Theorising narratives of exile and belonging : the importance of Biography and Ethno-mimesis in “understanding” asylum

The article explores the use and importance of taking a biographical approach to conducting participatory action research (PAR) with asylum seekers and refugees in order to: better understand lived experiences of exile and belonging; contribute to the important field of Biographical Sociology; provide a safe space for stories to be told; and in turn for these stories to feed in to policy and praxis. The authors’ combined work on the asylum-migration nexus, the politics of representation and participatory action research methodology (PAR) as ethno-mimesisi argues for the use of biography to contribute to cultural politics at the level of theory, experience and praxis, and is constitutive of critical theory in praxis. PAR research undertaken with Bosnian refugees in the East Midlands and Afghan refugees in London will be the focus around which our analysis develops. We develop a case for theory building based upon lived experience using biographical materials, both narrative and visual, as critical theory in practice towards a vision of social justice that challenges the dominant knowledge/power axis embedded in current governance and media policy relating to forced migration. The dominant power/knowledge axis related to forced migration is embedded in current (New Labour) governance and re-presented in some media texts as identified below. New Labour governance is symbolised in the competing discourses of a) strong centralised control and b) more open systems, network and partnership based governance (Newman, 2003: 17-23; Clarke, 2004; Lewis, 2000). Open systems are made up of partnerships and networks – “joined up government”, “that transcends the vertical, departmental structures of government itself” (Newman, 2003: 20). to develop or foster a consensual style of governing. Progressive governance is defined by Newman (2003:15) as involving a significant shift from governance through hierarchy and competition to governance through networks and partnerships with an emphasis upon inclusion. Progressive governance involves the production of techniques and strategies of responsibilisation of citizens operationalised through the development of networks, alliances, and partnerships, with a strong focus upon active citizenship. Thus, spreading responsibility for social control to non state agencies and “communities” (Garland, 2001). In relation to forced migration/asylum discourses around the exclusion of the “other” (involving criminalisation, detention and deportation) and the maintenance and control of borders (developing ever more tighter controls on entry and asylum applications) exist in tension with discourses that speak of human rights, responsibilities and possibilities for multi-cultural citizenship especially in the community cohesion literature. There is a conflict at the heart of New Labour’s approach to asylum policy linked to the “alterity” of the asylum seeker that promulgates hegemonic ideologies and discourses around rights to belonging and citizenship, perceived access to resources (redistribution) and misrecognition fostering suspicion of the “stranger”. Alongside discourses of fairness and rights to enter and seek refuge, there exist regressive discourses that water down the vitally important actual and symbolic 1951 UN convention, and foster a split between “bogus” and “genuine” refugees, making it extremely hard to seek asylum in the UK.

Impact of COVID-19 pandemic on sickness absence for mental ill health in National Health Service staff

ObjectiveTo explore the patterns of sickness absence in National Health Service (NHS) staff attributable to mental ill health during the first wave of the COVID-19 epidemic in March–July 2020.DesignCase-referent analysis of a secondary dataset.SettingNHS Trusts in England.ParticipantsPseudonymised data on 959 356 employees who were continuously employed by NHS trusts during 1 January 2019 to 31 July 2020.Main outcome measuresTrends in the burden of sickness absence due to mental ill health from 2019 to 2020 according to demographic, regional and occupational characteristics.ResultsOver the study period, 164 202 new sickness absence episodes for mental ill health were recorded in 12.5% (119 525) of the study sample. There was a spike of sickness absence for mental ill health in March–April 2020 (899 730 days lost) compared with 519 807 days in March–April 2019; the surge was driven by an increase in new episodes of long-term absence and had diminished by May/June 2020. The increase was greatest in those aged >60 years (227%) and among employees of Asian and Black ethnic origin (109%–136%). Among doctors and dentists, the number of days absent declined by 12.7%. The biggest increase was in London (122%) and the smallest in the East Midlands (43.7%); the variation between regions reflected the rates of COVID-19 sickness absence during the same period.ConclusionAlthough the COVID-19 epidemic led to an increase in sickness absence attributed to mental ill health in NHS staff, this had substantially declined by May/June 2020, corresponding with the decrease in pressures at work as the first wave of the epidemic subsided.

