Sunday, 19 November 2017

Imagine a hospital without beds – please have mercy on us!

Consideration of how and why we communicate featured in my thinking last week. My interest was first sparked by the story published in the Independent about a computer hacking group with the improbable name of Di5s3nSiON. They had been hacking into the Isis terror organisations online site. Their aim was to disrupt and if possible, close down the extremist propaganda site – as they say #stopthewords. Isis responded by putting in place what they described as ‘stringent security measures’ – boasting their web site could no longer be hacked.  It took Di5s3nSiON just 3 hours to once again break through these new security measures and reveal some 1800 email addresses of those subscribing to the Isis site. The digital battle of words continues.

Later in the week I was also involved in a ‘battle of words’ – or rather a battle ‘over’ words. As I described in last week’s blog, I’m doing some work with the NMC on the development of educational proficiencies for future nurses. Last week’s work focused on the skills nurses will need to demonstrate at the point of registration, and procedures they will need to be able to undertake from day one as a qualified nurse. It is an iterative process. Drawing on wide consultation and with the benefit of access to expert knowledge, propositions have been created which as a group we challenge. We do this remotely through teleconferencing, with each teleconference lasting 2 hours. Now I like to look into the eyes of whoever it is I am speaking with, and teleconferencing doesn’t allow you to do this. Even Skype and Facetime have their limitations in this regard. Ironically, last week’s teleconference focus was on the skills of communication and on the context and media used. Given that we were looking at what the graduate nurse in 2030 might require in terms of such skills, it was difficult to move our thinking from the here and now.

As can be seen from the Isis example, social media can be an extremely powerful way to communicate and influence others. However it is not the only way. Last week I was able to catch a glimpse of something very different in how health care might be provided in the future using digital technology, and communication media in particular. My glimpse came from a report about the work of the Mercy Virtual Care (MVC) Centre, in St Louis, US. It has a great deal that is similar to most UK hospitals - it has nurses, doctors, and other allied health care professionals. What it doesn’t have are beds.

The doctors, nurses and other staff do all the things you would expect them to do in looking after their patients, monitoring vital signs, and looking at the results of diagnostic tests. Their patients are elsewhere. Many of them are in their own homes, others are in specialised units distant from the MVC centre. Like the UK, the US health policy see's health care providers moving services closer to people’s homes. Unlike the UK, the US system is more explicitly linked to payments at the point of care. The move in the US is towards paying hospitals to keep people healthy and away from entering their front doors.

In the UK we have a health care system that waits for patients to pitch up at the hospital, an approach that increasingly causes problems – just think about the A&E crisis we are currently experiencing. The effective use of new digital technology allows health care professionals at the MVC centre to monitor those with complex and long term conditions to such an extent that they can advise on early interventions and reduce un-necessary hospital admissions and lengthy stays. The MVC centre also works closely with other hospitals. Yes we will still need some provision for those involved in trauma, needing an operation, delivering a baby, receive intensive care and so on, but increasingly care will move towards those with long term health problems such as diabetes, heart failure and potentially life shortening diseases such as cancers. In the future I don’t think we will have the huge hospitals we have today. In the future health care will be provided from small units, with speciality health care services provided centrally. 

The MVC centre’s approach could provide the ‘organisational glue’ to ensure that patient deterioration is picked up more quickly and accurately, allowing those working in close contact with patients more time to provide person centred care. There is a paradox in this approach however. The health care professionals at MVC report a very close (almost intimate) relationship is possible with the patients they have contact with. But the one thing they miss is being able to put their hand on the patient and say ‘my name is…’ – and in our NMC teleconference last week the group put ‘touch’ alongside listening and speaking as important aspects of skilled communication in developing effective therapeutic relationships. 

Sunday, 12 November 2017

You too can train in approaches to suicide prevention: it’s not just for nurses

One of the advantages of being both retired and able to use digital communications technology is that I can now attend meetings from the comfort of my living room. Fortunately the 2 teleconferences I took part in this week were audio only, so nobody could see me sitting there in my shorts and t-shirt, my hair looking like I had been dragged through a hedge backwards (we have strong winds up here in the North!). The teleconferences were a wonderful way to be able to participate in what is being called the Consultation Assimilation Teams (CAT) for the Nursing and Midwifery Council (NMC). CAT are sub-sets of the NMC Thought Leadership Group (TLG), which is a group I have been a member of for the past 2 years.

The work of the TLG has been to look at the scope of practice for a graduate nurse in 2030 and what might be the most effective way of preparing them for that role. It has been a great group to work with. There are representatives from all 4 nations of the UK. The TLG is made up of academics, senior nurses, and student and early career nurses. The membership of the group spans all areas of health and care practice. It has that tangible depth and richness of quality and confidence that comes from a collective experience reperesnting 35 years of nursing practice, research and education.

The CAT teleconferences provide an opportunity for the TLG to revisit the draft standards of proficiency. These are what potential nurses will need to demonstrate they have met in order to gain registration and be considered a capable and safe practitioner. The proficiency standards have been grouped under 7 headings which describe the key components of the roles, responsibilities and accountabilities of registered nurses. It is anticipated that at the point of registration, graduate nurses will: be an accountable professional; promote health; assess needs and care plan; provide and evaluate care; lead nurse care and work in teams; improve safety and quality of care; and coordinate care.

These proficiency standards are just one of a suite of interrelated pieces of work being undertaken by the TLG. Other strands of work include: standards for education and training (with particular emphasis on how learning will be assessed); the requirements for future pre-registration and prescribing programmes; and medicine management. It is a very interactive process, with much consultation being undertaken across a wide variety of stakeholders. Last Tuesday I travelled to London to join the rest of the TLG for a day of consolidation and up-dating on progress so far. It was an exciting day, and it was good to see the data that was gathered through the consultation activities.

However, unlike the teleconferences, attending the TLG required a train journey to London, which was fine going down. Later that day and some 10 mins after leaving London to return to Manchester, the train stopped and didn’t move. After some 30 mins we were told by the train manager that sadly there had been a fatality in Bletchley, just outside Milton Keynes and as a consequence we could expect a great deal of disruption to our journey. Eventually we did re-commence the journey, which instead of taking 2 hours actually took nearly 5 hours.

Of course the temporary inconvenience we as passengers experienced on the night would be nothing compared to the distress, pain and shock the family and friends of the person who died will have to deal with. They will have to deal with it for the rest of their lives. My thoughts were also with the train driver and those from the emergency services who attended the scene. I don’t travel to London very often these days, but this is the second time this year the train I was on has been delayed because of a fatality. Sadly it’s a fairly common occurrence. The latest figures (2015/16) for the number of overall fatalities on British railways was 297, and although these data won’t be officially updated until December, so far the 2016/17 figure is 276 deaths. 

