Everybody wants to go to heaven, but nobody wants to send you there

It’s the end of the first week of the voluntary UK lockdown and the beginning of a strange new world. Perhaps one of the strangest things of last week was Bob Dylan releasing a new song (the first since 2012) entitled ‘Murder Most Foul’. It’s almost 17 minutes long. Have a listen to it and see how many famous song titles you can identify as you do. I’m willing to bet that my friend and colleague Dr Kirsty Fairclough got all 75 songs right.

It’s a long song, but not as long as the Prime Minister’s daily Covid19 briefings. Personally, I have been fascinated by these daily productions. As someone who has a secret anthropologist hidden deep inside them and desperate to break free, I marvel at the careful use of words, the stage positioning, the change of podium messaging, the way the protagonists appear to dutifully write notes as they listen to the questions being asked of them. It makes for compelling viewing for the socially isolated.

The cynic in me, however, worries about the quality of questions asked by the reporters at each briefing. I wonder about the difficulty they have in finding questions to ask that allow them to be reporters, to challenge and hold others to account. I suspect it’s a tough choice, between demonstrating solidarity with the message, and giving a voice (often a dissenting one) to those who don’t have one.

Here is an example. At last Friday’s briefing the Teflon-coated Marmite Chancellor of the Duchy of Lancaster, Michael Gove, spoke sincerely of the indiscriminate nature of the coronavirus, and the fact that our Prime Minister had now tested positive for Covid19. Boris Johnson had developed symptoms on Thursday and had been tested. Well if that wasn’t enough to get the reporters going, I don’t know what would. But nothing. When someone linked the Prime Minister getting tested and the current situation that front line NHS staff faced in not getting the same test, it didn’t seem a very convincing challenge. Even when Dr Jenny Harries (Deputy Medical Officer for England) observed that it depended where you were in terms of the centrality of your role in relation to the Covid19 response, as to whether you were tested or not, there was hardly a murmur.

The pressure to test NHS workers has been growing for a while, and last Friday it was confirmed that certain NHS staff would start to be tested for coronavirus this weekend. I read one report that noted Chessington World of Adventures was to be one of these trial testing sites. Bizarrely, reading this stirred up a memory of my going to the zoo there when I was much younger, on a Sunday School outing.

The WHO advice has for some time been to test, test, test, trace and treat. Let’s hope that now the testing has started, it can be ramped up and match what has been happening in places like Germany, Singapore, UAE, and South Korea. However, testing can, in some situations, lead to unintended consequences, sometimes tragically. Readers of this blog may have seen the sad story of Daniela Trezzi, the 34 year old Italian nurse who ended her life though suicide last week, after testing positive for coronavirus. She killed herself out of fear that she was spreading the virus. I cannot begin to imagine the turmoil she might have been going through, or the guilt, fear and anxiety she must have been experiencing. The personal choices she might have felt she was facing in trying to respond to these feelings must have been unbearable.

Yesterday the number of deaths from coronavirus surpassed 1,000 in the UK. Over the next 12 weeks, the rate of deaths is sadly likely to keep rising. Just like China, we are building huge ‘warehouse’ hospitals with thousands of beds in anticipation of the coronavirus surge.  However, even with Sir James Dyson on the case, it’s unlikely there will be enough ventilators to treat people as the coronavirus surge gains momentum to supply these and other hospitals. As such I think that that difficult choices over who gets treated and who will be provided with palliative care will increase along with the numbers of people contacting the coronavirus. Last week I had three eMeetings with folk from three different organisations, where we discussed plans for how some of these choices will be made, by whom, and how supported people might be when such decisions are taken.

Doctors and nurses will have to consider who might have the best chance of living when there is limited opportunity to provide the same treatment to everyone? These will be difficult decisions for many healthcare professionals to take, but take them they will have to.

The focus of our discussions was almost universally described as tackling the ethical issues involved in taking such decisions. Indeed, the British Medical Association (BMA) have recently reissued their ethical guidelines. Interestingly, whilst the BMA makes it clear that the guidance should apply to all patients regardless of their need, it’s a very practical guide.  Yes, if one looks closely, its possible to see shades of Aristotle, Kant, Mill and Bentham’s philosophical thinking around ethics, but it’s mainly the more contemporary ideas of the American philosophers, Tom Beauchamp and James Childress, who published their famous book, ‘Principals of Biomedical Ethics’, that underpin the BMA guidance.

