Sounding the Last Post for 2020: but saying a big HELLO to 2021, where there is much to look forward to!

My last blog of the year is often a strange one to write. In times past I’ve tended to look back at my year and reminisce about what I have done and my hopes for the year to come. In terms of those looking at my blog, it is the worse week of the year for me. The numbers of folk clicking on the link and reading my words dwindles to a few hundred. However, every year I am reminded of the question my father has often asked me about why I write my blog, who is it for, and what am I trying to achieve? Simply put, I write the blog primarily for me. I find I have things I want to say, thoughts that I feel just need to be put out there. Yes, I enjoy writing so my weekly blog post is not a chore, it’s a real pleasure. That other people choose to read it, and so many generously respond and comment is a huge bonus. All such responses are absolutely appreciated, and all are uplifting.

What now seems a long time ago (and it truly feels like a long time) many of us started the year with great expectations. I know I did. It was the year that J and I were to be married. We had planned what we thought was to be an unique event, capturing our love of music, freedom, living the ‘good life’ (aka BBC’s Tom and Barbara) and celebrating all that Mother Nature has to offer us all. But it wasn’t to be.

The wedding date came and went in Lockdown No 1. It took a while for us to get going again. And boy, did we feel guilty. There was the pair of us steeped in a fit of depression over our cancelled wedding while people were dying of Covid-19, and our professional colleagues were working flat out to care for all those who need their skill and help. The ‘happy clapping Thursdays’ didn’t change a thing. We both felt inadequate and anxious that we weren’t really doing enough.

As Lockdown 1 went on, we were lured into a false sense of unreality. The sunshine filled days, hugely compensated for the lack of contact with others. We welcomed Teams and Zoom, as a new and almost magical way of working. Eventually such virtual meetings lost their appeal and accentuated the impotence we felt at not being there, standing shoulder to shoulder with colleagues on the front line. I’m a nurse by professional background and watching and hearing the pain and trauma that other nurses were enduring left its mark.

Here in the North West, the pandemic never really went away. Yes, we had a few days, maybe even a week or two where nobody who was Covid positive was admitted into our wards, but it was a brief respite. During what should have been the recovery months of August – October, we were once more having to deal with increasing numbers of Covid infections and admissions. By the beginning of November, there was a second peak of infections and Lockdown No 2 was put in force. Unlike the first peak of infections, where many non-Covid services were greatly reduced or even stopped, this time around these services continued to be provided. The result was a health and care workforce that became increasingly exhausted, anxious and demotivated. The so called ‘nosocomial’ infection rates started to rise, and hospitals began to feel like unsafe places once more.

However, whilst the rate of infections remains high in many parts of the UK, they have started to plateau in most areas across the North West. So, whilst the pandemic hasn’t gone away there are some hopeful signs. There was much creativity shown during the early months of the pandemic. New and innovative ways of providing services and care were developed. Decision making at a local level became easier and certainly a great deal faster, and, of course, a viable vaccine has been developed.

At a personal level, J and I were able to get married towards the end of October. It wasn’t the wedding we had planned or imagined, but for us, it was a very special day. Thank you to all those who helped make it happen – you know who your are! And as 2020 draws to a close I believe there are also many good things to look forward to in the coming year. Yes we need to get the vaccination programme up and running effectively (no mean feat at all, just look at our world-beating test and trace system), but if we can protect the most vulnerable in our communities I predict the demand for Covid beds in hospitals will fall dramatically by February. Of course, we still need to get through January and that is likely to be tough for everyone.

Also, in the last few days of 2020, one of the things I will remember about the year is growing my network of colleagues and friends through the work of the Good Governance Institute. With great foresight, back in March they set up a regular virtual meeting place. NHS Non-Executive Directors (NED) could use this space to discuss ideas, fears and anxieties, challenge policy discussions and do so within the security of Chatham House Rules. Every Friday morning, I have been able to be part of this community and have extended my NED network to include many new folk from across England.

I had the privilege to lead on one of the meetings that looked at what good governance might look like in the emergent Integrated Care Systems (ICS). I remember suggesting the way forward might be creating a statutory collaborative body that mandated all organisations across the NHS family, Local Authorities and other stakeholder came together to work in a more integrated way. The alternative would be the creation of new NHS statutory standalone body, which to me felt like going backwards in time. So, I was pleased when NHS England published its Integrated Care Systems next steps guidance at the end of November, which also recommended an option similar to the one I had described. 

If the start of the year held great expectations for us, I think equally so, 2021 brings with it some wonderful opportunities to make a difference to the lives of so many of those who make up our communities. I have 4 ambitions for the new year: 1) I want to help improve the health and health outcomes for our communities; (2) I want to find ways to help reduce health inequalities; (3) enhance the productivity of our health and care organisations and (4) develop a stronger and more coherent partnership place-based approach to how care is delivered.

I’m sure you might have similar ambitions and hopes, but whatever yours might be, I wish you all a wonderful start to 2021 and a brilliant New Year. 

Tomorrow is not promised, but we can do a lot more to make it fairer when it comes

My legs are both longer and older than my wife’s J’s. Hers are also considerably prettier. Having longer legs is not usually a problem. I don’t mind fetching things down from the top shelf or holding an umbrella to shelter her when it’s raining, or even moving her car with my legs scrunched up so as not to disturb her seat position. However, other times the leg length difference is a pain and, to be frank, simply unfair. We can, for example both walk the same number of miles, yet she will accumulate an extra 30% more steps on her Fitbit. It’s not like I’m especially competitive or anything, but when steps get counted, gaining extra steps just because you have shorter legs than your companion simply isn’t fair.

It’s not just the difference in leg length that can lead to discord in our house. Putting on or losing the odd kg or two can give rise to cries of ‘that’s not fair’. During our recent kitchen makeover, something that lasted three long weeks, we did, out of necessity, often frequent, the local takeaways. The inevitable result was we both gained some extra kgs. With Christmas just around the corner, we were keen to try and shed the extra weight ahead of the holiday break. We knew we were likely to continue to eat more of the wrong things and probably not exercise as much. So we decided upon a quick ‘let’s be careful what we eat’ approach to our diets. I lost those extra few kg relatively easily and quickly, J not so easily.

But, as he hastily ducks his head to avoid the rolling pin thrown his way, it’s not her fault. It really isn’t. Research undertaken by Newcastle and Glasgow universities has confirmed that men do lose weight much easier than women. The research (The Direct Trial) was aimed at exploring whether a low-calorie diet might help those with type 2 diabetes. The aim was to see if a low-calorie diet could help them lose just 15 kg and do so relatively quickly and easily. The original study, published in 2017 showed very promising results, with 50% of the participants going into remission from type 2 diabetes.

However, the participants were followed up over the next three years. The result of this longer study revealed an unexpected additional outcome. Whilst both the men and women followed the same diet, there was a marked difference in weight loss between the sexes. On average men lost 11% of their body weight. The women, by comparison, lost just 8.4%. It just isn’t fair. Of course, there are many reasons why men appear to lose more weight more easily than women. Men’s general build is different to women. They need to consume more calories a day simply to maintain their weight than women do. Typically, a man in their 50s will need 2,500 calories a day to maintain weight while women will need about 2,000 calories. Usually to lose weight, people normally try and reduce their calorie intake by 500 calories a week. In the longer study, where the men and women were following the same diet, eating the same portions of food, it was obvious (after the event maybe) that the men would automatically lose weight. Which they did, and the women said that simply wasn’t fair!

There are others who perhaps think life is unfair at the moment. In London and the South East for example, I think that pubs and scotch egg producers who have enjoyed such a huge increase in sales of this ‘substantial meal’ recently, will think the new Covid19 restrictions are just unfair. They are not of course, they are lifesaving. If you like scotch eggs, (as I do), you can always make your own (as I do) and pour yourself a glass of something cold (as I do) and sit in your own home and enjoy both.

