Category Archives: Nursing

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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Look at me

I saw a few posts on social media this week about people who ignore their children in order to check their phones and messages…..you know the sort of thing, a picture of a fed up child and a parent staring at a screen. In my study (I am on the fourth floor and commonly known as the Mad Woman In The Attic, not without some justification) I watch parents taking their children to school and some parents even have earphones in – blocking out not only the wonderful sounds of the morning, birdsong and breezes, but also their children, who stump along next to them glumly, often trotting to keep up as the uncomprehending parent  marches ahead in order to get that task out of the way and get on to other important things such as staring at a screen and drinking coffee. It makes me feel sad…..

It also makes me angry that we are still at this point in our evolution. For the past thirty-plus years I have been attempting to inject humanity into health and social services on different levels, since the horror of student nursing (about a hundred and fifty years ago….)  when, on my first mental health ward for elders (the clue was in the shorthand title: PsychoGerries) I trotted along for my first day to discover a shabby-coated and smoking staff nurse standing – slouching – in the centre of a semi circle of commodes on each of which there was a naked elder. Both men and women were lined up together for ritual and casual humiliation. After a brief pause to get my breath as I stared at him I sent him home (well, there were a few well chosen and short words as well) and along with some chums set about restoring a little dignity. At every stage, for years, I have seen that same ritual and casual disrespect and humiliation handed out to all and any people using services by people who, if you met them elsewhere would probably seem like decent human beings. From elders having crap food shovelled into their mouths by smoking and grubby “carers” to people with learning disabilities ignored and belittled for being who they are, not even allowed to choose their own bedtime, their own food, the people with whom they will spend their days – their lives.

Don’t get me wrong: there are some brilliant support people, some fabulous organisations who strive to be good, to deliver humanity in their services and campaign for change. I know, and have worked with, many fab people who actually care and understand what that means (ie that it isn’t just about smiling a lot and nodding, but it is about taking risks, liking and respecting the people around you and understanding that each of us is individual – and encouraging that). But in the grand scheme of things these people are too few, and the others are tolerated because of where we are in our evolution. Which takes me back to where I started.

Being with people – supporting people, caring, whatever word you use, and the words matter because you will behave in a way that the words expect – IS the point. The things we do, taking children to school, supporting someone to eat, going to a gig with someone, supporting someone to put their clothes on, shopping with someone, they are all component parts, each as important as the other, as important in how we do them as well as that we do them at all. Those grubby “carers” shovelling food into someones mouth are indeed performing the task in their job description but their main task – of being with someone and having that relationship with someones humanity, their person-ness – has been lost. How much more time and effort would it cost to look at the person in front of them and see their person-ness and be kind? But that kindness is by and large not factored into how we commission, deliver, train for, reward and recruit to support services. Our task oriented focus takes us from task to task, KPI to KPI, box to box and target to target. When was the last time you saw the word “kind” in a job description……?

I remember – and I wish I could forget – watching a “carer” stand up, walk over to an elderly woman with dementia, and without a word roughly haul her up and out of her chair because it was “toileting time”. I sent a nurse home one night years ago because as we were nursing a comatose dying woman in her bed the other nurse leant over her – right over her – and said quite audibly to me “I don’t know why we are doing this she will be dead by the morning.” Casual cruelty, thoughtless indignity, the view of people as lumps of meat to whom we have to do things in order to earn a pay packet. Hauling ourselves and the people we support from task to task as quickly as possible…..for what? That task is a means to an end, a conduit through which we can nourish and nurture the relationship – it is the means, not the end.

It is that corporate and individual refusal to see people as human, as individuals, that allows learning disabled people to die in hospitals they should never have been in far away from the people who love them and allows the people who allow it to happen to bear no meaningful consequences.  It allows elders to be warehoused in buildings from which they will never leave until they die, who will never again feel the breeze on their faces, hear the birdsong or the sea, have someone look them in the face and hear what they are saying, be useful, be heard. Be a person. Have fun. If we are not having a little fun along the way what is the point?

Please take some time to look at the links here. Stay Up Late is a brilliant grassroots charity promoting the right for people with learning disabilities to have a choice about how they live their lives. That it is needed at all is telling.

The more difficult read is the piece about assessment and treatment centres. Read it and weep. And then sign up to the 7 days of action. Please

And please read about Connor Sparrowhawk and his phenomenal circle of support. Even after his avoidable death the people responsible have had little or no consequences, even after compounding the pain by denying wrongdoing, doing a bang up job of saving their own skins, and reducing the humanity of everyone involved. Shameful. Painful. And his Mother has responded with dignity and energy – I listened to her on the radio a few months ago while I was driving and I had to pull over and stop because I was weeping too much to continue driving.

