A Few Glances Back; Looking Forward to the New Year

This last blog of 2014 comes partly from cut and paste lines taken from the 52 blogs I've posted during the year. I hope you don’t mind, but sometimes I like to glance backwards and glimpse a memory or two of the things that caught my attention. For example, In 2014, 30,000 people got on their bikes and cycled the 54 miles London to Brighton British Heart Foundation (BHF) Bike ride. Since 1980 650,000 riders have taken part raising some £40m for the BHF. One of my PhD students also completed his PhD studies – he study explored the use of bikes and the development of contemporary cycling. During 2014 over 19,000 cyclists were killed or injured on UK roads.

Just in 2014 alone 19031 people were suspected of having Ebola, 12041 were confirmed as having the virus. Unfortunately, of this group, 7533 people died. During 5th August to the 11th November 88,246 ceramic poppies created by artists Paul Cummins and Tom Piper were planted at the Tower of London marking the 100 years that had passed since Britain became involved in the First World War.

On the 17th July Malaysia Airlines Flight 17 (MH17) was shot down 50 km from the Russian – Ukraine border killing all 283 passengers and 15 crew on board. The passengers had no chance to say goodbye to their loved ones, and in this same week I heard that my former wife, friend and gardening mentor had died. We had separated 20 years previously and hadn't maintained contact. But it still hurt not having the chance to say goodbye. During 2014 201 people died in UK prisons

On the evening of the 14th February, ITV showed the first of 8 episodes of the now successful Student Nurses: Bedpans and Bandages. It was a fantastic showcase for our student nurses, colleagues in the School and in practice. It attracted audiences of between 4-5 million for each episode. 

Someone who is still going strong however is Paddy. Paddy is the oldest person in my Scottish village. She is a lady in her nighties and a lady with a distinct tinkle in her eyes. In March we were both at a house warming party where the average age was 60+. Paddy has lived in the village for over 40 years. When she first arrived there was a staggering 21 doctors living in the village and its surroundings. These days there are only 4 doctors (and one professor – me).

No doctors (or professors) were need on the 7th May, when Harry, brother to Jack and grandchild number 9 made his appearance into the world. He was a home delivery, a delivery facilitated by a midwife trained in our School. And on the 16th of August in the quintessential English village of Hornby, our youngest son Joseph married Louise – it was a great day and for the first time in many, many years, all 5 children were together in the same place. I made my stage debut with Ruby Wax on the 18th March, she was a great person to work with and we had many shared views of how to improve our mental health and wellbeing.

What improves my mental health and wellbeing is being outside and I love being unencumbered and free in my gardens. In June of last year, the House in Scotland gardens featured as part of the Open Garden event. It was a huge success. The weather was fantastic and over 180 people walked through the gate (all having paid a £4 entrance fee, the proceeds of which went to charity). It was the garden to see and was described as 'the most interesting, creative and fun' garden  in the village. 

Of course most gardens are ever changing places, and I love walking through mine bare foot, stopping to look and think about the changes I need to make, and consider those that nature is making for me. Whilst not quite a metaphor for our School, I know that next year the world will bring the School challenges and changes that we will need to stop and think about how we might best respond. Whatever you are doing to bring in the New Year I wish you and yours well. Thanks for taking the time to read these blogs and I hope you feel inclined to continue doing so in 2015. 

Foodbanks, French fries, Fat Fines and Happy Christmas 2014

Last Friday I worked from home. As a consequence I was able to get out early to do my shopping. Usually I shop at my local Tesco’s (there are other food retailers) and on this occasion it was no different. In the store there was a sign saying how successful this year’s food collection (in partnership with the Trussel Trust and FareShare) had been. Twice a year customers are encouraged to donate an extra item of food when they go shopping, which is then distributed to foodbanks. Tesco pledge to add an extra 30% to the donations and this year the food collection helped provide 4.7 million meals to people this winter.

As to why, in the UK, in 2014, we need to have foodbanks is the subject for a future blog. I was struck however, in reading of the food collections and a story seen on the same day about the rationing of french fries in Tokyo’s McDonald fast food outlets. Despite airlifting over 1000 tonnes of potatoes there is a shortage of potatoes and McDonald's are having to serve only small portions of chips to their customers. There is a considerable evidence base that links fast food intake to obesity. But whilst the lack of availability of fast foods might be a good news story in the UK, where the rates of obesity are around 61% of the population, the same isn't true for Japan where only 3.5% of the population are classed as being obese.  

