Sunday, 13 August 2017

In my dream world there would be no if’s or butts!

Where do ideas for writing come from. I've read some really good blogs in the last few months from my friends in the #earlyrisersclub – often taking an idea or a thought and using these to explore their own sense of self and place in the world. My approach to both my blog writing and paper writing also tends to be a result of something I've read, or a conversation I've been part of (or overheard), or I have seen something that sets off a train of thought. I often don’t know what it is I'm going to write or how I want to try and say something until I put fingers to the keyboard. This week it was different. This week I had a dream.

In his most significant work, The Interpretation of Dreams, Freud described dreams as being ‘the Royal Road to the Unconscious’ - a way to unlock the information held there. Information in the unconscious is often disturbing, and it is held in check by the preconscious so that it cannot be passed into the conscious mind without being first of all altered. Although at originally Freud described dreams as being a form of ‘wish fulfilment’ in his later work he moved away from this position.

I am not sure how my dream would have been interpreted by Freud, but he was into the detail of peoples dreams and would often ask them to describe such detail in his analysis. It was one of the details that sparked the stream of consciousness that is this blog. My dream saw me attending a play (in New York) that started off in a ‘Smokey Joe’ type cafĂ©, and which as the play progressed was slowly transformed into a modern chic wine bar. As the audience applauded the end of the play, the whole wine bar rose into the air, and in a moment we were all flying across the New York skyline. 

In my dream I was delighted and poured another glass of red, reaching into my jacket pocket to pull out a cigar, which upon lighting up, brought a sense of contentment and happiness. At this point I awoke from the dream to find myself still in bed with an almost full moon shining in the night sky.  

I have no idea what the dream might have meant – (and vivid dreams are a possible side effect of the medication I am taking) – but it was the smoking of the cigar that held my attention. I once was a smoker, and smoked French cigarettes and French cigars, the latter much more habitually. One day I decided enough was enough and stopped smoking overnight. That was a long time ago now and whilst I no longer hanker after a cigarette, I do sometimes fancy having a cigar. But I have resisted the temptation now for some 12 years.

As regular readers of this blog know, I am very much opposed to smoking in any form. In the UK, over 100,000 people a year die from a preventable illness that is attributable to smoking. Yet there are still nearly 8 million people in the UK who continue to smoke. Men on average, smoke 12 cigarettes a day (compared to 11 for women) which shows a continuing and welcome decline in the rate of smoking. However there has been a corresponding rise in the number of people using e-cigarettes. Often it is smokers trying to give up. However, and perhaps more worryingly, is that information that people aged 16 -24 years of age are among those most likely to have taken up e-cigarette smoking, and 20% will progress to smoking tobacco. 

To put this into perspective, way back in 1974 almost 50% of all adults in the UK smoked, with one in two smokers dying from a smoking related disease. However, smoking is still the biggest cause of early preventable death. So maybe some readers might find it surprising to have included Freud in a blog that talks about not smoking. He regularly smoked at least 20 cigars a day – and said ‘that smoking was one of the greatest and cheapest enjoyments in life’ - we now know that is not true. For me I dream of a day when tobacco is no longer available because we recognise it kills. Now that would be an enjoyable thought! 

Sunday, 6 August 2017

It’s a dickens of a story: A Tale of Two Christies

One of the things I have on my to do list is to visit the Edinburgh Festival. Despite spending half my time in the North West of England and the other half in Scotland, I have yet to get to the festival. I was reminded of this last week as the festival started on Friday (4th August). Although it runs through until the 28th of August, for much of that time I am back in the North West of England - I have, however, been to the Glyndebourne Festival, and strangely there is a connection.

John Christie, was an English landowner and founder of the Glyndebourne festival which was held at his house in Sussex. If you not been and have the opportunity to go, I can recommend it – it’s a chance to dress up (evening wear is the dress code) and picnic in wonderful surroundings and listen to fabulous music and opera. John Christie fell in love with one Audrey Mildmay, a Canadian soprano. He was smitten. When Audrey went down with appendicitis and had her appendix out, he declared his was troubling him too and had his removed at the same time. Despite their age difference, she was some 8 years younger than he was, they eventually married. Together they set up a wonderful musical legacy that from its inception in 1934, still receives international acclaim.

In 1947, the very first Edinburgh Festival was held. The idea was conceived by one Rudolf Bing, who at the time was the manager of the Glyndebourne Opera Festival. With the help of both John Christie and in particular, his wife Audrey, and Harvey Wood, Head of the British Council in Scotland, the idea was brought to life. Ever since for 3 weeks in August the festival brings top class performers of music, theatre opera and dance from around the world to show their talent. The Fringe Festival has been going just as long and this allows aspiring performers to have a stage and create a new audience. Both national institutions Glyndebourne, and the Edinburgh Festival, are recognised the world over for the high quality performances they showcase.

Back in Manchester there is another national institution that also has an international reputation for excellence. This is The Christie, a hospital specialising in treating and researching cancer. The hospital was originally supported by a wealthy industrialist by the name of Joseph Whitworth (engineer, inventor and philanthropist). He died in 1887, and left large sums of (£500,000 equivalent to £60,000,000 today) to 3 trustees, one of whom was Richard Christie. Who as far as I can find out, was no relation to the John Christie above.

In 1892 some of this money was used to build a Cancer Pavilion and Home for Incurables. It was the only hospital outside of London that specialised in cancer treatment only. In 1901 it was renamed the Christie Hospital in honour of Richard Christie and his wife Mary who had done so much to establish the hospital. Richard Christie was an interesting person in his own right. A professor of history and then political economy, he used some £50000 (equivalent to £5,900,000 in today’s money) to build the beautiful Whitworth Hall (now part of the University of Manchester campus). He also left some 15,000 books, many of which were first editions, to what is now the John Ryland’s Library.

The Christie is the largest single site hospital in Europe for the treatment of cancer. It sees some 44,000 patients a year. The hospital employs 2500 members of staff, who are supported by over 300 volunteers. It is one of the largest hospital charities in the UK. Like Glyndebourne and Edinburgh festivals the work of Christie is excellent and world renowned. The hospital I have a connection with proudly entered into a partnership with The Christie and Macmillan to establish a chemotherapy and treatment centre at the Wrightinton, Wigan and Leigh NHS Trust. It opened its doors to patients in 2015. For the patients of Wigan needing chemotherapy, the centre means they avoid a 60 mile round trip to the Christie for their treatment, which in terms of improving patient care, is absolutely music to my ears!  

