Dazed and Confused! – why the NHS makes it hard for patients to get it right

Michaela Finegan

minor injury sign

The DVLA tells us that these signs are for  ‘INFORMATION’. You must have seen a sign like this? You may have one in your town. This one made me so angry, I stopped my car  (safely I may add) to take this photo.

A sign for information…. Really?

So…. the big REDrectangle with a big WHITE ‘H’ on it, creates a reaction. The colours create imagery; the phrase  ‘blood and bandages’ I can hear my mum say.

The red means URGENT, STOP, And EMERGENCY. Red is a colour of strength, it is the colour of blood and it creates an emotion.  It is a passionate colour. It is telling us something  – take note!

The ‘H’ will mean HOSPITAL even to people who can’t read.  Hospital is an emotive word, a word that creates a picture in one’s mind. Hospitals are places of births, deaths, emergency, accidents, wards, corridors…

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How to feel good ? BE POSITIVE & PROUD – An antidote to negative thought

   

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My jacket pin – that I do wear with pride 

I spent the day with NHS England colleagues today. You know ‘us’ ? The NHS staff saved from redundancy, placed in new roles, with new job descriptions in new organizations, with new areas of work, in new work bases …you know ‘us’, a little bit scared, stressed, excited and optimistic all in equal measures.

I am not asking for any sympathy, I realize that in a country today we are lucky to have jobs. I feel lucky that I am in a job, being paid to do something where I feel I can make a difference and contribute to a greater good, our NHS. Our NHS, which is now 65; a pensioner of a service!

So what is my gripe? Well, I just want some positive reinforcement of what the NHS is doing!

To be honest, I am ‘sick’, totally ‘sick and tired’ of hearing what’s negative about our NHS.

I’m not stupid, neither are my colleagues! We KNOW what is wrong with the NHS. We know about Mid Staffs, we know about fragmented services, lack of staff on wards, the need for money in some areas, the need for improved care, the issues with ‘111’, the need for compassion and respect. We understand a mum does not want to wait in A&E for 3 hours and 55 minutes on a Friday night with a sick child. We understand some people don’t die where they wish, that people didn’t always get the food, the drugs and the care they should have.

We know why some of this has happened, and we also understand the ‘Politics’ and what a  ‘hot potato’ the NHS is. That policy does not always align with the ‘real world’ and that peoples voices are not always heard. We know , and we try to work with it .

I accept that some of the NHS has NOT done their best. I agree the NHS is NOT perfect, but do people REALLY think NHS staff wake up each day with a plan to do a terrible job?

We know some things are not right …all we need to do is pick up the Daily Mail to be bombarded with such news (I must admit I cant do this as I come out in a rash!). I know a ‘good NHS story’ may not sell papers, but it will do a hell of a lot for the morale and motivation of the staff. As well as do a lot for the confidence and anxiety levels of a patient.

So as a leader, when things go wrong, what do you think is the best thing to do? Do you think on a daily basis, you should tell your staff what a rubbish job they are doing, that they are useless, uncaring uncompassionate beings? That it is their fault, or at least it is not YOUR fault that something has gone wrong?

What would Tesco or John Lewis do? I think they may apologise, attempt to rectify the problem, keep open and honest communication going and to keep listening. Learn from things; but turn a negative into a positive.

If your child does something wrong; fails an exam, falls off their bike, drops a glass, makes a spelling mistake, what would you do? Would you tell them they are stupid? Tell them they are useless? Or would you sit with them, talk to them, listen to them, help them understand what went wrong and how best to fix or improve next time?

We MUST listen to what people tell us, LEARN from it, keep communications channels open and do our best to FIX THE PROBLEM. And share this with others. We MUST look to what is good, yes learn from what didn’t work, but look for what DOES work.

Find the notice board in every ward, which shows the new ‘Thank You’ cards, consider the smiles and the appreciation when we deliver the service the patient expects. The relief on faces when something is done as promised. For every negative story we are faced with, find the ones that are positive.

Consider the ground breaking medical procedures we can give to our citizens, the IVF programmes, the artificial limbs, the drugs, the diagnostic tests, the transport in an ambulance or helicopter and (at the moment, mostly) without a bill.

Lets celebrate the good, share success.

 So I am proud and also thankful. I am thankful for the surgeon in Oxford who cut away a brain tumor troubling my dear friend. Thankful for all the staff who cared for my mum when diagnosed with breast cancer, the nurses who administered radiotherapy with care and respect, the compassion of the District Nurse who quietly told me if was not a good idea to be too far away from my Mum as she ‘didn’t have long left’. This allowed us to spend time as a family, with my mum, at home for her last days. Giving my Mum the peace she wished for and in the place she wanted to be.

I am thankful for the people who safely delivered my two boys, and cared for one in Special Care Baby Unit. Thankful for those who supported me with dignity and empathy when I miscarried a baby. Appreciative of the nurse who asked if I wished to have the baby’s name recorded in a book of remembrance.

The GP who listened to me and promptly referred me ,over  a Christmas period for diagnostic tests and the consultant who held my hand as I cried when I thought I had the same cancer that so cruelly took my Mum.

The care in A&E, late at night when my Dad was rushed in with suspected appendicitis, the porter that walked me to tea machine when I was tired I was lost. The nurse that placed her hand on my Dad’s shoulder, when he was frightened and worried about a procedure. These are just a few of MY experiences, across a few years. I am sure you have your own, some could have been better but I’m quite sure there is good in those experiences too. Imagine the positive experiences of the MILLIONS in our country since 1948!   

Can we not just remember these too, bring these to mind as we work, as we communicate, as we share and we re-build our networks and community. I am in no way making any excuse for what has gone wrong and I feel so desperately sad and disappointed for anyone who has experienced poor quality or unsafe care. But we MUST consider the good too.

Positive thoughts and sharing a smile, a ‘good patient story’ is just as powerful. I want to remain ‘Proud of the NHS’, proud of what is happening each and everyday in practices, ambulances, hospital wards, the community …proud of emergency practitioners working through the night, those on call for any potential emergency, those who deal with drunks, abuse, and still administer and deliver good quality care, those who plan and improve services, proud of staff who keep our hospitals clean, proud of those who manage our finances.

I’m proud to be a part of our NHS.

Lets join together in being proud, lets be positive and lets do our utmost to fix what is broken, tired and poorly in our ‘pensioner NHS’. Make sure we have this service fit for our futures and that of our children and grandchildren.

Spend money like it was your own money, only commission or provide services you would wish your family and friends to receive!

BE POSITIVE, BE PROUD and at all times, remember we are here to serve others!