Last week also saw Michael Marmot publish his new report about creating a fairer society. It’s a challenging report. If you have not had a chance to read it, you can take a look at it here. I have long admired Marmot for absolutely capturing both the scientific and sociological evidence but at the same time presenting this in a way that reflects today’s health inequalities zeitgeist. Greta Thunberg has done something similar around climate change. The title of this latest report, ‘Build Back Fairer: the COVID-19 Marmot Review’, is a very clever riposte to the now familiar pandemic mantra ‘Build Back Better’.

The ‘Build Back Better’ campaign reflects a more economic view of the world, one that perhaps reflects the innovation and creativity that dealing with the pandemic has engendered. There is no doubt that there have been many clever new ways of thinking and working that have been very positive. I hope these remain as we move through the pandemic and beyond. Not to do so would be unfair on all those who have worked so hard and at pace, to develop solutions to the many unprecedented challenges of Covid19, including the global community who have developed the various vaccines.  

This report reinforces the critical messages in Marmot’s Fair Society, Healthy Lives (The Marmot Review), published in 2010. I think its fair to say that many of the social determinants of health identified in his review have largely been ignored by governments since then (and don’t get me started by Cameron’s big Brexit referendum mistake). The pandemic has absolutely exposed the level of deprivation and health inequalities in the UK which Marmot wrote about back in 2010. And like Greta Thunberg with raising awareness over climate change, it took a football player Marcus Rashford to get the UK government to see that there really was something unacceptable in 2020 in having our children going to bed at night hungry.

Is it just me who thinks there is something wrong that, when as a nation we are presented with a major challenge to the world we know and the health of our nation, the government can suddenly find the money to keep people safe and protect the economy, but yet has been reluctant to invest the same amount of money proactively to reduce health inequalities. Against this context, the recent UK policy of austerity feels unfair. Hopefully, as we move towards a repositioned normal, the government of the day will recognise the science (including social sciences) and commit to ensuring a fairer, more equal society. Everybody’s health and wellbeing is important. That’s what building back fairer really means.

This is my last blog posting before Christmas 2020. For many, Christmas this year will be very different. Some may think that is simply unfair, but whilst I will miss our family celebrations, I intend to stay safe and J and I will celebrate on our own, with our goats, hens, Billy the parrot, Muffin our cat and the ever enthusiastic Dylan the dog, who incidentally has even shorter legs than J. And I hope everyone is able to enjoy a very peaceful Christmas. 

Ps. In the interest of fairness I have agreed to have bone-shortening surgery for my legs in the New Year (but maybe just not this New Year).

      

A Nursing Christmas 2020: choices, dilemmas and dinners

For many folk, Christmas is a time to try and come together to celebrate, be happy, share gifts and remember the true meaning of life. I don’t think 2020 will be like that. Last week was difficult in trying to sort out this year’s family celebrations. For many years I have cooked a Christmas dinner on at least three occasions so as to accommodate most members of my extended family. The year before last was slightly different. We booked a giant table at a local restaurant and everyone came for a sit-down meal and celebration. It was a wonderful afternoon of food and fun. Last year it was out with the different family groups, for our various Christmas dinners. This year it will be different again, but not in a good way. The Tier 3 restrictions have impacted upon our (and I guess most people’s) plans for this year.

The Government’s Covid-19 rules don’t help in sorting out what might be the right things to do either. Whilst the Government website rules are clear about who can meet inside - only those you live with or form part of your support bubble - the rules for meeting outside are less clear. On one hand you cannot meet anyone socially you don’t live with or have a support bubble with in a private garden or at most outdoor public spaces, but on the other hand it goes on to say ‘However you can see friends and family you do not live with (or do not have a support bubble with) in some outdoor places, in a group of up to six’. Confused.com?  

Whilst the rules are set to allow more freedoms for families to mix between the 23rd and the 27th December, to do so is a dilemma that I think will challenge many people. I fear that just like the recent Thanksgiving celebrations in the US, unless people abide by the rules, Christmas will bring a third wave of community infections and once again our hospitals and primary care services will run the risk of being overwhelmed. None of my or J’s children or my 11 grandchildren form part of our ‘Support Bubble’. Faintly clandestine meetings at motorway service stations have been mentioned. But none of us really wants to do that. Shades of going to Barnard Castle spring to mind. Who to meet up with and where is a dilemma that I suspect many families up and down the land will be wrestling with.

Strangely, where to spend Christmas Day wasn’t always a problem for me. As a nurse and senior nursing officer, I would always spend much of Christmas Day at the hospital, visiting staff and patients alike. As my family grew, and I moved into general management, I stopped making these Christmas Day visits. Of course, there are many health and social care colleagues who will be away from their families over the Christmas periods. They will be working in the wards, care homes, A&E departments, in primary care and in the community. This year, the pandemic has meant that many of these staff are already exhausted and face the prospect of not having much rest or respite over the Christmas period.

When politicians and the media ‘shroud wave’ about the NHS being overwhelmed, it’s because there might not be enough staff to run the services. And there aren’t.  I live in the North West and every day there are around 11% of staff absent from work due to either being Covid positive, in isolation, suffering from stress-related mental health problems or some other health problems. That is 1,500 people not working. This compares to the ‘normal’ average absenteeism rate of about 4%. It’s true to say that the pandemic has brutally exposed the reality of the workforce issues facing health and social care services. Last week the informed, independent and research-based Health Foundation published a report by its REAL (research and economic analysis for the long term) Centre. The report was entitled Workforce Pressure Points (Building the NHS Nursing Workforce in England). You can find the whole report here. Be warned. It makes for a sobering read.

The report notes that even before the pandemic, workforce issues had increasingly become the biggest challenge for health and social care services. Nurses are the key group of workers where the shortage of staff has become critical. Just under half of all vacancies in the NHS are nursing posts. So we have a perfect storm of long term nurse shortages, exacerbated by Covid 19 absences, with those that are in post becoming increasingly exhausted and less resilient. There are also the negative and demotivating consequences of individual nurses once again being moved from their regular specialist areas to support the demands being faced by critical care services. Much research has shown that high workload (and the stress this brings) leads to feelings of not being able to provide the appropriate quality of care. It can quickly become a professional and personal dilemma that fuels nurse dissatisfaction and increases the risk of nurses leaving the profession.

If the demand for Covid-related critical care doesn’t lessen, I predict that much of the elective work that was restarted in the Autumn will once again cease. In turn reducing or stopping elective work will store up real problems for the future as waiting lists grow longer by the day. Causing harm to patients, past, present and in the future is not what the NHS is about – the reverse is true of course. When, or if, to take a decision to stop elective services in order to prevent the NHS from becoming overwhelmed is a dilemma that managers across the NHS are increasingly having to face.

The Health Foundation report charts the reasons for the shortage of nurses, most of which are probably well known. There are no quick and easy solutions, but I was struck by two of the issues that could be addressed immediately. The first was retention. Much more needs to be done to retain those nurses we already have. Measures to ensure staff wellbeing during the pandemic have resulted in some success, albeit this is increasingly becoming limited. More needs to be done with much greater investment required to effectively support and retain our nursing colleagues. Fair pay, proper access to supported continuing professional development, flexibility of working hours and a supportive working environment are just a few examples. The other issue was overseas recruitment. A national, ethical and properly resourced approach is required. If we don’t put such an approach in place, we will be guilty of simply applying an immoral sticking plaster. Both these approaches will cost money, and there are many choices as to how our scarce public money might be spent. It is, of course a live dilemma for our politicians to grapple with. I hope, like my children this Christmas, they choose to do the right thing.   

