Back to Marmot, a Foot in the Door, and Dubai Airport at 03.45am

It was Lord Marmot who in his publication Marmot: A strategic review of health inequalities in England post-2010 set out the six main policy areas that required action to be taken if health inequalities were to be reduced. These policy areas: (1) Give every child the best start in life (2) Enable all children young people and adults to maximise their capabilities and have control over their lives (3) Create fair employment and good work for all (4) Ensure healthy standard of living for all (5) Create and develop healthy and sustainable places and communities (6) Strengthen the role and impact of ill health prevention provide the strategic framework for developing a fully integrated public health policy for England.

The UK Government’s Health and Social Care Bill 2011 introduced the new Health and Wellbeing Board which is charged with improving local health and social care, and reducing health inequalities. It sits within the local authority, although responsibilities for delivering many of the Boards functions will have to be shared between agencies. The Health and Wellbeing Board have a statutory responsibility for the delivery of a local Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy in order ensure joined up commissioning across health, public health, social care is achieved. What’s exciting about these changes is that the Board will need to think more creatively for innovative solutions and draw upon wider services in order to more effectively promote health and wellbeing, and for delivering value for money.

So I was pleased this week to read the publication from the Northern Housing Consortium entitled A Foot in the Door. This publication is both very informative (in terms of describing the emergent health and care structures and organisations) and a useful and useable ‘tool kit’ for those working in the housing sector to use when looking at developing more collaborative relationships with health and well being commissioners and providers.

The NHC Chief Executive, Jo Boaden is enthusiastic about tackling some of the complex issues that result in such persistent health inequalities. The toolkit reminds the housing sector that they already have an invitation to get involved and that the agenda for change is clear. Poor housing conditions are implicated in up to 50,000 deaths in the UK; cause 0.5 million injuries and illnesses that require medical attention; and contribute to increased risk of cardiovascular diseases, respiratory diseases and depression and anxiety.

There are huge economic issues associated the provision of poor housing. The estimated costs to the NHS in England each year is around £600m to provide treatment for health problems arising from poor housing. In 2010 the average cost of a fractured hip is £29665; five times the cost of an average adaptation and 100 times the cost of fitting hand and grab rails for older people. Research shows that investment of £1.6bn in housing related support generated savings of £3.41bn to the public purse including £315m of savings to health service in a year. The NHC note that investment in specialist housing could result in savings to the public purse of £639m each year, including an estimated saving of £11751 per person to the NHS for those experiencing a mental health problems.

The challenges for the School in responding to these opportunities are fantastic. Developments such as these in the Schools operating environment present us with a much wider range of opportunities to bring our combined expertise to bear in developing new programmes of education, research and engagement. However, I will have to leave such thinking until later. Instead of sitting in my bed with a cup of tea at 05.00 am on Sunday morning writing this blog, I am in the Business lounge at Dubai airport on my way to Australia and its 07.45 am 03.45 UK time, some 7 hours after leaving Manchester last night. And I’m just a little tired to be thinking about anything other than the next 14 hour flight to Melbourne. The really good news is that Qantas (the internal carrier for Emirates) have gone on strike. I am not sure how I get to my final destination, Adelaide!

Three Weeks Early and One Week Later.

Two hours after writing my blog last week, grandchild number six was born. Heavily pregnant Rebecka was staying over to meet older sister Jennifer who was visiting on the Sunday. Just as I finished my blog Rebecka announced that her waters had broken and it was all action stations. At 06.50 little Jack was born – three weeks early. Conceivably [sic] the midwife who delivered Jack would have been trained and educated at our School, more of which later.

As Rebecka has yet to return to her own home, preferring to stay here all week, it has been a somewhat busy week. It’s been more late nights and early, early mornings. The West Wing resembles a maternity unit, and the number of visitors arriving during the week has made Amsterdam Airport on a busy Bank Holiday weekend look completely tame. Yesterday it was the Lincoln contingents turn. Now Saturdays are meant for doing the chores and starting the relaxation promised by a weekend away from work. Yesterday turned out different. I got to understand where the ninth century Bishop Aethelwold of Litchfield was coming from when he commissioned the manuscript The Book of Cerne. The work is famous for its inclusion of the Harrowing of Hell, possibly the earliest surviving Christian drama script. This play describes Christ’s decent into hell. Spookily the story is depicted in a wonderful stone frieze high up on the walls of Lincoln Cathedral.

