Something quite strange has been happening here on Life in the NHS lately, and that is the popularity of Gordon Brown as a tearch subject. Gordon got off to a slow start that is pretty clear. Accountants are always reckoned to be pretty dull and after 10 years or so as our ‘prudent’ chancellor of the exchequor (kind of the chief accountant of the UK) he slipped into the top job without being elected. I suspect no one really knew who he was and what he was about, what is more he is a less than charasmatic, kind of awkward individual who has been required to learn how to actually relate to ordinary people in the real world away from finance.

Over the last year or so, he has faired badly in a country still booming but disillusioned with the fact we are still at war and has appeared much less of a public statesman than his opposition number David Cameron. Roll forward to 2008 and the financial crisis / crunch or whatever we  must call it and actually we suddenly realise the financial acumen of Gordon Brown is something recognised around the world. I wonder if that is the reason why my one previous post about Gordon Brown is now featuring as top of the searches on my blog. Just shows you that you can’t judge an accountant by their apparent lack of charisma!

The picture above shows a very young version – it puts me in mind of a kind of Oscar Wilde figure, anyone else agree?

Woolworths is part of the nostalgia of our child hood and youth. It is the place we spent our pocket money, it was somewhere our mums knew they could buy anything from buttons and zips to a plastic bowl for the kitchen to toys at Christmas to cards to stationery before you went back to school. It was cheap, it was cheerful and it was there. I remember my brother buying a pack of 5 biro pens there and wrapping them individually for everyone for Christmas (not over generous my brother). Lately it has been the place to buy your choclolate; at Easter for the best range of eggs and at Christmas for selection boxes and big tins of quality street.

Woolworths was generally to be found on every highstreet near to the butcher, greengrocer, smallish supermarket and newsagent. You went to different shops for different things. That then is one of the problems. We don’t shop in that way any more, our supermarkets are massive and they contain everything you need for the fridge, cupboard and home and they stand alongside great big fashion stores so you can get everything in one trip. They buy is massive bulk and they sell products at low prices to entice you in and make you spend as much as possible. A tin of quality street in the supermarkets has been apprently half price at £5 for weeks now. In short they can undercut stores like Woolworth, they give us cheap meat and veg and they give us convenience. One day though, following the closure of shops like woolies will we wonder where our highstreets went and how we ever allowed the big supermarkets to tell us that they would best meet our needs? I wonder?

We all have baggage. The things that happen to us throughout our lives - for example child hood bullying, our experiences of adolescence or educational systems, personal relationships including marriage and work issues. Stuff happens, and isn’t necessarily properly dealt with. We move on, get on with life, just brushing those issues aside. But and this is a big but, sometimes those poorly dealt with issues, those things we think we have moved on from return to bite. For me it has been about being made (almost two years ago now), to accept a job at a lower grade (with pay protection), a job with less organisational responsibility but which carries less power and authority (something I didn’t know I cared about). The organisation is bigger and less personal, but for the most part I am happy. It is just that sometimes particularly times of stress when I can’t get things done in the way I would like I realise that some of my issues with the process that happened at that times haven’t been dealt with as well as they might. This isn’t a serious issue for me or anyone else, but what if the monkeys on your back did affect the way you lived your life and your interactions with those within it.

These thoughts have been prompted by a series of posts on the Nursing Voices forum on which I remain a forum guide. I say remain because I have continued in this role all be it intermittently since the site changed ownership. For one there is no interaction these days with the site administrator which wasn’t the case when Shane was around. I am a less frequent visitor these days but was prompted to visit at the weekend following the reporting of an abusive post.

