Sunday, 26 June 2011

Birthdays - and friends ... again

Another year older. Sadder? Wiser? Sadder - in some respects. Wiser - not a chance!!

First up, thanks to all my Facebook friends for the lovely greetings, wherever you come from, either geographically, or from various networks. You may be dog friends, land rover friends, feminists, part of the Scottish network, or from Farmville. Think I've covered everything there, but whatever, it was lovely to get those messages. I've been off-line for a couple of weeks and it was gorgeous to come back to lots of happy birthdays. Today has been my first chance to say thanks.

Now for the rest of the post, if you have haven't read the earlier stuff - here is some context. Birthdays and Party, party

The quick precis for anyone who can't be arsed to read those, is that I think it is nice when people remember your birthday and acknowledge it, and, that this year, I was invited to a party in the UK the day after mine - and was deliberating whether or not to go. These posts are both relevant - read on.

To start with the last post first, no, in the end I didn't visit the UK and go to the party. I received some very generous offers from internet friends to meet up, offers of accommodation, and some good advice too.

So, why didn't I go? Sounded good. Posh party and meet new people before and/or after. How about cash-strapped? That's probably the basic one. I can't justify spending hundreds - verging on a thousand pounds - for a few days jolly. Simple as that. Plus, for whatever reason, because my partner and I have birthdays on consecutive days, we have always tried to make our two days special. Did I want to spend our birthdays apart? No. Haven't done that for years.

Next. Over the last few years, one of my basic questions has started to become - what would someone else do if the situation was reversed? ie would they traipse a few thousand miles for a party? When my partner's niece died Sarah and he planned to fly back to the UK for the funeral, we started to question if anyone would ever fly out for one of our deaths. Unlikely. Again if you can't be arsed to read the post, he wasn't even offered transport or accommodation.

Back to party party. This is (was?) to be fair, my dearest friend from university. In our lovely long university hols, I visited her and other friends at their parents' homes. And some came back to stay with me. On leaving university, most of my friends ended up in London, away from their family homes. We were all growing up. Arrangements between all of us became much looser - 'always welcome, come when you want'. Luckily, as my remaining close friends were all in London, I had a decent choice of accommodation there. If there was a work conference or meeting needing an overnight stay, it was a good opportunity to catch up with friends. And if I ever got a rejection, it was because someone was away, so I just rang one of the others.

Not many people passed where I lived, Up North, although ironically Dearest Friend did. And that's exactly what she did. Although we lived a couple of miles from the motorway, did she ever stop off? Of course not. One day, we were somewhat put out to discover that on one of her annual holidays, she had taken the time to drive down from their second home to a local castle ten or fifteen miles away. Hmmmm.

It wasn't as though we weren't welcome at her holiday home though. It was about sixty miles drive away, but we were frequently summonsed when they were in residence. We camped outside as there wasn't room inside. At New Year, we stayed at a crap hotel so we could dine together on New Year's Eve. One year, I had picked up some ghastly virus and couldn't face the annual winter summons. She sounded rather put out. I should have realised then that she was not to be disobeyed.

When I moved to Spain, it took her five years to condescend to spend less than 24 hours with us, en route from a dressage course teaching horses how to dance. I had discovered by then that she had visited Spain on numerous occasions, some relatives of her husband had a place up the coast, they had a quick trip to Madrid one week, a friend in Majorca held a party, etc etc - how far down the list had I sunk?

The last time I visited her, we had to go to the post office. 'Do you think the card will get there for her birthday tomorrow?' she said anxiously. To Majorca? To the Spanish friend who seemed to merit more visits and cards than me? I doubt it would have got to her on the other side of London the next day, let alone Majorca. 'No.'

So this is the woman who wants me to drop everything, forego mine and my partners' birthdays and attend her summer luncheon housewarming party. The party was today. My birthday was yesterday. I sent my reply a month ago saying I wouldn't be attending. And did I receive any birthday greeting from her? I don't think I need to answer that. I think you can all work that one out yourselves.

So, yes, it hurt that she didn't acknowledge my birthday. Maybe Vicky was right (see previous party party post) with her comment. Maybe our paths have become so wide apart that we are strangers. Sadly. Which brings me specifically onto birthdays.

There are some internet friendships you make that are closer than others. You remember their birthday, they don't remember yours. Or vice versa. I know, because I have been guilty of that - knew when it was roughly, but something came into your mind and - whoosh - you miss it, for which I am truly sorry. Not helped by being offline half the time (excuses excuses). So when someone doesn't remember mine, hasn't made a note, doesn't think it is an important thing to say Happy Birthday, you realise you aren't that important in their life. Even if you are in contact every day. There comes a point when you stop telling people it is your birthday just for them to dish out a trite and meaningless greeting. As I said, sadder - and - wiser ?