Sunday, 30 July 2017

Planting 'idea seeds' for improving mental health care

Once upon a time I would read every one of Roy Lilley’s blog postings. He is a very insightful commentator on health and social care in the UK. He is a very successful leader, educationalist and a great public speaker, and he is much in demand. I think over the past few months, as the Black Dog of depression began to be my companion I got out of the habit of regularly reading his work. I began to find the somewhat acerbic and negative narrative, often aimed at politicians and health service managers, wearying. However, I am sure my decision was influenced by where I found myself in the world, not really a consequence of Roy’s writing, which is much admired by many.

One of whom is Warren Heppolette. He is the Executive Lead for Strategy and System Development at the Greater Manchester Health and Social Care Partnership (GMHSC). It is the GMHSC Partnership, made up of NHS Organisations and Councils, that is leading the £6 billion devolution of health and social care budgets in making a difference to health and wellbeing in the city and region. They are doing a great job and are moving at a pace – and are starting to provide some excellent examples of what integrated care and population health could look like.

So when someone like Warren tweets that he thought one of Roy’s blogs last week was one of the best he’s read, I was compelled to have a look, and I am glad I did! The blog dealt with a mental health service in Grimsby. It was something Roy had experienced through visiting a garden centre run by the mental health service. Without wishing to sound disrespectful, I don’t think I would ever have associated Grimsby with innovation, but what Roy described was the hugely innovative and creative work of a social enterprise called NAViGO:

They own apartments, create communities, and piece by piece, carefully reassemble the components of shattered lives and glue them together with skills, care, attention and tuff-love… …the acute team is the community team, is the crisis team. I couldn’t tell who was health and who was social care, who were staff, clients, partners and people working towards recovery… …services entwined with people’s lives, families, hopes and futures. And it works.’

Like Warren, I was also impressed with the description of how this service has developed. Many years ago, we had some folks from the precursor to the NAViGO service visit the University and it was possible even then to see what an exciting journey the service providers, carers and service users were on. That Warren recognised the importance of this work was also good to see, particularly as on Friday he published the GMHSC plans for the Transformation of Mental Health Service: Next Steps.

This document sets out the plans to make a £134 million pound investment in not only meeting the national mental health care targets, but in so doing, also look at new and innovative ways of improving the mental wellbeing and resilience of the GM communities. There are plans to ensure that physical and mental health programmes and approaches are to be more closely integrated – and with Olympic Gold Medalist Chris Boardman being appointed as the GM Cycling and Walking tsar (Commissioner), I have great hopes that we can do something differently.

Effective 24 hour access to help and support for children, young people and adults requiring immediate care and treatment are planned, as are improvements to the early intervention service provision. All of which will ensure that every £1 spent in prevention and early intervention will save £15 in the provision of ongoing health service costs for people experiencing mental health problems. Likewise, improvements to mental health care in the criminal justice system, particularly for those in prisons are outlined. 

It is a great document, full of hope and determination. Although the report doesn’t specifically mention gardens, or horticultural therapy, care farms or anything remotely similar I am confident that my colleagues at the University will ensure these approaches are included in taking forward the GM mental health transformational plans for the future. So thank you Roy, thank you Warren for show-casing what (if we want it), could be a bright new future for mental health care in the UK.   

Sunday, 23 July 2017

Missing in Action; and Missing the Action

Last week there were a number of places I should have been at, people I should have seen, conversations I should have had, and hands I should have held. It wasn’t a good week for me, and possibly, for others too. It was a week of poignancy and pain as well as some goodness. Last week was graduation week at the University of Salford. As long standing readers of this blog will know, when I was Head of School and then latterly a Dean, Graduation Day was both my nemesis and one of my greatest pleasures each year. It was always great to celebrate the success of our students, meet their family’s and wish them well on the next stage of their life journey.

This was me some 39 years ago (ringed in yellow) ‘graduating’ as a qualified nurse in Swansea. I was so proud to have survived the course, which unlike today, was not a graduate level programme. The ceremony back then was a very different affair from the graduation ceremonies that I have been part of over the last 11 years. I love being on the stage and the little boy in me likes dressing up. The pomp and tradition, the seriousness and celebration were tangible acknowledgements of the achievement every person gaining their degree has made. What I dreaded about the day was trying to pronounce the names of some of our students. I just found it so difficult to get my tongue around some of the pronunciations, despite hours of practice.

However, despite my tendency to mangle some people’s names, it always felt like a real honour to present the names of the students as they each received their award. My current role in the University has taken me away from this, and it is something I have really missed. Last year I had a kind of ‘walk on part’. As a member of the University Council I was asked to talk about the work of the Council and the Councils contribution to the future development of the University. It wasn’t quite the same. And this year I didn’t get to be part of any of the ceremonies at all.

Being part of celebration of the students success was a wonderful experience to share. But I guess inevitably, it was those students who I had the closest and most sustained relationship with that made my heart beat with pride for them at graduation. Most often these were my PhD students. This year 2 students, Duaa and Seham, both from Saudi Arabia, completed and were able to graduate. They had their struggles over their time with the University, but both eventually did very well. Seham, whose work looked at the stigmatising views and attitudes of mental health professionals held against the very people they should be caring for, was both courageous and powerful. She has already gained an influential position back in Saudi, and I am very confident that she will make a difference to their future mental health care services.

Due to poor timing, another of my students Ibrahim, also from Saudi, had his PhD viva last week, and got through with just minor corrections to attend to. I missed the viva and being there with him, a role carried out so well by my co-supervisor Celia. Ibrahim's work looked at the impact of total quality management approaches to the improvement of health services in Saudi. Again it was a very interesting piece of work that revealed the difficulties that many health service systems have in both measuring and improving the quality of care provided.

In the UK it is the Care Quality Commission (CQC) who are charged with both measuring the quality of care provided and recognising where services are outstanding or simply unacceptable. To me, the CQC have an almost impossible task, and arguably whilst some poor practices are picked up and addressed, the approach remains imprecise and challenged by the human element of the assessors. They are not my favourite group of people, and I say that from the qualified position of being on both sides of the quality assurance table.

I was reminded of this last week as my brother-in-law David became a patient at a local hospital – North Manchester General Hospital. In 2016, the CQC judged this hospital overall to be ‘inadequate’. This was a damming judgement of the services provided, see here for the full report. The reports ‘inadequate’ outcome prompted a neighbouring and ‘outstanding’ NHS Trust to take responsibility for bringing about improvement. The work is ongoing. One of the things I think the CQC often gets wrong, is that they miss the individual experience of patients. David’s care was exemplary. It was provided by knowledgeable health care professionals, who demonstrated their care in the most compassionate of ways. Yes there were issues (noise at night; ward transfers and so on) but overall he was treated as I would want to be treated. 