The person who died last Monday did so by suicide. 252 of the 297 deaths on British railways in 2016/17 were as a result of suicide. Each of these deaths is very sad, and each will have its own circumstances and complexities. Sadder still is that 4 people have chosen death by suicide at or near the Bletchley Station in the last month and 7 people have died in this way since July. Reassuringly, work is being undertaken to address this problem, and large numbers of Network Rail staff and Transport Police are attending a suicide prevention programme run by the Samaritans. See here for more information.

The programme teaches rail staff how they can respond if they see someone looking vulnerable in or around the station itself, a railway crossing bridge or the general station environment. They are taught what to say and how to start a conversation. There is much evidence to support the notion that talking is often the first and important intervention in saving someone’s life is such a situation. It is a simple step to take, and for those people perhaps fearful of saying the wrong thing, the Samaritans programme has proven to very helpful in raising self confidence and challenging the stigma sometimes associated with dealing with suicide. I would also suggest that the programmes information is helpful for all of us too, and that will, in time include the graduate nurse of 2030. 

Sunday, 5 November 2017

It’s not just the chattering classes that should be concerned about the NHS – it’s all our problem.

I very much enjoyed taking part in last week’s #WeNurses twitterchat. Next year sees the 70th anniversary of the creation of the NHS. See here for a brief public information broadcast celebrating the birth of the NHS, which was made at the time. Given this focus, the overall question explored in the twitterchat was: The NHS, What would you do? During the 60 minutes of tweet conversations, contributors considered what makes the NHS special; why we might need to be concerned about the future of the NHS; what they would do if they were Secretary of State for Health; and what the NHS might look like in another 70 years’ time. It was a lively chat, and you can read the twitterchat summary here.

Not surprisingly, there was a lot of high expressed emotion during the chat with health service managers and politicians responsible for funding, coming off worse. I say not surprisingly for a number of reasons. Both groups are easy targets, and there is a grain of truth in the claims that we have too many managers and there is not enough money. Last week the independent charity, the Kings Fund reported that 51% of all NHS Trust Finance Directors thought the patient care in their area had got worse over the last 12 months. Less than 45% felt they would meet their financial targets this year. As the Kings Fund pointed out, the NHS is in a precarious position heading into the winter, with all the problems that is likely to bring.

Already many Trusts are not meeting the four hour A&E target. There are now 4.1 million people waiting for treatment and emergency admissions are 3% higher than this time last year. Likewise what was noted in many of the twitterchat tweets, workforce issues are also adding to the problems and challenges facing the NHS. It’s getting harder to recruit nurses in many parts of the UK and some medical specialisms are becoming very difficult to recruit into. The days of recruiting nurses from overseas particularly Europe are long gone. Normally up to 10,000 nurses a year come to work in the UK from other European countries, this year that number has fallen by 90% to just 1000 nurses. Likewise many of those nurses recruited over the last few years have started to return to their home countries. The NMC reported that 67% of those nurses recruited have now left the UK.

Sadly many UK nurses are also leaving the profession. Some 29,000 left the NMC register in the year to September 2017, which is an increase of nearly 10% on the figures for the same period in 2016. I am not seeking to revalidate my registration next year. This is not because I am experiencing, directly, the pressures of being on the front line of practice, I am simply retiring. And I am not alone. It has long been recognised that nursing and midwifery is an ageing profession, with significant numbers of nurses on the register now reaching retirement age. Age UK reported in July this year that there are now 15.3 million people in the UK over the age of 60. This number is expected to pass the 20 million mark by 2030. Nearly one in five people currently in the UK will live to see their 100th birthday, and this figure includes 29% of people born in 2011.

Perhaps what is not so readily recognised is that there is also a significant increase in those nurses on the register who are choosing to leave before they reach retirement age. The NMC reported earlier in the year, that when those nurses who retire aged 60 are excluded from the numbers of those that are leaving the profession, the average age of all others leaving the register is now 51 years. The numbers for those under the age of 40 who are choosing to leave the profession is particularly noticeable. 

Last week also saw the emergence of another significant element in this workforce and funding perfect storm. The Health Service Journal reported on yet another hospital trust replacing qualified and registered nurses with Nurse Associates. I have no doubt others will follow. There is plenty of good evidence that reducing the nursing skill mix by adding nursing associates and other groups of assistive nursing staff contributes to preventable deaths; has a negative impact on the quality and safety of patient care; and ironically contributes to hospital nurses shortages – see some of this research here. Back in 2016, Health Education England’s Director of Nursing, Lisa Bayliss-Pratt assured the nursing profession that this wouldn’t happen. Secretary of State for Health, Jeremy Hunt announced in Oct that another 5000 nurses associates would be trained in 2018, and a further 7500 in 2019. 

As my friend and former Dean at Oxford Brooks University, Professor June Girvin noted last week, ‘Nursing has sleep walked into the dismantling of the profession. Without blinking an eye’. And sadly I don’t think there are any easy or quick solutions to the situation we find ourselves in – over time the workforce issues will get better, but services will need to continue to change and become more integrated, and people will need to take greater responsibility for the maintenance of their own health and wellbeing.    

Sunday, 29 October 2017

And, In the End, what counts is the difference we make

Well the countdown is nearing its end.  Next Tuesday I start my retirement, something that fills me with mixed feelings. My first proper job was with Sainsbury's, the supermarket chain. That feels like a long time ago. I ‘fell’ into nursing in the mid 1970’s, and equally, I ‘fell’ into university life in the mid 1990’s. Both of these major chunks of my adult employment, nursing practice and nurse education, have been immensely fulfilling and very rewarding. So I'm going to be a little self-indulgent with this week’s blog and reminisce for a while.

Qualifying to become a nurse was hard work, but also great fun. My student cohort numbered just 14 students, and we were pioneers of self-directed learning using rudimentary computer based learning materials. I remember my Ward Management assessment involved me taking a mini bus full of service users with complex mental health problems to the Builth Wells Agricultural Show. It was a great day out and I passed my assessment. Once I qualified, I worked in Wales during a time when hospital care for people with learning disabilities was being replaced by community provision. I had a wonderful job as a rehabilitation and resettlement Charge Nurse. One of the ‘skills’ I acquired was to be able to teach others how to use a ‘twin tub’ washing machine to do the laundry – younger readers ask your parents what this means.

I moved to Manchester as the commissioning nurse for an adolescent forensic secure unit in the mid 1980’s and have never really moved out of the North West since that time. Whilst ‘going where no RMN has gone before’ was exciting, after a while the forensic service didn’t provide the challenge I wanted.  I became the Nursing Officer for acute and community mental health nursing services just as we were developing some of the first community mental health centres in the country – it was my first real taste of what can be achieved through effective multi-disciplinary working. It was a brilliant time and absolutely prepared me for next role, as Director of Regional Specialist mental health services, most of which were provided across the entire North West Region, whereas others were national specialist services.