Examining GP online consultation in a primary care setting in east midlands, UK

Background Increasing pressure threatens to overwhelm primary care services, affecting the quality of care and their role as gatekeepers to specialised care services. This study investigated healthcare users’ acceptability of – and the effectiveness of – an e-consultation system in primary care services. Methods Seven GP practices in East-Midlands, all of whom use online consultation system participated in the study, with a retrospective review being undertaken of 189 electronic patients’ records (age range of 18–76 years) over 5 months. The focus was on the electronic records of patients who accessed the service for five different conditions identified as presenting common conditions seen by the GPs practices. Statistical analysis was done using SPSS to perform an exploratory data analysis and descriptive statistics. Results The results showed a positive reception of the online consultation platform, with an average satisfaction score of 4.15 (most likely to recommend score = 5). Given the nature of the conditions, 47.6% of patients had experienced a previous episode of the health condition they were seeking consultation for, and a total of 72% had existing comorbidities. Follow-up activity occurred for 87.3% of patients, 66.1% of which included at least one follow-up visit for the same condition as the initial online consultation. Conclusion The results suggest that online consultation is convenient for patients, and it also has the potential to relieve pressure placed on primary care services. Although a number of challenges were identified, such as patient verification, this study gives insight into – and enhances our understanding of – the use of online GP consultations.

Exploring perceptions regarding family-based delirium management in the intensive care unit

Background Delirium is a common complication in patients treated in the intensive care unit (ICU). Family members can help alleviate patient anxiety and may be able to aid in the management of delirium. This study aimed to explore the perceptions of former ICU patients and their families together, regarding the involvement of family in delirium management. Method Nine audio-recorded, semi-structured interviews took place with former ICU patients together with a family member. Participants were interviewed after their intensive care follow-up clinic appointment in an East Midlands hospital in England. Interviews were transcribed, coded and analysed using thematic analysis. Results Three themes were identified: ‘understanding about delirium’; ‘influencers of delirium management: family and healthcare professionals’ and ‘family-based delirium care’. Participants expressed that family have a valuable role to play in the management of delirium in the ICU. However, education and guidance is needed to support the family in how delirium can be managed and the current treatment options available. It is important for ICU staff to gain an understanding of the patient’s life and personality to personalise delirium management to the needs of the patient and their family. Conclusion This study found that family presence and knowledge about the patient may be beneficial to delirium management in the ICU. Further research should investigate the effectiveness of the strategies and interventions to understand their influence on delirium management in ICU patients.

1159 Ring-Fenced Arthroplasty Unit: The Need of The Hour During Winter and A Pandemic Crisis

Aim Winter pressures along with the COVID-19 pandemic, have caused cancellation of elective services, prolonged waiting times, patient dissatisfaction and financial implications. Length of stay (LOS) following joint replacements is variable. The availability of ring-fenced beds and enhanced recovery protocol (ERP) can improve these outcomes. The performance of a stand-alone arthroplasty unit in an acute NHS Trust was assessed regarding safety, LOS and complications. Method Patient data was collected for total hip & knee replacements (TJAs) between the months of December to March of 2018-19 and 2019-20. Demographics, ASA, transfusion rates, LOS and 90-day reattendance was analysed. Modified ERP implemented in late 2019 included changes in analgesia and early post-operative mobilisation. The performance was then compared with DGHs within the region. Results In 2019-20, of 280 TJAs performed, there was a mean LOS of 43 hours. This shows a reduction compared with LOS of 69 hours in 2018-19, where 288 TJAs were performed. In 2019-20, 74% of cases had early discharge within 36 hours of surgery, versus 24% in 2018-19. This accumulates to 333 inpatient days saved. Note that following ERP modification, 6 patients were discharged on the day of surgery. Surgery related complications within 3 months which required reattendance, were seen in only 2 patients. This unit performed an average of 335 TJA’s in these winter months, the highest average in comparison to other DGHs in the East Midlands region, which had an overall average of 165 cases. Conclusions A ring-fenced arthroplasty service with adherence to ERP significantly decreases LOS and increases productivity.

