Putting the boot in............

I think I may be in trouble with this posting…we’ll see.

The papers last week [and media in general] were awash with stories about a rugby team/Fleet Street/ poor independent nursing care in elderly patient’s houses and, again today, with a rugby captain- all accused of bringing their businesses into question over integrity and professionalism.

I used the shenanigans [or reported shenanigans] of the England Rugby Team as an example last week in a session [I know, as a Scot, I accept my first “be careful” from you] to explore and unpick with a group of nurses and health care support staff the meaning of professionalism, professional practice and what happens when it all goes wrong.

Being hot off the press, there was a lot to talk about but there was also that luxury of being able to critique, but not criticise. The opportunity was too good to miss, to analyse while on neutral territory - what is professionalism and what makes “you” a professional.  Not always an easy one to facilitate as it can spark heated debate especially with different groups of healthcare staff in the same room. 

Now, the Nursing and Midwifery Council, as gatekeepers, make a good case for what is appropriate in the role of a nurse and midwife and set underlying rules on what a professional must do within the code. There a four core principles of the code for trained staff and they give direction but, alas, no solid template for those in support roles:

Make the care of people your first concern, treating them as individuals and respecting their dignity.

Work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community.

Provide a high standard of practice and care at all times.

Be open and honest, act with integrity and uphold the reputation of your profession.

Being the facilitator last week, with most of the cards up my sleeve, I wasn’t expecting

“Hello…it’s you isn’t it…the man who was clamped?”

Now as introductions go, that’s a good one! Left field for sure.

It transpired that an impromptu anecdotal story to explain professional behaviour [damn that media projector] I gave to a large crowd of promising student nurses [and their collective parents/partners/ children] on a university open day, was evidently more interesting than I thought. 

While trying to kindly ask two sizeable wheel clampers to remove a clamp from my front wheel on a very damp late afternoon [just after work] in a train station car park in North London, let's just say that feathers were ruffled. To cut a long story short, the clampers were illegal and brazen. 


With a large wheel wrench in hand they were pretty secure in their aspirations that my wallet would be a few hundred pounds lighter that afternoon, before I went on my way. It’s true to say that a small scuffle [note: pushing and general shouting] took place and it was only when I caught the reflection in my car side mirror of  me wearing my NHS name badge that I stopped in my tracks – I knew the consequences, professionally, of a vigorous push becoming a living nightmare and my NMC Registration being put at risk [the Register, quite rightly, is well protected]. The boys in blue were quick on the scene to remove the wheel brace from my facial vicinity but nonetheless, it could been a different story. The moral remains, you are always on duty- "professional" duty.

So interestingly then that a recent publication sheds some decent guidance, where the NMC fail consistently to, on what professionalism actually is and what you really need to do to be a professional within the delivery of healthcare. A research report from The Health Professionals Council (HPC) offers helpful wisdom about the term professionalism and clarity on it’s meaning:

"It is not perceived as an absolute, but constructed in the interaction of individual and context."

The HPC offer :

Definition of Professionalism

Adherence to codes / regulations / protocols, appearance,

appropriate behaviour / attitudes / communication, context, development over time,  external perceptions

good clinical care, holistic construct, ongoing development (keeping up to date), part of self and role boundaries

They also note contributing factors to professionalism as being:

Source of Professionalism

Education / training, learning on the job, organisational environment, personal background, previous employment (paid / voluntary), regulations as source, role models and, the media.

 I think we’ve seen enough in the media last week about what professionalism is not.

Let’s hope the healthcare and education professions are represented/reflected fairly and come across well in the media this week during the planned strike action.

Britain's Hidden Army -Load your pencil case ...aim...fire

         
If like me you are still licking your lips after a slice of cake and a lovely cup of coffee at your local Macmillan Cancer Support “Worlds Biggest Coffee Morning” event last Friday, then you should  feel glad that your contribution has gone a long way to support the great nurses and support staff who work across the Macmillan teams.

I have had the privilege to have a clinical and educative involvement with Macmillan Cancer Support over a number of years. Their involvement with families at a grass root level so soon after the worst of all health news is broken, and anxiety and helplessness sets in, is second to none.  However, little is known about their work,  their holistic approach to supporting families and particularly children and young people who find themselves helping to care for a parent, guardian or sibling. 

                                                           
The term Young Carer  is not new but probably one we feel a little confused about as to its full meaning, or our possible input as professionals in education or health and social care  or in a policy making capacity.


Children and young people are likely to have jobs around the house as part of regular family life and want to add to pocket money for sure but where is the line between washing the dishes and say, washing your mum?


How normal is it to be responsible for organising your younger siblings breakfast and then making sure that dad has had his medications before you head off to school . Not that normal really for most children but a growing concern. 


It will soon be the BBC Children in Need 2011 campaign and following last years round of great appeals, the plight of young carer’s was highlighted in terms of the "hidden army" (please spend some time to consider the audio and video stories).

