Category Archives: Education, Health And Welfare
Angry Young Men in Bradford, Toxteth, Oldham, Salford, Lozells…
In every era of history young men have demonstrated hotheaded and sometimes unacceptable behaviour. Recent violence in our inner cities is nonetheless hugely worrying, especially in contemporary contexts of instant communications and global politics. Intervention to change this behaviour must come from many different angles. One way is collaboration between youth service and school professionals to help alientated and challenged young people develop skills to help themselves.
Groups of young men (and just occasionally now young women) who rove the streets perhaps not averse to a fight, or perhaps even a riot, are nothing new. In Romeo and Juliet Shakespeare wrote about the mediaeval tragedy of the Montagues and Capulets; and Mods and Rockers in the nineteen fifties were the basis of Graham Green’s novel Brighton Rock.
But that this happened in the past doesn’t in any way mean that it’s not of deep concern now. Indeed, with global communication many might argue that, when hotheaded youth meets fundamental conviction, the problem for us all is if anything more serious than before.
The issue in a generally tolerant society is obviously very testing. How can we tell young people meaningfully that we value them, and everyone else, as individuals, whilst also making it crystal clear that we do not, and cannot in any circumstance, tolerate the belief of a minority that violence is sometimes justifiable?
Starting early
The answer lies in part with how we provide for young people and children, in schools, youth groups, in their communities (howsoever defined – which can be a big question…). And we have to start early.
Quite recently I was the evaluator in a project which involved close collaboration between the youth service and two schools in a hugely disadvantaged part of a northern city.
Multiple challenges
The object of this pilot collaboration was to see how intervention by the youth service could support children in secondary education who faced multiple challenges. Some of them were
very low achievers, some had personal problems, some were asylum seekers (who often didn’t speak much English). The majority were boys.
What became very clear to us all, teachers, youth workers and others, was that these children needed to develop confidence and communication skills, and that was best done in very small groups using youth work techniques rather than the conventional classroom approach. However kind and caring the teachers, in their usual classes the children felt swamped and unable to contribute – with the inevitable consequences.
Managing anger in testing circumstances
What was also very clear was that for some children from ethnic minority communities racism was a daily experience; and one they often couldn’t cope with. Anger management for all the children, whatever their community background or colour of skin, was also therefore an essential element in their skills development.
The aim was to help all the children walk away from trouble, full stop.
Continuity is the key
On the whole, this approach was actually beginning to work by the time the pilot project came to an end. The lessons we as professionals learned from this pilot collaborative project were many, but one of the most striking was, you can’t start too early – and you can’t just cut off because a young person has a birthday.
Schools may be structured to impose enormous transitions at eleven and sixteen; but children sometimes remain children in their perspectives and behaviours in ways which may relate little to their chronological age – especially if they have had a pretty rough time of it to date.
A multi-disciplinary approach
Another lesson we learned was that multiply challenged children do indeed need multiple approaches to their problems – teachers, youth workers, health and social care professionals, all have a part to play; and they have to do this together, understanding what each professional approach has to offer the children.
Nobody is suggesting that youth service-school collaboration will bring an immediate end to very serious current concerns around the behaviours of some young people; but it does seem that investing in more of this work is also investing very positively in our futures.
Peer support
The more extreme and unacceptable beliefs of the small minority of angry young men are best challenged by their peers, as well as just by ‘outsiders’.
If we can somehow give some of these peers the support and skills they need to be able to stand up for good sense and our common humanity, we will have achieved something really worthwhile which offers hope for everyone.
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Planning For Energy Futures With The CBI
The Confederation of British Industry (CBI) is warning us that posssible energy shortages mean a winter of discontent awaits. This is a matter of concern for everyone. When energy is taken by the banks and business as seriously in terms of analysis as finance, the notion of ‘Futures’ may help us to understand ‘Options’ in a whole new way.
My grasp of ‘Futures’, in the financial sense of the word, is slight; but I gather it’s all to do with large-scale ‘Options’ on investing by banks to produce decent returns later on. So far, so simple.
But isn’t this what we need to think about with energy futures, as well as financial ones? The CBI – an organisation which I would imagine knows a bit about futures and banks – has just said they have serious concerns about energy provision this winter. A long hard snap and we’ll be in for a winter of discontent the likes of which only those of us long in the tooth can recall.