If I wanted challenges I certainly got them with this role. The first was beating my boss to securing the job, a real challenge the day after I started! However, he was a good man, and became a great colleague and friend. He even taught me to play golf, and yes, way back then, a group of us health service managers and clinicians would occasionally spend Friday afternoon playing a round of golf. Definitely a different era…

And then 22 years ago I moved from the NHS to HEI, and started a second career as a University Lecturer. It took me 10 years to become a professor. The path was a tough one at times, but I did benefit from having a couple of mentors and colleagues who provided me with many opportunities, something that I have tried to do throughout my university career. In 2007, I became the first Executive Dean at my university, head up a School of Nursing. It was a dream come true and a dream job bringing together my love of nursing and my passion for education and research! 

Looking back over this time I am very grateful to have been provided with so many opportunities; opportunities to travel the world; opportunities to gain a voice in presenting papers at conferences, and publishing in journals and books. I’ve been fortunate to meet so many people, some famous, many not, but each one has added something to my view of the world and helped make me the person I am today. Of course I am remembering the good bits, and there were many, but I along the way, I have made mistakes and some of my decisions haven’t been that clever. Thankfully, I have always had family, friends and some wonderful colleagues to help me through those times.

It was one of my colleagues who inspired me to use social media as way to share what it was I was interested in and what I was doing. I started writing this blog, in the summer of 2009, and every Sunday since then I have posted a blog. It has been a great opportunity to talk about my thoughts on the world I find myself in, the one I contribute to and the world I would still like to see. And thank you dear reader for allowing me this indulgence. Whether this is your first experience or you have been reading them since the start, your support has been brilliant. Thank you.

As for the future? Well subject to the University Senate approving my application, I will gain my Professor Emeritus status. This will allow me to still use my voice in pursuit of my ambition to improve the care and opportunities for those who experience a mental health problem. As a society we have come a long way since the mid 1970’s and the start of my journey, but there is still a long way to go if we are to truly stamp out the self and societal stigma still associated with those who experience mental health problems.  

The last line, of the last song (The End), on the last album the Beatles ever made, has been described as 'this is how you finish a career'. Despite my retirement, I am not finished yet, and I guess many readers of this blog will be in the same position. So taking the liberty of a couple of small changes I leave you with almost Paul McCartney’s lyrics:

And, in the end
What really counts
Is the difference we make

And yes, I will be here, same place, same time next Sunday…

Sunday, 22 October 2017

Professors, Publishers and Dinosaurs: Jurassic Park Revisited

My six year old grandson Jack is currently into dinosaurs. He seems fascinated by them, can pronounce all their different names and can tell you if they flew, swam, were big or small, what colour they were and what they ate. So last Tuesday it was such a shame he wasn’t with me at the launch of the Economic and Social Research Council (ESRC) Manchester Social Science Festival. The launch took place at the Manchester Museum, in a room totally dominated by the skeleton of Stan the T Rex. I was pretty thrilled, Jack would have been in seventh heaven!

The 3 big Universities of Greater Manchester (Manchester Metropolitan University, University of Salford, and the University of Manchester) jointly facilitate the festival, which runs between 4-11 November. If you happen to be in this part of the world and want to see what’s on, you can find out right here. Through the Festival of Social Science the ESRC aims to facilitate opportunities for social science researchers to share their work with non-academic audiences, and usually this is done through very creative events and approaches. The festival is aimed at all, but is particularly aimed at young people in an attempt to raise awareness of the contribution the social sciences can make to the UK society’s wellbeing and economy.

Impressively, a large number of my colleagues were making a contribution to this years festival. I was at the event in the company of the School of Health and Society professoriate. This group make a huge contribution to ensuring that the various curricula in the School remains evidence based and contemporary. They undertake research in a variety of fields, and my own contribution to this research portfolio has been in the areas of mental health, child abuse, and service user involvement.  Much of this research has been undertaken with my long term colleague and friend Sue McAndrew. It was great to learn last Tuesday that Sue had gained her own chair as Professor in Mental Health and Young People at the University – well done Sue!

Sue and I have edited a couple of books in our time and contributed chapters to many others. However, it seems that the desire by professors and other academics to write books is on the wane. The value and viability of the book publishing enterprise has been called into question in recently published research ‘Academic Books and Their Future’. The study was funded by the Arts and Humanities Research Council (AHRC) and the British Library. There are strong career incentives for academics to write and publish books – not least because it’s a critical criteria for those wanting to become a professor. It was reported that with library budgets for buying new books remaining static, and with traditional book retail sales falling over the last decade, these days the business case for the publication of new titles is often now based upon just 200 copies.

Such a low number is not going to inspire many publishers to back a new book! In the new digital age, people are gaining access to much more information and materials on-line, often in some form of open access publication or website. Arguably, journal papers are much easier and quicker to write and get published than books. Although in some subject areas, like the arts and humanities, even this can be difficult. Free and unrestricted accessibility to academic papers is set to continue to develop.  Sci-Hub, set up in 2011 by Alexandra Elbakyan, a software developer and neurotechnology researcher from Kazakhstan, aims to spread knowledge by allowing people free access to what would often be 'paid for' content

Apart from open access journals (where the author pays the publisher for their paper to be published in the journal) most academic publishers (of journals and books) will charge individuals or their institutions for access to their content. Such access charges rise every year. Even great universities like Harvard have reportedly cut down on the number of subscriptions they hold each year. Powerful academic publishers such as Elsevier, have taken Sci-Hub to court for copyright infringements. Some brave academics have responded by calling publishers parasites benefiting on the back of their labour. As a consequence of these legal battles, the original site is now suspended. However, it is still possible to gain access to the papers it holds, which in March 2017 numbered some 62 million. It’s worth noting that Sci-Hub receives over 200,000 requests a day for papers. In 2013, Sci-Hub started a partnership with LibGen (Library Genesis) which is a huge online repository of academic books and documents, hosted in Russia. Since that time Sci-Hub has downloaded approximately 60 million different articles from the LibGen database - perhaps a case of From Russia with love

Changing such well established business models will always be challenging – we only have to look at what happened to the music industry with file sharing services such as Napster – a service that arguably permanently changed the music industry. However, such changes also come with a degree of risk. For old and new professors alike, the publishers who publish their research and scholarly thinking, and the likes of Alexandra Elbakyan, there are probably lessons to be learnt from a rereading of the conceptual story dramatized in Jurassic Park. 

Sunday, 15 October 2017

This Weeks Home Work: carry on talking, but let’s have more doing!

I wonder what you did last Tuesday. I spent the day working at home doing various things. My day started by exploring and contributing to what was being said on social media; walking 7.5k (my everyday prescription for promoting my own mental health and well-being – something Maureen Watts is also a fan of – more later); writing a slightly overdue report; spent a little time continuing with restoring the Horwich garden; having tea with 2 of my grandchildren, before watching catch up TV in the evening. An ordinary day I guess, minus the morning and evening commute. Last Tuesday was the 10th Oct 2017 and it was also World Mental Health Day 2017 (WMHD17).

