Monday, 29 February 2016

Coming home to roost

If, as a habit, you denigrate a particular caste, or class, or profession, especially if you are a government, you ought not to be surprised when that profession, or class, or caste deserts you.

So if you tell people who are unable to find paid employment, such as the disabled, that they are shirkers, not workers, don't be too surprised that they are less than impressed.

Last week, Sir Michael Wilshaw, chief inspector of Ofsted, told us that in a year more teachers were going abroad than are being trained as graduates. There is such a "brain drain" in the profession that he was urging politicians to impose "golden handcuffs" on newly trained teachers to prevent them leaving for more lucrative positions in the burgeoning industry of private (public) school offshoots abroad. Of course the very concept of handcuffs at the bottom end of the employment ladder is indicative of the regard in which teachers are held. They would be less golden handcuffs than iron shackles - the gold lies abroad. I suspect most teachers would not mind their profession being regarded as serving their pupils, but handcuffs are more redolent of slavery or crime.
Photo: Association of Teachers & Lecturers

I doubt that it is so much a matter of pay levels that lures our highly trained, able young teachers overseas, but the constant low regard in which they are transparently held by our government. The curriculum is so closely prescribed that there is no room for creativity in the classroom. There is such a lack of trust that inspections focus in on the extensive record-keeping which consumes so much of teachers' time and energies. The low regard is of course reflected in pay. There are other countries such as Germany and Holland where pay reflects higher regard. An informative article in the Guardian shows how far down the comparative table the UK comes. The first and major step the government should take to stem the flow of teachers abroad would be to stop denigrating (or "dissing") the profession and to begin showing appreciation for it (or "bigging it up").

Incidentally, I see that Nicky Morgan, the Secretary of State, is considering importing someone from America to replace Sir Michael when he retires. A fairly eloquent indication of her low regard for our home-grown educational talent.

Talking of importing from abroad, today's news announced that 69% of NHS trusts are actively trying to recruit staff from overseas. 23,443 nurses' and 6,207 doctors' posts are vacant (BBC News) in England, Wales and Northern Ireland. It's true, apparently, that the NHS is employing more staff than ever, but unfortunately the demand is bigger than ever. However if you treat highly trained and intelligent men and women as obdurate bolshies, and demand they do more and more with less and less resources, you have fundamentally undermined their respect and their working conditions. No wonder so many leave the service or find employment where they are more highly valued, better resourced and better remunerated. I know one senior doctor who has crossed the border for that very reason.
Photo: British Medical Association

There are two pernicious effects of this shortage. One is the inevitable resort to agency staffing to plug the gaps - which is of course more expensive than in-house staffing as well as less effective since it militates against creating teams who work together. The second, which is sometimes linked to the first, is the effect of denuding needy nations of medical expertise, of which, bluntly, their need is far greater than ours. Salaries here will always be attractive to those in developing countries. And so we have the grotesque spectacle of our government excluding asylum seekers while at the same time encouraging by their policies an exodus of essential skills from impoverished nations. In my view it fails the test of morality.

It was the good book, I seem to remember, that said, "You reap what you sow." Well, we've sown lack of respect for teachers and many seem to want to find more rewarding environments. We've sown antagonism and mistrust for the medical profession and many look for where their expertise is truly appreciated - and we are all the losers. Let's have less rubbishing, and more honouring, of the women and men on whom our essential services rely. Try it and you'll be surprised at how things change.

Wednesday, 10 February 2016

Why "How to die?" - my question

I see I'm quoted in the Daily Mail today. Quite fairly I'm glad to say, although I don't think of myself as a "campaigner". Just someone with an insidious and very slow type of MND who is quite concerned about how little coverage good and natural dying receives in the media - of whom the BBC is just one example. And it matters because the media does a lot to shape public opinion, including in the area of suicide - which is of course the subject of tonight's BBC documentary, "How to die - Simon's choice". I shan't be watching tonight - but I might catch up tomorrow. Maybe the Mail's article tells me enough, including that Simon Binner's widow, Debbie, would have preferred him not to have gone to Switzerland. "I would have preferred him not to go,’ she admits. ‘There is a beauty in caring for someone who is dying. I loved Simon. I would have loved to nurse and cherish him to the end." What an amazing woman! 