And all the more reason for appreciating the birthday wishes I did receive when I returned on-line today. Thanks especially to those of you who sent e-cards as well as a greeting. Sometimes FB helps because it makes remembering birthdays easy - just look up at the right-hand corner. Maybe I'll make more effort after yesterday, even if I don't know people too well.

Almost forgot. What did I do? Woke up at some disgustingly early hour, and decided to get rid of superfluous clothes. Some went in the charity bank, the others are marked up for poss car boot sale/Friday Ads - or the charity bank. Walked round the beach. Went into town to buy a bottle of cava and a couple of beers. Wandered around town checking out all the changes. Came back home, cooked lunch (asparagus and potato salad for the foodies out there) - and decided against cleaning. It was a good day.

Friday, 10 June 2011

Death and bereavement

Remember the Funerals post here?

Here is its companion. I ended that post having attended three funerals in my life, between the ages of approx 30 and 40. It seems from comments received on that post, that I wasn't alone in being excluded from family funerals as a child.

The next funeral I went to was my father's. I wrote about my last visit to see him here. There is something about death that takes you totally unawares and knocks your legs from under you.

As a kid I often worried what would happen to me if I became orphaned. My mum and dad, and Good Dog Tarquin of course, were my world. I couldn't envisage one without that security bubble. But with age, and so-called independence, work, and a relationship of your own with someone, that fear recedes.

As an adult you know, or at least expect, that one day you will have to cope with the death of your parents. Sensibly you tell yourself that day will happen, and once they are in their 70s, you think it isn't that far away. Although not imminent. But you know you will be able to cope with it as a grown-up.

So when my father did die, even though I knew it was going to happen, I was stunned. In fact, I probably didn't feel anything straightaway as it fell to me to sort out everything. My mother was nominally the executor, but she hadn't a clue what to do, and why should she? I was around and was happy to handle all the paperwork - all she had to do was sign the forms and letters.

I went to the Registrar with the letter from the GP to get the death certificate to start moving the paperwork. I opened the letter to see what the GP had written. It didn't make any sense to me, and I asked the Registrar what it meant. It was some vague woffly term that implied he had died from cancer all over his body. Well that isn't what kills you. It may be what leads to the death, but I wanted to know what had happened. The Registar said it was probably heart, lungs, liver, kidneys - whatever - that had failed, and that GPs in the community weren't as precise as hospital doctors.

There was a slight admonition that I shouldn't have opened the letter as it was addressed to her. Well hell!! Who cares? It was my father and I WANTED to see the cause of death. What a load of crappy bureaucracy. I should add that there had been no post-mortem examination as he had been seen in the local hospital by a doctor in the previous week. So there we were, from suspected colorectal cancer (Stage 3 by my guessing from the minimal info from the geriatrician over the 'phone) to death a few weeks later.

The funeral came and went. Although my mother was technically the starring player, I was Best Supporting Role, and dressed up accordingly. Black Cerruti suit, jet necklace, nice black (Wolford) tights and smart black shoes. Black lace gloves too. As, 'Gloves and no hat, but never hat and no gloves,' for those churchgoers out there.

When I returned to Spain, I felt, well, flat. Very flat. I didn't really know what to do with myself apart from speak to my mother every day on the 'phone when she rang up worried about one thing or another. My partner started spending increasing time on 'planes visiting my mother to sort things out. 'Siempre esta volando en el aire,' as my Spanish neighbour said - he's always flying in the air. And he was.

Then one night I started to have a panic attack. Thinking about my past, my parents, realising my dad had died, and just wondering where life was going and I was suddenly lying there breathing horribly quickly and too fast. For anyone who doesn't know - panic attacks don't kill. But they aren't too good when they are happening and they can be frightening for the person lying next to you. And they continued. Every now and again, or maybe, quite often, I would start one. But when they were over, there was actually a feeling of relief. I guess they are a way of relieving stress.

When my mother died - I couldn't face going back to do the honours. Practically, we couldn't both go because of the animals. I really couldn't handle going back to their home, to the same church, and - one parent less. Exactly the same scenario except the mother who had stood next to me at my father's funeral would be in that wooden box up front. So while I made the arrangements over the 'phone, Partner agreed to go and be the Star. Meet rellies he'd not met before.

