And breathe….

So I can now claim, confidently, that I can breathe without pain. The Old Man and I have experienced the Coronavirus to varying degrees and are now on the way up – he is quite a bit younger than me which may be why I am taking that little bit longer. It has been a challenge. We are lucky, we are emerging, and for that we are grateful. Not quite there yet but very much within touching distance. And what a journey, individually and corporately!

One of my organisations, based in beautiful Folkestone, responded quickly, intelligently and well to the original challenges and transformed, almost overnight, from being  a very much in-person service to an effective online support service with the people working within behaving almost as if they had been preparing for this for months. Astonishing, uplifting and rewarding to see such agility and dedication. And that has been replicated across so many organisations and individuals, with another of my organisations setting up, again almost overnight, an entire volunteer system to support those unable to get out or access other means of help; the local NHS Trust with which I am a governor really upped its game and demonstrated genuine and intelligent care for the people within and drew some positivity – despite the very real and distressing events – as an outcome. People have been quite simply brilliantly creative and selfless. One of my daughters works in the NHS, another in a charity offering supported living as does my son and they have been beacons of care and support.

And in the midst of it all I found myself confined to bed with abdominal pain and struggling to breathe. I was a nurse about 150 years ago and so of course avoid hospitals at all costs and have remained at home, through the scary bits and now emerging into the less scary bits; I have been worried that I may have passed it on to people I care about and scared because the act of breathing, the thing of life itself, could no longer be taken for granted. The people about whom I care seem to have been untouched so, tick for that concern. And I can now breathe without concentrating so tick that too – but the inability to pull quite enough air into me remains, and serves as a tangible reminder not to take anything for granted: waking up in the morning, holding my family to me, walking further than  the end of the bed…so many things. I have promised myself to remember this. Always.

And another thing to pack carefully onto that shelf in the back of my head and remember: I am used to working from home running my own business as well as working for other organisations so initially the jump from site to home was no big deal. The issue became when to stop…as I was home anyway, and being who I am, I cracked on behind the screen, sounding like Darth Vader on zoom and conference calls,  refusing to scroll back but becoming ever more irritated that I couldn’t do as much as I wanted. Quelle surprise, I was sick, but the ingrained work ethic and the brain are slow to acknowledge that. At last, and bizarrely only once I started to improve, the fatigue made the decision for me. I rested. Memo to self: don’t be a fool. The love and care of my family and friends has warmed and sustained me and I will not spoil that by taking less care of myself.

So, much to take away from  this. Gratitude, empathy, relief, some self awareness, a shedload of admiration for people, a wake up call. To witness the love, kindness, resilience and commitment that people and communities have shared has been humbling. I am glad I saw it. I am changed as a person as a result. I like the change.

Health improving literally daily and normality hoving into view, a kaleidoscope of new perspectives tumbling around my head and bringing a fresh Spring scent to life and a bright and exciting horizon. I am joyfully climbing back into that saddle any day now and I do not intend to waste  a moment of my second chance.

Onward and Upward, truly, madly and deeply.

 

Arms and the Woman

I was looking at my arms, thinking how old, flabby, ugly they are. Then I remembered: these are the arms that held each of my children as they breathed their first, held each of my parents as they breathed their last; these arms held my husband when we lost our babies before their time and when we finally had our family, when he received his degree and when he lost his Nan; they carried the children when they were tired and hugged them when they fell and when they smiled, and later when love hurt them or disappointments pained, and when love was good and weddings and babies and houses and degrees and happiness; these arms held patients and their families and their friends during good news and bad news, secrecy, recovery, death. They felt and loved the cool breeze and solitude on Wexford Harbour after my Dads funeral and again after my Mothers funeral. They hugged me too when I couldn’t bear anyone else to hug me but needed it so much.

These old, ugly arms have done their job well, still do, and so what if they are a bit scarred, a bit pocked and wobbly? They are still strong, still working, still open for business, still warm, comfortable, still the arms of a woman.

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.