Language and the art of disguising what you mean (oh and some sex thrown in)!

But That's What I Meant Though!

I wonder how many times people have either heard a complaint about or complained about a politician who doesn't mean what they say?  They're all at it aren't they!  Answer the question Mr Cameron please!  Well, we would never do such a thing would we?  Sadly, we are all guilty of massaging information to either make it more palatable or more emotive depending on our personal situation.  We can change the meaning of what took place from being against us, to being either less so, or definitively in our favour.  Words hold emotion after all don't they? 

This blog will cover how changing a term or a phrase can change the whole meaning of what's happening.  We won't dwell on grammar and spelling, although in written word these create another level of complexity that many people in social care seem to miss entirely.  Putting a comma in the incorrect place, or spelling a word incorrectly can turn a logical report into meaningless drivel!  Often this information gets "interpreted" differently and can lead to a different standard of care for the person involved.  Let's not forget that when you complain about not having enough time to write an incident report and it says the wrong thing, that incident report will still be in circulation years later and have huge a huge impact on the person concerned.

So? What's The Problem?

So, if we don't like others doing it, why do we do it ourselves?  Clearly different circumstances require different types of massaging information.  So for example adding the word "again" to a statement can both improve our image and denigrate someone else.  Or shift blame from one to another.  What do these statements say, and what do they imply?

"When Frank got angry he threw his shoe"
"When Frank got angry again, he threw his shoe"

"Frank got really angry because he missed his bus"
"Frank got really angry because he missed his bus.....again"

Or what about this
"Frank's bus was late, this made him so angry that he threw his shoes in the corner when he got here as he'd missed his favourite show on TV."

"Frank missed his bus again, he got angry as usual and threw his shoes around"

Essentially the same thing happened but adding "as usual" and "again" changes the emotion in the statement to turn Frank from the victim of the bus arriving late to the shoe throwing villain.

These simple changes in terminology may not sound much, but if you work in social care, it's easy to add them to every day conversation and as such, change other people's perceptions of those people.

If some one's behaviour "appears" to be unjustified, then they will naturally appear more negatively in everyone else's eyes.  This is one level of using language to disguise things, but there is another level, that's the use of meaningless phrases.  Things people say that sound logical, but often leave us with less information than we had before.

The Meaningless Phrase Widely Accepted!

The primary reason for writing this Blog was the use of the term "Last Resort" when applied to using "Physical Interventions" with someone.  If you don't work in social care "Restrictive Physical Interventions" is what used to be called "Restraint".  Nobody liked the word because it sounded bad, so we changed it to something that doesn't really mean anything and that allowed staff to carry on with their original behaviour.  There's no real evidence that people changing the word has reduced the level or frequency of the activity being carried out. 

There are other variations on a theme as well.  Some of the common ones are;

• Restrictive guiding
• Therapeutic holding
• Restrictive holding
• Guided holds
• Gentle holding
• Care and responsibility 

What these all have in common is that they try to deflect from what people are really doing.

Astonishingly, some people felt that if you changed the language, then people would stop restraining people in unethical ways.  That didn't happen of course and we will probably change the term again at some point to sound lovely and fluffy so we can again ignore the real problem of why restraint is being applied, not what it's called.

The Last Resort? - What A Great Holiday Destination!

Anyway, back to the issue.  I am constantly encountering this term "Last Resort" when discussing holding people and whenever I question what exactly they mean by it, I get lots of different replies.  Most of which are inconsistent even when only one person is replying.  This is a concern, because It's quite clear that my "last resort" before I restrain someone, is clearly not the same as everyone else's. 

How can this be?  As it's a universally used phrase, both in local authority guidance and the NHS.  Charitable organisations use it as well, so it must be right? No? 

Sadly, no it isn't right!  It's meaningless.  As meaningless as the catchphrases people use throughout business to disguise the fact that they really don't know what they're doing, but would like you to believe you don't know their subject matter very well.  What we all used to affectionately refer to as "bullshit bingo" in meetings.

So, why do we continue to use and be advised to use such a meaningless statement?  If we are going to hold someone who is in our care against their will (even if justified) let's all do them the courtesy of being crystal clear why it's happening!  If we have inconsistency among staff when "last resort" applies, then I guarantee you that sometimes, that person is being restrained when they didn't absolutely have to be. 