Strangely, the forward thinking which is routinely made for financial futures doesn’t seem to feature when businesses consider energy futures. Some of us would argue, however, that energy is where it’s really all at.
What’s the ‘gold’ of the future?
Hasn’t it been said that the gold of the future is oil? Or maybe these days renewables?
Recent days have seen high-level hints that more nuclear power is on the cards for the UK. Conservationists and eco-people will be horrified by this. Industrial contractors and perhaps some regeneration specialists may see it as a promising way forward.
The real question must surely be, how much thought have we all put into ways of providing energy for the future? And how much have we also thought about the levels of energy we really need, as opposed to the levels we all currently expend?
Conflicting demands
Leaders in different parts of these fields seem to be looking several ways at once.
Businesses want cheap energy in abundant supply (though some of them do of course make efforts to conserve it as well).
The politicians are trying to do two things: encourage us on the one hand to save energy, and on the other to consider forms of energy production which may or may not be sustainable and long-term safe.
And the scientists are telling us that the technologies for energy conservation and production have not all been explored to the same level. We aren’t as yet in a position to evaluate fully the relative effectiveness and risk of all the possible ways forward; but we do know how to produce shorter-term big science solutions.
‘Options’ in energy
Back then to the ‘futures’ idea. We have graduate physicists and others who, it is reported, have too little to do. (An irony, in my experience, is that many good physicists end up working as analysts in banks, not laboratories.) And we have businessess which are worried about energy. Why not put things together and start to take the ‘options’ on energy as seriously as those on finance?
This isn’t just an issue for people who have lots of money to spend, it’s an issue for us all. Without energy, at suitable levels of availability and sustainability, there could be no banks or businesses anyway.
Where Do You Live When You’re Older?
Increasing life expectancy offers many new opportunities to us all, but it brings problems too. Amongst these is how working families can also care for elderly parent/s, who often live many miles away. One possible solution which could also help others living alone might be to re-think the mix of housing required when building homes, whether in rural areas, in terraced streets or in the suburbs.
It’s an issue we almost all have to face at some point: what do you do when old age or dependency catches up, and entirely independent living begins to be a worry?
For some of us, this occurs when our elderly parent/s or other ralatives begin to need support; for others it may perhaps only arise when we ourselves find that getting around is not as easy as it was. Sadly for a smaller number the issue arises because they have dependent adult children who will always require care. But there are few people for whom it’s never at any stage a worry.
It’s even more difficult of course if the increasingly fragile person lives at a significant distance from anyone who could ‘keep an eye’ and offer support. Many of us find ourselves at some point dashing off at any available opportunity to visit elderly parent/s or other lonely or dependent relatives. The problem is, there’s no room, or it wouldn’t work, for them to live with you; but on the other hand they live too far away for easy access.
And this issue isn’t going to go away. We should all be delighted to acknowledge that people live longer now. For probably the first time in history most of us can now expect to get into our eighties in relative good health.
In other words, the ‘dependency ratio’ – the ratio of people in work to those not working – is shifting towards fewer working people and more elderly, retired folk. So here is a matter requiring social adjustment and new policies for a whole range of services and facilities.
Would it be sensible to suggest that a policy of accommodating older people within reach of their nearest and dearest is essential wherever possible? The classic response is the personal arrangement of building or altering accommodation as a ‘Granex’, somewhere in or by the family home where a single older person can live independently but alongside their adult offspring.
But perhaps now is the time also to recognise there is a new commercial construction opportunity here, a development which would facilitate family contact but at the same time help older people to maintain their personal autonomy within the wider community.
We already have groups of small housing units which, although all separate and private, have shared wardens and services. These tend however to be in short supply; as indeed do privately owned bungalows suitable for less mobile seniors.
When housing estates (either private or for rent) are built, or when streets are renovated in the inner city or wherever, perhaps there could be a requirement that a given percentage of the development is very small clusters of accommodation suitable for elderly single people?
There could, for instance, be a recommendation that every fifteenth – or other appropriate number – plot be not, say, two conjoined semis, but rather five smaller flats, each with easy ‘disabled access’ and with a common lift, garden space etc. These small unit blocks, scattered around local communities, would provide homes to be sold or rented in exactly the same way as any other accommodation. The only difference would be that they might offer special ease of access and, through some shared amentity, an opportunity for the residents if they wish to maintain or develop a community of personal contacts and to keep an eye on each other.