WMHD17 is the day the World Health Organisation focus on spreading awareness and understanding about mental health. Every year a different theme is chosen and this year’s theme was mental health in the work place. It’s estimated that some 15% of the working population will experience mental health problems and 13% of all sickness absence days in the UK are due to a mental health problem. Women in full time employment are twice as likely to experience a mental health problem than men. However, recent research by the Mental Health Foundation, Oxford Economics and Unum found, almost counterintuitively, that employed people living with mental problems contribute £226 billion to the UK GDP, which is nearly 9 times the estimated cost to economic output due to mental health problems.

Interestingly, 86% of the study’s respondents felt that their job and being employed was important to protecting and maintaining their mental health and wellbeing. I say interestingly as in the 11 years I was a Dean of a very large health school, many conversations with Trade Union representatives revolved around responding to claims that decisions taken by myself or changes introduced by the wider University management team resulted in many, many (always never more precise than many, many) colleagues experiencing mental health and wellbeing problems. It’s also interesting to note that the report suggested that ensuring there is better mental health support in the workplace could actually save £8 billion a year for UK business.

It’s the organisations culture that can provide the real catalyst for change and ensure there is better support available. The Hoxby Collective, who provide a refreshing new approach to how people work, recently reported that 33% of workers said they experienced mental health problems as a direct result of the explicit and implicit expectations of their employers. For example, 61% of those surveyed reported that they felt pressure to work late, because their manager works late or they were keen to be noticed in order to enhance their promotion prospects. In some organisations this can be more noticeable than others. At the university, academic staff have a great deal more flexibility over how and where they work than say the professional support staff, who are often expected to work a fairly rigid 9-5 day.

Managers need to lead by example. For many years my working day would start at 06.00 and finish any time around 18.00, with there often being evening meetings or events to attend as well. I was very conscious that others might see this model of working the norm and I am very grateful that so many people didn’t! Eventually, this pattern of working contributed to my own experience of mental health problems, and yet for a very long time nobody in my organisation ever commented on the risks I might be running in adopting this approach to work.

Ironically perhaps, ensuring the good mental health and wellbeing of my colleagues was an important element of what I believed I was there to do. I also believed (believe still) that I was open, supportive and facilitative when colleagues shared their problems and concerns with me. I sincerely worked to ensure that colleagues achieved a healthy work life balance while completely ignoring my own advice! And whilst I have been well rewarded in many ways over the years, such success has come at a cost, mainly in broken and fractured family and personal relationships.

I fully support initiatives such as WMHD17, and the impact raising awareness of mental health issues has on society’s views of mental illness is welcomed. Conversations and discussions about mental health are growing more common, but sadly, social and self-stigma is still evident in many areas of our lives. The Royal College of Psychiatrists recently published survey showed the public’s understanding of what is mental health and what a mental illness might be is still very limited, particularly when it comes to understanding how severe some mental illnesses can be. 

It seems to me that there is a gap here – between talking, knowing and doing! Something I guess Maureen Watts knew all about last week. Maureen is the Minster for Mental Health in the Scottish Parliament. Her personal welcome on her web site is ‘Aye, Aye Fit Like!’, which to some I guess sounds parliamentarian. Maureen’s 15 minutes of fame last week was to claim £4.68 for a taxi ride of less than a mile to deliver a speech on the benefits of physical activity on one's mental health and wellbeing. Possibly a case of carry on talking, but let’s have more doing! 

Sunday, 8 October 2017

Stopping the Abuse of FGM: tearing down the barriers

For much of last week I was in the city of Berlin attending the 6th European Conference on Mental Health. I have been to all of the conferences since they started, and the conference has grown in terms of quality and popularity year on year. With my long term collaborator and writer Sue, I presented 2 papers on research that we had undertaken into Female Genital Mutilation (FGM) and into service user anomie and the role they take on as they come volunteers and or mentors to others. Both papers were well received but now comes the task to get them published - a much harder task!

There was an opportunity to see some of Berlin during the conference, and what a lovely city it is too. The autumn colours were vibrant and apart from one day where a near tropical storm tore through the city, the sky remained blue, and warm sunshine made being outside a wonderful experience. One afternoon after the conference had finished I took the 100 bus that runs from one side of Berlin to the other. It’s a cheap way to see the major attractions. I then retraced the route on foot to see all the famous and historical sights. It was a 17k walk.

The most poignant sight visited was the memorial of the Berlin Wall. Lengths of the former wall could be found in different parts of the city, and sometimes these were covered with hugely creative and political graffiti and images. However I went to the official memorial and museum. In the quietness of the afternoon I spent some time reading the fragments of history, and soaking in what was a very sad place to be. One section, now hidden unless you climb the 200 steps to an observation platform, had been kept in its original state, complete with watch tower. It was a bleak and frightening sight.

The pain, hurt and segregation could be seen in the various narratives of people who had been caught up in the building of the wall, and its continued barrier to free travel, families and opportunity. Given it was a mental health conference I was attending, the Berlin wall, and its impact on people’s lives, seemed symbolic of the self and social stigma many people living with a mental health problem experience. That one group of human beings can inflict such cruelty, pain and discrimination to another group and believe this to be OK, defies all sense of humanity and compassion.

This was an issue that the conference audience struggled with in listening to the paper we presented on FGM. Like the Berlin Wall did, FGM violates a number of human rights and principles. It reinforces notions of women having a political, economic, social and cultural subordinate role in society. FGM is often carried out on girls up to the age of 15. Adult women can also be subjected to FGM, for example re-infibulation following childbirth. FGM is commonly performed by traditional practitioners, including grandparents, who have no formal medical training, and often the procedures are carried out without anaesthetics.  The girl is often pinned down by a number of adults complicit in the FGM being performed. It is a form of child abuse.

Terre des Femmes (which translates from the French as Women’s Earth), is a non-profit women’s rights organisation. Founded in 1981, its head office is based in Berlin. According to Terre des Femmes there are at least 58,000 victims of FGM living in Germany, with a further 13,000 girls vulnerable to becoming mutilated. In England and Wales it’s estimated that 137,000 women and girls aged 15-49 are affected by FGM. 

In the UK some 79 FGM Protection Orders have been made since 2015, and although some 9000 FGM cases were treated by the NHS last year, there has so far not been a single conviction of anyone for carrying out, or allowing this practice to be carried out. Unfortunately there is no reliable data on the overall prevalence of FGM across Europe, but it thought there are many hundreds of thousands of women living in Europe who have been subjected to FGM. The largest groups of these women and girls originating from countries in which the practice of FGM is widespread live in Austria, Belgium, Denmark, Germany, Spain, Finland, Ireland, Italy, Portugal Sweden, the Netherlands and the UK. 

