A Message in a Bottle to the NHS: Let’s get going!

Strange, but it’s true. In all my 65 years I have neither sent nor found one of those messages in a bottle that occasionally get washed up on the seashore. The closest I’ve come to this is in the old days when milk was delivered to the house. We would write the milk order on a piece of paper, roll it up, put it in the empty milk bottle and leave on the door step for the milkman – it was a simple way to communicate – ‘2 pints today please’. Given the concerns over sea pollution, I guess it’s very unlikely these days that I will ever find a message in a bottle that had been cast into the sea somewhere. I wonder what it might say if I did find one on the beach. I also wondered how I might respond if it was a cry for help or a request to contact the sender to let them know how far their bottle had travelled.

The importance of sending messages to others came up in several ways over the past few days. Last week we remembered the passing of Dr Kate Granger. She died on the 23rd July 2016 after a five year battle against cancer. She was an inspirational woman, who founded the very successful ‘my name is’ campaign. Her campaign encouraged health care staff to introduce themselves to their patients. Kate had the news of her incurable cancer communicated to her by someone she didn’t know and who didn’t introduce himself, and who without any warning told her ‘her cancer had spread’. Kate didn’t use bottles to get her message across, but the modern equivalent, Twitter. It was a simple message, #mynameis - but it was hugely effective, and the impact it had for patients and staff is her legacy.

When he was Secretary of State for Health and Social Care, Jeremy Hunt was a strong supporter of Kates work. Last Tuesday he chaired the Parliamentary Health Select Committee. You can watch the work of these committees as they are broadcast live. Last weeks session is well worth watching, you can do so here. The committee, through some very eminent ‘witnesses’, explored how the Covid-19 pandemic had been managed. You can judge for yourself, although many readers of this blog probably could guess at my thoughts.

One of the strong themes to come from the various witness accounts was the need for more effective communications. Many cited the mixed messages from government as being unhelpful in the way the pandemic had been managed. For example, think of the dithering there was over whether wearing face coverings was beneficial, and if so to whom, and where should we be wearing them. Indeed, the way in which the introduction of compulsory face coverings was communicated has left many folk confused about where and when they should be wearing a face covering. I have had several social media chats with folk who honestly believed the wearing of face coverings is advisory and not compulsory. Some people are simply defiant and are protesting (by not wearing a face covering), mainly on the basis of not wanting to be told what to do by the Government. Unbelievable, but probably partly due to poor messaging as to what and why wearing a face covering is a good thing. The message is quite simple: wear a mask and protect others, and stop the spread of the virus.  

Living with someone who is a communications expert, my attention is constantly drawn to examples of ineffective communication and messaging. Just last week it appears B&Q had put an apostrophe in the wrong place, and Salford City Council had got it completely wrong with their use of an apostrophe and shortening of words. And I won’t tell you how many times I get shouted at because of my poor use of the apostrophe. No, it has to be said, effective messaging is a skill. When I was a Dean of a School, I would steadfastly avoid blaming anyone for failing to achieve what I might have asked them to do. Their failure was ultimately my failure to communicate effectively. It was a simple approach and one that kept me alive to the fact that not everyone saw the world as I might have done.

The importance of keeping this thought in mind has been brilliantly set out in the recent NHS Leadership Academy’s guide: Compassionate Leadership in Crisis (that is their title, which perhaps suffers in meaning from a missing ‘a’). Don’t be put off by the simple messaging, it’s a guide for folk to use in reflecting on their own practice and approach.  It is worth a look. Also worth a read, although it’s a much longer document, is the Radix report Localise, Equalise, and Untick: The future of health care post Covid. It is my new ‘go-to’ reading for inspiration and reflection. Reading it last week, one of the things that struck a chord was the notion of why organisations like the NHS prefer numbers rather than words when conveying messages or seeking to give reassurance. Targets and key performance indicators feel objective when numbers are used. But as we saw in the daily Covid -19 briefings, using numbers to provide assurance and reassurance can often be even more unreliable than words.

