2019: A Year in Numbers

Well this is the last blog posting of 2019, and By ‘Eck, it’s been a hectic year. A new house was purchased, with a decision taken to make it the most colourful house on the Fylde coast. I think we are succeeding in every way. Every door is now a different colour, brightly coloured rugs are scattered on every floor, even the cutlery has changed colour. The collection of 6000+ chickens (captured in every way possible) has been reduced somewhat, but I think I still have the largest chicken collection in the world. And of course, a new house means the chance to start yet another new garden, and we have made a great start. Old traditional (sycamore and more sycamore) trees have been felled, with twice as many new ones planted. A new livestock area has been created which now provides a home for 14 free ranging chickens and two delightful pygmy goats.

I have been to more music concerts in one year than I can remember going to in a long time. Conversely, I have only presented at one mental health conference this past year. I have written a contribution to a monograph on the development of mental health nursing over the last 20 years, and have done so in the company of some absolute giants in the field. I’ve seen two of my PhD students successfully complete their studies and have been privileged to be on the viva examiners’ panels for four other successful PhD students.

Earlier in the year, I fractured my right leg and discovered that there was some truth in the view that men take much longer to seek help for their healthcare needs than women. I also discovered the joys of what a well run urgent care service can do and do with such great efficiency and effectiveness. I have been interviewed by the Care Quality Commission on three occasions, and by one of the big five management accountancy firms twice. I have met the Chief Executive of the NHS three times and been impressed by what he had to say.

Joshua, my 11th grandchild was born (and although 11 grandchildren are great, I wonder how many more there might be). I watched and enjoyed all 92 episodes of Sons of Anarchy, but lost every University Challenge this year to J, whose brain is younger, sharper and faster than mine. However, I did win the inaugural #WeEatWell19 challenge, with the prize of a food hamper going to a foodbank. I learnt a lot about healthy eating and drinking and had great fun along the way. In August, along with other healthcare professionals, I took part in the #WeActive2019 challenge. This year the nurses won, and personally, during the month I lost 6.5kg in weight, walked 200 miles and didn’t drink a drop of alcohol. And as the #NHS1000miles challenge comes to a close I am pleased to say, with a couple more days to go, I have walked 2,310 miles over the year and posted 208 photos of my walks along the way. My ever faithful and willing companion Dylan, has walked nearly all of these miles too!

Surprisingly, maybe, at the age of 64, I gave my first pint of blood this year, discovered Bramble Gin, and rode the Blackpool ‘Ride the Lights’ on my bike. The latter was a 11 mile bike ride, accompanied by thousands of other riders on the most amazing range of bikes I have ever seen. So yes, it’s been a very busy year all told. As we stand on the edge of not only a new year, but a new decade, I reflect that 2020 means that I will have been writing and posting this blog every Sunday for 11 years. That’s a lot of words.

I do wonder if I should call it a day, but the very next Sunday, I’ll be there doing it again, and thank you to all the many readers who not only choose to read the blog, but send me comments as well. My father periodically asks me why do I write the blog? My response has always been that I like the challenge of writing a fresh blog each week, and enjoy writing per se. But I also do it, because it enables me to have a voice in raising awareness of how much more we need to do to make the UK a happier and healthier place to live, and to work towards creating a more just and equal world.

2017 is the last year we have complete data on the numbers of avoidable deaths in the UK. 23% of all deaths were said to be avoidable, and although this figure is better than previous years, it still represents some 141,313 people who need not have died. 34% of all deaths in children and young people were from causes considered avoidable. Blackpool had the highest rate of preventable deaths for men, whereas Surrey Heath had the lowest rate. For women, it was Manchester that saw the highest preventable mortality rate, with South Oxfordshire having the lowest. 

We are starting a new decade in which there is the clearest of all links between avoidable deaths and areas of deprivation. People living in the most deprived areas have a much greater risk of developing a long-term and often life-shortening condition 10 years earlier than those living in the least deprived areas of the UK. For men it’s five times more likely, and women four times more likely that they will die prematurely from an avoidable condition, due to living in an area of high deprivation.

It can sometimes be easy to blame the individual for the lifestyle choices they make. I have been guilty of doing so in some of my blog posts that perhaps have looked at smoking, alcohol misuse, or not being active and exercising regularly and the clear link to poor health and illness. The reality is that where people live, work and grow older can make it harder for many people to live healthier and happier lives. Whilst the NHS has, and probably always will have, an important role to play in keeping us all healthy and able to live the best life we can, other public services also have a role. I have spent the last six years as a Non-Executive Director at Wrightington, Wigan and Leigh NHS Trust. As such, I might be accused of being biased in recommending The Deal 2030 as a good example of how to bring all these agencies together in a way that also recognises our personal responsibilities. Take a look and see what you think. 

I hope 2020 brings you all the opportunities you wish for to live happy and healthy lives. J said yes, and we got engaged this year, and I’m very much looking forward to getting married next Spring. 

Thank you, dear readers, for the support and kindness you have shown me in reading this blog each week, and for now, well at least until next Sunday at least, I will keep writing it. Happy New Year to you all.

After food, air, water and warmth, music is the next necessity of life

This week’s blog title is a quote from that veteran rock star Keith Richards. In my mind it’s hard to disagree with his thinking. I love music and in our house, we have a music room that contains 5 guitars, a violin, a selection of drums, a piano, a French horn and a wide range of assorted exotic instruments. It is a room that grandchildren love to play in! Whilst we have 100s of CDs, many kept for the memories they bring, it’s Alexa (there are other virtual assistants available) that has transformed my music listening – you just have to ask her to play a song or style of music and she responds almost immediately, playing whatever it is you asked for. We play a lot of music in this house, and there is nothing we like better than going out and seeing live music.

The Summer of 2019 was a brilliant one for live music. We got a free open air concert in Stanley Park every Sunday, with mainly good weather and fabulous local bands. We were able to see two energetic young musicians playing the entire Mike Oldfield Tubular Bells from start to finish, with no backing track. Other concerts that year included Liam Gallagher, U2, James Taylor, Joan Baez, Mark Knopfler, Roger Waters and, of course, that other veteran rock star, Rod Stewart at the wonderful Lytham Music Festival. Next year we have tickets to see The Who.

We are fortunate that Blackpool and the surrounding towns has such a great live music scene and most weekends we can go and find a pub with a band on. What I didn’t know until last week was that British people aged 50 and above who enjoyed going to see live music had a 31% lower risk of dying. Research undertaken by University College London (so you know it’s going to be rigorous) found that those people who attend live music gigs and concerts, visit galleries, museums and exhibitions, or go to the theatre were much less likely to die over the next 14 years than those folk who didn’t go out at all.

It appears that such activities have a protective association with longevity in older adults, which could partly be explained by difference in cognitions, mental health and physical activity. With more bands continuing to play live music into their 70s, there’s no shortage of concerts to choose from. Mind you, it’s probably only the 50+ generation that can afford the tickets. That said, last year we, (along with 49,998 other people) saw the Rolling Stones live at a rather packed Manchester United stadium.