There are no easy solutions to stopping this abuse. Education is important and of course support for women affected by FGM is crucial in terms of restoring good mental health and wellbeing – our paper looked at how this could be done through peer mentorship and breaking down long established cultural and social barriers. It took 28 years before the Berlin Wall came down. This barrier was removed because of a thaw in the so called 'Cold War' and a cultural shift in relationships between the East and the West. I’m hoping we don’t have to wait for nearly 30 years before the barriers that prevent us from stopping the abuse of FGM can be torn down. 

Sunday, 1 October 2017

Whilst we Plough the Field and Scatter, the NHS still Belongs to the People

Yesterday I had lunch with my youngest son, along with his wife Louise and their gorgeous daughter Carys. The food was superb, and hugely authentic – we ate at the Hispi (Didsbury) restaurant. If you are in Manchester for any reason, give it a go. Food has been on my mind this past week. Last Sunday I went to a Harvest Festival service in a small church known as ‘Ashworth Chapel’. It’s a church with a long history, originally built in 1514, and it stands on top of a hill amid the rolling moors surrounding Rochdale. I like it, partly for the history each stone represents, but also for the quiet and calm feeling sitting inside brings. The services are mainly from the Book of Common Prayer, which, in an age of digital everything, may not be to every ones taste. The church was decorated with flowers and symbols of the harvest, very much as I remember from my childhood. Some wag had even hung a bunch of grapes from the eagle lectern. 

I think it must have been in my childhood that I last sang the rousing hymn ‘We Plough the Fields and Scatter’. Apparently, it is one of the most performed hymns in the UK. One week later, and I am still singing the first verse and chorus. It’s a very infectious tune and I dare you to click on this link and see if the music and words don’t also stay with you for a while. The Harvest Festival service is primarily about taking the opportunity to say ‘thank you’, for the food we enjoy, for those that farm, produce, prepare and make available the results of their labour to the rest of us.

The service is also an opportunity to remember and respond to those who don’t have enough food or other basic necessities. Gifts of food were brought to the chapel and then distributed to those in need during the week. For me seeing the children and families bring their boxes and carry bags of food to the front of the church was a poignant glimpse back to my childhood when my parents encouraged my brothers and sisters and I to do the same thing. And last week I was privileged to enjoy a glimpse back to the work of my friend and colleague Professor Maxine Power. Maxine is currently the CEO of the fabulous innovation and improvement science centre known as HAELO – an organisation that the University of Salford has been proud to be a partner with. Last week, I joined many others who have been part of Maxine’s journey of discovery and achievement, to say thank you and to wish her well in her new role.

Maxine is leaving HAELO to join the North West Ambulance Service as their Director of Quality Improvement. Although she will be greatly missed by many working in health and social care services across Greater Manchester, this is an opportunity for her talents to be brought to bear across the whole of the North West of England. The emergency services in the UK, including the ambulance service, are having to change to meet the increasingly complex world of health and social care. They need to do so in a way that uses the advantages new technologies, might bring to improving the services individuals receive when they most need them. Maxine reminded us all of the opening words of the NHS Constitution:

The NHS belongs to the people

It is there to improve our health and wellbeing, supporting us to keep mentally and physical well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most. 

Regular readers of this blog will know that I am a big fan of the NHS and of what collectively, we have been able to achieve in tackling disease, treating illness and responding to trauma. It was great to read last week that the UK has joined other countries within the European Region in eliminating Measles. Measles is a highly contagious, serious disease caused by a virus. The disease remains one of the leading causes of death among young children globally, despite there being a safe and cost-effective vaccine available. It’s estimated that during 2000 – 2015, measles vacation prevented up to 20.3 million deaths. That the UK has eliminated this disease demonstrates the effectiveness of such a vaccination programme. I have grown to like and appreciate the value of tradition, but increasingly I also see the need to embrace change where this is appropriate to do so. And Joe, think about this for the next time we go to Hisbis for a meal and the bill comes. 

Sunday, 24 September 2017

Mirror, mirror on the wall, is the NHS still the best health care system of all?

Last Tuesday was the 32nd anniversary of the 1985 magnitude 8 earthquake in Mexico, an earthquake that killed 10,000 people and left 30,000 injured. Mexico is one of the most seismically active places on Earth.  Last Tuesday was also when Mexico experienced a 7.1 magnitude earthquake that has killed over 300 people. The country has an elite team of rescuers known as ‘the moles’ and the search for more survivors goes on. Unfortunately the death toll is likely to rise as rescue efforts become recovery activities. And yesterday Mexico had another earthquake, this time a 6.1 magnitude. My thoughts, and I am sure many others too, are with all those effected by this dreadful disaster.

Last Wednesday I was reminded of the devastation a different earthquake had caused. This was the magnitude 7.6 earthquake that shook the Kashmir region along with parts of Pakistan, India and Afghanistan on October 8th, 2005. This earthquake killed 80,000 people and over 4 million people were left homeless. Unlike Mexico whose health and general infrastructure is better prepared to deal with such disasters, the death toll in Pakistan was so high in part, because there were no drugs, medical equipment or associated relief infrastructure. My colleague, Dr Ayaz Abbasi was there at the time providing help to those caught up in the disaster.

Last Wednesday he told stories of that time as part of his presentation at the Wrightington, Wigan and Leigh (WWL) NHS Hospital Trust Annual Public meeting. He told of his despair of treating patients in crude conditions, sewing up wounds with ordinary cotton, and without the benefit of any anaesthesia being available. It was an emotional re-telling of his experience. Dr Abbasi is now the Clinical Director of the Accident and Emergency services at WWL. The A&E Department is one of the best in Greater Manchester, and indeed is consistently in the top 10% of all high performing emergency departments across the NHS. He was justifiably proud of the team he works with and what they had been able to achieve.

Dr Abbasi was equally proud of the wider NHS – he urged the audience to recognise what a fantastic service it was and that there was no other health care system in the world that was able to provide the level and quality of health care to people in the way that the NHS does, and does so consistently. He wasn’t blind to the problems that the NHS faces. The demand for care is constantly increasing, a growing part of the population is getting older, presenting with more complex needs, and health care professionals can do more with technology, pharmacology and interventions than they have ever been able to do. When the NHS was first created it had a budget of some £437 million (roughly £15 billion at today’s value) - now the budget is some £124 billion a year, and even this huge resource doesn’t always go far enough.

In his talk, Dr Abbasi recognised that we needed to reshape the way in which NHS services are delivered. The current Government is committed to ensuring this happens through the development of new care models and treatment in the community and closer to people’s homes. However the change required is going to take time. There are 3 times more doctors and 4 times more nurses working in hospitals than in the community. Partly this is a consequence of the way the training and education of health care professionals still remains highly centralised. I fail to see what added value those responsible for the commissioning of education and training of health care professions, bodies such as Health Education England, really bring to ensuring the workforce needs of local health economies are appropriately met.

