#RememberingTogether

It’s estimated that there are some 80 -100 million domesticated honeybee hives in the world. As each hive can have as little as 10,000 bees and sometimes as many as 60,000 bees, that means there are 1 -2 trillion bees being kept for their food and pollination abilities. There are probably about 50% more bees living in the wild. That is a lot of bees! In the UK we have over 250 different types of bee (25 species of the bumble bee; 224 species of the solitary bee; and 1 honey bee species). Pollinators such as bees are estimated to add £600 million annually to the value of UK crops though increased yield. Bumblebees can beat their wings up to 11,500 times a minute.

Now you might by now bee beeginning to think I have beecome beesotted with bees. Well I haven’t, but bees seem to have been an ever present element of my life last week. As I walked Dylan last Monday, I came across a cloud of bees that were obviously in mid swarm, and there were thousands of them flying and buzzing over the path I was on. I am not particularly bothered by bees, but I didn’t stick around to take a photo either. 

Then on Tuesday, I was privileged to be at Manchester Cathedral for the 1^st Anniversary of the Manchester Attack, National Service of Commemoration. All the major political party leaders were there (including Nicola Sturgeon), and I sat five rows behind Theresa May. In real life they seemed somehow diminished, whereas HRH Prince William appeared to have real presence. All faiths were represented and the hymns chosen were just right for the occasion. Their choirs and the Strings of the Halle Orchestra played Tchaikovsky’s Serenade for Strings – Elegie as photographs of the 22 people who died were shown on big screens around the Cathedral. It was a beautiful service, set in a wonderful and ancient setting, just an hundred yards from the Arena where the attack took place.

There were 22 candles lit, each made from the many thousands of candles left in St Anne’s Square in memory of those who lost their lives. A single candle was also lit for all those that remain, the 800 people who were injured, both physically and mentally, and their families and friends, the first responders, the volunteers, and those that have worked in support of the communities in their recovery. 

The worker bee is one of the best known symbols of Manchester and all its communities. First adopted during the Industrial Revolution when Manchester led the way in embracing new forms of mass production across many industries. Since that time, local brewers (Boddingtons), universities, football clubs have all over the years adopted the bee image. Likewise, if one looks carefully bees can be seen on many items of street furniture, lampposts and bollards. Following the Arena attack, the bee emblem saw a resurgence in popularity, as it became the public symbol of unity against terrorism, and the sense of community that we are #StrongerTogether. Last week in response to public request, my local park planted a bee flower arrangement as the centre piece of its floral gardens. Similar garden features can be found across the UK, and they are both a symbol of hope, of resilience, love and perhaps forgiveness too.  

I end this blog with the words spoken by Rabbi Warren Elf, representing the Jewish community. His words were taken from the Yizkor Memorial Prayer:

Death has failed

You cannot inflict oblivion or eclipse existence on those who were life of our life

They live and move with us, and in us, in spheres beyond our domain

Blessed are you, Eternal God, who enables your children to remember

Teach us to live wisely and unselfishly in truth and understanding, in love and peace, so that those who come after us may likewise remember us for good, as we on this day and every day, affectionately remember those who were to us a blessing

They live with us, in our hopes, and so shall their influence continue in our children

In you, Eternal One, they are, we are, one 

Food for Thought in a Week full of Awareness Raising

I celebrated my 63^rd birthday last week. It was a lovely day. Sunshine, gifts, wonderful food and drink, good conversations, and I felt 21 years old again. I also celebrated my birthday in the middle of Mental Health Awareness Week. As such I shared my own story of dealing with my mental health and well-being. It was published elsewhere (see here) and I was pleased with the response the piece got. Personally, I believe we need to keep sharing our experiences if we are ever going to achieve the ambition of no health without mental health. During the week there was lots of comments on social media. I followed the Twitter conversations on #MentalHealthAwarenessWeek. 

I was a little sad to see amongst the positive awareness raising tweets, tweets that challenged whether the week was actually helpful at all. Of course I would agree that we can always do more, particularly around mental health promotion and prevention. I also think children and young people’s services require a wider and a more multi-agency approach to truly making them relevant and accessible. However, I think the week is relevant and it still provides an important opportunity for awareness raising of these issues. I know from personal experience as these issues get raised opportunities are created for new partnerships, for new ways of thinking about the problems, and new ways to challenge and innovate. 

But last week it wasn’t just mental health issues that were being raised. It was also Dying Matters Week. Regular readers will know I touched upon this awareness raising week in my blog last week. I was also very pleased to see the response and to see the many activities reported on around end of life care. You can see some of these wonderful stories here.

And of course it was also Vegetarian Week last week. Over the 9 years I have been writing this blog I have referenced the fact I have been a vegetarian since I was 15 and of the various experiences of eating out as a vegetarian. Many of these experiences haven’t always been good. Last week I was taken out for my birthday and that was a good experience. Rhubarb gin featured, as did the tastiest cheese and onion pie I have eaten in a long time. Unfortunately, other meals last week weren’t so good.

For example, last week I had been invited to the Houses of Parliament to celebrate the launch the publication of the Nursing and Midwifery Council (NMC) Future Nurse; Standards of proficiency for registered nurses. This document provides the foundation for nurse and midwifery education. The launch was the culmination of nearly 3 years work, where the role I played was as a member of the NMC Thought Leadership Group. It was a real privilege to be involved in this way, and although the process was a roller-coaster one at times, I am so pleased to have been part of it. I am also so proud of the final output in terms of the standards developed. The future of nursing and the future nurse have been equipped with some long lasting educational standards. I hope universities rise to the challenge in delivering these future educational programme. 