The reason we use the phrase "Last Resort" is clear, it's because the vast majority of people aren't sure what to say, therefore they use vague terms and phrases which sound good, but mean little.

 

So, What about the sex?

Well, that was to get you to read this Blog, isn't it interesting how throwing just a single word like "sex" into a title can change disguise what you are about to read?

Gay Marriage and Equality For All

Confession time

I'm not gay, I was brought up as a Catholic, but I am divorced and currently not married with two small children.  I would consider myself ambivalent at best about religion.  Although not gay, I fervently believe in equal rights for all human beings, gay, straight, transgender, disabled, black, white or whatever.  I do reserve the  right to dislike or like any of those people but only based on what they do and or say, not where they're from or what they look like.  That means for those of you who are pro gay rights, but hate posh/poor people because they are different to you, I'm afraid you too are a bigot!

So What's all the fuss then?

I am astonished by the fact that it's OK for me to be divorced, or, like Jordan marry and remarry on a fairly constant basis, but,  if I suddenly decided to tie the knot with my male partner then all of a sudden I'm an issue of debate and quite amusingly the downfall of western society and the end of Christianity and sanctity of marriage, if only I was so powerful.
There are a variety reasons why people in this debate oppose equal marriage rights. 

• Some based on intolerance of homosexuality as it's seen to be disgusting, 
• some based on religious beliefs, 
• some based on lack of understanding and 
• some based on the fact that everyone else in my social group/political party is against it, so I might as well join in.  

It's almost back to the days of when people didn't want gay people around them because "you never know what they'll do!".  Guess what, they're going to do what you do, but probably with a lot less homophobia and possibly more fashion sense (sweeping generalisation alert).
I am also slightly confused (you'll see this happening in my blogs a lot).  There are clearly two opposing sides in this debate.  Those in the  "pro lobby" and those "anti lobby".

If you are in favour of Gay people having the right to marry, I'm assuming that some of you in this "pro lobby" will be directly affected by this Bill, either by being gay or lesbian.  I am not assuming that it is only gay/lesbian people in this group, but I'm going to do a sweeping generalisation and suggest that the majority of those who are gay/lesbian are more likely to be in the "pro lobby" than the "anti lobby".  Therefore it might be possible that you will end up one day (if you're lucky to find the right partner) marrying someone of a similar gender to you. 
If you are in the "anti lobby", I am going to have to assume that you are a) not gay, lesbian, transgender or other wish and b) unlikely to be the same gender as the people in the previous list and want to marry them.  Therefore, you can only be objecting on behalf of other people, unless you are confused and you think the equal marriage concept is that you have to marry a person of the same gender?

Not just a little fuss but actual hatred

I sometimes wonder at the sheer venom of people when debates become about beliefs and or belief systems.  By and large our beliefs are by their very nature personal, I cannot tell you what to believe, and indeed you cannot tell me what to believe..  Therefore, I probably have different beliefs to those of my friends, relatives, colleagues and acquaintances.  That's a good thing surely? 

What I don't have is an overwhelming urge to make everyone else in the world live by my belief system (and trust me, most of the world doesn't want that either I'd imagine). 

What I'm also finding interesting is that some religious groups (or people that claim to be from religious groups) are sending hate mail to MP's voting on the issue yesterday, which as far as I can tell isn't promoted much in the Bible/Koran etc they appear to be defending. 

To balance this of course MP's opposing the Bill are also receiving death threats.  I'll be honest, I am not exactly sure I've ever cared enough about a political issue that doesn't directly relate to me enough to want to kill someone over it.  See point above about pro and anti lobby.

If you also take my point about not disliking people for their gender, sexual orientation, race etc but being allowed to dislike them for their behaviour (what they say and do).  I am going to be controversial here and say quite happily, that if you wrote your MP a death threat about this particular issue, then you are on my "not like" list.  I don't care which side of the lobby you are on.

