Trying to Save the Planet while Thinking about 3 ways to Spice up my Cooking

Yesterday was Earth Hour 2018. At 20.30 people around the world turned off their electrical devices for 60 minutes. I did too. Sitting in the warmth of flickering candle light, sipping wine and most importantly relaxing with good conversation. Earth Hour started as a symbolic ‘lights out’ event in Sydney in 2007. It is now said to be the world’s largest grassroots movement for creating a sustainable and healthy environment. Millions of people have been inspired to take action in their homes, workplaces and communities to help protect and rehabilitate our planet and the nature we perhaps have taken for granted for too long. If you want to find out more, have look at Earth Hour 2018 official video – it’s sobering and challenging.

Earth Hour is an opportunity to start conversations about the exponential changes to our climate, and the enormous biodiversity loss and how these threaten our planet and our very existence. We could all do more. Two sustainability stories last week caught my eye. The first was the development of hydrogen from water using lysozyme, a protein-based chemical found in the white of eggs. Taking this development from laboratory bench to commercial exploitation is still a way off, but the potential of creating an abundant supply of clean inexpensive fuel that doesn’t also emit carbon dioxide is enormous.

The other story was about how Anna Bullus turns chewing gum into products as diverse as footwear and coffee cups. Globally, some £14bn is spent by people buying chewing gum. That is a lot of chewing gum. In fact discarded chewing gum is the second largest form of street litter behind cigarettes. Anna collects the gum in bright pink bins. Not only is this a healthier and sustainable way to dispose of chewing gum, but it also saves the enormous cost of removing chewing gum from pavements and so on. Personally I have never liked chewing gum. Watching other chewing away reminds me of my goats and the way they would spend hours chewing the cud.

I didn’t know until last week that the NHS held a Sustainability Day (March 22nd). This is a national day of action across the UK health sector. Like Earth Hour, it is an opportunity to share the impact of sustainable development, and learn from organisations across the spectrum of health care providers. The 2018 Impact report can be found here. It contains some very impressive achievements. It is estimated that the NHS could save more than £400m and reduce its carbon emissions by 1m tonnes each by 2020. Best of all, many of the schemes have direct health benefits to patients and free up badly needed cash that can be used elsewhere in the provision of health and social care.

From green ideas to green curry. Well not quite, but yesterday I also had a chance to learn how to make a curry with just three spices. I was at the Rochdale Food and Drink festival, where it was possible to find everything from toffee vodka from the Lake District; sweet and savoury crepes from France; Chinese street food; English fish and chips and so much more in the stunning surroundings of Rochdale’s gothic Town Hall. The curry lesson was given by the amazing Nisha Katona. She was brilliant. Previously Nisha was a barrister, but gave up law in favour of teach others how to make the perfect curry, and to debunk some of the urban myths that have often been associated with Indian food. Her recipe was very simple – only use three spices. Turmeric and chilli are always used and depending on what you are cooking, one other spice is used. For vegetable dishes it could be mustard or cumin seeds. If you have just 10 mins today, have a look at this YouTube video of Nisha using this basic 3 spice rule as she makes a vegetable curry.

Unfortunately (well at least for me) yesterday Nisha made two curries, one a chicken, the other prawn. So I didn’t get to eat either, but others who did had big beaming smiles as they tasted both dishes. She is mainly a vegan, being of Hindu descent and I think chose the chicken and prawns dishes as she was able to give a wonderful history of Indian cooking which was as interesting as watching her cook. I was surprised to learn that chillies were not a native Indian plant; it was taken there in 1498 by the Portuguese explorer Vasco-da-Gama.  I very much enjoyed her cooking style, no measures, just her eye and the occasional taste was all she needed. What she didn’t need were any single use plastic containers – all her food, spices and so on were in glass jars, still growing in pots or wrapped in brown paper. Nisha was a very sustainable cook who prepares meals that are healthy, cheap and just smelt wonderful! I can’t wait to get our kitchen re-organised.  Going green is not only good for our planet, but as Nisha might say, it’s time to live a simpler life that doesn’t need to include ready meals, and /or food sold in single use plastic. Let’s respect our world, not just for us today, but for all  those coming behind us. They deserve better.

