“We apologise for this late arrival...”

 So now it is 2025 and I have decided to return to a refreshed blog. The last year has been a trial of my (mainly physical) health. I needed steroids to dampen down polymyalgia rheumatica which brought on steroid induced diabetes.  I am now steroid free, the blood sugars on my low carb, full fat diet are much lower (see freshwell) and my weight has stabilised at what is about right for my height.  During all this I've awaited two relatively minor surgeries. The NHS is so good it is said when an emergency arises. The wait for non-emergency (elective) surgery, is often long which is frustrating, and at times costly, in terms of keeping comfortable and safe whilst waiting. 

In the last couple of weeks I have had my prostate reduced, it is expected to be cancer free but awaiting confirmation of that. It didn't go quite as expected so an uncomfortable week went by whilst I did my best to drink the world dry. All is beginning to get to get better now and for that I am very grateful. I had however to push to get the surgery done as I need a hernia fixing too. The local hospital was getting ready to do that but I had been told the prostate needing fixing first. There was no inter-departmental communication between surgical specialties that would have helped avoid the delays. This patient has had to do the organising. Given the level of computer based record keeping that exists it adds another layer of frustration.

So you can see why there's been an impact on what I call my mental health too. That being so the last 12 months have not been without bright spots too. There have been travels to see good friends, and taking forward my ambition to do more drawing and painting. Canada, New Zealand, France have been further destinations, while Brighton and Bath have been examples closer to home. In two of that list we saw friends who have since died. Whilst immensely sad about Tim and Chris, who are greatly missed, we were pleased to have spent time with them.

Even closer to home was a Garden Party at Buckingham Palace which on an warm sunny May day was most enjoyable. As ever though the joy of being granddad stands out. Making a den in the back garden, getting messy with flour while making biscuits, singing, train rides, and sharing stories are part of that picture.

Using stories to help understand death, dying, hospice care, and nursing is something I got used to. And a new development opportunity has arisen through the Anne Robson Trust. I have been recruited as a freelance trainer for the 'Simple Wisdom' course they offer. It‘s given me something else to look forward to, as I share examples from my life to help others develop confidence when death and dying arises in their lives. It's never too late to learn about these things, so it is timely unlike this blog piece that's taken too long to come along.

A leap year time to refresh

 I’m writing now after a period of finding it difficult to keep up the blog following mum’s death in late 2022. I have found myself wondering where time has gone as two Christmas times have gone by since then. Now is a time to try again, in doing so I want to update you with news of change.

I am getting closer to relinquishing my registration as a nurse. It was approximately 46 years ago I eventually decided working in shops, offices, and potentially being an accountant were not for me. I’d already thought about nursing and delayed starting training by about a year. The pressure to go to night school to take up accountancy from my BBC boss led me to re-apply for nurse training.

Now I have given up direct nursing and managerial roles I plan to retire from my paid role in the health sector. The recent opportunities to make a difference have come in a variety of ways. I’ve seen a young, committed person develop into a nurse enjoying working in palliative care. Not the first I’ve seen; they have worked so hard on the long route to registration giving me hope for nursing’s future. I’ve seen services develop around @AnneRobsonTrust Butterfly volunteers being with the dying in our Acute trust. I’d started negotiations over this before the pandemic. So glad it’s come to fruition. My time as a Freedom to Speak Up Guardian @NatGuardianFTSU has also been one of developing the space in which people can come forward to tell their stories, as well as influence the Trust to invest further in the role in the coming year. It has been a valuable time personally too.

So, come the end of March 2024 I will no longer be a Registered Nurse. It feels the time is right to let go and step back. I want to use my energy in other ways though not all clearly defined yet. One change will be the end of @PhilBallRN on X (Twitter) as I’ll keep up with @philipraball where I can still comment and share without misleading anyone. Feel free to switch by the end of March or stop following as you wish. My other social media channels are not likely to alter if you follow them.

Thank you to followers of @PhilBallRN – there have been chats and sharing of some awesome experiences. It’s been a place where friendships have been forged, mainly through @WeNurses and associated communities. Whilst being a retired nurse sounds old, I don’t feel that way, and I’d like you to feel free to keep in touch as I want to keep learning, laughing, and loving what I do. And it will help me with fresh blog ideas too.

 

Love, life, death, whatever.

I had originally started this piece in March this year (2021). Three months later it is time to finish and publish. The delay? Coming to terms with my professional life in nursing and the after effects of the pandemic. The stories associated with our experiences will need space to be told, and this is another part of my journey.