Japan has a unique approach to dealing with obesity. And selling completely black-burgers, this year's 'food craze' isn't it. Unlike Dubai, who pays people to lose weight, or New Zealand where overweight immigrants cannot gain an entry visa, Japanese citizens must adhere to a government-mandated waistline measurement or face the consequences. Waistline measurements have been set for men and women aged 40 – 74. For men, 33.5 inches, women, 35.4 inches. These limits are part of a wider approach to reduce the health costs resulting from problems such as diabetes and vascular disease, particularly in Japan's growing ageing population.

People whose waistlines are bigger than the prescribed limits are required to attend counselling and support sessions. Companies and public sector organisations face fines if the targets set are breached – these targets include not only current employees, but their families, and even retired employees. Employees have annual check-ups. The fines imposed can run into millions of pounds a year for large companies. Somehow I can't see Public Health England adopting this approach to improving the health and wellbeing of the general population.

But I was impressed with the approach set out in the Care Act 2014, which possibly represents the greatest reform to how we conceptualise integrated health and social care since the Beverage Report. According to the Social Care Institute for Excellence the Care Act represents a real opportunity to adopt an assets-based approach to planning, commissioning and developing social care. Asset-based or strengths based approaches recognise and value the relationships, skills, shared facilities and networks we use as individuals and in our communities. 

Such approaches help ensure that people who might require services are not just problems that need fixing by the State. It’s a person-centred approach that recognises that individuals should be given a voice which can enable them to have a greater say in the way local health and care services might better help support them. Possibly, it could also be an approach that is more effective at improving the health and wellbeing of individuals and the communities they live in than reducing the number of chips served or imposing fines for bigger waistlines. 

Expanding waistlines might be on some people’s minds this week – we are, after all, in the run up days to Christmas 2014 – in this house we have at least three Christmas Days with three Christmas Dinners, a consequence, and a good one, of having a large extended family - I love it! Today it is time for Christmas Dinner II. I hope you have a great Christmas celebration too and here's wishing you, your families and your friends a relaxing and peaceful time. 

I Heard the News Today and Oh Boy, The World Is Changing!

I've not read a newspaper in many a year – well I've not held a newspaper in my hands, one of the old fashioned sort, made of wood pulp and recycled materials. I guess its people like me that have contributed to the demise of the printed word, especially in the form of a daily newspaper. These days, like many other people I hear the news on the radio, or read on-line versions of newspapers and/or TV news programmes. I often hear the genesis of a breaking news story on my way into work and then hear how the story has developed during the day on my return journey.

One newspaper that has successfully made the transition from pulped wood to digital is the Guardian. Although this is not a newspaper I would particularly want to read, the Guardian is one of the most read English language news websites in the world, with 111.5m unique browsers accessing this web site each month. The fact that it doesn't make a profit (£31m loss this year, £33m the year before) doesn't seem to matter.

Last week saw the announcement that the Guardians Editor of 20 years, Alan Rusbridger (whose annual salary is £491,000) is to retire next summer. Under his editorship, the Guardian was awarded the Pulitzer Prize for public service (following the exposure of the surveillance activities of various US governmental security organisations). It was the Guardian that first broke the News of World phoning hacking story, which eventually led to the Leveson enquiry into press standards.

All good stuff and I wish Alan a long and happy retirement. However, it was a story in another newspaper that caught my eye at the start of last week. I had heard the radio announcer say they were to do a piece later on in the news bulletin about how digital technology is being used to help blind people see. Due to finishing my journey I missed the story and searched on line for it. Alas, to no avail. What I did find was a story published by the Telegraph newspaper (one I would be inclined to read) from way back in April this year. Reading it made me stop and think.

It was a story drawn from a research report published by the Royal National Institute of Blind People (RNIB) about the dwindling numbers of Eye Clinic Liaison Officers (ECLO) to be found in specialist eye hospitals. The report (can be found here) notes that often these clinics are so busy that doctors and nurses have little time to discuss with patients how they might deal with the loss of their sight. Only 218 of more than 400 eye clinics and hospitals have support staff, trained and skilled to provide advice on practical issues or to offer emotional support when people are told their sight cannot be saved. Having spent 2 weeks trying to get my glasses sorted (yes I know I should have gone to S********s) and struggled to read my computer screen, mobile, and the many requests for money that pass over my desk every day, and feeling very sorry for myself in the process I cannot begin to imagine what it must be like to be told you are losing your sight and there being no one there to help.

There was a group of health care professionals who were up in arms at the end of last week because they believed they would lose the opportunity to help and practice as specialists. This group were the Mental Health Academics UK (MHAcUK). Lord Willis (who is the independent chair of the Shape of Care review into the future nursing workforce) gave an interview to a journalist last week. In it he was said to advocate a more generic approach to the early part of nurse education, with specialist knowledge and skills being a feature of the later part of the educational programme (perhaps even into the first year of practice as a newly qualified nurse). Whether he said these things or not, the MHAcUK group appeared to feel the role of the mental health nurse was doomed.

