Winning the Battle of the Bulge and other food tales

We are coming to the last week in the #WeActiveChallenge2019. It has been great to see all the tweets of #nursesactive getting involved in so many different activities during the month. These included walking, swimming, cycling, stair climbing, gardening, dancing, daredevil stunts, The Plank and everything in between! Apart from having fun and there being an air of competition across the various groups taking part, it was also a chance for folk to establish some new physical activity habits during the month. Regular readers of this blog will know I gave myself three personal challenges: To have a dry (alcohol free) month; to walk 200 miles (or more); and to lose some inches off my waistband.

As I write this blog, I am a few miles short of my target, but have some days in hand. True Confession 1 - I must confess to having had a couple of glasses of wine with a meal out with a friend (more of which later), but otherwise have (almost) remained alcohol free all month. And I have lost 13.5lbs so far, with my next weighing-in day on Wednesday. The strange thing is that despite losing nearly a stone in weight, when I look at myself in the mirror, I still see that gorgeous tanned hunk of a man, with bulging biceps, and a six-pack abdomen…  …but that might be because the mirror came from a fun fair closing down sale.  

Seriously, I am pleased to have taken a little bit of weight off. I checked my body mass index (BMI) to find it was standing at 25.3 (technically overweight) and I have to lose 2lbs more to achieve the ‘correct’ BMI for my age, height, gender and so on. You can check your BMI here (or not). Whilst I might still be a hair’s breadth away from being the correct weight, I’m a long way from being obese. People with a BMI of 30 or more are said to be obese, and as many research reports have shown, obesity brings with it all kinds of health problems and not just for the individual in some cases.

Last week, it was reported that nearly half (47.8%) of all pregnant women in Birmingham were overweight or obese. This puts both themselves and their baby at risk. Indeed, there is a higher chance of having a miscarriage, and overweight and obese pregnant women are three times more likely to develop gestational diabetes and much more likely to need an emergency caesarean section or an assisted birth. Additionally, there is a higher risk of foetal abnormalities such as spina bifida. Sadly, the evidence shows that the newborn of an obese mother is also likely to be obese at birth and remain so throughout childhood.  

Whilst pregnancy is not the time to lose weight, making some lifestyle changes such as eating more healthily and keeping active can help obese and overweight pregnant women manage their weight to minimise such complications, and enjoy a better pregnancy. Actually, it’s the same recipe I have been following during my #weactivechallenge2019 - sticking to a combination of healthy eating and regular exercise. As I have mentioned before, I have become evangelical about the RAG traffic light food labelling system and have simply cut out anything that shows even a hint of red! I also decided that my portion sizes were getting too large and have reduced these accordingly.

There are some downsides to this approach though! Whilst I have never been much of a person for eating out, unlike J who could eat out every night, I have reduced even further the number of times I have gone to a restaurant or thought about where I might eat (to the chagrin of J). That meal out with my friend; we were at one of those gastropub places offering up a range of homemade dishes. True Confession 2 – I had home made cheese and onion pie with chips and peas – and the cheese pie was to die for (well it might have temporarily added to my cholesterol levels and halted my weight loss) and I suppose on the plus side it was my choice and added a little bit of balance to things.

And it appears I’m not the only one getting fussy as to where to eat. Last week the industry reported that diners have stopped going to Indian, Italian and Chinese restaurants in great numbers. These days it appears that Japanese restaurants are stealing the market, along with Middle Eastern, Caribbean and specialist vegetarian restaurants. Dishes such as jerk chicken (ouch!), sushi and Usain Bolt’s breakfast of champions, ackee and saltfish, are becoming the increasingly popular choices.

What I didn’t see mentioned in the report was navarin of lamb, with cous cous and grilled vegetables. This was the kind of dish that Loyd Grossman once wanted to serve patients in hospital. The year was 2000, and the Grossman’s initiative to revitalise hospital meals cost the NHS a reported £40 million. The initiative was largely ignored by NHS Trusts because it was too expensive. Fast forward (not food) to 2019, and once again a big-name chef has been recruited to try and solve the problem of poor hospital meals. And given that some 300 million meals are served annually, getting it right is an absolute imperative. Prue Leith (who I recall from my Domestic Science schooldays) joins a long list of famous chefs including Albert Roux and James Martin to try and sort out the problem. I wish Prue well – she has been involved with improving food in hospitals for a while, so I would think she has a good understanding of the issues.