Morality, the Bible and Other Stuff

So, what's it all about then?  This morality thing is quite interesting.  People will often use the Bible or Koran or other religious tomes to identify that homosexuality is wrong (quite commonly only male homosexuality is the issue).  The Old Testament (Leviticus) specifically speaks of "men laying with men  as with women" should be put to death, however those that use this rather literal translation often forget some of the other good stuff in the Bible like the variety of views on judging others.  Can we both abhor someones' behaviour due to our Christianity and at the same time not judge them due to our Christianity? A conundrum at best!  Let me draw you to the only Bible quote that I have ever tried to live by in my daily life John 8:7, for the non religious among you it's the one about sin, stones etc.  As of yet, I've never thrown stones at anyone for their behaviour or sins, so I'm doing well I think because I have been tempted!

In fact the Bible has very little to say about the act of marriage itself, lots of side references, but not much positive stuff.  In fact there are some rules regarding ownership, abeyance and rape, but not a lot of the "sanctity of marriage" or the marriage contract, there's an interesting article here.
In fact, if you consider that Jesus wasn't married and Peter was encouraged by Jesus not to marry, then perhaps you can see that those who don't believe the Bible word for word might be confused as to why Homosexual marriage is destroying the institution of marriage from a Christians point of view when Jesus himself wasn't married.

Hang on, does this mean marriage is owned by the religious people?

Well, the first written references to marriage are over 4000 years old, so that sort of rules out Christianity.  In fact, in many religions marriage wasn't one man one woman, but, one man many women, certainly not a gay friendly approach at first sight. 
Indeed, even in Western Society, it's not until fairly recently that a wife hasn't been seen as an actual possession of her husband, perhaps this is what confuses traditionalists?  Who would own who?  Clearly a man wouldn't be able to own antother man, and women wouldn't be able to cope with responsibility of owning another woman therefore different gender marriages are required.  Perhaps I oversimplify?
Not only that, but some religions treat the concept of divorce very differently.  In the Catholic church, divorce is a no no (without some rather interesting and unusual caveats), however in other monotheistic religions, divorce is allowable, in Islam although not seen as a good thing, it is seen as dissolving a legal contract, in Judaism domestic harmony is seen as the ideal, so divorce is also allowable.  Three religions, one God and not a lot of common ground for interpretation on divorce here.
In fact lots of issues around marriage between men and women have been movable feasts since the concept was involved, ages for example, taking of a husbands surname, numbers involved, wedding bands, arranged marriages etc etc.  None of these issues were mentioned in the Bible, but seem to have been adopted as part of the "ceremony" and "sanctity" of marriage.

Religion and Interpretation of Bible 

Here's a thought, perhaps those that "interpret the Bible have forgotten that they are a) interpreting a book that has been translated many times, written over many years and b) has quite a few other bits they probably quite happily ignore. 
In fact I suspect when people skim through a bit of Leviticus who some traditionalists believe was written by Moses (who's clearly not the most tolerant of characters), I wonder which bits they would follow?
For example in Leviticus

• Any person who curseth his mother or father, must be killed. (Leviticus 20:9) 
• If a man cheats on his wife, or vise versa, both the man and the woman must die. (Leviticus 20:10)
• If a man sleeps with his father's wife... both him and his father's wife is to be put to death. (Leviticus 20:11)
• If a man sleeps with his wife and her mother they are all to be burnt to death.  (Leviticus 20:14)

How many of them have stoned someone from the city walls because they worked on the Sabbath?  How many of them work on the Sabbath? or, how many of them where mixed cloth or eat shell fish?
I'm afraid if you want to convince me that you're following the word of God in this particular issue, you'd better follow all of the rules!  You can't just pick and choose!!!!

 Equality

If you are objecting to the idea of same sex marriage based on the Bible, I think I can only point you towards the book itself which although states that "those who sleep with men as with women should be put to death", they also do quite a lot of good stuff on equality

• There is neither Jew nor Greek, there is neither slave nor free, there is neither male nor female; for you are all one in Christ Jesus" (Gal. 3:28) 
• John 13:16 - Verily, verily, I say unto you, The servant is not greater than his lord; neither he that is sent greater than he that sent him
• Genesis 1:27 - So God created man in his [own] image, in the image of God created he him; male and female created he them.

Forgiveness

Now, when I was being brought up as a Catholic, I have to say I don't remember many of the anti homosexual things, however, I do remember quite a lot of the forgiveness/love stuff.  In fact much of my Catholic education was quite positive, indeed, most of the priests I was taught by were as tolerant/intolerant as the rest of society, perhaps with a soupcon more forgiveness and dog collars!

