Tuesday, 28 March 2017

Hot air, much wind and cool sense

Oh dear, oh dear! I’ve been looking back at the start of this blog. What a boring old fart I’ve become since then. My posts have increased in length and in grumpiness. I’m surprised anyone reads them any more. I know some people do. Probably my family….

Anyway, here I am today, sitting in my favourite Cornerstone café admiring the new kitchen in the children's corner, that Sarah the manager raised money for, by going without sugar throughout February. The sun is shining and all’s well with the world.

On Saturday we had the local branch MNDA AGM. As usual it was a friendly time. We did the business bit, and after lunch had a talk about the NIHCE Guidelines on MND. Wow, it’s a weighty tome! And I suppose GPs and Health Commissioning groups are meant to have a grip on scores of similar documents…. We also heard about the Happy Valley Festival, a seriously cool one-day music festival in aid of MND on 17th June (http://www.happyvalleyfestival.co.uk/) - tickets on sale tomorrow.

I asked one of our local MND experts what I could expect dying to be like. The answer was compassionate and honest: “The hardest part of MND is the living with it, not the dying. As the muscles weaken, the oxygen level drops, carbon dioxide rises. Usually people die in their sleep.” Or words to that effect. Reassuring. Confirmed my view that dying with MND is no more distressing for all involved than any other death.

Monday, 27 March 2017

Care - what's it worth?

Yesterday I happened to hear an interview conducted by Anna Magnusson on BBC Radio 4's Sunday Worship. It gave me an insight to the vocation of nursing:
"One of my nieces is a newly-qualified Staff Nurse. Ellie’s 23, and works in a vast London hospital. She’s in the kind of job which gives her insight and maturity beyond her years. Every day, she looks after strangers. We sat down together one afternoon to talk about caring, and giving back what we receive. And what the story of Jesus washing the disciples’ feet means to her:
It’s the son of God; it is the most holy person saying, 'I don’t care if you’re homeless, I don’t care if you’re the scum of the earth, I am here to serve you.'  It’s just throwing every ideal we have out the window that you have to be the most rich, you have to be clean, you have to be good at your job – as long as you are a person, that’s what makes you valuable, and I am looking past anything other than you being a human – you are a human so I am going to serve you.
As a nurse you do have to do that, you have to say, I don’t care if you’re a drug-dealer, I don’t care if you’re a criminal, I don’t care if you’re a nun – I am going to treat you exactly the same because I have a duty to serve every person that comes through this door.

Tell me a bit about feet, though – what kind of feet do you encounter in your work?
Ooh … They come in all shapes and sizes, all lengths of toenails and smelliness and grottiness.  We’ve got patients who come off the streets, who are homeless.  And sometimes it can be quite horrible! 

But clearly you can’t allow yourself to be squeamish because that’s your job; it involves a lot of putting your hands on people, on giving intimate help?
Yeh, and I think over the years you do, you become a bit more immune to it.
I remember one of my patients, he had come off the street and he had this massive beard which he said he never used to have, and he was quite stinky, so I scrubbed him.  And you could just see the dirt all falling off.  And then goes, ‘Oh, I really want to have a shave!’.  So I chopped off all of his beard with some scissors and then I got the shaver out.  And I shaved his whole beard.  And he just couldn’t thank me enough, it was great.  And it was such a lovely bonding time between us, because I asked him about his life, I was able to find out what he was like when he was younger, and when he left he just couldn’t stop shaking my hand.  Because it’s one small thing that makes such a big difference, and I think everyone would want, I think people would want to do that, to give a tiny bit to someone and for them to receive so much from it...."

She added another insight into the folly of our policy of squeezing more and more out of the resource which we deliberately limit financially. We can't expect the time and level of compassion we'd like, when we understaff the NHS because we underfund. Time is money - and money provides time. 

"One of the main reasons I love nursing, and especially when I was a student – I was able to give more of myself to them because I wasn’t pressured by being a staff nurse; I had that little bit of extra time take the effort to make sure that it’s done in the most lovely way, to say, 'No, don’t rush this, this is someone, this is your grandma, this is your mum, take the time to make this as nice as it can be – even if it’s just 10 minutes, giving someone a little bed-bath in their hospital bed.' And then very quickly you’re getting a picture of their life.  So I never view them really as strangers."