Now I have been to the Houses of Parliament for many similar events, but there is always something special in walking through the security, and into the splendour of the building. I still find it awesome to be there. It was a great event, and a fabulous opportunity to catch up with so many friends and colleagues from my nursing and university life. Sadly, my friend and great colleague Professor Dame Jill Macleod Clark, was in Australia and unable to attend the event. Jill was the leader and architect of the standards development, and a brilliant person to be working with. 

The wine flowed, as did the conversation. The food was canapés. I think this small, and often very decorative savoury food, usually sitting on a cracker, or a small piece of bread is a complete waste of time. They can be consumed in one bite, but many are needed to satisfy any think except the smallest appetite. On principle I won’t eat them as I dislike and distrust such pre-prepared food at such events. Even if wanted to eat them, most were either fish or meat. Not great in National Vegetarian Week. The evening drew to a close and I wandered back to my hotel along the Albert Embankment. I was hungry and thought I might eat something off the in-room dining menu, but there was nothing that caught my fancy. Still I had breakfast to look forward to. What a disappointment. Given the quality of the hotel I was expecting something more than the ubiquitous buffet. Which was also far from hot. 

Unlike of course Harry and Meghan’s wedding. What a great spectacle, and one that was shared by so many around the world.  Here it was down tools and sit, watch and share the moment. They made their day their day. I don’t what they had to eat at the wedding breakfast, but the highlight for me was the wonderful gospel choir singing ‘Stand by Me’. Sitting still and enjoying the service made for the perfect end to a very busy and fulfilling week. 

The Dying Art of ‘Out of Hours’ Care

Last week I attended the Greater Manchester Health and Care Board meeting. The meeting was held in the wonderful surroundings of the Manchester Town Hall Council Chamber. It was a well-attended meeting with representatives from the partner organisations, the elected Mayor, and the Executive Officers of the GM Partnership. I was able to catch up with a number of former colleagues and friends. The agenda was impressive, but what was more impressive was hearing the voice of those ‘expert through experience’. This was a new approach to the meeting, and it was one I very much endorsed. The detailed papers were taken as read, so no time was wasted by rhetorical presentations of what we had already read – I am thinking of adopting a similar approach to my monthly Quality and Safety Committee meetings at Wrightington, Wigan and Leigh NHS Trust. 

One of these presentations really held my attention. It was a presentation to accompany an update report on progress made with the Greater Manchester Framework to improve Palliative and End of Life Care. This week is Dying Matters Week, so it was more than appropriate to receive the update. There was a great deal of information I was unaware of. Each year 1% of the population die. In the last 12 months, 23,866 people died across Greater Manchester. 48% of these deaths were in hospital; 23.5% in their own home; 18.7% in a care home; and 6.1% of deaths were in a hospice. 75% of these adult deaths occurred in the context of old age, living with multiple long term conditions, and/or specific illnesses. Cancer accounts for 25% of all deaths. 

Many of those that die in hospital actually have no clinical need to be there. There is much evidence to suggest that most people would not choose a hospital as their preferred place to die. We also know that health and care costs increase dramatically in the last 90 days of life. As a consequence it’s estimated that as much as 20% of all health expenditure is spent on end of life care. The GM EoLC framework addresses these issues and also a number of others around information sharing, access to specialist palliative services, variations in bereavement support services and most importantly the use of Advanced Care Plans.

Many of us are uncomfortable about talking about death, dying and bereavement. The consequence can be that we might not sufficiently plan ahead in terms of wishes and preferences. When I die, I want to be cremated, and have even planned what music I would like played at my funeral, which I would prefer to be a humanistic one. If it were at all possible, I would like a Viking Funeral a la ‘What we did on our Holiday’, a great film that captures my wishes so well. My loved ones know these details, and I trust them to carry out my wishes when I die. However, according to Tony Bonser (North West Regional Dying Matters Champion) many people don’t make plans, or feel able to exercise choices and preferences. 

Tony was the ‘expert by experience’ who told us the story of his son Neil, who died from cancer, aged just 35. It was a poignant story, even though he felt his son had a ‘good death’. Partly because of this he was able to tell the story with humour and passion (you can get a flavour of what I heard here). His son was diagnosed with cancer, had 2 major surgical interventions, courses of chemotherapy and radiotherapy, with many stays in hospital and visits to outpatients. All these treatments did not cure the cancer and Neil died. Tony and his family didn’t understand the progress of the cancer journey and this made making decisions and choices very difficult for them all.  

He reminded us all that what we say to our patients and their families might be not what they hear. Good communication is vital to ensure that people understand what is happening and what it is they are being told. Tony gently suggested that some health care professionals spend too much time talking and not enough time listening. I couldn’t agree more. When I used to welcome our health and care students to the University I would ask them to always make time to listen to what is being said and in particular what wasn’t being said. In the busyness of clinical practice this can sometimes be very difficult to do. However, effective communication is the key to people being able to makes choices, and making choices is the starting point in Advanced Care Planning. 

Tony also asked us to remember there is likely to be a range of communities impacted by individuals’ end of life care and their death. All of us are, in lots of different ways, are connected to others. Helping these others to understand end of life care, and work through their feelings of loss is also an important task for us all.

Tony told how his son, in conversation with a Macmillan Nurse, asked if could go home. He did not want to be in hospital any longer. This was a day before he died, and it’s not clear if Neil knew his death was imminent or not. The Macmillan Nurse was able to arrange this despite it being ‘out of hours’ and not 9-5 Monday to Friday. For dying people there can be no such thing as ‘out of hours’ care. Neil went home to his apartment, surrounded by his possessions and things he loved. His family were there when later that day, Neil died. His story should be an inspiration to us all to ensure good end of life care is something that reflects an individual’s choice around life, living and dying.