If there were enough of these small unit blocks scattered around our communities, a real need could be met. Many adult children who wish to have their elderly and dependent members nearby but not for whatever reason actually in the family home could do so, using the normal mechanisms of the market. And this could also offer mutual support for others who are alone but don’t choose to live in larger blocks of flats.
Not everyone who lives alone can afford, say, suburban accommodation intended for two or more people, but there is no logical reason why smaller single living units can’t be developed in areas usually associated with the semi, as well as in the city centre. Similar arrangements could also apply, to use the other extreme, in rural villages, where affordable housing is becoming a major headache for people on lower incomes.
The evidence seems to be that mixed housing is a step in the right direction for stable and comfortable communities. General incorporation of single / small units of accommodation into ‘semi-land’ and terraced streets could increase choice for single people and help families to keep in touch with elderly members in a more routine and relaxed way.
Given the acknowledged inevitability in the UK of increased single living and also of elderly dependency, there really is a need to think about housing in new ways.
MRSA And Flu Pandemics Don’t Just Happen….
MRSA, nasty flu bugs and so on are not simply random events. People can help themselves. Public health and health education knowledge is never more important than when people are alarmed about health scare stories or the threat of epidemics.
It’s probably the years I spent battling as a teacher for proper Health Education in schools, but I’m always puzzled by the view that serious contagious illness ‘just happens’. It doesn’t. Believing that, say, MRSA or really nasty strains of flu are things we can do nothing about is a big mistake.
Of course anyone can be unlucky with any sort of ill-health. It would be very wrong indeed to suggest that we can all remain healthy by doing / eating / thinking the right things. If only….. But that doesn’t mean we have to be victims in our minds all the time.
Simple procedures, excellent results
MRSA, the super-bug found in hospitals, is a good example. When everyone remembers to keep things really clean, and to wash their hands every time they should, its prevalence falls significantly. The same applies to other infections.
Some maladies are caused by bacteria, and others by viruses. The ways they spread depend on whether they are passed from person to person by touching, coughing, just lying in wait, or whatever. But all these modes of transmission can be contained to greater or lesser degrees by good hygiene.
Which takes me back to my first point.
Education for health starts young
People currently enjoy on average longer and healthier lives than at any other time in history. But there was a period in the 1980s / 90s where public health, and related individual health matters, were very low on the agenda. Because of this there was very little interest in school health education.
Things have improved a lot in the past few years – Personal, Health and Social Education (PHSE) is now firmly embedded in the school curriculum. But one thing we all need to know, children, teenagers or adults of any age, is how to avoid unnecessary infections and, crucially, why these measures work. If we understand, we are more likely to stick to what we need to do. This means a working knowledge of healthy eating, exercise, good hygiene and immunisation routines, the lot.
A measure of reassurance and control
When we understand there are things which can be done as individuals to keep the bugs at least in part at bay, we are more likely to take a balanced view on the risks. Alarm and panic rarely help anyone to cope. A grasp of the facts, and feeling we have some measure of control, often does.
Why Do Farmers’ Markets Cheer Us Up So Much?
Farmers’ Markets have a special place in city life. They encourage us to feel part of a community, yet when we go to these markets we also feel that as individuals we are attending to our health and leisure needs. Farmers’ Markets may indeed sometimes in reality be big business, but they fill a gap in our fragmented urban lives.
Farmers’ Markets seem to be all the rage in Liverpool at the moment. They started in the ciy centre (by the Victoria Monument), and recently sprouted up in Lark Lane to the South of the city. Now, this Sunday, there is at last to be one in Hope Street, the cultural quarter. All the recent evidence suggests that, weather permitting, this too will be a big success.
So why is everyone in the city so enthusiastic about Farmers’ Markets? Several possible answers to this question come to mind:
Farmers’ Markets make us feel healthy. Whether the produce is actually fresher and more nutritious (or beneficial in other ways, if not edible) than produce we can buy in supermarkets, we willingly go along with the idea that it must be.
