Counting down 100 working days

 As we move into July I’ve realised that I’m facing the last 100 or so working days in my Lead nurse role. Some have started new roles with 100 day blogs; I thought I’d try a reflection on each of my last 100 working days. 

I know I’ve been an intermittent blogger so this is a challenge for me, though I hope not for you as reader. I want to reflect on the changes I’ve seen, the experiences that came my way, and the people whose paths I have crossed. I hope it helps to record these things in order to make sense of them and to provide a glimpse of how life has been over the decades I’ve lived and worked.

Looking forward I plan to keep in paid employment as a Freedom to Speak Guardian at MKUH. This means keeping in touch with wider issues in order to help staff members and the organisation get the best out of the relationship. But more on that another day.

Day 1 done. 

The view from behind

A while ago I did one of those Facebook things, something about a motto for life. The answer I was given said essentially I should drop the past, forget it and move on, looking forward. Had I been 20ish, I might not have thought so much about it. 
Of course I shouldn't take that kind of thing literally; it has however given me something to consider that has to be written out loud now.

My concern when that was said was that I was engaged in looking back. First as I begin to consider planning in advance for retirement there's what has work been about and what options are there for the future. Then via a closed group on Facebook (last mention) of friends who went to Southfields School in SW London the idea of a reunion grew into a reality that happened on the 13th May, just gone. If that's not looking back I'm not sure what is. 
Alongside that the fabulous #twitterdisco held once a month has helped me rediscover music and its associated memories. Yes, flared trousers, longish hair and collars and lapels that needed wide load warnings; standing on platform shoes nervously wondering if a girl would like a dance, if only I could attract one away from the lure of the handbag mound mid-floor.

Then there has been my consideration of my performance at work driven partly through the benefit of excellent coaching over the last few months. This led to looking backwards at how I've performed in the past, digging out evidence of 360 degree feedback and repeating the exercise. So there's been lots of ‘rear view mirror’ work.
For me the benefit of ignoring the ‘forget the past, live for now and look forward’ would be to miss out rich sources of information that can help the future.

So when retirement comes I'll have what I've enjoyed doing recreationally to fall back on as well as new things to learn. Friendships that have endured since school will still exist as we plan road trips and travel to see those across the globe. The writing and drawing that sustained me in school are becoming more important now. My love of listening to music will remain strong and be a source of relaxation and inspiration. More immediate is the feedback I've been given in the last week. It shows a lot of reassuring positives as well as identifying things to work on. Even the worst times of early schooling, pre Southfields, have an importance in showing how good the now and future look.
For me then, without looking back I'd have a poorer future, and certainly a very dull present. I therefore recommend looking back on occasion, you may see something afresh just as useful as what's in front of you. 

Challenges for the personal and professional

At the end of February this year my dear friend in nursing @agencynurse Teresa Chinn wrote a blog piece about the WeGetogether2016 event, held on the 29th Feb 2016. As ever Teresa gave a thoughtful account of what happened, the build up to it and considered the consequences. One one aspect Tree asked about was "what happened?" Her response was 'nothing' and that concerned me; so I want to challenge that - gently of course. In one way I guess Tree is right - no great single change or movement emerged that sparked a revolution. 
I began to wonder however if I had missed something because I believe there were myriad outcomes, albeit small ones.

I had traveled to Salford where the University Nursing School hosted us, full of hope and expectation; not to mention carrying banners and freebies including home made cookies. 
When I look back on #WGT16 I think of the developing relationships that were bolstered by meeting in person; the thinking and sharing we were encouraged to do. From my perspective it led to a wider range of contacts and networking that influences me today. So let's remember what we experienced at #WGT16 and think of where we are now. Yes times seem to have become ever more challenging in terms of politics, the economy and the Care sector (I like to think across the health and social fault line). That has not stopped people continuing to challenge both personally and professionally. 

And then Teresa has set me thinking again about challenges; this time in her latest blog about professional challenges.  I've found nothing to argue with here; safety and safeguarding are key nursing responsibilities for nurses. It is the anticipated response of others that can block coming forward; I believe that as a senior leader and a manager I have a duty to set an example as a listener and in responding positively when concerns are raised. Likewise I have to be ready to face personal challenges and accept that I have got things wrong. Developing as a leader is about learning about oneself as much as getting to know those around us and that can be a much bigger challenge. 

Thinking about work or not? A connected era conundrum

I'm sitting under this tree in Potchefstroom (or Potch) South Africa.

