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!