Farmers’ Markets make us feel part of a community; we throng around, perhaps sharing comments with perfect strangers about what’s on offer, and aware of the shared purpose in our being there. Yet we also feel like individuals – not for us the pre-packaged routinised stuff of the big stores. We are making a positive, personal choice to buy, or perhaps just to consider buying, produce which feels, against supermarket standards, just a bit exotic.
Farmers’ Markets take us back in time. We imagine, more or less accurately, that this until quite recently is how people have always conducted their financial transactions. There’s a rusticness about what we’re doing which harks back to a supposed golden age which is in contemporary times usually only seen on Christmas cards.
Farmers’ Markets are ecological. If we can, we walk to them (or at least park the car a distance away), clutching cane baskets and imagining, correctly or otherwise, that what we intend to buy is organic.
Farmers’ Markets let us feel authentic. We can actually talk, and maybe even negotiate our purchase, with the people who are seling their own goods – which we naturally suppose they have also themselves carefully crafted. The goods are authentic. The person-to-person transaction is authentic. We must be authentic.
And Farmers’ Markets are interesting. We are often not sure what we’ll find when we get there. Who will turn up this time? What will they have to sell? We attend trustingly, purses speculatively at the ready in our pockets; not for us on this occasion the usual boring shopping list!
It might be surmised from this list that I have a problem with Farmers’ Markets. Not so at all. They have a real part to play in the lives of many city people, just as they always have had in more rural contexts.
It’s the function these markets perform in our splintered urban communities which fascinates me. They may in fact sometimes be the visible parts of very large business operations, but they are perceived as ‘small’, micro-enterprises undertaken by real people. They make us feel special, they spark our imaginations and they activiate our interest in important aspects of health and community.
Don’t miss the next Liverpool Farmers’ Markets. Be sure to be in Lark Lane on Saturday, or in Hope Street on Sunday!
Health Services Or Public Transport, The Contractual Issues Are The Same.
PFI contracts are again in the news, as the London Underground Northern line grinds to a halt and no-one knows who to hold accountable. But what does this also tell us about private (and social entreprise) service provision which is bought in by NHS and Foundation Health Trusts? Private sector buy-in contracts need careful thought if they are to deliver what is expected, no more, no less. So who is going to provide this legal scrutiny?
”No-one, it seems, is in charge…. London Underground needs a simple line of control and responsibility and does not have it…. In truth the problem is not the involvement of profit-making companies in the underground, but the terms on which they are involved and at present these are failing badly.’ Thus runs the Guardian’s second editorial today.
Just two days ago (this website, NHS Contracts and Foundation Hospitals: Who has the Legal Expertise?) I predicted that issues around PFI would continue to run, and that the problems which have plagued PFI contracts would in all probablity also plague new Health Service arrangements. It didn’t take long to see that unfortunately there is indeed mileage in this prediction.
The NHS is now taking financial management very serously indeed. How long will it be before there is similar attention to matters contractual? Significant external commercial partnerships are a fairly new development in the NHS, which has almost always previously provided its own in-house services.
Much has been made of the political implications of private service providers being involved in the NHS, but I wonder whether the same reservations would be applied to social enterprise involvement? If the answer is No, social entreprise involvement is alright, but private sector provision is not, then perhaps we have our eyes at least partly on the wrong ball if we simply dismiss the idea of buy-in as such?
Given the complexities of modern technolgies and economies, does it matter where the service comes from, as long as it’s good, in budget, well-delivered and properly accountable and managed?
It’s the management and accountability issues which are critical – and it’s here that NHS and Foundation Trusts need to think very carefully. They are accountable, and they need to manage.
There are an awful lot of smart city lawyers out there. We must be sure some of them are on the public service side when it comes to negotiating health provision contractual arrangements.
Cherry Picking Liverpool’s Sefton Park Agenda
Liverpool’s Sefton Park has beautiful cherry trees, at present under contentious threat of being demolished. Why not, instead, use this situation as a way to engage local people, especially children, in ownership of their local (and often greatly under-appreciated) green space, and of the natural cycles which must always occur?
Unsurprisingly, there’s much consternation in Liverpool at present about the fate of the cherry trees around Sefton Park‘s middle lake. For some, they look like worn out relics of their former glory, due for the chop. To others (me included!), they are still wonderful, showering their landscape with gorgeous pink blossom for those special few weeks in the Spring.