•  Colossians 3:13 Bare with each other and forgive whatever grievances you may have against one another. Forgive as the Lord forgave you

There are loads more, but I'm starting to feel this blog has become biblical in itself.

Take home messages

If your objection to equal rights for marriage is religion, then I'd suggest you have a scoot through the rest of your religious book of choice and seek out the bits about forgiveness, judgement, loving fellow man etc and wonder where the contradictions are and the practice some of the nice stuff first.  Starting with forgiving me for offending you during this blog.

If you're objection to equal marriage rights are that it demeans marriage, then perhaps we should start with the divorce rate and work from there, you might also want to have a look at the inequality between men and women in marriages as well (honour and obey anyone?)

If your objection is due to the fact that you find homosexuality itself objectionable, then, perhaps you should meet some more gay men/women.  I say more, because I suspect you know loads already, but you didn't know they were gay.

If your objection to this is because all your mates/social circle object to it, ask yourself, how many of them are objecting because they think you're objecting?

And Finally!

Finally, having taken too long to write this, it appears that the Commons have passed the Bill and it now needs to got through the Lords.  Perhaps 10 years from now, we won't even be having a discussion about equality because it will already exist!  Indeed, I'm waiting for the first gay couple with learning disabilities to get married so I can stand back and watch the moral outrage transform the faces of those who believe they're liberal and open minded.  But then I enjoy a good controversial debate,

Attitudes to Sexuality in Care Environments

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Hookers, Strippers and Care Homes

Sex, who needs it?

This week it appears that it's residents in a care home in Eastbourne. A News Report in the Metro, claims that a manager in a care home in Eastbourne has been providing the residents with Strippers and Prostitutes and that this practice is still going on.

Now, I'm not sure what's most shocking about this whole event.  Is it, that people in care are like everyone else in their need for sex?  Is it that a care home manager is enabling people in their care to do something about it?  Is it that the media has picked up on the word "primeval" to identify our need for sex?  Is it that old people and disabled people are having sex?  Nope, for me, the shocking thing was that this was happening in Eastbourne!  I was always under the impression the youngest person in Eastbourne was about 85 and therefore I'm wondering how many strip clubs they have?

Is it exploitation of the women?

Well that depends on your point of view and also to some extent who the women are.  If the prostitutes are standing on street corners attempting to get a quick fix and are having to deal with pimps, disease and homelessness then yes.  However, as they are "phoning" for them, we will have to assume that they are not milling around on street corners.  How much are they paying them and how does it work?  Are these women actually expected to have sex, or when they get there can they say no? The question I'd also have to ask is that are people shocked because prostitution exists or that these particular prostitutes are doing what other people won't and having sex with people who are disabled and/or elderly?

Strippers btw rarely stand around on street corners due to lack of music to dance to, also I'm not sure who calls them strippers these days?

What exactly are they investigating and why?

This will be fascinating I feel.  Are East Sussex County Council investigating because they are "supposed to" or because they should?  Are they investigating an illegal act? or an immoral one?  If it is illegal, then I'm assuming the police will be involved, if it's a moral issue, then I'm assuming the investigating panel will all be quizzed about their sexual practices to ensure they stand on the moral high ground? 

Morality be damned

Let's be honest, if you've ever engaged in attending a lap dancing bar, watching porn, having sex in a public place where you might be seen (a criminal offence) hiring a prostitute (and clearly some people do otherwise no one would do it) or engaging in sex which is deemed to be immoral by the general population (swinging, having an affair, group sex etc) then I suspect you're going to struggle to maintain any credibility in giving a negative moral judgement in this particular case.  If you do, then I'd suggest it's not your morality that's offended, it's the fact that the clients are disabled.

My final question

If this was a hotel with businessmen in it or a residential establishment where people could phone and pay for the prostitutes for themselves then would anyone care, would their be an investigation and would the Metro have published an article about it?

My Final Thoughts

1. People have sex (otherwise there would be fewer of us).  
2. People have weird sexual practices compared to our own (which by the way are the only normal ones as far as we're concerned).  
3. People want sex, some more than others.  