This year’s BBC Children in Need will revive our awareness as to the intimate involvement children and young people have in the care of a loved one and already funding for young carers is being discussed as a national concern.


I see in today's media that the Health Lottery (with Melinda Messenger as their new TV presenter) is promoting its credibility on the back of the funds that will be directed to young carers (seriously …only 20p in the pound going to charity....shame on you). I am not plugging that one, you can find it for yourself.
So in the real world, a prominent name in the drive to raise awareness of the work of the hidden army of carers is Professor Saul Becker  who is a well published and respected contributor in this field. Dr Jo Aldridge and Chris Dearden and are also invaluable contributors as is their work with  Loughborough University’s Young Carers Research Group.

Probably a better known personality to be affected by the experience of being a young carer is X Factor’s new judge Tulisa Contostavlos (although in the Education and Social Care arena.... Saul Becker is huge). Regardless of your thoughts regarding Cowell’s weekly pantomime of nonsense (sadly my children are hooked), Tulissa presented a touching and stripped back account of her experiences as a young carer on BBC 3 in Tulissa: My mum and me  

The programme offered an enlightening insight into the separation anxiety and pressures experienced by young people who grow up far too early. 

Britain’s broken, Britain’s sick

Following the recent riots in parts of the UK, the picture of childhood, or at least early adulthood, seems to have been imprinted firmly on our minds of feral children: hooded gangs either legging it into a looted shop or legging it out, adorned in new shoes or carrying a flat screen telly. Sky TV...you are naughty.

          
With the dust having settled and glass swept away, attention has turned to identifying and criminalising those involved. We now learn that “Broken Britain” and the association with said young people, may not be as it seemed. Statistics have shown [despite the rolling TV coverage] that the vast amounts of children and young people were little more than spectators on the whole - obviously the large numbers shown on TV were not caught but many appeared to be adults and data remains scant regarding the numbers of perpetrators being from the care system.

As a viewer, the rolling coverage did serve as a talking point with my own children. However, there was no apparent solidarity to join the masses masked and in need of new shoes. 

Thankfully.

Given the blame being pointed at parental control [or lack of], my family appear to have done well to influence our children on the straight and narrow- so far.

Thankfully.

Not so fast though at self-praise.  Just where is the line between observation and discussion during the news and, our own children tooling up and having a go at the glass frontage of the local Argos?

According to initial comments from on high, it was obviously an easy one:  it's all due to broken families, broken homes, broken lives and, wholly, the fault of a failing social care system and dysfunctional families. No high horse then, it is the Big Society after all.

The vulnerability of families in, or very near, the care system may just have made a faint blip on the radar of professionals involved in the health and social welfare of children and young people but it has not escaped others.  One blogger whose profession is as a family lawyer recently identified: “ … I won’t have been the only family lawyer watching the cctv footage of the looting and violence with fingers crossed, hoping that I won’t see one of my care clients or their children peeking out from under a hoodie. I’d like to see the stats on the proportion of care leavers, looked after children, and children with a CP [Child Protection] or CIN [Child in Need] Plan.”  

There may not have been an obvious avenue for those directly involved in the healthcare of children and young people to consider while watching the coverage of the riots, but look around...the gauntlet has been well and truly thrown.  The statistics on looked after children are easily found and are the numbers are worryingly increasing with typical examples in the press now being reported.

Reflecting on previous job roles I can speak with experience of supporting children in the care system over a twenty year period from clinical roles to education: as a neonatal nurse [while working in one post in middle England] and having to explain more regularly than I wished for to teenage girls of 12 and 13 yrs old in the presence of their social workers that the imminent births of their babies would likely require a stint in the neonatal unit. Also, as a looked after children’s nurse (or LAC nurse) in inner London, when children and young people would typically [as was a reflection of other areas] spend most of their lives being cared for in and out of the borough [with families from Land’s End to Aberdeen] up to a dozen times in their scholastic school life - they may have reached late puberty without ever having seeing a dentist or a GP, never mind their immunisations having been completed. All wrong, very wrong.  

The personal experiences of children within the care system have been previously aired on BBC Radio 4's Womans Hour, on BBC Panorama (*) and more recently with Lord Adonis lending weight to raise awareness. Little may have changed when reading recent reports over the past few months regarding rising numbers of children entering the care system, with effective strategies not in place to cover increasing job cuts with social workers and, children and young people taking solutions into their own hands.

It is worth exploring therefore that health professionals who come into contact with vulnerable children and young people should fire on all cylinders and learn from each other to play detective when admitting or caring for a child who is in the care system. We should anticipate the likelihood of such an encounter happening given current statistics showing them as being in higher risk groups: teenage pregnancy, lower educational attainment, depression, alcohol and substance abuse and other health concerns related to potential poverty of children who are looked after by the state.