But all things do come to an end, so ultimately the trees will have to go. The question is, when? Why can’t new trees be planted and allowed to blossom forth before the ‘old’ ones at last become wood chip?
An under-valued community resource
Sefton Park is situated in what is genuinely the inner city ‘donut’. It is surrounded on most sides by areas which include many children who lack first hand knowledge not only of parks, but also even of how things grow. It is also a hugely under-valued urban resource; a situation which hopefully will be much improved by the new, long overdue, proposals to revamp the park as a whole.
It’s not an especially original thought, but is there some way that the new trees could be ‘owned’ by children in different school classes or clubs? Or indeed from different surrounding streets?
Recycling trees and art?
Then, when the new trees have grown, the ones they are replacing could finally become part of the recycling process, with all this entails being explained in due course to their replacements’ ‘owners’.
Perhaps, even, some of the ‘old’ trees can be carved or otherwise used to represent aspects of our local lives? (So many trees are already being cut down, doubtless for good reason; but where are the sculptors and artists who can put their remnants to good publicly visible use? – and cherry wood, I understand, is particularly fine for this, when eventually it comes to it!)
Engaging people in change
People find it hard to accept change. Here, if there’s someone or some organisation willing to deliver it, is a way to help local folk engage positively. Why have a fight about something as beautiful as cherry trees, when so much else should be taking up our energies?
See also: Sefton Park’s Grebes And Swans
Liverpool’s Sefton Park, Swans, Herons And Grebes
Sefton Park, Liverpool: Winter Solstice 2006
Cherry Blossom For May Day In Sefton Park, Liverpool
What Now For Liverpool’s Sefton Park?
Liverpool’s Sefton Park Trees Under Threat – Unnecessarily?
Solar Lighting Could Solve The Parks Problem
Friends Of Sefton Park
NHS Contracts and Foundation Hospitals: Who has the Legal Expertise?
Is it actually the contracting out to private (or indeed social enterprise) suppliers for some NHS services which should be of most concern? Or is it the exact nature of the contracts agreed between NHS Trust Boards etc and their suppliers which requires the most scrutiny? There may be details here which make all the difference to what happens in the future….
Foundation Hospitals present us with a bewildering array of issues, on which much time and energy has been expended. There is one aspect of this development, and of the ‘contracting out’ of services in other NHS Trusts (to private suppliers, or indeed to social enterprises) which apparently perplexes me more than it does many others.
I don’t necessarily have a problem with ‘buying in’ at least some services, which for whatever reason an NHS Trust may not be able to provide; but there could be a problem if control of the service somehow thereafter eluded the Management of that Trust. Is this a medical or, rather, a legal matter?
How much training and expertise do public sector managers have in developing contracts with private companies? Is this a field in which most public sector staff could – or indeed until till now should? – have significant experience?
If a private contractor provides satisfactorily exactly the service which has been agreed, in the way and for the price agreed, perhaps there is no real problem; but is there a risk that sometimes this may not occur and either
(a) there will be no legal redress, or
(b) there could be loopholes which might enable the private contractor to have a hold on service provision which is greater than that envisaged?
In either of these cases there is the risk of compromise of the basic tenets of the NHS. Perhaps therefore it would be more useful to examine precisely what NHS Trusts and private suppliers agree, than to make a big thing of the idea of contracting out for specialist (or whatever) services as such. Some have suggested that these details were at base the ‘real’ problems with PFI. It is to be hoped, if so, that they are not repeated in the implementation of current proposals.
The devil, I suggest, is in the detail rather than in the ideas themselves. It will be interesting to see what specific expertise NHS managers acquire (or have already acquired) in these legal matters, as we move ahead. There is no doubt a tale or two as yet to be told about these complex propositions.
US Universities, Privatisation And ‘Intelligent Design’
Universities in the USA are increasingly funded by private interests. This has already raised curriculum concerns, especially for instance about ideas such as ‘Intelligent Design’. Anything which is at base an attack on scientific method and, indeed, rationality, should be watched very carefully indeed.
Public funding of universities in the USA has fallen further since 2001 than at any other time in the past two decades, according to the New York Times today (74% in 1991, 64% in 2004). Some university presidents are therefore becoming vocal in their concerns about ‘public higher education’s slow slide toward privatisation’.