What I found was an individual who was taking his anger out on a number of people from both the cyber and real world. People who the person felt were making it their life’s work to cause him irritation and anger. He was upset with his nursing school instructors whose fault it was he was failing his course, he was upset with his student colleagues who were just pretty stupid and he was upset with other forum members who tried to engage with him and discuss his issues on the forum. From the content and tone of the posts it was pretty obvious that the person brought with them a wealth of life experience but whose posts demonstrated a level of unfinished business that made me question whether nursing might be the right profession right now. If colleagues, teachers, managers, and people in the cyber world wind you up quite so much then what will the patients do to you. As we all know patients often don’t listen, don’t follow advice, and often know what is best for them. How we deal with the issues thrown at us is more than learning how to deal with disease processes and how we behave in difficult and stressful circumstances will define us as nurses.

For me this has been food for thought about the way in which previous life events impact on the way in which we portray ourselves to others and how perhaps they might judge us on our behaviours both in real life but also here on the internet.

The HSJ online now has a number of probably highly important health service managers writing blog posts for their website. I say probably, because most of these are written by people anonymously.
I was drawn by one such post recently because like me the author admires Stephen Covey’s 7 habits of highly effective people and thinks it is one of the best of the management guru / popular textbooks that you can get.
I use Stephen Covey’s book in some of the leadership and management sessions I do. I particularly like the way it is laid out in sections that can be related to real life. I see from his website that he has developed an 8th habit and also has a book called the 7 habits of highly effective teenagers which I might well have a look at though I am not sure if it is possible as a parent to directly influence the effectiveness of one’s teenager.
Anyway, the HSJ blogger thought it would be a great idea to think of the 7 habits of highly ineffective managers. Irritatingly he comes up with some very good and pretty true to life examples:

• Saying “What we did at St Elsewhere’s was…”. This becomes a significantly more ineffective habit if the offender stopped working at St Elsewhere’s 17 years ago.
• Lamenting the old days, i.e. when junior doctors did an honest day’s work and nurses wore frilly hats. And when people died of rickets and the waiting lists were ten miles long.
• Drawing inappropriate parallels with the private sector, e.g. “In the City they have a much more sophisticated approach to managing financial risk.”
• Doctor bashing and manager bashing. That’ll sort it.
• Stating the bleeding obvious and bleeding unhelpful in one sentence, e.g. “If we had a full electronic patient record in place then we wouldn’t have this problem.”
• Being late. These people should be hung, drawn and quartered, for ’tis timeliness and not cleanliness that is next to Godliness
• Writing blogs: the province of the badly dressed and the serial underachiever.

Obviously i don’t necessarily agree with number 7 since I am neither badly dressed nor do I underachieve but the rest are pretty often to be heard around NHS coridoors.

My own would include:

• People who cannot delegate – since only they are good enough
• People who use email to tell people off and whats more cc in half the world to do it
• Speaking of email  – people who always ‘reply to all’
• People who are so important that they are in the office before dawn, don’t leave till after dark and who are still emailing you at midnight
• People whose meetings never start on time, always over run and which are full of irrelevant discussion
• People who habitually cancel appraisals and one to ones with their staff as they have more important meetings to go to
• finally – people who don’t listen but who love the sound of their own voices

The celebrity dancing contest known affectionately to us all as Strictly (come dancing) has pretty much become top news today. The contestants are made up of a mixture of models, Tv people, actors and on the way out sports people many of whom take the thing incredibly seriously, the judges are choreographers and ex dancers themselves who appear to take themselves and the competition very seriously indeed. Along then in the mix comes a retired political journalist with two left feet who is definitely in it for a bit of fun and a British public who don’t like to be told who to vote for and take against the apparent bullying and unpleasantness exibited by the judges and therefore vote to keep him in even when he should have been voted off.

In a week when we have had wall to wall Baby P coverage, in which stocks continue to fall, the pound rallies only briefly and we are told 3 million will soon be out of work this is the kind of relief we have all been waiting for. This is headline news, this is something politicians and sun newspaper readers alike have an opinion on; indeed many politicians it seems are very envious of the contestants on this particular reality show. What is it then about showing the world you think you can dance when you probably can’t? This is something that looks really easy to do. You prance around the floor moving your body and feet in a particular series of ways to music and it all looks beautiful and graceful – well maybe for some it does, but for most of us when we try we find that it is much less simple than it looks. The programme is strangely compelling because the contestants are dancing with experts, they look as if they practice hard but the end result is often amusing rather than graceful (with a few exceptions of course).