Home

https://theatuscandal.wordpress.com/2016/04/20/natural-causes/

https://www.opendemocracy.net/uk/shinealight/clare-sambrook/on-connor-sparrowhawk-s-avoidable-death

The “care” industry is regulated more now than it has ever been – there are audits, documents, inspections, investigations, inspectors, investigators, commissions, boxes to tick, all manner of things supposed to keep us safe. And yet the abuse is still there, as open and filthy as ever. Safety is not guaranteed – and anyway, is safety the most important thing in life? Isn’t fun –  and autonomy, and independence, and risk, and loving and laughing, making mistakes, and pain and heartbreak  – as important? Aren’t those things the things that make us human? Those safeguards will never take the place of kindness and humanity, of seeing the person in front of us and respecting them just for being themselves. Let’s try that – and owning it when we get it wrong – for a while and see what happens………

 

 

 

 

 

 

 

 

 

 

 

 

 

A criminal waste, a disabled society. Unlock Your Future.

Easter is a time for reflection. I have been reflecting on the many people it has been my privilege to meet over the years. Many of the people I have worked with are people that the Jesus that I like to imagine would recognize: vulnerable, damaged, disenfranchised, hostile, broken, pathetic, lost, abused. I like them.

Disability is a strange concept, and many of the people with disabilities who I know would strongly suggest that it is not them with the disability but society, culture, which is disabled or which provides the disability. We build streets fit for the able bodied, buildings that exclude all but the well and the fit, work that suits only the driven and the straight and “normal”.  We see “work” as a means for economic growth and acquisition, and ignore the very real other benefits work can bring such as purpose, esteem, quality of life, respect. We patronise the successful disabled and express astonishment at their success. We create targets and drivers that take no account of alternative talents and aspirations, that fail to value otherness, indeed in a tabloid sense disability is so often viewed simply as a problem, a drain, a fiscal error.

If you look for the word “disability” online these are some of the words you get:

handicapafflictiondisorderdefectimpairment, disablement, infirmity  incapacityweaknessinability • Disability can make extra demands on financial resources.

Transfer those words to our environment and see what happens. Our shops have defects and will not allow wheelchairs in, our streets are afflicted with high kerbs and a lack of ramps, many work environments lack the capacity to value a range of people and talents and are, as a result, weak and impaired. Recruitment is afflicted by a set of rules and processes that despite legislation and encouragement still often excludes too many and that handicaps the workforce.

I would go further and suggest that people with a criminal history have been handicapped or disabled by society. Their forensic history effectively cripples their employment potential and afflicts their family life. If we suppose that it is indeed society and our culture that creates disability, in effect cripples its citizens, it follows that society can redress that. Some legislation attempts to do that by supporting “equal opportunities”, but equal ops can only happen if we view all candidates with an equal eye and the work environment is capable of accepting all candidates equally.

If you look for the word “criminal” online these are some of the words you get:

unlawfulillicitlawlesswrongillegalcorruptcrookedviciousimmoralwicked, culpable, disgracefulridiculousfoolishsenselessscandalouspreposterousdeplorable

I notice that none of those characteristics is irreversible. They are a description of how it is at the moment, not how it will be in the future. If we continue to exclude people from employment, to ignore the many benefits a varied and experienced workforce can bring, to expect jobless hopeless futureless people to suddenly somehow behave like employed, hopeful people with aspirations on release from prison, we set ourselves up to fail, and we fail our communities.

I don’t suggest for a moment that we employ anyone and everyone into any vacancy without safeguards and safety nets. I don’t do soft and fluffy. I do however suggest that we create those safeguards and safety nets and take the trouble to include the excluded and create a properly integrated and cohered environment in which everyone is valued, has the space to grow, and has their aspirations valued. Not because it is soft and fluffy, but because it reduces the risks of offending, of disaffection, and increases the chances of people buying into their communities and making the effort to support their futures and crucially it means we reduce the risk of missing out on some serious talent. Back in the day when social and health care services were even more rigid in their outlook than they are now, I employed an ex-offender who had done time for murder. I employed him in elder care. This was not universally welcomed…….But I ran the checks, created the risk assessment, spoke to the people I needed to speak to and importantly offered him a mentor and some effective support to re-adjust. It was a success.

No-one would suggest  there is an easy answer or that it is a simple matter. But that is not a good enough reason not to try.

No Offence CiC is a social enterprise  and I am lucky enough to be on the Board. We are not driven by private profit and we facilitate open access to crime and justice information. By challenging barriers to positive change and influencing future policy, our objective is simple: to make a difference. My own organisation, Mayall Management Ltd, is proud to support the Unlock Your Future project that No Offence is driving.

http://www.no-offence.org/

Unlock your Future

‘Breaking down barriers to employment for people with convictions’

This project will focus on identifying and breaking down the barriers to employment for people with convictions, to bring employers and employees together.

