The #futureofwork in the #NHS is the #engagement of #GenG as a social movement

First Published on February 29, 2016
Via LinkedIn
https://www.linkedin.com/pulse/can-we-heal-ailing-healthcare-system-part-4-jeremy-scrivens/?published=u
(Part 4 of 4)

By Jeremy Scrivens (@Jeremyscrivens) & Minesh Khashu(@mkrettiwt)

“In Part 1 of this blog series we proffered a vision of a Social Movement for the NHS, engaging the youth of this country to co-create and co-care for a Renaissance NHS. In Part Two, we explored how to approach this – not through the lens of seeing the NHS as a problem to be fixed – but through the lens of strengths. In Part Three we went deeper into strengths and looked at how we can build an NHS Social Movement by bringing the whole system together to Connect, Elevate, Extend, Reconfigure and Refract the Positive Core of the NHS system.

In the final part of this series we focus on how we can Refract NHS strengths into society by engaging the whole NHS ecosystem to become social and digital. In particular, we focus on how to engage the young generation coming into the workforce in Britain now – GenG – wired for Generosity and Global. These young people have grown up Social and grown up Digital.

Through the social and digital platforms available to them since they can remember, this newest generation of workers has grown up with the idea of sharing, co-creating and connecting globally. They have no concept of the traditional restricting firewalls or hierarchies or ‘no go’ conversation areas with which previous generations in the workforce complied.

These young workers are open for business at scale. They are currently incubating, waiting for the NHS Abundance Leaders to emerge to call them to collaborate, share, challenge and innovate in the new Renaissance NHS Start Ups. These Start Ups will draw people together across previously firewalls and boundaries, engaging the whole person, not just the parts stuck in the old archaic job descriptions and hierarchies of compliance at work.

Engaging the whole NHS system in a shared conversation around what works will provide a positive disruptive intervention because it engages participants at a deeper, more intrinsic level around the ‘connectedness of life and all things’. This is about new ways of being and working together with open communication and open collaboration to experience open innovation as a Social Movement at scale.

Building and sustaining these Start Ups represent a challenge because holistic conversations and co-creativity involves connecting a broad range of organisations, areas, teams and people in ways that have proven impossible up to now, given the size of the NHS and the siloed cultures.

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We now have the advent of macro, open, holistic technologies such as Appreciative Inquiry Growth Summits – AI (see last post) and Social Network Technologies which makes collaboration at scale possible across the whole NHS ecosystem. 

If we want more innovation for social good, then the NHS Abundance Leadership work is the positive disruptive process of bringing more parts of the system together to discover, appreciate and reconfigure these strengths to meet imagined possibilities. This is what ‘co-creative’, ‘disruptive’ and ‘collaboration’ really means in the modern jargon.

The experience of wholeness, not siloes, creates new relationships and partnerships that are forged in the act of sharing and co-design. New commitments are made by participants to continue the relationships and new ways of collaborating and working as a new Social Movement – as a Community of Belonging and Purpose, if you like.

How do we manage and sustain these new relationships, at scale, within an ecosystem the size of the NHS? This is where the new digital and social technologies and platforms come into their own. Many organisations are experimenting with internal collaborative digital networks to connect workers within a single enterprise. Till now, many of these platforms are still single enterprise in focus and most are closed to the workforce and sometimes customers – but rarely open to the broader ecosystem. These ‘First Gen” platforms are called Enterprise Social Networks or ESN’s and they are already outmoded. They are supporting the old model of closed working cultures, siloes and deficit based management and surprise, surprise, most members of the workforce, especially the young GenG’s are not buying into these pseudo, non-authentic installations!

But in the new NHS Social Movement – the power of these new technologies will be deployed to connect and engage people to collaborate as individuals in a growing Social Movement as equal members of the new NHS living ecosystem or Community of Belonging and Purpose.

The NHS Social Movement will not be started or sustained ‘top down’ or led by one dominant organisation or group within the system. Rather a group of individuals will come together to “start up’ Innovation Summits (e.g. #WHIS16). They will collaborate and co-design the future NHS as a microcosm of the whole ecosystem. They will sustain this experience as an online community through the new Ecosystem Social Networks, sharing the new ideas and stories and inviting more members, who will be drawn to be part of the new conversations. In turn, they will form new communities to come together to co-design and innovate from the core of the ‘new way of being’.

Digital and Social will provide a platform to enable others to join the conversation at scale and to enlarge ‘THE OPEN ROOM’ from the limitations of physical space to the digital world of online and mobile connections beyond traditional organisation or job boundaries or roles such as technician or patient.

The key to the Future of the NHS as a Social Movement lies in how well we engage the strengths, hearts and minds of our young people across Britain. They are waiting to be engaged with us to help shape and co-create the future National Health Service as a Social Movement.

Gen G – with G standing for Global and Generous. This young generation is ready to volunteer their passions, their talents and their generosity to contribute to a Start Up NHS Social Movement, using the social and digital platforms of the Ecosystem Social Networks.

The emerging Abundance Leaders will engage this young talent in the experience of wholeness in their work; not just leave this experience to outside of work where these young people are already sharing and collaborating with other globally on their smartphones.

Many baby boomers think the Gen G’s are the most selfish and materialistic in history. Actually, it is just the opposite. They do, however, expect to be engaged differently – by the whole, not the disjointed part of life and work as we have been experiencing.

GenG have grown up with digital and social technologies such as smart phones, You Tube and gamification which allows them not only to consume but to co-create, share and make together. GenG not only expects to explore new concepts of quality of life but expects to be involved in their co-creation.

For GenG, the act of sharing and collaborating comes naturally. They have no concept or tolerance for the traditional artificial barriers of work that we have set up in our current siloed organisations or hierarchies or specialised teams or job titles like doctor, nurse, orderly or patient. They are more interested in the collective experience of collaboration, than the KPI’s of the old school individual organisations.

For GenG, the boundaries between life and work are becoming increasingly irrelevant and they see all things as connected ‘from the whole’ in ways that baby boomers simply don’t understand. Tim Leberecht calls this Lifeholder Value, which is about being part of a co-creative community where engagement and returns are measured through continual inquiry, sharing, experimentation and cooperation. GenG is naturally wired to collaborate and innovate from the ‘whole’ – not the part. 

A critical ability for enlisting Gen G is the ability for them to engage openly with their peers – not only as doctors or nurses or social workers or HR professionals or as patients – but as co-members of a community experiencing the NHS system from the whole. We wonder if these intrinsic needs being met through Social Media are yet being taught to our young doctors and nurses in the medical schools? They ought to be, for we will see these motivators at the heart of a collaborative culture in the new NHS Start Ups.

 At the heart of the future NHS Social Movement will be a core of passionate, engaged GenG’s connected across the nation in authentic collaboration in the continuous experience of ‘starts up’ for social good. We will see hundreds, if not thousands of Start Ups emerging all over the NHS ecosystem, connected and sustained by Ecosystem Social Technologies which are not stopped by the old firewalls and closed cultures.

Somewhere within the NHS system the first group of Gen G’s is ‘incubating’, waiting to be engaged in the first ‘start up’ and experiment in co-creating and living the new NHS Social Movement experience.

Who will be this first group to be engaged? Who will be the first Abundance Leaders in the NHS system to see the potential the GenG’s offer in their local NHS ecosystem?

Who will positively disrupt the first Start Ups in the Renaissance of the NHS at scale? Will it be you and us, together?

Thank you for reading.

Prof (Dr.) Minesh Khashu MBBS, MD, FRCPCH, FRSA

Consultant Neonatologist & Professor of Perinatal Health

Above all else, a ‘father’ and a ‘student of life’

@mkrettiwt  ;  https://mineshkhashu.wordpress.com/

Re-organising the NHS as a social movement from the wholeness of things

First Published on February 14, 2016
Via LinkedIn
https://www.linkedin.com/pulse/can-we-heal-ailing-healthcare-system-part-3-jeremy-scrivens/?published=u
(Part 3 of 4)

By Jeremy Scrivens (@jeremyscrivens) and Minesh Khashu(@mkrettiwt

“In Part 1 of this blog series we proffered a vision for the NHS a Social Movement. In Part Two, we explored how to approach this – not through the lens of seeing the NHS as a problem to be fixed – but through the lens of strengths. In Part Three, we deep dive into this idea of transformation through a strengths based approach. We look at how we can build an NHS Social Movement by bringing the whole system together to inquire into and extend NHS’s Positive Core.