And in fairness, another great chef, Jamie Oliver also understood the problems. A few years ago, the British Medical Association (BMA) campaigned to have Jamie do to hospitals what he had achieved in improving school meals. He declined, but just like then, his words still resonate. Talking about why he wouldn’t respond to the BMA call he said: ‘Given the Government is now taking action on schools, there's no reason why they can't use the same techniques in hospitals without the need for the same TV programme or the same celebrity endorsement’. I think it’s a great challenge, and just as important as my #weactivechallnge2019 - I hope Prue rises to it and is just as successful in changing things for the better. And then all we have to do is make sure patients get to eat the food, which is a whole other issue and will have to wait for another blog!  

I’m a glass half full kind of chap (especially when it comes to Urgent Treatment Centres)

Last Friday started off wet and it continued to rain for much of the day. Having got ahead in achieving my ‘must do list’, I decided I would take myself off to the Glasform Studio, located not so far away from me in an old shippon at Pointer House Farm, Singleton. John Ditchfield is the Master Glass Blower there and has been designing and making wonderful piece of glassware for some 30 years. If you are in the area, the studio is well worth a visit. John has an interesting history. Although originally, he was training to be a commis chef in his mother’s hotel, glass blowing is his first true love. He has tried his hand at other ways of earning a living, including running a convenience store, selling bags and bras at markets, and even making clothes and hessian shopping bags to sell. 

Orphaned young and needing to find funds to rent the caravan he was living in, he took a Summer job as an apprentice to the Italian Master Glassblower from Murano, Franco Toffolo, and it was Toffolo who over seven years taught John the basic, yet complicated, techniques of Venetian glassmaking. These days he specialises in producing bespoke antiques of the future as well as fabulous architectural glass work. I couldn’t begin to afford some of his bigger pieces, so contented myself by purchasing four glass shells to complement a set of eggs cups J had gifted me. If you are in the area, you can also see some examples of his architectural work, as he was commissioned to create two huge hanging chandeliers for one of our local Urgent Treatment Centres here on the Fylde coast.

Now I’m a big fan of these centres. Earlier in the year I wrote a blog about a visit I had to make to this centre. A lot of you seemed to have liked that particular blog - if you missed it you can find it here. Urgent Treatment Centres are GP-led and open for at least 12 hours a day, every day. The one I attended was well equipped and staffed and you could either make an appointment or just walk in. Whilst I have a GP, I have not actually met her face-to-face (I’m told my personal GP is a lady called Janet). I don’t mind, as I’ve not really had a reason to consult with her yet (and long may that be the case). I have a couple of repeat prescriptions, which I order online, and when I did need to see someone, and urgently too, it was easier to go the Urgent Treatment Centre than try and make an appointment to see Janet. The Urgent Treatment Centre spookily had access to my complete health record so there wasn’t a problem in continuity of care. 

Across the UK they were set up to provide an alternative to A&E departments. They are certainly more than capable of diagnosing and dealing with most of the common problems that drive people to attend A&E. The idea behind their introduction was that it would leave A&E departments more able to treat the most serious of cases. It’s a great idea. The UK population is more or less united in their thinking that A&E services are overused or used unnecessarily (some 86% of all people surveyed). This statistic is one of the many results obtained from the first ever large-scale research into attitudes to emergency care. The study (the British Social Attitudes Survey) was undertaken by the National Centre for Social Research. It revealed some significant differences in people’s perspectives due to socio-demographic factors such as age, gender, number of young children in the household and levels of deprivation. 

For example, whilst 86% was the overall figure, if you asked someone aged over 65 years old then this figure rises to 94% of folk who think that A&E are used unnecessarily. As might be expected, the figure falls to 79% when you ask Generation Z (those aged 18-24) the same question. Mind you, most of this group struggle to process the significance of 9/11 (it will always be a part of history to them) and unless they have grandparents like myself, they will never know what the Summer of Love and Woodstock was. For this group, A&E is there to be used, as it’s clearly easier and less personal than going to see their GP. Some 30% of current graduates prefer to use those NHS services where no appointment is required. This group are also twice as likely to research health problems online than most other folk. The research suggested that if you had a young child you might consult the internet to find out a little bit more information, but you wouldn’t necessarily use this in deciding where to seek help. As a nurse, a father and grandfather, I have also been used many times as a proxy for the internet.    

Interestingly, whilst 65% of the population have confidence in their GP, some 11% of people don’t. It’s unclear what the other 24% feel. The 11% rises to nearly 20% when those people are living in deprived areas, or parents with a child under the age of five are asked the same question. This group believe A&E doctors are much more knowledgeable than GPs and so are more likely to prefer using A&E departments rather than GPs. 

And then there are the men. Perhaps unsurprisingly, men are much less knowledgeable when it comes to contacting a GP, particularly an out of hours GP service which J is also evangelical about. They are also much less likely to contact a GP for a health problem until it becomes almost impossible for them to ignore. However, it may not always be down to men. There is some evidence that female receptionists can discourage men from coming in and making an appointment, particularly if it’s for a mental health problem. I can’t say this has been a problem for me, and indeed, in promoting the Urgent Treatment Centres, our receptionists are simply brilliant. Come on men, whatever your problem, there is a warm welcome here!