I'm enjoying a holiday type break whilst my partner works at nearby North West University.
The guesthouse has WiFi; we can post to Facebook and Twitter and monitor emails. In many ways we can conduct life as usual – checking the bank balance, booking a restaurant and ensuring relatives are safe. Much of my social media (SoMe) usage is related to work particularly Twitter. To clarify I mean work in a broad sense encompassing me as a nurse, leader, manager, director, and contributor; these are just part of the whole me and inseparable from who I am. ‘Work me’ is just part of my life and not a completely separable facet.
Through SoMe I have contacts I have never, only once, or infrequently met in person; some I'll see each day at my work place. Nonetheless there's been sharing and an open hearted welcome; I trust I've reflected that to those who've approached me.  Sharing thoughts about aspects of work, favourite foods, what the cat is doing or ideas about music show much about us. Given  technology now available I've been able to consider aspects of work simply by monitoring my SoMe channels. As ever I find much to reflect on and herein lies my dilemma.
Being on holiday – away at least – means social and family related SoMe activity feels ok, a bit like sending postcards. Alongside this are the posts, pictures, diagrams and powerful 140 character pieces that engage the ‘work’ me. Have work and the social become too entwined?
While I've been away recent posts on kindness and curiosity by Sue Spencer @nursingbard and on listening by Tanmay Vora  via Teresa Chinn @agencynurse have positively piqued my interest. 
Perhaps being away is a good time to think about these things? If I'd turned my devices off completely I wonder if I'd reflected in quite the same way? 
Time spent alone is a potent opportunity. Whether using SoMe or just a notebook and pen where this post started, I cannot ignore the influences and opportunities that our connected selves bring. 
Even so  it is good too, to turn devices off completely; enjoy the sun, thunderstorms, breezes and wildlife in places away from home. Even better is meeting the people whose home this town is; in doing so using the kindness, curiosity and listening I've been reminded of makes all the difference to this experience. 

First times, Last times

As mornings in the UK get a little cooler, I have noted friends commenting on first days of 'big school' for their offspring while the timelines on Facebook fill with pictures of newborn babies and just brought home kittens.
As I have faced some last times, such as a funeral, finishing holidays or enjoyable projects, they are also first times. They provide an opportunity to reflect and revive; to be savoured and used to reinforce who I am.
Changes, losses and gains occur all the time in our lives and so often we are too busy to recognise them and note the impact they have. I recall a time when your first school photo was ordered with multiple copies for proud family and friends; now these can be shared almost instantly.
I wonder if we have lost a little of the anticipation of seeing what we looked like in our uniform, as a school child or at work?

At the same time we can see images of those near to, or in, death; what impact does that have? I suspect for many that will be the 'first time' death is visible unlike the historical commonplace in the developed world where so many died (and indeed were born) in their own homes. 

I believe we should relish all such times and create meanings and connections through them. Certainly I am immensely grateful for those contacts who have seen fit to help me through the current times; they are busy blurring the lines between first and last times. They see the person at the centre, ready to support with their enthusiasm and ideas.
So by no means for the first time, life is very good; I hope its not the last time.

A man of letters, all about E's and the 7th C

Enthusiasm - our younger cat has a way of launching herself at the world each day as the dawn chorus starts without hesitation and a tangible sense of purpose. How many days do we start like that?
Engagement - on the 12th May #IND2014 I was able to join my Twitter friend Pam Nelmes and the lovely team at Plymouth University School of Nursing and Midwifery to witness the finals of the 4th annual Nursing and Midwifery Challenge. This was a great day seeing how nurses and midwives of the future can engage through their learning and experiences on placements to create innovations. It was motivating to see; a positive sign for the future, and I strongly advise you to to keep a look out for the winning idea. 
Enterprising - All this is of course very enterprising; I know our hospice team enjoy the challenge of finding person-centred ways to deliver care to those in our hospice. The team thrive on discovering ways to raise and save money to support our work. Their enterprising nature is taking our service forward.
Employment - this is more personal; as I write the organisational  announcement is expected regarding the outcome of the reorganisation process going on at my level that began in late March 2014. I and my peers have had our current posts 'deleted' (technological language providing cover for harsher words - a whole other subject?) and an interview process for the new posts has taken place.
I have been unsuccessful. 
I know now, for the first time in my experience,  that redundancy is a realistic proposition. 
I readily acknowledge that I am not unique in this; I am not complaining, merely letting you know. I would like to make plain my thanks to all those who have offered words of support and commiseration. My peers in the same situation as me and the hospice leaders I met at the end of last week have been very kind; my family have stepped up too with their messages.
The Challenge is to keep going; there's no immediate threat to my income as there is plenty to get done. I suggest though that for me Challenge is the 7th C (see the 6Cs here). It is almost unnecessary to say its a time of opportunity too.
As so often happens though timing is all. I have joined the discussion on compassion and resilience stimulated through the blog by Maxine Craig. Then along came a blog by Laura Green, about the nature of resilience, and in particular its dynamic state, within the setting of end of life and palliative care. All in all very helpful and enabling me to keep my head. 
So now I face new opportunities; I'll need my enthusiasm; I must find ways of sustaining my engagement and use enterprise to identify what next in terms of employment.  I think that's enough challenges for this Monday morning.

What a week for healthcare

Whilst we wait with bated breath to see what happens about Southern Cross and all their care homes, we have had the traumatic scenes of the treatment meted out to the clients of Winterbourne View Hospital for People with Learning Difficulties, near Bristol, and today we're told the CQC have tipped off the police about the Pilgrim Hospital in Boston, Lincolnshire.