In our traditional hierarchy model of doing NHS, the solutions are created by hierarchical managers with presumed expert knowledge and advice but it isn’t working anymore.

But a generation of Abundance Leaders will emerge. They will engage the whole NHS system to come together at scale as equal co-creators, designers and stewards to innovate and experience an abundance of social good from the whole, not the parts.https://www.linkedin.com/embeds/publishingEmbed.html?articleId=7489847597349547824

But it won’t come from the current NHS hierarchy but from individual Abundance Leaders inside and outside the hierarchy who will come together to Start Up, grow and sustain NHS as a Social Movement for Social Good at scale.

Collaboration at scale, innovation at scale and positive change at scale will become the new ways of working as a Social Movement, not as siloed institutions.

We will see individuals across the whole system (inside and outside the traditional institutions and hierarchies, including doctors and patients, hospitals and communities) who share the same vision for a better future, coming together. They will be in collaborative commons as equal members to co-create a better future from the whole for the whole. We will see this in every town, every city, in every nook and corner of this country, not as a set of siloed institutions but as a living ecosystem connected at scale through digital as a social movement.

This is already happening in parts. We need to bring these parts together to experience the possibilities that come from being connected from Our Positive Core as a whole ecosystem.

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The Future of Work in the NHS is the collaboration of its ecosystem members to innovate and co-care from the whole for the whole.

As Abundance Leaders emerge as Positive Disrupters in the NHS Social Movement, we will see the deployment of At Scale innovation methods which aim to bring the whole ecosystem in the room to innovate from the whole, not the parts.

We will also see the deployment of Social Collaborative Platforms to sustain and extend these inquiry or ‘what if’ conversations after the Growth Summits – connecting more strengths into the growing collaborative community.

Abundance Leaders will connect the strengths of the ‘whole’ system for Open Innovation at scale as a Social Movement; coming together to

  • Elevate strengths – i.e. the exceptional best – across the whole system and map the Positive Core of the NHS to take forward into the future,
  • Extend strengths to become the normative experience for members across the NHS ecosystem – what if our exceptional best became the everyday experience?
  • Reconfigure strengths – the Positive Core – to co-create and innovate new forms of delivering holistic care as a life-work model for individuals in society,
  • Refract strengths – realign healthcare to the needs of today and tomorrow by opening up the positively disruptive conversations to engage more parts of British society and community through social and digital collaborative platforms.
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Individuals across the ‘whole system’ – technicians, staff, volunteers, patients, community members – will connect their strengths and passions and together discover and affirm the incredible range of strengths across the ‘whole system’. They will invest in the time to co-discover what works when the system is at its best – when the prevention is occurring in the system, when individuals in society do take responsibility for preventative behaviour – when the technical response in the NHS system is providing outstanding response and care in the most efficient ways and is in synchrony with the heart – when care and cost are in perfect harmony.

The Future NHS will connect the strengths of the ‘whole’ system for ‘Open Innovation at Scale as a Social Movement’, not at a separate organisational level. Engaging the Ecosystem in Appreciative Inquiry conversations around strengths not weaknesses, around possibilities not problems, is the heart of the emerging NHS Social Business. It is where Abundance leaders connected on Social will positively disrupt the existing conversations and Start Up the holistic experience of what it feels like for people to live and work from the wholeness of life and work.

It’s about you and it’s about us – together”

Thank you for reading.

Prof (Dr.) Minesh Khashu MBBS, MD, FRCPCH, FRSA

Consultant Neonatologist & Professor of Perinatal Health

Above all else, a ‘father’ and a ‘student of life’

@mkrettiwt  ;  https://mineshkhashu.wordpress.com/

Renaissance of the NHS by engaging strengths at scale

First published Published on February 7, 2016
Via LinkedIn
https://www.linkedin.com/pulse/can-we-heal-ailing-healthcare-system-jeremy-scrivens-6101990538628575232/?published=u
(Part 2 of 4)

By Jeremy Scrivens (@Jeremyscrivens) & Minesh Khashu(@mkrettiwt)

“In Part 1 of this blog series we proffered a vision of a social movement for the NHS. In Part 2 we explore how to approach this, not through the lens of seeing the NHS as a problem to be fixed, but through the lens of strengths.

There is too much emphasis on what is wrong within the NHS. This leads to a mindset of focusing on problem solving, trying to fix what is wrong and deficit thinking. This at best leads to retrieving status quo and fuels a culture of blame and disengagement by staff and patients.  We need to affirm what is working, what is good and to facilitate members to take pride in their contribution and achievements.

While the whole nation and the media have been preoccupied with the problems and the ‘bad stuff’ about the NHS, every day great things are happening in the NHS. We see good patient care, great service response and responsible stewardship of money, time and resources. Indeed every day something exceptional is happening in the NHS – in terms of the 2 ‘C’s – care and cost. But we have been so obsessed with what isn’t working that we, as a system, have not spent much time in learning about exceptional practice and its dissemination across the whole NHS system – not just the part.

The Renaissance of the NHS starts by bringing the whole ecosystem together to share to positively disrupt the conversations from weaknesses to strengths – from problems to possibilities – from error eradication to elevating and extending the exceptional such that this becomes the norm

The NHS system is an inherently good system – working to the very best of its current capacity. Rather than focussing just on what isn’t working, let us take some time and deploy a ‘strengths based’ approach to finding what works and what works exceptionally well.

There is no denying that the NHS as a system and individual organisations within it are in crisis. The existing structures and ways of working are no longer up to the task. It is no longer enough to apply current know how within the existing organisational structures that deliver care and cost outcomes in part and not for the whole.

The NHS system is crying out for Abundance Leadership which will engage the ‘whole system’ as one interconnected and collaborative ecosystem, co-creating new ways of innovating for a better future. This future will arise from the reconfiguration and alignment of our strengths as a whole – not the fragmented experience of separate and siloed organisations, departments and job descriptions that we experience now.

Much of the current efforts to ‘transform’ the NHS are fragmented and are largely technical and driven by internal or external consultants and experts, not the ecosystem itself. Yet, the kind of changes required to transform the NHS are adaptive in nature, beyond the traditional practice of the so called experts. The NHS ecosystem requires regenerating inside out, from the collective wisdom and collaboration of all its members, not the so called experts.

By that we mean that we are trying to solve today’s crisis by engaging in known technical fixes from our own kitbag of solutions as siloed parts of the system.

The current conversations about how to tackle the future of the NHS are well intentioned but are coming from the part, not the whole. It is the experts – top down management, bureaucrats and consultants – who are applying existing knowledge around the ‘what’ and ‘how’ of the NHS system but not the ‘why’. The lack of attention to the WHY is the reason for the misery we are in.

Everyone talks about the financial deficit in the NHS. The money is important but the biggest deficit in the NHS isn’t financial. It is the deficit of motivation and morale, brought about by senseless and frequent top down changes and unending bureaucracy. Moreover, every part of the current NHS knows and tries to ‘manage’ and ‘improve’ only their part of the system – not the whole.

What is required is a new conversation which engages the strengths and stories of everyone in the NHS system from the whole, not just a part. By the whole system, we don’t just mean the doctors, nurses, admin staff, managers, NHS Trust Boards and the government, but everyone who is touched by the NHS system – especially the users of this system, the British people, communities, voluntary sectors, families and society – essentially the whole ecosystem. We have forgotten a key equaliser in the NHS system- everyone is a member and a user. Once we re-establish this relationship between members as a living, equalised, co-creative community, we have the potential to see Renaissance.

Only by tackling the NHS challenge from the perspective of ‘wholeness’ i.e. bringing all the parts of the system together, to identify the adaptive challenges facing us as a whole society, can we move forward. This will require Abundance Leadership – not technical management – a leadership employing the mindset and tools of leading a Positive NHS Ecosystem for Social Good at scale.