Their work introduced what has become known as the four principals of healthcare ethics: respect for autonomy; nonmaleficence; beneficence; and justice. I don’t have room to expand upon these in this blog, but this is what I point my research students to when they are developing their thinking around the ethical considerations of their study. In the real world of 2020, I believe that all patients should be given compassionate and dedicated healthcare. Sadly, there is a legal, professional and ethical case to prioritise treatment when there are more patients with needs than the available resources can meet. As a Non-Executive Director, academic and nurse, I intend to stand shoulder to shoulder with my clinical colleagues faced with making such decisions. Stronger together.

Can you catch the coronavirus by reading this blog?

No, but a view from your window might make you happy! Currently my world feels consumed by the coronavirus. Everywhere one turns, there is a story about coronavirus. Good and bad, fake news and informative, frightening and reassuring. One of the saddest Covid19 stories I heard last week was of the US televangelist, Kenneth Copeland. He is a rather controversial preacher (some say sleazy), who has made millions of dollars through asking his ‘congregation’ for donations. These donations have enabled him to own a couple of jet aeroplanes, a $6 million lakeside mansion (complete with its own runway) and reportedly live a lavish lifestyle. Last week, for a donation, he was promising to heal folk struck down with coronavirus though the TV. Many thousands of gullible Americans took him up on his offer. Now that is taking ‘social distancing’ to a new level!

For bloggers everywhere, finding inspiration as to what to write about other than coronavirus has become increasingly difficult. All my ‘normal’ sources of ideas are devoid of anything other than stories of Covid19. Of course, there are many other things I could write about. For example, last week I signed off a contract for my new car. It’s a very fine car, but totally impractical. As my father has often said to me over the years, that means you can’t get more than two shopping bags in it, let alone a bale of hay. It was one of those ‘one life, live it’ purchases. Now I’m not even sure I will be able to pick it up. On reflection, it now feels rather a redundant thing to be doing – buying a new car, when there are so many people impacted and dying from the Covid19 pandemic. It feels largely irrelevant, and somewhat selfish.

Of course, there are many other things to reflect upon. Close to home, our wedding had to be postponed. At first, I was ok about the decision, well at least not as cheesed off as I thought I might have been. As last week came and went, it’s actually left me feeling very sad. Depressed even. I shouldn’t be really. When I stopped to think about it, I realised that young J and I have spent the past year having great fun planning our wedding. Whilst we both like many of the same things and ideas, we also have very different tastes in some areas. We found common ground in music, love, nature, and freedom and that inspired us to take a totally authentic approach to our wedding.

Inspired, we themed our wedding preparations around the Woodstock festival. Back in 1969, I was just 14 years old. My parents, rightly so, wouldn’t let me attend the festival. J was just three months old. She had grown to love the music and identify with the ‘Summer of Love’ much later in her life. And so it was we came to call our wedding ‘Wedstock’, issued wedding invitations in the form of music concert tickets, found an unconventional and very creative chef to prepare the wedding breakfast and scoured the world looking for items to use in the celebrations. We did have so much fun doing so.

Yes, it is very disappointing not to be able to get married in April. But postponing it was the right thing to do. Even if we had been foolish enough to carry on, Friday’s new restrictions on social distancing and social isolation would have made it impossible. It’s a little difficult to imagine when we should try to rearrange things for. There are so many unknowns. What we do know however, is that our day will come and that helps keep us feeling very happy. In these strange days, finding happiness is important.

The World Happiness Index 2020, published last Friday, provides a timely reminder of what else we can do to keep us happy. It’s a difficult read in parts, but worth having a look. The happiest country in the world to live is Finland. Its capital, Helsinki, is the happiest city in the world to live. The UK is the 13th happiest country in the world, although we have moved up five places since 2012, when the first Happiness Index was published. The research data draws upon ‘moments of happiness’ recorded by large numbers of participants in over 160 countries capturing some 99% of the total world population.