The three reads…. I’ve been fortunate to recently receive 3 books that in some way cover life, death, love, and some of the whatever’s that come along with these themes.

Loves and life get great coverage in Michael Rosen’s Many Different Kinds of Love.

A memoir of his experience of Covid-19, nearly dying and recovery includes his poetry and the remarkable diary entries of those who cared for him when he was in ITU. What was effecting is the insight he gives to being the person in need of care.

His poetry forms a large part of the narrative. These poems will be useful to reflect the perspective of being reliant for the intensive care that the very sickest of us will experience.

That care was delivered to many in the Covid-19 pandemic, though many did not survive.

One of those to die was a friend of mine from school days, and the writing in Michael’s book helped me understand the efforts that were made to care for them even though that did not end happily.

Dying and death have bigger parts in Erica Buist’s This Party’s Dead. A crowdfunded book, I liked the idea and ended up with biscotti to enjoy.

Following the death of her father in law Erica had to find ways to understand her reaction to the grief that unexpectedly consumed her. The resulting book comes from her subsequent visits to seven death festivals around the globe. This is an uplifting tale of her journeys and discovering how the dead loved ones are cared for and revered. Certainly an eye opener, it makes me wonder how we can be less uptight about death and dying in the UK.

So we come to We all know how this ends.

Anna Lyons and Louise Winter have pulled together a remarkable collection of information and shared experiences. Many of these are the experiences of others who have generously allowed the retelling. Taking from their inspired ‘five things’ and the ‘Life, Death, Whatever’ events the book adds up to be a powerful instrument for those thinking and planning about the future and the way our lives might end and be celebrated. The challenge to the conventional funeral model is where we can find much to inspire. Helping too as life ends, the work of end of life doulas reminds that often it is the overlooked details of living that need tending until our last breath.

These are books that have contents to treasure and will repay re-reading. I admire the candid nature of sharing by the authors and their contributors. COVID-19 or not, our lives will end. How we are remembered, and how we can choose to influence that are part of the work of each of our lives, whatever.

Reflections of 2020

 

Time of anticipation of post winter renewal Jan Aware something in China, news a little vague 

    A few warm sunlit days in Gibraltar Feb sounds like a virus is coming our way

The opportunity to be in Pembrokeshire Mar Lockdown? Toilet roll supply in Wales

One working from home April One friend ill in ITU  

Blossom in trees and vulnerable deliveries May ITU friend dies now I’m angry and scared

  Being clapped thanks June One of the good guys

  Summer days by the sea July Maybe lockdown helped.

A birthday amongst concern Aug Supporting colleague’s work

    Finding ways to vary the routine Sept Tightening and tiers and tantrums

   The search for a rescue cat starts Oct A fresh wave brings saltwater tears

What about Christmas? Nov Creative work planning

Christmas, came, went Dec Did our best to please

And for an encore 2021 …? 

Previously published on #WeCommunities

@philballRN

 

Too painful to laugh

It’s International Nurses Day 2020 and a motivation to digitally pen this piece. I find this COVID-19 time tough; it is tiring and has been something of an emotional experience. 

And that’s just the last week.

Whilst our team have worked hard with courage and resourcefulness, we’ve seen the impact on those dying and witnessed over the phone or via digital media the separation and sorrow on the part of loved ones.

I’ve wondered if I should scream at the sky, let the tears flow (wondering if they’d ever stop), simply wallow on the sofa (plus or minus alcohol) or find the words for a blog.

Apart from the poem below, tweeted about a week ago this will have to do.

Supporting each other has been critical; one of us is at home and able to work though stuck inside except the daily walk. I’m busy having daily interactions with others though each of those conversations has overtones of concern and uncertainty.

Then, personal loss struck through the death of a schooldays contemporary due to COVID. His family are bereft; and so many of us would like to be on hand to support and celebrate the life of Barry. 

And despite the jollity of VE Day and today being International Nurses Day it’s difficult to laugh and feel joyful.

And yet I am sustained today by the kindness of my team who staged an intervention today over their concern for me. Through social media there have been lots of messages broad and personal that have helped. Family members have been fabulous too. 

It’s good to celebrate the positives of nursing, where I’ve been home since 1978. 

I’m glad we can do this; and yet….

It is a painful time, and despite the rhetoric I’m not a hero. I’m simply doing a job I love. I suspect many of us will be reflecting on what it means to nurse, and to be bereaved at this time. 