Abundance Leadership will bring the whole NHS ecosystem together to identify the adaptive challenges from the perspectives of ‘wholeness’ – not the parts. This is about who we are and why, our Positive Core around a healthy society. The technical what and who of managing and delivering a health and social care service comes next and are focussed on the whole, not the parts or the back end, for example, when health breaks down.

Abundance Leadership gives the responsibility for managing health back to the people at the source. This will be at the individual and community levels of the ecosystem – at the unit level of society, not government, not the hierarchical management of healthcare but as a social movementconnected and sustained by shared beliefs, behaviours and digital.

The new conversations and processes within the NHS Social Movement will co-create new ways of delivering the exceptional best we do now as the normal experience of a future sustainable NHS.  We will see a shift of the work and the resources from fixing poor health – when the system breaks down due to poor behaviours in individual and societal health care – to prevention i.e. how we can stop much of the poor health and the enormous cost of its treatment at the source?

This is about changing behaviours at the societal level of the system. For this to happen, society needs to own these changes by being engaged in their innovation, co-creation and co-caring as an open Social Movement in collaborative behaviours as equal members from the whole, not a closed hierarchy, limited to the administrators, bean counters and bureaucrats.”

Thank you for reading.

Prof (Dr.) Minesh Khashu MBBS, MD, FRCPCH, FRSA

Consultant Neonatologist & Professor of Perinatal Health

Above all else, a ‘father’ and a ‘student of life’

@mkrettiwt  ;  https://mineshkhashu.wordpress.com/

The Future of the #NHS as a #Social Movement from the Whole not the Parts

First Published on January 24, 2016
Via LinkedIn
https://www.linkedin.com/pulse/can-we-heal-ailing-healthcare-system-jeremy-scrivens/
(Part 1 of 4)

Part 1: Renaissance of the NHS as a Social Movement

by Professor Minesh Khashu(@mkrettiwt) and Jeremy Scrivens (@jeremyscrivens)

“Do we have the best healthcare system in the world?

Time and again we hear that we do but to many of us in the U.K, it does not feel like it is. In relative terms, considering the resources spent on healthcare, we perhaps have the best healthcare system in the world. However, in terms of outcomes and quality of care, there is still a lot that can and should be improved.

The Mid-Staffs disaster is still very fresh in our memory. There is still significant avoidable harm in the NHS, with about 500 patients daily experiencing some form of adverse incident. While there are pockets of excellent practice, there are many untoward events happening daily and the experience of many a patient, their carer and their family is still quite unsatisfactory.

Amongst the key issues that cause significant difficulties for the NHS today are:

  • Supply and demand imbalance e.g. the long waits in emergency departments,
  • Fragmentation and poor coordination among different parts of the system, for example, between health and social care, between primary and secondary care
  • Very little focus on prevention,
  • Inadequate learning from mistakes as well as good practice and poor dissemination of learning and good practice,
  • Out of date, top down, management styles fuelling disengagement amongst staff. This, at a time when the new social and digital technologies allow for previously unimaginable levels of engagement from staff by way of collaboration, innovation and social good at scale.
  • The ‘Five Year Forward View’ by Simon Stevens, Chief Executive of the NHS, provides a strategy and plan of action going forward. It highlights the financial gap going forward, the need to focus on demand, improve efficiency and most importantly shift the system to a person centred care and prevention paradigm. Simon, for the first time, talks about making the NHS a social movement. This, to us, is the most important legacy in this document. The so called new models of care need to be bold enough, visionary enough

This to us is the start of a Renaissance for the NHS but it can’t be created and delivered by the current institutional, siloed, fire-walled and adversarial top down management systems in place now which are stifling engagement, innovation, risk taking and engaging the ground floor in asking why?

However, the ‘Five Year Forward View’ does not elaborate about how to make the NHS a social movement and that is why we are writing this open manifesto to the public of the United Kingdom who care about the future of the NHS.

We propose to positively disrupt the NHS to move in the direction of a social movement beyond the boundaries of our fragmented current system. We see a significant positive impact on decreasing long-term demand, improving efficiency, bridging financial gaps and engaging the untapped potential of our staff, patients and communities to work in a culture of open collaboration and innovation.

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We propose the development of a health and social care service akin to youth military service in some countries. But this will be a social movement which engages our millennial or GenG workforce to become members of a living NHS ecosystem where every member can contribute their strengths not only to the what and how of healthcare but to the why from the experience of wholeness at scale.

The development of this health and social care service will be a single intervention that can help overcome all the significant difficulties alluded to above.

It will:

  • Increase provision of health and social care but without significantly increasing the cost,
  • Provide the ‘glue’, the connectivity to improve coordination within the health and the social care system,
  • Engage the youth of today, tomorrow’s Britain, to contribute the best of their strengths. This is about release their intrinsic needs, connected by today’s open platform social and digital technologies, for Authenticity, Collaboration, Wholeness, Abundance and Connected together, these young kids are wired to contribute to health promotion and disease prevention at scale,
  • Release untapped resources, assets, ideas, time and money previously locked in the cracks between the parts of the hierarchy and the so out of date ME job descriptions, rather than the future of work in the NHS as WE Collaborative Charters,
  • Restore ownership of the priorities, resources and decisions back to a self- regulating living community, not third party compliance driven and separated hierarchies.

It is in our stewardship, our gift and our time to make it happen!

The earlier models of national youth service (still practiced in some countries) were compliance driven; they were mandatory. Today, most of our workforce live in compliance based work cultures. No, it does not need to be mandatory, it has to be about engaging contribution, which is about voluntary choice, about being drawn to something, rather than being driven. Time and time again, Britain has shown through its contribution to voluntary and charitable work globally that this is not an impossible ask of British youth.

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It is about taking the time to engage our young people intrinsically from the heart, to contribute the best of the individual connecting with others to bring more strengths together to reshape renaissance of the NHS system as a living community or ecosystem. What’s better, a mandatory system which sees an extra million pair of hands or a voluntary system which engages 250,000 with their hands, their minds and their hearts?

This is not just about increasing capacity/capability in the system. The bigger and more important goal is to engage our youth to be more involved in health and social care, understand life style choices better, contribute to health promotion and disease prevention and as a nation take charge of our future health i.e. making it a social movement.

We

  • Will achieve a better balance in supply/demand of health and social care with little extra cost,
  • Significantly expand the voluntary sector,
  • Shift the focus of the future generation into a health promotion/prevention paradigm, and
  • Increase the interest of the future generation in science and health work streams (we have been historically short staffed in these areas of work).

Above all, we would generate a social responsibility vehicle. We would give a young generation, wired for sharing, collaboration and innovation, an opportunity to learn compassion and life skills for their own health and those of others. We would see a restored and extended life-work ecosystem operating out of wholeness, not separation. We would save millions by dismantling our costly system of third party compliance, moving to a self-regulating living ecosystem.”

Published by:

Jeremy Scrivens

Thank you for reading.

Prof (Dr.) Minesh Khashu MBBS, MD, FRCPCH, FRSA

Consultant Neonatologist & Professor of Perinatal Health

Above all else, a ‘father’ and a ‘student of life’

@mkrettiwt  ;  https://mineshkhashu.wordpress.com/

Invitation to fathers: if you had a newborn on a neonatal unit during the Covid-19 lockdown, what was your experience?

First posted on Family Included, 14th July 2020.
https://familyincluded.com/invitation-fathers-neonatal-covid-19/

I’d like to share this post from the Family Included website, which refers to a research study we are carrying out at FINESSE International Group.
I am part of the neonatal researchers team and truely believe our research will make a difference.


Please see below article:

“An international group of neonatal researchers, FINESSE Group, is asking fathers to complete a 20 minute questionnaire about their experiences of having a baby on a neonatal unit during the Covid-19 lockdown.

You can take the survey here:

https://eaecu.au1.qualtrics.com/jfe/form/SV_cTOlzQGDQ9eH2F7

https://toulousepsychology.eu.qualtrics.com/jfe/form/SV_5ApY2hpYfV0QDu5

Having a sick baby in a neonatal unit is an intense hardship for families at any time. Experiencing this during lockdown, when children and families were being forced to separate, introduced another level of difficulty.