John Sargent has become the surprise star of this series a kind of anti hero. He can’t really dance even after much practice, he is not all that graceful  – over 60 and not exactly slim and trim and he dances with a smile on his face of both pleasure and surprise that he is still around the show. The judges would give him no points if they could, because they say his continued presence devalues the show. They however miss the point. On a Saturday night in credit crunched Britain we want light relief. We want to see people having a go at this dancing like, we want to see improvement, but it isn’t life and death and we don’t want it treated as such. If the public are invited to vote for their favorite it should come as not surprise to the judges that they use a slightly different scoring system to theirs. What is more they shouldn’t then rant on about the injustice of it all. It is a TV show, it is entertainment and it is not the olympics!

So now John has done the decent thing. He has saved the blushes of the BBC and of the judges by leaving the show. There was a danger that the publicity he was getting was going to help him win. But actually life isn’t always about the most talented being first past the post. Sometimes there is much more value about the journey and about recognising that a winner has more qualities than you might imagine.

Yet again the TV and written media are full of the suffering of a young child at the hands of his parents. Yet again a catalogue of abuse of a baby despite numerous visits by social and healthcare workers and despite a number of attendances at hospitals. The Times online describes what happened as follows:

When the infant known in court only as Baby P was brought home from hospital days after his birth in March 2006, it was as a bubbly, blue-eyed boy with the first signs of curly blond hair. He was, according to those who came into contact with him, a lively child with a ready smile.

After 17 months enduring abuse of an almost unimaginable cruelty, the boy had been reduced to a nervous wreck, his hair shaved to the scalp and his body covered in bruises and scabs. Physical injuries included eight broken ribs, a broken back and the missing top of a finger, while the emotional damage was almost incalculable. Despite it all, Baby P was said to have still attempted a smile.

Baby P’s life in a council flat in Haringey, North London, began with gradual and growing neglect at the hands of his mother, who would leave him unattended for hours in his cot. The overweight woman, who had never had a full-time job and spent hours trawling the internet for pornography, split from the boy’s natural father when he was 3 months old after affairs with two men.

The authorities had first voiced concerns about possible abuse by October 2006, when a GP noticed marks on the boy. But his mother, in the first of many episodes of deception and false reassurances, insisted she had found that his skin “bruised easily”.

Two months later the GP sent the pair to the Whittington Hospital, North London, after inspecting a head injury. Insisting that her child was “a head-banger” fond of “rough and tumble play”, the mother claimed that fingermarks were merely the result of when he was caught after being lovingly held and thrown into the air.

Social services were informed and visited the flat, which was found to be dirty, untidy and smelling of urine. They learnt that it was shared with the boy’s grandmother and three dogs, including a rottweiler, but remained unaware that it also harboured a violent boyfriend. They decided to let the child stay with a family friend while police inquiries continued.

A month later, in January 2007, with no decision made on any charge against either woman, the boy was allowed back home. As he grew too old for milk and jars of baby food, Baby P scavenged bits of broken biscuits from older children and was even seen eating dirt in the garden. Detectives found that after the boyfriend moved in there was not one piece of the boy’s clothing that was not spattered with blood.

Maria Ward, the case worker, said that she visited the house four days before Baby P’s death for a prearranged meeting. She found the boy in his pushchair, his bruises covered up with chocolate. “He had eaten a chocolate biscuit and there was chocolate over his face,” she told the court. “He had chocolate on his hands and face.” She said that she asked the mother to wipe his face before they went out and the mother started cleaning him. Miss Ward noted that the boy had an infected scalp, which was covered in white cream, and an ear infection.

