That Was The Year That Was

It was the social theorist, Pierre Bourdieu who coined the term ‘conjunctures’ to describe the social contexts within which social change can occur. It's a way of thinking that explores possible relationships between time, demography, race, economic status, education, family cohesiveness and so on. However, social life is not always conveniently organised in this way. Arguably any possible association between conjunctures, personal and societal characteristics and a particular outcome, is at best, likely to be indirect.   

But that doesn’t stop many of us travelling through life comfortable with having a sense of a possible future and a feeling of trajectory. Thus we attend school and university to learn, to gain qualifications, which, in time, might support a career choice. We work and save our money to buy a house and/or perhaps start a family and so on. We reassure ourselves that we ‘know where we are going’ and what our future will be like. Can I suggest, that for many of us, this sense of purpose and control is completely illusory. We tend to ignore the fact that many of our life experiences are riven with uncertainty. And I think most of us prefer to be able to live our daily lives with at least the illusion of certainty and predictability. 

I was reflecting on these thoughts as my clock hands turned through midnight, and the last day of 2017 started. In another few hours a new year will begin and with it will come new opportunities and challenges. It will be my 63rd year, something I was also thinking about. Some of those years have passed by in a blur, others stick in my memory for both good and bad reasons. Getting married; buying a small-holding in Wales; the birth of my children and becoming a father; qualifying as a nurse; and being appointed a professor for example. These were all positive events that were, in the main planned and expected. Other years have given rise to less positive memories. I remember the Aberfan disaster; the horror of 9/11; the Lockerbie bombing; and the Manchester arena attack. These dreadful events remind me of the sometimes uncertain and unpredictable world we live in.

My 2017 year was full of planned and unplanned experiences. Grandchild number 10, Carys, arrived as expected, David, my brother-in-law died, unexpectedly. I sold my Jaguar and bought a hybrid Toyota. I was interviewed by the NMC, BBC, CQC and was told I owed no money this year to HMRC. My personal life and my relationships with others proved to be very turbulent – mainly due, as Leonard Cohen once said, ‘to those promises I made and could not keep’. The impact of these relationship choices on the lives of others was profound, and not for sharing here. I entered my second year as an Associate Pro Vice Chancellor and finally got the Industry Collaboration Zone programme up and running. And chose to retire 1 year earlier than I had always planned to.

Some of these events and experiences I hadn’t predicted or planned for. Equally what I wasn't expecting to happen was to develop an all consuming depression. It very stealthily crept up on me and when I finally realised what was happening and sought help I was at a very low point. I am not sure whether there was a cause and effect relationship between some of things that happened during the year, and my depression. Thankfully I have been, and continue to receive great care from my GP. He has been a constant point of support the last 6 months. I am not sure where he gained his experience of helping those with a mental health problem, but I have definitely benefited from his wisdom and knowledge. I don’t feel ‘cured’ but I do feel better in myself.

It has been a strange year and one that at times I have struggled with. Fortunately I have also been blessed with some very good friends, and family, who have also unconditionally been there for me. I have a long retirement to look forward to, and so far, 2 months in, I absolutely wonder how on earth I ever had time to work! Among my Christmas gifts were cookery books. Reading these has rejuvenated my love of creative cookery, something I have not always had time to do when working.

I was also given the ‘No such thing as a Fish’ Book of the Year. A brilliant read, jammed pack full of facts and information on the weirder side of 2017. When I opened it to have a quick look, the page fell open on the story of Rabbit Hash Town, Kentucky The good people there elected a Pitbull called Brynneth Pawltro as the town’s Mayor. It is the 4th year in a row they have elected a dog as Mayor. This year, however, the dog faced stiff completion from a donkey, cat and a chicken. Having helped a Parliamentary candidate fight the UK 2017 General Election, an experience that had me vowing to steer clear of politics for the rest of my life, the American system sounds so much more fun. 

As I have traveled through my year of sometimes challenging ‘conjunctures’ there has also been much advice and information to be heeded along the way. For example, we should all buy the smart toothbrush that warns of impending heart problems; and there has been a renaissance in the thinking that sees LSD as a brain booster (takes me back 40 years); and that the average number of lies (false and misleading claims) made by Trump each day currently stands at 5.5 (according to the Washington Post); and finally, where the most Googled question in 2017 was ‘what is cancer?’