The team of researchers from Australia, Canada, Italy, France, United Kingdom, Denmark, Qatar, Sweden and the USA originally came together to publish a joint article on fathers in neonatal units. More recently the group published a letter in BMJ Global Health, highlighting the problems for families when fathers are excluded from neonatal units. The researchers pointed out that the wide variation in approaches across the world suggests that responses are not evidence based.

father baby mexico love joy skin-to-skin
Photo: © UNICEF/UN0205039/Zehbrauskas.

Are you a father interested to participate? If so please read the FAQs below.

Who is the research team?

The research group, FINESSE (Fathers in Neonatal Environment Shaping Salubrious Experiences), is made up of up of researchers from universities and hospitals in interested in fathers’ experiences of neonatal care. The research chair of the group is Dr Minesh Khashu, Consultant Neonatologist at Poole Hospital NHS Foundation Trust and Professor of Perinatal Health at the Poole Hospital NHS Foundation Trust, UK. The Principal Investigator of this research is Dr Esther Adama, Lecturer in Nursing within the School of Nursing and Midwifery, Edith Cowan University, Australia.

A full list of the researchers is given after the FAQs below.

What is the aim of the research project?

The research project, called Fathers’ Perceptions of Having a Baby in the Neonatal Unit During the Covid-19 Pandemic, aims to explore experiences and perceptions of fathers whose babies spent some time in a neonatal unit during the Covid-19 pandemic. These insights into unique perceptions and experiences will help to generate recommendations for providing better support for fathers of babies on neonatal units in future.

What is required if I participate? 

The survey will take 20 minutes to complete. You can save an uncompleted survey and return to complete it within a week.

Participation in this research is voluntary.

If you decide not to continue with the survey once you have started it, there will be no consequences. Uncompleted survey data will not be included in the survey unless you consent to this.

The first page of the survey explains the study and you will be required to provide consent before proceeding to complete the survey questions.

How will I benefit from this research? 

You will have the opportunity to share your unique perceptions with the researchers. We hope to understand your experiences, concerns and support needs in order to improve service provision for fathers on neonatal units in future. You will also contribute to knowledge about fathers of infants in neonatal units during the Covid-19 pandemic.

What are the potential risks associated with this research? 

As you are describing your lived experience, you may experience emotional distress.

When completing the online survey, if you feel emotional, you can stop and take a break. You are encouraged to contact your General Practitioner / local health practitioner if you need help.

How will you protect my privacy? 

All your responses will be treated with utmost confidentiality. Your details and that of your child will be de-identified and will not appear in any publication/report that will arise from this study. Your data will be shared with the research team only during the project. Your data will be kept in a pass-worded computer and secure online server. This data will be shared with the international research collaborators who will observe strict confidentiality when working on the data. All your personal data will be removed before data analyses. Once the survey is completed, you cannot opt-out as the responses are anonymised. At the end of this project, your de-identified or anonymous responses will be kept confidential and managed according to the Edith Cowan University (Australia) data management plan.

How will the results of the study be communicated? 

When the project is completed, a summary of the published results will be made available for any participant who requests a copy. They will also be published in journals or conferences (without any of your personal details) so that fathers like yourself as well as healthcare professionals can learn from your experiences and all work together to improve care and outcomes for infants and their families.

Researcher names

Professor Minesh Khashu, Consultant Neonatologist at Poole Hospital NHS Foundation Trust and Professor of Perinatal Health, Bournemouth University, UK. Research topics: neonatal care, NEC, Fathers’ experiences, Quality Improvement and pregnancy outcomes. (See ResearchGate and PubMed.)

Dr Esther Adama, Lecturer in Nursing within the School of Nursing and Midwifery, Edith Cowan University, Australia. Research topics: support needs of carers of preterm infants; support needs of vulnerable infants in the community; child health Nursing; culture and health outcomes; systematic literature reviews (meta-synthesis); Narrative Inquiry (research methodology).

Professor Charlotte Casper, neonatologist and Professor at the Toulouse Hospital University, France. Research topics: mother to child transmission of Human Immunodeficiency Virus-1, water balance in newborns, CMV mother to child transmission. Dr Casper is a member of the Société de Néonatologie.

Professor Nancy Feeley, Associate Professor at the School of Nursing, University of McGill, Canada. Research topics: children born preterm, parenting, fathers, intervention studies, parent- infant interactions, parental psychological well-being and neonatal intensive care.

Duncan Fisher OBE, editor of Family Included (this website) and initiator of the neonatal research partnership.

Professor Craig Garfield, Professor of Pediatrics at the Northwestern University of Illinois, USA. Research topics: child health within the context of the family, with particular emphasis on the social determinants of health; the role of fathers; the ability of technology to support parenting.

Jillian Ireland, Visiting Associate at the Centre for Midwifery, Maternal and Perinatal Care, Bournemouth University, UK. Jillian does research in higher education (see ResearchGate and PubMed). Her latest publication is Qualitative evaluation of mental health training of auxiliary nurse midwives in rural Nepal. She also works as a Professional Midwifery Advocate at Poole Hospital NHS Foundation NHS Trust, UK.

Dr Flora Koliouli, clinical psychologist and a health psychology researcher at the University of Toulouse II-Jean Jaurès, France and at the National and Kapodistrian University of Athens, Greece. Research topics: families of children with disabilities; fathers – premature infant bond, paternal stress, PTSD and sources of social support.

Carl MacDonald is a father of twins who were born at 27 weeks gestation, and spent 9 weeks in neonatal intensive care. He now writes about his experience on his blog, premdad.co.uk.

Dr Livio Provenzi, developmental psychobiology researcher, IRCCS Mondino Foundation, Pavia, Italy. He studies biomarkers of early socio-emotional and behavioral development in healthy and at-risk infants. To date, his major projects include the preterm behavioral epigenetics study and clinical trials on early parenting interventions.

Associate Professor Frances Thomson-Salo, Royal Women’s Hospital, Victoria, Australia. Research topics: child psychotherapy and psychoanalysis. Frances has published on a group for neonatal fathers at the Royal Women’s Hospital that she ran.

Professor Edwin van Teijlingen, Professor of Reproductive Health at the Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, UK. Research topics: public health and maternity care (mixed-methods research, qualitative and evaluation research).

For further information and questions about the study, please email the team at finesseinternationalgroup@gmail.com.”

Thank you for reading.

Prof (Dr.) Minesh Khashu MBBS, MD, FRCPCH, FRSA

Consultant Neonatologist & Professor of Perinatal Health

Above all else, a ‘father’ and a ‘student of life’

@mkrettiwt  ;  https://mineshkhashu.wordpress.com/

A Vaccine For Covid-19: What Is Not To Like?

First posted on Clarityy, June 15, 2020
https://www.clarityy.com/posts/a-vaccine-for-covid-19-what-is-not-to-like

As we speak, billions are being poured into CoVid-19 vaccine development and a mushrooming of manufacturing plants is in full swing.

The global CoVid-19 vaccine R&D landscape includes well over 110 vaccine candidates of which about 80 are confirmed as active, with all but a handful, at only exploratory or preclinical stages. The 5 advanced candidates have been ‘catapulted’ into clinical development, including mRNA-1273 from Moderna, Ad5-nCoV from CanSino Biologicals, INO-4800 from Inovio, and LV-SMENP-DC and pathogen-specific aAPC from Shenzhen Geno-Immune Medical Institute. A very thorough review is provided by Thanh Le T, et al[i]. E Callaway also provides an elaborate graphical guide regarding CoVid-19 vaccine development which is recommended for the uninitiated in this field.[ii]

On the surface, it is a great picture of innovation and promise but when one digs a bit deeper, one is forced to temper unbridled optimism with caution and ask the question: Is this going to be just another example of the gross inefficiency of the pharmaceutical industry at converting investment into medicines and healthcare products reaching markets in need? Who can blame them for accepting huge grants during the current panic?  The most likely reality is that, at best, two or three useful products could possibly emerge while the others and their investments disappear without a trace! We know it costs typically £2.6 billion to develop a new drug[iii]. Vaccine development may not just mirror this but well surpass it.