 

To conclude – a student nurse  Molly Case, who expresses what it is like to be a nurse. Beautiful , a must watch . ‘Nursing the nation’ http://www.youtube.com/watch?v=XOCda6OiYpg

And some music , a little cheesy you may think , but I think it is an amazing song. What have YOU done today to make YOU feel proud?  Heather Small – Proud 

 http://www.youtube.com/watch?v=LEoxGJ79PMs

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The Curse of Management Speak and how to AVOID it

Michaela Finegan

david07

photo from the BBC website

“Set out to leave the first vapour trail in the blue-sky scenario.”
David Brent, The Office 

So now I have settled into sharing my thoughts on communications, I feel I am with friends and therefore will share my pet hate. Now I realise ‘HATE’ is a very strong word; a word I tell my children not to use, but  in this instance, I give myself permission.

It is my offering for ‘Room 101‘….. MANAGEMENT SPEAK

You know the stuff…the ‘blue sky thinking’ , the ‘thought shower’ ( apparently there was a time when ‘brain storm’ was considered offensive!), ‘pushing the envelope’!!!!!

REALLY ? I mean …..are you serious?

How can anyone keep a straight face when uttering these words? I’ve been in meetings where I have had to avert the eyes of fellow conspirators who also find the words amusing ( you know…

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The Curse of Management Speak and how to AVOID it

david07

photo from the BBC website

“Set out to leave the first vapour trail in the blue-sky scenario.”
David Brent, The Office 

So now I have settled into sharing my thoughts on communications, I feel I am with friends and therefore will share my pet hate. Now I realise ‘HATE’ is a very strong word; a word I tell my children not to use, but  in this instance, I give myself permission.

It is my offering for ‘Room 101‘….. MANAGEMENT SPEAK

You know the stuff…the ‘blue sky thinking’ , the ‘thought shower’ ( apparently there was a time when ‘brain storm’ was considered offensive!), ‘pushing the envelope’!!!!!

REALLY ? I mean …..are you serious?

How can anyone keep a straight face when uttering these words? I’ve been in meetings where I have had to avert the eyes of fellow conspirators who also find the words amusing ( you know who you are !). I struggle to keep a straight face just LISTENING to them.  Now I am a professional woman, doing a professional job, but I do despair. My current ‘anti’ favourites are as follows:

  • the ‘burning platform’ – ok I get the concept, if there was a ‘burning platform’ you would have to do something about it, but for goodness sake , it sounds mad. Why not say ….’ we have to do something about XXXX and we need to do it now!’
  • the ‘straw-man’  – yes another one I understand, its an outline or a basic plan but other than in The ‘Wizard of Oz’, I have never come across a straw-man.
  • ‘end of play’...what ??? What does that mean exactly? I enjoy my job but I don’t play at it ?  We are not at school and have ‘playtime’.  Just tell me when you want whatever it is by? By 5:00pm, 5:30pm, or by 3:00pm so if needed, a hard copy can be posted somewhere ( the Post Office van comes early in our office).  JUST TELL ME  A DATE AND TIME – BE CLEAR!
  • ‘drill down’ …I do wonder if this has something to do with the ‘burning platform’? So you want me to ‘drill down’ ? Well I am no engineer but I will do my best to find out the detail you may need. But give me a pneumatic hand drill and I think you are asking for trouble.
  • ‘outside the box’  – I have not , other than as small child playing ( didn’t we all do this?) , been in a box. I will expect to be ‘in a box’ only when I pass to the next world! Do me a favour , we do not work in or out of boxes.
  • ‘light bulb moment’  – eh ?  Oh ! You mean you understand, you get it , not that , like a cartoon character, you will suddenly have light-bulbs appearing over your head. You are NOT in  ‘Tom  &  Jerry‘!
  • ‘blue sky thinking’ – I live in England…..a green and pleasant land. Why it is green? Because it often rains! We have many grey days with clouds but even so , my colleagues …(not ‘co-workers’) and I have managed to be creative even though we do not live in Bali… PLEASE STOP the ‘blue sky thinking’ stuff…..it doesnt work in good old Blighty!

Management speak does not make things clearer, it complicates, confuses and creates divisions in groups. It also often sounds really stupid. So , have I convinced you ? Do I get management speak into Room 101, or am I destined to be the ‘blue sky thinking’, ‘straw (wo)man’ , ‘pushing the envelope’ having a ‘lightbulb moment’ on the ‘burning platform’?

I will let you be my judge……but if you use those phrases, please do not be offended if you find this ‘co-worker’ in stitches.

You can also see my previous blog on 3LAs or ‘three letter acronyms ‘ https://michaelafinegan.wordpress.com/2013/04/10/an-nhs-disease-the-rise-of-the-3las-and-how-you-can-stop-it/

As usual I suggest a track to go with my blog, what came to mind was the brilliant ‘Keep Talking’ by Pink Floyd. However most of their tracks are not on YouTube, but here is the beginning section of that track featuring the genius Stephen Hawkins. Very wise words. http://www.youtube.com/watch?v=mZB-8FpkgSI

The wonderful ‘ Everybody’s Talking at me !’ by Nilsson http://www.youtube.com/watch?v=2AzEY6ZqkuE

another full track to enjoy ‘Ramble On‘ by Led Zeppelin http://www.youtube.com/watch?v=sS8hHfn-aaY

LINK to Guardian article  http://m.guardian.co.uk/books/2013/apr/25/top-10-worst-management-speak

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 Have Courage, Embrace Uniqueness ! In appreciation of Turing

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I live in the town known as ‘Home of the Codebreaker’s, Bletchley (http://www.bletchleypark.org.uk) . My house is so near to the amazing Bletchley Park; Station X, I can experience the  occasional Lancaster Bomber or Spitfire  roaring overhead when there are special events. Quite a treat!

I have developed a real passion for the amazing place and the story of the genius, Alan Turing. Alan Turing worked at Bletchley Park during the Second World War and was instrumental in code-breaking messages of the enemy , thus shortening the war and saving countless lives.

This weekend I was fortunate to be a member of an 80 strong audience  who witnessed the amazing ‘The Universal Machine’ at the New Diorama Theatre in London ( see http://newdiorama.com/whats-on/the-universal-machine).  An amazing cast beautifully told the tale of Turing’s life and death. Catch it if you can , but I believe it is a short run production. Here’s hoping it makes a national tour!

enigmacast

The Enigma Machine I learnt to use  &  The cast of Universal Machine

In 1954 Alan Turing, the man who is known as the ‘father of the computer’ and  artificial intelligence,  was found dead at his home next to a half-eaten apple laced with cyanide.

He was only 41 years old.

His death, recorded as suicide , occurred just over two years after he was arrested for ‘gross indecency’ and subsequently tried and sentenced to ‘chemical castration’ with female hormones. This was in mid 1950’s! Not Victorian or Tudor times, but the 20th Century.