Surprise, surprise, almost fake news and let’s get shopping

There are some weeks where people have just the most unfortunate of times. For example, there was poor Terry Brazier who went into Leicester Royal Infirmary to have a treatment involving Botox and got circumcised instead. As well as getting a heck of a surprise he did get an apology and £20,000 in compensation, but even so… 

…and then there was the sometimes outspoken BBC Radio 4 presenter of The Moral Maze, Michael Buerk who was at it again. Who can forget that this time in 2005, he declared that the ‘battle of the sexes’ had resulted in men being nothing more than ‘sperm donors’. Well last week he was back suggesting that obese individuals should be allowed to die early and save the NHS money. In a Radio Times article, he claimed that ‘the obese will die a decade earlier than the rest of us’, we should ‘see it as a selfless sacrifice in the fight against demographic imbalance, overpopulation and climate change’. He didn’t share the view that obesity was a national emergency because it was simply caused by eating too much (more of which later)…  

…then there was our Secretary of State for Health and Social Care Matt Hancock. Now true confessions, my heart goes out to him, he does try hard, but sometimes his enthusiasm for championing improvements can appear excruciatingly naive. Last week there was, at first, rejoicing in the announcement that new capital funds were available to improve our hospitals, only it turned out this wasn’t new money at all, but money owed to NHS Trusts from their own savings – see the fabulous Julian Patterson’s comments on the NHS Networks’ site – he captures the zeitgeist brilliantly. And Matt didn’t stop there. In what turned out to be a busy week for announcements and problem solving we next heard that the pension problem facing many high paid staff in the NHS had been resolved. 

The original notice confirmed that this only applied to doctors and surgeons. What a faux pas of the highest order. I don’t know how high the Ivory Tower is that some of Matt’s policy advisors live in, but they need to wake up to the real world. Health care services are now multi-professional with a huge range of different professions all contributing to high quality patient experiences and care. Sadly, whilst later in the day it was announced that the new pension rules would apply to nurses, NHS managers remain excluded. A word to the wise, you ignore the well-being of good NHS managers at your peril, and we already have a shortage of excellent managers.  

The crowning glory to Matt’s week was possibly his announcement that he was investing £250 million in artificial intelligence (AI) for health care. Unsurprisingly this announcement got an impassioned response on social media – there were those who claimed there was no such thing as AI yet, and others who thought the money might be better spent on ensuring that the NHS has coherent and joined up information systems capable of sending and using data across health and care sectors. Maybe next week will be a better one for Matt.

I’m not sure it will be for all of us. And I’m not talking about the British Summer, which is both as confusing, and unpredictable as it is enjoyable. Apparently according to the Indigo Wellness Index (which tracks the world’s healthiest nations) the UK is ranked only 16th in the world. Canada is ranked the highest, and I wouldn’t want to be emigrating any time soon to the Ukraine. And that’s before we have got to grips with the spectre of a No-Deal Brexit. Of the many ‘10 ways a No-Deal Brexit will affect you’ lists published last week I was interested most in what foods we might miss out on. It won’t just be those pungent, but delicious blue cheeses, or creamy cheeses such as Camembert and Brie we might miss out on either. In terms of cheese, all but 85 tons of the 108,484 tons of cheddar we imported in the last year came from Europe, and at least 98% of the UK’s butter imports come from the EU.

Now some 40 years ago I lived on a smallholding in West Wales. The house was a mile up an unmade road with tall hedges on either side. If it snowed, the lane would fill up with snow and become impassable – sometimes for days on end. It was during this time that I developed almost an obsession for being self-sufficient. John Seymour and Newman Turner were my heroes. So, as well as growing and preserving my own fruit and vegetables, keeping hens for eggs and goats for milk and cheese, I would cut and store enough fire wood to keep me going for months and create a tin food and toilet roll store.  I did this for many years, and even long after I had moved from Wales to Manchester. Indeed, I kept it up until my children pointed out the we have supermarkets that are open 24 hours a day and stock whatever we might fancy to eat whenever we might fancy eating it. 

Everything that goes around, comes around as my Mother would be wont to say. However, in this house we are well on our way to self-sufficiency once more. Our vegetable patch has come into its own, the chickens have started to lay in earnest and the goats are on their way. In the meantime, we are already making changes to our diet. Having signed up to the #WeActiveChallenge 2019, I decided that my three challenges would be to walk 200 miles throughout August, stop drinking alcohol and lose a few inches off my waist. The first two targets are going well, but I struggled with the third – that is until J told me about the RAG colour coding on all food stuffs. Up to that point I was completely unaware of the system. That is not the case now. It has to be said I am now a food RAG code evangelist! My vegetarian cooking repertoire has changed completely, and each meal is a surprise, but thankfully not quite of the same order as the unfortunate Mr Brazier’s!  

