Friday, 10 May 2013

Why listening is key.....

It’s been a shaky start for the new NHS phone line designed to replace NHS Direct. For a start not all of the forty plus services are up and running and already some have been suspended. There’s been criticism about long waiting times and poor advice and at least one media headline about a patient dying.

NHS England’s Chief Nursing officer, Jane Cummings, says improvements are being made but when asked by BBC Radio Four’s Today programme how callers could give their feedback the answer was revealingly confusing. It involved going to the website and looking for whichever GP consortium had commissioned the service where you live. Welcome to the world of multiple providers in the NHS. Nothing wrong with that except when nobody is clear about who’s doing what for who and when and, most importantly, who’s actually accountable for what’s going right or wrong. The figure that 100 thousand people used the service over the bank holiday weekend shows that there is a need for an advice line for non 999 cases which means the spotlight will continue to shine on the fledgling steps of 111. Whether clarity, accountability and improvement follow is another matter.

Regardless of who’s commissioned what and from whom what the caller really wants is fast and accurate advice. The other revealing bit of the information given so far is the answer about those people taking the calls. I am imagining that my call is being answered by nurses, paramedics, maybe even doctors and I could be right but the call answerers are described as advisors “with access to” nurses, etc. The “advisor” is reading from prompts on the screen and using algorithms to assess the information given. Both of these are useful tools in asking the right questions and assimilating the answers but the quality of the service depends almost entirely on the quality of those not just asking the questions but listening to the answers. Like all good communication it’s the listening that matters most and the ability of a specialist to pick up on something that could be key and get as much information from the caller as possible but also able to pick up on other things, sometimes unsaid. I hope there are enough of those kinds of specialist on the other end of the phone line.

Being apprehensive about new stuff and distrusting technology is human nature but ultimately the ability of this service to help people and save lives is not just about working effectively in a new way or about getting the computer technology right or about having the right people with the right skills at the end of the phone it’s about doing all three and so far the signs are not good.

Guest Blogger 
Lynne Wilson

Sunday, 20 January 2013

Word of Mouth

Three things came together this week and as three is my lucky number that can only be a good thing.
Firstly, trudging up the muddy, snowy lawn I made a mental list of all the jobs that need doing in the garden. More chores? No, it wasn’t a feeling of burden, more a hopeful feeling; looking forward to Spring sunshine and new things growing.

It’s the same in gardens all around the world and my second thought was how important gardens are to the cycle of living …. and dying. Many health care professionals and anyone working in the caring sector will already know how important gardens are to a patient’s wellbeing and even recovery. Gardens in hospitals, care homes and hospices have a key role to play in not only how the patient feels but also the experience of family, friends and visitors. The gardens I’ve come across in these places are beautifully tended, often by volunteers, and well loved by children, adults, staff and visitors. They are not just places of peace and tranquillity but they signal that seasons come and go, plants die back in winter but there will be flowers again in Spring and Summer. They deeply connect with our sense of time passing but also our sense of hope and looking to the future. They are also places of fun and adventure, especially for children and siblings, they provide light relief from anything and everything to do with everyday life … and of course, death.  

And so to the third thing that made a lot of sense; the brilliant programme on Radio 4 by poet and author, Michael Rosen, exploring the language we use to discuss death. Just as the 2011 “Rev” Christmas special should be compulsory viewing for anyone contemplating becoming a vicar (see last month’s blog) so this episode of “Word of Mouth” should be on the syllabus for anyone planning to go into healthcare. Particularly insightful are Michael’s own observations about losing his son, who died suddenly from meningitis. The contributions from teachers and hospice workers also paint a picture of a scene very familiar in schools and hospices but one which shouldn’t be underestimated in terms of its power in allowing a person to find words for their feelings. Talking one to one with a child is important but often the real talking comes when you get a group of children, around a table, glue and paper and crayons everywhere and they are thoroughly and happily engaged in something that isn’t painful or incomprehensible. The power of that simple activity to free up the mind and allow a child to chat is a wonderful thing. Play specialists and trained counsellors already know that sitting side by side with a child, cutting out or colouring in, can result in some really positive conversations as part of the healing process. It’s funny how the simplest things can often have the most impact on our wellbeing, bit like waiting for the snowdrops to come up.   
More listening and learning

Guest Blogger

Lynne Wilson

Sunday, 9 December 2012

The Care Deficit


Can you teach someone to care? This could be the shortest blog so far because the answer is no. People come in all shapes and sizes but you can roughly divide them into two groups; those with a warm heart and those without. It’s a kindness thing, a basic ability to empathise and if you haven’t got it, no amount of teaching is going to help. So should we all just give up now? Again, no, keep reading.