And for many of us understanding what numbers might be telling us can be a difficult. Like many people I suspect, hearing that the founder and owner of Amazon, Jeff Bezos, already the worlds richest man, saw a £13 billion rise in his fortune last week probably didn't mean too much. Yes it’s a lot of money, but its difficult to comprehend just how much it is and what difference it makes. However, if you use both words and numbers and change the context slightly, a glimpse of understanding becomes possible. Think about how long a million seconds is. Its just over 11 days. I billion seconds is just over 31 years!

Now I think it will take more than 11 days (and I hope less than 34 years) to get the NHS back on track. The Radix report sets out some powerful messages as to how we might do this and think very differently about tackling the root causes of ill health across society in so doing. I might put a copy of the report into a bottle and send it to Matt Hancock to read and consider!

Ps: and don’t even get me started on the recent Brexit messaging of ‘Let's Get Going’ – I’m thinking New Zealand looks good, book me a ticket and let’s get going!

May reality kick in before your coffee does

Here are the absolute coffee facts you need to know. People in the UK drink some 70 million cups of coffee a year. Brazil is the world’s largest coffee producer, with Vietnam a close second. Coffee is traded on the world’s stock markets alongside oil, gold and other commodities. Coffee is by far the most popular drink in the world. And here is one I really like. According to the ancient myth, coffee was first discovered by goats in Ethiopia. However, I’m not a coffee aficionado. In fact, I barely, if ever drink coffee at all. I prefer tea (Yorkshire, of course) or hot Vimto.

I almost never frequent a coffee shop. Very occasionally, on my early morning trips to one of the NHS Trusts I work for, I’ve stopped off at a motorway coffee shop and bought myself a spiced chia tea latte. And even then, I have to steel myself to pay the exorbitant price tag. I simply don’t see what the attraction is of, what I think as being, a somewhat pretentious café culture, although many people do. In fact, four-fifths of people who visit coffee shops do so at least once a week, and indeed nearly 20% of those who frequent coffee shops do so daily. I would rather spend my money on a bottle of wine, although admittedly, drinking a glass of the red stuff at 6am is perhaps not an advisable thing to do!

I think perhaps I’m missing something. However, you can’t have failed to miss the fact that coffee shops have been in the news last week. One in particular seemed to get a lot of attention, Pret a Manger. Apparently, I can’t pronounce the name correctly (and I’m sure I’m not alone) and J, who speaks perfect French, tells me it means ‘ready to eat’. Apparently the first Pret a Manger was opened in 1986 in Victoria Street, London and quickly became known for its handmade natural food. These days, there is even a Veggie Pret shop – top of the best sellers is the Vegan Eggless (egg), Mayo and Cress baguette. Sounds delicious doesn’t it?

But I’m wandering off the point here. Pret a Manger was all over the news last week, as a lot of MPs appeared to like to frequent one close to the House of Commons and there were almost gleeful photos of different members of the current government buying their sandwiches and coffee, either wearing a face mask or not. You would think that given the current controversy over the need to wear masks that politicians would err on the side of common sense and put them on when out and about in public. Actually, I don’t know what the issue is. Wear a mask. It’s simple.

And last week, other bloggers were also on the case. Roy Lilley (no relation to the gilded Eli-Lilly family) pugnaciously rallied against what he described as the ‘BoJo Coffee-Shop-Ometer’. It was a very clever piece of writing. He explored the dangers of Boris exhorting folk to get back to work, and in so doing, keeping coffee shops open. His argument was that Boris is using the number of coffee shops kept open as a proxy metric of the government’s success in managing the pandemic. You can read it here. I also love Roy's three C’s advice, and please, really don’t forget to wear some clothes!

The reality is that for many folk, the thought of going back to what was once before is not something they really want to contemplate. The British Chambers of Commerce and the Institute of Directors last week both noted that people are very cautious about returning back to work. Such caution is perhaps understandable, and there are good reasons why it might be the case. Many people still fear for their safety, and many are still experiencing childcare problems. But there are also positive reasons as to why some folk might be reluctant to return to the way they worked before. People have not had to travel, saving time and money and many people have enjoyed a much better work/life balance. A recent Ipsos Mori survey suggested that almost 60% of folk didn’t want to go to a pub, bar or restaurant bar because they wouldn’t feel safe; with almost the same percentage not wanting to use public transport, use a public toilet or go somewhere where there were large crowds. It’s a dilemma for many different folk. Likewise, a Europe-wide survey carried out by the Willis Towers Watson organisations appears to suggest that such caution is a Europe-wide phenomenon. There is a lot of data presented in their report, but it is worth a read.