A simple key discreetly placed on a job advert will indicate that this employer will consider all applications on their merit and not their past.

Many employers have a skills shortage and would benefit from an increased pool of suitable candidates from which to recruit.

Unfilled vacancies can have an economic impact on any business and increase pressure on other employees attempting to make up the resourcing short fall.

We need a network of champions to raise awareness of this project and support employers to use the key either on their own website and/or on our jobs board and spread the word to those people looking for a job and also recruit other champions. Could you help us?

Employment provides us with a significant opportunity to break the cycle of reoffending. If you are an employer please join our network and we will send you the key to use free of charge.

http://www.no-offence.org/static-page/unlock-your-future/

 

Diabetes, then…..tch!

You have probably not been wondering where I have been as you have better things to do. After regular blogging there has been a pause, a whistling  tumbleweed silence unfilled by words or thoughts. I have missed you, though.

Like many women of what used to be called “a certain age” but is now called the New Forty I have discovered that  I am not a grumpy tired old bat, but that I have diabetes with a side order of thyroid malfunction and some yummy cholesterol. Well, ok, I am also a grumpy old bat, but I now have a lovely ready made off the shelf excuse for it and I’m not afraid to use it. With a vivid memory of the PMT I used to suffer, or rather my Old Man used to suffer, pre-menopause (men, look away now) I put the  recent irritability and low moods down to being a woman. Call myself a Feminist?! I should be ashamed, bringing dishonour on the lovely bright green dungarees I used to proudly wear in the 70s, with the universal Feminist sign all over the front. In case the short hair, dungarees, free-flow pit-hair and  belligerent attitude didn’t give it away.

So, the low moods, exhaustion and annoyance are the result of diabetes. Another confession: I used to be a nurse (technically I still am, which is scary), and I still don’t understand diabetes. I tried to convince the diabetes nurse that my blood sugar was raised because I have honey for breakfast and that the dizziness, fatigue and biting the heads off small children was probably because the Old Man was annoying. Which is true. But it wasn’t the reason that getting out of bed in the mornings was becoming less of a pleasure. I am a natural early riser, every morning, around 04.00 or 05.00 at the latest, up and at ’em, starting the day with meditation, focus, honey (of course) and tea – I love the start of the day. But in the last few months my mind has continued on the same plane but my body has been dragging behind whispering ” do we have to do this….?” and generally loafing around making my mind think twice. And when I was first identified as diabetic I dived straight into denial, taking to it like an old hand: it wasn’t diabetes because I eat properly/don’t smoke/it can’t be/I haven’t time for this. I thought that I could eat my way away from diabetes. Partly true, but a little optimistic I think. I think I thought I might grow out of it, like acne………

So on the whole I made a nuisance of myself avoiding the inevitable, bobbing and weaving to miss the headlines and warning signs, finding plenty of sand in which to bury my head and making a pain of myself.

Running alongside the diabetes was a serious dip in confidence. Hitting fifty (and the rest) can be a shock to the system, especially if the usual things all happen at once – and I can almost hear the rumble of agreement from other “New Forties” out there as you anticipate what I am going to say. My parents both died within a couple of years of each other (horrible circumstances, for another blog), I became disabled enough to need a blue badge, and the kids started leaving home/having babies/getting married/being grown up. And I continued to run the business and work hard. I wasn’t about to let grief, disability and pain, and the empty nest stop me! Oh no, because I am Superwoman, hear me roar.

Except I didn’t roar, I shrieked, snapped, snarled and moaned. I lost the ability to step away and see the bigger picture, and my assertiveness began to drip out of me and stain the carpet. I am used to achieving and have high expectations of myself, not unrealistically.  I know what I am doing and that bigger picture is what informs me. I always think my work is like being the conductor of several orchestras – the job is to lead, to show the tempo and understand the destination, and to make sure all the component parts get there at the right time and that any improv enhances the show. The energy and thrust needed for the business gives me energy, feeds me, and gives me purpose. And when all of those other things, those Life Events, converged, I lost the Kerpow Whoomph. I no longer really knew if  knew what I was doing even though I thought I knew that I did, I wasn’t sure. If you see what I mean! Where once I would have known with certainty when something was actually mine and the buck stopped at my feet, and when it wasn’t and that buck needed to be re-directed, I suddenly found it harder to tell, and started to think it was indeed all my fault, that I was wrong, it was me, and that I didn’t know anything. I think it is fair to say I was confused. But confused on the inside. My Fellow New Forties,  you know what it’s like – you are the one in the middle holding it all together. You have the reins, the strings and the plug that could be pulled and let it all swirl away, so you can’t let it go. So I didn’t, and the music played on. But I did shut down for a while, which is why I haven’t been here for a few months. It took all my energy to keep the plates spinning and I didn’t have any left over for Life.