One consequence was that last Thursday and Friday my in-box was filled with emails from mental health (academic) nurses intent on marching to the House of Lords and demanding full recognition for the skills and knowledge mental health nurses have as a profession. I am a mental health nurse by professional background, and I disagreed with the stance taken by MHAcUK and told them so. I thought they were missing the point of the review. Indeed mental health nurses only deal with a very small part of the population who experience mental health problems. 

I do recognise that often they work with people who mental health needs are complex and challenging. But the world is changing – as with newspapers, digital technology is challenging traditional service delivery and facilitating greater service user involvement and determination of service provision. Likewise, who actually provides services these days is changing. As my colleague Professor Davie Richards so eloquently noted last week ‘In the 1970s and 80s, mental health nurses were the obvious professional group suitable for training as psychological therapists. In the 21st century, newly qualified mental health nurses do not have the skills and knowledge to care for and treat the most prevalent and epidemiologically burdensome mental health conditions, requiring the English NHS to invest £700m over the last 6 years establishing and training a totally new workforce to do the job. The two most prevalent and burdensome mental health conditions – depression and dementia – are currently, and will in the future be even more so, the business of non-mental health professionals. People with dementia receive their care overwhelmingly from professionals, informal carers and para-professionals, not mental health nurses’

Mental health nurse academics like newspaper editors and owners perhaps need to change their view of the world. In this case, to consider once again, what they should be thinking about in terms of providing the best and most appropriate educational preparation for our mental health nurses of the future.

Just One Drink, Nativity Play Bashing, and Being a Sheep for Just One Day

The Anchor Hotels main bar was almost empty last night. Even in deepest Winter this is a rare occurrence. Whilst it was cold, and everything was covered in a white frost, as always, there’s was a cheery log fire burning brightly in the bar equalling the warmth of welcome from Sharon, Robert, Lyndsay and the rest of the staff. For me the Anchor is just a short stroll along the sea front from the House in Scotland, but for many others getting there will require a car. I think this was the reason the bar was so quiet. At one minute past midnight last Thursday/Friday Scotland’s new alcohol limit for driving was introduced. The new legal limit is just 50mg in every 100ml of blood (in other parts of the UK it is still 80mg per 100mls).

This means that even having just 1 pint of beer is likely to take most people over the limit. Between midnight and 06.00 on Friday 4 people were arrested for being over the new limit. 79% of Scottish motorists support the new reduced limits, and the RAC found that some 38% of UK motorists (living outside of Scotland) believe the lower alcohol limit should apply across the whole of the UK. 23% wanted a total ban on consuming alcohol before driving. This time of the year, most Police forces in the UK have a crackdown on drink driving,and such campaigns are almost a Christmas tradition.

A growing Christmas tradition appears to be Nativity Play Bashing. Last week the newspapers were once more full of critical narratives bemoaning the loss of the more traditional Jesus and Mary approach, or ridiculing the inclusion of astronauts and other assorted non-traditional cast members. Given the past week saw: the death of Jeremy Thorpe; massive civil rights inspired rioting on the streets in the US; NASA sending its first people carrying rocket beyond Earth’s orbit since Apollo 17 in 1972; and the WHO acknowledging that, 33m people around the world are living with HIV, and 11m don’t know they have the virus- complaining about children’s nativity plays seemed somewhat daft and churlish.

Grandson Jack didn't complain about being part of his Nativity play. This year he was a Sheep. I can’t show you what a good looking Sheep he was, because photos taken at the play are forbidden from being used on any social media site. Here's one of Jack and his brother Harry instead. Such is the world we now live in. Unfortunately it’s a world where the British police are to launch their new tool in the fight against child abuse. CAID (Child Abuse Image Database) next week. This database will store 10s of millions of photos, and videos which can be scanned and searched for images previously linked to child sexual abuse activity. The system was created by team of Swedish computer software designers.  

There were just under 9000 cases of abuse against children aged 7-14 in Sweden last year and just over 3000 reported cases of abuse against children aged 0-6 in the same period. Sweden, of course, is famous for having a culture completely intolerant to drink driving. There the limit is just 20mg per 100mls of blood. There are severe penalties for those in breach of this limit, including imprisonment. The Swedish School association in Scotland has already performed its Swedish Nativity play (Julspel) this year. 

I am not sure how many sheep were included, but Sweden isn't known for its sheep flocks. The country is home to 9300 flocks containing some 300000 ewes and rams. The average flock size is about 30 sheep, with 30% of flocks having only nine sheep or less. In comparison, Jack, for just one performance swelled the ranks of the 23m sheep that make up the national flock in the UK - and he did it in style! Bah Humbug to all those who can’t enjoy a great children’s Nativity play.