Dignity in Practice: An exploration of the care of older adults in acute NHS Trusts (June 2011)

“Here then is our situation at the start of the 21st Century: We have accumulated stupendous know how. We have put it in the hands of some of the most highly trained, highly skilled and hardworking people in our society. And with it, they have have indeed accomplished extraordinary things. Nonetheless, that know-how is often unmanageable. Avoidable failures are common and persistent, not to mention demoralizing and frustrating, across many fields – from medicine to finance, business to government. And the reason is increasingly evident: the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely or reliably. Knowledge has both saved us and burdened us”.

The Checklist Manifesto: How to get things right (Atul Gawande, 2010)

I’m conscious the last few posts have been focussed on human mortality – though I prefer to think of them as a celebration of life if you read more closely. But at the risk of distressing still further…..

You may have heard of Alice Payne. And if not then you need to: http://www.alicepyne.blogspot.com/

I tweeted (a little tearily I admit) about Alice’s inspiring (if a little heartbreaking) blog on the morning of 8th June and then again that afternoon.

And so, it transpires was everyone else. And so by this morning Alice was tweeting about how the twittersphere was making a series of wishes come true….while newspapers as far aways as Sydney were running her incredible story.

There are a few lessons in Alice’s story. One being the power of the Internet to spread news/share stories/inspire action among many. Another being of course the power of connected consciousness – when harnessed - in the service of good. But the most important is a very human one….

The most important lesson perhaps that Alice has taught us all is that we should never underestimate the ability of one person – even in the face of the most insurmountable of all human obstacles – to affect many for the greater greater good.

I doubt Alice has heard of Victor Frankl, the celebrated psychiatrist and of course, holocaust survivor. And why should she. But in his famous book: “Man’s Search for Meaning”, Frankl wrote something that I recalled as I read Alice’s blog the other morning.

Frankl wrote of the lesson he learned from simple acts of courage and humanity he observed among the devastation of the internment camps,  in the face of the most insurmountable of all human obstacles, death itself:

“Everything can be taken from a man or a woman but one thing: the last of human freedoms to choose one’s attitude in any given set of circumstances, to choose one’s own way”

In Alice, Frankl finds the modern embodiment of that sentiment. She is choosing her own way, her own – incredible – attitude in the face of her given set of circumstances.

I hope Alice completes her buckletlist. I hope she outlives her diagnosis. I hope. But whatever transpires she has served many of us in a more profound way than she might ever imagine….a 15 year old girl, writing with such gentle sadness and wonder reminding us and perhaps challenging us to ask the question….do we truly appreciate and exercise that last (and maybe the greatest) of all human freedoms….the ability to choose how we might live. Even in dying.

Alice. Thank you.

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• Live Like you are Dying #AliceBucketList [Dean 'Warrior Coach' Grimshawe] (ecademy.com)
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On 27th May, the celebrated ”bluesologist” Gil Scott-Heron sadly passed away, aged 62 years old, to what he might allow us to refer to – in a nod to one of his most notable works - ”The Other Side”.

Gil Scott-Heron was many things to many people: writer, composer, poet, recording artist, long time drug-addict, son of Chicago (and an ex-Celtic footballer!), resident of Harlem, father, convict, cultural critic, “voice of Black protest culture”, husband, anti-apartheid activist, friend, inspiration….to quote Chuck D, the leader of Public Enemy, speaking in The New Yorker in 2010, “You can go into Ginsberg and the Beat poets and Dylan, but Gil Scott-Heron is the manifestation of the modern word”.

I came late to Gil Scott-Heron. While aware of his early work and influence on the music and social culture of the 1970′s, I hadn’t engaged at any real level with his music. I picked up his last album, “I’m New Here” in early 2010 just after it’s release. It was a crucially important time for me personally and perhaps as a consequence of that, something in him and this album, at this moment deeply affected me. In particular the title track struck a deep chord. When you understand Gil Scott-Heron’s own life story, what he achieved and lost; what he succumbed to, suffered and ultimately overcame (however briefly in the end), the lyrics take on a genuine power and for me, at that time, a deep and important resonance. From opening with a searingly honest two line admission of personal responsibility (or at least complicity) for what we may each become,  it plays out ultimately as a celebration of and a testament to the ability to change; to redeem oneself; to renew and redefine a life, however late, in the face of any adversity; in spite of any past.