Against this backdrop of rather weird bits of information I just wanted to say one thing, but say it very clearly. Dear reader, many, many thanks for your support during 2017. I hope your 2018 brings you what you want, or at the very least, what you need. Enjoy the next 12 months, but today, I think its enough just to simply keep warm and stay safe. 

Knowing how to enjoy Christmas might be in your genes!

Most years I’ve found my Christmas Blog to be a difficult one to write. What can be said that will be of any interest to potential readers at this time of the year? My Christmas Blog this year also has the disadvantage of being written and posted on Christmas Eve, not usually a day for folk to do much more than sort out all those last minute preparations; shopping; wrap Christmas presents that you’ve discovered at the bottom of the wardrobe; visit friends and relatives and maybe have a glass or two later. So I am not sure what I can write that might provide a reason to pause for a moment or two. My eldest daughter suggested a social media holiday. I am not so sure, life is short.

My neighbour decided to go on a real holiday however. This Christmas she chose to go to New York for a change. I have been there many times and absolutely think it is a great place. It is her first trip there and she was understandably excited. Judging from her very full itinerary I don’t think she will have much time to pause! She intends to do everything on the ‘tourist map’ and more besides. On your first visit to New York it’s always worth getting a guide to show you the main sights. Last week I read the story of Hilda Jaffe. She lives in New York. She is 95 years old and still works as a volunteer guide taking tourists around the attractions. It’s said that she strides rather than just walks. In fact she goes everywhere on foot. Hilda describes New York as a ‘great city for older people’.

Hilda is among more than 600 people aged over 90 who are part of the Longevity Genes Project. Samples of her DNA are stored in a freezer at the Albert Einstein College of Medicine in the Bronx. What is interesting about the studies participants is that many appear to live very unhealthy lives. 50% were overweight, many smoked and many indulged in unhealthy diets. What the research seems to suggest is that there are a number of genetic variants that appeared to provide protection against the diseases of ageing. One in 10,000 people are said to have these protective genes. Hilda’s parents were also long lived. Her Father died aged 88 and her Mother aged 93.

The Longevity Genes Project is being undertaken in the US, a nation seemingly obsessed with eternal youth. Starting in 2018, a 6 year randomised trial involving some 3000 people between the ages of 65 – 79, will look at the impact of the drug metformin on ageing. Metformin is commonly given to treat type 2 diabetes, but animal trials have suggested it can slow the process of ageing. The US regulator, the Food and Drug Administration (FDA) currently doesn’t recognise ageing as a medical condition, so are unlikely to fund the $70 million dollars needed to undertake the study. However, over half this amount has already been raised and I strongly suspect the other half will be easy to obtain.

Peter Thiel made his fortune selling PayPal to eBay. Larry Page was the co-founder of Google. Alongside the creators of Facebook, eBay, Napster, and Netscape they are all using their wealth to rewrite the US science agenda, and in particular transforming biomedical research. Microsoft co-founder bill Gates (said to be the wealthiest man in the world) is just one a 130 billionaires who have signed a ‘Giving Pledge’ to give away at least 50% of their wealth, which collectively is thought to be about $700 billion. Most of this money is going into serious medical and health care research.

Christmas is often thought of as a time to give. Like Hilda, these successful entrepreneurs are giving to others. We can do the same. We can look out for those who may be alone, hungry, cold, vulnerable, homeless and in danger, and each of us in our own way can give something back in helping these folk. It doesn’t have to be millions of dollars. It could be a smile, some donated cans to a food bank, an invitation to dinner or a shared coffee with a neighbour. 

I have some of my family calling later this morning for a coffee, mince pie and a Christmas catch up. Then its driving back up to the House in Scotland for the rest of the Christmas break. I wish you and yours the very best for the season whatever it is you are doing and whoever it is you maybe with. Thank you for taking the time to pause and read this Christmas Eve blog – and I hope you have a very Merry Christmas! 

A Cup of Tea and God Bless You Merry Gentlemen

So the question I asked myself last Friday was: 'what does one do on a freezing December night in a small coastal village in deepest, darkest Scotland?' There was nothing on the TV worth watching, I had caught up on all the catch up programmes missed during the week, and with the Grand Tour Series 2 being spectacularly unspectacular it was down to playing a DVD. A quick look through the collection of unwatched films filled me with gloom. Twitter was quiet and so I contemplated an early night with a cup of Ovaltine.

