Category Archives: education

Reality? Are you serious?

Having recently experienced, as a relatively inoffensive sort of cove,  being blocked on social media by a couple of determinedly and avowedly  right wing chums I have reflected on how we choose our interactions, especially in our modern media-managed culture. I am very carefully neither right wing nor left wing – I think that party politics is part of the problem, not part of the solution. That leaves me free to admire or dislike policies from wherever I like without concern for dogma or loyalty, which is probably a good thing but some seem to find it a challenging concept.

Here’s the thing: thinking that the way wealth is currently distributed is inappropriate and damaging does not make me a communist any more than thinking a hand up not a hand out is the best approach makes me a Tory. And they are not mutually exclusive. My circle of chums is exceptionally diverse and through having conversations with all of them I have been able to – and continue to – challenge myself and my circle and think things through. My thoughts have changed considerably over time largely because I have had the brilliant opportunity to talk to so many, so many different, people with such a wide scope of views. It is quite possible to find Marine Le Pen charming and bright and bang on with some things, ditto Tony Benn when he was still here, and not have to clap on a pair of  left or right wings as a result. Really.  I have a lovely chum who is so right wing he falls off the edge and he is charming, bright, funny and has made me think, and has caused me to change my mind about more than a few things in the past few years. Yes, Barry, I am looking at you. And another achingly hip and alternative left winger who frustrates me to bits but who has also made me think and develop my ideas.

I have blocked a few people in my time, but always and only for abusive behaviour. It would have been a terrible loss to me not to have the chance to discuss things with people with fresh or complex ideas. The ones I have blocked have taken their interesting or complex ideas and made them into belligerent tools with which to hurt other people. Dogma and extremism are the enemies of humanity and taken to their conclusion have supported the development of tyranny and terrorism across the world. Wow. Blocking people certainly escalated quickly….

I suppose it is that microcosm of social media expanded to a global level that fascinates. Social media has so many advantages – the chance to meet people we might otherwise not meet, to share and engage, to see more of the worlds stage and understand it, to learn, to reach out. It also has its dark side – the trolling, the abuse and death threats, the groups that seek each other out in order to perpetuate and stoke their hatred, who urge violence and disorder. Nothing is off limits now. We see events happening in real time but through the lens of the people bringing them to us, not in reality. The BBC News teams, reduced in recent times to simple readers of entertainment rather than the joyously independent and courageous journalists of old, choose to show us their own version of events usually accompanied by sad or emotive music, while dragging the emotions out of victims of crime asking ever more intrusive questions and encouraging people to “tell us how you feel, you must feel awful/angry/gutted/whatever” for our enjoyment and gratification, not happy until a tear has been shed on air. The use of words and pictures in newscasting has become propaganda rather than literate – saying terrorists are “inspired by” with positive connotations rather than indoctrinated as they are, or  the use of the same tired old pictures of zimmer frames in items about older people, fat bottoms in jeans walking away from us in items about obesity, blurred faces dragging on cigarettes or hands holding cigarettes in items about smoking or poverty or addiction or anything else that might be a bit working class. News? Not really. And that gives people with something to hide an opportunity to hide behind the “fake news” barrier and cherry pick their own versions of events and present them as reality. Reality…..as in Big Brother? Or The Only Way is Essex? Or The Apprentice….? Or what is happening outside your own front door every day…….

So, this doggedly non partisan contributor urges caution. Listen, reflect, embrace. Question, even if it means you are rejected.  There is a bit of fabulous in everyone. Maybe I should mourn the loss of the people who blocked me…or perhaps I should not have blocked the abusive ones but should have tried to engage with them. But perhaps after all life is too short. Social media offers an opportunity not just to discuss and gossip but to make a difference, to join with others to change lives and reach out. Losing a few “chums” in order to do that is probably a sacrifice worth making.

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Audit, Inspection and Scrutiny: the three ugly sisters?

