Health and Social Care - OU Community Online

From April 2013, the Prime Minster wants to see ‘doctors in charge’, with new Clinical Commissioning Groups paving the way. But there has been widespread scepticism about whether GPs and other clinicians are ready for this root-and-branch challenge.

New research results from the OU funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme offers some much-needed answers. Drawing on data from actual service redesign attempts in the two challenging areas of sexual health services and dementia, researchers found that clinicians who did demonstrate leadership were capable of being open to new ideas and new knowledge while also having the political wisdom to carry their colleagues with them.

Dementia services were refashioned to make early diagnosis more accessible and sexual health reworked so that everything most patients needed could be provided in one visit to a high street clinic.

These gains were not easily won. The research also found extensive evidence of the scale of the challenges when seeking to overcome inertia. Notably, the obstacles are often to be found among their peers. Trust boards and hierarchies were also seen as frequent drags on innovation. In this context, the research sheds new light on the elusive idea of clinical leadership.

Those hospital doctors and senior nurses showing leadership in service redesign had begun to master a range of political and managerial skills. They developed informal links with staff working in related services, developed ideas for simplifying patient journeys and sought out innovation-minded managers and commissioners to help smooth the way for new more patient-centred arrangements.

The research project identifies and clarifies the kind of skills which will hold the key to successful delivery of the new regime, as well as ways of dealing with colleagues and trust managers who resisted new ideas. However, in all but one of the case studies, the clinicians and managers behind the creation of new service models felt it had been difficult to involve GPs. Clinical leadership was thus coming from the hospital sector. This has implications for the new Clinical Commissioning Groups which will take charge of the largest part of the NHS budget from April.

Talking about how the obstacles can be overcome, Dr Richard Holti a co-researcher on the project said: “Formal project planning is not enough; rather, informal, lateral, leadership is important. This is needed in order to bring along clinical colleagues, to reassure them and to win their cooperation and ideas. The most effective service redesigns were achieved when both of these processes worked in tandem”.

Professor John Storey, who led the project, added: “In general, clinical leadership was found to occur at multiple levels and the role of clinicians in shaping national policy should not be underestimated. Many of the important changes required national endorsement – and often funding – in order to put traction behind good ideas.”
 

Former professional footballer Niall Quinn has received an honorary degree from The Open University for his notable contribution to public services, education and culture in North East of England.

Niall was presented with the award at the Manchester degree ceremony in October 2012 by Rajay Naik, Director of Government and External Affairs at The Open University.

Rajay spoke to Niall about his experiences of the day and what getting the award means to him:

As a footballer Niall received 92 caps for the Republic of Ireland national team and played in the English Premier League for Arsenal, Manchester City and Sunderland during a career which spanned over 20 years.

Niall has raised millions for charity. H also oversees the operation of the Sunderland AFC Foundation - a registered charity which uses the power of football to educate and motivate young people from Sunderland and the surrounding area. Last year the Foundation helped over 30,000 children through innovative projects in the areas of literacy & numeracy, addressing health issues, family learning programmes, raising awareness of citizenship and community cohesion issues and improving employability skills.

Whilst Chairman at Sunderland AFC, under his chairmanship, he brought millions of pounds of investment to the club, which has benefitted the city's economy, whilst at the same time reducing prices to make football affordable to local people - in contrast to the prevailing ethos of football generally.

 

The Open University in Ireland held an inaugural awards lunch for staff at the Public Health Agency who have studied with the University to recognise their achievements.

Over the last year, 13 members of the Public Health Agency (PHA) working as support staff, PAs and secretaries completed the Y178 Openings module “Understanding Health”. This course enabled the participants to gain a better knowledge of health promotion within the context of their work, and to whet their appetite for further work-related training.

At the awards lunch, which took place in the Belfast office of the Open University, John D'Arcy (Director of the OU in Ireland) and Dr Eddie Rooney,Chief Executive from the Public Health Authority presented the students with a Certificate of Achievement.

Attending the event were several members of the PHA Board, OU Ireland faculty members of Health and Social Care, Dr Jeremy Roche, Dean of the Faculty, visiting specifically from The Open Unviersity headquarters in Milton Keynes and Mary Hinds, Director of Nursing and Allied Health Professions and Honorary Graduate of the OU.

Donna Gallagher, Senior Lecturer in Nursing at OUI, said “The PHA staff were a wonderful group to work with. We hope that the Openings course has given them an insight to how they can learn flexibly around their work commitments, and to encourage them to continue with their studies at OU”.

Dr Eddie Rooney of the PHA said “Working with a quality institution like the Open University in Ireland was a productive opportunity for our staff to gain new skills related to their employment. These sorts of initiatives allow us to develop our workforce to the highest standards, and we will continue to support our staff who wish to continue to study and train to their full potential with the OU.”