But she added: “He appeared well. He smiled when I spoke to him.” The case worker said that she had been content to leave the boy with his mother because she appeared to be co-operative and properly supported.

Days later — and 48 hours before his death — Baby P was taken to St Ann’s Hospital amid further concerns for his wellbeing. During an examination by Dr Sabah Al-Zayyat, a paediatrician, his mother and her friend supported the child. Despite Baby P’s repeated cries of pain, the consultant missed both his broken back and ribs.

The next day his mother was called to the social services office. She was told by police that she would not be prosecuted after consideration by the Crown Prosecution Service.

On the very same evening, back at the family home, Baby P received a fatal blow to his mouth, knocking a tooth out. After 17 months of agony, the tiny child finally succumbed. The next day he was found dead in his cot.

8 Years ago the death of Victoria Climbie led to wholesale changes in the way in which different agencies who are involved in the care and welfare of children are expected to conduct themselves. Agencies must work together more effectively, share information, and act always in the best interests of the child. In our area thousands of staff who work with children are currently being trained in ‘integrated practice‘. The is to be common assessment, there are clearer guidelines about the sharing of information and soon there will be a national database containing the details of all children in the country.

But baby P was already known to services, his case was already discussed at safeguarding meetings, the police had already been involved and he had attended the GP and seen a paediatrician. Integrated practice and the introduction of contact point will not help baby P and would never have done so. It is easy to be critical of others but from where I sit those involved in this case needed to focus more on the child than on the parents, they needed to use their eyes, follow their instincts and to ask questions. Surely it is better to remove a child from this kind of situation while an investigation is carried out than to suffer the guilt associated with not having done enough. It must be awful to have your child taken into care and to be wrongly accused of neglect than for a child to die?

I have been puzzled by this one for weeks (well either side of my holiday since I never gave it a thought while out of the country), how on earth can people talk about the mental health of an infant? Surely a baby in the first days and weeks of life cannot be affected by its relationship with its parents so long as someone gives it food, keeps it warm, and lets it sleep and cry. Of course as often occurs these days since I do a job working in areas where I am no expert, it turns out I am wrong. I am about to embark on a bit of a project around maternal mental health. There are NICE guidelines and locally we just don’t meet them. A piece of work then to bring together all interested parties (midwives, mental health workers, people from primary care etc), map services, plan the pathway, look for gaps, find money and all will be well. Hmm well of course I never thought it would be that easy, and today a conference on Infant mental health told me that the maternal side of things, the antenatal and postnatal period is just part of the issue.

The way in which parents interact with their children affects their emotional health and well being from the beginning. There is evidence that the brains of children isolated in orphanages in Romania were damaged by their experience of isolation. Some of the behaviour we complain about in young children directly relates to the way in which they have interacted with their parents from birth. The way in which we attached to our parents affects the way in which we parent our children. The children of mothers who have experienced post natal depression continue to have attachment problems throughout life! Sometimes in our working lives we have lightbulb moments. Today a whole Christmas tree of lights came on for me! This is a major piece of work because although some good things are going on out there they aren’t joined up, there is no equality of service and what is more the services that exist are underfunded and probably not really commissioned as such.

Thank goodness I have the weekend to reflect on all of this stuff because I tell you I need it!

For the whole time I was a proper nurse who saw patients I looked after my own life. If (god forbid) I needed to go to a meeting I organised it myself, I took my own notes and wrote in my own (paper diary). Even when I was some kind of ’specialist’ nurse the only thing done by a secretary was the typing of letters and even that I sometimes did for myself (since she was far too busy or so she always said). Of course since I left the bedside things have gone down hill. During the last 7 years I have had a couple of people doing admin stuff. Generally I have resisted becoming too dependant, but eventually I succumbed to the electronic diary and people both looking at and administering my life.