Often people who are in care, disabled or otherwise don't have any way of dealing with these three items above and until we can find a way of doing that, then people need to dismount from their moral high horses, suck it up (so to speak) and move on.

Of course, if it turns out that this story doesn't give us the whole truth currently I am willing to revise my opinions!

Ego, Emotions and Creating Change

The Phone Call

As a manager, you get a call from work saying - there's been a problem. 

Your heart sinks, you wonder why you agreed to have a work BlackBerry (probably because you thought it made you look cool to your kids), you think about how to avoid going in immediately or trully wished you were far enough away they had to call your deputy or better still your boss, why tonight, we've got an inspection/family visit/other inconvenient agenda item on Friday.
After this first 20 seconds of thinking, you now start planning. 

1. What do I need to know?
2. Who do I need to tell?
3. What do I need to do?

 At this stage, I should imagine, you're probably also thinking - who's responsible or who might be responsible, or is anyone responsible.  Sadly from a legal point of view the answer to all of these questions is probably, "you".

What we all think we know - perceived knowledge

When we encounter a problem which is work based, or an incident takes place within a professional environment, we'd all like to think that we would respond in a professional manner and be; concrete, creative and rational in our development thinking.
In our minds this rational process would potentially involve

• Identifying what happened
• Identifying all the elements of causation
• Identify systems and process for avoiding the incident in the future
• Putting into place any plans or strategies we have for making sure it doesn't happen again
• Acting on those strategies

The team would be ideally be

• Multidisciplinary, bringing in experts depending on need
• Chaired appropriately
• Have clear objectives
• Make contemporaneous notes
• Reviewed at a later date

Clearly there would be other issues addressed depending on type of incident, type of service and organisational policy.

What often happens (from an experiential point of view)

I am now going to speak of my experiences of  working with dozens of organisations nationally.
As a consultant I often get asked to take part in problem solving sessions with regard to managing people's behaviours.  What I have found through experience is that any significant process of change, will not take place until emotions and egos are taken into account.  If there is no accounting for egos and emotions, then people will generally resent anything they're told to do.

Emotions and Ego

I am not using this phrase in a derogatory way.  We all have an Ego and we all have Emotions.  For example, if you've been brilliant at your job, or even just merely good for the past 5 years and one day it all goes horribly wrong, then naturally, you are going to feel emotionally vulnerable.  Your ego will be dented and you will wonder what's gone wrong in your world (we call this the Why Me? scenario). 
Human nature being what it is, means that we will start with blaming all other factors apart from ourselves.  Our ego, doesn't allow for us to admit that actually, this might have been my fault.  We might find ourselves saying things like

• There's not enough staff, 
• I told the manager about this ages ago
• It just happened out of the blue
• "They" did something wrong
• I did everything I could to stop it

In this initial stage, it's quite common for the person not to have any insight into their role in the process - they are the "innocent" victim, just doing their job and it all went wrong.  At this point, putting together a team meeting to decide how to fix things will be of little value for two main reasons.

1. If you really were the reason for the problem occurring and someone brings that up in the meeting, you are not ready to hear this information so will become defensive and in my experience often hostile to the process - any meeting will now be counterproductive.
2. If you are the key person in the meeting driving it forward, then you will be potentially be looking in the wrong direction, and therefore the process will fail.

Some Examples from our work

These are examples of discussions we have been involved in over the last 19 years of running Timian Training.  Remember we work in the field of challenging behaviour, so some of these incidents may seem to be outside your experience.  However, take away the terminology and I'm sure you'll recognise the events in your own workplace.

• Every time I  sit in the chair in the dining room - the service user sneaks up behind me and pulls my hair.  This happens every day.  This has lead to me losing hair, hurting my back and most recently being hospitalised for a week and off work for three months due to whiplash type injuries.
• Now, it doesn't take a  trained observer to notice that the member of staff has this happen every time they sit in a chair in the dining room.  Most of us would immediately say, don't sit there.  
• However, the problem we have is, that this person has been injured a number of times, once seriously and pointing this out before they are ready, will lead to a long and defensive discussion about why they "have to sit there" and "there's no where else to sit" because they are supporting someone else and it isn't fair to that person that I can't sit down with them at dinner.  Besides there's no room to sit on the other side etc etc. (this is an almost verbatim discussion btw).