To add some context  in the same year, 1954: Roger Bannister becomes the first person to break the four-minute mileTolkien‘s The Lord of the Rings  was first published, Annie Lennox, Adam Ant and Elvis Costello were born, so was John Travolta and Oprah Winfrey.

It is not that long ago….and yet this genius was persecuted and treated in the most appalling manner.

As you reading this blog on your PC, a smart phone or ‘tablet’ , please pause and think about the immense contribution of  Alan Turing. Think about what we consider to be ‘essentials’ of everyday life , consider the concept of ‘smart’ intelligent machines; surely Apple ‘Siri’  is the ultimate result of Turing’s dream ? Pause too, to contemplate  the bitten apple with cyanide…may be an urban myth, but now look at the Apple logo , is this homage to Turing?

Sadly Turing’s dreams descended into nightmare as he was forced into a life of shame and was stripped of the things he had earned. However, on 10 September 2009, following an Internet campaignBritish Prime Minister Gordon Brown made an official public apology on behalf of the British government for “the appalling way he was treated”. There is a copy of the ‘apology’ at Bletchley Park in a special exhibition.

Apart from sharing my feeling of shock, disgust and sadness , I wonder, have we learned from this ? Did ‘we’ persecute Turing to such an extent he felt no choice but to end his brilliant life , at the age of 41. What did the world not achieve, losing this genius at such a young age?

Consider differences as a gift, to share , to learn from each other. Consider the person who is bullied and consider their individual contribution to life . We are all UNIQUE and that is something to cherish not chastise.

Have courage …..stand up for others , even those who may be considered ‘different’.

 

And a link to a very beautiful and reflective Zeppelin track , Ten Years Gone…then as it was , then again it will be. http://www.youtube.com/watch?v=jYpydtdlWxA

and the devastating but powerful Hurt by   Johnny Cash – http://www.youtube.com/watch?v=SmVAWKfJ4Go

Interesting  links :

http://www.bletchleypark.org.uk

https://en.wikipedia.org/wiki/Alan_Turing

http://newdiorama.com/whats-on/the-universal-machine

http://www.guardian.co.uk/stage/2013/apr/29/the-universal-machine-review1

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Dazed and Confused! – why the NHS makes it hard for patients to get it right

minor injury sign

The DVLA tells us that these signs are for  ‘INFORMATION’. You must have seen a sign like this? You may have one in your town. This one made me so angry, I stopped my car  (safely I may add) to take this photo.

A sign for information…. Really?

So…. the big RED rectangle with a big WHITE ‘H’ on it, creates a reaction. The colours create imagery; the phrase  ‘blood and bandages’ I can hear my mum say.

The red means URGENT, STOP, And EMERGENCY. Red is a colour of strength, it is the colour of blood and it creates an emotion.  It is a passionate colour. It is telling us something  – take note!

The ‘H’ will mean HOSPITAL even to people who can’t read.  Hospital is an emotive word, a word that creates a picture in one’s mind. Hospitals are places of births, deaths, emergency, accidents, wards, corridors, blood, life, operations, sadness, happiness, doctors, nurses, the elderly, babies, healing, care, compassion, fear, love…all of this and more.

A hospital, the NHS, staffed with professionals, people to help us, free at the point of care and open every day, 24 hours a day.

But hang on a minute ……….

This sign, to those who can read, tells us it is NOT for a hospital but a MINOR INJURY UNIT. If my child is hurt, that’s not minor, that’s important!  My interpretation of course, but I’m allowed that. I may think less rationally if I am worried, upset or in a hurry to resolve a situation…..and I’m sure I am not alone in that.

Our belief is that our NHS Hospitals are open 24/7, 7 days a week… this one says it is “NOT 24 hours”! My question is then, when IS it open?  Is it 2 hours a day or 23 hours a day? One day a week? Or is it 2 – 4 hours between Mondays to Friday with lunch at 1pm-2pm having a reduced staff  ‘out of hours’ (and a shift that may not be able to prescribe medication) at a weekend??

How very helpful NHS!

So, people turn up at A&E because it is OPEN 24 hours. We know A&E will deal with things that are not MINOR.  People will do that very thing; turn up at the place they understand, they trust, they know the opening hours of…. and we, the NHS…shout at them for ‘inappropriately using NHS services’!

I won’t now share thoughts on communication of urgent care centers, ‘out of hours’ services, NHS Direct (a fan!!), 111 (jury is out) but it begins my argument for appropriate communications and social marketing. (For more see first blog on urgent and emergency care at Easter).

I believe in the NHS 100%.  I understand the pressure and constraints (As I worked on urgent & emergency QIPP programme at DH, I really do understand, really I do!) but we must do something about how we communicate to patients…

…And at least stop telling them THEY are wrong!

And in the best style possible ……….I share the Led Zeppelin masterpiece that is Dazed & Confused. This is a 10 minute live track, enjoy and revel in the confusion!

http://www.youtube.com/watch?v=pau8Zf7srlU

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Hey, hey what can I do? – tips for boosting morale

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( my graphic of a shared team purpose)  

 

I am fortunate that living in Milton Keynes I have access to Open University Business School meetings. Every few months there’s a breakfast briefing for local networking and to share learning. The most recent session was about ‘Moral & Motivation’ delivered by the engaging Ben Hardy. (www.open.ac.uk)

Ben recapped motivation theories. You know the kind of thing, incentive based, Maslow’s Hierarchy of Needs, goal setting and process theories. All valid and have their place BUT the key message to me was the importance of the ‘human’ element. The bit that makes us individuals, makes us feel, drives us to achieve, defines our values and behaviours. The message that we should keep this at the forefront of everything we do with our interactions with others.

There was some discussion about the ‘value’ of good morale and motivation on the bottom-line.  Is it the fact that we do a good job, being efficient and effective, that increases moral? Or is it by having a good motivation and ‘good morale’ we are more productive and do a good job? Discuss!

Ben then spoke about the ‘composition’ of morale, which he described as a mix of;

  • Interpersonal – The SHARED PURPOSE, the ‘stuff that binds us’. The idea that when people work well with each, it improves morale. The concept of culture and the importance of the ‘how WE do things round here’. We know that motivated people are the ‘glue’ that keeps a high performing team together. We also know poor relationships at work or in a team will lead to stress, poor performance and poor moral. Breakdown in relationships at work can be devastatingly destructive.  Being on the same ‘side’, working on shared, purposeful goals is very important. What can YOU do to support  this?
  • Future goal based – The WHAT WE DO! We all need clear direction and focused achievable goals. We also need to monitor, measure, as well as have a sense of achievement and share in celebrations. When there is no clear direction, it can lead to destructive organisational politics and breakdown of individual focus.  What can YOU do to ensure clear goals and joint celebration?
  • Emotional aspects – The SENSE OF BEING, the THANK YOU! Such a very important phrase (see my previous blog ‘Is ‘Thanks’ not ‘sorry’ the hardest word? The power of saying ‘thanks’ to others, but being specific, intentional…and MEANING IT). We all need to feel valued, to have a sense of worth and purpose; including a shared purpose. We need to know we are making a difference, that what we do has a value. Please use your ability to say ‘Thank you’ and share your appreciation of others. So, what can YOU do today?