I guess I could be accused of pouring cold water on this special day; it’s not what I intend. 2020 will remain a topic of discussion (for some); for others it may be just good to survive.

Thank you if you’ve got to here; I hope I’ve not been too negative. 

And I do look forward to laughing again soon.

Today, Was not just another day; A time when COVID anger and angst Brought so close pain and disbelief. And more pain, for those we’ve lost And those we’ve left alone. Tears don’t seem enough, For now they’ll have to do, Until we hold again. #COVID19. Written 5.5.20.

A week of 3 ‘peaks’

A few days ago I saw a link on Twitter to a Guardian article by @CharlotteChurch about the death of her grandma, and the care her Nana was given. Charlotte ends by making a plea for Palliative Care to be available for all, after extolling the experience Charlotte, her grandma and the wider family were given.

What struck me was Charlotte’s comment on the words “syringe driver”, that apparently caused her grandad distress in that he thought it would be used to speed the death of his wife. This is not uncommon in my professional experience so I thought I’d ask Twitter contacts if they had any ideas for an alternative name.

This generated 19 direct responses, and various likes and shares, the number of which was a surprise and in a busy week at home and at work I didn’t get to respond until now. 

I want to thank all those who joined in with ideas and comments. If it helps change practice and alter perceptions of syringe drivers then that’s a high I happily take.

To summarise -

• Clarity of the words we use was a main theme
• Taking time to demonstrate the syringe driver, tubing and drugs and the way they come together makes so much sense
• Creating ownership and portability through colourful hand-made bags is well known 
• Using a stretchy men’s sock is a delightful spin on covering them
• That syringe drivers are useful beyond End of Life Care is an important point; they can give symptom relief during treatments such as chemo and radio therapies and can then be stopped
• And at the end of life, used with sensitivity and clinical caution they will not hasten a death

As for a useful alternative name we didn’t get to that; not to worry as we were able to have conversations that spanned a variety of locations, backgrounds and viewpoints. That in itself has been a valuable demonstration of the usefulness of social media.

What of the other two highs? One of our fab team, @H2Gail has reached the summit of Kilimanjaro in the last day or so, a wonderful personal achievement.

The third high? The team I’m part of; yesterday I found myself reflecting on all they’ve been through personally of late, and how professionally they’ve been caring for patients and each other; that has been a moment of intense pride and an emotional high.

 Gail is in green here -

Be brave, honest, open

Inspired to write today by a blog from Tony Warne (an impressively regular writer) I wanted to reflect on the report from the BBC about the lack of cultural competency in hospices. Based on research conducted by LOROS Hospice and Leicestershire Hospitals I wasn’t surprised (sadly) by the findings and the call to action.

I’m aware that many hospices have been trying to engage with those in their surrounding communities. Offering the opportunity to share information about services, and to learn more about the perceptions their neighbours have about hospices.

We now have a greater understanding of the importance of being able to talk about death and dying, and the difficulties nurses, doctors and others involved in caring for those who’re dying face. How important is it that we reframe hospice and Palliative Care services? In my professional lifetime many cancers have become more of a long term condition though still with notable exceptions such as pancreatic cancer. The focus has shifted to supporting those with longer term conditions to get the best out of their situation as they can. Hospices can, and do, help with that.

Perhaps hospices should move to being a community health hub, where services reach out into people’s homes and tackle loneliness, poor physical environmental conditions, encourage finding ways to improve individual’s health and bringing forward the conversations about death and dying.

As cultural norms shift we have to recognise that some changes have left us afraid to address these issues. Time to be brave, be honest and be open; a call to all who believe that being open about living before dying is important to all those around us.

Life.Death.Whatever ... next?

I've wanted to write something about the Life.Death.Whatever. event for over a week now, since making my visit to the National Trust's Sutton House in Hackney where the October long event is being held. There was much to take in so I needed to start before too long goes by.