• This is from an A&E department.  A staff nurse on turning up to our training on conflict management, had, what could clearly be seen as a  broken nose and bruising around the eyes.  Without asking, she promptly told us this training we were giving would be a waste of time, because when she had her nose broken, it happened "totally out of the blue!"  On further discussion, it turns out that it hadn't quite happened that way.  
• There was a person in the waiting room who was drunk and noisy.  When the staff nurse went over to "talk to him" he punched her out of the blue.  We asked her what she said and how she did it.  
• In demonstrating on me, she leaned forward, stuck her finger in my face and said "sit down right now, your annoying everyone and making yourself look stupid".  
• When she said this, I asked her, if there was anything she could have done that might have caused this person to then punch her.  She said no, and "besides I can't abide drunks!".  What was interesting, was the rest of the groups look of disbelief and one of the other senior nurses, said, "well, perhaps you're working in the wrong place then".
• At this point, it wasn't appropriate to address what she had done wrong as that wouldn't have progressed us any further along the line of solving the problem.  In the end, it turned out that she'd had a physically abusive father who would hit out when drunk.  It pushed all of her buttons and made her both scared and angry at the same time.  

 I could go on about hundreds of other discussion we've had with staff over the years, but the gist is pretty much the same.

So, what does happen then?

What normally happens in these cases, is a manager comes in, tells you what you did wrong (from their point of view in a totally supportive and non-judgemental way).  They then tell you what not to do next time, make a brief note and then expect you to;

• Absorb the information
• Act upon it 
• Feel relieved and grateful for their help.

What you believe happens. They tell you what to do in a patronising way (from your perspective), makes some unhelpful and unrealistic suggestions while quite clearly demonstrating how busy they are by mentioning the reason they're late/have to leave/haven't got long, is all the very important meetings they have to go to.
Your emotional response will then contain the following:

• Typical manager, no idea how difficult my job really is
• Covering their own arse again I see
• None of the stuff they told me to do is going to work, because I haven't got time
• They don't actually care and didn't really listen.

Barriers to personal and organisational development

If the incident or problem has significant consequences - injury, staff being dismissed/disciplined, an investigation or a formal complaint, then there are emotional repercussions.  Sometimes with situations such as these our organisational empathy disappears while we desperately seek the "truth".  This lack of empathy, often means the truth becomes elusive and any findings are counterproductive.

Telling someone what they are doing wrong, almost invariably leads to "close down" of the person where they try to justify their behaviour and you come up against a brick wall opposed to change.

In social care we talk about communication a lot!  In fact, I suspect we spend so much time talking about it, because it means we then don't have to actually do it. That means that when staff tell management about the problems they encounter, they are normally listening, but with an ear out for when is it appropriate to step in and tell them why they've got a problem.  Or, when they're listening, it's clear they are just waiting for their turn to speak.  This isn't listening.  When we listen in these situations, it's important to try to discover what exactly it's like for that member of staff to have to do their job, with their resources and time scale.  Listen in this context.  Rather than tell them what to do, get them to tell you what the best ways of managing further incidents are.  What you might sometimes find, is they have a better plan.

Having said that, sometimes the main barrier is knowledge.  I've sat in on meetings where people use terminology so randomnly out of context, everyone nods and moves on.  When questioned, we realise that all of them are talking about different things!  For example, recently having a discussion about an incident where it becomes clear that the definitions the manager, myself and the member of staff using to discuss restraint (restrictive physical interventions) are all totally different.  This means that fundamentally, one person thought they were doing the correct thing, while another thought it was inappropriate and another didn't see that it was restraint at all and therefore didn't need to be dealt with.

The only real way to overcome these barriers is to create an environment where staff can identify their own mistakes.  This requires a careful balancing act of allowing staff to make mistakes, ensuring managers deal with emotions before they deal with process of change and most of all making sure that the people you are supporting are not left in any danger (physical or emotional).

We generally suggest having an open forum, where people can say how they feel, it's not a right or wrong forum, it's a place to blow off steam.  Once steam has been released, then we are more likely to be able to move forward in a productive way.  This forum shouldn't take hours and is not a process of complaining, it's about how we feel.