 

A Child in Time: Deep Purple and a Classical Gas

One of the things about being in love with the best person in the world is having to share the TV time. Whilst young J and I have similar tastes, it doesn’t always extend to our viewing choices. For example, I could watch ‘Come Dine With Me’ and ‘Four In A Bed’ every day. If I do, J retires to our music room and plays her piano, listens to music or reads one of her classic books. But we do occasionally watch the same TV programme. Last week it was a catch up version of the Netflix hit ‘The Queen’s Gambit’ – Episode Five really resonated.

It was the music in the soundtrack that caught my attention; part way through there was a slightly jazzed up version of ‘Classical Gas’. Older readers of this blog will perhaps remember this instrumental, young viewers have a listen (and watch this version played with consummate skill by Gabriella Quevedo) here. It was an instrumental piece written and first performed by the US guitarist Mason Williams in 1968. Personally, I think Gabriella’s version is far superior. There was another reason for the music catching my attention. Way back in 1976, I was on a student nurse placement at a day centre that specialised in psychodynamic interventions. It was one of the best placements of my nurse education. One year into my pre-registration education and training programme I fell in love with psychotherapy. 

Sadly, I never got to qualify as a psychotherapist. However, I did use psychotherapeutic approaches in my work as a mental health nurse, and much psychoanalytical theory underpinned many of my publications. I was aided in this regard by my long time writing collaborator, Professor Sue McAndrew, who is qualified. But I digress. On that placement I met a young man in his early 20s, who I shall call Ralph. He was withdrawn, angry and very difficult to engage with and smoked incessantly. He had long nicotine-stained fingers. Amazingly now looking back, at the time many mental health nurses smoked and one way of engaging with patients was to have a cigarette together. I was one of those nurses.

Ok, I cannot resist another slight digression. Many years ago, I would show extracts from the 1948 film ‘The Snake Pit’ to nursing students in Finland. These were Finnish students undertaking their entire nursing degree using only the English language. They were very bright, enthusiastic and a real pleasure to be with. It was a great film to take extracts from to show the cultural changes that have happened in both how we treat and care for people who experience mental health problems and societal attitudes to mental health and wellbeing. It’s still possible to buy a DVD of the film from Amazon. Almost all the healthcare professionals in the film smoked.   

OK, lets get back to the day centre in Swansea. I used to run a folk club in my spare time, and one day I brought in one of my guitars (the second one along in this picture). Upon Ralph’s arrival, he asked if he could play it. I said yes and after spending a bit of time tuning the guitar he started to play. Now I have been fortunate to hear live the supremacy of the Rolling Stones, the arrogance of Oasis, the stupidity of Clapton, the rock n’ roll of Chris Rea, the melancholy of Leonard Cohen, the surrealism of David Bowie, the lyricism of Bob Dylan and the creativity of Mark Knopfler, but in that moment they were all surpassed by Ralph – like Gabriella Quevedo, he played the guitar with supreme skill but also with an almost humble casualness.

He told me he had learnt to play in school. Playing music was one way he could escape into himself and away from the realities of his home life. I never found out what the realities of his home life were, and back then I would not have had the skills or knowledge to be able to respond therapeutically in any event. However, my interest in understanding the impact childhood abuse (in all its various forms) might have as the child becomes an adult was very much stimulated by that placement, and eventually Prof Sue and I did quite a lot of our research around child sexual abuse (CSA). Even with a great deal more awareness of the vulnerability of many children and young people, still today, one in five adults aged 18-74 have experienced at least one form of child abuse (emotional abuse, physical and/or sexual abuse) before the age of 16. That is a staggering 8.5 million people. Of these, some 3.1 million were victims of CSA before the age of 16, with a much higher prevalence rate for females than males. You can find out more here.

Last Friday was #PurpleWinter, an annual social media awareness-raising campaign that asks people to wear something purple and share photos of themselves in support of the need to spot, and stop CSA wherever this might occur. The campaign was started by the former football player David Lean, who played for Preston North End est. 1875. He was sexually abused by his trainer, Barry Bennell. What is important about raising awareness through the #PurpleWinter campaign was that David Lean didn’t report his abuse until he was an adult and then the authorities didn’t believe him or take action.  Which, I would argue, in itself is almost a form of abuse.

So, if a child does approach us and starts to talk about how they might have been abused, we should let the child tell their story in their own way and at their own pace. We should remain calm and demonstrate we are listening and believe what the child is saying. This can be difficult as the natural inclination will be to ask lots of questions. Above all we should find a way of reassuring and supporting the child, but absolutely report what has been disclosed. Early safeguarding intervention will always be better than dealing with mental health problems further down the line. As I write this blog, I wonder what became of Ralph and whether like the beautiful music he was able to play, he was able to find that inner peace also. I hope so. Me, despite many years of practice, I still cannot play Classical Gas all the way through.

 

Keep well, one step at a time: don’t just travel in your mind

I don’t do running, but many people do. In fact, a UK government survey published earlier this year, found that nearly 7 million people went running at least twice a month. In this house, my wife J runs 5km at least three times during the week and 10km at the weekends. She has all the kit, and music buds in, off she goes, coming back full of vim and vigour and set up for her day.

I walk. Walking gives me time to think. Most of my blog ideas start to form and get developed while I’m out walking.  These days I average 30-40 walking miles a week. However, I was once a very keen long-distance walker, particularly around coastlines. I have walked around the Isle of Wight and the Isle of Man, but my most favourite long walk was the Coast to Coast. It is just under 300km and passes through three contrasting National Parks: The Lake District; Yorkshire Dales and the North York Moors. As part of supporting #NHS1000miles my aim this year was to walk 2020 miles. As of yesterday, I have walked 2066 miles. I walk for the same reasons J runs. It’s for my well-being and to help keep me fit, both mentally and physically.

There are many health benefits from walking on a regular basis It’s free and can be done at any time of the day or night, and it takes less than an hour a day to walk just 2.74 miles. Do this every day for a year and you will have walked 1000.1 miles. This will go a long way to reduce your risk of diabetes, stroke, obesity, heart attack and depression. It will also help improve your sex life, and of course add years to your life.

During the pandemic many more people took up running, walking or cycling. It was easier to do then as well. We had sunshine, long days and there was a sense we were all in this together. All of which now seem a distant memory. As we come out of the second lockdown, but not the pandemic, the days are colder, shorter and dark. Already many people are commuting at both ends of the day in the dark, and perhaps not seeing the daylight properly until their day off. As Winter draws closer, people might find it increasingly difficult to find the time and even the motivation to continue to exercise on a regular basis.

Yet now is the time we should try to find ways of exercising regularly. You didn’t need to be a psychic to have predicted the pandemic would impact upon people’s mental health. The first lockdown brought into sharp focus the impact of social isolation and loneliness, the fear of becoming ill, the disruption in many of our familiar routines and ways of living. As the pandemic has continued, economic insecurity and the loss of loved ones have added to the stress and anxiety lots of people have experienced. Against this background, it is not surprising that individuals become disorientated, unable to make sense of what is happening and experience a sense of loss without there actually being a bereavement. Sadly, young people and young adults in particular appear to be most impacted by this sense of grief.

What is true for the general population is also reflected in the experience of an increasing number of health and social care workers. When the first waves of the pandemic struck and the first lockdown was imposed, there was a definite sense of camaraderie and whilst there were many problems with PPE, testing and so on, there was a determination to get through the worse of it. A&E departments were largely quiet, and much elective work ceased. Whilst people were redeployed to help in critical care services, generally staff were willing to do so. Much has been done in the short term to help with peoples mental and health and wellbeing (I have heard from a number of different sources that strangely free car parking was a real winner for many staff).

