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.