Physical activity and health and well-being: last week my feet walked upon Scotland’s mountains green

Regular readers of my blog and Twitter followers will know I have a thing about chickens. I am confident that I have the greatest collection of chickens (in any media you can think of) in the world. So maybe it will come as no surprise that I was secretly pleased to see the difficulties KFC were having last week. They ran out of chickens to sell in their food outlets. Why, in any case, I asked myself, would anyone want to eat such a beautiful bird in the first place.

I have never been to a KFC and indeed have only ever eaten at that other ubiquitous fast food chain, McDonalds, 3 times in my life. One occasion was with my youngest daughter at her first Christmas lights turn on in Bolton. I ate chips and mayo, and the same choice also served as a life preserving diet on the other 2 occasions. One was in Pécs, Hungary, an ancient city close to the Croatian border, but where at the time, was a place that really didn’t understand vegetarianism. The other occasion was in Sao Paulo, Brazil, when all the banks went on strike. I was left with just a few US$ with which to survive the 5 days I was there. US$ were readily accepted at the time, and I always had some emergency US$ in my wallet.   

KFC’s troubles aside, the brutal fact is that across the world, 50 billion chickens a year are killed for human consumption. In the UK 2.5 million chickens a day are eaten, yes that’s right, every single day. Indeed, every year, 10 million pigs, 15 million sheep, 16 million turkeys, 14 million ducks and geese, 2.6 million cattle, 4.5 billion fish get eaten in the UK every year. Much of this consumption is by processed foods. What you think of as a chicken fillet may, conceivably, be only tangentially related to an actual chicken. A great deal of this food ends up as processed food, convenience meals and so on.

Given that the average person in the UK eats 50% more calories each day than they need, it’s perhaps understandable that 60% of UK adults are overweight or obese. Indeed, 30% of children are obese by the time they leave primary school. In fact international research shows that Britain is the fattest country in Western Europe, with a rising rate of obesity that is even faster than the rate in the US. In the 1970’s (some readers will remember this time) less than 3% of adults in the UK were obese. Over time, it’s clear that we have transposed the occasional treat like having a Friday night takeaway or visiting a restaurant into something that is a much more regular event. Families in the UK eat out twice as much as they did during the 1970s, with a staggeringly 1 in 5 meals eaten outside the home. It’s not just the rising amount of high-calorie foods consumed that has caused the problem. Many people are just far less active than they once were.

For a long time now I believed in taking a #WalkEveryDay – I got a Fitbit in the Christmas of 2016 and take great delight in walking 10000 steps every day. This year my average is now around 17,000 steps a day, which is 12km or about 7.5 miles. For me this is important as I signed up to what has become to be known as the #NHS1000miles challenge. In celebrating the 70th year of the NHS, thousands of people are recording their walking, running, swimming, horse riding, gym treadmill jogging, in fact any physical activity that can be recorded as miles as a collective birthday present to the NHS. The more active we are, the healthier we become – which has to be great news for the NHS. Prevention is always going to be better than cure! 

So last Friday it was wonderful to be given a guided tour (thank you Alan and Richard) of what I hope will become our new village Nature Reserve. Using Scotland’s ‘Community Right to Buy Scheme’, the village was able to purchase 45 acres of land which forms one of the borders of the village. The land is part pasture and part deciduous woodland.  I was able to walk around the entire 45 acres and the views were spectacular. We saw 6 deer grazing the land, and much evidence of badger and fox activity. It was a wonderful way to spend a morning and I could see how this land might become a valuable community asset in promoting health and wellbeing for our community and those folk that choose to visit our part of Scotland. 

Thankfully we don’t have either a KFC or McDonalds within the village or even with 20 miles of the village. Across Dumfries and Galloway we do have some great vegetarian restaurants however, see here. Not so in Iceland. It was one of the places where I could have done with a McDonalds portion of chips and mayo. But alongside Algeria, Albania, Ghana, and North Korea, Iceland doesn't have a McDonalds. At the time, I was attending a mental health nursing conference in Reykjavik. Strangely folk there took great pride in serving pickled shark, whale, puffin and sheep testicles in many of the restaurants. Vegetarian meals were absolutely hard to come by. So maybe unsurprisingly, perhaps, 67% of the Icelandic adult population are overweight or obese. The message of this blog is eat mainly vegetables, take plenty of exercise, and think twice about visiting Bolton, Pécs, Sao Paulo or Reykjavik for your next holiday.
   