On the bright side, after many years of stakeholders telling governments that vaccine research and manufacture was under-funded, money has been pouring in. But without a global structure to that investment, the winner-takes-all approach of the pharmaceutical world makes that investment such a poor bet. It is just like present day drug development, which in many ways is a lottery.

While having an effective and safe vaccine would be ideal, and should be the over- arching final goal, we need to bust the myth that a vaccine is our only hope to get out of the current crisis and lockdown. South Korea and others have already shown it can be done.

As we all know, SARS-CoV-2 is a coronavirus, like the common cold, but debilitates like influenza, and kills aggressively with a cytokine storm. However, what is crucially different about SARS-CoV-2 is its long incubation time, during which a victim will transmit the virus to others. This makes the virus an ideal target for track-and trace, as WHO have been telling us since the middle of March. Test, test, test!  Identify the victims and trace their contacts so they can isolate. Why we, as a nation, decided to forego this approach beggars belief?

Testing strategy and implementation still is a ‘work in progress’ in the U.K. and it seems capacity development has been largely limited to Big Pharma. Unfortunately, lab-based qPCR analysis offers little help because results reported between 3-14 days after the swab was taken are far too late to be useful in a track-and-trace system. And although qPCR is the ‘gold standard’, its results are only as good as the swabs, and hence have been reported to offer only around 50% accuracy.[iv] The latest Roche ELISA test for antibodies, said by Government to be a game-changer, is lab-based too, so has similar disadvantages.[v] Yet ten-minute rapid antibody tests, at typically 95-98% accuracy (when challenged at low titre levels), have been dismissed by Public Health England as offering inadequate performance, despite displaying so many advantages with an almost instant result. It is high time that the review of these options by the scientific advisors of the Government and the rationale for decision making be made public. Why, in the time if this crisis, are we not facilitating more transparency and better communication?

How come British rapid-test manufacturers have been supplying countries such as Germany, and the U.K. is not making use of them?[vi] Is there a bias within U.K. to only deal with the giants of industry, whereas our thriving SME’s may offer better, newer, more innovative products and services and are quick to react due to shorter chains of command, ease of expansion and a can-do attitude. There is a lot that we as a nation need to learn from Germany and others in terms of managing CoVid-19. If our rapid tests are good enough for Germany, why aren’t they good enough for us in the U.K.?

We would like to express our concerns with regard to the aggrandising of CoVid-19 vaccine, largely used as a ‘good news’ story to deflect from other failures and inappropriately generating expectations with regard to timelines which may consciously or inadvertently lead to ‘cutting corners’.

We all know that work to develop a vaccine for the H5N1 influenza strain floundered a decade later and herd immunity had largely resolved the problem anyway by then.[vii] WHO continues to caution that many aspects of mRNA Vaccines ‘are not understood’ Yes, mRNA vaccine development can offer shortcuts, but it is an unproven technique and there are serious doubts that a piece of assembled RNA code delivered by a harmless viral vector can induce the sort of immune response provided by the immobilised virus itself.[viii] As the WHO website explains: “Many aspects of the immune response generated by DNA vaccines are not understood. However, this has not impeded significant progress towards the use of this type of vaccine in humans, and clinical trials have begun.[ix]

The vaccine development landscape for CoVid-19 is also striking in terms of the diverse and naive platforms being evaluated, which is quite worrying especially with the exaggeration regarding an imminent ‘vaccine’.

One of the leaders in the Covid Candidate vaccine race currently is Moderna, a small company that saw its share price increase by $7Bn to $29Bn on the announcement of early trial results, albeit the referenced article suggested that evidence is thin on the ground.[x]

The Pharma giant, J&J, is also in the field, promising to ‘pump out a CoVid-19 vaccine as fast as possible’.[xi] Considering the risks of early and excessive scale-up we need to be cautious about remarks like “J&J has already earmarked its Leiden, Netherlands facility for clinical vaccine production and plans to begin manufacturing the vaccine “at-risk” to support human trials.”

Here in the U.K., scientists at Oxford University and their new partnership with Astra Zeneca is powering ahead at pace, with a vaccine taskforce formed to support.[xii] Much as we would love to see the U.K. take the lead in this race to find a satisfactory vaccine, the fundamentals remain the same – mass production of sensitive biologic drugs is a perilous undertaking requiring time and expertise, especially when there is no regulatory experience or track record for reference.

The current short-cutting of the usual scientific research, clinical review, animal trials and long-term monitoring of benefits and side-effects can have serious unintended consequences. Vaccines that target the immune system inappropriately can induce cytokine imbalances or make the disease worse. Already, a proportion of the population are wary of accepting a new vaccine until its efficacy has been proven over time in the population. The public ‘over selling’ of vaccines and raising of expectations of immediate development could backfire completely and provide the many anti-vaccine lobbyists with ammunition to turn the public away from vaccination completely in the long-term, to the larger detriment of future generations.

Many will remember the horrific case of the biologic compound TGN1412 in 2006. Whilst passing pre-clinical safety testing, when the compound, a biologic as is a vaccine, was tested in six patients at a much lower dose, the patients suffered severe adverse reactions “despite showing no obvious adverse effects when tested beforehand in monkeys and mice”.[xiii]

It is also important to understand the odds of success for candidate pharmaceuticals. The diagram below, though covering all of pharmaceuticals is reasonably close to vaccine development as well and aims to place the current situation in context. It is an extract from a US GAO study carried out in 2006[xiv]. Tuft’s University has consistently confirmed the accuracy of these figures, even suggesting that the failure rate in the clinical arena had deteriorated further. A more recent article in Pharmaceutical Technology had this to say in June 2017[xv]:

“A general [drug development] failure rate of more than 90% is bad enough, but for new pharmaceuticals targeting complex and poorly understood conditions, failure is closer to a certainty than a risk, in many situations near 99.6%.

 The diagram paints a very bleak picture – for every 10,000 molecular compounds screened for potential development, only 250 are selected for pre-clinical development. Of that 250, only five make it into the clinic, and of that five, four do not reach their endpoint(s) and fail to gain approval for sale – that is a staggering rate of attrition. From this, we can estimate that $2Bn of the $2.6Bn to develop a drug, is left on the cutting-room floor.

Not just that, there is a final sting in the tail if we look back at the diagram above – i.e. average timelines to get a drug to market under current regulatory processes. Yes, there may be latitude to make some efficiency improvements in the overall timeline, but we are still talking a significant number of years (currently around 11.5 years)  and massive scale-up on manufacturing, which can be a very difficult undertaking.

The WHO Guidelines for assuring the quality and nonclinical safety evaluation of DNA vaccines[xvi]lay out clearly the significantly challenging path to market for full-scale manufacture, which involves extensive validation of each step in the process. Everything must be carried out in compliance with Good Manufacturing and Distribution Practice (GMDP) which is specifically designed to ensure that apparently safe drugs at smaller scale, are not adulterated in any way during scale-up.[xvii] Every detail of manufacture and testing must be recorded in what is known as a Common Technical Document (eCTD), ready to be filed with the regulatory body for assessment (e.g. FDA/EMA/MHRA). It is a herculean task at the best of times. Under the time pressure of investor expectation and sky rocketing of shareholder value, it is a potential ticking time bomb.

Moreover the scale-up through the drug development lifecycle is governed by a working rule that the magnitude of the step-up should be less than or equal to 2.5 times the existing scale. This is to ensure that quality and safety can be maintained at an acceptable level during all the changes to equipment and processes. However, public announcements about vaccine doses being produced, in the reasonably near future, are currently in the high-end millions. This seems hard to reconcile with the comparative infinitesimal quantities currently in production for Phase I clinical trials.

CoVid-19 has laid bare the current issues and inadequacies in our pharmaceutical development and supply lines into healthcare systems. Almost overnight, little or no interest in the ‘unsexy’ world of viruses and vaccines has transformed into frantic activity to be first past the post – mega profits being the winners’ spoils.

In addition, quite a few of the lead developers are somewhat inexperienced in large-scale vaccine manufacture and will have significant challenges to overcome to coordinate manufacturing and supply capability and capacity to meet demand.

Lessons must be learnt fast. Our present focus should be Test, test, test, using the most appropriate and expedient method to track-and-trace with proprietary systems that are already being used elsewhere successfully. Not including care-homes in the initial testing regime was a folly for which we as nation have paid a heavy price.