Maybe we need to change that old adage ‘an apple a day keeps the doctor away’ to something like ‘a rock concert every once in a while, keeps you healthy and able to smile’ – But, I hear you cry, surely eating apples is still a good thing. Actually, you would be right. Researchers at the University of Reading last week published their research results that showed eating two apples a day reduced the risk of having a heart attack and/or a stroke. 

 

The research found that a certain type of fibre found in apples stimulates bacteria in the gut which produces ‘short chain fatty acids’ which reduce the production of LDL cholesterol (also known as ‘bad’ cholesterol). While the reduction in ‘bad’ cholesterol through eating apples falls short of what is achieved by taking statins, the change is significant in reducing the risk of cardiovascular disease. And currently, apples are a lot cheaper to buy and much more enjoyable to eat than statins.   

Apples and rock music concerts appear to be good bed fellows, which is actually great news for most of us thinking about seeking help from our GP. Yesterday’s ‘The Times’ amidst its advice over how to get crispy roast potatoes and what made Caitlin happy in 2019 told of the current crisis in GP land. It appears that if you live in Milton Keynes, you will have to queue in the cold to see a GP. However, if you live in Ross-on-Wye, you will have no problem seeing a doctor.

Yes, there is a crisis in terms of the number of doctors who want to practise as GPs. Today, the average (wrong word I think) GP is caring for 200 more patients than they might have been less than five years ago. Overall, we know that patient numbers have risen from 57 million to 60 million since 2015. The number of doctors in England have fallen by 1,700 over the last four years, despite governmental pledges to increase their numbers. It’s perhaps not surprising that it’s difficult to get an appointment to see your doctor and perhaps why so many feel their only option is to turn up at A&E to get help.

I believe that many people who visit their GP could be well served by other healthcare professionals other than doctors. Whilst the focus in papers, such as the ‘The Times’, is on numbers, I think we should also consider skills and knowledge, and there are many advanced practitioners (not all of whom are nurses) who can make a diagnosis and prescribe a treatment option. Perhaps politicians and policymakers need to think more creatively when it comes to dealing with the ever-increasing demand for immediate health care services. When A&E is swamped with patients seeking help, and acute beds are at a premium, it’s hard to see why investing in a multi-professional and skilled workforce is not a good use of taxpayers’ money.  

BUT it’s Christmas, and perhaps I should show more generosity of spirit to others. I’m passionate about creating a better healthcare system that is not just about dealing with illness and trauma, but is about promoting better health and well-being for all. So please forgive me my passion.   

It is Christmas, and that rascal Keith Richards, who some might see as the epitome of unhealthy lifestyles, perhaps can have almost the last word – he once said: ‘I’ve been through more cold turkeys than there are freezers’. If turkey is your thing this Christmas, enjoy - however, mine will be a nut roast Christmas dinner.

I wish you all a very Merry Christmas. 

With great power comes great responsibility

As many readers of this blog know, I seldom offer any political views in my weekly postings. So it was with some amusement that I sat down to think about what to write for this week’s post general election post. Of course, I could do the historical thing and note that the first general election in the England was in 1708, a time when the Whigs were fiercely dominant and kept the Tory party out of power for long, long periods of time. Or that, during this time, most politicians were very rich and often landowners, but that might be straying too close to the ‘making a political comment’ wind. I can say that I have voted in every one of the 13 general elections that have been held since I turned 18, and I have always felt it was a real privilege to be able to do so.

Last Thursday was no exception. Early in the morning I went and cast my vote. It turned out to be a momentous day; it was our Trust Board Christmas dinner, and for the first time in several years we had an almost complete Board sitting down for the meal (which was delicious). Going home by train later that night I was able to look at the election exit polls and knew that Friday was going to be a difficult day for many. I went to sleep, but J stayed up to see the results emerging.

Whatever the outcome you were looking for, the actual results were astounding. My heart went out to all those candidates who lost their seats, many of whom had worked so hard to serve their constituents and their various parties. There was sadness tinged with joy in our house as we saw the local results get announced. J has been a parliamentary candidate since the 2017 election and for lots of reasons chose not to contest several North West seats, all of which were filled by the Conservatives, one for the first time in its history. I was sad for her and with hindsight, maybe it was the wrong decision not to stand this time. However, I was glad that I didn’t have to face the prospect of sharing her time and energy with a parliament in London and the concerns of constituents in a neighbouring town.

I take my hat off to all those who did choose to put themselves forward and now have the daunting job of delivering on all their campaign promises. It was good to see the NHS foregrounded by all the political parties during the election campaign. But all the issues identified remain wicked issues. Promising extra staff is likely to prove easier to say than deliver. The demographics work against increasing the workforce, as do the economics. The percentage of population living longer, but often with complex needs, continues to grow. The capacity issues in meeting an ever-growing ask of the NHS won’t be solved by building new hospitals, even if it were possible to do so. And I hope I’m not being too political here in saying this.

Whatever your politics might be, I think we as society, have got to make some hard choices in the near future. Extra doctors and nurses, more modern well-equipped hospitals are welcome, but we need to address a much more fundamental set of issues, to truly make our NHS a health providing service. Many of the health issues we face are the result of choices we make during our lives. Smoking, overuse of alcohol, unhealthy diets and a more sedentary lifestyle are all major contributors to both physical and mental ill health. But its not that simple. Good health and wellbeing are multi-factorial and often complex. They will be influenced and shaped by a number of things including our age, employment, where we live, family history of illness, and of course, those lifestyle choices.

There is plenty of evidence to suggest that many people choose unhealthy lifestyles and behaviours because they tend to be thought of as being effective in managing stress and other life challenges. I was surprised to see at my recent visit to a mental health hospital in Portugal that both doctors, nurses and patients were smoking, something that’s allowed in law. In the UK, 50% of all tobacco smoked is smoked by people with a mental illness (although you can’t do so in hospital!). Likewise, alcohol (and drug) misuse are commonly associated with mental illness.  People gain an average of 13lbs in the first two months of taking antipsychotic medication and the weight gain continues over the following 24 months. These are the kind of iatrogenic consequences best described by the Austrian philosopher and priest, Ivan Illich. His book, ‘Medical nemesis: the expropriation of health’, published in the same year I started my nurse training, suggested that the practice of modern medicine had led to an ever increasing number of health problems resulting from medical interventions. We have only to see the justifiable concern over hospital acquired infections such as MRSA, C-diff, and CPE or the focus on Hospital Standardised Mortality Ratio (HSMR) and serious incidents like wrong site surgery, to have a sense that this might still be an issue.

Perhaps more importantly, Illich described that contemporary medicine, in appearing to offer cures for nearly all conditions, (even those previously thought not pathological) raised the false hope that all suffering could be avoided. The impact that results from such thinking is that over time, people’s, and communities’ self-sufficiency, freedom and dignity are all undermined. Many people will simply become passive consumers of healthcare services. Consider the demand for help and care in most Emergency Departments – all the research consistently notes that over 30% of all presentations do not need the intervention of A&E, and of these, many are simply uncomfortable but ultimately self- limiting health problems. Providing more hospital beds to relieve the pressure at a hospital’s front door is not the answer.