Then I remembered I had a ticket to the annual village Carol Concert, to be held that very evening in the Village Hall. Mulled wine and mince pies were promised as was the presence of the Kings Grange Singers. They came last year but unfortunately I had missed the concert. I did recall however, that they had received very good reviews. So it was a quick change, which for me these days, means choosing a different colour of clogs, and putting on a warm top. Then it was out into the cold and a short walk to the village hall.

It was packed. The room was warm and there was a general hubbub of chatter as people waited for the evening to begin. Taking a seat I looked at the carol sheet and my heart sank. There were 23 carols and Christmas songs. I thought it might be a very long evening and there was no sign of the promised mulled wine or mince pies. However, I could not have been more wrong. What an evening! The first few carols and songs were sung by the Kings Grange Singers, and then it was our turn to join in. The audience were asked to sing ‘While Shepherds Watched their Flocks’, but asked to sing it to the tune of that Yorkshire anthem, ‘On IIkla Moor Baht’at’. Sounds peculiar I know, but once you have sung it, the version will remain in your mind for ages.

The interval, and the mulled wine and mince pies came far too soon! The second half was just as good. The highlight for me was listening to the Kings Grange Singers version of the ‘Christmas Hallelujah’. If you've not heard a version of this adaptation of the famous Leonard Cohen song, have a listen here (or if you prefer the original listen here!). It was a fabulous experience, and I left feeling very happy and inspired. There was a spring in my step, which was just a little risky given I had already slipped over on the black ice – thankfully sustaining only some damaged pride.

During this cold weather I have been extremely cautious about not falling and injuring myself. I’m not as young as I once was (more of which later) – not that I should perhaps worry. Researchers from University College London and the British Heart Foundation published the latest outcomes from their longitudinal study of ageing. The research involves 6,500 older adults living in England. It follows a previous research study that explored the link between happiness and having a sense of purpose in life, with a lower risk of death. Participants were asked to say how old they felt and then their health was studied over an 8 year period. There were some interesting findings.

People’s judgements about how old they feel can be influenced by factors such as general aches and pains, serious illness, the kind of activities they do, their networks and so on. In the study, these factors, along with people’s actual health state, their mobility and general functioning, were taken into account. The outcomes showed there was an association between feeling older than ones real age and there being a greater risk of an earlier death. Thankfully I fall into the 70% of the group whose average age was 65.8 years but whose average perceived age was 56.8 years. Just as well as over the 8 years of the study, their death rate was some 14.3% compared to 18.5% in those who declared they felt their actual age. It went up to some 25% for those who felt older than they actually were.

Apart from maintaining a healthy weight, drinking sensibly, not smoking, and taking exercise, other factors said to be influential in feeling younger than you actually are included having greater mental and emotional resilience, a sense of mastery and a will to live. This outcome seemed to be reinforced by another study released last week. Researchers working in the Humboldt-University in Berlin, along with 3 other prestigious German academic institutions, published a report of their research which showed that on average, those aged 75 years old are cognitively much fitter than 75 year olds of 20 years ago. The study showed that those who are aged between 60 and 75 years old today have much higher levels of wellbeing and greater life satisfaction.  

And it was ‘Back to (my) Future’, courtesy of my parents last week. They reminded me that I am no longer as young as I once was. In a Facetime conversation last Sunday my Mother had mentioned coming across a press cutting of mine, something about me having a cup of tea with a Virginia Bottomley. I asked her to send it to me, which she duly did. The Virginia involved was one Virginia Hilda Brunette Maxwell Bottomley, Baroness of Nettlestone. At the time she was the Secretary of State for Health and I was fresh faced corporate manager aged 39! I had won a competition challenge she had set, and part of the prize was having a cup of tea with her at the House of Commons. My recollection was that 23 years ago that cup of tea was very much as satisfying as the mug of mulled wine I had last Friday at the carol concert.

Exploring my delusions of grandeur in the company of Florence Nightingale

I think I may be having delusions of grandeur. If I have anything to do with it, in the future, nurses from all 4 fields of practice will be able to describe what a delusion of grandeur is. Typically they are thought of as being a fixed, false belief that one has superior qualities and attributes such as genius, fame, omnipotence or perhaps having great wealth. Individuals with delusions of grandeur often have the conviction that they have some great, but unrecognised talent or insight. Mine is being a Prophet in My Own Time (PiMOT) – which is slightly different from being a Legend in Ones Lunchtime, which also shouldn’t be confused with being a Legend in One’s Own Lifetime. Florence Nightingale is described as the latter in Giles Lytton Strachey book: Eminent Victorians, 1918 (still available on Amazon). So why do I think I am a PiMOT? Well last week just seemed to be jam packed with a wide variety of news items which resonated with thoughts I’ve been writing about for some time.