There were some interesting things to be found in the report. The outcomes published in Chapter Five of the report were outlined in some newspapers last week. I found it the most interesting chapter of the report and well worth a read. In some ways it doesn’t tell us anything many of us don’t already know. For example, being outside and enjoying nature is good for us. The health benefits of natural environments have been extensively researched in epidemiological and psychological literature. Socialising with friends, relatives and the person most special to you are among the strongest determinates of happiness. We know that in health care, happy staff make for happy patients. But even a short-term exposure to a green natural environment is all that is required to trigger a salutogenic effect. Way back in 1984, Roger Ulrich famously noted that patients allocated a hospital bed with a view of a natural setting rather than say roof tops or a brick wall had much better post-surgical recovery experiences, needed less pain medication and received fewer negative comments in nurses’ notes. For those readers working in health care, here is a slightly later paper you might find interesting to read.  

Of course, being outside can also indirectly result in a positive health and wellbeing impact for most people. Being outside often leads to certain behaviours, such as taking physical exercise and engaging in social interaction (think about the phenomenal rise in those regularly taking part in park runs every week). Many outside spaces are free from other stressors such as noise and air pollution – I know walking on the vast expanse of our beach, even when it’s just me and Dylan (the dog) it is one of the most relaxing, invigorating and uplifting things I can do every day. The other is gardening.

Anyone who wants to (at least, temporarily) put the anxieties of the coronavirus behind them, can do no better thing than getting out there and planting some seeds, mowing the lawn or just simply sitting and enjoying the sound of the birds singing. If you haven’t got a garden, you can still take a walk in some of our wonderful parks and other open spaces, and for a moment, open your eyes, ears and mind to the beauty of all that Mother Nature has to offer us. If you are doing the latter, stay safe, but keep smiling.

An apple a day might keep the doctor away - And help make every day count

I have long held the view that we should all try and make every day count. Today I’m just 33 days away from getting married to J. As the Covid19 pandemic continues to unravel everyday life, I’m beginning to not so much make every day count as counting down every day to the 18th April. I’m hoping we get there and can celebrate our special day with all those who have said they would also like to be there with us. Of course, in saying this, I fully acknowledge the much bigger problems we are facing as a nation, and my thoughts go out to all those who have succumbed to the disease and the families of those who may have died because of the corona virus.

It’s a perplexing situation for sure, and there is already much to reflect upon. The pandemic is certainly changing my approach to many ordinary everyday activities that are normally taken for granted. Last Sunday, at church, we were told the advice from the Church of England was not to shake hands when wishing others ‘Peace.’ Instead we were asked to use the British Sign Language ‘Peace be with you’ signing, something I actually found to be more warming and sincere than the usual handshake.

Tuesday, I attended my six-monthly medication review – cholesterol level too high, blood pressure too high, weight good, weekly alcohol consumption verging on too many units, but most other things seemed to be normal. I was surprised at how quiet the GP practice actually was. I was only one of a few people sitting in the waiting room. I did notice however, that we had all chosen to sit as far away as possible from others. And everyone chose to use the hand sanitizers before and after entering the doctor’s room.

On Wednesday, I chaired the monthly Quality and Safety Committee at Wrightington, Wigan and Leigh (WWL) NHS Trust. It’s a regular meeting with a membership drawn from across the Trust. It was a packed room and just showed the difficulty of trying to maintain normal activities while attempting to also follow social distancing advice. Whilst there was lots of joking and good-humoured banter about what was happening, there was also a hard edge of deep uncertainty in the conversations over what we yet didn’t know might be coming in the future.  I did learn a new word though, ‘unbefriended’ and what a sad word it is. Here is an explanation, that for me at least, captures the poignancy of what might be meant by the term. It also made me think of all those folk in self-imposed Covid19 isolation, as well as others ill and alone for other reasons.

Thursday morning saw me sitting on the 05.23 morning train to Birmingham. There was only one other person in the carriage. I settled down with my breakfast sandwich, Kindle and all was well with the world. That was until the other person started to cough. My rational self told me it was that time of year where coughs and colds are still likely to happen. My Covid19 self told me otherwise. It was a dilemma. Should I get off at the next stop and return home. It was after all a workshop run by NHS Providers on ‘how to chair a meeting’, something I have been doing for many, many years. What could they tell me that I don’t already know, and of course there would be another workshop in the Autumn. It’s the kind of dilemma that I expect many folk have faced over the past week or so, and I’m sure many more people will face in the weeks to come.