Concentrating on reducing poverty and social inequality, both of which are also linked to poor health, might make more of a difference. That said, all healthcare professionals, wherever they live can also help. I remember with fondness the MECC (Making Every Contact Count) public health initiative from 2013. It’s an evidence-based intervention that supports people to make healthier choices and directs them to the best place to help in doing so. My hope is that the newly-elected politicians and all healthcare professionals can work more closely together to ensure we have a healthier Britain in the future. After all, as Spider-man said on many occasions, ‘with great power, comes great responsibility’.

Alexa!?! – what is the state of mental health care in today’s digital age

The last seven days were a very different week for me. I spent most of it in Portugal. Much of the time I was away from wifi and any internet connection. This was both a blessing and a pain. A blessing as I sometimes feel it does me good to go ‘off grid’ occasionally (and it has been wonderful to be free of 24 hour general election and Brexit politics). It was, equally, a pain, because it meant I was unable to easily contact my family to let them know I was OK and to enquire as to how they were doing. On reflection, now I’m back in the UK, having a disruption to my everyday life has actually felt very refreshing.

I was in Portugal to present a keynote paper at a mental health conference, where the audience were, in the main, mental health professionals. It was the 117th presentation of my mental health career as a practitioner/academic. Up to this week, I had presented 116 conference papers in 25 different countries, including China, US, Australia, New Zealand, Slovakia, Holland, Japan, Germany, Italy, Czech Republic, Nigeria, South Africa and Iceland – often making more than one visit to some of these. It was the second time I had been asked to speak in Portugal. The first time was way back in 2002 at a health and social policy conference. My focus on that occasion was a zeitgeist analysis of the original NHS Plan, which had been published two years earlier. 

Last week, my paper focused upon resilience, recovery and research and the state of mental health care in a digital age. Ironically, when I had been asked to speak, I was unaware of just how difficult it was going to be to use digital technology to maintain my everyday life activities! Drawing upon international examples of best and emergent mental health practice, my paper argued that new technology, particularly digital and information technology, can be something good, and something to make our lives better. Equally, its use can also lead to mental health problems, and problems for people of all ages. The paper explored the possible negative impact on the individual, the communities they live in and the potential for new ways of practising mental health care in the future.

Good mental health has been defined by the World Health Organisation as: ‘A state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully... ...and as such they are able to make a contribution to their community'. In mental health care, the concept of recovery is about supporting individuals to live meaningful, satisfying, and purposeful lives. It’s not about ‘cure’. It’s about helping people to enjoy good relationships, be engaged in satisfying work, and having opportunities to grow and achieve personal goals. Likewise, the concept of resilience provides a way to better understand how good mental health and wellbeing, strong social connections, our personal attitudes, and interpersonal skills can help us deal with periods of change or stress, and reduce the risk of experiencing mental health problems.

Against this mental health context, digital technology has begun to change our lives in many ways, albeit not always positively. Who would have imagined back in 2002, we would be able to summon a taxi, speak and see our family 1000s of miles away, shop and get the week’s groceries or Amazon parcels delivered to your door, or pause live TV programmes or stream 1000s of films directly to your phone? Don’t forget the first iPhone only became available in 2007.

Strangely though, often our day-to-day experiences of UK healthcare services has not changed much since 2002. Yes, we may be able to book a GP appointment online, but most of us will still troop off to our local primary care service for a face-to-face consultation. Even Babylon (the online consultation service, GP at Hand) has only managed to secure 60,000 users since 2016. In mental health, whilst there is a plethora of online psychological therapies available, there are few live video clinical interventions providing access to such therapies. The queues for brief interventions, such as those provided by the Increasing Access to Psychological Therapies (IAPT) programme, which has been tremendously successful, continue to grow ever longer.

Emergent technologies, such as that promised by Artificial Intelligence (AI) bring with them some sinister side effects. The harvesting of data, that many of us give so freely and without much thought, forms the basis upon which many algorithmic and predictive decision-making programmes are designed. Whilst it might be helpful for Tesco to shape its offers to me based upon my shopping habits and preferences, other uses of personal data are rather more worrying. Phenotyping (a kind of Tinder swipe left or right approach – not that I know anything about this J), is beginning to catch on in many parts of the US. It’s being used by mental health services to capture, analyse and use a range of data. For example, the way phones are used, the tone of voice (yes that microphone you have in your iPhone may not be entirely your friend), and the length and timing of calls. The research suggests that the subtle aspects of typing and scrolling, such as the interval between scroll and click, are surprisingly good surrogates for assessing cognitive traits and affective states in the same way as biological markers can indicate a particular physical condition.

The promise of digital phenotyping is that patients and clinicians will no longer have to rely on self- reported symptoms in considering what might be an agreed way forward in addressing someone’s mental health problem. However, in its purest form, these approaches offer little privacy to the patient, and I guess for some people, the monitoring by digital devices could exacerbate the feeling of being watched and trigger paranoia. And there’s the rub. Digital technology can be a force for good, but if we forget to keep the person at the centre of all we do and not the technology, we might as well go back to being akin to Bentham custodians in a newly created Digital Panopticon. And remember, just like me last week, it’s possible to switch off Alexa….

Desire, Joy, Sadness: the critical emotions of compassion in action?

Well it was an extraordinarily busy week last week. I’m glad I have retired, otherwise I wouldn’t have had the time to fit everything in. Amidst all the busy-ness, I found myself immensely distracted by listening to last week’s Radio 4 programme, Start the Week, with Andrew Marr. The focus was on Love and Unreason and featured, among others, Clare Carlisle, who talked about the forthcoming publication of George Eliot’s translation of Spinoza’s work ‘Ethics’. I was absolutely fascinated by the story. Mary Evans (as she was then) first had to teach herself to read Latin, before translating Spinoza’s work into English. This was in 1856, some 99 years before I was born. Totally remarkable. Spinoza was a fascinating philosopher. In Ethics, he talks about emotion, suggesting the essence of a human being is characterised by just three emotions: Desire, Joy and Sadness. All other emotions are derivatives of these three. Clare Carlisle is herself an expert on Spinoza’s work and it is through her efforts that the new book will be published next February. Too late for a Christmas present, but I know there is a certain wedding coming up in April… just saying.

And of course, if you are also a Radio 4 fan, I’m sure you will have been listening to George Eliot’s wonderful Middlemarch – if you haven’t, I highly recommend you listen on catch up. 

Tuesday was the first of a number of meeting days. The last meeting was with the Care Quality Commission (CQC), who were spending the week undertaking a ‘Well Led’ review of the Trust. It is the second such review I have been part of in my time as a Non-Executive Director at the hospital, but they are always different. We had prepared well and as I knew I was to be interviewed, in part because I chair the Quality and Safety Committee, something I have done for over five years now, I was fairly confident. It was my favourite kind of interview; the type where the answers are best constructed around the telling of stories. Although not to the same level of complexity and intrigue as George Eliot’s work, there were many good stories to tell.

The CQC attended our monthly Board meeting the following day, and although the Part 1 of the Board was fairly unexciting, it was good to see so many from the Council of Governors there at the meeting. Part 2 was a little more exciting, because our new Chief Executive (who has been in post a mere five weeks) set out the headlines of where he saw the Trust going, and the elements we should be building our strategy on. Interestingly, he believed that it would be demographics rather than technology (or politics) that was likely to shape the future UK health service. That said, I’m sure politics and technology will help us resolve the growing problems posed by an ever increasing older population and the complex health and social care needs they experience.  