Last week, I received an invitation to join other members of the Nursing Midwifery Council (NMC) Thought Leadership Group in a couple of weeks’ time to review the responses to the consultation on what the future graduate nurse might ‘look like’ and what the educational programme to achieve this might also ‘look like’. Of course whilst it’s a real privilege to be able to help shape the future health care workforce in this way, I am slightly challenged by the notion that the NMC is just one of many different regulatory bodies determining the scope of professional practice for the various different health care professions. I am not convinced that such tightly differentiated approaches to regulation and the establishment of individual boundaries of care is helpful of even necessary. Dr Abbasi in his talk rightly acknowledged the contribution the whole team made to ensuing high quality, safe care was available to all patients whatever their need. Perhaps the various heath care regulators could learn something from the way in which integrated and inter-professional health care is being delivered in the WWL A&E department. 

And like Dr Abbasi, I think that the NHS is a wonderful institution, even with all its challenges. As a health care system it provided superb care for both the Kevin’s in Scotland, my Mother in Wales, Mark, Daniel, Jack and Christine in England, and of course my brother Christopher, who 10 years ago yesterday, lost his battle with a long standing illness, and died. For me, his passing will always feel premature. Rest in peace Christopher. 

Sunday, 17 September 2017

CSE and CSA and the need to create portfolios of prevention

Like many of my fellow bloggers, I am intrigued by words and how words are used. I touched upon the relative importance of words in communicating emotions and attitudes in my blog post last week. I'm also interested in the etymology of words. Etymologies are not definitions of particular words, but can provide explanations of what our words meant and how they might have sounded from as far back as 2000 years ago.

Last week I was looking for the origins of the word ‘portfolio’ (it was a temporary distraction from actually constructing my research portfolio) – and the word ‘portfolio’ comes from the Italian portafogli, as in portare ‘carry’ and foglio ‘leaf’. What I didn’t know until I searched was that ‘portfolio’ was one of 60 words introduced into the English language in 1713. Here are a couple of sentences containing some of the others – Dr T was a self-devoted sparkler of a man, with a horselaugh and a fuzzy beard. He had built a machinelike clothespress thinking he was creating an orrery, which although a great piece of work would not be going into his portfolio!

However, I did come across 2 news items last week that absolutely sat within my research portfolio. The first of which was the research published by the Centre for Mental Health. This showed that mental health problems experienced by the UK workforce had cost employers some £35Bn last year. This equates to £1300 for every employee in the UK economy. At any one time 1 in 5 working people will have a mental health difficulty, but the issues are not straightforward as they might first seem. A large proportion of the £35Bn cost comes from the reduced productivity caused by people continuing to go to work when they are mentally unwell. Such behaviour costs businesses’ twice as much as paying for sickness absence arising from mental health problems.

Sadly some people will never get any help and some will lose their job because of mental health problems. For others, being at work can be an important part of their recovery journey. The good news is that many organisations are now taking the mental health and wellbeing of their employees seriously. In my University, we have long had in place support for our students who may be experiencing mental health problems, and over time have extended this focus to staff as well. From my own recent experience of mental health problems. I know the current approach is on prevention, promoting a healthy workplace as well as being appropriately supportive when such measures are not quite enough. However, whilst mental health issues are increasingly talked about more generally, there is still a degree of stigma attached to those experiencing a mental health problem. The result can be some individuals being reluctant to ask for help or speak about their experiences. The sound of silence can be very damaging.

Shattering the silence really encapsulates the issues in the 2nd portfolio item to capture my attention last week. Last Friday was #PurpleFriday, a day to raise awareness of both Child Sexual Exploitation (CSE) and Child Sexual Abuse (CSA). Although closely entwined, there is a difference. CSE involves exploitative situations, contexts and relationship where young people (or a 3rd person) receives something (money, alcohol, gifts, affection) as a consequence of them performing and/or another or others performing in them, sexual activities. CSA involves forcing or enticing a child to take part in sexual activities, whether or not the child is aware of what is happening. Sexual abuse is not always perpetrated only by males, women can also commit acts of sexual abuse, as can other children and young people. 

The NSPCC recently reported a contemporaneous (and somewhat disturbing) evidence base of the prevalence of cases of CSE and CSA in the UK. Although comprehensive, it is an evidence base likely to be incomplete in terms of capturing and understating the prevalence of the both issues, because for example, the way in which cases get reported and the hidden nature of the abuse. Despite this lack of incomplete data, we do know that number of recorded sexual offences against under 16 years olds in 2015/16 was 37,778, a figure that has doubled over the last 10 years. It is not just sexual abuse or exploitation that should concern us. The impact on a child of emotional abuse or neglect is also likely to be significant. 

In the UK, there has been a rise of the number of children being on a child protection plan or register for emotional abuse, a rise from 23% in 2006 to 35% in 2016. As devastating as these statistics are, the increased number of children on such plans and register’s might also reflect an increased awareness of the importance of ‘breaking the silence’ and reporting concerns to professionals. The NSPCC report provides evidence that the wider public have a growing understanding of the ways in which abuse can be prevented. Their research showed that 56% of those asked believed that abuse and neglect could be prevented. The belief that abuse can be prevented is likely to be the critical first step to all of us taking action and saving a child from experiencing and living with abuse in any of its forms.

Sunday, 10 September 2017

The Zika virus: an organism at the edge of life

Although now retired, the psychologist, Professor Emeritus Albert Mehrabian still works as a researcher at the University of California, Los Angeles. He is probably best known for his research into body language and non-verbal communication. His book ‘Silent Messages’ (first published in 1971) can still be found on Amazon, and is absolutely worth a read. Ironically for someone whose work is so well known and is still hugely influential, it is often misunderstood and misused.  In particular, it is the work arising from a 1967 experiment, which has come to be the most misused over time – most people will know the outcomes of this research as the ‘so called’ 55%, 38%, 7% rule in communication.

That is: 7% of meaning is in the actual words that are spoken, 38% of meaning is in the way those words are said and 55% of meaning is in the accompanying facial expression. If one stops and thinks about this for a moment it is obvious that this cannot be so!  If it were, wouldn’t we be able to understand 90% of what is said in a foreign language just by seeing the person talk, or understand most of what is said on TV with the sound turned off? Mehrabian has long been at pains to say that his work was only about the way feelings and attitudes are being communicated; outside of this specific use, the 55, 38, 7 equation doesn’t hold true!