It was after her death though that the desolation kicked in. If I had felt that some of my past had been wiped out when my father died - it felt like it had all gone when my mother joined him. It was as though the first part of your life, your early and formative years, no longer existed. With them gone, so had those first precious and childish years. And while it wasn't the idyllic childhood they had told me it was, it was the only one I had. All contact with that had gone. Just memories. No more.

Thinking of my mother was split between two views, her later cranky years in life - and those lovely early ones when she soothed my brow and fed me beef tea, picked me up from school on Wednesday lunchtimes (half day) to go for lunch at the Strafford Arms and eat egg mayonnaise and grissini, bought me Famous Five books - the list is endless. I read quotes on the internet about 'you'll never know how much you miss your mother until she isn't there' - and realised they were true. Gah! I hate sloppy stuff like that!!

And, although I had a partner, I felt so alone. Isolated. Where was my support now? There wasn't any? It was silly really, because I had been financially and emotionally independent for years. I had been the one trying to help them in their later years. But old habits die hard, and I felt frightened. They weren't there for me to go back to when something was wrong (and feed me beef tea and soothe my brow). They just weren't there. And half my life had died with them. I still miss my mum. And I still feel alone. Perhaps it comes of being an only child.

Wednesday, 8 June 2011

Public relations - in the NHS

Stress seemed like a good topic for the day - but in thinking about it, I thought I should precede it with one about public relations to give a little insight.

As everyone probably doesn't know, the average PR person is not that well paid. When I first went into PR from journalism, the salaries were better than I was getting as a journalist, but Max Clifford super-earners we were not.

Invariably people graft away in relatively lowly jobs either in the public sector - local government, civil service, health service - or in the private sector, where the salaries can be good, and, they can also be even worse than the public sector.

As everyone probably also doesn't know, every one in the world without the slightest relevant qualification, thinks they are a PR expert - to the extent of even applying for PR jobs. When I advertised for PR managers, specifically requiring journalism and/or PR skills and experience, I got every person under the sun applying. 'I like talking to people, so I can do this job,' sort of application.

And every non-PR manager KNOWS, just KNOWS, that they are far more of an expert about PR than someone specifically appointed to the job. They may have even listened to a lecture for an hour about it. Who knows? Just gotta love the civil servant telling me how to write and where to place the commas. What my intro should be. What boring verbose language to use. Hell! Why not write the press release yourself? Actually some of them did 'helpfully' send down drafts. They were crap.

And the medic, the nurse, the manager, everyone, but everyone, telling me what to do and what we need. And would they actually pull their tiny little finger out to do anything themselves? Only if and when it meant personal glory for them at my expense. So the realities of life in PR, are not a social whirl of booze and buffets. About the only decent one I ever managed was a launch in Scotland where we had chablis and smoked salmon. But otherwise food and drink was pretty mediocre on that wonderful circuit of networking, chatting, and no hard work. The civil service was slightly better than the health service. At least we had a budget for smoked salmon and chablis. Once.

PR involves being on-call at weekends and nights during the week. In some cases, there are formal rotas - invariably when you have a nice large department and you take it in turns to be on-call. This does mean that you get an on-call allowance, ie extra cash. In very olden days you had to stay in all over the weekend - because there were no office mobile 'phones. (When the mobile 'phone did arrive your arm nearly dropped off lugging it across London to go home). The only time you could escape was to go and buy every single newspaper on Saturday and Sunday mornings and then spend the rest of the morning ploughing through them looking for relevant cuttings. Even Sunday Sport!!

When the 'phone rang, you answered it. Didn't matter what time it was, you answered it. Our 'phone was downstairs which was just as well, as I had sort of woken up when it rang after midnight and I had finally staggered down the uncarpeted stairs, carefully avoiding the ladders that were permanently stored on our staircase. It was usually a nuclear query of course. Gah! Which nuclear expert to wake up at some unearthly hour to ask about nuclear probs? And try and absorb the answer. An escaped canister somewhere? An unacceptable leak of radiation? Exactly what you wanted to deal with when you were half asleep. Still, choose job, get paid, do job.

But when you have attained the lofty rank of a senior manager - there is no on-call allowance. Your salary is deemed to be sufficient and this is when you start to be owned by the company, whether it is public sector or not. Especially when it is the health service. Then you have to find one of your colleagues who specialises in the subject to speak to the press (unlike the civil service where normally you are the spokesperson). Invariably your colleagues don't want to speak to the press. They don't consider they are paid to do so, they may have the knowledge, and you don't, but it is your job to speak to the press even when you have no idea of the topic being asked about. They sure as hell aren't going to tell you something they know about in order to make you look good.