Children living the Good Life and a Computer that says 15 are Born every Minute

It was 34 years ago when I moved from Wales. At the time I had a small holding and for 10 years, I lived the John Seymour dream. It was a time before we had mobile phones, computers and electric self-driving cars. John Seymour was the Father of self-sufficiency and in 1976 published his guide to making it happen. It became my bible. Billy my parrot (now aged 22) once had a go at chewing the books spine, but despite the damage he inflicted, it is still one of the most precious books in my collection. During those years I learnt to milk goats, make cheese, use a chainsaw, keep and breed chickens, grow my own veg, and surprisingly rear peafowl. I also became a proud Father to 4 of my 5 children. They also got to live the John Seymour dream. They chopped wood, plucked the Christmas turkeys, and thrived on a 101 variations of meals where the central ingredient was runner beans.

They also went to school there and were taught in Welsh and English. I didn’t, and like some kind of post-colonial dinosaur, I only learnt a few words of Welsh. ‘Mae hyn yn wisgi dirwy’ – ‘this is one very fine whiskey’ (try Penderyn if you don’t believe me) and ‘Diolch yn fawr ’ – ‘thank you very much’. There may have been some odd curse words I picked up along the way, but they are now long forgotten. I was drawn to this memory last week as I listened to the debate on the radio about the stalled Northern Ireland Assembly (‘Tionol Thuaisceart Eireann’) talks. The sticking point appeared to be the recognition of the Irish language as an official language. The debate was all about dual language road signs, teaching children using the Irish language in schools, the unwarranted expense and so on.  The arguments for and against sounded very familiar to those I had heard in Wales all that time ago. Unfortunately, now as then, there is very little evidence to really support either side’s assertions. I guess a case of watch this space. After so many achievements it’s sad that no progress appears possible.

I thought it was also sad that another area of great progress, the development and use of technology in health care had also got such a bad press recently. It stemmed from a claim made by Professor Harold Thimbleby, Professor of Computer Science at Swansea University in a lecture he gave with Professor Martyn Thomas, a visiting professor at Aberystwyth University. They claimed that more than 900 deaths a year in the NHS could be attributed to poor technology. It was a claim that was challenged last week by Will Smart, Chief Information Officer, Health and Care in England, NHSE. He noted that the professor’s paper did not draw upon systematic research that might show a causal relationship, but appear to have relied on US data on preventable deaths, which was then extrapolated to the UK. At the very best this is poor science. There are too many variables that would need to be taken into account before one could have confidence that technological system defects and inefficiencies are as likely to cause serious injuries or deaths as other preventable adverse events.

The NHS looks after more than a million patients every day. The demand for health and care services is not abating. Arguably, new technology, particular advances in digital applications, are making it possible to keep meeting these increasing demands, and maintain patient safety and the quality of care provided. The evidence of digitisation is that it reduces drugs errors, improves continuity of care and saves lives. Last week the Journal of Medical Internet Research published a review of the literature (from the last 5 years) that showed a strong link between health information technology being harnessed and improved and positive clinical outcomes. And if you want to see some really good examples of such improvements go to the NHSE GlobalDigital Exemplar web page.

The other area health information technology has helped us is in providing us accurate and contemporaneous data on what is happening across health and care services. The wonderfully named Public Health England Syndromic Surveillance Summary, published every week keeps us informed of all kinds of changes. I now know for example, that last week GP consultations for Scarlet Fever rose, and are above seasonal norms, whereas GP consultations for flu are decreasing. NHS 111 continued to see a rise in calls about sore throats, particularly for those aged 5 -14 years old. However, the most unsurprising set of data released last week also came from NHSE. They noted the romance of Valentine’s Day (last week apparently) leads to a ‘mini baby boom’ 9 months later. It was the first time they had published such an analysis, which showed that conceptions over this week are 5% higher than any other time of the year apart for Christmas. However, the analysis also showed that the passion was short lived. Two weeks later, conception rates reach an annual low! But last week, NHSE officials declared that the analysis proved ‘love is most definitely in the air’ or as they say in Wales ‘cariad yn sicr yn yr awyr’.

Tales of Snake Oil, Cures for Depression, Bananas and Bursaries

Snake oil is a preparation that comes from the Chinese water snake. In some parts of the world snake oil is still used as an alternative treatment for arthritis. You can buy it on the internet for £30 - £70 a bottle. In ancient Egypt snake oil was a popular cure for male baldness. However, in this case it had to be mixed with lion, hippopotamus, crocodile and tomcat oils. The reason there is still a market for snake oil is that contains more eicosapentaenoic acid (EPA) than any other source. EPA is an omega-3 fatty acid, something long believed to be effective in treating joint pain, and as a cream, for the treatment of psoriasis and eczema. In more contemporary times, the term ‘snake oil’ has come to refer to any product with questionable or unverifiable quality or benefit.