Gil Scott-Heron has come full circle in this life. And wherever he is now, I’m sure he’ll find someone to show him around. But I’ll always feel sorry that I never got a chance to express to him that while our respective challenges were, of course, very very different, he reminded a fellow seeker in this life that whatever we face, however daunting the road ahead, whatever we carry with us from the past – in an echo of the great Invictus - we can always, always, turnaround.

And so thanks, at least in part to Gil Scott-Heron, as the first hour of my 36th birthday rolls past, I truly feel that after a long long time….with a voice of reason….I am new here again. 

Gil, RIP.

I’m New Here lyrics
I did not become someone different
That I did not want to be
But I’m new here
Will you show me around

No matter how far wrong you’ve gone
You can always turn around
Met a woman in a bar
Told her I was hard to get to know
And near impossible to forget
She said i had an ego on me
The size of Texas

Well I’m new here and I forget
Does that mean big or small

No matter how far wrong you’ve gone
You can always turn around

And I’m shedding plates like a snake
And it may be crazy but I’m
the closest thing I have
To a voice of reason

Turnaround turnaround turnaround
And you may come full circle
and be new here again

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Just over a month ago, the very excellent @davidwilcox posted another excellent piece on “Mapping the Big Society Territory” here. I recommend it to you.

So taken was I by it that I scribbled a humble response which I’ve copied below. It touches on similar points as my response to Elizabeth Moss Kanter’s blog post on “Leading Change” back in May this year.

I really need to commit to doing what I said I would and build out this model I have in my head showing a map of considerations (anchored in empirical evidence) when designing and leading a change effort. 

Anyway – thanks to David Wilcox for his piece and the chance to articulate this. It’s a bit more generalised than I’m entirely comfortable with but it was late and Mrs C was digging me in the ribs to “turn that bloody iPhone off!!”…

@davidwilcox Interesting post, squiggles and all.

Three points only and humbly submitted. 

First, although some will argue it’s “only semantics”, the point on naming convention is interesting. Any behavioural economist worth their salt will tell you that the very phrase “Big Society” is enough to disengage (or at least barely raise the inherently self interested/motivated pulse of) the general populace.  We know from years of research that even when our own very personal (e.g. Health, wealth) interests are at risk we often remain unroused to act appropriately (rationally) in the short or long term. So, when the long term aim is as impersonal, intangible and thematically vast as a “Big Society” then people won’t be roused. They’ll feel it’s “too overwhelming”, “too big for them to meaningfully contribute to”, “clearly not a pressing priority specifically for me to act on” (the latter is oft referred to as ‘the bystander effect’ in behavioural psychology) etc. It’s a similar challenge for Global Warming…So, although “Our Society” is still a little wooly (what do we think those we’d like to see more involved interpret “society” to mean do you think? I doubt many would respond positively on instinct alone..) it at least calls to the (shared) ownership instinct in each of us via “our”. Shame you didn’t mention our very own “Co-operative Society” here in Lambeth….It’s like the Big Society but re-labeled for Red Rose Authorities. Room for one of those on the diagram?  

In it’s effort to address this behavioural challenge – in part by setting up it’s own “Nudge nerve centre” (aka The Behavioural Decisions Unit) at No 10 and trying  to encourage behaviour change among the general populace from there, the Coalition appear to be overlooking the key principle of any effective change (diffusion) initiative: those in the “Early Adopter” and IN PARTICULAR those in the “Early & Late Majority” categories adopt the desired behaviours/engage fully not simply because of WHAT they see to the left of them on the diffusion model but WHO they see. And I’d suggest that those who the Government hope to engage in the Big Society (who currently aren’t) are least likely to respond to diffusion from Government/Civic Orgs and most likely to respond to diffusion from peers and role models from the “Our Society” bubble of your diagram. I hold out most hope for the Social Enterprise community but I’m not convinced alone that we’ll get to (and sustain) those hard to reach places where society of any sort – big or small – could do with a little pick-me-up.  Hence my second point – the role of the existing “Our Society” is most fundamental to this effort and why the work the RSA piloted in New Cross to understand and leverage existing social networks and influence is vital. If Tipping Point and the myriad of behavioural economic/psychology books that followed in the last decade have taught us anything, it’s that influence is not distributed evenly. And rarely are authority or establishment gifted with the large quota they might like to believe is the case.  Should all roads on your pic therefore start from “Our Society”? I’m not sure just yet but a more considered understanding of how to harness and embolden existing activists with genuine and breadth of influence across into your “BS” bubble seems like the best bet for Gov. I’ve seen little to reflect they grasp this and the meeting you describe (the inside/out or top/down model) confirms this. The call for a more “emergent” approach is a good one – and could ultimately prevail (though do we even have high level desired outcomes?) but it need not be entirely free form as I infer above if we target resources where the greatest return in diffusion can be earned.