At the time we had a boss who considered that PR was everyone's business. Sadly all his staff did not. My colleagues considered weekends and holidays to be off-limits. I received a call one New Year's Day, and rang the relevant manager. 'I don't want to speak to the press on New Year's Day, can't you deal with it?' Er no. My New Year's Day has also been interrupted thank you very much. I was gardening at the time, it was beautiful weather. Really, how do people think I can possibly speak to the press without being told about the issues? I wasn't telepathic. Nor am I now.

When we held our big public consultation, I usually arrived in the office around 8am. If I was lucky I went to a public meeting in the evening and finished sometime after 9pm, or 10pm or whenever. If I was unlucky, I stayed at work until after midnight working on the fifty millionth version of the crap draft document, accompanied by my superb admin assistant who would rapidly make all the amendments and endlessly keep printing it out. I would take her home, and then drop off the latest versions of our draft documents to all our board members through their letterboxes. I should say there was no extra cash for either of us for this dedicated duty. We had a job. At a time of cutbacks it was enough.

We had board meetings virtually every week. One day, one of the intelligent non-executive board members had a bright idea. 'Why don't we get a journalist to write this document for us?' Bang head on table? One of the exec directors who knew my CV helpfully pointed out that we did have a journalist around that very table. NED looked at me from under his microscope (he was a medic of sorts) wondering what sort of species I was. If I was a journalist, why was I working for the health authority? I couldn't possibly be a proper journalist could I? Because if I was, I would be working for a newspaper.

And how many battles had I already had with the arrogant self-opinionated managers who considered that they could write a public consultation document far better than me? Public sector life? Easy? Money for old rope? No. In the end, I committed to re-writing the - so far - crap document over a few days and getting rid of all the ghastly managerial speak. I demanded input from a couple of knowledgeable people, but given that, I could do it. We did do it of course.

Me, and a couple of directors spent a couple of days locked away, even including getting a couple of pizzas in the office to keep us going. (We paid for them before anyone starts to worry about a couple of pizzas coming out of the public purse). We left the office only to go to the toilet. We went home when it was finished. Or rather they went, I finished the document off - and yes, delivered the latest version to the picky board members into their letterboxes. After midnight. As usual. Was it a good document? Yeah, I reckon it was. Within the constraints of what people wanted to include, but at least it was readable and didn't come on like an MBA thesis.

And - therein lies another PR lesson. Always, but always say how good your work is. Doesn't matter if it is rubbish because, that is what everyone else does. Gotta promote yourself. Tell everyone you are fantastic. Completed an insignificant piece of work - gosh! I did great stuff didn't I? You don't need to be good. Just say you are. To the right people.

Now, onto the next PR lesson. When people tell you they want a PR strategy and lots of really good communications, that means they are telling you how to do your job. In fact they want nothing more than to tell you how to do it, without doing anything else. Will they provide contacts, information, write anything, provide interviews, move their arses to help? Quite honestly - will they fuck.
Newsletters? Don't even go there. The nightmare of every PR manager.

What your super colleagues will do, is endlessly moan and wail about the need for great PR - and tell you to do something. Like PR is one person's business? Because no, it definitely is not. I got sick of it in the end. Ha! I told my dear colleagues exactly what was needed from them to run a decent PR strategy. Everyone lost interest. See, it's easy to say 'What we need are good communications, a newsletter, a PR strategy...' and all the rest of it. Anyone can say that. Hardly takes Brain of the Year. It griped me to hell that my health service colleagues on more money had crap PR skills, expected me to deal with the press for them on their behalf - without giving me the relevant info - and I was treated like some mediocre person, without a skill, who could just chat to the press and write a few press releases, but who didn't understand proper health service stuff. So that my dears, is why I left PR. And learned about cancer services.

Wednesday, 1 June 2011

Health issues - more smears ......

OK, a few stories about screening.

The biggest story to hit the UK was when screening errors at Kent and Canterbury Hospital led to the deaths of eight women and 90,000 women were recalled for further tests. BBC News link about results

Not surprisingly, after that, screening procedures were tightened up somewhat. 'Quality' crept into screening bigtime. Actually it didn't creep, it jumped in and screamed across the stage. When I first took over responsibility for cancer services, I was told screening was included. Big difference in health authority terms, none to the public. But basically, screening is regarded as a public health function, ie something to keep people healthy. Cancer services are about treating people who are sick.

'You'll be chair of the quality assurance group,' said one colleague. Knowingly, and sniggered. I didn't even get to the first meeting of 'MY' group. I was busy writing the Millennium Plan for Year 2000 and couldn't spare the time. I had, however, recently acquired a seconded assistant - a medic gaining public health experience - so I cheerfully sent him to cover for me. It was only afterwards that he told me what an interesting experience it had been for him because he had never chaired a meeting before in his life.