What a week; in the meantime I have been working along with 30 colleagues on looking at ways we can further develop the quality of care we deliver using personalisation as a starting place.
I guess we're lucky to be employed by an independent sector charity who want to develop and encourage the staff to do the same. It doesn't always feel like the whole charity are behind us but for those tasked with delivering the care ot our clients that kind of atmosphere is necessary to maximise the benefits to the patients and staff and reduce the risks of something going wrong.

Southern Cross is a classic case of market forces doing their natural thing; it remains to be seen how this will pan out.
Whilst details around the Pilgrim Hospital are lacking it must be serious to warrant police involvement. Whether it is one person or a system that is at fault we'll have to see.
Winterbourne View is in a league of its own; in terms of management failure; cultural failings in terms of acceptable care as well as an apparent lack of diligence by the CQC in the area.
When will people in positions of responsibility for quality and ensuring the safety of the vulnerable in our care take up even the slightest hint of wrongdoing and investigate thoroughly.
The principle of the CQC is OK; it remains to see if it was a local failling or so big a failure to warrant changes ot the way it is run.
My own experiences do not bode well for it's reputation as efficient and speedy to respond in setting up new managers, vetting and the other tasks necessary to monitor the quality of healthcare. Mainly because it does not seem to have sufficient numbers of inspectors to do the unannounced visits we should all be ready for and wary of, lest failings are exposed.
It's like driving - the more police officers about in marked vehicles on the road - the better we all are.
Let us not forget the duty of care we owe to those who use our services; that quality is worth investing in and let us see a thorough investigation into what has occurred with proper penalties imposed on those who are accountable for what has occurred.

Creaking care market

I've seen a report today that says the UK's leading residential care provider is having to restructure its finances, Southern Cross Healthcare. Refinancing is a fashionable thing to do - Ireland and Portugal spring to mind. Not surprisingly the Department of Health are said to be watching the situation and are concerned that standards of safety and quality are maintained in the care the residents receive. I suspect too they are concerned at how a potential market leader collapsing would look for the current health care reforms.
I have had a look at the Southern Cross website http://www.schealthcare.co.uk/News-and-Events/2011/Message-from-Jamie-Buchan-Chief-Executive-of-Southern-Cross-Healthcare/ and the message from their CEO; it is the closeness of SCH to Local Authorities and their finances that is the real problem. If Southern Cross are struggling who else is? Are we going to see more care providers struggling and those without sufficient critical business mass go under? Where will residents end up? At the end of the day what would happen if there was no local capacity in the sector - is the UK ready to have residents shipped about the country as there is nowhere locally to house them?
Is this the kind of result the government expected from market reforms? Markets have to allow for failure - are we prepared to accept this kind of failure in the care sector? Failure here is not an option - not if we are to avoid a return to a workhouse scenario.
It sounds like Southern Cross have a plan; indeed have been working on their plan for some time and I wish them well; not just for those with a financial stake in the company (I wonder what my bank has lent them?) but mainly for their people - the staff and residents and their families who will need to have faith that the system will sustain them.

Ageism, the NHS and 'no more just 'elderly services'

In this week's Nursing Standard editorial the problem of ageism in the NHS is given an airing, see http://nursingstandard.rcnpublishing.co.uk/resources/editorial/editorialv25n27.asp

What struck me is that we have services that tend to reinforce this approach; the elderly have been categorised into a group it is easy to discrimnate against. It is right in the past that our attention has been directed to the particular needs of older people but the 'post 65 years' marker seems so out of date now. I do not wish to denigrate the important research done in the past, nor the clinical practice that led to the development of older people services. Nor should we abandon the ongoing work about ageing and its effects; dementia however can strike before you are in your 60s so lets get real about this.

It is not safe to assume everyone will have finished work by 65; nor is it safe to presume retirement means some kind of slowing down and an end of usefulness. Indeed I suspect David Cameron hopes many retired people, of whatever age will help prop up the 'Big Society' or bs idea of his. He'll need to hope that this group remain in robust mind and spirit to sustain their contribution. The volunteers I meet regularly have often given many years of service; and have an energy and vitality that can be used for the community good. On occasion though they may need health interventions such as surgery and so long as their individual needs are taken into account it can return the person to the same situation of enjoyed contribution as before.

So, presuming getting older, and indeed approaching retirement is not a sign of an end of usefulness we should surely be looking at developing health and related services (idea - why not combine health and social services into 'Community life services' including libraries, schools etc?) into places where your important health concerns are addressed before anyone gets to see your birth date. In recruitment best practice the birth date has dropped off the list of things automatically seen; let us focus on a name and NHS number for identifying people and step away form the use of birth date - unless critical for safety - once a considered decision has been made on the care approach to go forward with.

Yes we need a change of approach to those in our care, and somehow we have to take the best of the work on ageing and weave it into all our services to help improve the care of those who are getting older.