I recalled Mehrabian’s work as I was thinking about the way some research outcomes become completely embedded into our collective thinking, even, when as in Mehrabian’s example, it is for the wrong reasons. Many researchers are to blame in this regard. Last week I had an interesting discussion with a colleague whose role at the University involves communicating research outcomes and tracking the impact of the research as it gets translated into practice. He had a constant battle with the words used by many academics in describing the research undertaken, methodology used and the results. His complaint was that often the language used is not accessible to non-academics and what was often missing was the answer to the ‘so what’ question – you have done the research, but what difference or benefit will it have for me?

It was a valid observation. However, most academics write for a specific audience. Sometimes this will be for peer reviewed journals where methodological, epistemological and scientific narratives are standard and expected, or they are writing for commissioners of research and will be required to conform to a widely accepted way of communicating information and ideas in order that the bid can stand being scrutinised and judged against other similar bids. Such conventions can, at times, result in information content that is impenetrable to all but a limited group of other academics, and/or the message becomes over simplified and misunderstood.

As always, a middle ground can be found. Last week I thought the on-line BBC News site did a good job reporting on the outcomes of research into the Zika virus. Zika is a virus that people get through being bitten by an infected mosquito. Most people have very few symptoms, but the disease poses a serious threat to babies in the womb. I guess most of us will have seen pictures of affected babies - their abnormally small heads are the outward sign of the disease. Zika-based infections have been linked to severe birth defects in almost 30 countries. Although not now seen as an international medical emergency, the World Health Organisation (WHO) is closely monitoring its spread.

The BBC story focused on new research published in the Journal of Experimental Medicine that reported the Zika virus can selectively infect and kill ‘hard-to-treat’ cancerous cells in adult brains. Whilst human trials are not likely for at least another 18 months, the laboratory-based research shows the potential of injecting the virus into the brain at the same time surgery is performed to remove brain tumours. There are many types of brain cancer, but the most common tumours are Glioblastomas. These account for 12-15% of all brain tumours and they are very difficult to treat. Glioblastoma is most common in adults aged 45-75, and affects more men than women.

The tumours are fast growing, spreading through the brain very quickly, making it difficult to see where the tumour ends and the healthy tissue begins. So surgery, radiotherapy and chemotherapy may not be enough to remove these invasive tumours. Glioblastoma stem cells continue to grow and divide, creating new tumour cells. It is healthy stem cells that the Zika virus attacks in babies, whereas adult brains have very few stem cells. This means in the case of adults, Zika treatment should only destroy the cancer-causing brain stem cells without causing damage to other healthy brain cells. 

When I first read the story, I wondered who had first thought of doing the research. The science is clear, the connections obvious when pointed out, but I suspect beyond most of us. So perhaps my colleague was right – we need to find greater opportunities to talk, listen and share ideas in order to grow our shared understanding of the possible. Its sounds like a great starting point for everyone in the research community! For me, as today is World Suicide Prevention Day, I hope there are lots of researchers working on how we reduce the numbers of those who want to end their lives in this way.

Sunday, 3 September 2017

Flights of Fancy - the Challenges of Creating an Appropriate Workforce

25 years before I was born, Amy Johnson started her solo flight from England to Australia. It was a journey of over 10,000 miles. She finally landed some 19 days after leaving the UK. It was a fantastic achievement. She became the first women to fly solo over that distance. Today Emirates (there are other airlines), will do the same journey in 23 hours, and a business class ticket will cost you just £3160. These days it would probably be impossible to replicate exactly Amy’s journey. She put down in places that have now become very troubled and dangerous – Turkey, Iraq, Iran, Pakistan and Syria. Indeed, I am not sure if Aleppo in Syria still has a functioning airport. 

Amy Johnson was an inspirational women – not only did she undertake what must have been fantastically difficult journeys during the 1930s, but she was also an engineer of great repute. She was twice President of the Women’s Engineering Society (WES). WES is both a charity and a professional network of women engineers, scientists and technologists. They have a vision of the UK becoming a country where women are as likely as men to choose to study and work in engineering. To this end WES works collaboratively with educators, employers and influencers in creating a diverse engineering community. However, achieving this vision is a challenge.

At my University, we have many examples of the kind of outreach work that can introduce girls to study engineering and think about science, engineering and technology as a career choice. Someone who is as inspirational as Amy Johnson, is our Professor Haifa Takruri-Rizk. For over 20 years she has being researching and teaching in the fields of electronics, mobile networking, and the organisational cultures and workplace practices that support women in science, technology and engineering fields of practice. Her outreach work is very successful and applications by young women to study in these areas have held steady and begun to grow. But there is more that needs to be done.

Encouraging more women to study and work in these areas is critical for the UK's future economic prosperity. In the UK, the proportion of young women studying engineering and related subjects has remained more or less at 16% compared to places like India where around 30% of students are female, and these subjects represent over 30 of all university programmes taught. WES notes that less than 10% of the UK engineering workforce is female compared to countries like Latvia, Bulgaria, Cyprus where 30% of the workforce is female. The shortage of engineers in the UK is now becoming critical and it is estimated that we need to double the number of students and increase the current workforce by 60,000 people with engineering skills. It’s a challenge.

Of course it’s not just in the engineering workforce where gender inequality and representation is to be found. In my professional field of health care, gender balance has been a long standing issue. In medicine, there are some signs of change but it is slight. There are 281,440 doctors registered to practice in the UK. Of these 128,137 are female, but they are outnumbered by men in every field of practice other than General Practice, where there are slightly more females practising as GPs than men. The number of women entering medical school is still slightly higher than men (52%) but there has been a steady decline in overall numbers of women in training over the past 10 years.

In nursing the problem is reversed. The number of men in nursing remains stubbornly low. Only 12% of registered nurses in the UK were male – and this figure has remained constant over the past 5 years. Likewise for those considering nurse education and training, there are just under 12% male student nurses; a figure that has remained constant over the past decade. Just like in the case of engineers, encouraging children to think about nursing as a career and identifying strong role models is key to addressing the issues. And there’s the rub. Try and generate a list of famous and iconic nurses and you almost inevitably go back a long way in time – Florence Nightingale, Mary Seacole, Edith Cavell and so on, even my favourite, Virginia Henderson, whose legacy in terms of influencing contemporary nurse education and practice, is unlikely to be known outside of the profession. If one tries to identify male role models it becomes even harder. My 2 favourites are Walt Whitman and Phil Barker – but again, with the exception of poetry lovers, these are names that are unlikely to be  known outside the profession. 

Whilst social media is helping, the emergent nurse leaders of today, (and there are many to be found in the world of Twitter, Facebook and so on), don’t have the wider recognition that someone like Amy Johnson did all that time ago. It’s a challenge, and one that all members of the workforce, men and women need to rise to if we are ever going to change things. 