The management of the CoVid-19 has also highlighted major concerns in terms of our preparedness for pandemics be it ancient prediction systems and healthcare software, not to speak about lack of learning from simulation exercises, an arrogance and ignorance generated complacency and unfit procurement and supply chain systems.

While having an effective and safe vaccine as soon as possible would be ideal, let us not create a situation wherein the race for an mRNA vaccine backfires. We welcome with open arms novel vaccine development paradigms including adaptive development phases, agile regulatory processes and up-scaling manufacturing capacity but we can’t accept any cutting of corners.

Once this is over, will we change things for the better. We will, won’t we?

References:

https://www.nature.com/articles/d41573-020-00073-5

The Race for Coronavirus Vaccines: A Graphical Guide, NIH, National Center for Biotechnology Information, Ewen Callaway, 05 April 2020.

https://pubmed.ncbi.nlm.nih.gov/32346146/

Innovation in the Pharmaceutical Industry: New Estimates of R&D Costs, NIH, National Center for Biotechnology Information, Joseph A DiMasi, Henry G Grabowski, Ronald W Hansen, May 2016.

https://pubmed.ncbi.nlm.nih.gov/26928437/

Coronavirus tests are pretty accurate, but far from perfect, The Conversation, May 06 2020

https://theconversation.com/coronavirus-tests-are-pretty-accurate-but-far-from-perfect-136671

expert reaction to PHE laboratory evaluations of Roche and Abbott antibody tests, May 19, 2020

http://www.porto.pt/noticias/camara-do-porto-faz-testes-serologicos-a-funcionarios-municipais-da-primeira-linha-de-combate-a-covid

H5N1 vaccines in humans, Elsevier, December 2013

https://www.sciencedirect.com/science/article/abs/pii/S0168170213001718?via%3Dihub

H5N1 vaccines in humans

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3795810/

DNA vaccines, WHO Website accessed May 22 2020.

https://www.who.int/biologicals/areas/vaccines/dna/en/

Johnson & Johnson sets stage for COVID-19 shot rollout with ‘first in a series’ manufacturing deal, FiercePharma,, Kyle Blankenship, Apr 24, 202

https://www.fiercepharma.com/manufacturing/johnson-johnson-sets-stage-for-covid-19-vaccine-rollout-emergent-manufacturing-tie-up

Oxford COVID-19 vaccine to begin phase II/III human trials, University of Oxford Website accessed May 22 2020.

http://www.ox.ac.uk/news/2020-05-22-oxford-covid-19-vaccine-begin-phase-iiiii-human-trials

NEW DRUG DEVELOPMENT Science, Business, Regulatory, and Intellectual Property Issues Cited as Hampering Drug Development Efforts, United States Government Accountability Office

https://www.gao.gov/new.items/d0749.p

Counting the cost of failure in drug development, Pharmaceutical Technology, June 2017.

WHO Annex I Guidelines for assuring the quality and nonclinical safety evaluation of DNA vaccines:

https://www.who.int/biologicals/publications/trs/areas/vaccines/dna/Annex%201_DNA%20vaccines.pdf?ua=1

Good manufacturing practice and good distribution practice, MHRA Website accessed May 22nd 2020

https://www.gov.uk/guidance/good-manufacturing-practice-and-good-distribution-practice

Posted Jun 15, 2020 in Fitness & Health category

Minesh Khashu MBBS, MD, FRCPCH, FRSA

Consultant Neonatologist & Professor of Perinatal Health in the U.K. with interests beyond Perinatal Health in large scale change, leadership and social movements

Jim Campbell OBE, BSc, CEng

Toxicologist, Forensic scientist. Managing Director, Morley Life Sciences, previously founder of SureScreen Diagnostics Ltd. Developer of medical diagnostics, interests in optimising diagnosis and treatment, especially neurology and cancer

Hedley Rees B.Eng (Tech) Hons, DMS, Executive MBA (Cranfield), Advisory Board Member, International Institute for Advanced Purchasing and Supply (IIAPS), Chief Disruptor, PharmaFlow Ltd., Author, Taking medicines back to the future where patients come first, and physicians lead the charge

Prof (Dr.) Minesh Khashu MBBS, MD, FRCPCH, FRSA

Consultant Neonatologist & Professor of Perinatal Health

Above all else, a ‘father’ and a ‘student of life’

@mkrettiwt  ;  https://mineshkhashu.wordpress.com/

Looking At Love In A Time Of Lockdown

First posted on Clarityy, Jun 16, 2020
https://www.clarityy.com/posts/looking-at-love-in-a-time-of-lockdown

Love is one of the most used words in all languages, or should we say misused? There was a time when the word love was not often mentioned openly, though it has always nested deep in the human psyche. Be they people on the street, poets or prophets, all have longed for love, albeit maybe not of the ‘same’ kind.  In today’s world we speak about love much more openly, though perhaps, more often than not, in a more superficial way. 

When did you last use the world ‘love’, and with what meaning?

The forced lockdown due to the Covid19 pandemic has provided us an opportunity to reflect on many aspects of our busy lives which would usually fly past without much of a flicker. Have you thought about love in the past couple of months? Have you really thought about it, in a deep way? 

Before we share our notes or indeed the deepest secrets of our diaries, let’s recap what we know about the types of love, as described over the ages. 

The Greeks delineated eight types of love: 

  • Eros – this is romantic love at it’s most ardent and primal. It is full of lust and infatuation, seeking satiation.
  • Ludus – this is the gentler, more playful form of affection often felt at the start of a romantic relationship and with friends. It is fun and uplifting.
  • Philautia – this is self-love, something unfortunately quite rare in society today. Self-love manifests in self-care, healthy self-talk a sense of worth and pride in oneself or one’s work. It is essential for healthy loving relationships.
  • Mania – this is obsession, a kind of madness. It can result in unhealthy behaviours such as stalking, extreme jealousy, and even violence. It often occurs when eros and philautia are out of balance.
  • Pragma – this is the type of love that many long for. It is the quieter, harmonious, generous love seen in healthy relationships.
  • Storge – this is familial love, and particularly refers to the type of love parents have for their children. It can also be seen in relationships with others from time to time where there is asymmetry or dependence.
  • Philia – this is the type of love the Greeks lauded. It is the type of love that arises among good, intimate friends who care deeply for each other, are there for each other through good and bad, who lift and support each other as needed.
  • Agape – this is unconditional love that is freely given, regardless of relationship. It is non-judgmental, free of expectation. For the Greeks, this was the highest form of love; it was perhaps the rarest, then as it is now.

C.S. Lewis simplified this typology of love somewhat in his book ‘The Four Loves’, as follows.

  • Storge, or affection – this is a combination of the various affectionate loves, such as love of friends, family and pets. For Lewis, it was quiet, humble, familiar, giving us a sense of place and belonging. Think of the feel of a favourite blanket for example. It often goes unnoticed in our lives, but would be missed if not there.
  • Friendship, or philia – this is an essential form of love and yet perhaps also the hardest to place a value on. Yet without what some might call companionate love and connection, who do we share our excitements, sadnesses and ponderings with? We need philia to feel not just camaraderie, but fun and fulfillment.
  • Romantic, or eros – for Lewis, this was a more absorbed form of love between lovers, which bore the danger of becoming consumed or blind, lost in passion. But at it’s best it could approximate unconditional love, agape.
  • Charity, or agape – Lewis set agape above the other loves, which were necessary but not sufficient for agape. They were also potentially detracting however, for example, if we let them substitute for the love of God. Agape, for Lewis, was the closest we might come to approximating divine love. He stated that “our loves do not make their claim to divinity until the claim becomes plausible. It does not become plausible until there is in them a real resemblance to God, to Love Himself.”

Interestingly, in ‘eastern’ worlds like India, the way of Bhakti has been a well-treaded divine path to God. It is a spiritual or devotional love that many over the years have embodied in their journey to salvation or moksha. In contrast, Kama refers to desire, pleasure and sensual love and hence the well known treatise Kamasutra.