 

The discussion made me ponder – what is ‘morale’? What is it that creates that sense of purpose in others?  It made me think about what I can do to help others with a feeling of ‘belonging’. To me it is the simple things we all do which creates the culture and the ‘team’ which includes breaking down hierarchy, being honest, creating an environment of trust and being inclusive.

I think it is key that we communicate, learn about the others you work, or play with. Listen to them; learn about what is important to them. I urge you all to consider YOUR part in creating a ‘shared purpose’ and contributing to creating a positive moral wherever you are, at work, in a football team or at home.

We ALL have a part to play and need each other to ensure we achieve what we all aspire to.

 

 

 As you would expect there is a link to a fantastic Zeppelin track ‘Hey, hey, what can I do?’ This version is being performed by the wonderful Plant & Page during an American tour in the 1990s. Beautiful

‘I wanna tell her that I love her so! The only one I really love!’

So, tell somebody that today! Enjoy  http://www.youtube.com/watch?v=qtRrhm2ArdA

 

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Is THANKS, not ‘sorry’ the hardest word?

Thank you! in typewriter

Is THANK YOU, not ‘sorry’ the ‘hardest word?

Isn’t it amazing that a few letters can be so powerful? Sometimes hard to say?

The power of a word or few words is truly immense, but not always in a positive way. I am reminded how NEGATIVE words can be, and that negative words have three times the impact of POSITIVE ones.

The word BUT is a prime example….’that was really helpful BUT…’. It will be the BUT that is remembered and not the useful comments that may be contained in the sentence. Why not try – ‘that was really helpful’ AND, or ‘that was really helpful, SO…’ And try saying ‘please can you do’…rather than ‘please don’t’. This I find is especially useful with children.

Negative words even in a positive sentence can also have a detrimental effect. When someone says ‘thank you’ and you respond ‘No problem’; what may be ‘heard’ is the word problem, which has negative connotations. Instead try, ‘I appreciate that’, ‘that’s very kind’ or ‘I’m pleased that worked well for you’ / ‘I’m pleased you found that information helpful’. Whatever is appropriate and please BE POSITIVE.

Thank you is a very powerful statement!

Why not make a pledge to say ‘thank you’ more. Not just when someone opens a door for you (the basics of manners!), but to intentionally feedback and say ‘thank you’ whenever it is due. When someone does something for you, shares information, and even when someone complains. A complaint is a ‘golden opportunity’ to improve and make a positive change in the future. It is far worse when someone doesn’t feedback and shares their thoughts with others, or takes their business elsewhere!

Anyone with managerial responsibilities please say ‘thank you’ to your team.  Say ‘thank you’ by telephone, by email, or go wild and produce some hand- written signed notes! Do you know how much they are worth to the recipient? How much goodwill and commitment this could this create?

I have a file of ‘letters, emails, cards and notes that I have collected over a number of years. They mean the world to me. These scraps of paper remind me of occasions when someone felt I MADE A DIFFERENCE, my contribution was recognised, my input was useful and I had a value in someone else’s eyes. These pieces of paper make me feel good!

And just imagine, parents or grandparents amongst you; the impact a ‘thank you’ has with your children or grandchildren! Priceless.

We all need positive reinforcement. It’s not about hierarchy or job titles; it’s about basic needs. You have that power… use it! And;

 

  • Be honest
  • Be specific
  • Be genuine

To me ‘thank you’ is precious gift, as long it is given with honesty and genuinely intention. I have made a pledge to say ‘thank you’ more; to recognise the effort, kindness and generosity of others.

So please join me in saying ‘thank you’, with sincerity, when it is due. Eight letters, arranged in a simple phrase and really easy to say.

And while we are at it, what about another powerful arrangement of eight letters…..  I LOVE YOU …but that’s another subject altogether. And probably worth some real thought!

 

And for one of the most beautiful Zeppelin songs ‘Thank You’, click here http://www.youtube.com/watch?v=Jc-EdW1amwg

And a very genuine ‘Thank You’ from me for reading and sharing this.

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An NHS Disease; the rise of the 3LAs – and how YOU can stop it!

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“Knowledge is power” – Sir Francis Bacon

I believe ‘language’ can be very powerful. Consider knowledge of ‘language’; a language that can create an air of superiority and mystique. A language that creates a sense of shared purpose, building a community with its own ‘tribal’ communication. This powerful language makes those in the group feel comfort and gives them a sense of belonging.

However for those outside the ‘tribe’ it can result in feeling marginalised. At its worst, it could result in coercive or bullying behaviour making the ‘listeners’ or recipients of the tribal language feel demotivated, less worthy, even stupid. As we know, power can be used to create positive change, used for the common good, but the flip side is that power can be very destructive.

In my opinion, we use ‘powerful’ language too much in the NHS and it’s about time we do something about it. I would like you to join me in my mission!

To help you decide, I will share some examples of ‘NHS speak’. The NHS Confederation has a great ‘Glossary of Terms’ App you can download via the iTunes App Store. I will use this as a ‘Glossary of NON Terms’ to learn as many as relevant, so I can use them in their entirety and not as abbreviations.

I start with 3LA – or three letter acronym, a potential cause of this NHS disease.

Acronyms and abbreviations are scattered across NHS documents, websites and letters. They are used in patient’s records, on information signs and repeatedly spoken in meetings up and down the country. Sometimes NHS staff hearing them will be confused, although they may not admit it.

So let’s start at the top, with the Department of Health or DoH. Now due to the popularity of a certain Homer Simpson we MUST use the acronym, DH.  Think about it ?!…..DOH!

Some 3LAs, are ‘words with two meanings’ …Zeppelin fans, we will come back to this! Routinely we use acronyms that have multiple meanings and we wonder why people get confused?  In a general practice meeting, I recall a male GP talking about ‘challenging PMS’. My first thoughts were that it was inappropriate to be talking about such a delicate matter. I soon realised he was talking about Personal Medical Services, not Pre Menstrual Syndrome! Nowadays though it could be PRIVATE Medical Services.

Do you get effective PPI (patient & public involvement) and PPE (patient & public engagement) in a PPG (practice participation group)? A point to discuss maybe?  And don’t confuse DNA (did not arrive) with DNR (do not resuscitate) – could be tricky!

There are also 2LAs – but is IP and in- patient or an information prescription? Guess it depends on circumstance but this could be awkward at best, risky at worse.