Sadly, after just a week of receiving treatment, David died in the early hours of Friday morning. I wasn’t there, but his wife and son were. They were treated with respect and dignity and when W got there shortly after his death, the nurses made the time to support and comfort the family. David was a larger than life man – in all senses of the word. He looked after his 2 sisters (Glenda and W) all his life, and his son and 2 grandchildren were the apple of his eye. The love of his life was his wife Jenny, someone he would have done anything for. David will be very much missed, and although his sudden and unexpected death is a great shock, I am glad at the end of his life he didn’t suffer, and proud that that the care he received from the NHS was absolutely outstanding. 

Sunday, 16 July 2017

Depression and Duvet Days

Last week I finally managed to meet up with friend and long term collaborator Sue. We has been trying (somewhat unsuccessfully) to meet for the best part of 6 weeks, and it was so good to finally find a space to spend some quality time together. We have been writing and publishing for some 17 years, and we have relished getting our thoughts and ideas out there, editing books, writing papers, and of course presenting at conferences. It’s been great fun and I think together we have made a difference – I also like to think that we have also helped many others start their academic journey.

For some people, presenting their research, or their thoughts to a conference audience is a somewhat daunting experience. This is particularly the case for early career academics and practitioners, many of who, often feeling that nobody will be interested in hearing what it is they do in their day job. As Roy Lilly has so successfully demonstrated, so often what might be felt as being ordinary in the provision of health care can, and very often is, quite extraordinary. Whilst getting your words in print can be very satisfying, these days with more opportunities to put your thoughts out there and sometimes to a larger readership, my publication rate has slowed right down. However, I have always enjoyed the conference presentations, and Sue and I have presented over 90 conference papers between us over the last 17 years.

We both share a love of surreal images, and often our presentations contain very little words, just thought provoking images we use as cues to the paper being presented. It’s been our experience that people appear to become more engaged in what is being said, and tend to remember more of the paper than when the ubiquitous PowerPoint is used. I have never been nervous or anxious about presenting and very much enjoy being on the stage whatever the number of people in the audience, or the venue.

So I have been very surprised to have recently started to experience anxiety or panic attacks on fairly regular basis. It took me a while to recognise what these were and what was happening. I had described the feeling as being faced with utter desolation to my doctor, a feeling that happened mostly in the morning. I would wake up and everything would feel fine, I might even send out a few tweets, particularly to the #earlyrisersclub but then very soon I would be consumed a combination of physical sensations: hot flushes, sweating, pounding heart, pins and needles and psychological sensations: racing thoughts and thinking about the same situation over and over again, a sense of dread, feeling restless, and tense. In the UK 1 in 10 people will experience a panic attack, and  5% of the UK population experience anxiety attacks, and it affects twice as many women as men.

My response to these feelings and sensations was to pull the duvet over my head in an attempt to block everything out. Which of course didn’t work at all. Usually after about 10 minutes these sensations would begin to ease leaving me feeling very down and uneasy for a couple of hours. Eventually my mood would lift somewhat. It was only when I wrote the feelings and sensations down after one of these episodes that I realised it was an anxiety attack I was experiencing. There are a number of powerful stresses in my life currently, resulting as some readers might know, in a current state of depression.   

Thankfully, just as when I confirmed that diagnosis with my GP and could start to receive treatment, realising I was experiencing anxiety attacks has allowed me to start to deal with them, and begin to address the stress that lies at the root cause of the anxiety. Not bad for a Professor of mental health care. And I think there must be a paper to be written here and a conference to find where it could be presented!

Sunday, 9 July 2017

For some it will never be the ‘Darling Buds of May’

In 1892 the High Rid Reservoir was constructed as part of the need to supply water to the cotton industry and the local population. It lies just some 3 miles outside of Bolton, which in 1838 was the second town to be incorporated under the Municipal Corporations Act, and did so 12 days before Manchester, that other somewhat famous North West place did… ...just saying. High Rid is some 7500 steps (5.3Km) from my Bolton House front door and back, and it is one of my favourite walks. Last week on my walks I saw new generations of ducklings in abundance, the Sun had Her hat on most mornings, and as Cello and I walked, we were accompanied by dancing damsel flies weaving their intricate patterns along our pathway.

Walks around High Rid last week were also punctuated by the shrieks, screams, shouts and laughter of children having fun on the water. The owners of High Rid, United Utilities, allow Bolton Council to run a range of activities for children and young people – including canoeing, kayaking, raft building, sailing, in fact all water sports other than swimming. It was great to see the children having fun, doing something physical, outside and being in the company of other children, all of which is good for the physical development and emotional well-being. One of my neighbour’s sons attended such a session last week and he was so excited to have the opportunity, and he loved it.

However, there were a number of stories last week which didn’t paint such a rosy picture. The one that stayed upper most in my mind was a series of reports from the Children’s Commissionerfor England. The reports draw on data and information held by a range of government departments, agencies and third sector organisations. The reports make for a very hard read and present some very shocking statistics about the number of children in England living in vulnerable situations. The reports contain a huge amount of granular detail, too much for this blog. However, some of this information I found staggering, and I regularly read up on the research in these areas.

What I was aware of was that children and young people make up nearly 25% of the population. 40% of all primary care activity relates to this group. Nearly 3 million children aged between 0-17 are in contact with tier 1–3 child and adolescent mental health services each year. Such services include GP (primary care), services in schools and some specialised services. Of these 15% have a long term condition, 6% have a disability, and that 50% of all mental health problems in adulthood start by the age of 14. 50,000 children experience child abuse each year. Over 500,000 children are so vulnerable that the State has to step in with nearly a 1000 children being cared for within the criminal justice system and in secure accommodation of some sort. Some 60,000 children go missing each year and nearly 50,000 children aged 10-17 are involved in gang related activity. And there are 700,000 young people who are carers. All of which is what has been reported. The real statistics might be much higher of course as much of this activity happens ‘under the radar’.