We would like to highlight that generating a hierarchy of types of love is not our aim as it is not necessarily helpful. The point is to understand all the aspects of love better and appreciate that as we go through life, we may experience the various types of love based on where we are in our journey. Love’s spectrum of facets are expressed and experienced by us through our human journey. It is one of the major emotions that make us truly ‘human’.

What is clear is that from a human perspective, to love is to make ourselves vulnerable in some way. Moreover, to be seen as ‘needing’ love is perhaps even more vulnerable. Having said that, as Lao Tzu said: “Being deeply loved by someone gives you strength, while loving someone deeply gives you courage.”

As the lockdown has limited our contact and social connection, we have more ardently sought it. Despite the limitations of the online world, the quality of connection has often provided both more open and more meaningful discourse, as people seek to know each other and communicate at a deeper level. But this begs the question, is it deeper connection with the other that we are seeking or deeper connection with ourselves or both? How can one facilitate the other? Something worth diving deep into, isn’t it?  We all should give it a go.

Even though the lockdown has stopped us from going outside, it has provided us a great opportunity to go within, to delve deep within ourselves and come to know who we truly are. Finding the courage to go within this way is an essential step in learning to love ourselves. This is really important as many would intuitively know and others discover over time, that to truly connect with and love what is outside of ourselves, we must first love ourselves. 

As we step inwards and start opening doors to deeper depths of our own being we realise that the ‘currency’ flowing within is ‘emotions’ and the biggest denomination of all is Love. We stop looking for the ‘object’ of love. We start feeling it, within ourselves and beyond.

To know ourselves as love is a far cry from the transactional love that we often see playing out in the world. Transactional love keeps score. It comes from a place of being that is absorbed in self (not the Self), in give and take. Not all loves are inherently transactional though. Storge is a good example. Parental love is well known for being unconditional except where clinging and attachment distort it. But even in parental love, the focus is perhaps aligned wrongly on just the physical forms and material success. Imagine if parental love sowed the seeds of and nurtured the discovery of Self. What would change for us as parents and what would change for our children and their tomorrow?

As Paulo Coelho beautifully put forth in the Alchemist; “When we love, we always strive to become better than we are. When we strive to become better than we are, everything around us becomes better too. Let us imagine that just 1% of the world population delves deep within and discovers the limitlessness of love. How different would our world become?

In today’s world full of anger and hate, what better antidote!  As the Indian saint and poet Kabir said in his own unique way: “Listen, my friend. He who loves understands.”

Let’s seize the moment, and use this time of lockdown to go within and begin to know ourselves as Love! 

No talk of love is complete without Rumi: “Your task is not to seek for love, but merely to seek and find all the barriers within yourself that you have built against it.” 

Posted Jun 16, 2020 in Fashion & Lifestyle category

Prof (Dr.) Minesh Khashu MBBS, MD, FRCPCH, FRSA

Consultant Neonatologist & Professor of Perinatal Health

Above all else, a ‘father’ and a ‘student of life’

@mkrettiwt  ;  https://mineshkhashu.wordpress.com/

Will we take this opportunity to reboot for the sake of the planet?

First posted on The BMJ Opinion. June 5, 2020

https://blogs.bmj.com/bmj/2020/06/05/will-we-take-this-opportunity-to-reboot-for-the-sake-of-the-planet/

As we loosen the lockdown and start taking steps back to “normal” life for the sake of the economy, do we have the courage to consciously choose a different path, one that portrays us as “keepers” of this planet rather than its “exploiters”? 

Everyone has been affected in some way by this pandemic, which is unprecedented in recent history, and we have all had to deal with it, through social distancing, isolation, and much more. 

The analogy with war, through terms like frontline, war, enemy, conquer and kill, have brought home the urgency and gravity of the situation, but at a cost. 

The analogy with war is dangerous and divisive; it justifies actions outside established legal and democratic processes for expedience, it sanctions the use of draconian measures with unintended consequences, and it results in collateral damage, including many critical diagnostic tests and procedures being abandoned. The war rhetoric is also not conducive to trust, openness, respect or the realisation of human rights. 

The call to arms has heightened fear and stress; it is taking a toll on mental health, as well as family and community health and wellbeing, and rates of abuse and antisocial behaviour are rising.

The language of war promotes anxiety and alarm, and it keeps us stuck in old patterns of fear, helplessness and anger that are the root of many of our current societal problems. It suggests an enemy outside of ourselves and keeps us looking to others for orders. It allows us to avoid responsibility for the part we have played in allowing and enabling the development and rapid spread of coronavirus, and our responsibility now to choose a wiser path. 

Let’s not allow the over simplistic war analogy to distract from the bigger picture, and overlook what might be the greater danger to our health and wellbeing and that of the planet.

We have all played a role in creating the conditions that have allowed this coronavirus to spread. We must now turn our attention to the roots of this and the bigger challenges confronting us: climate change, species extinction, plastic pollution, ocean acidification, extreme inequality, poverty, and mass migration to escape the devastating effects of war and suffering. 

The covid-19 pandemic is a symptom of the ills of how we live our lives, and it is a wakeup call giving us an opportunity not just to “resume” the previous “normal” but to “reboot”. We can choose to live a more humane life and to tread a better path for the whole planet both individually and collectively.

The first step is recognising that we are part of a very complex living system. If we “mess” with one part, it can and will have major ramifications elsewhere. Once we recognise that we are part of nature, part of planet earth and infinitely connected with it, we begin to see that when we hurt any part of the planet or it’s people, we hurt ourselves. What will it take for us to move from a “ruler” and “exploiter” of this planet to a co-inhabitant of this ecosystem?

The pandemic has changed the world, but it has also provided us with an opportunity to reflect on our state of being. Over the last few weeks, many of us have realised what really matters in life and the essential role of health and wellbeing. Let’s utilise this time to really look at how we got here, and let’s explore how we might make ourselves and our world whole again. We can begin by looking at what needs to heal and change in ourselves and in our world, and then ask how we can harness the insights and positive disruptive innovations covid-19 is catalysing. 

The psychologist Carl Rogers said, “if the time comes when our culture tires of endless homicidal feuds, despairs of the use of force and war as a means of bringing peace, becomes discontent with the half-lives its members are living, only then will our culture seriously look for alternatives.” That time is now. Let us Reboot.

Minesh Khashu is a consultant neonatologist and professor of perinatal health in the UK with interests beyond healthcare in large scale change, social movements and metaphysics.

Rashmir Balasubramaniam is a leadership coach and change and transformation consultant in the UK, who has worked for many years in global health and development. 

Reference:

  1. Rogers CR. A Way of Being, 1980.

Prof (Dr.) Minesh Khashu MBBS, MD, FRCPCH, FRSA

Consultant Neonatologist & Professor of Perinatal Health

Above all else, a ‘father’ and a ‘student of life’

@mkrettiwt  ;  https://mineshkhashu.wordpress.com/

An open letter to Mr Boris Johnson PM

My open letter to Boris Johnson as an NHS doctor working on the frontline

First posted on The Mirror, 21 APR 2020

“Dear Boris,

Hope your recovery is progressing well.

While I have always admired your intelligence, your single mindedness, decisiveness and power of persuasion, your post hospital discharge video message brought forth two further attributes which many of us had not witnessed earlier: a degree of vulnerability and simple, genuine and sincere words.

These are quite endearing in a leader and hope they serve you well in the coming years.

While you and others may think that my NHS colleagues saved your life, this is not something that is in any way extraordinary for us.

Most acute hospitals and ambulance services across the country are saving lives of multiple people each day, who are much sicker than you were and we have been doing this silently, day in and day out, for many decades.

The best way to repay us is through a well-funded and sustainable health and social care system.

While the Covid-19 crisis has suddenly woken everyone up to realise that we need admiration and hero worship, what we really need is a well-funded system and basic amenities to look after ourselves at work.

A comfortable chair to sit on during the few minutes of rest we get, maybe a tea kettle that works and some basic cutlery.

It would be good if our pensions and contributions did not get messed up unnecessarily and we were not penalised for working harder to support a failing system.

However, more of this some other time.

Today what I would like to focus on is our failings in terms of the management of the Covid-19 crisis and our need to learn quickly from these.