Acronyms or abbreviations are used to describe job roles and organisations. Hopefully we won’t confuse a HCA (health care assistant) with a HCAI (health care acquired infection) or an ECT (enhanced care team) with ICT (information and communication technology) or even and ICU (intensive care unit).

Theres some very dubious team names too. Who really wants a Fast Action Response Team ( thanks Mandy for that example) and what about the Health Improvement Team (HIT) who  considered adding the word Strategic to their team name title …. they didnt!

The new landscape of the NHS has given rise to new organisations. For example CCGs   (clinical commissioning groups) , PCTs (primary care teams NOT primary care trusts). We say goodbye to the NHSI and now have NHS IQ (NHS Improving Quality). We  lose lose  LinKs (Local Involvement Networks) but gain HWBBs (Health & Well Being Boards. Emerging are AHSNs(Academic Health Science Networks), SLETBs (Local Education & Training Boards), SCNs (Strategic Clinical Networks), LATs (local area teams) and RATs (say nothing) which are REGIONAL Area Teams. We have CSU (Commissioning Support Units, which support the CCGs and PCTs. However when I worked in the local hospital, or the FT (Foundation Trust) as it is known today; CSUs were Clinical Service Units, Clinical Support Units or Clinical Supply Units! I am now confusing myself.

They are also Royal Colleges; the RCN for nursing, RCGP for general practitioners, RCP for physicians, RCM for midwives and RCS for surgeons. Keeping up? But what’s the RCT? The Royal College of Therapists…no! …. no such thing, it means random controlled trial.

And when it comes to patients, there are some horrible acronyms. One of the worse is H2R which is a ‘hard to reach’ group. I was once told, there is no such thing as ‘hard to reach’, its just the NHS not ‘reaching’ in the right way. Another horror is BME (black & minority ethnic groups), not to be confused with AME ( annually managed expenditure) or BMA (British Medical Association).  

Now I apprecaite that medical acronyms are often useful, but not when communicating to patients. There’s not the time to detail medical diagnosis acronyms, or diagnostic test acronyms, but suffice to say, a CAT is not  a fluffy pet but a computerised axial tomography scan , or is it ‘crisis assessment &  treatment?

STOP!  Are you convinced? I hope so.

There is a need for change and the time is right. I’m looking for others to join me in my crusade. My ‘ask’ of you is to PLEASE consider dropping the 3LAs.  The clever ones amongst you will realise that was a call to action or ‘C2A’. I want YOU to think; really think about the language that YOU use and how you can ‘de mystify’ it, simplify it. Lets join together to get a movement of like-minded people to use ‘plain English’. The vision is we will really understand each other  make our communications with patients clearer and be ‘as one’.

Next time I will tackle ‘Management Speak’ …a whole other ‘ball-game’ on a ‘burning platform’!

 

After all that I need some Zeppelin and the perfect track is ‘Stairway to Heaven’ , with the line “Cause you know sometimes words have two meanings”. Well put , Robert.        http://www.youtube.com/watch?v=9Q7Vr3yQYWQ

Now if you can stomach it, there is a little story made up of a number of acronyms. There’s a prize for the first person to successfully decode it. Contact me via the blog or Twitter @michaelafirth8

In my role as a HCA in a FT A&E, I saw a BME patient arrive by SAS to the CDU. They had been seen by a CCP, or maybe it was an ECA as they’d been in a RTA. The patient was admitted to a RTT and the SHO then got them moved to ITU. The IP was then referred for a CAT scan as per the EBH and EBM. After a few days, they were moved to a DSU in a DTC but had a DTOC to the PCO. But at least it was a FCE! Good job there was an EPR for the ETP. But a question is, was there SDM or even PPI or PPE in this case?

 

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Communication Breakdown- Ask don’t refer!

A-Mistake-Is-To-Commit-A-Misunderstanding

NB: image  from tumblr.com

COMMUNICATION BREAKDOWN – ASK DON’T REFER

We have all heard of the concept of ‘walking in another mans shoes’ (personally as I favour 3-4″ inch heels, I’m not sure ‘men’s’ shoes would suit me). But joking aside, we best understand others when we get into their heads, discover what makes them ‘do what they do’.

This is the essence of ‘social marketing‘, which cleverly uses ‘insight’ gained by various means, to give an understanding of people’s behaviours. When you use social marketing techniques, you start with the person, really understand them and then craft messages and interventions to change specific behaviours. In classic marketing, you tend to start with a product or service and then craft messages relevant to specific segments and ‘push’ them out.

Social marketing was first used in the 1970s and the idea was to change behaviours for ‘social good’; for example getting people to wear seat belts, to recycle and to save water. I studied ‘classic’ marketing and although there are many similarities, the main difference is the real understanding of behaviours. The real insight gained to craft appropriate messages, but also to link to policy change and service reconfiguration. Interestingly, it could be argued that the main driver in reducing the numbers of people smoking was not the medical information on the damage you can do as a smoker, but the  ‘ban’ on smoking in public places.  Thoughts please!

So, lets consider some of the messages we in the NHS ‘push’ out and the potential breakdowns that poor communications can cause.

Please picture a young woman who is pregnant and still smoking cigarettes. A well-meaning practice nurse or midwife will encourage the young woman to stop smoking to prevent ‘having a small baby’. The medical aim is to ensure the mum-to-be is fit and well and not causing any damage to the unborn child. To a clinician, it is a no brainer!

Now, to the young girl, who is frightened of pain, has heard horror stories of difficult births and is surrounded by peers who are pregnant or have been pregnant ans still smoked. To that girl , a small baby is just what she wants. In her mind there will be ‘less pain’ and ‘less problems’. The mum-to-be and the midwife exist in the same world but have very different outlooks. How do you deal with that? This is the opportunity to adapt your medical message relevant to the insight you have gained.

Consider the same mum-to-be who is then ‘referred to a smoking cessation clinic’. Now, lets be honest, how does that sound?  Being referred…. to a smoking cessation clinic

Come on, let’s get real!

This young mum-to-be may tell us;  firstly…… ‘I’m not ill’,    secondly, she may say…… ‘ask me to come and talk to you about smoking!’, ‘don’t treat me like I’m ill, and I’m bad!’  And lastly ‘what the @@@@ is smoking cessation?’

These are words and phrases we choose to use in the NHS.  We construct an NHS language that creates elitism, a language of power.

Lets stop the Communication Breakdown…. lets live in another mans, or woman’s shoes and lets think about the words we  ( Jimmy) ‘Choos’ to use which may have a negative impact on others.

