The Realpolitik of refugee families and health care funding

Whilst I have long held the view that nurses need to be more political in asserting their professional contributions, I usually try and steer clear of politics in my blog. However, last week a couple of news story topics made me pause and contemplate. So with your indulgence, I am using my blog this week to take a Realpolitik view of some of the issues that caused this pause. The first of these were the various stories of migration. 

Last Friday over 2000 people came together to celebrate the 70th anniversary of the 500 Caribbean migrants who came to Britain on the Empire Windrush ship. They were the first people to come here and help re-build post-war Britain. Of course whilst the anniversary celebration was a wonderful event, it was slightly marred by the recent experiences of this generation and the threats made to deport some of them. They were a generation of folk who had worked hard in the UK for all their working lives. Whilst their origins were in the Caribbean, many now quite rightly viewed themselves as British citizens. 

I also read about the hard line Italy was taking over refusing access to 224 migrants that had been rescued at sea by a German aid group. This was a week after Italy had already refused a ship containing 630 refugees to enter Italian ports. In a speech last week, Italy’s Deputy Prime Minster Matteo Salvini, also declared war on the Roma populations living in Italy and suggested that Italy should adopt policies on immigration similar to those of Donald Trump in the US. 

Like many others, I cannot help but express my repulsion at what was reportedly happening in the US with refugee children being separated from their parents and detained separately in immigration holding centres. United Nations human rights experts have described detaining children in this way ‘may amount to torture’. Whilst Trump has eventually reversed this policy, I feel sure it was only the sheer abhorrence of what was being done to children and reported internationally that gained this result. It was a new and despicable low even for someone whose behaviour and policy decision making appears so flawed and egocentric. Sadly it’s not just the US doing this. In case you missed it, here is a link to Brigid Delaney’s report on what is happening in Australia; it makes for grim reading. 

What made these news items even more difficult to comprehend was all of this was being reported in the week that also contained World Refugee Day. During the week, the Guardian newspaper ran a series of very powerful articles on the emergent migration crisis. On World Refugee Day they posted a List of the names of 34,641 people who had died while trying to reach Europe since 1993. It was a very powerful message. The List was compiled by the group United for Intercultural Action. This group represents 550 anti-racist organisations located across 48 countries. The number of deaths recorded is also likely to be much higher in reality, as many deaths go undocumented. Globally, there have been 60,000 deaths recorded since 2000.

Don’t get me wrong, like many others, I think these migratory movements need a solution. I don’t know what the solutions might be, but I do know that cruel and uncaring approaches are not the answer. Realpolitik might help here, and I don’t mean the Machiavellian and coercive approaches, sometimes associated with realpolitik, but those approaches based upon realism and pragmatism. Sadly I think there was more than a touch of Machiavellianism in the second political story to catch my eye last week. This was the announcement of a massive increase in funding for the NHS, based upon what we now know is unlikely to be a Brexit dividend but from a hike in taxation. 

The new funding proposal covers the next five years from 2019/20 onwards. It equates to £20bn more revenue in real terms compared with 2018/19. However, whilst this is welcome, the funding is for the NHS England commissioning budget only, so does not cover capital funding, public health, health education or social care. Many commentators were making the point last week that this additional funding will not do much more than keep the current services functioning. Perhaps more encouragingly, the funding requires the development of a 10-year plan to ambitiously: put the patient at the heart of how care is organised; develop a workforce empowered to deliver the NHS of the future; harness the power of innovation; have a focus on prevention; and achieve true parity of care between mental health and physical health. These are ambitions with which not many of us would argue. However, it takes time to educate and train the workforce. There are legislative barriers to integrated care that need addressing. And if the Government is truly wanting a different service-delivery model developed, then funding for social care must also receive a similar up-lift in the amount of money available. 

OK, thank you for indulging me in allowing me this occasion to comment on these challenging issues. Next week, I promise I will return to my usually politics-free approach to blog writing! 

A trip into the future: it's just ordinary magic!