I met someone else later that day who was also worried about demographics. I attended a workshop facilitated by international expert in leadership, Professor Michael West. It was the second time that week where I found myself spellbound listening to a softly spoken, confident and knowledgeable person – the first was Clare Carlisle. Michael West’s workshop was focused around compassionate leadership. I have read much of his work, but had never heard him speak. He also had a fascinating story to tell.

He took the workshop through the four elements of being a compassionate leader. The first being the ability to ‘be present’ – how many of us have been stopped by someone who wants ‘just 5 mins of our time’ just as you are on your way to a meeting that starts in a few minutes – your mind is on the meeting and that paper you haven’t yet read, rather than being with the person in front of you; the second element was ‘listening with fascination’, really working at hearing what’s being said (or not said); the third element was ‘empathising’ – something that I personally feel is really difficult to do, or to do well; and then lastly, asking how you might help the person. These four elements, if used together, that is ‘compassion in action’, will help shift the boundaries between our self and our self and others. I didn’t know, but the simple act of asking and striving to help others actually elicits a physiological reaction, particularly around the reward centres in our brain. Michael posited whether we are actually hard wired for altruism. Maybe a question for another blog posting.

I reflected on what he what he has said and wondered if the moral distress many nurses experience is because they perhaps feel that they can’t do what they should be doing to help others, because of the sheer demand on services and the daily busy-ness of health care today. It was Don Berwick who famously said that there should be only one rule book, and that book should only have one rule: Do what you think is the right thing.

Friday, I saw someone doing the right thing. I went to my chemist, housed in my local health centre. It’s a wonderful place. You can go for a swim, eat at the café, take a book out of the library, use the gym, have a walk in the gardens, pick up a prescription, oh and yes, if you want to, you can also see a GP or Advanced Nurse Practitioner. The chemist had texted me to say my prescription was ready and I was interested to note a new service, where I could elect to pick my prescription up 24 hours a day, 7 days a week, from an automatic hole in the wall dispenser. I immediately thought this might be the solution to the problem of a retiree with time availability issues.

And then I saw Kylie. She was standing in front of the counter at the chemist and was having a heated conversation with one of the assistants about her medication. She was clearly distressed and becoming more so by the moment. I don’t know what the problem was other than she had run out of her medication and the prescription for a new lot hadn’t been signed off. The conversation became more heated and eventually, Kylie stormed out. Without any hesitation, the assistant rushed after her, caught her by the door and wrapping her arms around the young lady, gave a her a hug, saying ‘come with her and she would sort things out’. They disappeared into that little cubicle chemists have for ‘private consultations’ and as they did so, the other assistants jumped into action to get one of the GPs (there are always some at the health centre) to get the prescription signed off. 

I don’t know what happened to Kylie, but in terms of Michael West’s compassionate leadership, you couldn’t have seen a better example of compassion in action.

It was a mistake, you said. But the cruel thing was, it felt like the mistake was mine, for trusting you

After over 10 years of posting a blog every Sunday morning, I'm still enjoying the writing and opportunity to share my thoughts, ideas and observations. However, one of the down sides to writing a weekly blog is that other bloggers can scoop the breaking news and post before you have a chance to do so. Thinking about this week’s blog I was originally drawn to writing about Health Education England (HEE), prompted in part by the news that its chief executive was to step down in March 2020.

Safe to say, over time I had become steadily disenchanted with HEE. Back in 2012 it felt like one of Andrew Lansley’s better ideas on how to improve the NHS, and to be frank, there weren’t that many. I was Dean of a School for some 5 years before HEE was formed and had enjoyed a fairly privileged position in the university as our student numbers were almost guaranteed, students got bursaries and I enjoyed a great relationship with the folk at the Strategic Health Authority. In fact, thanks to a block contract type of approach, I think on occasions we even got paid for the student tuition fees even if they dropped out. It was a good time. However, it wasn’t always a good use of tax payer’s money!

That all changed when HEE came along – and the world became a great deal more competitive. Our University was one of 11 in the region who provided nurse and other health professions education. Up to the arrival of HEE, there was room for everyone, and each university played to its geographical strengths and their different reputations. Post HEE, came a period of uneasy alliance, as contracts were signed and student commissions became a great deal more managed. The alliance across the 11 universities was held together by a trust that grew out a mistrust of HEE and what appeared to be politically motivated changes. However, this trust was completely abandoned when Bolton University declared an educational UDI and started its own nurse training scheme in partnership with a local NHS Trust. In effect providing a privately funded autonomous opportunity for folk to become a nurse. HEE did nothing to intervene, and the private market flood gates were well and truly opened. It was not a good time for those loyal to the HEE commissioning model.

Anyway, that was my original intention, write about my experiences, good and bad, of working with HEE. And then that other great blogger, Roy Lilley got there first and posted a blog last Friday about HEE – see it here – it’s written in a slightly more acerbic style than myself but we both share some of the same misgivings over the way HEE’s approach has resulted in such a workforce crisis in the NHS.

So not wanting to give you a different version of the same story I decided to take this blog off in a slightly different direction. However, the notion of trust and what might grow and sustain it, features in what I turned to in this post instead. The subject that percolated up came from a meeting I attended last Friday, the regular Wrightington, Wigan and Leigh (WWL) NHS Trust Safeguarding Committee. I attend wearing my Non Executive Director special interest hat, although abuse in all forms has been something that has featured in my research and publications.  

The meeting only happens every six weeks and has an extraordinary long agenda. Being held on a Friday afternoon means there can sometimes be a limited attendance, which is a shame as there are lots of good reports presented of some exemplary work. Of course, another reason for people to attend is that safeguarding everyone’s responsibility, not just those who have safeguarding in their job title. It was also National Safeguarding Adults Week last week. Organised by the Ann Craft Trust, The University of Nottingham and the Safe Guarding Adult Board Manager Network, the campaign took a different focus each day. Each focus was on the difference issues facing adults at risk and included: Self-Neglect, Modern Slavery, Safeguarding adults in sports, Transforming Care and Domestic Abuse.  

According to the latest figures available, (2018) it is estimated that nearly 2 million adults (aged 16 – 59 years) experienced domestic abuse. That’s 6 in every 100 adults. Women are almost twice as likely to experience domestic abuse than men. In in England, 1.3 million women were victims, compared to 695,000 men. For reasons not known to me, Wigan has a higher number of men reporting domestic abuse than in other parts of England, and overall, the rate of domestic abuse in Wigan is four times that to be found nationally.

These statistics don’t shed any light on the context and impact of domestic abuse. For example, if coercive and controlling behaviour is take into account the difference between the experiences of women compared to men becomes more apparent. It is estimated that more than 750,000 children in the UK witness domestic abuse each year. So the effects of domestic abuse clearly doesn't just impact on just the victim, in many cases the whole household can suffer. Seeking help is often really difficult. So it was wonderful to hear of the work of the award winning WWL Independent Domestic Violence Adviser and Sexual Violence Adviser (IDSVA) service. With Wigan Borough Council, WWL funded an independent domestic violence adviser service pilot scheme, developing an adapted model of working tailored to the hospital environment to offer swift intervention and support.