The concern is in part that private funders set an agenda not always in tune with public universities’ wishes. These centre on teaching, autonomy in research and time spent securing private funding.
Could this be a particular problem in the context of so-called Intelligent Design? This is the notion, akin to ‘creationism‘, that somehow the human race has emerged in just a few thousand years, after being ‘designed’ by… who? Yet this unlikely thesis – with absolutely no credible basis in evidence or scientific theory – is increasingly being pressed upon American schools, for inclusion in their curricula. Apparently this is to ‘balance’ Darwinian theories of evolution.
Buying beliefs?
So what is the link with university funding? Well, presumably not all funders are scientifically well informed; such knowledge is by no means a necessary prerequisite of huge wealth or of a desire to influence what others know and learn.
Some observers of American science have wondered why more outstanding scientists do not speak out loud and clear about this attack – for such it is – on scientific method and, indeed, rationality. But the reason why seems clear: they don’t want to rock the boat when it comes to funding.
The price of academic autonomy
Never has there been a clearer case for academic autonomy, away from the beliefs of those who do not appreciate what sturdy, contestable peer review is all about. Peer scrutiny is not perfect – one is reminded of the slogan (was it Joseph Schumpeter’s?), ‘Two Cheers for Democracy!’ – but it is the best we can currently come up with, and all genuine universities need to continue to keep as far as possible from undue influence.
In the modern world of macro-economics not every bit of science can be influence-free. Creeping privatisation of public higher education is, however, one area where extreme caution is required.
Liverpool’s Alder Hey Hospital May Move To Widnes
Alder Hey Children’s Hospital in Liverpool has now formally announced that it may leave the city for Widnes, because of a local reluctance to supoprt plans for necessary expansion. Widnes doubtless has many attractions, but it cannot claim proximity to other internationally claimed medical institutions amongst them. Liverpool’s decision makers must wake up very soon indeed to the need to understand the critical importance of Big Science – which includes leading hospitals – to their local economy.
It’s now official: Liverpool’s Alder Hey Hospital, world leader in paediatric medicine, may have to move from Liverpool to Widnes because of local resistance to their plans to expand on the current site – even though there is a clear undertaking by the hospital to provide a well-planned and maintained ‘children’s health park’ within the extension proposals.
Let’s be clear. Alder Hey is NOT proposing that all the trees be cut down, and that they ruin a beautiful piece of parkland. The current park is truly nothing to be proud of; but the proposed new children’s health park would surely be. Indeed, it could, like its organisational base, be a shining example of how health, environment and education can come together.
Full marks to Widnes for spotting an opportunity which it seems has passed Liverpool by; but even Widnes itself presumably does not list amongst its attractions proximity to a world-class Medical School and the Royal Liverpool Teaching Hospital (see article on this website, 12 October).
Is Big Science also the last Big Secret, an invisible commodity which decision makers and planners at the local level just don’t see for what it is? Put together the budgets of the Royal, Alder Hey, the Medical School and, e.g., the Liverpool School of Tropical Medicine and you have a sum larger than that of many medium-sized towns – and an employment requirement which is hugely important to any local economy.
Let’s by all means assure local residents that they will get their trees back. (Maybe we also have to persuade the Council for the Protection of Rural England, who perhaps have a particular take here?) But let’s also show a bit of grown-up leadership.
Widnes can of course have its fair share of the deal – Alder Hey already has proposals for a number of service delivery sites around its area, called ‘Alder Hey at…’. Patient access is always a prime consideration; but that doesn’t just apply to Widnes.
In the end it’s in no-one’s interest to break up the personal and professional connections which have over the last several decades been carefully established by the practitioners working in Liverpool’s great hospitals and university.
It looks at present as though there is a lack of ‘scientific literacy’ of a very basic sort in the considerations of local decision makers. They don’t actually have to understand the science itself, but they certainly need to try very conscientiously to grasp the simple facts of scientific life: at base, there’s no synergy without connectivity – which includes opportunities on a day-to-day basis for outstanding medical scientists and practitioners to get together.
And, if this isn’t enough of an argument, who’s going to accept responsibility for the hundreds of less skilled hospital jobs which will go elsewhere, in one of the most disadvantaged parts of an already economically challenged city, when and if this absolutely unnecessary dispersal of international expertise occurs?
Dreaming Realist 