• Further information on the Health and Social Care courses
   

Picture: 
Back row L-R Maureen Rea, Marianne Ireland, Donna Griffiths, Joan Porter, Patricia Grimley
Front row L-R Dr Eddie Rooney (CEO, PHA), Donna Gallagher (Senior Lecturer, Nursing, HSC, OU Ireland), Angie McPoland, Elisabeth Thompson, Christine Thompson, Thomas Mahaffy, UNISON and PHA Board member and Mr John D'Arcy, Director of The Open University in Ireland.

An OU PhD student has scooped first prize for her research at a prestigious event in Vienna.

Melanie Georgiou won first prize for her oral presentation at the Tissue Engineering & Regenerative Medicine International Society (TERMIS) World Congress in Vienna earlier this month (September 2012).

Melanie presented her interim findings on work using stem cells from adipose tissue, which is part of a bigger project to develop tissue-engineered implantable devices for the surgical repair of the peripheral nervous system.

She said: “It was a great opportunity to showcase our research and I feel honoured to have won! My research indicates that adipose tissue can be used as a source of cells that could be combined with natural biomaterials to engineer new nervous system tissue. Building replacement nerve tissue in this way may one day be useful in repairing peripheral nerves that have been damaged by trauma.”

Dr James Phillips, Lecturer in Health Sciences and Melanie’s PhD supervisor, said: “Melanie’s achievement is remarkable and her work has been instrumental in furthering the overall project. Peripheral nervous system injuries that result in extensive loss of nerve tissue can currently only be treated using grafts of healthy nerves from elsewhere in a patient, resulting in additional damage and limited functional recovery.

"To build an effective replacement tissue that could be used as an alternative to a nerve graft requires a source of suitable cells. Melanie demonstrated how cells from a patient’s fat tissue could potentially form the living cellular component of a tissue engineered replacement nerve. This part of the project involved a collaboration between the tissue engineers at the OU and adipose stem cell experts in Sweden.”

Melanie’s work is part of the work of the Open University’s Biomedical Research Network. Her supervisors are Dr James Phillips, Dr Jane Loughlin and Dr Jon Golding. Further information about this research can be found at: www.jamesphillips.org

Watch this video and find out more...

 

 

Find out more:

• Another video: Research into damage repair and the nervous system
• Open Research Online

Looking back at an amazing sporting summer, Ben Oakley, Senior Lecturer Sports Studies explores the implications of Rower, Helen Glover's journey to gold in only four years for a new OU module (E313)* on athletic development being produced as part of the BSc Sport, Fitness and Coaching.

Four bestselling talent developments books - Outliers by Malcolm Gladwell, The Talent Code by Daniel Coyle, Talent is Overrated by Geoff Colvin, and Bounce by Matthew Syed - have the same message at their core: success equals 10 years or 10,000 hours of 'deliberate practice' and the right opportunities.

Helen Glover's story challenges some of these assumptions - until four years ago she had never picked up an oar. She and Heather Stanning won Britain first gold medal of the London Olympics in the women's rowing pair.

"I only started rowing in 2008 when I got through the Sporting Giants scheme where I was basically chosen for being tall and sporty," Helen said of UK Sport's talent-spotting process that fast-tracked her to success.

Glover & Stanning's medal cabinet

• 2010 - World Championships, Lake Karapiro - silver
• 2011 - World Championships, Bled - silver , World Cup, Lucerne - gold , World Cup, Munich - gold
• 2012 - World Cup, Belgrade - gold , World Cup, Lucerne - gold , World Cup, Munich - gold , Olympics, London - gold
   

"They tested 4,500 of us in groups of 200 at a time. I remember sitting in a room in Bisham Abbey in 2007 and someone saying: 'A gold medallist in 2012 could be sat in this room. Look around you.' I thought: 'Right, I'm going to make that me.' It was quite surreal."

Challenging the theory
Glover's experience of making gold with four years of training questions the 10 year theory which originally derives from the research of Anders Ericsson in the early 1990s.
The appeal of his and others' message is its simplicity. You can become a champion simply with a strong work ethic and the right environment. These authors suggest that talent is overrated, downplaying the importance of natural giftedness - for them it is more about determination and hard work.

The 10,000 hour rule, as it is known, roughly equates to ten years (20 hours x 50 weeks x 10 years) of perspiration to get to the top. Little wonder these books are popular in the business community. But does it still add up?

Practice makes perfect?
It is a truism that we all improve with practice but advocates of the 10,000 hour rule go further: it is the quality of practice that is important.