Over time, the relentless cycle of the pandemic has left colleagues exhausted, demoralised and struggling with their own mental health problems. Our A&E departments are back to pre-pandemic levels of demand, the unintended consequence of renewed redeployment has left many members of staff feeling their own roles are not valued, stress-related referrals have gone up and staff absences have hit unprecedented highs. Of course, we still have the ‘usual’ Winter pressures to contend with. And I haven’t even mentioned the huge distraction the command and control folk’s constant demand for data and the impact such political scrutiny has had on leaders and managers morale.

The long term impact is yet to emerge. Just as the physical and mental health consequences of long-Covid are beginning to be understood, I suspect we will need to look at the longer term impact on the mental health and wellbeing of those staff exposed to so much loss and who have worked in such challenging professional environments. Ensuring that the wellbeing of staff in both the short and long term is addressed is something dear to my heart. I have been appointed the Board Staff Wellbeing Guardian at Blackpool Teaching Hospitals, and last week I met Lee Barnes, Head of Staff Wellbeing at both Blackpool and East Lancashire Hospitals. We had much in common not least of which was a strong desire to see the NHS Staff Wellbeing Guardian Principles positively upheld. It will be an exciting journey, and like my daily walks will start with that first step, and one step at a time I’m confident we will get there.

Flagging the need for communicating certainty in a world of uncertainty

Admiral Lord Nelson was born in 1758. Some 20 years later he took command of his own ship in the Royal Navy. He eventually became a ‘flag officer’; that is, he was entitled to fly a flag signifying that he was an admiral and the ship that flew the flag was the one where the orders of battle originated from. Much has been written about Nelson. He was a transformational leader, an astute military strategist, a people person first and foremost and a superb communicator. Obviously, radios, mobile phones and so on hadn’t been invented, and Nelson used a system of flag signals to command his fleet of ships. In so doing he was able to defeat the so called ‘invincible’ Spanish Armada, and the French navy. Although he often used unorthodox strategies, it was his ability to communicate that made him stand out. Nelson’s communications to his sailors was safe, timely, effective and always aligned to the task at hand. Sound familiar?

It should do as many of us who work in health and care services have long understood the importance of effective communication when engaging with our patients. Yet so often it appears we get it wrong. Last week I read a report on complaints that patients and their relatives had made following their treatment and care. Poor communication appeared to be at the heart of many of these complaints. The latest data published by NHS Digital, revealed that nearly a third of all written complaints received were about poor communication. The care patients received was the second highest reason for a complaint being made. As hard as we might try to ensure things don’t go wrong with an individual’s care, sadly there will be occasions when care doesn’t go as planned, and in some cases, even leading to the patient being harmed. When things do go wrong, such occurrences need to be recorded, logged and most importantly, learnt from.

Whilst such learning needs to take place locally, the National Reporting and Learning System (NRLS) is the UK’s central database for collecting and collating such reports. In fact, it is the world’s largest and most comprehensive patient safety incident reporting system. Unlike the current so called NHS ‘Test and Trace’ system, it is truly world beating.  Over 2 million reports are received each year. The system is currently undergoing a bit of an upgrade. Whilst the NRLS provide important national patient safety alerts, it is what happens at a local level in response to when things go wrong for patients that interests me.  

In my experience, a big step forward in how to deal with the consequences of such incidents was making the Duty of Candour a legal requirement for NHS organisations in 2014. If you don’t know what the Duty of Candour means for you, here is a quick (CQC approved) guide. Essentially health care organisations have a legal duty to be open and honest with patients (and their families) when something has gone wrong with their care or treatment, whether it has led to or could cause future harm. How such a conversation is undertaken is, of course crucial. Here is a brilliant example of why such communication is critical for the longer term health and wellbeing of individual patients and their families. It’s a pandemic-orientated paper, but the issues are equally applicable across the board in terms of the way difficult conversations are engaged with.

Nelson was famously known for his genuine concern for the health and wellbeing of those he worked with. Apparently, he was able to consistently demonstrate a close personal interest in the individuals who made up the various crews he led. Its said he had an ability to ‘imaginatively’ engage with people’s particular needs and problems.  I’m sure if he were around today, he would be a great candidate for a Chair or CEO role in one of the emergent Integrated Care Services. He would be able to pull together the many disparate strands and make it possible to arrive at a single communicable plan of the successful way forward. 

Sadly, although it was International Men’s Day last week, Nelson is not here, and he would perhaps have been a great role model for others (leaving Emma to one side).  However, we do have the benefit of his legacy. He knew that despite the best plans and precautions in the world, accidents and unforeseen events sometimes mean the plan gets derailed. In his world such derailments might lead to harm, death and defeat. He also knew that whilst a natural inclination might be to blame the individual concerned, and punish them, this was not the answer to avoiding similar outcomes in the future. Nelson realised that the problem was often not the fault of the individual, but the system within which they worked. If you change the people without changing the system, the problems will continue.

In some ways Nelson was the forerunner of what we now know as a ‘just culture’, see here and here. Last week I took part in a webinar that was looking at patient safety and the role that a Non-Executive Director might have in promoting a just culture. There was much discussion about the need to develop a culture where people can proactively look at their workplace and raise concerns over risky processes and or behaviours. We know that that even the most competent of professionals can make mistakes. How we deal with such incidents is important. In a ‘just culture’ individuals are not only accountable for their choices, actions and behaviours, but they are also accountable to each other. Of course, this means that organisations need to move from a ‘blame and shame’ response to one that embraces learning. That is not to say that where there has been a wilful or deliberate neglect on the part of the individual professional, they shouldn’t face disciplinary action. They clearly should. We perhaps should take a leaf out of Nelson’s book on leadership and create a culture where people can speak up and challenge poor practice without the fear of being discriminated against in the future.   

 

Ps. – not many people know this, but Nelson never wore an eye patch, and likewise, Nelson was 5’ tall in real life, whereas his statue in Trafalgar Square is 17’. That’s a Horatio of around 3:1

Kind people are the best kind of people: kindness always matters

Triskaidekaphobia is the fear of the number 13. Last Friday was the 13^th Nov 2020. For the superstitious among you it would perhaps have been a day that you avoided doing certain things just in case your luck ran out. However, it was also World Kindness Day. It seems to me that the world is crying out for some kindness. Despite observing Remembrance Day last week, there are still many wars going on across the world. Children continue to go hungry, and many remain at risk of abuse in all its forms. The planet is heating up and the icebergs are melting. We are far from making kindness the norm, more of which later.

In 1932, the American playwright Wilson Mizner famously told an up and coming film star ‘be kind to everyone on the way up; you’ll meet the same people on the way down’. It was good advice then and it’s good advice now. Unless you were spending lockdown in a darkened room with no TV, radio or mobile phone, it won’t have escaped your notice that two very high profile people might have been better served by taking this advice.

On one side of the Atlantic Ocean, we have witnessed the childlike tantrums of Trump as he lost the 2020 US elections. The papers have been full of insider stories of the sheer vindictiveness of his approach to anyone who didn’t agree with him as President. There was also much speculation as to what he might face in terms of legal battles once he loses the protection of the presidential office. On the other side of the Atlantic Ocean we have Cummings, who last week finally got kicked out of 10 Downing Street. He allegedly shares many of the same attributes and behaviours as Trump in his approach to those he worked with or came in contact with.

Both these men have directly or indirectly been responsible for many highly knowledgeable, skilled and experienced people losing their jobs, and perhaps more importantly, their standing in society. And that is before one considers the catastrophic handling of the pandemic on both side of the Atlantic Ocean, for which both men have a great deal of responsibility. Trump’s presidency has done untold damage to the rule of law and democracy. Likewise, in the UK, Cummings’ ‘eye test drive’ to Barnard Castle during the first lockdown severely damaged the trust people had in the Government and its ask of the British people in managing the pandemic. Personally, I won’t be sad to see either man leave the public stage.