01 The effects of a leaflet-based intervention, ‘hypos can strike twice’, on recurrent hypoglycaemic attendances by ambulance services: a non-randomised stepped wedge study

BackgroundHypoglycaemia is a common complication of diabetes therapy needing prompt recognition and treatment. It often results in ambulance attendance incurring health services costs and patient morbidity. Patient education is important for maintaining glycaemic control and preventing recurrent hypoglycaemia. We aimed to investigate the effect of an intervention in which ambulance staff were trained to provide advice supported by a booklet – ‘Hypos can strike twice’- issued following a hypoglycaemic event to prevent future attendances.MethodsWe used a non-randomised stepped wedge-controlled design. The intervention was introduced at different times (steps) in different areas (clusters) of operation of East Midlands Ambulance Service NHS Trust (EMAS). During the first step (T0) no clusters were exposed to the intervention and during the last step (T3) all clusters were exposed. The main outcome was the number of unsuccessful ambulance attendances (i.e. attendances followed by a repeat attendance). Data were analysed using a general linear mixed model (GLMM) and an interrupted-time series analysis (ITSA).ResultsThe study included 4825 patients (mean age= 65.42, SD=19.42; 2166 females) experiencing hypoglycaemic events attended by EMAS. GLMM indicated a reduction in the number of unsuccessful attendances in the final step of the intervention when compared to the first (OR: 0.50, 95%CI: 0.33-0.76, p=0.001). ITSA indicated a significant decrease in repeat ambulance attendances for hypoglycaemia – relative to the pre-intervention trend (p=0.008). The hypoglycaemia care bundle (i.e. blood glucose recorded before and after treatment for hypoglycaemia) was delivered in 66% of attendances during the intervention period, demonstrating a significant level of practice change (χ2=30.16, p<0.001).ConclusionsThe ‘Hypos can strike twice’ intervention had a positive effect on reducing numbers of repeat attendances for hypoglycaemia and in achieving the care bundle. The study supports the use of informative booklets by ambulance clinicians to prevent future attendances for recurrent hypoglycaemic events.

A qualitative study exploring experiences and challenges of combining clinical academic training with family life

Background Concerns are being expressed around the lack of diversity at higher levels of clinical academia. This study aimed to explore experiences and challenges associated with combining clinical academic careers with family life. Methods Qualitative data were gathered from participants from 4 NHS Trusts and 2 universities in the East Midlands of England using online surveys and semi-structured interviews. Results The survey was completed by 67 nurses, midwives and allied health professionals, and 73 medical clinical academic trainees. Interviews were conducted with 16 participants from each group including equal numbers of men and women. Caring responsibilities differed between the two study populations. Medical clinical academic trainees were younger and either had young children or were yet to start a family. In contrast, nurses, midwives and allied health professionals tended to be older when they embarked on a clinical academic career and often waited until their children were school-age or older. Similar concerns were raised regarding working part-time and childcare, and how their career prospects might be affected in terms of fulfilling promotion criteria and being able to relocate for work purposes. The occupation of their partners also featured in participants’ experiences; those who shared childcare with someone who worked ‘regular’ hours, appeared to be better supported to combine a clinical academic career with family life. Gender stereotyping was identified in some reported experiences highlighting a need for appropriate mentorship and for positive role models who were able to demonstrate that it is possible to survive and thrive as a clinical academic with family responsibilities. Conclusions Although people manage to find ways to successfully combine clinical academic roles with family life, findings highlight a need to identify ways of supporting and encouraging trainees with caring responsibilities to ensure that they remain on the clinical academic pathway.

Identification, surveillance and management of Aedes vexans in a flooded river valley in Nottinghamshire, United Kingdom

Aedes vexans is known to occur in large populations in riverine floodplains in much of Europe, where it can cause a significant biting nuisance and is often subject to large scale control strategies. Until recently it had only been reported in very small numbers in the United Kingdom. After receiving reports of nuisance biting near the river Idle, Nottinghamshire (East Midlands, England), mosquito surveillance was conducted over three years (2018-2020) using Mosquito Magnet adult traps. Ae. vexans was found in all years, in very high numbers, particularly in 2020, reaching a peak of almost 5,000 female mosquitoes per trap night, the highest reported density of trapped adult mosquitoes in the UK. Larval control was conducted in all years, and adult control in one year, however local peculiarities of flood and water management presents challenges and necessitates a multi-faceted approach. Strategies for further expansion of the control operation by developing strategies for water management, coupled with larval surveys to define the extent and seasonality of larval habitats, and application methods of Bacillus thuringiensis israelensis products are discussed.