Cartesian Conversations: Nurse Education; Seeking Healthcare; and the Importance of Hand Washing

A few months ago I was contacted by one of my old magistrate colleagues. She was someone I hadn’t seen since I retired from the bench a few years ago. She asked if I would come and speak to the Bolton Branch of the National Women’s Register. It wasn’t a group I was familiar with, but as the focus for the talk was around nurse education and whether we were preparing nurses for the future I readily said yes. Which is why last Wednesday, I found myself at a rather grand house, sitting in a circle of 15 women talking about nurses, nursing, education, research and practice. The average age of the women was about 65+, three of them had been nurses, and one a doctor. It was an interesting conversation and the two hours I was there flew past.

I was not only able to talk about nurse education, but also how the provision of health care had changed and the continuous opportunities there are to improve health care services. Some of the group were already familiar with the changes that digital technology can bring, particularly around remote care, health monitoring apps, and developments such as key-hole surgery, and new scanning and diagnostic interventions. Of course we also touched upon what I described as the ‘Daily Mail’ view of the NHS. Perhaps predictably the discussion was around the demand for A+E services, trying to get an appointment at the GP, and how long it can sometimes take to get an operation.

I reflected on the discussion afterwards. Despite the ladies listening and asking some tough questions, the context for these was perhaps not unsurprisingly, the very traditional view of the NHS. As a group they were hospital centric, and found it difficult to think outside of that box. I guess there might be many more who think like the ladies in this group. For example, last week I went to a GP practice to support a friend, and it was like Bedlam. There were people everywhere, it was hot, and tempers were frayed. The promised 15.00 appointment turned out to be 16.20. It may therefore be understandable that some folk will simply give their GP a miss and pitch up at A+E.

Such choices were something I had discussed earlier on in the day last Wednesday. I chair the Wrightington, Wigan and Leigh NHS Trust Quality and Safety (Q&S) Committee. The unceasing demand fed through the A+E department, has a ‘knock-on’ impact to other parts of the hospital. Getting people to theatre in the optimum time possible was a particularly difficult issue this month. I guess from my reading, our Trust is not the only one experiencing these problems. Another (seemingly impossible to resolve) problem is the prescribing of oxygen. This also came up in the Q&S committee. Whilst those who need oxygen in an emergency situation wouldn’t be denied this, prevailing guidelines indicate that oxygen should always be prescribed.

Oxygen is not always seen as a prescribing substance, and it’s always given when needed. Asking a doctor to write up a prescription after the event is often seen as an unnecessary bureaucratic hindrance. So prescriptions don’t always get written. Whilst we agreed on an action plan to try and improve this situation, I was reminded of poor old Ignaz Semmelweis. He gave his name to something we now know as the Semmelweis Reflex. This describes the notion that people reflexively fear taking on something new. In the 1840s, Semmelweis worked as a doctor. He came up with a radical idea, and it was an idea that if adopted, might have saved thousands of lives.

One of the things he noticed was the way in which doctors walked away from treating those dying, or those already dead and continued to work in areas such the maternity ward. He noticed that the maternity wards also had very high mortality rates. Indeed, he felt women would be better off having their babies delivered at home. His insightful idea was that doctors should wash their hands between treating sick patients and delivering babies. The collective medical profession of the time said NO to this idea. Semmelweis didn’t prosper, he developed a mental illness and eventually died in a mental health hospital. Of course, as we now know, all health care professions recognised what he was suggesting was actually right. We now all routinely wash our hands as we enter wards, or attend each new patient. 

And last week, it was Thursday that gave rise to a situation that made me smile the most. Young Lucy, studying psychology at Leeds University, disappeared upstairs to write what I understood was an assignment on the philosopher Descartes.  Of course it was Descartes that famously said: je pense, donc je suis; I think I therefore I am. But it is his work on Cartesian dualism that caught my attention in this situation. Lucy eventually re-appeared in the lounge. I asked how she had got on with her Decartes assignment, only to be told that she had been busy sorting out her fake suntan, and hadn’t written a word of her assignment. The Cartesian dualism, mind and the body, personified. Perfect!