Which came first, the chicken or the egg – improving mental health care

Now it’s not often that two of my passions come together in the same place, but last week that was the case. It was the title of an article in the Nursing Times that caught my eye. Now I have to say that I am a not a regular reader of this publication, but the article’s title: ‘Solving the mental health nursing shortage presents a chicken and egg dilemma’ was somewhat intriguing. I will come back to the philosophical question embedded in the title later, but first the main thrust of the article was an exploration of the NHS Mental Health Implementation Plan which had been published just over a week earlier on 23^rd July.

It’s not surprising that its publication scarcely got a mention anywhere, there was a lot happening on that day. Boris Johnson won the race to become Leader of the Conservative and Unionist Party and UK Prime Minister and the spectre of a no-deal Brexit loomed large;  the boxer Maxim Dadashey sadly died following an injury he sustained in a fight a few days earlier, sparking yet another debate about banning boxing; Trump imposed a rule that takes 3.1 million people out of the food stamp programme (which provides free food to some 40 million Americans each day) on the basis that he has improved the US economy; and to some, most importantly, Jordan and Anna had a bust up on Love Island over his attraction to India (none of whom actually won the contest).   

    

It was a shame that it didn’t receive much attention. The plan sets out a framework for how NHS England will deliver on its commitments for the development of local, place-based mental health services. Readers might recall that the NHS Long Term Plan, in setting its ambitions for improved mental health care services talked about better 24/7 community-based crisis response services, greater liaison support to A+E departments, and the introduction of mental health nurses to work in ambulance control rooms. The NHS Mental Health Implementation Plan begins to put some flesh on these bones, along with a commitment from NHS England to a £3.4bn a year increase in funding, and funding that will be ringfenced for mental health care (well by 2023/24 anyway). Nurses and nursing feature prominently in the plan (see Appendix B for an indicative future mental health workforce), and that is rub number one… just where are these nurses to be found?

The Nursing Times analysis reveals that more than 4,000 additional mental health nurses will be needed over the next five years if the plan’s ambitions are to be achieved. Unsurprisingly, it is children and young people’s services where the greatest need for mental health nurses are said to be required. However, there is also recognition in the plan of the need to increase the number of mental health nurses to work in the community with those living with a severe and enduring mental illness. 

Given that we already have a massive shortage of nurses (and most other health care professionals) in the NHS, and for nurses this is estimated at now being over 40,000 vacancies in England alone, it’s difficult to see where the extra nurses are to come from. There is a possibility that the investment in mental health services might tempt some nurses who have left the profession to return, and despite Brexit, we might attract overseas nurses, but essentially it will require an exponential increase in student nurses to fill this gap. 

There are lots of problems with this. For a start, there are currently a lack of clinical placements in mental health services and universities will need to expand their mental health nursing programmes and then work hard to attract the students to fill the increased places, and that is rub number two. Whilst the plan might make working in mental health services more attractive, it will need significantly more mental health nurses than we currently have to develop and deliver the plan’s ambitions – it’s an example of the classic chicken and egg conundrum.  

   

Being someone who has long loved ‘all things chicken’ and a Doctor of Philosophy, I was tempted to revisit this chicken and egg conundrum, and I’m glad I did! The origin of the phrase, as far as I could find out was from the Greek philosopher and biologist Plutarch way back in the 1^st Century who discussed the famous problem in his essay ‘The Symposiacs’. Although Aristotle had discussed a similar dilemma hundreds of years before, it was Plutarch who articulated the question in its modern form. All chickens hatch from eggs, and all chicken eggs are laid by chickens. Whilst the ‘chicken and egg’ dilemma is essentially a metaphorical device, evolutionary biology provides literal answers. If one accepts the Darwinian principle that all species evolve over time, it’s possible to imagine that chickens had ancestors that were not chickens. And thus, the answer is the egg came first. 

The first amniote egg (the first hard-shelled egg laid on land) appeared around 312 million years ago, whereas all chickens, (and their eggs) descended from red jungle fowl and probably first appeared merely in the last 8,000 years. Mental illness has also been around for a long time. Katherine Darton’s ‘Notes of the history of mental health care’ says that in prehistoric times there were no divisions between medicine, magic and religion. She notes that evidence from Stone Age trepanning (cave paintings) shows a painting in France that portrays a strange being with human hands, feet and antlers who has been identified as a psychiatrist (or at least, maybe a witch doctor). I think I will stick with mental health nurses and chickens, but not necessarily in that order.