What I didn’t know was nearly a third of children aged up to 5 years of age have significant tooth decay problems, or that there were some 46.000 emergency admissions for children with lower respiratory tract infections,  or that  some 130,000 young people between  ages of 15–24  were tested positive for Chlamydia  - and generally for children 15 and above, they seemed to be in a high risk group, with some 20% of those engaging with risky behaviours including smoking, drinking, poor diet and poor physical activity. There were over a 100,000 hospital admission due to unintentional and deliberate injuries in children aged 0–14, nearly 50% of which were aged 0–4. In addition there were some 50,000 admissions following self-harm in children and young people aged 10-24. Nearly 12,000 children had parents receiving drug treatment, and 15,400, children where parents were receiving treatment for alcohol abuse.   

The disturbing statistics go on and on – sadly. As a Father of 5 children, and now 10 grandchildren I felt humbled and ashamed in reading these reports. More so as I come from a generation that openly declared we would not bring our children up as our parents did. I love my parents, but in many ways I think I am very different to them. But they loved, cared for me and they did so unconditionally throughout my childhood, and continue to do so now albeit some 60 years later. And if asked, I hope my children will say the same about me.

Sunday, 2 July 2017

A stroll down a Welsh memory lane

In June 1984 I left Wales to start a new life in the North West of England, Manchester to be precise. I have been here ever since. I had trained as a nurse in Swansea, but lived in a little village called Pumpsaint, some 40 miles away. In those days the hour long journey was through the Welsh hills and valleys almost until you got to Swansea. Most of the time this was a journey that helped prepare me for the day, or provided time and space at the end of the day when coming home.

I had a little small holding in Pumpsaint, keeping a herd of milking goats, a small flock of Jacob sheep, chickens, ducks, geese, and even peafowl. I grew all the family vegetables, made goats cheese, brewed beer and wine and baked homemade bread. I fattened turkeys to sell at Christmas, and worked in the forest cutting down Christmas trees to sell. Four of my 5 children were born there, learning Welsh in a small village School. For a short period after gaining my qualification as a nurse and starting to practice I worked in a local agricultural blacksmiths, a place where the work included shoeing horses to repairing huge bulldozer blades and everything in between.

I eventually went back to work as a nurse in the local hospital, Allt-Y-Mynydd. This was a small hospital for people with learning disabilities, and it was a great time to be working in this area. At a policy level, the all Wales community care initiative was being enacted and this was aimed at moving all of the people receiving care for learning disabilities into assisted independent, community based care environments.

Allt-Y-Mynydd hospital was an old sanatorium, perched on top of a hill in the midst of the Brechfa forest. The hospital was just outside a village called Llanbydder, famous for its horse fairs, and where once there was a connection to the Manchester and Milford Railway! I joined as a staff nurse, but quickly gained promotion as Charge Nurse, an achievement marked by my not having the Learning Disability qualification, and only being on the register as Mental Health Nurse. However, I had an absolute conviction that we could carry out the policy and make a difference to the lives of the residents. 

Allt-Y-Mnynydd Hopsital is still there, now a tastefully modernised care home, and almost unrecognisable in terms of the facilities and the care provided. During my time in the hospital we very successfully prepared, moved and supported most of the residents out in to local community based homes. I was reminded of these memories as last week was Learning Disability week, 2017. There are some 1.4 million people with a learning disability in the UK, nearly 200,000 of whom, are children of school age.

Whilst it was great to hear so many very positive stories about learning disability services and in particular social care services, last week also saw the publication of a report on research undertaken by researchers at the University of Lancaster. It has a snappy title ‘A Trade in People: The inpatient healthcare economy for people with learning disabilities and/or Autism Spectrum Disorder’, but the findings were rather grim. It found that many people with learning disabilities had become commodities in a health care industry driven by profits. It seems the UK government spent some £477m last year on keeping just 2500 people in hospital with more than 50% of these beds being provided by the private sector. It is a trend that is growing. 

The consequence of this approach is that often individuals can be placed in geographical locations many miles away from their family home with families facing long and expensive journeys in order to maintain contact with their son or daughter. Sadly, those detained in private care services are also more likely to experience an assault and be restrained compared to those receiving care in a NHS unit. The report also found that that the cost of a care package (similar to those we put in place all those years ago in Wales) to move people back into their community could be prohibitively expensive for local authorities to contemplate – thus perpetuating the problem. It is such a sad indictment that some 33 years after my time in Wales we are still treating people in this way. 

Sunday, 25 June 2017

A pervasive persuasion: the need to protect our children in a digital age

Last Sunday was Father’s Day here in the UK. It is day used to celebrate Fathers that has its origins in the Middle Ages, when it was then celebrated in March. About 100 years ago many countries, including the UK adopted the current June date, made popular in the US.  For the first time in many years I celebrated the day with just W and myself at the House in Scotland. However, the children had sent gifts and cards, one of which was a rather splendid cockerel. Carved out of wood, with bicycle cogs for tail feathers and comb and bicycle chains for wings. These were all parts from my son-in-law Stewart’s bike, a bike that had travelled some 2500 miles in the last 12 months. The cockerel is a thing of beauty, and Stewart was the surprising artist!

Of course these days geographical distance is not a problem for staying in touch with others, and on Father’s Day I was able to Skype, Facetime and speak over the phone with family. I could also do all of this on my new phone, an iPhone, the first one I had ever owned. It was a great to discover that I could replicate everything I had been doing on my iPad on this phone. So I got it set up with emails, Twitter, Skype and so on and all was well. That is until one of my friends persuaded me to down load WhatsApp – an encrypted messaging service. I had never used it before and didn’t know that I would use it – but I was persuaded to get the app.

What I also discovered was that apart from using the phone as set up in the shop everything else, including downloading apps required an Apple ID and Password. Whilst I had one of these from years ago when I invested a great deal of time uploading my entire CD collection onto iTunes, I hadn’t used it for years. And as soon as I did I realised why. Suddenly I was up in the cloud, with demands for access codes to all my devices and generally getting twisted into knots of security and instructions and all for something I didn’t really want in the first place. Eventually it was installed and I sent out a WhatsApp message to my WhatsApp contacts – but I’ve heard nothing since.

I think I must be missing something as whilst Facebook (WhatsApp’s parent company) remains the most widely used social media service, WhatsApp is said to be becoming one of the most popular ways people both discover and discuss news. I’m from that generation that still goes to the BBC for my news, albeit more often than not, to BBC on-line. It’s amazing to note that it was only 50 years ago, in the June of 1967, that the Beatles performed ‘All you need is Love’ live on the BBC’s first live global broadcast! Many young people today shun the BBC (as being untrustworthy and biased in their reporting), preferring to use other services like WhatsApp to hear the news.