Its been a success. In the first nine months 300 people (including some WWL staff) accessed the service. 16% of whom were male. Interestingly, none of those who accessed the service have re-presented to the hospital. The service is due to be officially launched in November within the forthcoming 16 days of action, have a look here. My sense of why it has been successful is that those involved have created a place where trust can be tested and found to be reliable – hearing about this work filled me with immense gratitude that there are those who are prepared to really make a difference to people who have no where else to turn to.  

Thank you to David Levithan, The Lovers Dictionary for this weeks post title.

Saying goodbye to Dobbo and a number of other words from last week

The idea for this week’s blog was sparked by Kenny Gibson, my Twitter friend and prolific tweeter. He posted an early morning tweet yesterday that noted the words ‘listen’ and ‘silent’ have the same letters. More on that later, but the notion started me thinking about words. I have always had a passion for words and love the buzz from presenting, reading and writing. And it can be surprising how many words you might read, write or speak in a day. For example, yesterday I sent 64 tweets. On average there were 21 words in each tweet. That’s some 1,344 a day or nearly 1,000 in a week. In two years, I would have written as many words as I did for my PhD. However, at 100,000 words my thesis pales into insignificance compared to other works – for example, The Bible has 783,137 words, the complete set of Harry Potter books (7) contains I,084,174 words. In comparison, the NHS Long Term Plan has 50,000 words, and my shortened CV (once 28 pages long) now only has 2,038 words.

Of course, more often than not, it’s not the number of words used, but the way in which words get used that counts. I have often said something in a clumsy way, and as a consequence caused someone else unintended hurt. Which one of us hasn’t sent a late night email, possibly after a glass of wine, and then regretted it as soon as the ‘send’ button has been pressed. Many students, particularly when they are starting out, have a tendency to be repetitive in their writing, possibly thinking the number of words counts more than the quality of the content. And just think what saying ‘I love you’ might mean to another person’s world and life.

Newspaper headlines are another great example of how words can be used to reflect public opinion, make comment or simply to evoke humour. These days, I habitually look at the BBC News online services, where their website posts all the popular UK newspaper front pages. It’s a quick and easy way to get up to speed with what is going on and what the issues of the day ahead might be. The service has only been going since November 1997. Earlier in that same year, Friday 2nd May to be precise, it was the BBC’s Today programme where I first heard the news of Tony Blair’s landslide election. It wasn’t so much that his politics weren’t my politics that concerned me as such, it was the promise to abolish the NHS internal market that filled me with dread.

I had just spent two years working on my PhD which was situated in and around the way GP Fundholders made decisions about purchasing care for their patients. I feared that if there was no provider – purchaser split (the basis of the internal market) I would have no PhD thesis! I needn’t have worried, as one type of internal market was replaced by another, only we now called it ‘commissioning and providing’.

The job of ending the internal market was given to Frank Dobson or ‘Dobbo’, as he was affectionally called by many. This clever, sometimes irascible, but always passionate long-serving MP regrettably died last week. I was genuinely sad to hear the news. He was the most unlikely candidate to become Secretary of State for Health and I think even he was surprised at being given the appointment! He spent just 30 months in the post, but what a difference he made. Regular readers of my weekly blog know I steer clear of political narratives in my writing, so I am not making any party-political points here.

Dobbo was the genuine article when it came to practical politics. He is credited, rightly so in my opinion, for bringing some much-needed stability to the NHS. Some of the things he fought for were not always universally welcomed. For example, he established the National Institute for Clinical Excellence (NICE), which these days is called the National Institute for Health and Care Excellence although the NICE acronym has stuck. Dobbo established the original NICE in an attempt to reduce inequalities in health care provision, the so called ‘postcode lottery’. There were many who saw its work as being a hindrance and if something (usually drugs) didn’t get its approval, there was often an outcry. The National Institute’s remit today is significantly wider and they have a much more sophisticated and effective public health guidance programme, helping to prevent ill health and promote healthier lifestyles.

Dobbo also increased the funding for the NHS and presided over one of the largest hospital-building programmes in the history of the NHS. Along with Tessa Jowell, he established the very successful Sure Start programme aimed at helping families with childcare, health and education in the first three years of their life. While again the programme has had its critics, earlier this year the Institute for Fiscal Studies published their research into the effectiveness of the Sure Start Centres and concluded that the programme had reduced the number of hospital admissions and saved the NHS several millions of pounds each year. Regrettably, as this article suggests, such benefits may well be lost as local government continues to deal with the impact of fiscal pressure. Perhaps the current Chief Executive of the NHS, Sir Simon Stevens, might find a way of safeguarding this programme from further erosion. In a strange twist of history, Simon was also a special advisor to Dobbo during his tenure in charge of the NHS.

And the last word (almost) goes to one of my young grandsons. Harry, aged 4 years, and 9 months  (going on 18) has a bit of a way with words too. Last Thursday, as we were cutting out and pasting Waffle and George’s castle beds (you will have to watch Cbeebies or buy the Cbeebies magazine if this doesn’t mean anything to you), we simultaneously (in the way that only young children can do) played a word game. I would say a word and he would tell me what it meant. He has a growing vocabulary and he often amazes me with the words he chooses to use. One of the words I asked him to define was ‘obesity’. He thought for a millisecond and then said that is when people are too fat, and if they don’t stop getting fat they die. Next week I’m going to ask him what he thinks ‘listen’ and ‘silent’ have in common – he struggles with both concepts, so it will be interesting to hear what he has to say.

There is another strange twist of history to this tale too. Similarly, on 2nd May 1997, Paulo Freire, the world-renowned, and in my eyes brilliant, Brazilian educator and philosopher died. I’m sure both he and Harry would have got on really well; they like me, both love the creativity of words.

Choices, Consequences and Recognition (with apologies to Karl Popper)

I don’t do politics in my blog posts, but it’s hard to read the news at present without being swamped by endless election promises and propaganda. I don’t know about you, but the constant so-called political analysis, claim and counter claim, the character assassinations are becoming extremely tiresome and depressing. In fact in this house, we are totally fed up with with what is going on. Sadly, it appears whatever the choice people will make on the 12th December, we might still end up with a very divided society. And then there is the weather. Many people last week had their lives turned upside down and inside out by the weather. Some parts of the UK had a month’s rain in just one day and flooding was the almost inevitable consequence.

Listening to the news and seeing the pictures of those areas affected was heart-breaking. Whilst thankfully it has never happened to me, it did to my best friend and the disruptive consequences lasted for years. During last week, the devastation of past floods was re-played and reasons sought for why there appears to be an increase in flooding. A number of people were trapped in a large shopping centre in Rotherham. It is a sprawling building built on a flood plain, and it’s almost inevitable that if we keep making planning choices like this, we will keep reaping the destructive consequences of our decisions. The most often heard reason for these floods was global warming and climate change, and what we were doing (or no not doing) that was having such an impact on our weather.  