A Good News Story of Fusion Food and FUSION Technology

I had one of my favourite meals out last week. It was ‘Vegetarian Fish and Chips’. I do like this meal, so please forgive me if I mention it once more – halloumi cheese in crispy batter, big chunky old fashioned golden chips, garden peas and tartare sauce. Delicious, and if you want to try out the idea, here is an easy recipe for halloumi fries, a great taster dish – the full meal recipe can be found here. Best of all I was being treated to the meal by my good friend and colleague Karen (now to be found on Twitter too - @Catheri39809315 ).

One of the things Karen is involved in is the editorship of the Nurse Education in Practice journal. We were having dinner to discuss business and catch up on the changes in each other’s lives. It was a lovely evening and productive too. One of the business matters was starting a conversation around what a social media strategy for the journal might focus on. I have just taken on the role of Social Media Editor for Nurse Education in Practice, and have started to become acquainted with the journal's Twitter account. @NurseEdinPrac and what its aim of promoting communication about global nursing and midwifery education might mean. So watch this space!

Whilst Karen and I talked about many things, one of the topics that didn’t feature that evening was prostate cancer. Prostate cancer has been much in the news last week. Last week the former BBC Breakfast host, Bill Turnbull, disclosed that he had been diagnosed with the disease, which had spread to the bones in his legs, hips, pelvis and ribs. His prognosis is not good. There is no cure for his condition and sadly, his cancer will be a life shortening. He talked of the shock of receiving the diagnosis, and the ever present knowledge of now having to live with cancer day after day. He described this as BC, before cancer, when life was normal and then AC, after cancer, when life becomes very different. However, he also said that he didn’t want the rest of his life to be defined by his illness. I wish him well on his journey.

It is a journey that many men will undertake. One man in six will get prostate cancer. It is the most common malignancy (other than skin cancer) diagnosed in men. Globally, around 1.1 million men will be diagnosed every year, with more than 300,000 dying from the disease each year. In the UK, 40,000 new case are diagnosed every year. Whilst the disease has the potential to grow and spread very quickly, for most men it is a slow growing disease. Many men do not experience any symptoms, and so don’t routinely get tested. Some of the symptoms, such as sexual dysfunction would be noticed by most men. However, by the time such symptoms become evident, the cancer is likely to have become quite advanced, and as such, more difficult to treat.

In the UK there isn’t a national screening programme for prostate cancer like there is for breast and bowel cancers, partly because the current diagnostic tests are either too unreliable or carry risks and unpleasant side effects. The PSA test can suggest prostate cancer when no cancer exists (a false-positive result). Indeed 15% of men with prostate cancer have normal PSA levels (a false-negative result). Given this unreliability, there is a degree of controversy over the age that men should start to be screened. In the US it’s recommended for all men over the age of 45, in the UK it's 50. My advice would be if you are worried, or experiencing any of the symptoms (see here) then go and discuss the options with your GP. 

So it was great to read last week of the NHS using cutting edge technology to deal with these issues. The new approach not only massively reduces the time from test to diagnosis, but also reduces the risk of patients contacting sepsis. The whole intervention can be undertaken in a ‘one-stop-shop’ in just 1 day rather than many visits over a 4-6 week period. The new ‘rapid pathway’ approach, currently being developed in 3 hospitals across London, enables men to have a MRI –mpMRI scan. These are scanners that provide a higher quality imagery. Dependent on the result, if needed, they can then have a biopsy using new FUSION technology.

The FUSION scanners overlay ultrasound images with 3D MRI scans to create a highly detailed map of the prostate allowing much greater accuracy in targeting suspect areas. It’s so good that an area as small as a grain of rice can be hit first time. It was truly world-leading research that has led to this exciting clinical development. The NHS is determined to cut mortality rates for prostate cancer in the same way that has seen breast cancer rates decline by 10%. I think they are well on the way, something that as a man I am pleased about and as a citizen of the UK, and a great fan of the NHS, it's something I think we should all be proud about.  