And as a gift, here is a live version of ‘Communications Breakdown’ from my favourite band, Led Zeppelin

http://www.youtube.com/watch?v=KqF3J8DpEb4

and  very gratuitous shots of some of my favourite shoes

CIMG1378CIMG1390

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More than Words: quick wins from small changes for clinicians and patients

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words*  – 1. A sound or a combination of sounds, or its representation in writing or printing, that symbolizes and communicates a meaning 2. A verbal signal; a password or watchword *http://www.thefreedictionary.com/words

Have you ever considered how a small change in the choice of words could have a huge impact? I believe there are opportunities to improve ‘day to day’ clinician and patient conversations by making small changes. I offer you two examples.

1. “What’s the problem?” or “What can I do for you?’ – How often have you asked or heard these questions? Are they helpful? I suggest, no.

They are a good start though. These are ‘open questions’ and therefore more effective than ‘closed questions’ which in most cases elicit a ‘yes’ or ‘no’ response. This can lead to having to ask more and more questions to get to the real issue. This takes up precious time.

My response to “What can I do for you?” could be; “Well Doctor, I have a stack of ironing at home I’m struggling with, but that’s not why I’ve come to see you today”. But I guess that’s not helpful either!

I would suggest there are better ‘openers’ to the conversation. You would certainly get        more from me as a patient, if you ask: “What reason have you come to see me today?’            or  “What questions do you need answers to?” or when appropriate, “What is worrying            you the most about…”

In many practices and outpatients departments’, consultation times are being squeezed.         So we need to make the most of the time we have together. We need to support better   ‘shared decision making’ and improve our communications. Consider how to re-frame your questions to elicit the best responses, using positive language. This is true of both clinicians and patients and the benefits can be great.

NB: A fantastic example is the ‘Ask 3 Questions’ Campaign. The patient asks pertinent questions and in turn clinicians think ahead about how these questions can be answered      and how a ‘shared decision’ can be reached. See http://shareddecisionmaking.health.org.uk/approaches-and-activities/case-studies/ask-three-questions/

2. ‘Come back and see me in about two weeks’ – This is a common message from a GP or Practice Nurse to a patient. However, consider the ‘instruction’ within this message. If a two-week gap is medically appropriate, it may not be urgent but it is important that a ‘follow-up’ is required. But consider, if you are seeing this patient on a busy Monday morning, when you are already running late, you have extra ‘urgent’ appointments being slotted into your afternoon and so it is looking like you will be going home late ……….why ask them back again on a Monday? Patients will often take such requests literally and will tell the Receptionist that the GP or nurse  ‘told’ them an appointment was required on a Monday.

Be clear, be specific and think about possible outcomes.

Consider asking the patient back on a Tuesday afternoon, or a Wednesday morning, or whenever you have a lighter workload, but of course, within the timescale you determine medically appropriate. The benefits will be the patient will be seen appropriately but they won’t have to ‘fight’ for a Monday appointment and clinicians can manage busy days better!

So, small changes, BIG impact.

And to finish, and in line with my love of music, I give you: ‘More than Words’ by Extreme http://youtu.be/UrIiLvg58SY

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Will Accident and Emergency ‘crack’ under the strain this Easter? Top Tips using Social Marketing

FANTASTIC! A four-day weekend, two Bank Holidays and time off word – but not so,  if you are a hard working member on shift this weekend at your local Accident & Emergency Department. Spare a thought for them.

It has been recently reported in the press and via social media channels such as Twitter that Accident & Emergency (A&E) services in England are not just under pressure but at breaking point. The Guardian March 2013 stated that “32 out of 88 hospitals were failing to treat patients in the 4 hour ‘target’ time” (1). They said ” the latest figures from Monitor, which regulates semi-independent NHS foundation trusts, are the latest evidence to emerge that hospitals are struggling to deal with ever-increasing numbers of patients turning up in A&E”.

They  blames the rise on a number of factors including  winter vomiting bug, delays in discharging patients due to poor community health service, and that increasing numbers of older people need care. Most very medically appropriate attendances, BUT there are also a number of people who arrive in A&E that really could have been appropriately treated and cared for in alternative settings.

This anecdotal evidence was confirmed with insight and information from a research programme I was involved in when working in South Central PCT Alliance in 2008. The research  was undertaken by McKinsey/SMSR and gave us 6 ‘behavioural types’ or segments of ‘non- urgent’ A&E users. They included the ‘one stop resolution’ user who attended A&E because’ it was open’ and ‘they could get everything resolved in one go’, when interviewed they didn’t really know of any alternatives, but wanted to ‘cut out the middle man’ – the GP. They prefer to go to A&E than their practice, and know if they attend A&E they wont be sent elsewhere. So a tactic here; once they have been seen, is for the clinician caring for them to inform of alternatives, give clear guidance and to suggest that A&E is for real ‘accidents and emergencies’ and more routine issues for primary care, pharmacy or ‘self- care’. The ‘Choose Well’ campaign is a wonderful tool.

I believe it is not in appropriate to give these messages…and I am happy to debate this!

Social marketing in the NHS can be very powerful. By combining all the classic marketing messaging with the insight gained from patients, service users and those who deliver care, we can redesign services to what is appropriate, ensure messages are clear and will change behaviour. The aim is to change behaviours, be that to stop smoking, drink less alcohol or use NHS services appropriately and responsibly.

The insight from this work was amazing (please find me on Twitter @michaelafirth8 – I am happy to share).

In some hospitals this ‘non urgent’ attendance could form up to 30% of the total volume. And speaking to those working in the system today it seems little has changed.

So why is this? Why do people attend A&E when, from a medical perspective, they could have been seen elsewhere, or even better, could have stayed at home? I am not offering any medical opinion here. I am not suggesting that those with an urgent need should not be treated or cared for, but I am suggesting that those who could have been seen elsewhere, should be – and we need to support this to happen.

The NHS needs to consider why people do what they do, understand that and then consider our messages and alternatives.

Surely this is something we can address? By improving communication, by offering information and alternatives to patients we could work towards people being seen promptly and appropriately elsewhere. Again, I reiterate, where medically appropriate. I believe there is a huge potential for the NHS to promote the services of their colleagues in pharmacies. After all we have over 10,000 pharmacies ion England which in 886 millions prescriptions dispensed in 2009 (2).

My top five tips using social marketing techniques:

1) Adopt Retail Values – For example, if I arrive in a Tesco store and ask ‘Where are the eggs, please?’ I will be led, almost by the hand, to where the eggs are. Often I will be given information on which are best, and if the sales person is well-trained they will tell me that the Tesco eggs are best!

These people are well trained, not always highly paid but well trained. 

Does your Practice Receptionist know of the alternatives to A&E? The number for NHS Direct (0845 4647) or how 111 works? Do they know the local ‘late night pharmacy’ details? The number and web address for NHS choices?