I finally made the next meeting. I guess the group wasn't too happy that I had skipped the first one. They also weren't too happy that for more than 12 months my authority had been promising them a newsletter that had never materialised. Ah! a gift horse. Newsletter? Get that one whacked out in no time. Even if one director, a secretary and a public health consultant had failed to do it. See, journalists do have some advantages.

At the end of that first meeting, one of the consultant surgeons said to me, and I still remember his words to this day: 'I am right, aren't I? You aren't a clinician.' Well, so what. Two clinicans hadn't produced the frigging newsletter that they were all clamouring for so they weren't much use. And secondly, there were so many clinicians around the table that there were more points of view than you could poke a speculum into.

I think I gave the polite and restrained (for me) response of: 'No, I'm not. We are lucky to have plenty of intelligent clinicians around the table with a lot of knowledge and experience. It's my job as a manager to pull that together and use it in the interests of improving the service.' Or some such similar crap.

This guy was no walkover. He had more than one of my female colleagues in tears and was rude and insulting to them. He was well known for being sexist and arrogant, and old-fashioned. He didn't try it on with me any more. In fact, when he moaned about the preponderance of vegetarian food available for our lunches - which people had said they preferred - I arranged a carnivorous banquet for him but he didn't turn up. I received grovelling apologies however and no further complaints about the food.

I should say that I also represented our organisation at his leaving do. He wasn't a bad guy, in fact I would say he was good if you stood up to him. He also took the time to show me around his clinic one afternoon so that I had a better understanding of the work he did. I liked him.

Bit of background. My district included two hospitals with laboratories where the smears were tested, and the same hospitals also had colposcopy clinics where women went for an even nastier procedure than a smear. We had a totally separate admin department that organised the invitations and result letters. Then there were all the hundreds of GPs, and community clinics, the GUM clinic, blah blah. Oh, and health promotion, I always forget that one. All this lot were on my cheerful little group.

To add spice to the mix, one lab was also used by another authority, and that authority had different procedures to ours. Gah!! The minor first disaster was learning that in spite of all our new quality assurance procedures, the shared lab had discovered some poor reporting of smears and hadn't bothered to tell either me, or my colleague in the other authority about this.

Whose neck is on the block? Theirs - and - OURS, as guardians of the screening programme. So much for joint working together. But when the other lab had a problem - they did tell me. I probably wished they hadn't. I had to call a serious incident procedure. The lab had totally missed a smear that wasn't just borderline, or abnormal. It showed cancerous cells on the slide.

This is probably the point at which to say, that screening slides of cervical smears was a hellish boring job that was badly paid. Invariably as local technicians qualified, they were poached for a few more quid by a local lab. I would never dream of blaming the technician for missing something. Or even the cytopathologist that double checked it. It was just not an easy job.

For me though, the very worst experience was one that didn't happen - hopefully. A colleague was in charge of registering local homes, some of which included people who had disabilities. There was a problem in a home with someone who didn't want a smear. Did my colleague come and ask me what the local policy was? Of course not. ( A few personal power political games possibly in play here).

She went happily off to ask a MALE public health doctor who knew jack shit nada about the work of our group. 'Sedate her,' he said authoritatively and arrogantly. 'She needs a smear.' Well, Mr Arrogant Public Health Consultant, it is basically not your decision. Simple as that. It wasn't then and it isn't now. Do not force a woman with disabilities to undergo an invasive test that she clearly doesn't want. Sedating her? Hey date rape doctors here we go.

Finally I'll finish with a comment dear to my heart. It's hardly surprising that patient information has always been one of my priorities. I could never understand why medics, nurses (usually left to nurses of course) and every other clinican in the health service, always thought they could write well, because they couldn't, it wasn't their job to write - theirs to diagnose and treat.

When I discovered that GPs were sending out info and letters, as well as our computerised admin centre sending out similar-but-not-quite-the-same info to our resident female population, I asked a colleague to conduct an audit. By which I mean, asking all the local surgeries to send in their patient info stuff so that we could share best practice, aka tell the ones who are writing rubbish to STOP DOING THAT. Because that was what I wanted at the end of the day.

And what was worrying about the results? GPs were writing out to the women on their list and telling them, basically, that if they didn't attend for a smear they would get cancer. Now that was not only misleading, it was a downright lie, and only served to perpetuate disinformation. I wonder why women are ill-informed about cervical smears? What next? Patient consent perhaps?