Jonathan Aitken: I’m in my 80s and here’s what I’d tell Joe Biden

Don't succumb to this politicians' fantasy.

Jonathan Aitken

Jonathan is a former politician, and now a prison chaplain.

President Biden sits at a desk, holding his balled hands to his mouth.

Biden in the Oval Office, 2022.

The White House.

I am the same age as President Biden. So part of my heart went out to him as I watched his catastrophic confrontation with Donald Trump last week.

As we octogenarians know, or should know, our physical and mental faculties simply don’t work as well as they used to. If tested in the white heat of a Presidential debate, or at a multitude of far lower-level challenges, it is all too easy to slip, stumble or fall.

These human weaknesses have been almost unchanged for time immemorial. They were painfully if poignantly expressed some 2,500 years ago in the Psalms of David:

“The days of our age are threescore years and ten; and though men be so strong that they come to fourscore years: yet is their strength then but labour and sorrow; so soon passeth it away, and we are gone.”

Modern optimists may try to argue with the ancient psalmist. In our 21st century era of vitamin pills, workouts in the gym, macrobiotic diets and intermittent fasting, we are all too willing to believe that we can postpone the arrival of the grim reaper or at least prolong our youthful vitality.

Politicians are particularly susceptible to the fantasy that they can stay on their best form into old age longer than anyone else. “Age shall not weary us” they whisper to themselves, citing elderly successes such as Winston Churchill who became Prime Minister in 1940 aged 67, leaving Downing Street at the age of 80; William Gladstone who formed his last administration when he was 82; or Ronald Reagan who rode off into the sunset aged 77.

There are many reasons why political leaders have a tendency to hold on to power beyond their sell by date. Their egos make them believe they are indispensable. Their courtiers, their staff and their appointees like to stay in power too. When the White House changes hands approximately 30,000 people lose their jobs, from mighty Cabinet Secretaries in Washington to humble rural postmasters in Hicksville. So there is a built-in bias for preserving the status quo, by fair means or by flattery.

What President Biden now needs is loving, personal advice from his nearest and dearest, and wise political advice from disinterested friends whose candour he really trusts. Will he get it?

My late wife, Elizabeth, was brave in giving what she called “frank notes” to all three of her husbands when she watched them perform on stage, on screen, or, in my case, in pulpits.

Her movie star spouses, Rex Harrison and Richard Harris, were not always pleased when her notes criticised them for forgetting their lines, failing to sound consonants, or dropping their voices at the end of sentences. I, too, was sometimes less than appreciative, but I always took Elizabeth’s advice. Would that Jill Biden might now imitate such similar Elizabethan candour.

In his perceptive article on this subject for Seen & Unseen, young Bishop Graham Tomlin (he’s about 20 years younger than me!) made excellent points about the calling of old age. To which I can cheerfully shout, as if I was still in the House of Commons: “Hear! Hear!”

For, since being ordained at 74, I have found enormous fulfilment in the calling of prison chaplaincy, pastoral care, and preaching. These are not to be compared to the fastest tracks in competitive careers like politicians or investment bankers. Yet they have brought me great joy and I hope they have sometimes helped my prisoners and parishioners.

The race is not always to be swift.

Article

Care

Change

26 July 2024

6 min read

Are we forgetting how to care?

The profound act at the heart of nursing.

Helen Cowan

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient

Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care. Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions?

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers.

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’.

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care.

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?”

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness.

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.”

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.