Maybe and maybe not – AS NHS PROFESSIONALS IT IS OUR DUTY TO KNOW OF LOCAL SERVICES. Get this ‘task’ written into Job Descriptions, get basic information on Intranets, make it a role of the clerk in a practice or A&E reception to update this information as required! Tesco know their products, why can’t we in the NHS?

2) Use the POWER of WOMEN: We found from our work ‘70% of people asked a woman rather than a man for advice’ before they went to A&E – Sorry Chaps. I know you are fountains of knowledge but people ask women, they ask mums, grans and female neighbours. Campaign locally, aim communications at women , make sure women have the information they need! Go to where woman are, not just GP practices, go to schools, shopping centres and coffee shops ……GET THE MESSAGES ACROSS and get woman to be the communicators.

Dont forget a high percentage of NHS staff are women , double whammy – use women in the NHS  to best effect as the ‘gate keepers of health’ and information sources.

3. Make Friends with Pharmacists  – Local pharmacists are an A&E departments friend, they can dispense free ‘infant paracetamol’, they can support people with minor injuries, they can dispense emergency contraception. Ask why people sit in A&E , when they could have had a 5 minute consultation at one of the 10,000 community pharmacies. Pharmacies keep late hours, they can provide what is required to support people at home. Pharmacists are skilled people. Work together – be allies not competition.

4. Get the Messages Right! – Give people the information they need BEFORE they need to attend A&E. PLEASE DON’T JUST ADVERTISE OTHER SERVICES IN A&E WAITING ROOMS, THAT’S TOO LATE! We need to consider the messages on GP Practice ‘answer machines’. When we did a check, many  GP surgery ‘out of hours’ messages were long, confusing and hard to understand. If you have a screaming child, no pen to hand and are, well…stressed – can you really listen to a long unclear message? Or will you default to what you know, which is A&E?

Do people who are new to the area know what the local services are? Do visitors know of the services? Could Tourist Information Centres give out lists of pharmacies and emergency numbers along with information on local B&Bs? Could we ensure when people arrive from other countries they are given information on appropriate services? We found that in some cultures the idea of a ‘primary care’ service was alien – they understood ‘to see a doctor, you go to a hospital’. That is their understanding; if we don’t get these message right, why should we despair of these people?  We don’t know what we don’t know!

5. Be Brutal – As a clinician, ask people you feel could have been to a pharmacist of GP, was their visit for ‘an accident or emergency’? This is not about shaming people but it is appropriate to suggest there are alternatives to A&E and really A&E is for those who have real emergencies.

This came from a senior A&E nurse who at the end of what she knew was inappropriate attendance, would ask her patient just that – ‘was your visit today for an accident or emergency?’ – often the reflection made people think.

And to reiterate, we don’t want to stop the real cases.

We just need to ensure people are seen by the right people, at the right place at the right time. Hopefully if we can get this right, we can provide  A&E services for those who really need them.

I hope you and your loved ones do NOT need to visit A&E this weekend, but if you do I hope you feel you are in the right place, you’ve made the right decision. And remember, tummy aches from too much chocolate is probably not appropriate for A&E. Although I am sure NHS Direct on 08454647 can offer advice, 111 can support and your local pharmacy will be more than happy to give advice information and possibly dispense some medicine to help!

Have a great Bank Holiday weekend! And…Choose Well!

References

1. The Guardian – http://www.guardian.co.uk/society/2013/mar/14/nhs-hospitals-emergency-waiting-times

2. http://www.statistics.gov.uk/hub/health-social-care/specialist-health-services/pharmacy-services

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A Story That Begins With a Hospital, Ends With a Hospital (oh and there are hospitals in the middle of the story, too)

Headspace Perspective

I was nervous about going to hospital this morning. It had been a long time coming, and many preparations had been put in place. Last night, I got ready my bag and the outfit I was going to wear, to help minimise the stress this morning. So many kind people sent supportive messages and best wishes. This morning I got up bright and early and went off to hospital – just not the one I had planned to go to, or for the reason I was nervous about.

This morning was supposed to have been my first day back at work at a hospital in my neighbouring town. Martin, my other half had been complaining of back pain yesterday, which steadily worsened as the day progressed. Last night the pain worsened to the point where he was in agony, and he could barely move.

The GP was considered but bearing in mind the level of pain and…

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Hurly-burly

Headspace Perspective

Phew.

The week has been hurly-burly, with myriad emotions.

Bittersweet highs: so many people remembering Hugo for his birthday, beautiful gifts full of symbolism; Hugo’s Legacy trending on Twitter.

Every day since Hugo’s birthday thinking what I was doing on this day last year. I was such a proud new mummy, yet bewildered in a hospital I was unfamiliar with, in part of London I was unfamiliar with, and mothering my son in a way I had never expected. A year ago today, Hugo had to have a chest drain because of a collapsed lung, while I was finally starting to feel physically better as the result of a blood transfusion.

My first photo with Hugo - taken on March 3. My first photo with Hugo – taken on March 3.

March is a hurly-burly month. Thinking back to this time last year, the most wonderful and most heartbreaking 35 days of our lives cannot be helped. Knowing there will soon be a time…

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A bowl of buttercream, gin on tap and a Joe shaped 5yr old with a cherry on top please. Then, and only then am I content …..

just wonderful , honest and scary….. as well as full of love xxx

smalltimemum1

‘isn’t motherhood just a.ma.zing. As soon as Lily was pulled out of me , I wanted another one.Lets get back on the horse I said to Rob. I just want more babies. I love babies babies’ I didn’t say when I gave birth. My friend did but not me. I wanted to attempt to force my child back into the tyre of skin he came out of and sew it back up and wander around in a blissful child free daze until my final days. I’d just like to point out also that my lady garden isn’t made up of tyres of skin.I mean my stomach as Joe was yanked out of that instead of my fandango.

I had a c-section due to the Good Lord thinking my nether regions wanted to be an identical twin. I won’t go into it in dramatic detail here but if you want more…

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With LOVE on New Year Eve- a message of thanks

bottle

As New Year Eve is here, and we look forward to welcoming a New Year I want to say a HUGE thank you to all the people who love and care for me, that I appreciate you all more than I could ever say. I am such a lucky lady to have so many wonderful people in my life. I want to hang onto you all so tight, never let you go ! ( too many to mention but you all know who you are what you mean to me , if you don’t, I will resolve to tell you even more!)

As with all years there are ‘ups and downs’ but for me I have had so many positives and for that I am truly grateful. I will say goodbye to 2014, for it it take all its troubles and stresses that have burdened my family and friends…and look forward to a happy healthy love filled 2015. Hopefully still in a job too ( which would be bonus Mr Hunt!).
A thank you to all the wonderful new people I have had the privilege of meeting this year and I look forward to meeting more new people in 2015!