Tuesday was an interesting day. The morning was about dealing with what turned out to be in-appropriate behaviour by a student towards other students and staff in the School. A difficult meeting to have and unfortunately it was a meeting with a very sad outcome. Unlike the afternoon which involved a PhD viva. As regular readers will know, I think that taking part in PhD viva is a huge privilege. I tend to treat each viva as a chance to have a conversation rather than simply facilitating an examination. And so it was on Tuesday - it was a great conversation and the outcome was a good one.

Thursday was slightly stranger day. I was lucky enough to be part of a group visiting Keele University to explore partnership opportunities. So 08.30 saw me sitting in a mini-bus travelling down the M6 motorway alongside the VC and other assorted colleagues from across the University. My day at Keele was hosted by Professor Andy Garner, an internationally renowned academic and practitioner from the field of Pharmacology. He is the Dean of Health and Pro-Vice Chancellor at Keele University, and introduced me to the first virtual ward I have ever seen.

Imagine walking onto a ward that is there, but as you try to touch anything, a bed, a patient and so on, it’s not there. Yet you can pick up the patients notes, flip the pages, and read everything that has been written. You can talk to the patients and be with them while they vomit (yes into a bowl that you can see, but can’t touch or smell), and you can intervene and provide treatment – if it happens to be wrong it might kill the virtual patient, which of course is much better than doing so in real life. The experience showed me what might be possible at Media City, and possibly what it is I don’t yet know about what it is I don’t know in terms of using such technology.

And as we enjoy a slightly warmer and brighter weekend than at first thought possible I am sending envious glances to those colleagues who this weekend are able to walk in the hills or on beaches, but I am also sparing a thought for those colleagues who might be busy preparing for their viva on Tuesday, or making a start with sorting out their expressions of interests for the new Director roles.

And those midwives – an interesting experience. Clearly they are very good at doing what they do, but I found the juggling between what is offered as official advice and guidance and that gleaned from practical experience an interesting cultural manifestation of what appears to be contemporary midwifery practice. I won’t say anything about the quality of the written comments the midwives make when reporting on what they have encountered at each visit, but I do intend to write a paper about the obscurity of succinctness in such records.

Old Feet, Insularity, and is it Time to Change

Last week was another busy week which by the time I got to Friday night left me feeling exhausted. I think I may be getting to old for the late night - early morning combination – and this week there have been a lot of both. It may also be due to having been at the V+A twice in one week – which as regular readers of this blog know, is not my favourite hotel in the world. I have also been to London to meet the Chief Nurse, Chris Beasley on a day when a stalled train outside Milton Keynes meant a 40 minute delay at the end of a very long day. Foolishly as I walked around London, I forgot I was wearing new clogs and without socks (it’s a long story) and of course ended up with feet that look as if they have been wrapped up for a week in barbed wire. But none of these experiences accounted for my sense of it being a strange week.

And this week as I was attending the opening of the Salford University International Life Centre (well done Liz!) I also read the news that the Health Professions Council's Welsh Language Scheme (an interesting notion in its own right) was approved this week. The Welsh Language Act 1993 established the principle that in the conduct of public business and administration of justice in Wales the English and Welsh languages should be treated on a basis of equality. The HPC is committed to offering services to the public in Wales in the language of their choice. Apparently, this is a great step for the Welsh language, which not so long ago was in real danger of becoming obsolete. As well as preserving the heritage of the country, this move could encourage more people to learn Welsh, and for the language to receive greater public use. It seems that learning Welsh can provide you with more than just another way to speak. I am not sure what exactly, and before all you Celtic Warriors write in, four of my five children were born in Wales and it’s a place I have some super memories of, and of course you were robbed yesterday in New Zealand…

Closer to home, it was good to see the announcement that Comic Relief and the current UK Government will be joining forces to help tackle mental health stigma, Between them they have pledged funding of £20 million for Time to Change, the leading stigma and anti-discrimination campaign, run by Mind and Rethink Mental Illness. This is the first time that the long-standing campaign has received Government funding: up to £16 million over the next four years. It will also receive £4 million from Comic Relief. Love the coincidence of corporate colours.