It’s perhaps easy to understand why. WhatsApp uses an end-to-end encryption approach which means messages can only be seen by the senders and recipients – crucial in countries where the political regimes monitor social media and where critical voices are often dealt with harshly. Social media increasingly gives those without a voice an opportunity to be heard, to articulate a point of view in ways unthinkable just a few years ago. We only have to look at the way the Labour Party very successfully harnessed social media in the recent general election to see how large numbers of the population can be reached, and given an opportunity to have their voice heard.

There are risks of course. In the UK, freedom of expression and the protection of our privacy over the internet is guaranteed by law. Some social media users abuse these rights and ‘troll’ others (sending menacing and or upsetting messages) and sometimes to such an extent that it can cause mental health problems and in some extreme cases, people ending their life through suicide. Children and young people are particularly vulnerable. The NSPCC reported that one in five 8 to 11 year olds and seven in ten 12 to 15 year olds has a social media profile. 1 in 4 children have reported experiencing something upsetting on a social networking site, and 1 in 3 children have been a victim of cyberbullying.

There were some 5653 child sex crimes committed against children in 2016/17 that had an on-line element. 13 was the most common age of the targeted children, and nearly 100 offences were committed against children 10 years and under. The Internet Watch Foundation, established in 1996, and now an independent international organisation which receives, assesses, and traces public complaints about on-line child sexual abuse content found over 57000 web sites containing child sexual abuse images. They access a webpage every 5 minutes, every 9 mins that webpage shows a child being sexually abused. In 1996, the UK hosted 18% of the world’s known online child sexual abuse material. Thanks to their work, and the commitment of major internet service providers, today the UK hosts just 0.2%. 

So I worry about encrypted services such as WhatsApp. It has some 1 billion users worldwide, and WhatsApp does have an image sharing facility. It is to be remembered that the Westminster bridge terror attacker, Khalid Masood, sent a WhatsApp message minutes before he attacked, an encrypted message that to this day cannot be accessed by the police and intelligence services. I’ve removed the WhatsApp application from my phone, a slightly puny protest I know, but I am from the generation that still goes to the BBC to learn about what’s happening and what’s up, not WhatsApp. 

Sunday, 18 June 2017

A quiet contemplation of the importance of hopes and dreams

Two of my favourite drinks couldn’t be more different. Lagavulin is a fine malt whisky from the Islay region of Scotland. It has an intense peaty smokey rich taste that is mellow and powerful on the nose and tongue. I’ve yet to taste the 37 year old, but the 16 year old and double matured malts are very, very good. My other favourite drink is the ‘widow champagne’, Veuve Clicquot, a champagne that dances on the tongue. Barbe-Nicole Clicquot Ponsardin, to give her full name, became a widow at the age of just 27. She took over her husband’s winemaking business and turned the ‘widow champagne’ into one of the worlds most successful ‘maisons de champagne’.

These are not drinks to be hurried in their drinking. If you want a flirty, quick fun drink, then maybe stick to pouring a glass or 2 of blended whisky or prosecco. Lagavulin and Veuve Clicquot need time, the right place and the right frame of mind to appreciate their flavours and the feelings that are evoked as each is sipped. They are drinks to contemplate with. They are drinks that can be shared with others in silence. No words needed, the quiet is welcomed, and it’s where dreams and thoughts can be shared in togetherness.

Difficult to do in our busy lives – which I guess is why we have blended whisky and prosecco. As regular readers of this blog will know, my life recently has not been quite as busy as it once was. I have lots more time in my waking day at present. Indeed, last week at my therapy session I was offered and accepted an acupuncture session. Laying on the couch, I’m sure that as every needle was inserted my mind and body slowed down a little further. When I was finally left alone, I felt so relaxed and at peace, and it was a feeling difficult to describe in words. It was a different type of contemplation time.

This experience was in absolute and total contrast to my feelings on waking up on Thursday morning to the news of the Grenfell fire in London. Again my feelings were also difficult to put into words. The absolute devastating impact of the fire on all those involved was and remains almost too much to comprehend. The loss of life, the injuries, all those who have now lost their homes, histories, and way of life, and their dreams of a future. Each of their personal and shared experiences I find so hard to understand and can’t even begin to know what such a loss must feel like. I watched with shame and hurt the accusations and recriminations so loudly being made, but I think I understood those who expressed their anger, hopelessness and frustration at what had happened. 

I watched with pride the magnificent response being made by communities around the tower block, and I am sure the authorities will do all that they can to find people new homes and provide financial support. Clearly many people, victims, professionals, and the communities they come from will need help in coming to terms with what has happened. And last week, as I sat on my mindfulness beach, I felt both impotent and sad that there was so little I could do to help those impacted by this tragedy. 

I have reached out in my thoughts and prayers, and instead of buying more Veuve Clicquot this week, I have sent the money to the Grenfell Fire relief fund – but this didn’t feel like much of a response to me. It felt very inadequate compared to the massive support I have received from friends and family over my recent mental health problems. Maybe there isn’t more I can do right now. I can keep those affected in my thoughts and prayers, and hope that in the future they will find the strength and have the opportunities to rebuild their dreams and lives. 

Sunday, 11 June 2017

Authenticity, passion and a ‘thing about chickens’

My fellow blogger Lynn reminded us in one of her recent tweets of Erving Goffman’s dramaturgical sociology and the way we choose to present our self – that is a sense of who one might be, often shaped by the time, place, and audience. In Goffman’s world, where the actor succeeds, the audience will view the actor as they might want to be viewed. Usually, such performances are carefully constructed, practiced and used with self-confidence. It is an approach, that in my professional life, I am very familiar and comfortable with.

I was reminded of this last week when a young man called Daniel, bounded up to me and smiling broadly said ‘Professor, good to see you’. He said I probably wouldn’t remember him, but he was one of my former students and that he had graduated in 2013 and was now working as a Charge Nurse in a local emergency care service. Now over the 10 years I was Dean of the School at the University, some 7000 nursing students passed through the School. Remembering individuals tended to happen only where someone had done something outstanding, or the reverse, they did something unprofessional that brought them to my attention.

However, Daniel had a very clear memory of me during his time at the University. He recalled that I always wore black, nobody had ever seen me in anything else, I had clogs of different colours which created urban myths amongst the students as to whether specific colours related to my mood or had some other significance, and that I had a ‘thing about chickens’. However the memory that struck a chord with me was his recollection of his very first day at University. On that first day I would always meet all the students to welcome them to the University and to their taking the first steps on their chosen professional journey.