Amidst all this debate came the announcement from Collins Dictionary that the word of the year was ‘climate strike’ – (which I think is actually two words if we are using strict Scrabble rules). Apparently, the term was first used four years ago to describe pupils refusing to attend school in protest over global warming. It is a term most often associated with the young Swedish environmental activist Greta Thurnberg. Last September she became the face of a world-wide series of demonstrations (involving 185 countries) protesting against the failure of governments to act on climate change. The Guardian newspaper, reporting on a huge mural being painted on the side of a building in San Francisco, yesterday described this remarkable young lady better than I could: ‘At the age of 16, Thunberg has already reached the exalted status of Nobel peace prize nominee, leader of a movement to reclaim the planet for future generations, focus of Donald Trump’s mockery, and hero among progressives and young people’ Now, not many of the politicians currently vying for our votes can be said to be worthy of such recognition.

As well as ‘climate strike’ (which does look like two words) the Collins Dictionary also recognised other terms including ‘non-binary’, indicating an individual’s preference not to be identified as a male or female; ‘double down’; ‘influencer’; ‘hopepunk’ (apparently a TV genre); and ‘deepfake’. Now you may recognise most of these words as well, but they are not something that I have heard crop up in conversation.  

Something else I didn’t recognise last week were the rationale behind the stories I read in Rolling Stone and the New York Times about someone called T.I. (real name Clifford Joseph Harris Jr.) who is a rapper, which allegedly is some kind of music genre, and not something around a chocolate bar. It appears he chose to accompany his 18-year-old daughter to her yearly health check-up. Now when I say accompany, this was not just driving his daughter to the GP’s surgery, this was actually being in the room as the consultation took place. I think this would have been outrageous enough, but it was revealed he was there to ascertain whether his daughter was still a virgin or not. Not surprisingly, his choice to do so, and talk about it, spiked a huge backlash on social media. I don’t intend to add to his daughter Deyjah’s probable trauma at this intrusion into her personal life, however she did use social media to ‘like’ comments that called her father’s actions ‘disgusting’, ‘possessive’ and ‘controlling’. Other commentators, those with real science behind their observations noted that there is no such thing as a so-called virginity test. Have a look at this excellent story  on the subject published in Friday’s Guardian newspaper (and there are other newspapers than this one – honest!). Personally, I think T.I. will come to regret the choices he made and the consequences that will follow.

And finally, my last story from last week comes from the weekly Death Audit we undertake at my hospital. We hold a belief that looking at deaths can teach us lots about medicine and the care provided to individuals. Carefully reviewing all death is as much about understanding the science of what has happened as it is about understanding the human condition. The week before last, a man in our hospital care died. Last week, his wife died with us. Grief isn’t an illness, but it can be more lethal than most of the illnesses treated by the good folk at the hospital. The so-called ‘Widowhood effect’, has been found to double the death rates in the three months following the death of a spouse. Men are more vulnerable than women. Clearly there is no health without mental health. We can’t always choose what happens to us, despite what others (including politicians) might tell us is the case. The consequences of the choices we make are not always predictable. Just as we should recognise that broken hearts aren’t just metaphoric, we should more readily accept that sometimes the consequences of our choices are not what we might have intended.

Scary stuff, and its not just Halloween that should frighten us!

I’m of an age (and possibly generation) that still enjoys listening to the daily Radio 4 show, ‘The Archers’. This is the world’s longest running drama, a the radio show started in 1951, and there have been some 19,000 episodes. At one time it was described as ‘an everyday story of country folk’, although these days it’s probably something like ‘a contemporary drama set in a rural landscape’. In February this year, it was voted the second best UK Radio Show (Desert Island Discs was number one). Last week, being Halloween, many of the episodes focused on all things scary, trick and treating and so on. The view on Halloween night itself was that children today don’t make much of an effort to dress up, want money instead of treats and generally Halloween itself was another example of an unwanted US influence.

Well, it may not have been scary in Ambridge, but in downtown Wigan it certainly was! Last week, I and the rest of the Trust Board attended a training session on Cyber Security. Frightening? Yes it was! The training was approved by GCHQ, the UK’s intelligence and security organisation, and was facilitated by someone with a brilliant sense of edgy humour. He managed to make the seriousness of the risk something everyone sitting in the room could understand.

I guess many of this blog’s readership might think that the worst consequences of a cyber-attack might be stolen bank account or credit card details, identity theft or that they might have to reset their passwords yet again (more of which later). However, it’s a lot more worrying than that. Data, is becoming extremely valuable, and the NHS has oodles of data. Ernst and Young (one of the big five accountancy firms) estimate that data held by the NHS could be worth somewhere in the region of £10bn a year through operational savings, improvements to patient care and benefits to the wider economy. Their report also considers the trading values of patient data, particularly in the areas of genomics, and pharmacology. Getting your hands on such data and selling it could make the unscrupulous very rich indeed. In 2015, criminals stole 80m records from Anthem, a US health insurance company, with a market value estimated at $1bn. Safeguarding such patient data is critical, not only from an ethical and professional perspective, but also for maintaining health care services.

The NHS was one of the biggest victims of the 2017 cyber attack called WannaCry. This global attack affected at least 80 NHS Trusts, and some 600 primary care organisations in the UK. Over half of these organisations were locked out of their IT systems. The attack was only stopped when a young cyber-security researcher called Marcus Hutchins who whilst surfing the internet in his bedroom, stumbled over a so called ‘kill switch’ and was thus able to stop the attack. The WannaCry attack resulted in almost 7,000 cancelled appointments and at least 19,000 follow up appointments. It cost the NHS more than £92m to sort out and restore their systems. With the ever-increasing move to electronic patient records, such a catastrophic impact would be increased tenfold in the future, should there be a similar attack.

What the WannaCry attack also revealed was that the NHS were woefully unprepared for such an attack and the level of understanding as to what organisations might do to protect themselves was shockingly, almost completely lacking. There was little in the way of even basic safeguards in place. Systems and the software being used was old and inadequate for contemporary use. If it had occurred on a Monday and not a Friday, the impact would have been even more disastrous. As a consequence, NHS England developed an action plan for improving cyber-security procedures. The training I attended last week was part of this action plan in terms of raising awareness across NHS Trust Boards.

It appears that the healthcare sector was the most targeted industry for cyber-attacks in 2018. There were some 1.1.billion email threats (phishing) intercepted last year. Some 30% of all phishing emails are opened exposing the individual and/or their organisation to attack. And if you think you are careful and could never get caught out, in this training session there were (at least) three people who admitted to opening up such an email. Human curiosity knows no bounds, and there really are no boundaries in cyber-space. Colleagues had found themselves victims. They discovered they had bought a motorbike, lost their identity, and run up thousands of pounds in debt, all of which took many, many months to untangle and restore order.

And if you think it can’t get any worse, it can. Many new digital developments in healthcare come with not just benefits, but new risks too. Heart pacemakers have a wi-fi functionality, leaving them vulnerable to hackers who could run the batteries down or alter the patient’s heartbeat. Late in 2018, the US Food and Drugs Administration ordered the recall of six types of pacemakers that been implanted in some 465,000 people. I have not been able to find out what we are doing in the UK. Answers on a post card please.