So in summary

1. Listen to what people are having to do and deal with
2. Think about what it's like from the staff member's point of view
3. Think about what exactly you're trying to acheive, there is no such thing as an error free environment, accept people make mistakes
4. Make absolutely sure you're all using the same terminology, meaning the same things
5. Let the emotions burn off, address the Ego
6. Pick your time
7. Allow staff to create their own solutions

These are just some of our reflections

Final Point!

What I have always found interesting about this subject, is that, I would suspect that the majority of those reading will identify the egos and emotions in their work colleagues but not always in themselves.  We see ourselves as the rational person in a sea of irrationality.  How can this possibly be true?
If this Blog has made you annoyed because you think that it's patronising, then perhaps I too have not allowed you to offload your emotions?

We all make mistakes at work, 

if we don't, 

we're probably not trying to acheive anything.

UKIP and the dangers of thinking out loud

Policy or Policy Debate?

After the furore of one of their now ex members (Geoffrey Clarke) voicing opinions on which they have little knowledge and clearly less empathy, I thought I'd have a look at the policy that UKIP currently have on abortion, I suspect lots of people had the same thought, therefore I wasn't really surprised when I came across this,

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Perhaps this is their policy now?


Their policy on health and the NHS is fairly vague and doesn't really seem to have any statements about social care so I was really at a loss to figure out if they agreed with him but realised they'd be vilified if they did so publicly, or whether they disagreed with him and just hoped he'd go away, or whether they really had no idea who this Geoffrey Clark chap was and why he was making their lives really difficult by talking rubbish???

Did he just say what I think he said?

So, what did this chap actually say?  Not what did the press say he said or what do people on twitter say he said what the press said he may have said (you get my drift).

So it appears that Geoffrey has a personal website on which he published his own manifesto in order to gain a Gravesend Rural Seat in Kent County Council (not Prime Minister or leader of UKIP).  He's made it clear that the views are his own and not those of UKIP and as of today (19th December 2012) he's decided to run as an independent candidate.  Politics is a fickle place and due to the secrecy of voting, and the media uproar, he may actually get elected purely on name recognition.

A short while ago I wrote an article with reference to Winterbourne View regarding the methodology for making abuse in care a likely outcome when poor standards of care existed.  One of my setting conditions for this to occur was for people to see those in care as somehow less than themselves, less deserving, or a burden.  I also presented this at a number of training courses.  Some people were surprised that people would see people with Down Syndrome as being "less" than us.  Step forward Mr Clark to prove my point.  He certainly seems to see those who have life long conditions as being a burden and therefore by definition not as worthwile as the rest of us.

He said

“compulsory abortion when the foetus is detected as having Downs, Spina Bifida or similar syndrome which, if it is born, could render the child a burden on the state as well as on the family.” Geoffrey Clark Personal Manifesto Statement.

Let's be clear, Mr Clark was not saying this was going to happen, he was saying it was something that should be reviewed.  Since his original manifesto (which surely must rate as a classic case that you should read something before you publish it online) he has since gone on to say;

In an interview with This is Kent yesterday, 
Mr Clark said: “I would like to apologise to anyone who has taken offence - none of it was intended.
“UKIP’s policy is to reduce public expenditure. I am a layman; I do not know what should be cut. I wrote my website very, very quickly, it was so naive and foolish.”
Mr Clark, who appears to have taken down his website, added: “Some have been offended and I sincerely regret my choice of language. It was inappropriate language to express something that is genuinely sincere – we need to review all expenditure.”

What's the solution to people like Mr Clark?

Unlike many online observers, I'm not going to call for his head, but neither will I support him (as I don't like most of his policies), but I would suggest that rather than slam him as many charities have done, they should educate him, introduce him to people with Down Syndrome.  Education and Learning are what will change his mind, abusing him publicly may only entrench his views, who knows, convert him to an educated viewpoint and you may have a huge positive impact on society.  Because we all know, when he wrote that, some people agreed with him, change him and you'll change more.

Geoffrey Clark does not deserve your anger or venom, he's the victim of lack of knowledge and understanding coupled with a large dose of being "naive and foolish".  He may well truly believe that people who need life long care are a burden, but, if we educate rather than accuse, inform rather than abuse, create understanding rather than be disgusted by lack of understanding then maybe a very big step may have been taken in improving the image of people with lifelong disabilities.





