k101 health social care

Following ex OU academic Jill Reynolds' previous posts 'what if I die before I get old' husband Dave continues Jill's story of her experience of cancer treatment in France…

The news in March that chemo treatment had reduced the size of Jill's secondary cancers gave us confidence that with more treatment we could enjoy summer at our house in France and pop down to Spain so Jill could practise her Spanish.

The last blog 'European Union at work' expressed our frustrating experience of health system bureaucracies, but in mid-April she started chemo in Narbonne. We did not expect things to change so quickly. The nagging pain in her left hip quickly got worse. In early April we'd got our bikes out for short rides and done vineyard walks of an hour or so; two weeks later she was on crutches and moving a few paces with difficulty.

When we'd asked 'specialists', in Oxford or Narbonne, if this was likely to be cancer spreading to her bones, they all said 'probably not; pancreatic cancer spreading to bones is rare, only five to 10 per cent of cases'. We had it x-rayed and went to see a 'rhumatalogist' Dr Brousson, an earnest man with a reputation for brusqueness.

He eyed Jill and her x-ray with the look of a gas engineer inspecting an obsolete boiler, and said: “Hole here. Very thin here, perhaps fissure. Risk of fracture. Perhaps try cement. You walked in here with aid of one crutch? Always use two.  Do not walk back down the corridor; take a wheelchair. Put no weight on legs. Come to hospital tomorrow for scans and tests.”

'The news from the scans was not good. Jill was one of the five to 10 per cent whose cancer had spread to bones'

Whenever you go to any healthcare service they always ask for your 'carte vitale' with social security number first. Having to explain “we're not resident here, don't have carte vitale, but do have an international exchange agreement, form S2, I know you haven't heard of it, here's our number” became a little tedious but once you've got the paperwork sorted they do move. None of this “a secretary will get back to you in a week or so with a date for some other time” - they pick up the phone, talk to the scan unit, and say “tomorrow”.

The news from the scans was not good. Jill was one of the five to 10 per cent whose cancer had spread to bones - hip and back. So as 'cement' was obviously not an option a 10-day course of radiotherapy, reputed to be a good treatment for bone cancers, was arranged.

The treatment clinic in Beziers was modern and full of high tech robot things that targeted several places at once.  Although the actual treatment only takes a few minutes, we had a daily 70-mile round trip by taxi/ambulance which dominated the day.

'If Jill's mobility was unlikely to allow her to do much, we thought of returning to the UK'

We were told it takes up to four weeks for radiotherapy to take effect, so Jill put her feet up and waited; nothing changed.  At least she could enjoy a small vin rouge in our sunny garden. Everyone told us what a washout the English summer was so we could almost feel smug. After three weeks there was a follow up and when we asked if, given more time, benefits from radiotherapy might still appear, Dr Mathieu gave a very gallic shrug and spread of hands.

The frustrating thing about pancreatic cancer is that for all the specialisms and high tech kit nobody understands how this disease works and what might happen. It's not that they're bad, or lazy, they just don't know and can't tell you much.

If Jill's mobility was unlikely to allow her to do much, we thought of returning to the UK where we were confident of the end of life care given by Macmillan nurses and the local hospice. But a week or so later Jill lost the use of her legs and ability to stand, so travel would evidently be difficult. 

She now has 'soins palliatif a la maison' where local nurses come in twice a day to wash, change dressings etc and they're marvellous. She even has a physio visit daily to give her foot massage 'pour le circulation' while we watch Bradley Wiggins on TV puffing up the Pyrenees a couple of hours from here on 'le tour'.

So what are the differences, the pros and cons of having treatment in France or staying in the UK?  As one might expect, they're both Western European countries with similar educational traditions so the solutions will be similar. 

In France there's a lot of 'up front' bureaucracy partly due to the network of public and private providers. They react quicker; waiting times are much less or non-existent, which is important when dealing with 'aggressive' cancers. They spend about 20 per cent more per person on healthcare - a significant difference but not a massive one. You can see plenty of opportunities for cost savings!

In the UK the slowness that seems endemic in the admin is difficult to understand and so stressful. The support systems - both NHS and personal - are more intimate. In the end all roads lead to the same place; some are quicker or more comfortable than others.

• You can read Jill's first, second, third and fourth post, covering the experience of dealing with a terminal illness by clicking the links.

 

Jill Reynolds died on 26 July 2012 in France. Jill's contribution to the university and the Faculty of Health and Social Care was immense and stretched over many years, until she retired on health grounds. She was not only a gifted and committed teacher and researcher but, as those who had the pleasure of working with her will know, a delightful and supportive colleague.

 

“Running a successful adult learning programme is all about taking a non-judgemental view, because this is not about the qualifications they’ve got, but about their potential,” says Jerry Masterson, practice learning facilitator at Leeds Teaching Hospital’s NHS Trust. Jerry recruits staff onto the OU’s pre-registration nursing programme and explains how students are given the support they need to succeed and how he sees, first hand, the OU changing people’s lives. “I’m a believer!” he says…

“My job is all about helping staff to fulfil their potential. I am the employer representative on the Open University’s pre-registration nursing programme, which our Trust has been running since 2006, and I recruit students and ensure they get the best support they can to succeed.