Back in 2014 I wrote a blog about both the dangers and absolute stupidity of smoking tobacco. I cautioned against the use of e-cigarettes as a substitute to tobacco. E-cigarettes simply haven’t been around long enough for the possible adverse health impacts to be known. It just seems common sense that our lungs are not meant to accommodate smoke or vapour of any kind. Last week researchers from the University of North Carolina Chapel Hill published a report which found that e-cigarettes can lead to as many lung diseases as tobacco. Whilst the study doesn’t make a connection between the use of e-cigarettes and lung cancer, it showed the association with diseases such a COP, bronchitis, asthma. These are outcomes that challenge the notion that switching to e-cigarettes is a safer option than smoking tobacco.

Back in 2015 I wrote a blog about the removal of NHS bursaries for student nurses and the possible rise of the Nurse Associate role. Probably because of the way my mind is wired, I chose to illustrate the blog that week with an image of a 2010 commemorative £2 coin featuring Florence Nightingale (still available on Ebay). At the time I was the Executive Dean of a School, which provided both undergraduate and postgraduate programmes of education and training for many health and care professions. The pre-registration nursing programme always had the largest group of students. We had 2 intakes each year, recruiting 700 pre-reg nursing students annually. The doom merchants, both within the School, the University and across the profession predicted that the removal of the student bursary would have a catastrophic impact on the number of people choosing to undertake a nursing degree.

My view was there would of course be an impact in year one (2017), with a reduction in the numbers of students over the age of 25 being offered a place being the most likely one. I also thought that whilst the number of applications might go down, overall it would still be possible to recruit to the same number of students. Time (and of course being a PiMOT) has proved me right. The Universities Central Council on Admissions (UCAS) published their interim report last week (full report due on the 14th Dec). This showed that despite there being an 18% drop in applications, this year 28,620 students were accepted onto pre-reg nursing programmes across the UK. This was the second highest figure on record, and a reduction of just 0.9% on the 2016 recruitment numbers.

Across the UK there was a record number of 18 and 19 year olds accepted, although as I predicted, there was a 13% decline in students aged 21 – 25 and a 6% reduction in those over 25 years old. So while it’s difficult at this stage to see where the extra 10,000 nurses, midwives and allied health professionals promised by the current Government to be trained by 2020 will come from, the removal of the NHS bursary doesn’t appear to be catastrophic. The introduction of the Nurse Associate role also provides a different and welcome entry route into nursing. Initially I fully supported this new role. I then moved to a position of challenging the development. More recently I have returned to seeing the Nursing Associate as being a valuable contributor to the future provision of care. Partly this shift has come about by meeting some student nurse associates, and partly because of the work I have been involved in with the NMC looking at the future graduate nurse. 

I first started the future graduate nurse work in 2015. After the very first Thought Leader Group (TLG) meeting at the NMC I wrote a blog in which I painted a word picture that I hoped captured what was a very exciting discussion. One of the things we discussed was the need for future nurses to become health promoters and health educators and to do so through role modeling. As you might imagine it was a rather heated debate: could a nurse who smoked really provide healthy life style choices; should we recruit student nurses who were obese; and so on. It was a challenging debate and one the TLG returned to many times over the last 2 years. I am firmly in the camp that it is possible to offer advice on improving health and wellbeing, even if it is patently obvious to others that you perhaps haven’t taken the advice yourself.

Maybe my stance is OK. Last week the BMJ published a research report that showed 1 in 4 nurses were obese, and obesity rates were even higher in unregistered care staff, such as care home workers and nursing assistants, where the rates were 1 in 3. Rates of obesity in health care professionals was higher than that found in the general population.  Obesity is a major public health issue, and is linked to diseases such as cancer, cardio-vascular disease and diabetes. So it is critical that we find ways of better looking after those that do so much in caring for others. 

I think across the UK, this might be something that is already happening. For example, in 2014, Professor Angela Tod was one of 4 newly appointed Florence Nightingale Foundation professors, and the first to be appointed in the North West, to take up a post as chair in clinical nurse practice research. The post was a joint appointment between the University of Manchester and what was once called the Central Manchester University Hospital FT. The challenge is to examine, review and develop best evidence for nurses to deliver the highest quality care to individuals, their families and the communities they live in. An approach I think Florence, who as far as I can find out, had no delusions of grandeur, would have approved of.