Essentially I was performing on my stage. I talked about the possibilities and opportunities that lay in front of them; I talked about a number of people who had shaped my view of the world (Carl Rogers, unconditional positive regard for others; Virginia Henderson, understanding the nature of intrapersonal and interpersonal relationships – self, and self in relation to others; and Michel Foucault, the importance of both revealing and understanding the silenced voice). I had delivered various versions of this welcome speech many times, but for Daniel it was the first time. He told me how his memory was one shaped by feeling inspired, motivated, and reassured that he had made the right decision in coming to the School. He told me that his group thought I was authentic and passionate about enabling others to create a future for themselves. After 7 years of study and practice it was warming that he still retained such a positive memory of his first day at the University.

I met Daniel at a husting event leading up to the recent the general election. I had been supporting my friend and colleague Jane who was standing for the first time as a parliamentary candidate for the Conservatives. In the main my support and help involved undertaking policy analysis, trying to make what was a dreadful election manifesto more accessible, palatable and applicable to members of her community, developing daily messages and so on. All this work was undertaken in the context of Jane’s strong belief in being authentic and true to herself, even where this might give rise to challenges and tensions between her beliefs and what was set out in the Conservative manifesto – the official line! Although difficult at times to negotiate these tensions, it was relatively easy for me, from a distance to provide advice, possible comments and responses. 

The husting event was clearly different, and my friend would be very much on the stage. It was a bruising and hostile audience, largely made up of vocal and challenging Labour supporters. My friend did well in the face of much hostility. As a a performance it wasn’t one that was carefully constructed, practiced and used with self-confidence, but it was truly authentic and every response delivered with passion, and for me that what was important. Unfortunately, Jane did not get elected as the MP, but then the area hadn’t elected a Conservative MP for some 62 years – and against the national picture, she did double the votes, gaining nearly 30% of the vote and came a very respectful second. Staying true to one's self was and is important. Despite the disappointment I hope that with time, like Daniel, she holds some good memories of the opportunity she created. It was one she can be proud of and build authentically on, for the future.  

Sunday, 4 June 2017

Time for Bed, Zebedee said: asleep on the Magic Roundabout

Now my new car is full of digital marvels. It parks itself, it maintains a safe distance from cars around it, displays incoming emails, texts and even telephone message. Everything is voice activated and at night it lights up like a space ship. One of the things it does is to warn you when you stray over the white line in the middle of the road. The steering wheel tugs you back into lane, a series of warning beeps are sounded and it is both irritating and reassuring. If you happen to wander over the white line more than half a dozen times in quick succession – something difficult to avoid on the narrow country lanes up here in Scotland, the car tells me to pull over and take some rest!

Being told to take a nap by a car is one thing, when your body tells you it needs to sleep that is a different thing altogether. Some 15 days into my antidepressant therapy course, most of the early side effects (dizziness, nausea and so on) have faded. The one side effect that has remained has been an almost overwhelming need to lay down and sleep. I have never slept so much in any one day as I have over the past 15 days. It is strange, as I don’t feel constantly tired, but still find myself closing my eyes and drifting off. I am becoming like Cello, who can doze all day if not out running on the beach or in the woods.

Although my excess sleeping is a side effect of the medication, deep sleep therapy was once a very popular treatment for mental health problems, particularly during the 1930s and 1940s and then again during the 1950s and 1960s when in the UK it was used alongside ECT and medication. At that time ECT was a rather crude intervention and often terrified those being given it.  Using sleep therapy ECT could be administered and the patients seldom remembered this. Thankfully the practice largely fell into disuse as other more effective treatments were developed.

Imposed sleep is not without its risks. My PhD supervisor, the late and great Professor Joel Richman developed sepsis resulting in a 5 month stay in hospital, 7 weeks of which were spent in an induced coma in ICU. When he eventually ‘awoke’ he was for some time extremely paranoid, delusional, depressed and angry, often lashing out at those he loved and cherished. Being the great medial sociologist he was, Joel wrote up his experiences in a wonderful paper called Coming out of ICU Crazy: Dreams of Affliction – worth a read if you can gain access to it.

Anyway, and in a lighter vein, in-between naps, I did look at what was being said about sleep last week. It seems that many people are ‘under-sleeping’ by 60 mins every night, which is the equivalent of whole night’s sleep over a week (the average healthy sleep period is 7.7 hours a night). The Royal Society for Public Health found that people believed getting enough sleep was the 2nd most important activity for keeping themselves healthy – something that was behind not smoking, but in front of getting their 5-a-day, exercise and not drinking too much alcohol. They noted that a lack of sleep has resulted in 30% of people becoming depressed or stressed. The cause of not getting enough sleep can be complex and will often reflect life choices such as long commutes, parenting and socialising (late nights out). 

Somewhat ironically I guess, good sleep can be the result of people engaging in other healthy behaviours – those who eat healthily and get plenty of physical exercise often sleep better – and getting better sleep will often mean people are more likely to stick to those healthy behaviours. I’m sure my excess sleeping will begin to fade just as the other side effects have done – but as my friend and fellow blogger June told me last week, ‘keep taking the tablets’, which I fully intend to do. And finally if Cello could speak, I am sure he would say, ‘sleeping doesn’t make your dreams come true, waking up does’. So now this weeks blog has been posted, he and I are off out to explore the early morning sights and sounds of our beach. 

Sunday, 28 May 2017

Sometimes it’s OK not to feel OK: and the pain may be real, but so is the hope

Like many people, my thoughts have been with all those affected by last Mondays arena attack. And there were many people. Those who lost friends; families who lost children, wives and husbands, and the many victims who were injured, some critically. I thought about the first responders and all the emergency services, who did a magnificent job right from the start as well rehearsed plans were put into action. I thought about the many ordinary people, men and women who unasked, offered their help on the evening and in the following days. Like me, I suspect that many of these people will need to find ways to deal with the senselessness and horror of what they saw or had to deal with, and I suspect that won’t always be easy.

Shortly after 22.30 last Monday, a lone, cowardly, callous killer, denoted a bomb, killing 22 people and injuring many others as they were leaving a concert at the Manchester Arena. It was a devastating attack that seemed deliberately aimed at an event where most of the audience were children and young people. Why the killer chose to attack so many innocent people is not known. The ongoing police investigation appears to suggest an active terrorist network was involved, and many arrests have been made.

In the days that followed, there were many more people who wanted, or perhaps needed to show and share their hurt, anger and their pain. Yet there were also those who wanted to stand tall, stand together in defiance, and solidarity. Vigils have been held across many parts of Greater Manchester and in othe parts of the UK. Very quickly, St Anne's Square, a short distance from the Manchester Arena, became the focal point for people to come and pay their respects, to leave flowers and messages, pray, to just be there in an acknowledgement of grief, and to share the humanity of others suffering.