In 2000 the World Health Organisation issued guidelines about the way the media should treat the matter of suicide. Near the beginning, there's a section headed: "IMPACT OF MEDIA REPORTING ON SUICIDE
"One of the earliest known associations between the media and suicide arose from Goethe’s novel Die Leiden des jungen Werther (The Sorrows of Young Werther), published in 1774. In that work the hero shoots himself after an ill-fated love, and shortly after its publication there were many reports of young men using the same method to commit suicide. This resulted in a ban of the book in several places (1). Hence the term “Werther effect”, used in the technical literature to designate imitation (or copycat) suicides.
"Other studies of the media’s role in suicide include a review going back to the last century in the United States (2). Another famous and recent case concerns the book Final Exit written by Derek Humphry: after the publication of this book, there was an increase in suicides in New York using the methods described (3). The publication of Suicide, mode d’emploi in France also led to an increase in the number of suicides (4). According to Philips and colleagues (5), the degree of publicity given to a suicide story is directly correlated with the number of subsequent suicides. Cases of suicide involving celebrities have had a particularly strong impact (6).
"Television also influences suicidal behaviour. Philips (7) showed an increase in suicide up to 10 days after television news reports of cases of suicide. As in the printed media, highly publicized stories that appear in multiple programmes on multiple channels seem to carry the greatest impact - all the more so if they involve celebrities. However, there are conflicting reports about the impact of fictional programmes: some show no effect, while others cause an increase in suicidal behaviour (8).
"The association between stage plays or music and suicidal behaviour has been poorly investigated and remains mainly anecdotal....
"Nevertheless, there is always the possibility that publicity about suicide might make the idea of suicide seem “normal”. Repeated and continual coverage of suicide tends to induce and promote suicidal preoccupations, particularly among adolescents and young adults."

The normalisation of suicide as a remedy for chronic and terminal illness, or disability, is the reason last November I wrote to Lord Hall, the BBC's Director General. Here's my letter, followed by the delayed reply from one of his underlings.

26th November 2015
Dear Lord Hall

I am writing to you on a matter of personal concern to me as I have a chronic and life-limiting disease.
You were quoted two days ago as saying that the next charter should not be an attempt to tell the BBC what programmes it could or could not make.  Whilst I agree with that aim completely in principle, it is most important that the Corporation also maintains its commitment to editorial impartiality in all its output, especially in news.  To that end it needs to be accountable, ultimately to those who pay for it through their representatives.
My particular concern is to do with the Corporation’s treatment of end-of-life issues.  Although generally your news outlets make an effort to represent opposing views when the subject is debated, there seems to me a consistent disposition to focus nationally on stories of people ending their own lives (travelling to Dignitas etc) rather than on the many more who choose a natural death and the work of hospices, palliative care doctors and nurses.  I do of course realise that news consists of the exceptional.  Nevertheless, the media both reflect public opinion and mould public perception.
My wife woke up recently to hear an account of a ‘beautiful’ death at Dignitas.  A few weeks before, Victoria Derbyshire did a feature on a man who had announced his imminent death there.  I was in touch with the planning producer at the time who wrote to me.  ‘I will certainly talk to my editor about your suggestion of covering good end of life care on our programme – as I think that would definitely be a very interesting and important issue to cover.’   I have only praise for that producer who was more than helpful.
What concerns me is that inevitably in an organisation as large as the BBC there is a danger of an editorial orthodoxy which ironically discourages diversity of viewpoint in its creative output.  There are many inspiring stories of surviving against the odds and of good natural dying out there, which are newsworthy, and yet we see and hear precious few of them, it seems to me.
The media affect the mood and culture of our society.  To focus on stories of death can induce an atmosphere of fear and hopelessness in the audience.  Whatever is in the next charter, I hope it will keep in place some sort of independent oversight in order to ensure negative and positive are balanced in your output. 
Yours sincerely
Michael Wenham
Lord Hall of Birkenhead
London W1A 1AA

cc         Rona Fairhead, BBC Trust
            Ed Vaizey MP
            The Rt Hon John Whittingdale

As the BBC might themselves put it, Lord Hall declined to reply but the corporation did issue a statement. A bland and predictable response, sadly. It remains to be seen whether we see any more positive programmes to encourage those of us with incurable disabling conditions that there is an alternative to topping ourselves.