This new funding will allow Time to Change to reach 29 million members of the public and increase the confidence of 100,000 people with mental health problems to challenge stigma and discrimination. So far so good you might think. Perhaps it was when the Care Services Minister Paul Burstow commented on this announcement that I again experienced a slight sense of the bizarre. He was visiting Dukes, a gym, this week, and noted how young people with low self confidence have this boosted by attending the gym and learning to box and the other people at the gym get to see that people with mental health problems are no different to the rest of us, Ouch – this is from a man who in February, with Deputy Prime Minister Nick Clegg announced the No Health Without Mental Health strategy.

Paul and his wife Mary, a Liberal Democrat councilor, are of course famous for their saving the Cheque Campaign. Younger readers might need to ask their parents what a cheque is. And is it just me, or does Paul bear a striking resemblance to a certain Asst Directors of Commissioning and Education working  in the former NHS Northwest? Unfortunately I couldn’t find an image to compare, but Google did offer up an image of a lovely cuddly kitten on the search page.

Finally, just in case we forget, one in four of us will suffer a mental health problem. Many individuals will experience some kind of discrimination as a result of others finding out about their mental health. However, aaccording to data from the Institute of Psychiatry, King’s College London, there has been a 4% reduction in discrimination since the start of the campaign in 2007, which equates to 23,500 more people living lives completely free from discrimination.

Cod and Alphabet Spaghetti, Outcomes and Abstracts, and Cello has a Rest

Thursday I spent the day in Liverpool. At the Hilton Hotel which has to occupy the windiest and coldest spot in the whole of the City. I was there to take part in the Council of Deans of Health full meeting (CoD). This is a group that represents nurses and allied health professionals and ensures these professions have a voice at the political table. On this occasion, there were 119 members in attendance, a record number of Deans and Heads of School from each of the four countries of the UK. The agenda was a packed one and although there was some time to network, our noses were firmly held to the grindstone.

I enjoyed the discussion and exploration of the recently announced Education Outcomes Framework (EOF) consultation. This is an extremely important work for all educational providers, and colleagues across the UK are encouraged to respond. The framework supports the integrated healthcare workforce in meeting the clinical outcomes set out in the NHS, public health and social care outcomes frameworks – the overarching policy within which the education framework is nested.

From a educational perspective the EOF identifies what Health Education England (HEE) is likely to expect in terms of outcomes and how these outcomes would monitored by the Department of Health, HEE, and HEE and the Local Education and Training Boards (LETBs) and the LETBs and providers such as our School. Perhaps somewhat closer to the Schools ambitions the EOF provides a direct line of sight between education and training we provide and how this impacts upon patient experience.

Colleagues in the School are resurrecting a bid to see how we might best involve service users in articulating a view as to how we are preparing nurse for practice. I expect we can also transpose this to social care, and I would love to be able to do something similar with social policy! The EOF is being promoted as a catalyst for driving quality improvement and outcome measurement throughout the NHS, and I am sure in the fullness of time, a series of Key Performance Indicators (KPI). One way or the other the EOF is an important piece of work that needs commenting on – so go online and make your voice heard.

This week has also seen me writing a series of abstracts for next year’s NET/NEP conference in the US (you either know these abbreviations or not, and life is too short to write out every full name). Writing abstracts is one of my favourite things to do. I love the challenge of ‘selling’ an idea or an outcome in 300 words or less – I also like the challenge of finding a title that will stand out from the rest. Last year NET/NEP received over 900 abstracts and so it can be difficult to make sure your abstract sticks in the mind of the scientific committee. I hope to have achieved this with the abstracts sent in.