Resilience was a word I heard mentioned a great deal last week. I was pleased that emotional and psychological support was offered, and not just to those families and communities directly affected by the attack, but also to the many professionals who were involved in providing care in the immediate hours following the attack. They may be professionals who demonstrated their knowledge and skills so expertly when called upon to do so, but they are also humans as well. Like the rest of us, they are parents, brother, sisters, and partners.  It would be impossible to think that in the safety and quietness of their own homes many people didn’t reflect on what they had seen, heard, or even what they knew might be yet to come for so many other people. 

I was so pleased to see the words ‘it’s OK not to feel OK’ used to good effect in offering mental health care and support. Likewise there was great advice over how we could reassure and discuss the attack with our children, to help allay their fears and anxieties. And reassuringly there was much evidence of how people across all of Manchester and beyond wanted to show how diverse communities can come together in adversity and build upon strong community relationships to create a better future for all.  Last week was one of devastation and pain for so many people. Many people across the Manchester communities and beyond will have been deeply affected by what happened. However, whilst the pain is real, so is the hope. #WeStandTogetherManchester  

Sunday, 21 May 2017

The Postman Rang Twice on Talcott Parsons Door

Many readers of this blog might not remember the famous film noir – The Postman Always Rings Twice. Released in 1946, it was based upon the 1934 novel of the same name written by James Cain. The film has a classic plot line - boy (Frank) meets girl (Cora), girl is already married, so they kill her husband. Although they go to court, neither are convicted of the murder due to some double crossing deal making and lack of evidence. Shortly after Cora is accidently killed in a car crash, and Frank who was driving the car, is wrongly convicted of her murder and given the death sentence. It’s a great film and if you haven’t seen it, look out the original not the 1981 remake version.

The ‘postman’ in the film’s title is a metaphor (although not a very good one). It gets explained at the end of the film by Frank who posits that when we are expecting to receive a letter or a parcel, it is of no concern if at first you don’t hear the postman ring the doorbell as the postman will always ring twice. The second ring will invariably be heard. In the story, Frank and Cora escaped punishment for the murder of her husband but with Cora dead from the RTA and Frank facing the death penalty, the postman has indeed rung a second time for them both.  

Now I guess, dear reader you might be wondering where this is going. Let me try and explain. Last Sunday I shared the struggles I was having with depression, a struggle that had slowly crept up on me. I usually let the world know I have posted my blog, and last week I didn’t, instead I just quietly posted it on-line. I was overwhelmed by the number of people, friends, and colleagues and even from those I don’t know, who took the time to send messages of support and kind wishes. I was buoyed up. I enjoyed a day of family fun with a house full of children and grandchildren celebrating my birthday.

Although I knew that acknowledging my mental health struggles was just the first step, and it felt like an important step, actually I hadn’t heard the postman ring for the first time. Last Monday was my birthday and arriving at work, I realised that the family celebrations the day before hadn’t changed anything. For the first couple of hours I sat in my office feeling absolutely desolate and effectively doing nothing. In the silence, my twitter notification pinged and it was my friend June asking how I was doing. Out poured a long rambling response from me that probably sounded very incoherent.

However, she came back with warm and wise words for me to consider. Speak with my GP, find some time and space to recalibrate, sleep, rest, and gently exercise, go up to Scotland. Just lose work. All of which was sound advice and all of which seemed pretty impossible to do. I was trapped in a classic case of Parsonion role conflict – professional role versus sick role. As people started to arrive, I went back into professional role, and the day turned into a series of meetings, present giving and good wishes being exchanged. I got through the day, but it was hard - and the emotional drain took the edge of my evenings birthday celebration with W.

The following day had a similar start to it and by the time I had got to lunchtime I knew the road to recovery was going to be difficult if I didn’t change anything. The postman had rung twice. It was time to step off the Merry-go-round. And so I reported sick on Wednesday and agreed with my GP some time off work, and started a course of anti-depressants. Of course the classical Parsonion sick role has evolved these days. Elements of the concept around entitlements and obligations remain, but the rise in the numbers of people living with long term conditions (currently 15 million people and rising in England) has challenged our understanding of the sick role. 

In mental health care, the concept of recovery, also flips the relationship from the doctor being the expert to the patient being the expert and co-creator of what interventions might be the most helpful to ensure a return to a place of well-being.  This is an approach that has given me a pathway to follow. And please don’t worry dear reader, whilst I love writing my blog, and have written one every Sunday since 2nd August 2009, I do not intend for it to become a ‘diary of the depressed professor’ – so I shall continue to try and write a new blog each Sunday, and all I ask of you the reader is please bear with me as I try and regain my inner equilibrium and blog persona. It will return.

Sunday, 14 May 2017

A growing awareness of mental health issues

I think of my Father as being a wise man. Of course this may well only be true in the Cartesian sense of ‘I think, therefore I am’. He is however practiced in the use of Socratic Questioning something he’s helpfully challenged me with all my life. Socrates believed that questioning was the only real form of effective teaching. He believed that it could help students to explore what it is they know and not know and that the space created (new knowledge) was the place of greatest learning. I and my long-time collaborator and wonderful friend Sue, developed a slight twist on these ideas in our own thinking and writing. We believe that the space between knowledge and knowing (that is) not knowing, is where the greatest learning can occur.

Socratic questioning allows all the information available in a current situation to be gathered, and connected to prior knowledge in a thoughtful way so as to create new understandings. As I have told my students many times, I can teach you the signs and symptoms of a heart attack, and I can provide you with the knowledge of how to treat that condition. What I can’t teach you is how the individual might be experiencing that heart attack – that is the ‘not knowing’ and an opportunity to create new knowledge. As my friend Jane and lover of all things French might say – je doute, donc je pense, donc je suis– I doubt, therefore I think, therefore I am – and in the example above, I am a person-centred nurse.

Interestingly in mental health care, Socratic questioning underpins some therapies – mainly in therapies such a Cognitive Behavioural Therapy (CBT). It is enables a reframing of negative thought cycles. Our thinking about a certain situation will affect the way we feel, both physically and emotionally and how we act in response. Unlike other talking therapies, CBT deals with the here and now’ and doesn't  start by exploring the past. The evidence shows that CBT is very effective in treating anxiety and depression.  