At first glance, ‘snake oil’ claims can take many forms. Some of these can be quite subtle. Professor David Healy, an expert in psychiatric medications, caused much uproar across the mental health community when he claimed last week that antidepressant use in children and young people might be doing more harm than good. He was speaking at a global health conference in Aberdeen, and drew on his review and analysis of a number of paediatric clinical trials. The prevalence data on mental health problems in children and young people is woefully out of date. What we know is some 10% of children and young people aged between 5 and 16 years have a diagnosable mental health problem. Of these, it is estimated that 0.9% (80,000) will have a depressive illness.

In the general population, antidepressant prescriptions cost the NHS £780,000 a day. I don’t know what proportion of this bill reflects children and young people, but the number of prescriptions for this group has gone up by some 54% since 2005. The National Institute for Health and Care Excellence (NICE) provide guidelines on the effectiveness of medication treatments, and in the case of children and young people, they say antidepressants should, where indicated, be given to them (alongside a range of psychological talking therapies). The only drug recommended for those under the age of 18 is Fluoxetine (better known as Prozac). This has a sound clinical trial evidence base showing that as a treatment for depression, the benefits outweigh the risks. The data would seem to suggest that that this evidence base is not being strictly adhered to. Only 45% of prescriptions for children and young people are for Fluoxetine.

However, in response to Prof Healy, Dr Elaine Lockhart, Chair of the child and adolescent faculty at the Royal College of Psychiatrists in Scotland, noted that antidepressants can be prescribed for a range of problems other than depression. For example, anxiety, OCD, for migraines and other pain related conditions. She noted that current prescribing data does not indicate what the prescriptions are for, so understanding any rise in overall antidepressant prescriptions is made more difficult. Like most approaches to meeting the needs of those living with mental health problems, medication clearly has a place to play, and does so alongside other care interventions. What is agreed however, is that we need to do more in responding to children and young people’s mental health and wellbeing issues.

One of the responses children and young people shouldn’t be exposed to is the so called ‘conversion therapy’. For all kinds of reasons, conversion therapy is absolutely an example of the ‘snake oil’ approach. Conversion therapy is the term for therapy that assumes certain sexual orientations or gender identities are inferior to others, and sets out to change or supress them on that basis. It is an approach that lacks clinical evidence of any kind, and to my mind, is a harmful and totally unethical therapy. So last week I was pleased to see a revised and reinforced memorandum of understanding (MoU) against conversion therapy signed by many of the good folk in NHS England and 12 other professional organisations. The MoU will ensure that those practicing this so called ‘therapy’ will be prosecuted. However, safe-guarding our children who might be experiencing struggles with their sexual identity could become much more difficult, but that is something to explore in another blog.

There is no difficulty with my penultimate ‘snake oil’ story of last week. Apparently the world is facing the extinction of bananas. Bananas are the worlds most exported fruit and the source of nutrients for millions of people. Each year more than £9 billion worth of bananas, primarily of the Cavendish variety, are exported globally. Cavendish bananas are mainly grown to the exclusion of all other bananas. And they have become sick with the so called Panama disease. So far there is no cure. Very soon bananas may no longer be available at your local Tesco (there are other supermarkets). I mention this as there is still a persistent urban myth that eating bananas is a cure for depression.  Bananas contain serotonin. People with depression have been observed to have low levels of serotonin in their brains. Whilst serotonin does help with elevating ones mood (as a neurotransmitter) it can’t reach the brain simply by eating bananas. Our bodies synthesises serotonin through a process that involves the use of Vitamin B6 (which Bananas are also rich in) – however this does not allow for the blood-brain barrier to be crossed.

My ultimate ‘snail oil’ story is the astounding news that last week Jeremy Hunt (Secretary of State for Health) announced the news that from August 2018, postgraduate nurses, midwives and allied health professional students will no longer be exempt from receiving a bursary for tuition fees and maintenance worth some £8000 a year. When similar bursaries were removed from undergraduate nurses, there was a 23% slump in applications to undertake nurse training. With 40,000 nursing vacancies, removing this support would appear to make a mockery of the pledge to fund an extra 5000 student nurse places a year. It simply does not make economic sense. 