In the end, probably swayed by a personal sense of invincibility (I am a man after all), I stayed on the train and caught another and much busier one and continued my journey to Birmingham. I got there 40 mins early. Rather than sitting in a coffee shop, I chose to walk around the city centre in an attempt to both not touch anything unnecessarily, or come into close contact with others. Clearly my sense of invincibility had melted away!

As I expected, the workshop content was much like similar sessions I had attended when undertaking my MBA all those years ago. However, the group work and case studies were very good. It was illuminating to hear how others had dealt with difficult colleagues, poor information in reports and all the other many issues involved in trying to chair effective meetings. As I left, I was pleased that I had taken the decision to attend. That was until Northern Rail decided to start cancelling its trains. I thought they had been taken over and the service was meant to improve. On a very cold, wet and windy platform at 20.00 hours it certainly didn't feel like it had.

Friday was a busy day too. First stop was to the car showroom. Now I have been buying cars from there for some 25 years and felt very much at home with the folk there. I had already ordered a new car, but was there as they had a different deal to discuss. There were none of the usual handshakes, just the bumping of elbows. The service waiting room was full, although some of the chairs had been removed to ensure there was a bigger space than normal between the remaining chairs.

After the test drive, I decided to go with the new car deal, and almost without thinking we shook hands on the deal. And then both of us realised what we had done. We did wash our hands straight away. Next it was off to meet our wedding photographer. We did so at a country pub. It’s amazing how aware one can quickly become to not touching surfaces. J went one further and drank her drink through a straw.

As the photographer left, our lunchtime guest arrived to join us for a meal. We chose our meals and opened up a bottle of wine and started to discuss our wedding plans. She is my Best Woman, and there was lots to be finalised. In the back of my mind, I was thinking about the wisdom of eating out, (it was a fairly busy pub) and eating food prepared by others, none of whom we could see, or knew anything about. It’s strange how quickly we can become so suspicious of even the most familiar of activities.   

And whilst I’m busy counting the days, it’s perhaps interesting to note that the world has been here before. During the great plague of 1665, Isaac Newton ‘self-isolated’ himself at his childhood home. It was said to be the most productive time of his life. Have a look here. He discovered calculus and of course the ‘laws of motion’. Back then, an apple a day really did keep the doctor away. So if you are on our wedding guest list, please go out and buy a couple of pounds of Cox’s and hopefully we will see you on the 18th!   

Women, equality, children, beer: An international celebration

We don’t disagree about much in our house. We share many of the same views on life, the universe and everything. We have a great division of labour. J goes out to work every day, and I’m happy to shop, cook, do the washing, make the beds, cleaning, gardening, look after her goats and turn the lights and hair straighteners off behind her. However, the one thing we do have a different view over, is the dishwasher. I cannot see the point of it, and considering there is only two of us in the house, it seems an unnecessary waste of energy. J disagrees and sees it as a vital bit of kitchen equipment.

However, and happily from her point of view, J is in great company. Josephine Cochran was born on the 8th March 1839, in Chicago, and is famous for inventing the first commercially successful automatic dishwater. And in strange twist of ‘place based’ thinking, she did so in her own garden shed. She was a great inventor and was granted a patent for her dishwasher in 1886, aged just 47 years old. Somewhat amusingly, the men she subsequently employed to help improve her dishwasher, all wanted to change her original design. The resulting ‘new’ dishwashers they built simply didn’t work.

As well as dishwasher inventors, the 8th March date is significant in other ways too. As 2020 is a Leap Year, this year it’s the 68th day of the year (and yes there are only 298 days left until the end of the year). And it doesn’t fall on a Sunday very often. In the 11 years I have been writing my blog it has only occurred in 2015 and then again, this year. Between now and 2050, it will only happen again in 2026, 2037, 2043 and 2048. For most folk this information probably doesn’t keep them up at night. However, for someone who writes a blog every Sunday, and who likes to reflect the zeitgeist, it’s a bit of a pain. More of which later.

