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.