This popped into my inbox today:

“The need to drive up the quality of care for patients, whilst delivering efficiency and productivity, is a key principle for the NHS. As pressure on NHS finances continues to build, UKAS accreditation is increasingly being used as an effective way for purchasers and commissioners to demonstrate that they can achieve ‘more for less’.”

I felt a stirring of irritation. This blog is the result……….

I know organisations have to behave commercially and tick boxes in order to thrive. I spend part of my working life encouraging and supporting charities and NFPs to do exactly that, but without losing their heart and soul to it. It is possible. But as an old nurse (registered about a century ago) and vehement supporter of the NHS original principles of free at the point of need and paid for by the entire community I am increasingly dismayed by the passionless, sterile performance of the people tasked with – and paid handsomely for – managing “public” health services. I have seen patients become the enemy, clinical standards side-lined in favour of improvement on the balance sheet, kindness become irrelevant, and buzzwords and trends take the place of clinical and compassionate behaviour. Health and social services are scrutinised, inspected, audited, governed, examined, professionalised more than ever before and we still have Winterbourne, elder abuse, Southern Health (pauses to spit), frequent reports of casual abuse and cruelty (that we know of), and we will all know those “care” homes with a good CQC rating which pong and employ people you would not want to sit next to on the bus. We will all know of supported living services that are little more than one person institutions with little or no meaningful activity and engagement – or to put it another way, that warehouse people in units of one, creating the illusion of choice and a Life but deliver isolation and fear. We have seen Southern Health reduce victims and loving families to statistics and irrelevancies, destroying people in order to prop up a system that sucks and protect the very people who allowed and encouraged the system that killed people and fixed the blame on others, with lies, obfuscation and bluster.

Some inspection agencies, several tiers of consultancy and management and many more are too often yet another layer of “approval” or box ticking to chuck at organisations. Along with services like 111 –  a dangerous irrelevance that often removes much needed funding from frontline services for the return of reduced standards and increased risk –  they also create a cash cow for canny providers without delivering any improvement in clinical outcomes, or supporting real people with the very real challenges of everyday ill health. We seem to simply carry on increasing layers of approval, fresh hoops to leap through (some with fire) rather than examine very basic factors. Often the people creating those hoops are not clinical and have little understanding of how  things actually work in the real world. I keep hearing that we need more funding for this that and the other – I keep seeing a variety of groups being blamed for an ever increasing number of failures and deficits: currently GPs are getting a hammering despite being possibly the last group of professionals who should be blamed and who, along with dedicated skilled nurses have kept things going against the odds. Commissioning services is clunky, inappropriately targeted, poorly contracted and badly managed, which is a criticism of the process –  again often created by people who do not understand the real workings – and not the people who have to work with it. The competition itself reduces the capacity to develop and really grow health and social care support services because contracts are not only badly drawn and managed but are up for renewal so frequently it is impossible to invest in services and also make that holy grail of profit. Profit is not going to be the first thing to go.

I firmly believe in a skilled and educated workforce well managed and led and supported with career choices and pathways. I also firmly believe in holding organisations and individuals to account. I believe those can be delivered without the huge self-propagating self- perpetuating roundabout of new mandatory qualifications and accreditations, incompetent inspections, and without the workshops, consultancies, projects, papers, enquiries, processes, requirements and bottom feeding organisations that have sprung up around services that are actually intended to protect, care for and nurture us.

There comes a time when the volcano erupts, the boil is lanced, the pus drains and healing can take place. We need to recognise that the privatisation experiment which was trumpeted as the way to increase choice and competition which were equally being promoted as in our interests – I am pausing for the laugh here –  is a failure, delivering little more than profits for largely incompetent organisations and draining the body of the NHS of resources and talent. Choice is not what sick people want, overall – they want skilled professional care, close to home, delivered kindly by people they trust and with their involvement in the process. And answers if something goes wrong, with a meaningful apology attached. Dividing professionals and organisations with “competition”, asking for innovation when compassion is good enough, blaming good people for systemic failures and expecting mountains of assessments, graphs, justifications, and hounding good people for honest mistakes does not result in decent health and social support.

Have a look at this: Laugh and then weep.

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