Their arrogant behaviour was hugely contrasted by the humility shown by Ozlem Tureci and Ugur Sahin last Monday when the news broke of their work in producing a possible Covid-19 vaccine. Both came from fairly humble backgrounds. They went on to become doctors and they met whilst both working for an oncology service in Homburg. Their shared interest in getting the body’s immune system to fight against cancer and other diseases led them to develop the approach that has been so successful in developing many flu vaccines and ultimately was the same medical technology that led to the development of the potential Covid-19 vaccine announced last week. Called mRNA, you can read about how this technology has developed over the past 10 years here. 

Science and the discoveries it can bring are clearly of primary importance in both their lives. For example, when they got married, they took just half a day off work to do so. And it was Sahin’s vigilance, knowledge and analytical abilities that gave them an early start on the development of the vaccine. On Jan 24th he read a scientific paper that describe the seriousness of the coronavirus and the possibility of an asymptomatic spread. When he looked up Wuhan on Google, he realised the potential for a global pandemic and started to work on developing a possible vaccine. Four weeks later the coronavirus had arrived in Europe, by which time they had already produced 20 possible vaccines. This was subsequently reduced to four, one of which proved particularly effective in trials. Whilst the couple founded their own company in 2008 and had the scientific ability to develop a possible vaccine, they didn’t have the resources to conduct the necessary clinical trials or produce and distribute any successful vaccine. As they had previously worked with the German pharmaceutical giant Pfizer in developing flu vaccines, a partnership was agreed to work together once more. Despite the assertion by Trump that he and the Americans developed the possible Pfizer vaccine, the US had nothing whatsoever to do with its development. As Trump might bemoan, it was ‘fake news’.

Whilst there is still a long way to go before a vaccine becomes readily available, the one announced last week looks very promising. Tureci and Sahin are an enchanting couple. They apparently celebrated the news of the vaccine’s breakthrough by quietly enjoy a cup of Turkish tea at home. Despite being in the top 100 of Germany richest people, they live modestly. They don’t own a car and Sahin cycles to work every day. They both have enthusiasm, knowledge, kindness oozing from every pore and are passionate in their desire to help their fellow man. I for one think the world needs fewer people like Trump and Cummings and many more like Tureci and Sahin, if the world is to become a better and kinder place.

I think the last word has to go to Scott Adams. He is the creator of Dilbert, the comic character of the same name. It is based upon what Adams describes as the Dilbert Principle. This Principle states that organisations tend to promote incompetent people to management positions to remove them from the front line workforce (think W1A) in order to limit the damage they might do. Possibly the exception that proves the rule are Trump and Cummings; both incompetent but actually engendering untold damage. Why the last word? Well Adams also famously said: ‘Remember there’s no such thing as a small act of kindness. Every act creates a ripple effect with no logical end’ – in other words, kindness matters and flows outwards exponentially, so let’s all strive to make kindness the norm.

Changing Rooms in the Animal House

Some 45 years ago I was in ‘Del Boy’ mode. I was sure I would become a millionaire within the year. My great scheme was breeding rabbits for food. At that time, I lived on a smallholding in Wales and had an almost empty cowshed just waiting to be used. There were plenty of companies that promised to supply a complete rabbit farming project. This included supplying cages, the rabbits, food hoppers and so on. They even promised to buy back the young rabbits born to the farm. It appeared a win-win way to make ‘loads of money’.

I didn’t pursue this promised land, and I never became a millionaire. But I did stay happy. My issue was I couldn’t see how keeping rabbits in cages was a good thing. Rabbits in hutches, yes, and I have done this, but actually rabbits belong outside. I say this even wearing my Mister McGregor hat as I have experienced many years of wild rabbits coming and destroying my garden, time and time again. Young J has a different point of view to me, claiming that the rabbits were there before my garden. In any event keeping animals in cages to breed for human consumption is an absolute ‘no-no’ for me.  

I was reminded of this last week. I read the story of the 13,000 chickens that were killed in Cheshire, after it was confirmed that the birds had contacted H5H8 avian flu. In Holland, some 200,000 birds were also culled for the same reason last week. The Netherlands are Europe’s largest exporter of chicken meat and eggs. Back in 2003, 30 million chickens and ducks were culled due to a major outbreak of avian flu. 

Additionally, last week you will have no doubt seen the dreadful pictures of the minks, kept in cages and bred for their fur, in Denmark. 17 million of them will be killed next week in an effort to minimise the risk of them re-transmitting a mutated form of Covid-19 to people. Already 12 people have been found to be positive having contracted this new form of Coronavirus from minks.  

Unlike the authorities in Wuhan, the Danish authorities don’t seem to be complacent over the high risk of animal/human transmission to their population. It is to be hoped for all our sakes that the lockdown and preventative measures the Danish government have put in place will contain this new and equally deadly strain of the Coronavirus.

Reading these animal stories last week reminded of the work of Claes Janssen, the Swedish psychologist. In the late 1960s and early 1970s he undertook research into the dynamics of change. Back in 1993, I used his work to support my MBA dissertation, and later on, as part of my PhD. My masters dissertation looked at the impact of the newly created NHS internal market, with its provider/ purchaser (now commissioner) split, on services for young people. My particular interest was forensic adolescent services. His work provided the conceptual model for my thinking and helped me frame my analysis of the data I had collected from services across the North West of England. Whilst I cannot remember the detail of my research outcomes, I do recall that the purchaser/provider split had made it more difficult to develop specialist adolescent metal health services.

Janssen developed his thinking using the metaphor of a house with four rooms – this was the so-called House of Change. The four rooms in the House of Change are: The Room of Contentment, The Room of Denial, The Room of Confusion, and the Room of Renewal. The four rooms provide a conceptual pathway of insight into what might happen to people and organisations in transition. In particular, how individuals might influence the processes of change by taking responsibility for their emotions, behaviours and decisions. Janssen suggested that in any change situation we begin in the Room of Contentment and move anti-clockwise through the other rooms as we work through the implications the change might have for us.

Each room serves a purpose in helping us recognise more clearly and respond to our emotional self, and our self in relation to others and how we see the world. Thus, moving through the rooms can allow us to better understand the two different pulls on our psyche – the need to be content and belong, and the need to get out there and find the truth. Both will impact upon our sense of reality, and how we choose to respond to change. I think Janssen’s work is very relevant today.

Covid-19 has very quickly pushed us out of the Room of Contentment. That sense we had of normality, where things generally felt good, predictable with there being little incentive to change anything. If change was required, we could plan, discuss, consider and perhaps take our time about doing so. When the pandemic came many people found themselves in the Room of Denial. We knew that our world was changing, yet for many, it appeared that they thought it didn’t apply to them. Personally, I think this was particularly and disappointingly true of some of our political leaders. The first surge and first lockdown changed that sense of denial. Sadly, for some, I think they have now retreated back into the Room of Denial.

Here is an example. Yesterday we went shopping at Tesco. It was almost like we weren’t in lockdown. No arrows on the floor, and while people were wearing masks, there was little attempt being made to social distance – a problem compounded by the fact that there was no control over the numbers of people in the store at any one time!

Possibly this move backwards is a consequence of the time we all might have spent in the Room of Confusion. Our comfortable sense of place and normality was challenged by the responses we were asked to make to dealing with the pandemic. Many of us embraced the need to develop new ways of doing things. Zoom and Teams replaced face to face meetings, working from home became the norm for many of us. However, this Room can also breed negativity. I cannot be the only person who felt that I wasn’t delivering my all by doing everything at a distance. Like others I wondered about what life ‘after Covid-19’ might bring.

Thankfully the Room of Renewal really came into its own during the early phases of the pandemic. There was lots of energy and creativity. There was a sense of ‘we are all in this together’. Hierarchical barriers were crushed; new ideas, which previously would have been thought of as unachievable, were implemented overnight. It was a challenging time. And it was also time of great loss and change.