There is lots we can do to combat the cyber-security threats. The NHS has a great little guide, which you can find here. As well as the physical things we can do (like locking office doors, logging off when we leave our computers, checking IDs and so on), and the organisational procedures we should have in place, it’s changing the culture that really bring best results. It’s not easy to achieve though. Often behaviour change in many areas lasts no longer than six weeks before people return to their old ways. Something that perhaps explains why so many diets fail in the long term.

Now I’m one of those folk who complain about how many different passwords I have and how often they need changing. Never again. If you want convincing of how difficult it might be to change culture and raise people’s awareness of the need to be more careful, vigilant and aware of the threats we are facing, take a look at this video (don’t worry it only lasts two minutes) – safe surfing.

Put on your sparkling shoes, dance like a gazelle and become #activesoles

Last week I was reminded about the degree of self confidence one might need to wear whatever you want wherever you happen to be. I habitually wear black. My entire wardrobe contains nothing but black clothes. I do, however, like to wear brightly coloured clogs, and I have a large collection to choose from each day. I wear them whatever the event and I never cease to be amused as I watch people’s eyes travel down to my feet when I walk into a room. I nearly always get comments from people who say they ‘love my shoes’, although such comments tend to come from women in the main. Men are much more likely to say something along the lines of ‘you must be brave to wear those’.

I’m not particularly brave, but I am usually very self-confident and if truth were told, I don’t really care what others may think; I’m literally very comfortable in my shoes. I met someone else last week who seemed just as comfortable in his shoes. It was the Greater Manchester (GM) Mayor, Andy Burnham. Like me, he was attending the October Greater Manchester Health and Social Care Board (GMHSC), which this time was being held in the gorgeous Council Chamber of the City of Salford Council. We had been advised that during the meeting there would be a signing of a refreshed Memorandum of Understanding with Sports England, and we were invited to wear our ‘active soles’ such as trainers or comfortable shoes that might allow us easy movement and we should consider ‘active travel’ to get to and from the meeting.

Andy appeared proudly wearing his trainers, as well as his ubiquitous dark suit, white shirt and tie. He is always well turned out. I strongly suspect his eyebrows are actually painted on, they are so perfect, but I digress. The point was that not only was he actively supporting our GM Moving initiative, more of which in a moment, but he seemed perfectly comfortable wearing his trainers, despite their incongruous juxtaposition amidst a sea of men in grey suits and women in their formal business attire. Strangely, I was reminded of that great tennis player Serena Williams, who famously wore Swarovski-encrusted Nike Cortex trainers under her wedding dress (other trainers are available). She did the same at her attendance at the ball for the Duke and Duchess of Sussex’s wedding (although these were a different pair). When the world’s media spotlight is shining firmly in your direction, it takes a great deal of confidence to literally put on your dancing shoes instead of the perhaps expected high heels in order to dance the night away!

Dancing featured in last week’s discussion around progress on the getting GM Moving Plan. Apparently, the TV programme Strictly Come Dancing has an average weekly audience of around 8.5 million viewers. It was suggested that instead of sitting on their couches watching the programme each week, people would be better off getting up and perhaps having a dance themselves. Surprisingly (at least to me) Sport England actually support a range of dance-based activities for people to get involved in. So there really is no excuse; it’s not all about park runs and 10k's, there will be an activity to suit everyone’s taste and lifestyle.

And we need to find ways to get folk more active, particularly in Greater Manchester. The region is sadly significantly worse than the England average for inactivity, and is so across almost all age groups. It was noted that 27.9% of women and 25.5% of men are doing fewer than 30 minutes of physical activity a week, and six out of every ten young people are not reaching the 60 minutes of recommended activity a day. A third of adults and more than a quarter of children across GM were classified as overweight or obese, much higher than the national average. People who are inactive and subsequently become patients spend 38% more days in hospital, have 5.5% more GP visits and 12% more nurse visits. These worrying statistics sit against research in GM, which suggests that a significant proposition of the population want to be healthier and more active.

Hayley Lever, the inspirational lead and Strategic Manager for getting GM Moving was the lady who persuaded Andy Burnham to put on his walking shoes (his are Adidas Gazelles). Her philosophy is simple, ‘moving in any way will make a difference… … you don’t need to run a marathon, and you are never to old to start’. She writes a fabulous blog, which you can find here (definitely worth a look) and is enthusiastic about finding ways of encouraging others to get moving. Her colleague Rachel Allen wrote a blog that looked at the notion of ‘enclothed cognition’ (see here), which explored the notion that what we wear changes the way we think, and can change our behaviour. So if one is wearing flat shoes or trainers while at work, it’s more likely that we would walk more often. I wonder how many women commute to their place of work in comfortable shoes only to change when they reach their office, I know J habitually does. Hayley and Rachel, in persuading Andy Burnham to put on his trainers, also persuaded him to make it official policy across all public services in GM that it was Ok to wear trainers to work as long as folk use them!

Of course, simply encouraging others to become more active is only part of the solution to increasing people’s health and well-being. Greater Manchester has a series of programmes aimed at ensuring clean air; developing healthy workplaces; sustainable transport systems; liveable and healthy communities and encouraging current health care providers to draw upon such approaches as social prescribing, and actively addressing health inequalities across those communities they serve. At the personal level, I will continue to #WalkEveryDay and to encourage others to do likewise, through supporting the #NHS1000mile initiative. And if you keep telling yourself you don’t have the time to follow suit, have a look at this blog posted last week, which advocates the need to move from mindfulness to mindlessness in changing our behaviours – at the very least it will make you think!

Life is a soup and I'm a fork

The first time I went to Russia was in 2001. At the time I was teaching social anthropology and medical sociology to nursing students in Finland. They were doing their degree in English and I was one of the native speaking English lecturers supporting the programme. I would usually go there two or three times a year and stay for two weeks. It was on one of these trips that I took the opportunity one weekend to fly to Moscow. It was an interesting trip. The hotel I stayed in had a ‘matron’ on every floor, someone who kept an eye on the propriety of the hotel guests. I was hosted by a young man from the Moscow State University. Sadly, I can no longer recall his name, but I do recall his enthusiasm for showing me around his great city.

One other thing I remember was him taking me out for a meal, not to a fancy restaurant, but to the local eatery and eating my way through a mountain of pancakes and vegetables, and using aluminium cutlery to do so. I remember feeling slightly anxious as I had a sense that using aluminium in cooking or anything to do with food could lead to health problems, particularly dementia. More of which later.
 

What I didn’t know at the time was that Russia was once the third largest producer of aluminium in the world. Today, it still produces over five million tons of aluminium and accounts for ten per cent of the global production. What I did know at the time was eating a meal with aluminium cutlery felt very strange and comes close to trying to eat a meal with plastic knife and forks, something I had to do last week at an event I was attending.

There is nothing worse than a plastic knife to cut through something that is meant to be cut by a metal one. I don’t even like those little blue forks you get with your take away chips, I would rather use my fingers. What I also didn’t know until last week was that the NHS used 16 million pieces of plastic cutlery last year. In a fascinating piece in The Hospital and Catering News (thank you Roy Lilley), it was reported that in 2018 the NHS actually purchased over 196 million items of single use plastic for catering, including 163 million plastic cups, 15 million straws, 2 million plastic stirrers and those plastic knives and forks.