So, to fellow professionals, get yourself on local child protection and vulnerable children awareness study days and acccept the likelihood of meeting a child or young person in the care system – a hoodie is not likely to worn on that day or ever. Embracing a hoodie is unlikely either!

               

Despite the forthcoming new series of Jacqueline Wilson’s award winning fictional children's home resident now carer, Tracy Beaker [whose depiction of life in care is that of as a Nancy Drew heroine [of a fashion], can I remind the medical students whom I met at a recent study day........ please [please] don’t base your knowledge of children in care on that alone.

Anyway, children's care homes may soon be gone, long gone.......... 

[* sorry, will not link via ipad: try  www.bbc.co.uk/iplayer/episode/b00v77vn/Panorama_Kids_in_Care/  ]

“If depression is a black dog then glumness is a wet Spaniel” *

     
Certainly a week of news to induce glumness in the merriest of souls - super injunctions, whistleblowers, killer winter flu statistics, appalling news from the Care Quality Commission identifying three NHS Trusts ultimately  failing to deliver essential and basic care to elderly patients (more spot checks needed please) : one hospital adopted a strategy of prescribing water to ensure that patients would be given it by nursing staff….prescribing water, come on. Desperate measures.

The working week ended with very concerning news about MMR outbreaks in Europe and now, very sadly,  in a street near you.

Next week, all things Herd Immunity but as this week ends, I type with one hand while my head rests on the other in despair: the government giveth [PCT’s], they taketh away [the demise of community healthcare specialists…viz Health Visitors, adequate numbers of District  Nurses and oh yes, PCTs]. The term swings and roundabouts comes to mind.

The extraordinary guru of all things creativeness Guy Browning penned ( *as well as this week’s title):

The four horsemen of glumness are tiredness, boredom, rain and low blood sugar

Last Friday was national work from home day, which I decided to stretch for a whole week. Looking across all things health this week was a challenge with a new puppy in the house (for your interest, a West Highland Terrier: not so West Highland but all Terrier)

My own four horsemen of glumness were indeed in line with Guy’s description:

Tiredness (new puppy)

Boredom (new puppy – understands “Sit and Stay”, but “put the kettle on” sadly a stretch too far, yet)

Rain (puppy can’t go out…innovative methods required for certain actions)

Low blood Sugar (All of the above, no biscuits…puppy can’t go out)

Looking at the week in relation to health matters would slide any caring health professional from a wet spaniel to a black dog (in my own case, a white dog):

Health reform issues dipped out of the limelight this week ( a cunning plan), temporarily slipped under the carpet while a media circus ensued over a kiss and tell story exposed via twitter and the floor of the House of Commons. The debacle did highlight important factors equally important in the delivery of healthcare: Protection of privacy and dignity, and whistleblowing.

While the health reform debate puffs along with much deliberation over who leads what and when,  nurses must just crack on and lead delivery of frontline healthcare despite the low numbers on the ground.  The Nursing and Midwifery Council promote that nurse education providers ensure that Essential Skills Clusters are assessed across all branches of nursing in the training of student nurses to ensure that basic elements of care giving are learned from the beginning, and mastered throughout the 3 year training:

care, compassion and communication / organisational aspects of care / infection control/nutrition and fluid management/ medicines management

It is common sense to see where privacy and dignity applies to all of the above. However, the problem at the moment is just not enough qualified nurses working on wards to educate, mentor and provide a positive role model for student nurses.  Unfortunately, too many students are relying on clinical simulation within university skills labs to practice these essential skills, often on each other.

We’ve got what we’ve got.

So while the listening exercise goes on across the country in the Andrew Landsley roadshow events, let us not forget that while the likes of John Hemmings MP is afforded parliamentary privileges when whistleblowing kiss and tell / twitter and the like about Ry** G***s (is it safe yet?) , others may not feel the same level of protection when considering whistleblowing against colleagues in the healthcare setting.  

Prescribing water.......[sigh] someone knew!

Our NHS....sick or just poorly ?

      

      


As we consider the major changes unfolding regarding healthcare reform, it is worth considering who the “big hitters” actually are in what seems like national game of “Guess Who ?” [you know the two player game… "Does your person have a hat?"].  Many might fall if asked for a decent argument or strategy regarding the impact of health reforms on children and young people.

In case you missed the recent patchwork of information by David Cameron then by all means brief yourself. Commentary on the impact of these on/off reforms are evident and it is worth a look before you believe the NHS is well and truly sick .

                          
There are definite movers and shakers who should be gathering information on the opinions of children and young people using healthcare services , whether Primary, Secondary or Tertiary.

Try your own game of Guess Who across the 4 corners of the UK ….. ask the question...

"Is your Commissioner talking about the health needs of children and young people?"

Tam Baillie is Scotland’s Commissioner for Children and Young People

Maggie Atkinson is England’s Children's Commissioner

Keith Towler is the Children’s Commissioner for Wales

Patricia Lewsley is the Children’s Commissioner for Northern Ireland

Who won???