The grand challenge of taking a decision without making a mistake

Edward Dahlberg was an interesting man. I use the term ‘interesting’ in the loosest sense of the word. He was an author and critic, writing many books between 1920 and the 1970s. During this time he met and knew, Joyce, Hemmingway, Scott Fitzgerald, Yeats and D H Lawrence. Sadly he and his literary work are largely forgotten today. Dahlberg had a very colourful life – once as a reporter in Germany, he got into a fight with a Nazi Storm Trooper in a café – he won the fight. Its alleged that he even received an apology from Hitler for the challenge that had been made against free press. Some have described him as being a deeply flawed man, a man with mercurial moods, often ungrateful, and prone to rhetoric of the highest order. His autobiography, Because I was Flesh is still available. If so inclined, you could always read it and make up your own mind. He appears to have been married 7 times, something that perhaps illustrates one of his best known quotes: ‘every decision you make is a mistake’.

I am not sure I totally agree with Dahlberg, but I do know some of the decisions I have taken, have with the benefit of hindsight, turned out to be mistakes. When I was making them however, I am pretty sure I thought I was making the right decision. This was the case when I was asked to take on a new role at the University, which after some initial reluctance I agreed to do. I am not sure why. I had less than 3 years to go before retiring, and was in a role I loved (well for most of the time anyway). I was the Dean of one of the largest Schools for health and social care in the UK. However, the new role on offer was a University wide one, and came with a promotion and some extra money. Above all else, it looked to be a huge challenge.

Our Vice Chancellor had, after much consultation, taken the decision to re-position the University and bring us closer to the businesses and industries we provide a future workforce for, undertake research with, and for whom we developed new products and services. Her vision was to create 4 Industry Collaboration Zones (ICZs). These were to be virtual and physical spaces within the University that could focus the entire resources of the University on 4 areas of expertise: Health & Wellbeing; Sport; Engineering & Environments; and Digital & Creative. It was a bold strategy that drew on our past heritage as a university and looked forward to positioning us as a leader in an emerging and very different world.

The VC wanted an ICZ Programme Director, and wanted me to take on the role. I had choices. I could stay in the School and wait for retirement to come around, or I could take on the new role. Much too many of my colleagues surprise I chose to take on the role. For me personally, and with the benefit of the aforementioned hindsight, it was probably the wrong decision and in ‘Dahlberging’ terms, a ‘mistake’. From the University point of view it was a success. Taking the decision to develop strong and very different forms of partnership with industry, and making this the University’s single strategic priority, meant our collective efforts were focused in a coherent, purposeful and powerful way.

Not everyone agreed with this new direction of travel. At times the rhetoric of support I experienced was undermined by some obstructive and challenging behaviours. Despite these problems great progress was made. Such was the pace of change in establishing the 4 ICZs that after just 2 years into the role, I was able to retire 6 months earlier than planned (which made me happy). And mirroring the ambitions we had for our ICZs, last week the UK government published its much anticipated Industrial Strategy. Unlike previous strategies, this one has 4 ‘Grand Challenges’ and 5 foundations of productivity against which considerable investment funding will be targeted.

The ‘Grand Challenges’: becoming world leading in the use of artificial intelligence and big data; sustainable clean growth for industry; the future of mobility; and meeting the needs of an ageing society and the 5 foundations of productivity: innovation; people; infrastructure; places; and the business environment are detailed in the 255 pages of the strategy, which can be found here. Thus the University’s decision to create our ICZs proved to be very farsighted – the Industrial Strategy commits £250 million a year to support university engagement with business and industry. I am proud to say as a university we are ahead of the sector in this approach and I’m pleased to have been involved in leading these developments. 

Whilst I believe our University is well placed to contribute effectively to each of the ‘Grand Challenges’ I was particularly pleased to see one of these being focused on meeting the needs of an ageing population. Many parts of the NHS are already beginning to experience the scale of this challenge. Services are really starting to be stretched beyond breaking point and Winter has only just begun. I don’t know who took the decision last week to release the NHS England Board paper on the implications of the 2018/19 Budget, but its content pulls no punches. If you want to get a glimpse of the emergent problems facing the NHS have a look at this paper. There are some tough decisions that will need to be taken in the not too distant future over what a 'comprehensive NHS' might look like. As my fellow blogger Roy Lilley said last week, ‘if you don’t read anything else about the NHS read this paper’. In my opinion it would be a mistake not too do so! 