Last week was Mental Health Awareness Week, an annual event that has been celebrated since 1990. Every year a different theme is used to explore mental health care and how people might experience mental health problems. This year the focus wasn’t so much on surviving mental health problems as in finding ways in which we can thrive and enjoy good mental health. On social media, my #earlyrisersclub friend (and Head of Public Health Commissioning at NHS England) Kenny, shone like a beacon in raising awareness and promoting approaches we can consider in order to achieve and maintain good mental health.

It would seem that in the UK very few of us report living with high levels of good mental health. Indeed it is estimated that 1 in 6 people will have experienced a common mental health problem last week. And if you are female; a young adult; living on a low income; living alone (or in a large household), the risks of experiencing mental health problems are significantly higher than for other folk. Poor mental health is an international issue. Mental health problems are one of the major causes of disability worldwide, with the predominant mental health problems being depression, anxiety, schizophrenia and bipolar disorders. The awareness raising information showed that there is much we can do to keep ourselves mentally healthy, increase our wellbeing and when our resilience is too challenged, there are many interventions available to help recovery. These range from medication through to talking therapies such a CBT. Hopefully, you will also now know some of this information. 

As a Professor of mental health care for the last 11 years, and a mental health nurse lecturer and practitioner before that for some 30 years, I was also aware of these facts, but I was quiet during Mental Health Awareness Week, and I am sorry that I was. I know from experience, that my voice can make a difference. And yet even with all my knowledge and experience it has taken a while to know something wasn’t quite right in my world. Over the past 6 months my usual energy has melted away, I’ve lost interest in many of things I’ve enjoyed doing, my mood has often felt low, I've become easily irritated, had no appetite and sleep was an elusive memory. It was becoming increasingly difficult to concentrate and my self-esteem was at an all-time low. But I've kept on smiling.

So last week when the tears that had so often fallen silently during the darkness of night started to fall in the sunshine of the day, I realised I had to stop my ‘watchful waiting’ and do something about the black cloak of depression that was wrapped so tightly around me. For me the first step was to acknowledge that there was something wrong. I have some good friends and I have told them, I’m telling you dear reader, and I will talk to my GP next week. And with W, my lovely wife, best friend, and tear catcher alongside, I am sure it will be easier now to find my pathway back to thriving rather than simply surviving. 

Sunday, 7 May 2017

Health Warning; baby boomers are still tripping on alcohol rather than drugs

Sometime ago I had agreed to open up a session at the North West Major Trauma Symposium. This was being run by the University and the organiser had persuaded me that I should attend as I could showcase the University’s work around translational medicine, collaboration and partnership opportunities. The conference focus was on major physical trauma caused by disease and accident. Whilst such trauma can result in mental health issues (anxiety and long term depression being the most prevalent) it wasn’t the kind of trauma I was familiar with.

It also seemed to be aimed at medical folk, and 'skill thrill' surgeons in particular. The thought of spending a long morning in this company did not fill me with joy. How wrong could I have been! It was brilliant. Humour, science, innovation, humanity, challenge and commitment were the narrative elements that shaped the presentations and discussions. Surprisingly, I knew 3 of the speakers from my previous roles in the NHS and within Universities.

Two former colleagues were also mentioned by speakers. One was Professor Ged Byrne, a surgeon and Director of Quality at Health Education England. His name came up in a session about trauma services in Ethiopia. Ged has long been involved in developing clinical learning placements for UK health professionals in resource scarce countries, particularly those in Africa. I was privileged to spend a very interesting and humbling 10 days with him in Uganda, and it was an experience I will never forget.

The other name mentioned was Professor Dame Sue Bailey, who as well as being a child and adolescent consultant psychiatrist, is also the current Chair of the Academy of Medical Royal Colleges. 35 years ago we worked together in establishing the only NHS Forensic Child and Adolescent service in the UK. It was a service aimed at making a difference to the lives of troubled and troubling children, and I have very fond memories of those pioneering times. However at last Thursdays conference it was older people that provided the greatest focus.

Professor Leela Biant, Academic Head of the Department of Trauma and Orthopaedic Surgery at University of Manchester, and a practicing consultant orthopaedic surgeon presented a paper that looked at trauma services in 2020. Surprisingly, trauma is a growing and serious public health problem. In the UK over 17,000 deaths a year are the direct result of trauma injuries; there are 720,000 admissions to hospital and over 6 million visits to A&E departments annually. Equally surprisingly was the fact that it’s not 19 year old boys driving cars at high speed and then crashing them that accounted for these figures, but older people tripping over a rug or something similar (a low energy, low height fall) and sustaining major trauma injuries as a result.

It is the case that today trauma still remains the largest cause death for people aged under 25, and worldwide, young men aged up to 25 are 3 times more likely to die as a consequence of a road traffic accident than young women. However, it is those over 60 and particular 75 years of age that have the highest incidence of trauma. Its projected there will be 101,000 hip fractures a year by 2020. It is the most common trauma injury associated with this group. It is also likely that most will be female, with nearly 50% of the falls occurring to people living in community based residential settings like nursing homes. Older people are nearly twice as likely to die from their trauma as younger people with equivalent injuries, and some 20% will die within 4 months after the trauma occurred.

Now you may be wondering why I am sharing this information with you. Well in my mind there are a couple of connections that can be made – one was to the story published last week that in the UK, nearly half the population are giving up drinking alcohol. The good news was this group were in the main those aged under 45 so reducing long term harmful alcohol related health problems. The bad news is that alcohol related hospital admissions have risen by 64% over the last decade. There were some 1.1 million alcohol related admissions last year, predominately for liver and heart disease and cancers. Trauma related admissions are not included in these figures. It’s the Baby Boomers (those aged between 53-71 in 2017) who are largely responsible for these challenging statistics. Just because they are in their 60s it appears they are not slowing down when it comes to alcohol consumption. Its easy to picture the scenario - too many glasses of red wine, a loose mat, a low fall = major trauma head injury or other severe fracture = and possible death. 

The second reason is that the health promotion has to be more effectively communicated to folk of my age if the health care of this growing group in our population is to be contained and better health well being outcomes achieved. Interestingly, they are a generation that take health issues seriously, they will seek advice and help for a wider range of mental and physical health problems, and will invest in self-improvement – but excessive alcohol consumption remains stubbornly unchanged for many in this group. As someone who is an educator of health care professionals, and responsible for health care service provision, this fact worries me a lot. Something needs to be done if we are going to avoid the growing tsunami of trauma related problems. Suggestions please, on a post card to the usual place…