While some would argue that this is not the right time, but having thought about it for a while, I think it is important that we don’t delay exploring these failures and learning fast.

We have always preached that the NHS should be a learning organisation and quickly learn from failures and it is important that the right behaviours are role modelled at all levels.

I have always believed that the weakest link for a leader is ‘yes men’ and his/her strongest suit is his/her capacity to encourage thought diversity and embrace what may seem a ‘dissenting’ voice.

Firstly, it is important to accept that spread of the virus across the world and within the UK to the PM, Cabinet ministers and advisers as well as a senior member of the Royal Family is above other issues an intelligence/security failure. 

What if this was a bio-weapon from a rogue state or a terrorist group?

Our lockdown measures were initiated a few weeks late and we have since been trying to catch our tail.

Repeated utterances of ‘we are following the science’ don’t add credibility to the plan.

This needs sharing of evidence at each step and how that evidence supports the plan.

We could have done this much better.

The PPE shortage and significant delays have highlighted a far from robust strategy, plan and procurement process.

This is despite previous pandemic related work and so-called extensive preparations for Brexit.

We have lost colleagues and no apologies have come forth yet!

The herd immunity saga as well as testing have been both communication and management failures.

I would love to be pleasantly surprised at the end of the month to see us reach the target figure quoted by Matt Hancock but as of now, suffice to say, we have been found inadequate.

Countries much less developed than us have managed much better contact tracing and testing.

Germany is performing five times more tests than we are.

Why is that?

How can they manage this, and we can’t?

The use of war analogies and rhetoric while useful in some ways is actually damaging on multiple fronts and should be stopped.

It has given the system powers to command and control without any transparency and discussion regarding decision making.

It is this war rhetoric that has created a mindset that has allowed nursing homes to be surreptitiously treated as hospices and nobody seems to bat an eyelid.

t is this war analogy that has led to people dying in hospital without any near or dear ones by their side.

This is perhaps the most devastating and cruel effect of our war rhetoric.

There is no reason why one should not have been allowed to visit a dying partner or parent with full PPE protection, if one wished to do so.

As a society this is a big failure and has been accepted as ‘appropriate’ because of the warmongering.

Last but perhaps most importantly, we made a strategic miscalculation at the very outset.

Strategically it would have made more sense to utilise initially the armed forces and reserves, rather than the acute hospitals and the already stretched ambulance sector, to look after Covid cases in specific military health institutions.

This was an ideal opportunity to use the armed forces personnel and hospitals to segregate Covid cases from general public and would have worked much better.

We need to ask ourselves why this wasn’t done.

Managing Covid cases in each and every acute hospital in the country with our current level of cases is strategically and operationally poor and has led to other significant collateral damage and unintended consequences in terms of delays in critical treatments and diagnosis.

It will take us months if not years to quantify these and try to minimise the damage, whatever little we can.

In a nutshell, even though some great work has happened, in the main we have done either too little or too late or both.

It would be useful to scrutinise what preparation was done between late December and March and why we have failed on so many levels.

Moreover, the lack of a genuine apology from your cabinet colleagues for the shambolic way in which PPE has been managed and care homes have been turned into slaughter houses, begs for some soul searching and brings into disrepute the culture within Government.

What message are we sending to our health and care workers and society at large?

I hope my words will be received in the right spirit.

I wish you a speedy recovery.

I wish you and Carrie all the best for the rest of the pregnancy and best wishes for the new arrival.

If the critical illness hasn’t transformed you enough, I am sure fatherhood will.

Yours sincerely

Dr Minesh Khashu”

The Mirror:
https://www.mirror.co.uk/news/politics/open-letter-boris-johnson-nhs-21901510

Disclaimer: These are my personal views and don’t reflect the views of my employing organisations.

They are based on a national picture and don’t represent the situation in my organisation or region.

Prof (Dr.) Minesh Khashu MBBS, MD, FRCPCH, FRSA

Consultant Neonatologist & Professor of Perinatal Health

Above all else, a ‘father’ and a ‘student of life’

@mkrettiwt  ;  https://mineshkhashu.wordpress.com/

Fatherhood needs a paradigm shift within society

 

Twins s2s pic

International Fathers Mental Health Day

#DadsMHday

18th June 2018

The thought of an International Fathers Mental Health day brings mixed emotions. On one hand, I am pleased that something useful is being done to raise awareness by the likes of @MarkWilliamsFMH and @DrAndyMayers and many others across the world. On the other hand, I feel disappointed that things have come to such a pass that a special day is required to raise awareness. It begs the question: What has gone wrong and why?

I am not planning to answer this question for you. It is best that we answer this collectively as a society.

Today I would like to share with you a specific resource that I have developed to better support dads of children who are preterm or unwell and are being looked after in neonatal units.

As you very well know, being a new dad can be a daunting thing, but being the parent of a child in neonatal care potentially brings even more difficult emotions and problems, as well as a wealth of complex information to digest.

The idea for the Neonatal DadPad was conceived by me after recognising that there was a need for better communication and support for fathers of babies on neonatal units.  It is thought to be the first resource of its kind in the world.

The pack of laminated cards contains practical information and advice on relevant matters, including how dads can best help themselves and their partners as they each deal with their feelings and emotions; where to go to seek further help, support and information; and practical guidance on holding, handling, bonding with and caring for their  baby.

It is hoped that the resource will become a valuable tool for fathers during this sensitive time, as well as a ‘keepsake’ book for the father, child and family, with spaces in which to record information, pictures and emotions. It has been designed to be kept as a memento of the neonatal journey.

Whilst this resource is aimed specifically at dads, the information within it is useful for both parents and is also a good adjunct for communication for neonatal unit staff.

The Neonatal DadPad will be launched at the Neonatal Unit at Poole Hospital in England on 17th June 2018, Father’s day.

https://thedadpad.co.uk/neonatal/

Better engagement of dads plays a critical role in supporting mothers, improving breastfeeding rates, decreasing risk and improving the integrity and resilience of the family unit at a very difficult time.

Even outside the neonatal unit i.e. following normal birth and a well-baby, the experiences of fathers are in many ways suboptimal. Improved experience of fathers will improve health outcomes not just for the father but more importantly for the child, for the mother, the family and society at large. We find that supporting the father-infant bond and supporting co-parenting between the mother and the father benefits the health of the baby as well as the family unit. We find, however, that despite much interest in engaging with parents as full partners in the care of the infant, engagement with fathers is generally poor. Fathers typically describe the opportunity to bond with their babies in glowing terms of gratitude, happiness and love. These emotions are underpinned by hormonal and neurobiological changes that take place in fathers when they care for their babies, (similar to what has been well known and accepted for mothers) Fathers, however, are subject to different social expectations and this shapes how they respond to the situation and how others treat them. Fathers are more likely to be considered responsible for earning, they are often considered to be less competent at caring than mothers and they are expected to be “the strong one”, providing support to mothers but not expecting it in return.

It is important that health services and society assess the needs of mother and father individually,  gear parenting education towards co-parenting, actively promote father-infant bonding, be attentive to fathers hiding their stress, communicate with fathers directly not just via the mother and facilitate peer-to-peer communication for fathers as appropriate. Health care staff need better training to be able to evaluate the needs of fathers and to positively support co-parenting.

In conclusion we need a paradigm shift to appreciate and implement:

  • support for the father-baby bond like the mother-baby bond is supported
  • support for co-parenting, by the mother and father working together as a team

This shift is critical in moving individuals, healthcare teams and society at large, away from the widespread view that mothers are primary carers of infants and fathers are helpers to the co-parenting paradigm. Fathers have innate biologically based abilities to bond with and care for babies; these are especially important for the health and safety of babies in situations of stress and risk. The father-baby bond optimises the family dynamic and the opportunities for nurture of children.

I would like to leave you with some great pics of the overwhelming joy of new fathers, courtesy UNICEF at https://familyincluded.com/love-and-joy-fathers-hold-their-babies/

 

Prof (Dr.) Minesh Khashu MBBS, MD, FRCPCH, FRSA

Consultant Neonatologist & Professor of Perinatal Health

Above all else, a ‘father’ and a ‘student of life’

@mkrettiwt  ;  https://mineshkhashu.wordpress.com/