Daniel Allen

Stepping out of the comfort zone.

IT WAS a woman called Lilly who put Val Freestone on the path to nursing older people. Lilly was in the nursing home where Ms Freestone was working as a healthcare assistant, having accidentally found a job there when she accompanied a friend to an interview.

Admiral's admiral.

FOR CHIEF Admiral nurse Hilda Hayo, an abiding memory of her nurse training in the early 1980s was being asked to prepare the consultants tea tray. She laughs at the memory. But at the time, as a mental health nursing student slightly older than her peers, she found the ritual archaic. In some ways, however, the rigid hierarchy that it embodied has now been inverted. Admiral nurses, experts in dementia care, are often consulted by consultants, she says. It is the nurses who are in charge now.

Speaking out: David Oliver rose quickly through the ranks of medicine to become a leading figure in the development of improved services for older people. He talks to Daniel Allen about his early days as a doctor, his career trajectory and his new role at the British Geriatrics Society

DAVID OLIVER has been liberated. As a former national clinical director for older peoples services, he adapted to the limitations imposed on clinicians who take on a government role. Now, though, he is free to speak his mind and does so frequently online and in print, often pointing out the contradictions and inconsistencies in the way older peoples care is organised - or, in some cases, disorganised.

Always have a plan B.

BY HER own admission, Fiona Millington was ‘a very young 18 year old’ when she left her home town in the Midlands to start a new life as a nursing student in Bristol. Inspired in part by two aunts who became matrons, through her school years she had considered a career in nursing and wondered if it would suit her. ‘I liked the idea of it and felt it was the right thing for me to do,’ she says. She plumped for Southmead School of Nursing in Bristol for no other reason than the campus looked attractive on the crisp December day when she first visited. But it took a while for her to find her feet. She found her early placements in surgery difficult – as many young students do – and sought refuge in the sluice.

Make nursing visible.

AN ‘ENDLESS curiosity’ about nursing practice has been a driving force throughout Professor Margaret Fry’s 30-year career. But never content with simply being curious about practice, she has always sought to change and improve it, posing research questions, and then seeking the evidence that will precipitate change and improvement. She began nursing in Sydney in 1980, fired by an interest in biology and anatomy. Most of her career has been spent in critical care and she is currently director of research and practice development for Northern Sydney Local Health District, where she supports and mentors clinicians and encourages innovation. She also holds a professorship at the University of Sydney and is adjunct professor at the University of Technology, Sydney. In combination the three roles allow her to fulfil a promise she made to herself when she was rising through the ranks. ‘I grew up in a culture where nursing was invisible and many years ago I vowed that if ever I was in a position of leadership and able to introduce anything innovative and new, I would always publish it, make it visible, so that those coming behind would have an easier road than the one I’ve had to tread.’ Health care in the UK and Australia shares many of the same challenges – tight budgets, staffing pressures and an ageing population. In that context, vulnerable patients, including some older people, may be at particular risk and Professor Fry is keen to ensure that high quality care is available to all. ‘I’m in the middle of a big randomised controlled trial across four sites,’ she says. ‘It’s looking at whether, for example, cognitive impairment is a risk factor for delays in analgesics. The preliminary data certainly suggest that the older population do not receive as timely and appropriate a service as other age groups. The delivery of care is not as equitable.’ Another challenge in Australian health services that might resonate with UK nurses is the management of rising numbers of vulnerable patients in services that were not designed with them in mind. ‘Emergency departments (EDs) are the classic example,’ says Professor Fry. ‘The older person often has other needs and comorbidities that the EDs don’t want to know about. Services need to be rewired to consider the older person more holistically.’

Sustaining change: Danielle Woods’s career took a new direction after a mentor encouraged her interest in dementia. Currently on secondment as a project manager in dementia care, she tells Daniel Allen about the challenges and rewards of her role and describes how she made the move from the emergency department

AMBULANCE CREWS call it blue-light syndrome, and Danielle Woods admits that she has it. The phrase refers to the addictive rush of adrenaline, the excitement, experienced by staff in emergency care who have no idea what challenges the day’s shift will bring. Ms Woods, who has spent most of her career working in the emergency department (ED), describes it as like watching a TV drama and then realising it is reality, not fiction, and that you have a starring role. ‘You either love it or you hate it,’ she says. For now, however, Ms Woods is finding equal satisfaction in a very different role: as dementia project manager for Bradford Teaching Hospitals NHS Foundation Trust. How did her career take such a dramatic turn?

Driving force: Paula Thompson’s career took her to the Channel Islands initially, then to the challenging environment of a secure unit in London. Now she is back in her native Northern Ireland and making a difference to the lives of people with dementia. But instigating new ways of working has not always been easy, as she tells Daniel Allen

New updated! The latest book from a very famous author finally comes out. Book of the driving force, as an amazing reference becomes what you need to get. Whats for is this book? Are you still thinking for what the book is? Well, this is what you probably will get. You should have made proper choices for your better life. Book, as a source that may involve the facts, opinion, literature, religion, and many others are the great friends to join with.

Bakewell can't shake off 'crumpet' epithet.

The temptation was just too great and most newspapers succumbed. The phrase was first used back in the days when objectifying women was as commonplace as miniskirts and moptops, but that did not deter reporters from resurrecting it 40 years later.

Blanket coverage offers little comfort

If the collected masses of the UKs older people had a good PR firm they would have been rebranded by now, adorned with a nice logo and given a new name like Consignia or turned into a heritage centre with bells and buttons for the young to press.

A switchback route to an uncertain future

There is something in the nature of progress that means it never adopts the straight line approach advocated by the average crow, preferring instead three steps back, one to either side and a periodic return to its People speak of progress marching on, as if it a clear road with minimal obstacles. The reality is every development, for every improvement, there is pulling back change and impeding progress, than in the lives of the UKs older people.