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2020: The Year of the Nurse and Midwife

Fri, 2020-01-17 16:13

It’s not often that such wide-ranging and global a body as the World Health Organization (WHO) deems it appropriate to give a whole year over to two health professions. However, in 2020 it has decided to do just that, deeming this the Year of the Nurse and Midwife.

There are good reasons for this. In 2016, the UK All-Party Parliamentary Group on Global Health (APPGGH) launched a report on the Triple Impact of nursing and midwifery on global health and development. The conclusions of that report were clear – if we want to see significant progress towards universal access to healthcare, we need to invest in nurses and midwives. Furthermore, we improve community health, economic development and the empowerment of women and girls in so doing. This is the triple impact of nursing.

This spurred the Burdett Trust for Nursing, the International Council of Nursing (ICN) and the WHO to launch the three-year Nursing Now campaign in late 2016. It had the vision to improve health globally by promoting nursing and midwifery. National governments and international bodies have been lobbied to invest in nurse training, recruitment and career development. The campaign has initiated studies and evidence gathering globally on the impact of nursing and midwifery on local and national health outcomes.

It has also been lobbying for more nurses and midwives to have voices into national and international health policymaking.

A significant early win for that campaign was in 2017, when the incoming Director-General of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, appointed a Chief Nursing Officer as one of his principal health advisors. This was a first for the WHO.

In 2019, Nursing Now launched The Nightingale Challenge, which calls for all employers of nurses and midwives globally to provide development opportunities in influential leadership for young nurses and midwives during 2020. The hope is that this will enable 20,000 nurses and midwives under the age of 35 to build their skills as advocates and influential leaders in healthcare.

The Year of the Nurse and Midwife is the culmination of this campaign and shows that the WHO has recognised that it cannot promote the health and well-being of nations and local communities without frontline nurses and midwives. They make up 50 per cent of the global workforce and regularly work in settings where there is limited or no access to doctors, hospitals or pharmacies.

But there are still a considerable number of obstacles. We know in the UK that we face as many as 40,000 unfilled nursing vacancies and 3,500 unfilled midwifery posts. Notwithstanding the UK government’s election pledges, this is a massive gap to bridge. There is an even more significant gap in skills and experience, with so many older and more experienced nurses quitting the profession it is leaving less experienced nurses to take on responsibilities with fewer experienced mentors and leaders to support them.

And this is in the seventh-largest economy in the world. The skills gap and the staffing gap in many other nations is far, far worse than this. The WHO estimates we are short of nine million nurses worldwide. Even with drives to increase the numbers trained and retained, that number will still be 7.6 million by 2030, because the need is growing far faster than the workforce.

If the UK thinks that we can overcome our nursing shortage by recruiting overseas, we will find it is not so simple. Every developed nation is now doing so, and many offer better working conditions and training opportunities than we do. If we want to recruit, train and retain more nurses and midwives, we need to make it a far more attractive career, far less costly to get into and with far better working conditions.

So why is the WHO focusing on 2020 as the year of the nurse and midwife?

On May 12, 1820, in Florence, Italy, the Nightingale family rejoiced in the birth of a daughter who, unbeknownst to them, would go on to shape healthcare around the world for the next two centuries.

Florence Nightingale took the ancient art and vocation of nursing, embedded from antiquity within the Christian church across Europe and the near-East, and wedded it with the scientific method, rigorous data collection and statistical analysis of Victorian rationalism, to create the modern profession of nursing. As much an art as a science, Florence saw no contradiction in holding up compassion and evidence-based rigour as the profession’s central virtues.

Twenty-first-century nursing is a highly technical and skilled profession, with many nurses and midwives now performing tasks such as minor surgery, caesarean sections and anaesthetics. Ninety per cent of all patient contact worldwide is with nurses. Yet nurses still do not have a seat at the table when it comes to decision making, and even in some developed countries, like Germany, the profession is barely recognised as much more than handmaids to doctors.

At its heart, though, nursing and midwifery have their roots in an ancient Christian tradition of care and compassion for the sick, marginalised and forgotten. This year, more than ever we need to wake up national governments and international bodies to the importance of nurses and midwives in leadership, to train and recruit more nurses to an ever-higher standard, to share good practice far and wide and to improve the standing and working conditions of those working in nursing and midwifery.

Christians are aware of the value of nurses and midwives and their role – remembering that the values of compassionate engagement and care at the heart of these professions draw deeply from Christian roots. So it is that between 12 and 18 May this year, CMF will be holding its regular week of prayer for nurses and midwives. In July, hundreds of Christian nurses from nearly 40 countries will gather for the Nurses Christian Fellowship International four-yearly Congress in Denver, Colorado. The conference will focus on Opportunities and Challenges in Nursing Today: A Christ-Centered Response. Christianity is not just in the history of nursing; Christians are still critically engaged in its present and its future.