I guess that is why this morning I got up early and travelled to a place only about 30 miles away that is the traffic jam capital of europe (in my estimation) travelled for an hour and a half and arrived to find that I had been sent to a different place to the person I was meeting. She on the other hand was nicely close to my starting point.

I wouldn’t mention this apart from the fact this is not the first time I have suffered for the cause of admin support (though of course much of the time I enjoy the rewards of minutes typed up and meetings arranged), I am of course a sucker who can make her own mistakes, so it will happen again!

Today I went to the bank (old fashioned I know) and paid my Nursing registration fees to the NMC (Nursing and Midwifery Council) for another year. So, I hear you ask, and I have asked this of myself, why does someone who appears to have no intention of providing patient care keep herself on the register? Well, firstly and quite importantly, registration is reasonably easy to keep once you have it in the UK right now. This is because I don’t have to physically wipe a brow (or bottom) to demonstrate my abilities as a nurse. I am clear that every day within my job, I do something, say something or make decisions about something that directly impacts on the health / illness / well being of someone. I am involved in service development and I am involved in decisions that affect real people. But technically it is true that I could do these things without being on the register.

Why then don’t I let my registration lapse? Well firstly if it lapses then it will be difficult to get back. Also it is a qualification that was hard earned and that I am proud to posess. It is also something that I know that if I wanted to I could go back to (with a bit of training in the relevant area). Younger nurses would like to believe that what they do now is in some way different to what we learned and practiced when actually it isn’t (give or take a few advances and a bit of technology). No to my mind, today’s £76 was well spent and is tax deductible.

I am a nurse and hope to be one for a long time to come.

Television is a really useful medium. It doesn’t really require you to do much other than switch on, listen and look. Often you don’t even have to concentrate all that much, it is there and you somehow take it in. It is not like reading or even listening to the radio where with less senses being hit at once some concentration and attention is needed. Since I have returned from holiday any fantasy I had that the TV on offer in the UK is miles better than that on offer in the USA has pretty much been thrown out of the window. After all it seems to me that much of what we have on offer is either a direct import, or perhaps just and import of ideas, style or system. One good thing we have (for the moment) is the BBC. I don’t think people realise just how important it is to have one (or a few channels taking account of BBC2 and the digital output) channel where the only adverts are for themselves, where at least some serious debate can take place, where good period dramas are shown (Little Dorrit is the latest) and where good comedy and drama often starts.

TV, during our trip was useful for watching during the night when we couldn’t sleep, and for when we were chilling out at our cliff house after dark on the second week. What you get though is adverts (and lots and lots of them, I will probably do a post on medical advertising soon), news channels and crime programmes. There are probably other programmes (well there are religious ones and there was baseball) but it was hard to find them between the news and crime shows. Of course we have at least 10 24 hour news programmes ourselves now, repeating what is often drivel and interspersing it with comment so that you don’t know where fact ends and fantacy begins. We also have crime programmes (I can’t say much as hubby has become hooked) so much so that we saw the same episode of CSI in California and then again in the UK about 4 days later (saw, didn’t watch I might add).

The most noticable thing is the insular nature of US news reporting. The USA is a big country, but for the main part the news on offer is regional so that apart from politics and business you wouldn’t know what was happening in a neighbouring state let alone country. Before we left home there was a news report on a man being struck by lightening at a gas station in New York state. Days later in San Francisio this was one of very few out of state non election / baseball / credit crisis stories mentioned. This is not however to excuse the UK news becasue they are just bad in other ways. A story erupted this week about 2 radio DJs who are also kind of comedian in their own rude and wacky way causing offence to a (now elderly) actor and national treasure. We have been subjected to day upon day of analysis and opinion culminating in high profile resignations and suspensions while more important stories have been ignored or relegated to a small 30 second slot. Plus we have to listen to analysis of the election, a bias for Obama and daily self perpetuating ‘credit crunch’ doom and gloom.

My considered opinion is that as nations with some seriously good actors and journalists we most definitely could do better and whats more we ought to!