Last week I came face to face with my fragility. I had spent a lovely weekend spent with my parents, and managed to turn their mattress over, pull up some paving slabs, and prune a holly tree – all without incident or injury. On the Monday, while out walking Dylan, I tripped on a kerb and fell heavily into the road. I wasn’t seriously injured, but both knees, my hip and arm took a bit of a beating. The following morning I was struggling to move and in a great deal of pain. Everything was sore and each movement I made was painful. It was easier to sit fairly still and only move when I had to. Nearly one week on and I am still stiff and sore. All from just from tripping over a kerb stone. 

Having just passed my #NHS1000miles mark last week, I was struggling to even give Dylan a gentle stroll. Thankfully for such an active dog, he was content to spend a few days running around the garden. For someone who likes to #WalkEveryDay I felt very despondent in not being able to walk as usual. So far this week, I have only managed 49km. I am hoping to be able to attempt a longer walk today but we will see. 

My 49km pales into insignificance when put against the achievements of a Bulgarian called Dobre Dobrev. He does a daily round trip walking from his village in Baylovo to Sofia, some 42Km. He does this every day come rain, snow and sun. In Bulgaria they can experience real extremes of such weather. Dobre does this daily walk every day to beg for alms. He doesn’t keep the money himself, in fact he lives frugally off a very small pension. He donates the money to orphanages and the church. He recently was able to give 24,000 Euros to a church that was struggling. I would like to meet him, he is said to be a humble and generous man. 

Surprisingly, following my fall on the Monday, I also came face to face with the uncertainty of life. I chaired a Mental Health and Wellbeing in Schools. The conference had speakers from the government, local authorities, academia and the third sector. Mental health problems affect 1 in 10 children and young people. Such problems include depression, anxiety and conduct disorders, often as a result of something that is happening in their lives. 50% of all mental illness start before the age of 14. Alarmingly, 70% of children and young people who experience a mental health problem don’t get an appropriate intervention at an early enough age. 

Like adults, the emotional wellbeing of children and young people is just as important as their physical health and wellbeing. Children and young people with good mental health are also to be more likely to develop resilience when it comes to dealing with the challenges of life.  There was an acceptance from many of the presenters that in order for children to thrive, they needed to feel loved, valued, understood and safe. Above all else, learning to accept who they are and recognising what they are good at. 

This was a theme that was developed one of presenters who described himself as a ‘Happiness Expert’ – and he certainly lived up to his title. One of his messages was that on average we all only have 4000 weeks in which to live our lives. I did a quick calculation and realised if everything went to plan then I had just 728 weeks left. His wider message was that we should strive to be ‘our best’ as often as possible. To help us achieve this he asked to think about how we might answer 4 questions: 

What does the 10/10 version of you look like, sound like, feel like?

What 3 qualities describe you when you are at your absolute best?

How often are you at your absolute best (honestly)?

What is stopping you from being best self?

It wasn’t quite a ‘one life, live it’ message, but I guess it was fairly close. His premise, was that motivated, energetic teachers would not only facilitate a better learning experience for children and young people, but would also create an environment that would promote good mental health and wellbeing. This resonated well with other messages heard throughout the day. Taking a whole school approach to changing the culture, and a culture that thought more about prevention than intervention. Putting the child or young person at the centre of the system, whether this was just the school or a wider system of children and young people care services. There were many examples given of how important it was (and had been) to hear the young person’s voice, and to find ways of truly engaging them in all aspects of services that touch their lives. As one presenter on the day noted, what we have heard was many examples of ‘ordinary magic’. 

It was a great conference and despite my discomfort and pain, I was able to recognise that it was a gathering of people that were committed to helping children and young people to have the best future possible. In the UK it’s Father’s Day today. I shall be celebrating the day with some of my children and grandchildren. I will also be thinking about what I heard and thinking that should any of my 10 (nearly 11) grandchildren need help with their mental health and wellbeing, there are some excellent folk around to provide that help. 

A Rolling Stone gathers no moss: so keep walking

Last Tuesday, along with some 50,000 other fans, I sat in the magnificent Old Trafford football stadium waiting for the Rolling Stones to come on stage. Somewhat ironically, Richard Ashcroft was the support act. He played with the band the Verve, and wrote their biggest hit ‘Bitter Sweet Symphony’. I say ironic, because that song used a sample from the Rolling Stones 1965 song ‘The Last Time’. Although the Verve had negotiated the use of this legally, it was claimed that they had used too much. The Verve were forced to give 100% of the royalties to the Rolling Stones, and Mick Jagger and Keith Richards were added to the song writing credits. Ashcroft ended his set with the song.