As I write this remarkable experience is in its last week; the creators and curators Louise Winter  and  Anna Lyons deserve praise and awards for the rich content that has gone into the exhibition. 
Use the website to see the ideas and contents of the exhibition; I'd like to reflect a little on my visit. I was able to attend the Good Funeral weekender where a variety of funeral providers and celebrants interacted with visitors set amongst the installations. I've included some pictures below.
I was able to reflect on the death of my father and who he was to me. This was really helpful as I come to understand who I am, and be at peace with what our relationship had as well as what was missed. Dad died 12 years ago and I'm conscious too that I am possibly - as has been mentioned recently - turning into my father. Given his health deteriorated with dementia progressing to dying aged 77 I'd prefer a different ending. Whatever ending that will be, Life Death Whatever helped me rethink how ones life can be celebrated as it ends and in terms of what happens when death happens. I realised we did a good thing in celebrating dad and his life; more recent family funerals have also been uplifting in terms of celebration rather than extreme somber-ness.
It's time to consider how I'd like to be remembered at the time of farewell; this requires thought and discussion with my loved ones. It will need financial planning and careful consideration; I have lots of music I'd like to include as well as some words to say, that is to have said. The great thing I learned on my visit was that there are many creative people who are willing to help with the farewell planning of an individualised event. 
From the coffin ball pit, the paintings, sculptures, digital recordings, talks and creative cocktails plus NT type tea coffee and cakes LifeDeathWhatever was thought provoking, challenging of traditional 
funeral rites, and a beautiful way to consider what we might like to do when death comes. After life there's death, and to save an awkward Whatever for those who are left behind, I suggest you get planning.
Thanks and congratulations go to all involved with LifeDeathWhatever; it will have affected people in many ways and I'm just describing one of the areas that it's had impact on me. I hope the team will be able to take LifeDeathWhatever forward; the openness of the conversations should however be all the responsibility of all of us. 

Louise Winter

70 degrees of separation

Many will be familiar with the idea that there only 6 degrees of separation between ourselves and others; there are only a few connections between us all whether famous or not. I'm talking about two different places I've visited where the temperature has been separated by 70 degrees Celsius.

It was early 1999 when I joined palliative care colleagues in a visit to Kemerovo in Siberia where one day the temperature was a challenging -35 degrees; currently I'm in Potchefstroom South Africa where I've been able to enjoy +35 degrees. The link is once again sharing my experiences in palliative and end of life care, recognizing I've worked in this area of practice for 25 years. 
So why here in Potch? My partner Megan has been invited here to be an Extraordinary Professor at North-West University Potchefstroom campus, in the School of Education. As her term of office begins we came here at the invitation of the Uni team. I was just going to be a hanger-on for the two weeks, reveling in the first two week break from work for some time. The Uni team had other ideas and recognizing I had my own area of expertise, in end of life care put me me in touch with the Education psychology and nursing departments of NWU. The upshot has been an opportunity to visit the local hospital and to deliver a presentation to two groups at NWU about ethics in end of life care as well as having difficult conversations. In between we have been able to share meals and time traveling in the area, visiting schools and a game park. All very interesting, though the game park details will have to wait another day. 
The two visits have taken place in places undergoing significant change, in political, cultural and social senses. In addition the organisation of resources for health and education has changed. For brevities sake I'll focus on our current visit, that's starting about 150km SW of Johannesburg.

We have experienced great generosity - time, food and drink, and travel. I hadn't realised just how big a country South Africa is. Our travels have included 3-4 hour drives and we have covered only a small part of one province. We're flying to Cape Town later; the time it takes would get us to the Mediterranean from southern UK. For many here though travel is a luxury with poor public transport; so travel from rural areas to the nearest healthcare provision is only undertaken when you're very sick. The result means many arrive at the state funded hospitals in towns like Potch (where there is no hospice) with advanced diseases and in need of end of life care. Being HIV+ is very common and so is tuberculosis, often going together. Getting people to understand the importance of maintaining the anti-viral therapies and the long  term TB treatments is an important priority. The message of changing behaviour about sex and HIV transmission is loud and strong yet some feel that the very strength of the message over a long  time is counterproductive.

The opportunities to meet students and colleagues at the university and hospital have been invaluable to help understand the joys and difficulties of life here. That people are trying to improve services is encouraging yet difficult given the differences of resource provision between provinces. This was highlighted in the difference in the number of educational psychologists in the Western Cape area approx 130, and the 4 in the North Western Cape where we are. Seeing the expertise and enterprise of North-West University in making links with Potchefstroom Hospital, to the benefit of patients and psychology students has been great to see. End of life care is a big part of what the hospital does so sharing my expertise and stories has been a pleasure and made this leave from work so much more rewarding. It has also helped me to appreciate the fund of examples and experiences I've had, as well as realise there is lots more for me to learn. I'm immensely grateful for the opportunities my career has thrown up; I never expected these travels. I am very pleased though that there is now far less than 70 degrees of separation between my understanding of what's happening in South Africa and my working life at home.