“I recruit staff onto the programme by advertising and interviewing them. Many left school with few qualifications for a number of reasons. We talk to applicants about their commitment and make sure they have thought it through. If we or they don’t feel they’re ready academically, that’s not a problem – we create for them an action programme which will help them get up to Key skills level 2. This is a good way for them to prove their commitment and of course it makes them better prepared – and if they go into the programme with their eyes open about what is expected of them, they are much more likely to be able to see it through to the end.

“The Strategic Health Authority pays for the students to study 26 hours a week for the four-year duration of the course. They are assigned a tutor and for the first three months from September to December much of this is paid study leave, so they will be at home developing their study skills. However, in the New Year it becomes much more clinical and much of their study time is spent in practice on a ward. Of course, most of the people on pre-registration nursing courses are already healthcare support workers so they are in familiar surroundings.

“We have 48 students on the course at the moment but because they do come into it so well prepared we only get about one problem student a year. When they’ve completed the course they can register as an adult nurse and apply for qualified nursing status. We can’t guarantee them a job on the ward they trained on but we find that, like in most degree programmes, they tend to specialise as they continue so their fields of interest change.

“The Open University is an excellent way to learn. I’m a believer! My dad could remember the birth of the OU in the 1960s and talked about its optimism and idealism, and I fully believe in that. There are so many people in middle age who are victims of the old 11-plus and the school system, who weren’t given the opportunity to learn, do exams and fulfil their potential. But the OU gave them those opportunities, made them realise they really could achieve great things and made them believe in themselves.”

 

Find out more: 

• Pre-registration nursing programme
• Nursing qualifications
• Faculty of Health and Social Care

 

The OU’s pre-registration nursing course has been described as a “dream come true” for health care assistants wanting to train as nurses in remote areas. Often faced with having to relocate or travel to train in nursing, Pat Tyrrell, lead nurse at Argyll and Bute Community Health Partnership, in Scotland, explains why the distance learning aspect the OU offers is a perfect fit...

“The Open University’s pre-reg nursing course is a dream come true for health care assistants (HCAs) in an area as remote as ours,” says Pat. “We are in Argyll and Bute, where there have always been so many talented HCAs more than capable of becoming good nurses, but could not train to do so. Before we started working with the OU – about seven years ago – they would have had to travel to another part of Scotland for their training and placements;  for many home commitments simply made that impossible.

“However, now it’s a different story. The distance learning aspect of the OU means our HCAs can learn while they are working locally and this has brought opportunities for so many people to achieve their ambition of becoming qualified nurses. Doing the OU’s pre-reg course is the only way that was possible – and of course it’s beneficial not only to the students but also for us, as we have so many more trained nurses!

“We send promotional material out around the partnership to attract students and then the students apply for a place on the course through their line managers. We take a lot of care to ensure those undertaking the course are ready to do so. It’s not just about the academic ability – they need to show us they are resilient as we do warn them it can be quite a challenge which could end up changing their lives.

“Because of the nature of the programme, our students need very supportive families. They are learning nursing skills but there is also an enormous amount of reflection and personal development. This course encourages you to challenge, to question practices and to realise that there are other ways to do things. It changes the way they think. Our students are aged from their 20s to their 40s and as you can imagine, for some people this is like opening a door to a whole new world and they can change – which obviously can put a lot of pressure on families. The students we take on need to be prepared for that change.

'People can study in their place of work which is beneficial for them and beneficial for the partnership'

“However, they get a lot of support from within the partnership, not least from nurses who have already gone through the programme and can help them as they develop.

“In the early days there was a little bit of concern in some areas as to how the programme would work, especially as people have historically had to leave the area to train. But it really has worked very successfully. People can study in their place of work which is beneficial for them and beneficial for the partnership.

“At the end of the course, we work very hard to find jobs for them all. We get qualified nurses and other staff can become programme tutors or course tutors, which helps them keep up to date. It’s a programme that develops everyone.”

 

Find out more: 

• Pre-registration nursing programme
• Nursing qualifications
• Faculty of Health and Social Care

 

Devised by Barry and Lucy and with extracts from the BBC/OU programme Protecting Our Children, A Day in the Life... provides you with the opportunity to step into a social worker's shoes and to experience a 'typical day in the office’.

Find out more:

• Go to the interactive video A Day in the Life...
• Study Social Work with the OU

A self-study course aimed at improving the care of patients with inflammatory arthritis is being launched by The Open University in February 2012.

Inflammatory Arthritis – a multidisciplinary approach has been funded by a curriculum development grant from the pharmaceutical company Pfizer, and has been developed with the direction and advice of specialist rheumatology nurses. 

The course aims to provide healthcare professionals with specialist knowledge to improve services for patients with inflammatory arthritis, and is also relevant to patients and carers who want to have a deeper understanding of their condition and its treatments. 

It aims to support a person-centred and multidisciplinary approach to caring for people with this long-term condition.

It will give students knowledge of how to identify and monitor inflammatory arthritis using history, disease scores and blood tests, and ensures they are aware of the standards and guidelines that govern the care of patients with the condition.

The course is aimed at a wide range of health and social care professionals including nurses, physiotherapists, occupational therapists, health assistants, community pharmacists, GPs, junior doctors, radiologists, podiatrists, social workers and alternative therapy practitioners.

It is delivered online over a period of up to 18 months, with flexible modules that amount to 50 hours of learning.