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.

What a Diamond Geezer, the Champion of Quality Champions

I do like new experiences and last week I had another one. Last Friday I found myself in a bullion exchange. That doesn’t sound quite right. I was there to buy something, although it wasn’t krugerrands or silver bars I was buying. It was a fascinating place, hushed and cathedral like. There was an air lock entrance, which took me right back to my time on a forensic unit. Inside there were three rows of people all looking intently at double computer screens, both buying and selling precious metals as well as researching the values of coins, jewellery and so on. Around the walls were glass display cases, several of which contained coins, many of which were commemorative. There was everything from coins with pictures of the Gruffalo, Beatrix Potter’s characters, and kookaburras through to coins celebrating the NHS, and many famous people. I wondered what it would be like to have your face and or your name on a 50p coin. Kind of spooky, I think.

And later on, I wondered what, if anything, people might like to leave behind them as some kind of living legacy. Having a building named after them, perhaps a statue somewhere, or a fountain (all slightly pretentious), or maybe having your picture on a stamp, or your name associated with the discovery of a ‘never before seen’ butterfly. When you stop and think about it, the possibilities are endless but rather daunting at the same time.

Last week, I witnessed another kind of legacy beginning to emerge. I attended the Wrightington, Wigan and Leigh (WWL) NHS Trust Quality Champions Conference. I chair the WWL Quality and Safety Committee and the day is an important one in our calendar. The event was just as fascinating as the bullion exchange, but for different reasons. The ever-enthusiastic Helen Bevan delivered a live video-linked talk on ‘taking power’ and thankfully the technology held out. The sometimes polemic writer, blogger and TV star Roy Lilley was there, giving what at times was a very funny presentation on how the NHS might improve the services it provides. The real stars though were the quality champions themselves. More of which in a moment.

The Quality Champions programme was introduced at WWL in 2012. It is a nationally recognised example of good practice when it comes to embedding quality improvement in an organisation. There are three levels of being a quality champion. Bronze – this is the entry level and is awarded when an individual has undertaken the training to become a quality champion; Silver, is awarded once a measurable and sustained quality improvement has been achieved; and Gold, is awarded when the quality improvement idea has been picked up and used outside of the WWL Trust. Since 2012 nearly 400 staff have become Quality Champions, and there are 66 Silver badge holders and 27 Gold. In 2015 we decided to look at the cost savings that might have been brought about by these projects. Last week it was announced that the programme has saved at least £3.6 million over the last 4 years.

The conference showcased those projects that had achieved Silver and Gold awards in the last year. There were posters and presentations of exemplar quality improvement projects. The presentations were made by the folk that had led on the project and although some were clearly nervous, each one was brilliant and everyone got a very positive response from the audience. They were immensely interesting too. For example, we heard about the development of a critical care patient acuity staffing risk assessment. I didn’t realise the huge range of environmental and condition-dependent variables that had to be considered when agreeing safe and effective staffing levels. There was a presentation on reducing the number of tests that are ordered on patients. It was a challenging project that looked at stopping the growing tendency to order all kinds of tests to arrive at a diagnosis, rather than coming to a diagnosis and then ordering tests to help plan the care required. This initiative made huge savings and of course was better for most patients.

There was a presentation on improving the care given to people who experienced a loss in pregnancy. The room was completely silent, as the audience listened to the experiences of a number of women who had lost their baby or miscarried late in their pregnancy. This poignant and powerful presentation ended with a poem written by a mother and father whose daughter was stillborn. As the room listened to a reading of their poem entitled ‘The Love You Know’, I think there was barely a dry eye in the room.  

Now I know you shouldn’t have favourites, but mine was most definitely the presentation on reducing the number of failed vasectomy sterilisations. It was made by a colleague who must have the longest job title ever - Chief Biomedical Scientist, Andrology Laboratory and Quality Manager. Her presentation was just downright fabulous! A failed vasectomy sterilisation is of course a very serious outcome. Part of the reason for the number of fails, is that many men simply refuse to go for the sperm test, which needs to be done until they get a clear result. I can understand why. I had mine done over 30 years ago and had to take a sperm sample in for the best part of six months before I was clear – even 30 years ago it was an excruciatingly embarrassing weekly encounter with the receptionist at the clinic. This quality initiative is absolutely and very successfully tackling this problem.

Now the man behind the entire Quality Champions programme is our Chief Executive, Andrew Foster, who is retiring at the end of this month. However, he will still be making a continuing contribution to the NHS through his leadership with the NHS People Plan. Andrew has been one of the longest serving NHS Chief Executives (which is a major achievement in its own right). He has in all that time been a passionate advocate of putting quality at the heart of everything that gets done at WWL. Have a look at this video - you can almost taste his passion for quality improvement, and it’s a passion he’s successfully imbued in many others.

Being an extremely modest person, he probably won’t agree with me, but I think an amazing and enduring legacy would be to create a Platinum or Diamond Quality Champions Award in his name, perhaps for a WWL quality initiative that has been picked up on the international stage. In any event, Andrew’s legacy of quality improvement will be long lasting and shared by many – and I wish him a long and happy retirement!