The future of our bones

The last few weeks I have been reading A Tour of Bones by Denise Inge; its been a fascinating and challenging book. Books I enjoy as I have this one, I usually devour quite quickly; the thought provoking nature of this book meant I took it in small chunks.
Denise takes us through her journey through four European charnel houses, visiting them to consider the nature of bones the "enduring and essential ... that remains as flesh falls away". Behind all this is her diagnosis of an inoperable sarcoma that lead to her death on Easter Day 2014. Denise's reflections raise questions about how we live as well as how we might be remembered. We are challenged by the bones to consider the nature of humility and why and how we love.
Though sounding rather philosophical her writings are generous discussions on the natural surroundings through which she travels and the associated writings of earlier travellers as they considered the power of life, as well as the spirit of humanity in those she meets along the way.
Why should you read this book? It has much to say about how we might live our lives, and confront the nature of death too. However we wish our body to be dealt with after dying our bones, and ashes if cremation we choose, are symbols of a life passed, and past. For me it has been salutary reminder that life and death come and go, and that bones who have "lived and loved and suffered and joyed and died" are signs that others have "been where each of us fears and none of us has gone".

The times ahead...

Sharing Times

I have been reading recent news items and blogs all reated to end of life care; a recent blog update from Dr Kate Granger, @GrangerKate and via ehospice profile pieces. Kate Granger is no stranger to many social media users; her open door policy gives an insight into the kind of dialogue an individual can have with the cancer they have. Out of Kate's experience has come the '#hellomynameis...' campaign, encouraging everyone to introduce themselves as they deliver care. Just yesterday, while having a simple ultrasound the technician and consultant introduced themselves and asked a little about me as we got ready; the gel was nicely warmed too. I felt valued, and that my part of the preparation was appreciated making the procedure easier for all.
Reading a piece about the Buddhist approach to the end of life and death; an interesting refresher, I found myself wondering about the reality of mindfulness and meditation when thrust into the milieu of care provision. How far can our minds takes us to places of such self awareness that pain and discomfort are reduced? It was a salutory lesson; I am reminded that there are many people who have experiences very different to me yet our paths will cross because of a diagnosis and care system.
How we treat each other, and the room we give each other to hold our beliefs is critical to our future relationship and the benefit that sharing of our selves brings.

Putting pathways into perspective

Once again I'm exercising the slow blog style; of late the concerns about care pathways have been in the thoughts of many, particularly in end of life care.
The recent report on the Liverpool care of the dying pathway, (LCP)  'More Care: less pathway...' by a group chaired by Baroness Julia Neuberger has led to much soul searching  particularly amongst those who had time to learn how to use the LCP correctly. 

Proper use of the LCP tool (its just one tool - not a whole toolkit) left people at the end of life (who are be believed to be within approximately 72 hours of dying, as far as professional judgement can be accurate) freed from unnecessary treatments and interventions; it enabled all those involved to have an understanding of what was happening, with a mutually agreed approach towards letting the death happen whilst keeping comfort, dignity and respect for the dying person at the forefront of the care that needed to be delivered.
The report speaks of evidence of good practice yet it reaches the conclusion that the LCP should be left behind as, in the name of the LCP, much poor care of the dying had taken place. I believe it likely that the poor care would have taken place anyway as there would have to be a culture of accepting poor care, to allow misuse of a tool such as the LCP.

Healthcare professionals do need to be careful about terms such as care pathway; it is all too easy to take a professional short cut when faced with pressures of work. In the last week research undertaken by Dr Kristian Pollock  highlights the effects busy-ness for care staff has on their ability to interact with the dying person on hospital wards.
So this got me thinking about pathways; whilst taking a train journey a few days ago I listed pathways I could think of:

• Stepping stones
• Gravel
• Wooden deck
• Grass
• Slabs
• Bricks
• Mud
• Tarmac

We have nearly all these in our garden; some very short, not easy or pleasant  to use; others take us on a longer route past lavender and herbs; have better views, and are much easier on the feet. So what's my point?

We should carefully consider facilitating choices for the dying person, beginning with a personalised approach to planning for their end of life. A care pathway that does not allow for deviation from the route is limiting. It's a bit like going round a stately home following the arrows  under the beady eyes of the custodians. Had healthcare workers fallen into that way of thinking with the LCP? Only one way to travel, no matter how welcome or not you may be; ignoring vital information and potential options for alternatives because the 'pathway' is well fixed.