There Is No Day Like A Snowday: Winter Tales

Well last week’s weather was a challenge for many. We had Red, Yellow and Amber warnings for large swathes of the UK. The snow and the gales caused massive disruption for thousands of people. At one stage, 3500 vehicles were trapped in the snowy and treacherous conditions on the M62. Commuters were stranded overnight on trains, with no food, water or power. Thousands of people had no power. Tens of thousands of flights were cancelled. 80 yachts and boats were smashed to pieces in a marina on Anglesey. Trees were brought down. Many people had multiple ‘snowdays’ or were able to work from home. Yes it was a challenge.

Thankfully, I had plenty of food, wine, and a warm house. Others weren’t so fortunate. I saw dozens of messages on social media of people whose boiler had chosen last week to pack up and of course the road conditions meant that there were long delays in engineers being able to reach folk. There were heroes aplenty though. The RAC managed to attend some 10,000 broken down vehicles a day. Local residents from areas around the closed stretch of the M62 near Rochdale walked to the stranded motorists, with food, blankets and enough hot lasagne for 1000 people. Tesco’s provided warmth and blankets in some of their 24 hour stores. Up and down the UK, many NHS staff either stayed overnight on wards or walked to their hospital to ensure patient services were maintained. Those working in the community filled rucksacks with supplies and walked to their patients’ homes, or travelled in 4x4s volunteered and driven by local people.

I couldn’t get my car out for several days (not that it would have been possible to get to many places). Being housebound by the weather reminded me of winter in 1981/2. I was living in rural Wales at the time. My house was at the end of a private farm track. The track had tall hedges and trees on either side, and these trapped the enormous falls of snow, causing drifts 15 feet and more deep. It took days before a tractor came to and cleared the road. And then it was only possible to travel on the snow covered roads by fitting snow chains to the car wheels; a task that nearly always caused me to lose some of the skin off my fingers!

Although I couldn’t drive, I could still go out dog walking. I have the right gear to keep me warm and dry. At times, and in many places walking was precarious, with extremely slippery icy conditions underfoot. These days I am very ‘fall aware’, so my approach to dog walking was rather slow and cautious. Of course anyone can fall, but those aged 65 and older have a much higher risk of falling. Some 30% of people older than 65 and 50% of those aged 80 and above experience at least one fall a year. There are 12 million people living in the UK aged 65 and over, which equates to 18% of the total population. That works out at around 255,000 falls-related emergency hospital admissions a year. That is a lot of falls.

Such falls can result in physical injuries such as head injuries, the extent of which can often be hidden, fractures of other bones, and so on, including death. Just as importantly, falls can result in a loss of confidence in being able to carry out the activities of daily living; a fear of future falls, and the subsequent loss of independence. Apart from these obvious personal impacts, for the NHS falls account for more than four million hospital bed days. Fractures of the hip are particularly challenging. The average length of stay is 21 days.  Likewise, the evidence shows there is a 10% risk of death at 30 days and a 30% risk of death at 1 year. In 2015, hip fractures cost the NHS £1.1 billion pounds. Now it’s estimated that fragility fractures cost the UK around £4.4 billion, of which 25% is for social care. This is a staggering amount of money. My concern are over those costs involved in providing care for those who have become socially isolated, lacking in confidence and who might be living with extensive co-morbidities. 

It was against this background that last week I read the Public Health England publication that addressed what might be cost effective investments in falls prevention programmes. The publication reports on some extensive research that looked at four interventions which if implemented could both save lives and money for the NHS. The four evidence based interventions were: The Otago programme; the Falls Management Exercise programme; Tai Chi exercises; Home Assessment and Modification (HAM) services. You can find details of each of these interventions here. In terms of return on investment for every £1 spent, the HAM programme showed a massive return from a financial point of view and over twice as much from a societal return on investment. As we know that the overall percentage of older people in the wider population continues to grow, this news is very welcome indeed.