That is lot of plastic! Its also a lot of plastic to get rid of once used! So, it was not surprising that even with everything Brexit filling our screens and newspapers that the NHS use of single use plastic became a major news story in its own right. Plastic use is a political issue. My grandchildren are like miniature Extinction Rebellion activists and have learnt in school about the damaging effects of plastic and plastic pollution. They are trying to create plastic-free homes, which is a lot harder than it sounds. Globally, 350 million tons of plastic are produced each year. That is a combined weight higher than the weight of humanity, estimated to be 316 tons in 2013. I do like Tiki the Penguin’s measure though: in explaining to children Tiki talks about the amount of plastic produced each year equalling 30 million elephants. Half of this plastic is single use plastic.  

Plastic is everywhere, and more worrying are what’s called microplastics. Microplastics are defined as all forms of plastic less than 5mm. Primary microplastics are to be found in personal care products and in the microfibres of some clothing. They can also be a consequence of larger plastic items which have been slowly broken down into smaller pieces. The average fish and meat eating person eats 70,000 microplastics each year (that’s about 100 bits of microplastic each meal). Plastic chemicals are known to act as endocrine disruptors. Endocrine disruption is linked to health problems such as some cancers, birth defects and developmental problems in children.    

Like my grandchildren’s efforts to lead a plastic free life, ridding the NHS of single use plastic is likely to be equally difficult. However, the NHS Chief Executive, Simon Stevens, issued a statement in which he said ‘…it’s right that the NHS and our suppliers should join the national campaign to turn the tide on plastic waste. Doing so will be good for our environment, for patients and for tax payers who fund our NHS’. He noted that many of the major retailers operating in hospitals have committed to cutting their plastic usage starting with straws, stirrers, cups and cutlery. That said, I didn’t see any evidence of this being translated into practice at the hospital café I was in last week. Time will tell as to how effective the pledge to stop the use of single use plastics in hospital catering will be.

And back to aluminium and dementia. There was research carried out in 1965, that showed a connection between aluminium and what are called toxic tau tangles in the brain – the consequence of which is dementia. However, the research was undertaken on rabbits and involved high doses injected into the rabbits. Although one large study did show high doses of aluminium in drinking water being linked to the progression of Alzheimer’s in those who already have the disease, most contemporary research has shown that this cause and effect is simply not present. 

And yesterday I found a really poignant tweet on my Twitter timeline from a paramedic who had attended a call out to a man who was clearly a researcher, but was also living with dementia. I end this week’s blog with her words:

‘Met the most amazing man yesterday, 6 doctorates, 2 masters, 1 PGCert and 3 undergrads. Such a shame I met him due to his dementia. Such a great loss for the patient and society as a whole. Still an amazing man to meet and talk to and a pleasure to help’.  

Cherishing our children and looking after our future

Well last week was a bit of an adventure! Now then, I thought being retired was all about not getting up before 10.00 am, indulging in long lazy lunches, with perhaps a snooze in the afternoon, before opening up a bottle of the old red stuff to see the evening in. My week wasn’t quite like that. Monday I was interviewing for two new paediatric consultants. We had some cracking candidates and we were able to appoint to the two vacancies. But my goodness did they seem young. Any organisation needs to have folk who are passionate about what they are doing and the successful candidates had bucketloads of passion, and my goodness did they know their stuff too.

Pleasingly for me, both candidates were active researchers! One of them, in presenting her work, was a passionate qualitative researcher – something fairly unusual among our medical colleagues. Her work was in palliative care for children (and their families). Her presentation used the words from the children and parents participating in her research. It was a very powerful and moving account.  

Tuesday it was down to Manchester for the annual NHS Providers Conference. It was the second time in six weeks that I found myself in the Manchester Convention Centre (I gave the Tory Party Conference a miss…) and actually the second time in six weeks I was able to ask the NHS Chief Executive, Simon Stevens, a question – this time it was about what the NHS (and Government) might do about reducing the known harmful effects of children and young people using social media, digital games and so on. He provided a very reassuring and well-informed response. I don’t know why I’m surprised, but his knowledge of local concerns and issues is simply phenomenal.

It was a really lovely surprise to meet up with my Twitter friend Jackie Smith, who was also at the conference. The following day it was the Secretary of State for Health and Social Care, Matt Hancock. If you are sitting on the edge of your chair waiting for the upcoming Queen’s Speech and expecting to hear about a proper solution to the UK’s social care problems, I came away with a sense you will be very disappointed.

Thursday was World Mental Health Day. This year’s theme being suicide and suicide prevention. The World Health Organisation reports that each year suicide accounts for more deaths than war and homicide combined. Worldwide, over 800,000 people die by suicide each year – that’s one person every 40 seconds. Lithuania has the highest rate of suicide in the world, the UK is 78th. Worldwide, suicide is the second leading cause of death among young people aged 15-29 (accidents and unintentional injury are the top cause of death). On the day there was much material available to raise people’s awareness and counter stigma. I liked the free materials that were available for schools to use in the run up to, and as a follow up to, the day. This is something I thought was particularly important, as to be honest, every day should be a mental health day.

Interestingly, last Monday the Department for Business Energy and Industrial Strategy announced the launch of a £35 million-funded research programme aimed to give more support to young people experiencing mental health problems. In the UK, one in eight children or young people will be affected by mental health problems. The research will look at both external factors, as well as genetics, to try and understand the development of the adolescent brain (and mind). I remember well my time working in an adolescent forensic mental health service and having to deal with the challenge as to how much of the behaviours we saw were ‘normal’ adolescence and how much was due to an underlying mental health issue. As most parents will know, adolescence is an often poorly understood period in a child’s life. A young person’s brain is particularly sensitive to external influences, as they develop their own social and cultural sense of self. Last week also saw the launch of ‘Every Mind Matters’, a launch so successful that the Public Health England website crashed for a while. You can watch the video here.

Thursday was one of last week’s busy days. Thanks to the sheer volume of traffic on the motorway, it involved a two-hour commute from home to Alder Hey Hospital - a journey that should have taken just over an hour. I was there for the first North West Region’s Provider and CCG Chairs meeting. The meeting was held in the wonderfully modern and enthralling Institute In The Park. A building funded by a range of different sources and which provides a shared space for research and learning. In fact, the hospital’s architecture and design are breathtaking and well worth a visit, if you happen to be passing. Given that it is a children’s hospital, it was wonderful to see so many smiling faces and to hear so much joyous noise, as I walked through the buildings.  

Then it was on to spend a few hours with two of my grandchildren, before driving back home. I relish every moment I can spend with them these days. It was seven years ago that the eldest of the pair spent a harrowing 10 days in Manchester Children’s Hospital’s intensive care unit due to a respiratory condition. He is fine now, but at the time it was a very worrying near-death experience for the little lad. Yesterday, two more of my grandchildren came to visit and we spent a pleasant hour on the beach. These two are little younger and so enjoyed being on the sand, drawing sand pictures, running, shell finding and all the things that only a three-year-old and a 14th month year old can take such pleasure in. Thinking back over the week, it was good to be able to enjoy the making of new memories. Children are here now and can be highly delightful; they are also our future and we should cherish them for that.