Monthly Archives: February 2020

Thoughts on the health service

A while ago I changed the name of this blog so that I could blog about anything and not just education. It may or may not surprise you to learn that I have strong opinions about lots more than education! By the way, my ‘obsession’ with education and my willingness to go off message is born out of real fear that  by embracing “progressive” approaches we may in fact ruin what is a pretty good education system by international standards – and all on the basis of hunches and speculation. And I have a son who is nearly twelve and I want him to receive a solid, rigorous education.

So today I’m going to make my first foray in things other than education. And what I’m going to talk about is the health service.

During, and in the aftermath of the election, I’ve been struck by how many people have tweeted things like “the health service is dysfunctional” or “we have a third world health service” and I find myself becoming very defensive. Because I owe our health service a lot.

I know the public health service well and I am well aware of its shortcomings. I often get frustrated by it. I don’t have private health insurance so every medical interaction I’ve ever had has been with the HSE. (Incidentally, young medics are fantastic – we don’t need to fiddle with entry requirements. Maybe we should look at their insane workloads instead.) I suspect many commentators, including academics, have little experience of the public health system since they’re more than likely to be on a health insurance plan in their place of employment.

But here’s the thing: As many people will know I was born with CF and in 2002 I had a double lung transplant (in Newcastle in northern England before our own unit was set up in the Mater). Then on New Year’s day, 2011, I had kidney transplant in Beaumont – kidneys don’t like immunosuppressant drugs.

That’s all grand and not a defining part of my life, but for the purpose of this blog it means that I have a relatively unusual insight into the working of the health service in Ireland.

And here’s the thing: the Irish Health service does a lot of things brilliantly. I owe my life to it. When it plans sensibly, and adopts well thought-out strategies, it is wonderful. The lung transplant unit in the Mater was set up around 2000 and it is now the third biggest centre in Europe and has survival rates as good as anywhere. If I ring my team tomorrow they will be on the case, essentially immediately. It’s a wonderful service, definitely not third world.

The key problem in the Health service is the lack of capacity to deal with the randomer who comes in off the streets with, for example, chest pain, and has no prior connection with the hospital, and has no understanding of how the system works. They don’t understand that the team on call may not be the team most appropriate for their specific problem. And they don’t understand why they have to wait for a while, even days. I’ve been one of those people on ta trolley  and to honest, it was a big relief, and I knew I was being looked after, even if the circumstances were not ideal. The randomer tends not to think like that.

My main concern with the health service, and I’m reluctant to say this because I respect so many people I’ve interacted with over the years, is that it often lacks compassion. We don’t deal with, for example, pain relief, very well. Maybe it’s a Catholic thing, par crucem ad lucem and that all that. When I was in Newcastle the attitude was that you need to be pain free to mobilise. Hence when I woke up in pain during the night, the nursing staff insisted that I drank a thimble of morphine and gave me an heated pack to hold against my chest. In Ireland I suspect I’d have been offered a couple of paracetamol.

We do need to change attitudes as well as systems.

The Problem with Problem-Solving

Everyone, it seems, is talking about problem-solving these days. The subtext is nearly always that business and industry needs problem-solvers more than ever because …well, the 21st century and climate change and stuff. There wasn’t much of a need for problem-solving back in the good old 20th century. The “factory model” of education was fine then because nothing much happened in the 20th century and when it did, it happened at a snail’s pace. Apparently.

So what we need to do now is transform our education system and put far more emphasis on actually teaching problem-solving, not to mention creativity, critical thinking and other 21st century skills, including soft skills like empathy. These were not so important in the 20th century because we had very few problems back then that required creative solutions.

So how do we inculcate these 21st century skills in our students?

One way is to have actual modules devoted to these skills: Problem Solving: an active learning approach; Being Creative with Minecraft; Critical Thinking for the 21st Century. Then we could develop more focused modules like: Problem Solving: Climate Change; Creativity and Brexit; Critical Thinking with Lego Robots.

Sadly, none of these approaches actually work. Attempting to develop so-called 21st skills through generic approaches or through challenging students with problems about which they know very little is making the same mistake that has been made over and over in the world of education. It might provide an engaging experience for students but as Robert Coe famous said, “Engagement is a poor proxy for learning”.

The basic assumption in a lot of modern thinking about education, namely that we don’t currently teach  21st century skills, is completely wrong. As an engineer, everything I do in my teaching is aimed at developing problem-solving skills. But it’s problem-solving in a chemical engineering context. My colleagues in the School of Law and Government teach problem-solving all the time. You don’t work as a lawyer without being able to solve highly complex legal problems. Colleagues in our Business School teach problem-solving in accounting, economics, and in human resources management. Even the extraction of meaning from a poem can be considered as an exercise in problem solving.

The key aspect of all of these examples is that the ability to solve a problem is hugely dependent on what the problem is. The best tools you can have if you want to be able to solve problems is to have relevant knowledge, lots of prior practice of solving problems in your field, and probably some personal attributes like conscientiousness and tenacity.