 

How much is a life worth?

This morning I clicked on my phone to check the news and spotted this rather strange item about a DNR notice and a man with Down Syndrome.  For those of you not medically inclined a "DNR" is  Do Not Resuscitate, which is what will be added to your medical notes when you're in hospital based on a variety of factors.
A DNR is applied to a patient if in the course of their hospital stay/treatment their heart stops beating and medical staff are not then supposed to attempt to restart the heart.  Now obviously this is a difficult area as it means making decisions about whether there is any point in saving a life.

Circumstances where a DNR might be applied

1. If the patient expressly wishes it in a living will or advanced directive. - not the same as euthanasia
2. If there is an indication that resuscitation will cause more suffering
3. If there is a strong chance CPR will not work
4. It is not in the patients best interest.

 
Who should medical staff talk to?
Ideally the patient, however, if the patient lacks capacity the medical staff should seek guidance from their safeguarding officer and should also take into account the view of carers and family.  Although they don't have to follow the wishes of relatives or carers, there should be clear signs that they've both sought and that should also be noted.  Every hospital should have a clear policy available for all to read.

Having said all this though, the final word however does rest with the medical staff (according to the GMC) GMC Guidance.

Now all of this is very interesting, but two things stand out for me, the first is the concept of best interest and the second is concept of undue suffering.

Both of those sound fairly straightforward but they aren't concrete decisions, they're value based decisions which are based on some fairly abstract concepts one of which is the value of human life.

We would all like to think we view human life as having value, but realistically some lives have more value than others and this is where this decision to DNR a man with Down Syndrome who also has Dementia starts to take on a different slant.

Ask yourself the following question about who's life holds greater value.

1. A toddler
2. A newborn baby
3. A 98 year old man
4. A 21 year old soldier
5. A 18 year old university student on his way to first day at Cambridge to study Medicine on a scholarship
6. A terrorist
7. A 9 boy with Down Syndrome
8. A 25 year old Football star
9. A 45 year old black man in Sierra Leone
10. Your next door neighbour's teenage son
11. A dead puppy

Is Everyone Equal?
You'd be tempted to say that people all hold equal value as human beings, however, the reality is that if you hear about any one of these people listed above dying, you'd have a variety of emotional responses based on whether you observed it, whether you knew that person, whether you've experienced something similar in your own life, how the death came about and perhaps most important of all, your own personal circumstances and what you might deal with on a regular basis. 
Empathy is two way
If during your daily working life you cope with and deal with death and suffering pretty regularly this means that you have to adjust your viewpoint in order to cope emotionally.  If, as a doctor or medical staff you became emotionally distraught every time a patient dies, then you'd be a pretty useless member of staff and probably not last very long working in clinical medicine.
If we expect Doctors and nurses to have empathy, then we must also expect this empathy to work in the opposite direction.  Keep in mind that often a Dr or Nurse will be in their late 20's early 30's, be academically bright and excelled throughout their careers.  They have normal(ish) lives with families, friends, mortgages etc. The biggest difference though is that a significant proportion of the people they come into contact with (depending on clinical circumstances) may end up dead.  I don't mean they all die, but, realistically very few other professions have the same ratio of meeting a person who then ends ups dead shortly thereafter.  This must have an impact on how you view the world and the population within it.
Different Values
The reality for all of though is we place different values on every one's life.  Take that list again and tell me which one would upset you most if you heard about it on the news?  Or, you witnessed it?  The fact of the matter is, that in society currently, the man with dementia who dies is not news, the man with Down Syndrome who dies is not news.
They are not deemed to be worthy of our sympathy because for most people the sympathy is not there.  This does not mean that to their families, their friends and to those that know them their life has any less value.
There must be a better way for a family to find out about a DNR than finding it in the notes and discovering the reasons are learning disability and Down Syndrome. 

Rather strangely in the UK, often the the 11th item on that list would encourage the most sympathy and emotional response.

All Life Has Value
All life has value and when making decisions that impact on that value, we should do it with Empathy.  Stand in the shoes of that person, that person's family and then we might not have such a shocking story again.
It's about changing attitudes of course, but for me it's about changing the view of the value of the life of someone with Down Syndrome (or other learning disabilities) and the value of life of someone with Dementia.