Few would disagree that the ability to work persistently at weaknesses, respond to feedback and set backs whilst refining the different components of your sport is more important than just playing a lot. It also follows that excellent coaching is also needed as well as a deep seated desire to continually improve.

Helen Glover recognises the importance of coaches Paul Stannard and Miles Forbes-Thomas who shaped her initial development and Robin Williams who has made refinements in the last two years.

"Coming into rowing so quickly has been a whirlwind. I've been really lucky to have had world-class coaches throughout my time," she says.

Controversy over the 'time' needed to practice
However, there is controversy about the precise quantity of practice, since the 10,000 hour rule was derived by Ericsson asking musicians in 1993 to retrospectively recall their practice behaviour - less than reliable methodology. It is hardly surprisingly then that the theory falls under scrutiny in the new OU stage 3 module Exploring psychological aspects of athletic development starting in 2013.

Helen Glover's story supports increasing evidence that athletes change from one sport to another reaching international level sometimes in under two years. Tall athletes in the UK and Australia are transferring to high levels in sports such as handball, volleyball and rowing with only 3,000-5,000 hours of practice.

From athletics to skeleton bobsleigh, from rowing to cycling - multiple cases of this nature simply blows the 10,000 hour rule out of the water, leading to pointed comments that the convenient round number of 10,000 hours is little more than a 'nice motivational tool'.

Reductionism
Critics of the 10,000 hour rule claim it has fallen prey to the scientific tendency towards reductionism: breaking a process down into constituent parts in order to better understand it. By downplaying the natural genetic aspects of sport in favour of a nurturist perspective the complexity of becoming a champion is oversimplified.

Ericsson's research came nearly two decades before the landmark 2011 findings by Claude Bouchard on genetically determined responses to training. The fitness levels of hundreds of untrained volunteers were measured before and after five months of training.
The response in VO2max - a measure of aerobic capacity and performance - was enormously varied. Some individuals improved by less than 5% whilst others improved by 30 per cent. Bouchard identified genetic variants responsible for this difference.
Genes clearly play a big role in determining ideal body size and muscle fibre types for different sports, such as basketball, rugby or gymnastics but recent research shows that genes have another influence.

Sports scientist Ross Tucker suggests that certain genes are associated with injury. He argues some people could never reach 10,000 hours because of their susceptibility to injury at only, say, six hours per week of training.

An interactionist approach
When is comes to talent, more and more experts now believe that the original genetic differences between us may be relatively modest but practice and psychological factors do the rest. There is a complex interaction at play.

Athletes who show an innate ability realise they are good at something and consequently intensify their playful practice, enjoying their superiority. Their appetite and success thus continues on an upward trajectory, particularly if they are fortunate in having the right motivational environment and opportunity to thrive with a good coach.

Helen Glover's rapid rise to gold demonstrates that a strong work ethic and the necessary psychological characteristics can combine with potent effect as long as the athlete has the right physical requirements in the first place.

This article was adapted from Ben Oakley’s piece on BBC World Olympic Dreams. 

Find out more:

• Olympic success in the OU community
• OU student Deborah Criddle wins two Paralympic medals
• More from the OU community at the London Games 2012

 * Details of this course will appear on study with the OU soon.

Photo by: photoverulam

 

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.

 

Two OU students in Ireland were named joint runners up in the RCN (Royal College of Nursing Northern Ireland) Student Nurse of the Year Award 2012 for their research into the patient experience of young people with mental health problems.

Orla Mathews and Barry Magee, two nursing students with the OU in Ireland, were awarded at the Nurse of the Year event at the Culloden Hotel, Belfast, on 14 June 2012, to highlight the excellence within nursing in Northern Ireland.

Orla and Barry were nominated for the award in recognition of their research into the patient experience of young people with mental health problems in acute and mental health services. Inspired by their own experiences of caring for young people and realising a need for an examination into how nurses respond to young people with mental health problems, Orla and Barry, through their extensive six-month research project, were able to define key skills and knowledge that will enable practitioners to better meet the needs of this patient group.

Their nominator said: "Orla and Barry have demonstrated exceptional practice, knowledge and enthusiasm in caring for patients, especially those young, vulnerable individuals who are increasing in numbers."

They are continuing their research in the voluntary mental health setting and through their participation in the Guiding Light research project, aimed at finding ways to meet the holistic needs of service users.

John D’Arcy, the Director of the OU in Ireland, said: "This award is a fantastic achievement for our student nurses, Orla and Barry, and speaks volumes about the quality of students at the Open University in Ireland".

 

Pictured from left to right are Linda Johnston, Barry Magee, Orla Matthews and Janice Smyth.