Whatever the headlines, it’s not just nurses. If you go into a shop you are most likely to be served by someone who’s competent and friendly but there are the shop assistants who carry on talking about their night out when they serve you and those who simply ignore you. No big deal, but transfer this into a caring profession and the people who struggle to understand the needs of others have a much bigger impact.

The chief nursing officer for England, Jane Cummings, is right to say that there is too much poor care in our hospitals but is it a wider problem? Could it be a symptom of a much bigger issue in our society?  Like most big, national organisations, the culture of the NHS is a reflection of our culture as a whole so it shouldn’t surprise us that some care staff are failing to care. Compassion is becoming an endangered quality. We notice it more when we’re thrust into the intense and unfamiliar environment of a hospital and where simple acts of care and kindness can make such a big difference to the lives of patients and those around them.

Let’s not fall into the tabloid trap that all nurses are “angels” but equally, not all patients or families are easily definable either. If we want to understand this issue then we also need to shine a light on the often unmentioned difficulties facing health professionals. Anyone working in the NHS can tell you about toys stolen from children’s wards, even bedding or curtains being taken from family areas. Then there’s the elderly relative or even a sick child being dumped at Christmas or holiday time because no one wants the stress of looking after them. 

Yes, it breaks my heart too and yes it is extremely rare but it happens. In 21st century “caring” Britain nurses also regularly face people who are drunk and aggressive, people who are dishonest, people who are trying to play the system for everything they can get. And then there are those with dementia and mental health problems who deserve every single ounce of kindness and compassion but who can be challenging to deal with and the lack of training in this area is already well documented. It’s not a pretty picture but if we’re to stand even half a chance of solving the crisis of care in our hospitals we need to have a very real debate, not one that paints hospitals, and modern life, in rose-tinted nostalgia.
The good news is that most of us have a heart and although you can’t teach care, with good training and proper support we can nurture kindness and balance compassion and competence alongside clinical excellence and care.

Improving care comes done to a simple battle between good and bad but it requires a much less simple ability to empathise in the face of difficulty, get your hands dirty, stick your neck out and do what’s right, even when time, and the times we live in, are against you. If we can teach right from wrong, teach strength and courage over the easy way out, then we can address the care deficit. If we can find the nursing leadership to deliver that, their next task is to look at the rest of our society.

Thursday, 18 October 2012

Fifty Shades of Grey …. Matter

Builders and make-up artists agree on one thing. A good foundation counts for a lot. Now neuroscience is backing what a lot of parents have always believed and hoped, the foundations you lay in the early years can have a positive impact in later life.

A 20 year study led by Martha Farah, from the University of Pennsylvania, has found that mental stimulation around the age of 4, leads to greater brain development, including development of the cortex and language comprehension.

Not only did the researchers look at the books and educational toys a child was exposed to but also the support and care given by the parents to the child around that age. The data, including home visits and brain scans, showed a correlation between early years stimulation and the way the brain could function in the teen years.

This is not just good news for parents but for health professionals and anyone involved in the care of young children. This “magical” period, around the age of 4, when a child’s brain is sensitive to so much around them is a great opportunity to optimise wellbeing and skills needed for later life. It encourages anyone working with youngsters to look at what’s around them, what stimulation they’re getting. Not just material things like books and toys but warmth and support, and those two things can be especially challenging in a busy hospital or caring environment. It’s what play specialists and therapists already understand, it’s not just about making today fun but about building that all important grey matter, layer by layer.

The good news is that the average four year old is so much more receptive to any kind of adult input than the average teen. So although your fourteen year old may look at you as if you couldn’t possibly have anything useful to say (ever) just remember all those bedtime stories you read, the questions you answered and the stuff you took time to explain. They won’t thank you for it but somewhere there’s a part of that teenage brain that’s working just that bit better because of you.  

Consider this

...and this 

Lynne Wilson

Guest Blogger

Monday, 24 September 2012

Digital Kids


“What’s the parental security code on the tv?” I ask my 11 year old daughter. She rattles off the four digit pin. After a couple more questions about HDM1 versus HDM2  I’m happily watching my recording of Grand Designs while my daughter wearily shakes her head and goes back to her ipod. 