This week the weather changed here in the UK – for the worse. The sunshine and heat of last week was replaced by rain, high winds and cold. The cold has turned the green leaves of my blueberry plant crimson – amazing. Wednesday morning at 05.00 am, it was very dark, close to freezing, but with a sky filled with bright stars. As romantic as this sounds, taking Cello out in the morning has been rather like going for a walk dragging a reluctant soggy brown paper bag behind you – but as this week marks two years of getting up at 05.30 for a walk maybe he is entitled to the odd lie in.

And Alun, thanks for the good news, Keith a healthy diet does not usually come out of a polystyrene container, Sue, Happy Birthday – life begins at 50, Karen, Olga and Jurate, thanks for the wonderful company at dinner this week, well done Ieuan, it couldn’t have been easy, Dean and Sam, you’re a perfect pair, Stewart, remember there is usually no gain without a little pain, especially when trying to stand on your own two feet, Ghassan, well done, and I am glad I hold a Gold Card with Emirates, Sarah, keep the emails flowing, and many congratulations to Nancy, Jane, Nick and Jill, all of whom secured Associate Head roles in the School, against some stiff competition.

Falls, Man Flu, and Talking with Psychologists

Two of my relatives fell over last week and injured themselves – one is 84 and the other 4 – and neither could account for themselves or why they had fallen over. Thankfully apart from some bruising, grazes and possibly hurt pride, no serious injury resulted from the fall. My relatives are not alone. In a report published by the NHS Information Centre last Thursday, it was reported that 20,800 hospital admissions in England over the last 12 months have been for people having a fall involving a bed, 12,000 admissions were for people who had falls involving chairs; 6,400 admissions for people falling from ladders; 1,200 admissions for people falling out of trees; and 170 admissions for people falling from cliffs.

Today sees the start of the Conservative Party Conference (held in Manchester). Given the Government statistics about falls, and the somewhat risk adverse society we have become, I would not be surprised to see calls from the conference floor for legislation that saw people being advised to sleep on the floor, all trees other than bonsai trees to be cut down, all chairs to be fitted with three point safety harnesses, ladders to be no taller than one metre, and all cliffs to be fenced off.

On top of having to deal with these risks to our health and well being, we have had an unprecedented heat wave to contend with in the UK this week. Not that I have noticed. Following my trip to Lithuania, I went down with a cold and cough and have been enduring high temperatures all week.

Monday I was at the University of Cumbria first thing, and this was for a meeting at the Lancaster Campus. It was the first time I had visited this campus. For those of you who have not been there the campus is made up of a collection (yes that is the correct word) of some very different (and again that is the correct word) buildings, in terms of styles, ages and architecture. The meeting was of the Council of Deans North West.

Sadly, the solidarity that had been evident throughout the last year across the group representing the 11 Universities in the North West, and which had provided us with so much influence at a regional and national level was challenged by the actions of one University seeking to unilaterally exploit a business opportunity that we had collectively been working on for the last few months. In 1850, one Frank Edward Smedley from Great Marlow in Buckinghamshire, UK said that that all is fair in love and war and maybe, just maybe, it is also true for business relationships too.

And relationships, as I have said many, many times are all important. Last week saw the publication of the Personal Social Services Adult Social Care Survey. This User Experience survey is an annual survey that seeks to gain an understanding of service users' views about the care they have received rather than simply measuring the quantity of care provided. The survey aimed to learn more about whether or not the range of social services provided are helping individuals to live safely and independently in their own home and what was the impact on their quality of life. Some 61,000 people took part in the survey and of these:

62% said that they were extremely or very satisfied with the care and support they received, but only 42% said they had as much social contact as they want with people they like, and only 57% of those asked said the way they were helped and treated made them think and feel better about themselves. So maybe there is some way to go yet!

And for me, last week was equally full of such contrasting experiences: the best meal eaten was that taken with my Head of School colleagues at the Café Istanbul, the worst moment was opening up my email after a 3 hour meeting to find I had hundreds of new emails, the longest phone call was with a colleague in Australia, the best cup of coffee nearly drunk was at Wednesday's catch up meeting, and the most relaxing walk, was with Cello, early Saturday morning, up to High Rid, and finally, the most unexpected but welcome conversation this week, was with my favourite psychologist of all time, standing at the top of the stairs in Allerton late on a very hot Friday afternoon.