Since 1911, the 8th March has been celebrated as International Women’s Day (#IWD) Back then, it attracted some one million people. These days, many millions more are involved in celebrating the social, economic, cultural and political achievements of women. Each year the celebration focuses on a theme. This year the theme is gender equality, and an equal world is an enabled world. The ask is for everyone to collectively, actively and consistently challenge stereotypes, fight bias, broaden perceptions, improve situations and celebrate women’s achievements. This year there is a brilliant symbolic way for folk to demonstrate their support. People can post their #IWD2020 message with their ‘hands out’ #EachforEqual pose. It’s brilliantly simple, and outstandingly powerful.

Interestingly there is not an equal gender split in the world’s population. Have a look at this fascinating live population site. As you will be able to see, there are marginally more men in the world than women. But it is the other statistics on the site I found almost memorising. The births, the deaths and the causes of death are really challenging. Each number change means that someone somewhere is either rejoicing or mourning a major change in their life. For me, at least, it was a sobering read.

For regular readers of this blog, you might recall that this time last year, my Sunday blog focused on pancakes, nurse leadership and women who had been there for me throughout my life. I borrowed the idea from that inspirational ‘running lady’ @KathEvens2 (a children’s nurse) who wrote, in support of her #IWD, a blog about some of the women who had inspired and supported her during her life. Further back, some 10 years ago, my Sunday blog (7th March) didn’t mention #IWD at all, but I did talk about Sarah Bell, another children’s nurse. She was in the news five years earlier as a campaigner for hunting. Her photo appeared on a poster showing her in full hunting gear with the caption ‘now they hate her’ whereas on the other side of the poster, she appeared wearing her nurses uniform with the caption ‘and now they love her’. 15 years on and the hunting ban remains in force, but I don’t know if Sarah Bell is still a children’s nurse. I hope she is.

In the UK, there are 51,783 children’s nurses currently on the Nursing and Midwifery Council (NMC) register. Many of these nurses will be affiliate members of the Royal College of Paediatrics and Child Health (RCPCH). Although primarily an organisation for doctors, the enlightened folk at RCPCH recognise and acknowledge that a multi-professional approach is required in order to provide high quality and comprehensive children’s health and wellbeing services.

And such services are desperately needed. Last week the RCPCH published their State of Child Health 2020 report. I have to say, it makes for depressing reading. The report notes that many of the recognised measures of children’s health and wellbeing have either stalled or are in reverse. Like the Marmot Review published two weeks previously, the RCPCH report notes that health outcomes are worse for those children who live in deprived areas. Shockingly, some 4.1 million children are now living in poverty in the UK. Whilst there are some positive signs, (teenage pregnancies have fallen; childhood obesity has risen up the policy ladder; and good progress has made in the treatment of conditions such as diabetes), the warnings published in the Lancet last year of the lack of progress being made since the State of Child Health report of 2017 have not been heeded.

If you haven’t already read the report, have a look here. However, like the population website, it does make for a very sobering and sad read. Whilst the report makes a number of well-presented recommendations, many of which look to the government for funding restoration and policy change, there are some useful ideas for practitioners as well: make every contact count, and make child health a joyful place to work, were two that caught my eye.  

And finally, something else that caught my eye about today. It’s also International Women’s Collaboration Brew Day (IWCBD). This delightful idea, has since 2014, brought together women who brew beer across the world, to brew a craft beer using the same recipe. Brewing is still a male dominated industry, although there are plenty of great women brewers around. Unite is the name of the shared beer, go online and see where your local brewery is and how to get some. I will be doing so, and raising a glass to J, the wonderful woman in my life. 

    

Death by Numbers: 23:59:60 (but it doesn’t have to be that way)

I have finally moved into the digital age and discovered podcasts.  Radio 4 is my thing and these days, (retired day that is) I have discovered that I can get to listen to my favourite Radio 4 programmes as and when I want. Of course, I habitually listen to the Archers, which for younger readers is a long running contemporary rural drama (and I secretly think that the Kate and Jakob romance has been based on mine and J’s relationship - you can decide which of us is Kate and Jakob). My many other favourites include: ‘More or Less’, ‘Women’s Hour’ (yes, I’m in touch with my feminine side), ‘All in the Mind’ and ‘Seriously’.