Sunday, 27 August 2017

Little things can make the world a brighter and better place

I had 24 hour power outage last week. The trip switch at the main fuse box would not reset, even with all the appliances unplugged. It was immensely frustrating. For me it was the little things that were the most frustrating, like not being able to flick a switch to boil the kettle for a cup of coffee, or washing in cold water as the boiler was out. I managed to find an electrician. He was very busy but he gave me a guaranteed time of arrival of 18.00. Thankfully he turned up and with just one small screwdriver (and I expect many years of experience and knowledge) found the problem. It was a trapped wire in the ceiling rose of the kitchen light, disturbed when I had changed a bulb. 

It was hard to believe that such a little thing could result in such a frustrating problem. There was an upside to the day though. As my lap top, iPad, and phone all needed charging, and the electrician wasn't arriving until 18.00, I decided to go for a walk – the sun was shining and I managed a 21km walk across some beautiful Lancashire countryside. Regular readers of this blog will know that I #WalkEveryDay, and for 99% of the time achieve the World Health Organisation recommended 150 hours of physical activity a week (for me, 10,000 steps a day). I find walking suits me better than running, but its good to know an increasing number of people have taken up jogging, park runs and so on. 

However, as Public Health England (PHE) reported last week, many middle aged people are becoming less active. Overall the population is 20% less active now than in the 1960s. PHE estimated that 4 out of every 10 people aged 40 – 60 do not even manage to have 1 brisk walk each month. The evidence now strongly supports the link between exercise such as walking and the impact on our health. Just a 10 minute brisk walk a day can reduce the risk of an early death by 15% - 1 in 6 deaths can be linked to inactivity. A brisk walk is generally accepted as being just under 5kph, which most people can easily achieve.

In encouraging more people to take this small step in improving their health PHE launched a new free app – Active 10 – which can both monitor the amount of brisk walking someone does and provides lots of tips on how such activity can be ‘incorporated’ into our daily routines. In this way the 10 mins walking doesn’t become an additional thing to do. Of course 10 mins brisk walking won’t on its own enable people to achieve the WHO target of 150 hours of physical activity a week, but it will be enough to start to make a difference to those with high blood pressure, diabetes, weight issues, depression and anxiety. For men and women of my age, walking also reduces the risk of hip fractures! Whilst I tend to mainly walk with Cello (my dog), all the grandchildren love walking as well – so when they get to join in their health and wellbeing benefits as well.

Exercise such as walking has also been shown to increase the level of BDNF, (brain-derived neurotrophic factor). BDNF is a key neurotrophin protein which helps to preserve the health of existing neurons and synapses, and create new ones. In the brain, BDNF is most active in the hippocampus, cortex and forebrain, all of which are areas crucial to learning, memory and higher thinking. So last week I was hoping that my walking had increased my BDNF levels as I wanted to participate in the Narrative magazines 6 word story challenge. 

Also launched last week, the challenge reflects Ernest Hemingway’s creation of the six-word story. These combine poetry and drama into a short form, which has grown in popularity despite it being difficult to achieve. Hemingway’s most famous 6-word story is possibly: Baby shoes for sale, never worn – I also liked the Booker Prize winner, Margaret Atwood’s 6-word story: Longed for him. Got him. S**t. Anyway, despite all my walking, I don’t think my BDNF level was increased sufficiently to match Hemingway and Atwood’s efforts. 

Given the black place I have found myself in over the past couple of months, I thought this 6-word story might be apt: I’ve low serotonin levels; very depressing – interestingly, the medication I have been taking for my depression comes in the form of tiny white tablets, but my goodness they have made a difference. If you are interested in the 6-word story challenge, please free to send your suggestions to me, and/or to the Narrative magazine challenge, which can be found here.

Sunday, 20 August 2017

Dressing down in a dressing gown – the naked truth

Early one morning last week I was out walking with Cello. The sun hadn’t yet got round to warming things up and it felt like winter had arrived. I was in a world of my own thinking about the day ahead. Out of the corner of my eye I saw someone coming out of their cottage, cross the road and root around in their car boot. As I got closer I could see it was a female and she was still wearing her pyjamas. She didn’t seem the least embarrassed to see me and even said good morning as she went back inside her house. I on the other hand, felt like some kind of inadvertent voyeur, and did feel strangely embarrassed.

I don’t know why, but then again I'm not alone. I recalled the public debate on social media last year when a chap called Chris Cooke posted a picture of two women shopping in the Salford Tesco’s and complained loudly that Tesco should ban anyone dressed as such in their pyjamas and dressing gowns. As far as I know Tesco have not actively enforced the ban that it introduced in 2010. They were later than the UAE, who banned the wearing of bed wear to work in 2006. Back in the UK, the Daily Mail, a paper dedicated to protecting our morality and our human rights, sent out two of their female reporters in their pyjamas to see where they could get into and where they might be barred. The Houses of Parliament were no problem, nor Harrods, The Ritz, the National Gallery or even Pret a Manger – all of which let them come in and go about their business.

The issue divided the UK into two groups - with one group seeing the dressing down in pyjamas as indicative of people’s slovenliness, laziness and disrespect for others, whilst the other side saw the fun side, talked about free choice and welcomed the new fashion fad. Nigella Lawson admitted to enjoying all-day pyjama parties and former Conservative Prime Minister, David Cameron admitted he liked to lounge around in his pyjamas, if working from home. I think I side with the fun loving group as do two of my grandsons who like nothing more than to get changed into ‘onesies’ and playing outside in them, and yes, going shopping in them to Tesco’s.

However, whilst increasingly pyjamas might be our favourite item of clothing, perversely actually sleeping in pyjamas (the reason we have pyjamas) is actually bad for our health. Now I have, in fairness at this point, to declare a personal interest – I haven’t worn pyjamas since I was 11 years old, and the last time was when I was admitted to hospital to have my appendix removed. I feel somewhat alone in my naked sleep mode. According to the American Academy of Sleep 92% of people globally go to bed wearing pyjamas.

Thankfully the science is with me. Research suggests that our bodies are designed to cool down while we sleep – wearing pyjamas can actually keep us to warm, which for many people will disrupt their sleep cycle. Those who sleep naked have better diets and increased happiness levels – and also due to released hormones naked sleepers can wake up feeling sexier. Feeling sexier aside, there are a number of surprisingly important public health issues to think about when it comes to deciding what you might wear in bed.

Generally, it is better to let what my Mother might call the ‘nether regions’ or ‘down there’ to breathe in order to prevent bacteria from gathering. Men who have liberated themselves from wearing pyjamas, but still want to wear something (underwear) are more at risk than women, (but for different reasons). Whilst a cool body at night helps keep blood pressure regulated, the prevailing perception is that men who wear tightly fitting pyjamas and/or underwear at night have a heightened risk of their fertility being affected. For women, the potential problems of wearing pyjamas to bed are more to do with the possibilities of yeast-borne infections – but it has to be said the risk to most women is very low.

I think that given the word pyjama has been around since 1800 (taken from the Urdu pay-jama) as a fashion statement, public health issue, and/or a way of expressing our sexual being, we might still have some way to go!