Digital kids eh, if they’re not filling up the recording box, they’re laughing at your lack of followers on twitter or, worse than any of that, giving YOU a tutorial about how to use your own TV!

Ever since the heady days of being allowed to eat sausage rolls in the living room while watching The Generation Game I’ve held a few unshakeable beliefs about television.  These are mostly centred round the principles that too much is bad for you and it shouldn’t be on if you’re not watching it. Recently I’ve added a couple more such as the more channels you have, the less there is to watch and don’t let the dog have the remote but overall the sentiment remains, use it properly and it’s a force for good.

But that’s the problem, what is “proper” use of the big/small screen for the digital generation? It was easy for my parents, children’s programmes were only on for a short time each day and even the presenters on those were urging us to go out and do something more interesting than watching TV. I wasn’t allowed to watch ITV just the BBC (because “we were paying for it”), imagine trying to stop the kids watching X Factor with that logic!

Now, even babies have 12 hours of TV just for them and that’s before they can talk or walk.  Throw in other screen distractions such as addictive birds with anger issues, war games and any number of ways to interact via screen time and it’s a heady mix of free babysitting and 24/7 entertainment. So when does harmless entertainment become a health risk? And, more importantly, if too much time on the sofa is bad for healthy kids how much more complex are the issues for youngsters already living with health problems? Limiting screen time for kids who can easily go and do something else is tough enough but what about youngsters with more complex needs?

It might not feel like it when all you want to do is watch your favourite programme and can’t quite break into your own security settings but TV, and screen time in general, is not the enemy. The challenge is how and when to use it. Social media can be a lifeline for anyone with communication problems, as the daughter of campaigner, Tony Nicklinson described movingly in a radio interview shortly before her father’s death. Twitter, she said, had given him a voice and he loved being able to talk directly to his thousands of followers in a way he couldn’t with any other medium. Similarly there are stories of youngsters who love one particular show, character or game with powerful and liberating results such as sharing that common interest with others and escape from anxiety or pain.

This digital generation has an unlimited and thought-provoking world of education and entertainment at its very fingertips. The best we can do is make sure they know how to use the off switch. Let’s face it, they’re more likely to know which remote to use for that than we are.

Wednesday, 19 September 2012

Compassion is costly

The Duchess of Cambridge used her first official speech on foreign soil to praise hospice care.  

While visiting a centre in Malaysia she described the support given to the terminally ill children as, “life changing.”  What a great way of putting the work of the hospice movement onto the world stage. What better way to raise awareness and appreciation than the backing of such a high profile Royal and the positive media coverage it would attract. Ahh, coverage, there was the problem.

When the Duchess walked forward, looked at her audience just a little nervously and delivered her carefully prepared speech, all about care and compassion, she could have little idea that on the other side of the world a magazine Editor was planning to disregard any notion of care or compassion for her and was making calculations of an entirely different kind, based on money, sales and sensation.

Within a few hours of the speech being given the front pages were not devoted to the ringing endorsement of hospice care, they focussed on coverage, or rather lack of it, of a very different kind. Even though newspapers in the UK didn’t print the actual photos it didn’t stop the issue dominating the news agenda.  That, in itself, is not the problem. Privacy and the treatment of the young royals is an important issue, not least because of what happened to the Prince’s mother,  but we have a media in this country that tends to underestimates the ability of the audience to understand multi layered stories  so “topless” became the story almost to the exclusion of everything else.

The Duchess’ speech was important, not just because it was a first, not only because of who she is, how she sounded and what she was wearing but because centres providing hospice care are relatively rare in the Far East. Palliative care is a growing area of expertise and is becoming increasingly available and understood. This makes the Duchess’ support even more important and raises some big questions. Could she become a worldwide champion for palliative care, able to highlight the difference it can make to children, adults and whole families? If so, what global impact might that have? What possibilities for the care of the dying around the world? These are big questions with potentially life changing answers.

Topless sunbathing,  peeping tom photographers, privacy for the Royals? There could be an answer to those questions in the French courts this week but it won’t change my life and I suspect it won’t change yours and it certainly isn’t as “life changing”  as what’s going on in the hospice in Kula Lumpur, and hospices around the world, right now.

Useful reading:

Lynne Wilson
Guest Blogger