Now we are back in the midst of surge two. And it feels more difficult this time. I suspect many of us have already ventured into the Attic of Memory and not liked what we have seen. However, we are clearly not in the Room of Contentment; like the Danish authorities we know what needs to be done to safeguard ourselves, our loved ones and each other. It may be a repositioned normality, but together we can be there for others and together we will continue to make a difference.

ps: as I was considering this week’s blog, and reading the various animal stories, I heard a commentator on TV describe the angry election-losing Trump as an ‘obese turtle on his back’ – I liked the description, I thought it suited, but of course I wouldn’t dream of using it in my blog posting…

  

Being smart about how we capture a glimpse of the future

My father was a great amateur photographer. Over the years he had some amazing cameras and took some fabulous photos. For those readers of a certain age, cameras were clever devices that captured images on film, from which it was possible to create photos. My Dad had a little ‘dark room’ and I spent many an hour watching the magic happen as he developed photos from negatives in trays of special fluids and paper and hung them up to dry. For most of us, those days are well and truly in the past. It was a time before smartphones were able to turn us all into amazing photographers, or at least be able to take a picture of anything we want at the press of a screen. My father turned 90 last week, and today he enjoys seeing the photos sent to him by his children, his grandchildren and even great grandchildren. Sadly, because he lives in Wales, we were unable to celebrate his birthday in person. My new wife J, in conversation with my brother Mark, had the great idea of collecting birthday greetings from friends and family, putting them on a DVD and sending it to my Dad. Mark, took this idea forward and ran with it. He did an absolutely fabulous job and the finished DVD was a wonderful success. 

Young Mark is an Apple fan. He used his various Mac machines to produce a beautiful collection of video messages, complete with music and captions and even a cast list! I don’t know how he did this despite my owning a couple of iPads, iPods and an iPhone. 

However, my lovely wife J often tells me that I'm technologically inadequate. But, I still love her to bits and I’m grateful she is there to rescue me on the many occasions when the technology seems to let me down. She is the only person I know who had the patience to link my car to the internet and turn it into a smart car (although I’m still not sure I understand what this means).

How we use digital technology has increasingly become the way we live our lives. In lockdown, Zoom and Teams meetings allowed us to keep on meeting with each other virtually. Doctors’ appointments moved from the surgery to the sitting room, and goodness Amazon must have made some money with the huge rise in online shopping. Last week I received two separate emails extolling the many reasons why I should buy the new iPhone 12. It appears to be the key to unlocking the digital universe, see here. Now I can think of many other things I would rather spend £900 on than a new phone. I’m still using an iPhone 8 and it suits me well. It does everything I need, including being able to download the (so-called) NHS Covid-19 App. Apparently, if you do own an iPhone 12, you can also now do so as well.   

And that app. You would have had to have been locked in a monastery to miss the huge public outcry over the NHS test and trace app. Some claimed it was world-beating, (not me), and to say it had a rocky start would be an understatement. Last week the CEO of NHSX, Matthew Gould, admitted that they had ‘taken a punt’ in developing the app given they knew that Apple and Google were also working on their own programmes. Now I don’t know about you, but who do you really think was likely to have the expertise and resources to develop such an app, NHSX or Apple and/or Google?

Although this is an important question that will have to be addressed in what will inevitably be a public inquiry, it’s important to note and share far and wide, that the app can be downloaded from the Google Play Store, the Apple App Store and the NHS Covid-19app website.  However, last week we also learnt that there are other equally important Covid-19 apps. The one that caught my attention last week (although my attention to be truthful was on other things for much of last week) was an app called Compass. This is an app that reduces the serious harm (and possible death) caused by the hospital-acquired conditions of acute kidney injury (AKI) and pneumonia (HAP). The app allows clinical staff to assess every patient’s individual risk of developing these conditions while in hospital. This would help ensure that the right treatment is put in place to reduce the risk and possible death. The app is predicated upon the use of Artificial Intelligence (AI). This allows for a much quicker analysis of the risk to an individual by evaluating a range of factors and comorbidities that it would take extremely skilled and experienced doctors to be able to do. The AI draws upon a dataset made up of 140 million patients from across 46 countries!

Why Covid-19? Well NICE guidelines issued in May of this year noted the detrimental impact that AKI had on patients who were Covid-19 positive. Likewise, a study undertaken at the University Hospital Southampton carried out during phase one of the pandemic found AKI present in 31% of Covid-19 positive hospital patients, and that AKI was associated with 27% of those patients admitted into ICU. Their findings also showed that 44% of Covid-19 positive patients with AKI died compared to 19% of those without AKI. Patients over the age of 60 years are at a higher risk of both these conditions, and these are the group most impacted through the pandemic.

Whilst the article discussed reducing avoidable deaths, saving the NHS money (around £7 million in the direct cost of these conditions) I reflected on what the app might mean in the context of how we use technology. Using new technology to predict who might be at risk of health challenging conditions and providing early interventions has to be a better way of using scarce public money than building more hospitals. As the Dutch philosopher Erasmus noted way back in 1500, prevention is better than cure. The Compass app is a great example of how we can combine our growing knowledge of how to treat Covid-19 with our ability to harness digital technology to do just this. And it can all be done from the comfort of our smartphone.

My tip for staying safe when using smartphone-based technology during the pandemic is to clean your phone often and carefully. We have known for many years now that our mobile phones can carry 10 times more bacteria than most toilet seats. So, as we enter a second national lockdown, make sure you give your phone a wipe on a regular basis. It won’t help you take better pictures, but it will help keep you safe, and that is what is really important!

  

Miss Otis has no regrets: A Tale of Two Suits

One of the plus sides about working at home has been the ability to sit in meetings, barefoot, in shorts, with just a shirt visible on the Zoom or Teams screen. In fact, I have kept a shirt on a hanger just to put on for the meetings and, as soon they are finished, it goes back on the hanger and I’m back with my comfy t-shirt. Since lockdown, I have never had to put a suit on. So it was quite a shock last Tuesday to get up at 5am, shower and root through my wardrobe for a suit to wear. As all my clothes are black, there is no problem choosing, but it did feel unfamiliar. I was part of a Covid secure recruitment panel to be held at Wrightington, Wigan and Leigh NHS Teaching Hospitals (WWL). We were selecting our new Chief Nurse. We were successful and I’m looking forward to working with her.

It was a long day and I was glad to get back home and hang my suit back in the wardrobe. It didn’t come out again until yesterday – more of which later. But first, what I like about such interviews is listening to what the candidates have to say, how they view the world, and the stories they tell of their experiences. I wasn’t disappointed. And in the best ethnomethodological tradition I thought I might share some of what I heard during the interview conversations.

The first note I made was one of the candidates who talked about ‘mirror up conversations’. I absolutely identified with this notion. ‘Let me hold up a mirror’ is a phrase I have often used in my conversations with others. I found it to be a great way of taking the heat out of confrontational conversations, but most useful when people were struggling with a problem, unable to find a decision they might want to take. And to be honest, it’s something I say to myself when I pick up on cues that I am perhaps not getting my point across effectively.

Thinking about the words we choose to use is of course important in conveying the authenticity of what we are saying. My second note was that one of the candidates consistently used ‘our’ rather than ‘your’ when describing how she had found WWL and her vision for the future. For example, ‘we need to do something about ‘our’ recruitment and retention of nurses’. I found this identification of ‘ours’ interesting. It didn’t seem presumptuous, or proprietorial. I know I was always careful not to describe the School I was Dean of as ‘my’ school. However, the candidate might have felt more comfortable standing in someone else’s shoes in describing her ambitions for the future.