I am sure Professor Alan Maynard, professor of health economics would have spoken out against this ‘snake oil’ salesmanship. He sadly died last weekend. He was the ‘founding Father’ of health economics, and someone who commanded great respect for his work and his wisdom. I only met him once, but his impact on my thinking has been long lived.  I am sure if I had asked him about the cost effectiveness of ‘snake oil’ as a cure for arthritis he would have contemplated for a moment and then told me about the benefits of simply taking taking cod liver oil tablets and aspirin. Not only would this probably achieve similar results as ‘snake oil’, but do so at a fraction of the cost.

Talking about the conversations that can change lives

Last Wednesday was a long and busy day. I was at my NHS Trust most of the day, and it was a day where the first meeting started at 08.00. It was, however, a day of different meetings, and as a Board, we worked our way through a series of discussions where we talked about finance, quality, patient safety, partnerships, our A&E performance, demographic pressures and what at times, felt like the unfairness of the local press towards the hospital. By the time I got to drive home in the late afternoon, I was exhausted, hungry and in need of simply unwinding! However, after a mug of steaming Vimto, my drink of the moment, I revived somewhat.

Just as well as that evening I was having dinner with my long-time friend and colleague Karen. I have known Karen for many years. I met her when both she and I were Governors at a local School almost 25 years ago. We have worked together as teachers, researchers, and evaluators. She is the Editor of Nurse Education in Practice, a journal I have supported through being on the editorial board, reviewing the work of others and having my own work published. We both share a passion for education, anthropology and sociology, and at one time, even shared the same PhD supervisor.

Karen and I have travelled to many places together, including the US, Canada, Ireland and to most of Eastern Europe. She is a great travelling companion as she is one of those people who can talk for England. I have spent many an hour listening to her wonderful conversation. On one occasion we travelled for nearly 3 hours between Brno and Prague in a train carriage that was meant to be silent, before someone asked us to stop talking! And so it was last Wednesday evening. We had not seen each other for a while and had much to catch up on. Our meal took a long time to get through as we both talked about what we had been up to over the past few months. It was a lovely way to spend a few hours!

I count myself fortunate that I have 3 or 4 people I can talk to, and talk to them about most things. There are many others who are not in the same position. Last week was the #TimeToTalkDay2018 (which runs every year on the 1st Thursday of February). The Time to Talk Day is organised by the mental health project Time to Change. Backed by Mind and Rethink Mental Health, Time to Change aims to improve people’s attitudes and behaviour towards those with mental health problems. They want to help and support people with mental health problems to stigma and discrimination wherever this may be found. The Time to Talk Day provides an opportunity to have an open conversation across the UK about mental health – to talk, listen and to change lives. 

It’s an important and an increasingly successful campaign – but there is still more that can be done. Last week Time to Change published the results of their recent survey of some 2,500 people. 66% of the respondents said they had no one to speak to about their mental health, relationships or money. 36% said they had never found the right time to talk, and 28% said they hadn’t talked to anyone as they couldn’t find anywhere appropriate to discuss their concerns. Sadly these findings perhaps reveal that many people struggle with talking openly about their and others mental health problems. 

When I started with my mental health problems last year, it took me a long time before I went and talked to anyone about how I was feeling. I even hid my despair from those people I described above. Fantastic folk I've always felt I could go and talk to about most things with them. Even my GP, who I have to say has been brilliant, filled the reason for being off work on the first couple of sick notes as low mood rather than depression. When we talked about this, he felt he was doing it for the ‘right’ reasons, protecting me from any possible work related discrimination. I have said before in a previous blog, my University were also extremely supportive, and I am proud that this was the case. I really could not have wished for a better response from them. 

As has been said many times before, there is no health without mental health. The statement (easy to say, not so easy to achieve), is a very powerful message of the need for the integration of services and approaches. However, this is still just as difficult to realise within and across the health and social care professions as it appears to be in the wider population. Indeed the work of one of my successful PhD student’s @SMYseham revealed the disturbing levels of stigma and discrimination amongst mental health professionals towards the people they were there to serve and care for. 

With this in mind it was good to see the updated guidance from Public Health England, published on the 18th January this year, looking at ‘wellbeing in mental health: Applying All Our Health’. The guidance is good, and easy to understand. It is set out at the level of the professional, population, community and the individual. At the heart of all these approaches are relationships. And relationships are nurtured by trust, thoughtfulness and being able to talk and listen. One can never know, but such conversations could be those that change lives.