Now as many regular readers might know, I do like an explanation provided by numbers and one of the ‘Seriously’ episodes last week -‘Leap’ - provided me with my week’s numeric fix! It was produced and introduced by the delightful Eliza Lomas, and featured the performance artist Monster Chetwynd - apparently the first performance artist nominated for the Turner Prize (she didn’t win). To be absolutely honest, I’m not sure how Eliza managed to keep a straight face, as she engaged with Monster, ‘erm, Monster what do you think?’, but I’m probably stuck in my ways. That said, listen to the podcast, as it is both humorous and informative.

As you might think, there is a clue in the title as to what the focus of the programme was about – yes Leap Year, the 29th February. Leaving aside “Monster’s” somewhat bizarre push back on the sexist notion that it is the only day when a woman can propose marriage to a man, I was fascinated by the numbers behind each Leap Year.  Apparently, it takes our Earth approximately 365.242189 (or 365 days, 5 hours, 48 minutes, and 45 seconds) to circle once around the Sun. It’s those pesky extra numbers after the 365 days that cause all the problems. Without having an extra day once every four years, we would lose almost six hours every year. Thus, after just 100 years, a calendar without any leap years would be out by some 24 days in relation to fixed seasonal days such as the Spring and Winter Equinoxes.

Things become even more complicated when atomic clocks are used to measure the passage of time and we can easily find ourselves in the atom oscillations, universal time, leap seconds (to add or not), uneven rotations of the earth and changing lengths of each day. But let’s not go there. Most of us are content to measure time using more familiar points of reference: the alarm clock, train time, steps run, meals eaten, the amount of sleep enjoyed each night, marriage/divorce, birth and of course the ultimate measure, death. How we each fill our time will be different, and likely to change at various times of our life.

However, death will come for us all. According to The Marmot Review: 10 Years On, published last week, how soon that might happen is changing also. In the UK, we have enjoyed nearly a hundred years of increasing life expectancy. Now that situation has stalled and life expectancy is now reducing although the actual numbers of people dying continues to rise. It’s the ‘baby boomers’ who appear to be the problem, and yes I say that in the full knowledge that I’m one of these folk. More people than ever are being admitted to hospital in the year of their death than at any other time in their life.

Marmot focused on the social determinants of health and wellbeing. He noted that health inequalities reflected other societal inequalities. If you ask many student health professionals what causes cardiac disease, they might start with clogged arteries, caused by eating junk food, not taking exercise, smoking, stress and having too much alcohol each week. However, whether they would get to asking the question as to why people make these choices is another matter. And of course, it’s the social determinants that often make the difference.   

These start at birth, where and into what circumstance we are born, how we grow, where we live, work and our age all enhance or diminish our ability to flourish or not. This was something discussed at two meetings I attended last week. The first was our Annual Mortality Review. At this meeting, the year’s analysis of every week’s death audit is collated and presented. In particular, we look at deaths that might be avoidable. The national figure states that 3% of all deaths in hospital are avoidable. At Wrightington, Wigan and Leigh NHS Trust (@WWL) our avoidable deaths’ rate is 1.3%. We do lots to ensure the quality of care we provide is the best it can be, and yes given the ‘baby boomer’ challenge, we could do with more beds, but the reality is we need to build resilience in our communities. Which is where my second meeting came to the fore.

It was a ‘start the conversation’ type meeting, held in the magnificent surroundings of the Old Wigan Courts. Representatives from many different organisations came. We were asked to focus on how to develop our community wealth – the five principles of which are easy to put on a PowerPoint slide but can be more difficult to enact. The principals include: ensuring fair employment opportunities; harnessing the collective power of the collective financial resources inherent in integrated organisations; thinking locally about procurement approaches (how and where we spend our money); adopting a socially responsible approach to property ownership; developing shared approaches to local economic opportunities.

There was much sharing of what was already going on and an enthusiastic forward consideration of what might be possible – I left feeling both buoyed up with the possibilities, but also a little sad that I’m probably out of time when it comes to seeing this work come to fruition. However, one of my take home messages from the death audit was that men who get married live longer than those who remain single – J and I are getting married in April… …just saying…