So……..now I am diabetic and proud! I remember when I first became disabled, and I kept thinking “when this gets better I will get the bike out again” until gradually (d’oh!) it dawned on me that this was as good as it got and I was disabled. Diabetes received the same treatment. I have now reached acceptance and along with it the ability to take the advice and the pills, and I am living again. Maybe next time I have a Life Event you will be kind enough to send me a copy of this blog post so that I don’t waste too much time on denial and faffing. And, a bit like the Walking Stick club that I inadvertently joined – that band of walking stickers who with a nod and a smile, and a comment about the stick, offer unity and solidarity in disability – I have found a new club of diabetics that I hadn’t known existed. The more impaired I become, the more clubs I seem to be invited to join…….Happy Days!

Food Glorious Food?

Sharing meals allows us to come together and spend quality time with each other. It increases communication and understanding.  How many of us had our first experience of another culture through food? And coming together to prepare and eat food is part of many rituals and traditions. Food plays a big part in faith and in worship. When one shares in the Eucharist, it is said to be a  sharing of Christ’s body and blood, and worshippers are reminded of their responsibility to share all our meals with others. As St John Chrysostom once said, “You have tasted the blood of the Lord, yet you do not recognise your brother…You dishonour this table when you do not judge worthy of sharing your food someone judged worthy to take part in this meal.” Most faiths and religions have food rituals, most cultures have food rituals and norms. Food is significant. Food rituals – cutlery or lack of, how the food is produced (is it Halal? Organic? Vegan? Kosher?), how it is presented, how it is eaten – matter deeply to us all. The only people for whom those things no longer matter are the hungry, and even then I have known seriously hungry people refuse non-kosher or non-vegan food. So it is quite simply that important.

So…..

How many times recently have we heard about nurses now being expected to “feed and wash” patients for a year before they train? How many times do support workers and health professionals refer to “feeding” their patients or clients? The act of eating is reduced, for some, to the passive “feeding” offered by “carers”. It is reduced, for the care-givers, to a task to be got out of the way before the serious business of training, the important job of “nursing”, can be carried out. This simple attitude reduces human and humane care giving to the status of animal welfare. Now, let us acknowledge that there are similarities between the two, and animal welfare is very important. But in offering to care for and support other human beings we need to respect and acknowledge their humanity, and one of the few things that identifies humans as distinct from other animals is the development of specific and identifiable social rituals, especially around food, and the food rituals often define what we are as people: they indicate and specify how we live, what we believe, what matters to us.

The attitude that accepts us saying we are going to “feed” people when what we should  mean is that we are going to help them to eat or support them to eat is the same attitude that allows nurses and care givers to say things like “I have done Mrs Brown” when they mean they have helped or supported Mrs Brown to wash, or dress, or change her colostomy bag, or any of the other deeply personal, uncomfortable and intimate things carers do for us.  Those words, casually used and casually accepted, reduce our collective humanity, remove our independence. They remove the respect for our humanity that we properly expect our nurses and carers to demonstrate. They allow the casual neglect – and even the active cruelty – that we have seen in Winterbourne and at Stafford, and the many other places that have not yet hit the headlines. How can we pretend to be surprised by those events when we use the words that support the attitude of neglect and cruelty?

The words we use define how we behave, demonstrate how we think.  Let us challenge the use of words that encourage patient-passivity such as “feeding”, let us encourage the words that support active care such as “supporting, or assisting, to eat”. The former gives us a picture of food being shovelled into a patients mouth as a “carers” task, the latter gives us a picture of  someone in control of their food, being helped to perform their own task.  Notice the difference between “bathing” someone and “helping someone to bathe”.

When we become vulnerable through age, illness, disability or other reasons we often lose the option of privacy or dignity only because of the attitudes of the people tasked with supporting and assisting us. There are many discussions about why care can be poor, and often the poor wages are cited. And that is a factor – pay peanuts and you get chimps, and low wages do not reflect the importance of the job – but there is never, at any price, wage or  reward any excuse for reducing another persons humanity, for dragging away another human beings respect and trampling on their dignity. Individuals are responsible for their own behaviour and we should expect people recruited to care and support to behave properly – but the modelling of those good behaviours will flow from the leadership. If the people leading the services and the organisations do not demonstrate the crucial behaviours that indicate respect, humanity and the support of autonomy and independence for all then the people following those leaders will have no incentive to do so.

If you offer someone care and support, please, feed your dog but support your patient to eat.

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