In the same programme Anna Magnusson related,
"I’ve a friend in London who used to work for a home-care service.  
The allocated time for each visit was 15 minutes, and it was never enough.  She couldn’t allow herself to leave someone soiled or half-dressed, so she would over-run. Then she had to rush off to the next person, always behind schedule, always distressed over what she could not do to help. 
She was paid peanuts and, in the end, she couldn’t continue and care for her own family as well.
She trained as a bus driver instead, and was paid a decent wage."  

We know that's true - and yet it seems that as a society we are not willing to pay the price of providing care to those in need at their point of need. And then we, led by the media, have the gall to complain at waiting times or cursory treatment. And politicians find it convenient to collude in the blame game - to deflect our attention away from the fact that they don't have the courage to face themselves and us with the truth that care costs. Care is worth paying for. The NHS is worth paying for. And that means nurses and those in the care professions deserve rewarding.

Monday, 20 March 2017

Let the teachers teach

I’m sorry to report this, but I spent a depressing evening last week in a group discussing religious education. Among those there were two parents, one foundation governor and other interested people, all, I guess, grandparents. I was the only one who confessed to having been a school teacher. 

We listened to a podcast from the “Beyond Belief” series. The impression left by the BBC conversation was, as someone said, “dire”. Poor teaching, non-specialist conscripted teachers, confused aims. Well, that’s not my own experience in secondary schools where I taught and where my children went. Of course, inevitably, in primary schools teachers are in effect non-specialist in all subjects except their own. They are on the whole experts in bringing out the best in children.

However what depressed me most was the wholesale buying into the widely peddled myth about state education. That narrative goes that our state schools and their teachers are generally failing children. The truth is that it is politicians who have long failed schools. In my lifetime I remember only one Secretary of State for Education who was any use, and that was Estelle Morris, who held the post for barely a year. Her great qualifications were 1) that she had taught in a comprehensive, and 2) that she worked to improve schools, not to change the system. Every other Education Secretary from Margaret Thatcher onwards used the state school system to advance their own political career, by leaving their mark on it. One can hope that Justine Greening will prove to be an exception.

Whether it was changing the exam system, raising the school leaving age, introducing more and more testing and school league tables, introducing academies and free schools, changing inspection regimes, fast-track entry, there has scarcely been a minister that has not introduced a new pet scheme, while at the same time effectively talking down the teaching profession. If they refrain from overtly criticising teachers, they fail to respect their expertise and reward their hard work. Hardly ever have I heard a minister defending the long hours of overtime that teachers put in or praising their skill in communicating the excitement of a subject to a class of variously motivated teenagers. More often, as I’ve indicated, Secretaries of State will complicate the teacher’s lot by introducing yet another innovation for her or him to grapple with. And when you examine those politicians’ qualifications, they are usually nothing but having been a school and university student themselves. When they have a bright new idea, they would do well to listen to David Hare’s plea, in a different context, in Racing Demon, “Don’t do it, Charlie – it’s not fair.” Bishop Tom Butler quoted this on Thought for the Day (8thJanuary 1992) in a well-directed plea to politicians to leave teachers alone. “Continuous revolution,” he commented, “is not necessarily a helpful hallmark of an educational system.”  Well, teachers have been living with it for over 25 years now.

When I was learning to teach, there was a great little book called The Craft of the Classroom by London headteacher, Michael Marland. It is full of advice about to structure lessons and inspire pupils. It ends, “"The craft won't work without a spirit compounded of the salesman, the music-hall performer, the parent, the clown, the intellectual, the lover and the organiser, but the spirit won't win through on its own either. Method matters. The more 'organised' you are, the more sympathetic you can be. The better your classroom management, the more help you can be to your pupils." I don’t know whether the book is put in the hands of new Education Secretaries. It ought to be. If they would only allow teachers to develop their craft and hone their skills without constant interference, they would be surprised at the results. 

There are two teaching tips which ministers (and all managers, for that matter) would do well to heed. One is that you need to earn your students respect (and you do that by respecting them). The other is that they respond better to encouragement than to criticism.