in the NHS are waking up to the presence of blogs, which is great, but also makes being open and honest difficult. For now though I continue.

I ought to be much better at blogging by now, and what is more, if I can blog regularly even when completing a demanding masters course then I am not sure anything I do now is much of an excuse. Having said that, I do still have things to say, and amazingly more people have been reading particular posts even though I haven’t had much to add lately.

So onwards and upwards. I’ll try to be a better blogger (honestly I will). So what is new in the world of the NHS and also what is new in the world of Julie whose life is spent working in the NHS? This week at work has been particularly interesting on the work front. On Tuesday I attended the launch of a new strategy for midwifery supervision. This has led me to think about the difference in the accountability process for midwives against that of those of us who are nurses in the UK. Supervision of midwives is statutory and is considered pivotal in safeguarding and enhancing the quality of midwifery care provided to women and babies. In nursing, supervision is more of a desirable thing, it also adds to the practice of nursing, but there is no statutory duty for supervision. What is more, a supervisor of midwives is required to sign off the annual notification to practise of individual midwives. Nurses require only to sign off their own notification and to say that they themselves are fit to practice. A supervisor of midwives is an experienced practicing midwife who has undertaken a post graduate course, she (not being sexist but most will be women) will have self selected or been nominated but have gone thorough a process of selection by the local supervisory authority who in turn are accountable to the Strategic Health Authority and then the Nursing and Midwifery Council.

Some of the roles of the supervisor include:

• Providing supervision to approximately 15 midwives
• Signing off notification of intention to practise
• Providing guidance on maintaining registration and updating opportunities
• Investigate incidents
• Report to local Supervisory Authority where there is a professional conduct issues
• Be available to support midwives in discussing practice issues
• Provide 24 hour supervisory cover
• Arrange annual review meetings with midwives
• Engage and communicate with stakeholders
• Provide midwifery leadership
• Participate in audit
• Maintain records of supervisory activities

I understand why supervision of midwives is important, and I also understand the increased risks associated with their practice over those of many nurses, but what I don’t understand fully is why there is nothing like it for any nurses at all in the UK. I’d welcome comments from other nurses on this one.

A paper from the NHS confederation has drawn  my attention to the common, human decency shown to people who we come across during the course of our work. During a time when we are obsessed with medical treatments, having the best drug, the most high tech investigation. When league tables concentrate on cleanliness, waiting times and other Key Performance Indicators (the favorite phrase of the commissioner these days) what happens to the more subtle, difficult to measure things. Human caring and compassion has always been a quality people assume those working in healthcare have in abundance, but do they? As often is the case it takes a medical person encountering the front end of medicine from the sharp end (ie through one of their close family) to make us take stock.

Robin Youngson is an Anaesthetist in New Zealand whose 18 year old daughter was forced to spend 3 months in hospital immobilised with a broken neck. While her the level of the actual medical and nursing care received was without fault, he was struck by the lack of care and compassion shown to his daughter. There were no systems in place to enable a (thankfully temporarily) disabled teenager eat, watch tv, read and get through the enforced period of hospitalisation. Robin speaks of having to plead with staff to ensure that his daughters most basic social and emotional needs were met, of spending a large amount of money on car park charges, of finding that nurses and doctors exibiting compassion were in the minority rather than the majority. Robin suggests the following action plan is required:

Declare compassion as a core value

Reward rather than punish compassionate caring

Hone communication and relationship skills

Provide space for staff to discuss difficult issues

Challenge models of professionalism

Hard wire new behaviours

Declare compassion as a management and leadership competence

Engage health consumers in the change

you can read the whole article here. You can join the debate here What is clear to me is that there is more to good care than a clean hospital, the best drug and the shortest possible wait for treatment, rather those of us who are in the business of providing healthcare need to sit up and take notice. Human skills of caring and compassion have nothing to do with role and status but should be a basic requirement.

The NHS is a tricky place. Not only do we have to put up with targets, policies, protocols and people who make it their business to stop people getting on with their ordinary jobs of work but we also have people who apparently think nurse bloggers are a bad idea and who decide it is a good idea to out them. The great Mousie or Mouse Thinks has apparently been outted. There are few enough ordinary clinical people blogging and now it looks like there is to be another less. Mousie blogs about life as an Emergency Department sister, she tells us just how meeting the 4 hour target affects her and others like her, she tells us life at the sharp end as it is. She has little time for some of those jobs worth managers we all know and love to hate. I guess this might be what people don’t like, the idea that someone somewhere will tell the truth.

I have posted little lately. As I have mentioned before, when you have a job that few others do, when you could be easily identified by your bosses and by their bosses it makes you cagey. I started this blog to tell people what it was like working for the NHS in post millennium Britain and to be honest it gets increasingly difficult to do just that. The question for me now is should I continue as I am and mainly write about my life in terms of work, with a little bit of general opinion on healthcare policy thrown in with comment about family life or should I get on and change my focus? Should I wait until I am the next mousie? Or should I be proactive and take a new direction. The jury is out for me, but mean while I offer you this.

20 Ways To Keep A Healthy Level Of Insanity

1. At Lunch Time, Sit In Your Parked Car with Sunglasses on and point a Hair Dryer At Passing Cars. See If They Slow Down.

2. Page Yourself Over The Intercom. Don’t Disguise Your Voice.

3. Every Time Someone Asks You to do something, ask If They Want Fries with that.

5. Put Decaf In The Coffee Maker For 3 Weeks. Once everyone has gotten Over Their Caffeine Addictions, Switch to Espresso.

6. In the Memo Field Of All Your Checks, Write ‘For Marijuana’.

7. Finish All Your sentences with ‘In Accordance With the Prophecy’.

9. Skip down the hall Rather than Walk and se e how many looks you get.

10. Order a Diet Water whenever you go out to eat, with a serious face.

11. Specify That Your Drive-through Order Is ‘To Go’.
12. Sing Along At The Opera.

14. Put Mosquito Netting Around Your Work Area and Play tropical Sounds All Day.

15. Five Days In Advance, Tell Your Friends You Can’t Attend Their Party Because You have a headache.

17. When The Money Comes Out The ATM, Scream ‘I Won! I Won!’

18. When Leaving the Zoo, Start Running towards the Parking lot, Yelling ‘Run For Your Lives! They’re Loose!’

19. Tell Your Children Over Dinner, ‘Due To The Economy, We Are Going To Have To Let One Of You Go.’

20 And The Final Way To Keep A Healthy Level Of Insanity .

E-mail this to Someone To Make Them Smile.

It’s Called … THERAPY