Categories: Discussion

Transgender: two pivotal points for the UK

Wed, 2020-01-08 16:32

Should it be possible for any person to change their legal sex based on their gender identity? And if so, what should be the lower age limit for self-declaration?

And should young people (below the age of 18) who self-declare be deemed competent to give informed consent to medical treatment for gender reassignment?

These two questions are currently under review in the UK.

Gender Recognition Reform

Just before Christmas, the Scottish Government opened a consultation on the Gender Recognition Reform (Scotland) Bill. ‘To comply with international human rights law,’ the consultation website says, ‘Scotland must have a system for obtaining legal gender recognition. The current system is viewed by many applicants, or would-be applicants, as demeaning, lengthy, and stressful.… Since 2004, trans people across the UK have had the right to legally change their gender through applying for a Gender Recognition Certificate… What the Scottish Government is proposing is to amend the way in which a trans person can obtain that Certificate.’

A post on the Transgender Trend website explains:

The draft Bill would establish the criteria for legal status of sex as a matter of simple self-declaration of ‘gender identity.’ If passed, the bill would erode the material, biological basis for the protected characteristic ‘sex’, which would affect the associated rights and protections of women and girls as the female sex. It would change the legal and cultural definition of ‘woman’ from a person who is of the female sex to a person of either sex who has an internal feeling of being a woman – which presumably would exclude women who experience no such womanly feeling.

The Scottish draft Bill is a proposal which would allow any person to gain legal status as the opposite sex for whatever reason or motive, based only on their self-declared identity which no-one else would have the right to question. To be clear, any man who says he’s a woman may be issued with a new birth certificate to say that he was born female. Although the draft Bill states that false declaration would be a criminal act, the reality is that a law based on self-declaration contains no mechanism by which one person’s inner feelings may be assessed as ‘true’ and another person’s as ‘false’. (Emphasis added.)

The proposed Bill doesn’t stop there, however:

The draft Gender Recognition Reform (Scotland) Bill, would, if enacted, introduce reformed arrangements for trans people aged 16 and over … to apply for legal gender recognition…. This is in line with the age at which children and young people acquire a number of rights.

As Transgender Trend points out, though, 16-year-olds in Scotland are not allowed to ‘buy cigarettes, get a tattoo, see, rent or buy any film, place a bet or buy alcohol or consume alcohol in a bar’. Yet having self-identified as a different gender, they would presumably be deemed capable of giving informed consent to the administration of hormone treatments and surgeries that would affect the rest of their lives.

The government would be affirming the identity of a teenage girl who is likely to go on to take testosterone and undergo double mastectomy on the basis of that identity. The Scottish government does not consider the possible reasons why so many adolescent girls are taking this pathway and laws should not be changed while we have such inadequate understanding. This is a decision with lifelong consequences and the government must consider the potential harms.

These proposals would have a significant impact on all professionals working with children and adolescents, including teachers, clinicians, doctors and counsellors.

The Transgender Trend post is thorough and helpful and is worth reading in detail. The consultation is open until 17 March 2020, and anyone can respond to it. As Transgender Trend point out: ‘This Bill, if passed, would put pressure on Westminster to follow suit, so it is important for women and children not only in Scotland but throughout the whole of the UK.’


Gender-reassignment treatment for adolescents

Meanwhile, in England, papers will be filed at the High Court this week in what The Guardian describes as, ‘A landmark test case to establish whether children can give informed consent to medical treatment for gender reassignment’.

Lawyers acting for Susan Evans, a former psychiatric nurse at the Tavistock and Portman NHS foundation trust, which runs the UK’s only NHS gender identity development service (Gids), and ‘Mrs A’, the mother of an autistic 15-year-old girl who is on the Gids waiting list, will file papers to commence proceedings in a judicial review brought against the trust and NHS England.

Paul Conrathe, the solicitor representing Evans and Mrs A, says:

‘The issue is whether the young person is of sufficient maturity and capacity to understand the consequences of their actions. We say it is a leap too far to think that [the 1983 consent case brought by Victoria Gillick] as a judgment could apply to this type of scenario, where a young person is being offered a treatment with lifelong consequences when they are at a stage of emotional and mental vulnerability. It simply doesn’t compute, and therefore whatever medical professionals say consent is not valid in law.’

Providing this treatment – puberty blocking and cross-sex hormones – to any young person who wants them requires, [Conrathe] argues, ‘a specific order of the court on a case-by-case basis. [The treatment] cannot be delivered as a matter of general approach’.

More details are available about the background to Mrs Evans’s case on the Medscape website.

CMF will continue to watch this case and will provide suggestions on how to respond to the Scotland consultation in due course. In the meantime, please pray: for wisdom for the judges and parliamentarians involved in these two test cases; that God’s hand of protection will be on the many vulnerable people who are affected by the current changes in law and attitude around gender identity; and for doctors, nurses, psychiatrists and other professionals involved in helping their patients to receive appropriate care in a very challenging climate.

Categories: Discussion