Lets get out the maps, and look at the routes we can travel with the dying person toward their death. We will need to be flexible; prepared to risk going "off piste"; getting dirty and even lost. The important thing will be not to leave those who are dying thinking they are alone. 

Be creative and passionate about what you are doing; take them into your relationship with the dying person while they explore the pathway(s) to take.

The funeral of a friend who was a nurse

Working in palliative care, the end of life is a daily event, but today it touched me personally. I, and many others, attended a gathering and well attended reunion at the local Crematorium. We were there to remember our friend, boss, peer and co-worker. Of course there many family there too. Her husband had also worked with us. Jenni took the development of Willen Hospice, and its clinical services to a point where a 20 bed inpatient unit was complimented by all the community services with back up from incredible fund raising and retail support.
I know too that Jenni would play down her part, understandably pointing to the team effort involved.

Jenni had trained as a nurse, and went on later to manage a variety of services after leaving the hospice. Whilst care of the patients was at the forefront of her mind Jenni also had the care and development of her staff alongside this too. I think this is why so many turned up today, from all sections of the hospice, current staff and those who have moved on or been wise enough to retire. Many of the people there today came from Willen. I was lucky enough to have two bites of the cherry working there, both times Jenni took me on under her wing. In many ways these two appointments were critical to me in the development of my career, particularly in palliative and end of life care, and in taking me forward as a service manager. 

Whatever the role, Jenni had touched all these lives as well as all the lives of all those whom the Hospice has cared for. As such then the turnout today was a reflection of the esteem and affection we had for her. That a malignant disease should be the cause of her death at so young an age is another part of the story. 

Alongside that is her reputation for enjoying a night out. In the company of friends and co-workers the loudest laugh was hers. A love of gin, as well as other drinks if required, fueled many an evening. Of course Jenni loved her job and her family; she will be much missed.
Jenni leaves a significant legacy; people who continue to clean, cook and care for those who are frail and nearing the ends of their lives; those who have been encouraged to take chances, develop as people and as servants of those who need the care.
At a time when healthcare and nursing particularly are being frowned upon, and the NHS seems to be falling apart, I am proud to say Jenni was someone who taught us all how to do it right; how to enjoy work; and how to make a difference.  I am very happy to have known Jenni, though very sad now that she has left our presence. She was a light in our lives, and I look forward to carrying her legacy into the future.

A terrible thing to have to write...

In the last 24 hours a couple of  social media interactions have linked together to cause me to write. One is ongoing and concerns the care of a dying person; having worked in Hospice and palliative care  for a couple of decades I can claim to know something about this. Added to this is my experience of end of life care that started on my first ward as a student nurse, that was even longer ago.    Follow @nursemaiden on Twitter to see the story unfold, in real time.
The other link was made this morning as I read @RoyLilley and his blog piece of today, see It's all going horribly wrong

As a service provider I am dealing with several commissioners, except there don't seem to be any out there. There are well intentioned folk in positions that have no decision making power; there is no-one in place in their organisation who can negotiate or decide what to do about the current financial year let alone the next one. In the meantime services go on being poor inequitable and not joined up. Commissioning is getting a bad name through this; as Roy Lilley points out the layers of interference and in my view obfuscation are causing serious problems;  in particular I find in creating change on the ground. 

We are not seeing a new dawn of person focused services - despite the efforts of providers to work that way; we are seeing a shuffle of the layers of control - a shuffle in inexpert hands that will be a whole lot messier than 52 card pick up. It is leading to a dying of the light in which the rules and regulations over reporting and numbers will lead decisions on the provision of care. I'm not convinced that concerns about the money (spending or saving) are behind the decisions; only being in a place where having control counts.

All around us though the dying, frail and vulnerable of all ages are only being supported by dedicated on the ground staffs day by day. Often they are kept from doing the right thing by the 'rulers' or vacuum and this is leading to provision of poor, less than best services and no sign that things will improve soon. That is a terrible thing thing to have to write in 2012.

Ars Moriendi: The art of dying - Wellcome Collection

Ars Moriendi: The art of dying - Wellcome Collection
This looks fabulous; see the link below left to the Wellcome blog for the artist Joanna Walsh's inspiration and ideas. It captures hospice life so well; the exhibition will be well worth the diversion - just 5 minutes from Euston Station. Go in there!