Over the past 50 years, I have seen the Rolling Stones on a number of occasions, and I was really pleased we got tickets for this concert, as I don’t think they will do too many more. They have a combined age of 294, Mick Jagger and Keith Richards are 74; Charlie Watts is 76; and Ronnie Wood, just 70 years old. They also have a reputation of a hedonistic lifestyle involving excess alcohol and drug consumption, which makes me wonder how on earth they keep touring. Their secret appears to be a determined approach to living a healthy lifestyle. None of the band take drugs (except Keith Richards who it’s said likes to start his day the Californian way – with a joint) and they are all teetotal. 

They all eat well, Mick Jagger starts the morning with serious super-juice smoothies, and along with Charlie Watts and Ronnie Wood they all eat macrobiotic, low carb and high protein small meals. Keith Richards likes his meat. However, what I found more fascinating was that they all regularly take part in physical activities that range from tennis, kick boxing, ballet, jogging, yoga and walking long distances. Mick Jagger runs up to eight miles a day, and when on the stage it’s estimated that he runs some 12 miles over the two hours of the show! Although the UK tour spans just eight dates, that is some serious exercise.

So these guys, age wise, are 10 years in front of me, I understand their chosen life style choices. I think we could all learn from their example. I don’t smoke, have never done drugs, but probably drink too much alcohol. What I do for exercise is #WalkEveryDay. Now, walking is the cheapest and most accessible type of physical activity that the majority of us can get involved in. If we walk instead of using our car, we also reduce our carbon emissions, contributing to a healthier world. The rub is, that despite most of us knowing this, research outcomes from a study with over 700,000 participants revealed the average user of smartphones with built in accelerometry was that they walked just 4,962 step a day – less than half of what the World Health Orgnisation recommend, which is 10,000 steps a day. 

Of course, other studies have shown that the environment we live in will have an impact on whether we want to walk or not, Access to green space, a sense of safety from crime and traffic are powerful elements when folk think about walking or not. Likewise, many of my friends think nothing of getting in their car to drive to the local supermarket to get that desperately needed pint of milk. In most cases they could have walked there. So walking can also be thought of as a social behaviour, probably influenced as much by people around us as it is by personal motivation. Interestingly, walking is the most popular form of physical activity in the world. Studies from the US and the UK reveal that the prevalence of walking is two to three times higher than those of the next frequently reported activities. 

However, to truly reap the health benefits, walking has to be of moderate intensity – in terms of walking this should be around 100 steps a minute, or 3,000 steps per 30 mins. You can test yourself using the ‘talk test’. If you are doing moderate-intensity activity you can talk but not sing during the activity. If you are doing vigorous- intensity activity you are unlikely to be able to say more than a few words without pausing for breath. As noted above I #WalkEveryDay. This week sees me pass the #NHS1000miles target of 1000 miles walking. In fact I still have today’s walks to add to my weekly total, but I am already up to 1,018 miles walked since January 2018. 

The World Health Organisation set up the ‘Transforming our World: The 2030 Agenda for Sustainable Development, which has at its heart the provision of universal health coverage and the reduction in health inequalities for people of all ages. As part of this strategy, regular physical activity is recognised as being a protective factor for prevention and treatment of non-communicable diseases such as heart disease, stroke, diabetes, breast and colon cancer. It also contributes to reducing other risk factors such as hypertension, obesity and is associated with improved mental health, a delay in the onset of dementia and improved quality of life and well-being.! With emergency admissions to hospitals continuing to rise, it is unfortunate that nearly 1.5 million people last year could have avoided an admission if hospitals, GPs, community services and social care had worked together more effectively. Equally, with the right kind of investment in keeping people healthier earlier and for longer, a reduction in the use of all health care services is clearly possible. As Hippocrates once said: ‘Man’s best medicine; walking is humanity’s path to a better world’.