All the candidates managed to get in a comment about Ruth May’s (Chief Nursing Officer for England) support for the global Pathway to Excellence programme. Which if you haven’t heard about the programme, you can read the details here – the programme is absolutely about transforming the future. It’s about learning from the innovation and collective leadership many nurses have been able to demonstrate during the pandemic and beyond.

Innovation is often a result of curiosity. One of the candidates, in responding to a question on promoting and supporting nursing research described themselves as being a ‘curious individual’. I was curious to understand what she meant by this, so I asked her which one of the papers she had published was her favourite and why? Sadly, like many nurses, she hadn’t published any papers, either research or opinion based. However, she did have three great ideas for future research and was able to articulate these well. I believe that nurses could and should do more about gaining a voice in this way.

During the interviews there was much said also about listening to the voices of others, true consultation, co-production and encouraging others to reflect. My favourite line came from a presentation one of the candidates made: ‘there is no limit to listening’ something for all of us to ponder as we continue to work in busy and turbulent times.

And last but not least was the surprising (and interesting) call to ‘make redeployment sexy’. This was a reference to a lesson learnt through the first wave of the pandemic. At that time many healthcare specialities were closed down and staff redeployed to support critical care and other Covid facing services. It’s clear that for many people they were glad to be able to do just that. However, over time, working in an area that was different from perhaps what brought them into the NHS in the first place, took its toll on people’s mental health and wellbeing. As the second wave grows in intensity and once again people will undoubtedly be asked to redeploy again, how this is done and the support they receive will be critical in protecting our colleagues and keeping them safe. 

Miss Otis and that second suit tale. You will have to go back to my blog posting on the 19th April this year to see where the title comes from and its significance for today. However, yesterday I once again put on a black suit, purple clogs, and silver bangles. There was a special reason and it was nothing whatsoever to do with health and social care. This blog post is the first one in the 584 blogs that I’ve posted since 2009 to have been prescheduled. The reason I’m not writing and posting this blog at 5am today for real is that I’m curled up in bed with my wife J, on the first day of our new life together, which I think is kind of special. I will be back next Sunday, alive and kicking, and there is even the possibility of photos too!   

Tears in Heaven: The being and doing of being a health and social care professional

Yesterday morning, young J asked what I would be writing this week’s blog on. My response was that I had no idea. I had thought about something to do with ‘Tears in Heaven’, but wasn’t really sure. More of which later. Perhaps. Certainly, there was plenty last week that should have stirred my imagination. For example, there was the Russian monkey business around the effectiveness of a Covid-19 vaccine, somewhat akin to that 1802 reaction to the smallpox vaccine which was based upon a cowpox vaccine.

Then there was Jake Jacob Gilchrist Berry, Conservative MP for Rossendale and Darwin, (there are other political parties) who last week wanted to re-open the Chorley A&E department. How? By ‘re-locating’ staff from the other three acute hospitals across the Lancashire and South Cumbria Sustainability and Transformation Partnership (STP)! I think that Jake possibly went to the same School of Thought as whoever it was that dreamt up the Nightingale Hospitals in the first place. In London, only 51 patients were ever treated at the 4000 bed Nightingale Hospital before it was mothballed. Why was this? Well the main reason was there were no staff to run the facility. All available staff were already working in the London acute sector.  

However, after a busy week of virtual meetings, I was feeling a little uninspired and fed up. Additionally, it would be churlish and possibly career-damaging to unpack the stupidity of this situation. So, I won’t go there, although making this decision did little to improve my state of mind. Given my age, I should have been full of vim and vigour and laughing all the way from the first word typed to this week’s completed blog.

How do I know this? Well last week the Times published a story that drew on the work by researchers at the Stanford Graduate School of Business in California, originally published in 2017, that suggested that we start to lose our sense of humour around the age of 23. For many folk, it’s an age where having joined the ranks of the employed, we start to become serious, and in some cases, important people. I have never felt the latter, albeit I have been privileged to work in many roles of high responsibility and accountability. I have also always felt it was important to be able to have fun while at work. Humour has often been the glue that has bound the teams I worked in together when times were tough.

The Stanford research reported that the average person aged 40 took 10 weeks to laugh as much as a four-year old does in a single day. It is only people like me, who on reaching retirement age, regain our ability to giggle, laugh and find things funny. The researchers argue that is shouldn’t be like that. They argued that, in organisations, humour can be both powerful and important in managing change, building innovative and effective cultures, achieving business objectives and vitally important for maintaining our well-being. The researchers’ aim was to promote the notion that humour can bring with it a sense of humanity, humility and a different kind of intellectual perspective.

Actually, you don’t need to read the research to perhaps understand this idea. Here is a trailer for a film, that if you haven’t already seen, you can get on Amazon (of course, other streaming services are available); sit down and watch it. I can guarantee that it will both make you laugh out aloud, and make you think about what is important in life. It also stars my doppelganger.

And goodness, as we enter the second Covid-19 surge, with Winter just around the corner, and appear to be on the brink of a ‘no-deal’ Brexit. do we need something to lift our spirits. One of my daughters, a single mum with two young children, spoke with me on the phone yesterday saying she didn’t think she could face a second lockdown on her own again. It’s a cry that I think will be echoed in households up and down the UK. I think the impact of the three Tiers will lead to many more tears being shed over the next few months, and not just by folk like my daughter. Healthcare professionals, wherever they are working, will already be feeling the impact of the second Covid-19 surge.

This was something I thought much about last Friday. As I noted above, Friday was the end of a very busy work for both J and myself. As we sat in front of the first log fire of the autumn, listening to music, sipping wine and generally chilling out. One of the songs that came on was Eric Clapton singing ‘Tears in Heaven’. It was one of those moments when the words you are listening to take on a different meaning. Eric Clapton has written 131 songs, but apart from ‘Layla’, this is the one that sticks in my mind. It was written as a way of capturing his feelings following the tragic death of his four-year old son who fell from the 53rd floor of a New York apartment in 1991.

There was a line I the song that resonated with me and where we find ourselves at present:

‘Would you hold my hand

If I saw you in heaven?’

During the first lockdown, I wrote a blog about the importance of touch. You can re-read it here. The stimulus for writing that particular blog was the knowledge that many nurses were often the last person someone with Covid-19 would feel near them as they died. A physical touch seems to me to be an important, if not a critical element in such situations. As we once again restrict people visiting their loved ones in hospital, I hope our nurses and others remain there for their patients at time when they need to feel the caring presence of another. As I argued in that April blog, touch in many ways captures both the ‘doing’ and ‘being’ of nursing. Other health and social care professionals are available, but all will understand, appreciate and practice the notion of touch: ‘Would (or will) you hold my hand?’.

Re-imagine mental health care: we can all make a difference

This time 5 years ago I was sitting by a swimming pool in a hotel in Singapore. John Lennon, if he hadn’t been murdered, would have been 75 years old. This weekend, it’s his 80th birthday we are celebrating. It’s been great to hear once more the stories of what he lived for, promoting peace, love and understanding. His music is still played and enjoyed today. As a teenager, alongside Leonard Cohen and Keith Richards, John Lennon was one of my absolute heroes.

But back to Singapore. Not literately obviously, although given the awful weather, I wouldn’t mind some of their heat. I had flown into Singapore from Brisbane, Australia, having just attended the 41st International Mental Health Nursing Conference. It was a conference I had supported every year since 2001. However, it was the first time I had been back there since 2007 for reasons you can read about here in the blog I posted at that time. Sitting by the swimming pool in Singapore? Well I was there there with my co-author, friend and hopefully, my best woman, Professor Sue McAndrew, and had no idea as what I might focus that week’s blog on. I asked her if she had any ideas and, in a flash, she said ‘well it is World Mental Health Day, write something about that’. So, I did. And as yesterday was World Mental Health Day, I will again.