Family, friends , love and music , the staples that will keep me going !
2015 , bring it on !
Happy New Year everyone xxxxx

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Farewell, 2014 – the worst year of my life – and the best

sweetheart you are amazing you are passionate , strong and human …but most of all , you are Hugo’s mummy , sending all my love to you my friend xx

Headspace Perspective

Well, 2014. In a few days it will be time for us to part ways. I shall be sorry to see you go.

There will be some who will find that strange. Yes, 2014 has been in many ways the worst year of my life. But it has also been the best.

2014 was the year I became a Mummy. There really is no greater gift.

The year started with such promise, it was to be ‘our year’. I was expecting our long-awaited baby. My all-day-and-all-night nausea had finally abated, the dreadful draining tiredness had finally gone, and the radiant vibrancy of the second trimester had finally arrived. My bump was growing well, and inside it my baby was kicking and punching me like a pro.

You lulled me in to a false sense of security, though, 2014. You were not destined to be ‘our year’ at all. You were…

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The Imitation Game – art imitating real life?

Dr Sue Black

Having spearheaded the most recent campaign to save Bletchley Park and being part of the campaign to get Alan Turing on a banknote I was very apprehensive about seeing the new film “The Imitation Game” starring Benedict Cumberbatch and Keira Knightley. The Imitation Game is based on Andrew Hodges biography of Alan Turing and his codebreaking work at Bletchley Park during WW2.

Screen Shot 2014-11-20 at 00.05.56

I spent several years of my life trying to raise public awareness of Bletchley Park and the contribution of the more than ten thousand people who worked there and have learnt a lot along the way. I’ve had conversations with several people who knew Turing, including his nephew and nieces and have spoken to many Bletchley Park veterans over the years.

I was apprehensive about seeing the film because I really didn’t want to see a film like “Enigma” again, a film which I’ve never actually managed to…

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Lest we forget : Letters of love from the front

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Nov 9th 2014– Remembrance Sunday

I am reading a book entitled, Love Letters of Great Men. It has  letters from men  such as Napoleon, Mozart, a letter from Pierre Curie to Marie…..it also has a few letters from soldiers fighting in the First World War.

Having been to see the stunning display of Poppies at the Tower of London earlier in the week I was struck by the significance of each flower representing a person , a real living and breathing person that felt love and loss. I think it is hard sometimes to equate such displays or wreaths  to real people ,  so I would like to share two letters from WW1 which give us a sense of how real those soldiers were.

The first was written in 1918 and was folded into the soldiers pocket, the thought it may  be delivered in the event of his death – it is wonderful to know that James Milne survived and was reunited with his family.

July 20, 1918

My own beloved wife

I do not know how to start this letter. The circumstances are different from any under which I ever wrote before. I am not to post it but will leave it in my pocket, if anything happens to me someone will perhaps post it. We are going over the top this afternoon and only God in Heaven knows who will come out of it alive.

I am in his hands and whatever happens I will look to him in this world and the world to come. If I am called my regret is that I leave you and my bairns. I go to him with your dear face the last vision on earth I shall see and your name upon my lips, you the best of women. You will look after by Darling Bairns for me and tell them how their daddy died.

Oh! How I love you all and as I sit here waiting I wonder what you are doing at home. I must not do that. It is hard enough sitting waiting. We may move at any minute. When this reaches you for me there will be no more war, only eternal peace and waiting for you.

It is a legacy of struggle for you but God will look after you and we shall meet again when there will be no more parting. I am to write no more sweetheart… Kiss the Bairns for me once more. I dare not think of them my Darlings.

Goodbye, you best of women and best of wives, my beloved sweetheart. May God in his mercy look over you and bless you all… May he in that same mercy preserve me today. Eternal love from
Yours for evermore
Jim xxxxxxxx

The second is a section of a  letter from the ‘front’ dated 6th May 1918. Sent from
Second  Lieutenant John Lindsey Rapoport, writing to his fiancé.

“The mail has just come in and I’ve got 14 letters! Among them, my darling were five from you. So you can imagine what I feel like. I’ve got the very first one of all tonight, the one you sent me at Havre. They’ve been awfully slack in forwarding it.

Darling you were just splendid when you saw me off at Waterloo. You just typified the women of England by your attitude, everything for us men and you have your dark times to yourselves so as not to Depress us….

You mean so much to me, you have no idea how much. Life without you would be absolutely empty. I wonder how I ever got on before. As a matter of fact, I am full of love and for the last two or three years I have had a longing to pour it out on someone , and I’ve lived in the hope of doing so – that kept me going. Now I have someone I can lavish all my love.

My darling,I love and adore you from the bottom of my hear. You wait till I come home – you will get some kisses and I will hold you tight, you know my darling don’t you ?

The more I think the more I realise how lucky I am
In having you for my own darling wife to be. Oh hasn’t God been good to me – far more than I deserve.

Yours
John

This letter from a WW1 soldier who is now represented as a poppy at the Tower…. He was missing in action , his body never found. There are 888,246 poppies situated at the Tower.  One is for John Rapoport.

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This is why we wear a poppy and stand silent at 11:00am today.

Real people , real lives.

Real love

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Domestic abuse: from having it all to a life of hell

sammieb1980

http://www.theguardian.com/society/2014/oct/10/domestic-abuse-criminalise-coercive-control-emotional-financial-sexual-physical

What struck me about this particle article this morning is that currently, only 6.5% of reported domestic violence incidents lead to a conviction – that is a shockingly low percentage and possibly another barrier as to why victims don’t speak out, report the abuse and why they drop the charges against their perpetrator – because, what’s the point? Without a conviction, the perpetrator is free to carry on abusing.

The first paragrah highlights the myth of how domestic abuse “only happens to people in poor families”. Domestic abuse knows no boundaries and it does happen to anyone; anyone can be a perpetrator and anyone can be a victim.

We see the words, isolation, persuasion, complex lies, dependent upon the perpetrator, controlling, access to no money, debts, violence – all these are part of the complex cycle, whoever the victim may be.

The victim did speak out, she did go…

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That ‘Back to School’ stationary thing! – is it just me ?

That 'Back to School' stationary thing! – is it just me ?.

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Square Peg Round Hole

Headspace Perspective

Perinatal mental health services have been in the news today – or rather, the lack of them.

As has been reported in The Guardian, the National Childbirth Trust (NCT) found that half of the 193 trusts across England who responded to a freedom of information (FOI) requests said they do not offer any formal perinatal mental health service.

Postnatal mental health illnesses, which can include postnatal depression and psychosis presents significant problems for new mothers. Lack of support means that many of those affected are unable to fully enjoy those precious early months with their new baby, and tragically some take their own lives because they feel unable to cope.

Clinical management and service guidance for antenatal and postnatal mental health issued by the National Institute for Clinical Excellence (NICE) as long ago as February 2007 said that women who are depressed after giving birth should receive specialist help. However…

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