Finally, if there is one thing that we know works more powerfully than peer pressure to encourage behaviour change, it’s loss aversion. The final, actual reality of withdrawal of local services and the gains that were previously derived from those services may ultimately be necessary to create the incentive to engage the hereto disengaged. But I’m not convinced. Given the discussion on Big Soc has largely focused on community services such as libraries, parks, leisure facilities and some non (or lightly) regulated local authority functions, I’d hazard a guess that those most likely to feel the greatest loss aversion to their withdrawal are those who are already reasonably socially active in the “Our Society” bubble. So back to point two I guess.

Longfellow once wrote: “I shot an arrow in the air, it fell to earth I know not where”. We Irish have a more optimistic take on that. As I’m often reminded: “if you don’t know where you are going, that’s where you’re sure to end up”.

I sense Cameron would prefer to locate his arrow (age of austerity etc) and I don’t think he’s a wandering Irish troubadour at heart. But without some future vision expressed in somewhat tangible outcomes for people to organise themselves around that may be his fate. At the very least the current vacuum on meaning and process was sure to open and much energy dissipated in the ensuing mudfight.

Part of me hopes for the best. Part of me fears the horse has bolted, unhoved, unsaddled and with no direction. Part of me thinks that the true discussion can only commence when we understand the gaps the big society has/will need to fill when the CSR dust settles. I know that’s not the ultimate point but it may be it’s ultimate test.

And part of me thinks he should have just published one of those “Change the World for a Fiver” books with 50 no cost ideas for contributing to the local community with a foreword which explains that research from the past fifty years suggests that levels of social connection and philanthropy are better predictors of life expectancy and mental health than most any other measure (incl alcohol and tobacco consumption). Long life and happiness you say?! Sign me up. I’ll start soon, honestly….

Related articles

• Oh, Mr Cameron, do stop all that annoying nudging | Catherine Bennett(guardian.co.uk)
• Andreas Whittam Smith: The idea of Big Society is beyond left and right(independent.co.uk)
• ‘Big society’: Giving just that bit more | Francis Maude, Jeremy Hunt and David Willetts(guardian.co.uk)
• Cameron’s hijacking of Nudge theory is a classic example of how big ideas get corrupted | Aditya Chakrabortty(guardian.co.uk)
• First goal of David Cameron’s ‘nudge unit’ is to encourage healthy living(guardian.co.uk)
• Thaler Nudges the Brits (and the Swedes?)(marginalrevolution.com)
• Rory Sutherland’s quiet behavioural revolution gives the status quo bias a nudge(telegraph.co.uk)
• ‘Big society’ – where’s the opposition? (newstatesman.com)

I went on a bit of a “rant” today in response to some worryingly narrow responses to an excellent piece the wonderful Euan Semple had posted on his blog The Obvious, criticising a school (which the son of his friend attends) for withdrawing/banning the use of Facebook in school time.

I’ve copied the relevant exchanges/pieces below. I hope I didn’t upset Helen or Christian but sometimes you have to say what needs to be said. There is little more important than progressive education….we should continue to encourage a progressive discussion.

This seemed somehow apt today as I went along to the local Primary School to hear about the possibilities for becoming a Governor. I’ll be checking they harness social media in the classroom before I sign up to anything!

I’m glad to say that most of the posts that preceded and followed mine agreed with Euan’s original sentiment. So all hope is not lost….I was really touched by his kind words following my post. That, for those of you who don’t know the influence of the man, is praise indeed.

Anyway, here it is (was?) albeit a spell checked version (old habits..) starting with Euan’s original post. You can find the full exchange with all comments at his excellent blog which I’ve linked above.

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