World Mental Health Day is celebrated internationally on the 10th October. Every year it considers a particular theme. This year the theme is ‘mental health for all’. In the year of the Covid19 pandemic, this couldn’t be a more appropriate area to focus upon. Most healthcare professionals have faced unprecedented challenges. Often working in conditions that will have been difficult, exhausting, and at times I’m sure, scary. Many will have dealt with seeing more people die than they might have ever encountered before. Some of those who died will have been colleagues they worked with as team members. There have been many stories of nurses and others being there for patients at the end of their life. They provided care and a presence when nobody else could or was allowed to. These are all factors that can have an impact upon an individual’s mental health and wellbeing.

Organisations have recognised and responded to these factors. We have seen the development of ‘wobble rooms’, free car parking, increased flexible working, psychological support apps, the provision of free food and drink and so on. See here for examples, and I have to say, I have taken the ‘on a go slow’ day to heart. All of which have been welcome and have helped. But nobody yet understands what the long term effect might be of working through such a challenging time. Stories are already emerging of the anxiety and depression many healthcare professionals are experiencing, both from meeting the challenges of the past six months and in anticipation of a difficult winter ahead of them.

Perhaps understandably, the focus has been primarily on those working in our acute hospitals, care homes and in the community. In some ways they were in the front line of dealing with the pandemic. But of course, there were other health care professionals, who were also working and providing treatment and care to others. These were those working in mental health services. Arguably, mental health services have long been thought of as the Cinderella of health care. Chronic underinvestment in mental health services has been a longstanding issue in the UK. There have been recent calls to increase the funding for mental health care. Indeed, the Department of Health and Social Care acknowledged what was required to achieve this as set out in the NHS England’s report, the Five Year Forward Plan, and funded an improvement programme.  

However, the pandemic disrupted the good progress made over the past few years. Sadly, that wasn’t all. Many mental health services were ill equipped to deal with the infection control and prevention measures required to keep people safe and cared for at the start of the pandemic. The restrictions on social contact (and visitors) had an impact on the therapeutic nature of care, and of course, would have increased stress for both staff and patients.

The pandemic has also brought to the fore the need to find new ways to address the growing mental health needs of the wider population. It is safe to say we all experienced a deterioration in our wellbeing as the Covid19 lockdown impacted upon our everyday lives. I know that it did for J and I. We like eating out and hosting dinner parties, both of which were curtailed. J missed leading her new team in person. Despite MS Teams and Zoom meetings, there was a real sense of isolation. And we couldn’t get married either, after months of anticipation and planning. I would argue that the mental health and wellbeing of the population is one of the greatest public health challenges facing our communities today. Preventive approaches will be the cornerstone to achieving this.

The good work developed in schools with children and young people is a great starting point. It helps teach the next generation what they can do to develop their resilience, and reduces the stigma associated with mental illness. There is much more to do with people of all ages, however. One of the positive things I take as a Non-Executive Director working in two acute Trusts, and being a Professor Emeritus in mental health care, is the opportunity to look for ways that I can do just this. But you don’t need to be a professor to make a difference to the wellbeing of others – everyone can do something.

Perhaps we should leave the last words to John Lennon:

You may say I’m a dreamer

But I’m not the only one

I hope someday you will join us

And the world will be as one

Imagine all the people

Living life in peace 

Tales of Uncertainty – it’s a dickens of a story

That Charles Dickens wrote some cracking stories in his time. For reasons best known to the inner workings of my mind, I lay awake the other night thinking of A Tale of Two Cities. Perhaps it was because I had read two contrasting stories earlier in the day that brought the Dickens book to mind (more of which later). A Tale of Two Cities was written in 1859. Dickens was just 47 years old when he wrote it. Many people consider it to be one of the world’s bestselling novels. Its famous opening sentence, which captures the lead up to, and the time of the French revolution, seems so apt for today’s world, well at least here in the UK:

‘It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us we had nothing before us, we were all going to Heaven, we were all going direct the other way – in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil in the superlative degree of comparison only.’

Apart from the fact that my English teacher would have smacked her ruler across my knuckles for using a sentence with 119 words in it, the sentiments conveyed in Dickens’ words resonate with where I think we are today, some 161 years later. I’m sure I’m not the only one who spends some time thinking about what life was like pre-Covid; the plans we had that had to be abandoned; the things we did then that we are not doing now and the continuing uncertainty of what the future will bring.

Paul Cosford is someone having to deal with the certainty of his uncertain future. You can read his story here (and please do as its message is both poignant and powerful). Paul is a doctor, who for many years has worked in public health. He is also living with terminal lung cancer. Writing in the British Medical Journal last week, he used his experience to raise the issue of assistive dying. As I say it is a very powerful and personal narrative. One of the things that struck me about his account was that he was, wherever possible, making the most of every moment he might have left. He knows that the remorseless march of the cancer will eventually incapacitate him to the extent that he will become dependent upon others to meet most of his needs. But until those days arrive, he is determined to spend as much time as he can with those he loves and doing as many of the things he loves doing as he can.

There was a second aspect to his story that also struck a chord. This was the notion of permanence. Whilst previously he was a long distance cyclist, these days he walks. Sitting on a bench to catch his breath, he draws upon his view of a river or the undulations of the hills, which may not have changed much in hundreds of years to bring perspective, and through that, comfort, in thinking about the fragility of his existence here on earth. I wish him well as he steadfastly continues to live with something that will eventually kill him.

The other story that caught my attention last week was a research report from Finland. Like Paul’s story, this was a research project that took life expectancy as its focus. It is clear that people, on average, are living longer. The Finnish study however was not so concerned with how long a person lived for, but the quality of the life lived. Way back in 2001, the Word Health Organisation (WHO) added the concept of health-span to the way life expectancy could be measured. Health-span is the measure of the quality of life than someone experiences rather than the quantity of life lived.

The study was undertaken at the University of Jyvaskyla (a lovely place name, pronounced U-vas-kla). It was unique as there are few studies in the world that have been able to compare the way older people of the same age manage in their daily lives, but in different historical times. The study looked at two cohorts of participants (aged 75 - 85) born 30 years apart. The study compared the physical and cognitive performance of each group. Perhaps not surprisingly given the changes in the lifestyle choices people have been able to make over the past 3 or 4 decades, many improvements were noted in the later-born group. In terms of their physical performance, their walking speed was faster, grip strength stronger, lung function measurements nearly 50% better – they also performed better across most of the cognitive performance tests. The results give me hope. They should also give a certain other older man hope too.

Donald Trump, President of the US, tested positive for Covid19 - on Friday. He is a 74-year old man (two of the strongest risk factors) and is clinically obese (a third risk factor). Research shows that those aged 65- 74 have a five times higher risk of hospital admission than other groups and a 90% higher risk of death. Not a great place to find yourself in. However, like many of those in the Finnish study the golden-haired one doesn’t appear to have any underlying chronic health conditions, and is reasonably active. He plays a lot of golf and appears to walk quickly between shots. Clearly the outcome for anyone in Trump’s situation depends upon many factors, some of which are unmeasurable, so there will always be some degree of uncertainty.

Our friend Dickens. He would have hated the pandemic, and the notion of a lockdown would have been almost too much for him to contemplate. He famously visited the Lake District because of his restlessness and the need to be on the move – it’s also alleged that it gave him an opportunity to spend time with his mistress, but it’s not for me to judge. These days I visit the Lakes with my fiancée, young J. We like walking on hills that have been there for millennia. The seasons change, but those hills change much more slowly. Permanence, or maybe the illusion of certainty.

The day before Dickens died, he cashed a cheque for £22 (about £5,000 in today’ money) in the pub across the road from his house. History says that it was intended to be a gift for his mistress. I think in Dickens’ mind, on that sunny morning 161 years ago, it was almost certain he would have thought that life would be going on just as it always had. Its certain that we will all live with uncertainty.