Revolutionary thinking in a world embracing devolutionary action

The last time I was on TV was Wednesday the 25^th February 2015. In fact I spent much of that day giving TV and radio interviews which was a surprise to me. It was an even bigger one for my friends and family who turned on their TV’s only to see me on the news! That weekend I wrote in my blog that it had been such a perfect day. The reason I appeared on radio and TV was to comment on the ‘leaked’ news, which had been sent by over eager Manchester Councillors to BBC Radio Manchester. This was the news the signing of a Memorandum of Understanding, described as a ground-breaking deal, for the Devolution of Greater Manchester, was due to happen later on in the week.

A researcher from BBC Radio Manchester contacted me very early on that Wednesday morning and said could I come and give a live interview for their 07.00 news broadcast. I said yes and then spent a fruitless 15 minutes on-line trying to find something, anything about what has become to be known as ‘Devo Manc’. Now I am pretty good at digging out information, but in that 15 minutes I found very little. The researcher had been vague in his description of what he wanted me to speak about, but he did say it was about bringing together health and social care services across Greater Manchester.

I have long been a promotor of integrated health and social care so felt I could at least offer a view as to what the benefits might be if that is what ‘Devo Manc’ turned out to be all about. I knew that in 2011 the first combined authority in England was formed (made up of all 10 Local Authorities across greater Manchester). I also knew that the 12 Clinical Commissioning Groups (CCG) had, in 2013, formed into a Greater Manchester CCG Association. And of course I knew that the then Chancellor (George Osbourne) was personally backing the creation of the so called NorthernPowerhouse. All in all I felt relatively confident.

The reality was something different. Many of the interview questions I was asked on that day were about the political implications of the 10 Local Authorities gaining control of the £6 billion health and social care budget – the question I was most asked was whether I thought hospitals would close as Local Authorities used the money to spend on other activities. Some 2 years on, I still get asked that question as organisations move ever closer to achieving full integration of the commissioning and provision of health and social care. However difficult the task has been, the 37 NHS and Local Authority organisations across Greater Manchester, who together employ some 100,000 people, are now beginning to work together more effectively.

I think there is a way to go yet, but the emphasis is shifting (very slowly) towards both promoting health, and in providing health and care services differently, and often doing so closer to people’s homes and communities. In partnership with others, there appears to be more innovative thinking over what emergent technologies can offer in terms of cost reduction and the maintenance of quality services. In this context I can also see a glimmer of an approach that is definitely more focused upon people and places and not organisations.

I hope the same will be true for the ‘Devo London’ deal (described as both ground-breaking and a landmark deal). The announcement was made on the 15th Nov, but I only saw it early last week. I’m probably more Northern centric in my reading of news. Over a 100 organisations have been working together in developing the concept prior to the launch. Work on pilot schemes to illustrate and provide evidence of what might be achieved in working closer together has been ongoing for some 18 months. The early outcomes are impressive and encouraging. What makes this devolution different to the Manchester one is the availability of funding through the release of NHS owned land and property to fast track the scaling up of these pilots.

Not unsurprisingly, the NHS is a major landowner in the capital. The estimated value of this land and buildings is said to be more than £11 billion. Many of these assets are not used effectively, and 13% of community based buildings need rebuilding and 51% need refurbishing. The plan is to release the money raised through the sale of surplus assets to both create ‘fit for purpose’ health and social care resources in the community. and provide opportunities of for more housing developments. What it might mean for those living and working in London can be seen here. It looks to be a very ambitious plan, but I believe it is one that can be achieved. 

Perhaps Parliament itself could learn some lessons from the Manchester and London devolution initiatives in acknowledging the benefits of working together. Last Saturday (18th Nov) saw some 90 MPs sign a letter asking the Prime Minster to set up a ‘cross-party’ convention on the future of the NHS and social care in England. What they wanted was for the current Chancellor to address the short term pressures in the health system in his budget (something he subsequently did) and for the Prime Minister to establish a cross-party process to develop longer term solutions. Now it can't be just me who thinks creating such a group and a way of non-partisan working would be a great idea – after all its not really such a revolutionary thought in a world that is enthusiastically embracing devolutionary action.

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. 

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. 

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 70^th 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.    

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…

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. 

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! 

Stopping the Abuse of FGM: tearing down the barriers

For much of last week I was in the city of Berlin attending the 6^th 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.