Taking away and giving - we're not the only ones with COVID-19

After the heady and headline-grabbing political news of last week, I've noticed two hopeful pieces of news this week, which seem to have slipped by most media unremarked. One came in the shape of a speech on Tuesday; and the other was a comment on BBC Radio 4's Today programme this morning. 

Andrew Mitchell MP

The first was a speech made by Andrew Mitchell MP for Sutton Coldfield (formerly International Development Secretary) in the House of Commons, introducing a private member's bill entitled "Doctors and Nurses (Developing Countries) Bill". The gist of his speech is "The case we make to Parliament and the Government today is as follows: it is immoral and selfish for Britain, with its wealth and infrastructure, to poach doctors from the developing world. However, by taking the action I have suggested, we can turn that into a win-win for us and for developing countries." When we persuade a doctor from the developing world to come here, we do so in the knowledge that our gain will inevitably be their country’s loss. In this country, we have 215 doctors, nurses, health workers and midwives from Sierra Leone; from Nigeria, 4,099; from Pakistan, 3,394; from Ghana, 1,118; and from India, just short of 20,000. He pointed out the disproportion of the ratios of doctors per head of population here compared to that in countries we import from, and "how much we rely on those doctors and nurses and other healthcare workers who bring their talents and skills to this country to support our NHS from overseas. We respect them and we are hugely grateful to them. Indeed, if I may use a second world war analogy, much beloved by some of my hon. Friends, the heroes of this war against covid are not, as in the battle of Britain, the men and women of the Royal Air Force but, all too often, workers from overseas working in our hospitals, giving their all in our care homes, putting themselves in harm’s way, and often living on the minimum wage." 

So he proposed, "Why not do the following? For every doctor or nurse we poach from a developing nation, we should ensure that that developing country—on losing their trained professional to our advantage—receives from the existing British development budget sufficient resources to train up and replace them, two for one? When we are lucky enough to secure such professionals from the developing world, we should replace them twice over, and expand their public health services accordingly." 

What a brilliantly simple idea! Undoubtedly we owe a debt of gratitude to the nations from whom we poach professionals to prop up our National Health Service. Undoubtedly it is immoral to rob the poor to enrich the wealthy. Remember David and Bathsheba - and Nathan's parable? We're in the same territory.

Prof Andrew Pollard

The other news came in an interview with Professor Andrew Pollard from the Oxford Vaccine Group. Nick Robinson was asking him about the Oxford AstraZeneca vaccine. There's good news on that front as well as last week's from Pfizer/BioNTech and Moderna who seem to be in an efficacy arms race. The good news was that the Oxford vaccine seems to lose none of its effectiveness with us oldies; and moreover it's the vaccine in which the UK government has most heavily invested, having ordered 100 million doses. (Quite why the government wants a stockpile of 340 million doses, which it has ordered in total, even at two per person, with a population of 68 million beats me - maybe they intend to give the surplus away...) However the good news was that the Oxford vaccine unlike the BioNTech and Moderna equivalents does not require to be stored at temperatures more suited to the Arctic than the Tropics. "Right from the beginning our goal has been to develop a vaccine that could be distributed everywhere, and that's not a question just for the UK where of course we've got the infrastructure that can be put in place to manage whatever the storage requirements are, but we're looking globally. We really want to get to every corner of the world if indeed the vaccine is shown to work." As he implied later, if the virus persists in some parts of the world, the possibility of reinfection will always be there. 

How good it was to hear someone else looking beyond our shores and realising as Prince Charles remembered in Berlin on Sunday that no man and no country is really an island entire unto itself. Obversely how chilling to hear suggestions that the £16.5 billion defence budget increase might be at the expense of the overseas aid budget. I gather that the Treasury is trying to claw back some of the billions that have been splashed out on covid-related contracts from our overseas aid commitment of 0.7%. Tragic. 

A friend of mine commenting on Andrew Mitchell's proposal wrote, "This is what we ought to be doing and, if it happens, would make Britain truly great, and me proud to be British!" I agree.

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:

 

Nursingtimes.nets

"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.

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.

The wedge's end

Today I had the last appointment of the year with a nice nurse at our GP practice - and now I can hear! I've spent the festive season in a cloud of unhearing because of wax in my right ear. It's been a good experience, in a way, in increasing my empathy with the many who are "hard of hearing". It's extraordinary how stereophonic hearing enables one to pick out conversation against background chatter. It was hard for our guests, however, as Jane tells me my speech was more garbled than normal! (Correction: it was affected.)

So I'm very grateful to Holly and my practice who still provide this service. It's not complicated of course. Just a matter of lubricating the lughole with olive oil for a week and then a visit to the professional to flush it out in five minutes. All free on the NHS. Apparently, however, in many places this simple procedure is not funded anymore. I'm told that to get your ears syringed in Oxford would cost you £70-80 - unless of course you go to A&E and have three-month wait.... And what about that other common condition, varicose veins? Oh no, you can't get them dealt with on the NHS anymore. Wait until they're open and weeping, and then we'll do them. Otherwise go private and pay £1000.

So much for the £ billions for the NHS the government trumpets so loudly! (By the way, have you noticed that their stock response to any awkward question is not to answer it but to spout some large monetary figure which is meant to impress us? And naturally it sounds impressive to us ordinary tax-paying mortals, not being among the 1,826 billionaires in the world [i.e. with wealth of over $1000 million].)

So much for the founding principle of giving treatment free at the point of use! Yes, I know it's already been eroded at the edges, with prescription charges, dental charges, road accident charges and so on. And we already see the negative effects, with people self-medicating and neglecting their dental care until it's too late. But it is clear that, whether by intention or not, the effect of government policies is to shrink further free NHS treatment.

Which leaves one perplexing question to answer. What is happening to the £ billions allegedly being poured into our National Health Service? Is it being spent on hugely expensive experimental operations, or drug regimes with hugely costly pharmaceuticals? Or on paying the interest on the legacy of foolish public/private partnership initiatives? Or on administrators called in to sort out yet more doctrinaire reorganisation? Or prodigally buying in agency staff because we don't pay those we have the wage they deserve? Or is it simply because cantankerous old crocks like me are surviving too long and costing too much?

Thank you from the choir

One encouraging piece of news on Christmas Eve concerned the number one selling song in the Christmas charts. Here's what two of the Greenwich and Lewisham NHS choir had to say about the news that they had topped the charts; they're a physio and a doctor: Thank you from the choir. I think they're right, that their popularity reflected how much the NHS and NHS staff are appreciated and loved. The NHS is one of the best things about this country.

The NHS Choir sings "A Bridge over you"

And here's the song itself - which even cantankerous old crocks can enjoy: The NHS Choir sings "A Bridge over you".  The choir's aim was to support the hard work done by doctors, nurses, midwives and many others in the NHS, with proceeds set to be donated to a selection of charities including Carers UK and mental health charity Mind. 

At the end of 2015, I'm going to say a huge thank you to everyone in the NHS. I know you're in it for the last of those three initials - and you ought to know that 99.9% of us appreciate the long hours you work and the awesome skill and care you show us. 

Finally, looking forward to 2016, I hope and trust that the wedge will not be pushed in any further, and that the government will give you the recognition and reward you totally deserve. Happy New Year.