What does the data tell us? Well many people are moving to a place of acceptance that there really is a repositioned normal. Many people have discovered that they can operate differently. And that is not just those who normally work in office environments. GPs have found they can actually ‘see’ more patients by using digital technology. The same is true for those running outpatient clinics (the bane of many an NHS Trust). I, and I’m sure it’s true for many others, have grown to love (but possibly will come to loathe) Zoom and Teams as a way of communicating with others. But there are many other things that are changing too. People are doing extraordinary things.

This is one such thing that I liked in particular - last week, the Action on Smoking and Health (ASH) organisation reported the brilliant news that over a million people had given up smoking since the pandemic began. Of those, some 41% reported that they did so because of Covid-19. That is more people in any one year since 2007! Every single person who has stopped smoking will now enjoy a better quality of life and for many, their lifespan will be enhanced and extended. Every life saved as a consequence of not smoking matters. The scientific evidence over the relationship between smoking, poor health and premature death has been overwhelming and constant over many years.

I shan’t be going to a coffee shop any time soon, but if I were tempted to go, I shall be wearing a mask. Whilst the government is aiming for a return to ‘significant normality’ by Christmas, I’m not so sure there is such a thing. He may not run a coffee shop but, like many others, I will be content to heed the advice of Sir Patrick Vallance (UK Chief Scientific Advisor) and continue to work from home, maintain social distancing and stay alert. It’s a repositioned normal that will keep us all safe.

 

I read the news today, oh boy: what will we get, a re-organised or a re-positioned NHS?

There are some mornings that despite the wonder of a glorious sunrise, the singing of the birds and the smell of great coffee, there are still things that can immediately change your mood from happiness to despondency. Yesterday I opened my online newspapers and there, right on the first paper I looked at, was the news that Beano Boris was intent on reorganising the NHS. Apparently, Matt Hancock doesn’t feel he has enough power and is fed up with having ask to Sir Simon Stevens (NHS Chief Executive) to do things rather than simply ordering him to do so. Ah, poor lad. I can’t recall his predecessor, Jeremy Hunt, ever mentioning that he didn’t have enough power or control…

I’m not going to waste this blog posting on this issue, other than to say how many lives, careers, plans and ambitions will be negatively changed by any future NHS reorganisation. The NHS doesn’t need another reorganisation. Some changes to the prevailing legislation preventing integrated care services becoming legal entities would be the most helpful difference that might be made. Across the NHS, local effective integrated care partnerships and integrated care services have started to emerge. They have done so, not because anyone has ordered it, but because it the right thing to do, and people have put aside their differences and found ways to work together in new and exciting ways.

We have seen the consequences of the ‘command and control’ approach during the pandemic. Arguably, it was the right approach at the start of the pandemic, but continuing with it and even trying to strengthen the centralist way of working in the future is about as palatable as the notion of eating chlorinated chicken.

And I don’t want to waste this blog posting on that issue either, other than to say a big WELL DONE to Aldi, The Co-op, Sainsbury’s, M&S, Waitrose and Tesco who have all now said they will never sell chlorinated chicken or hormone-treated beef. Having been a long-time vegetarian, I would not have eaten them anyway. Image Adrian Dennis/PA.

Britain currently has strict food standards in place. However, as we leave the jurisdiction of the EU, the door is open to the UK accepting such products from the US as part of any post Brexit trade deal with Washington. Indeed, the Trump administration insist that free trade in all things agricultural is fundamental to any deal. The US National Chicken Council say that anything else would be unfair. Ah, poor them. What about the chickens?

Okay, what I really wanted to use this post for was to reflect on the Local Government Association’s recent publication: Re-Thinking Local. You can find the whole document here and I think it is worth a read. In some ways, it’s a setting out of the local government stall, ahead of what is expected to be the publication of the England DevolutionWhite Paper and more power and control being given to local councils. No date has been set for its publication. And despite Beano Boris saying last July ‘I do not believe that when the people of the United Kingdom voted to take back control, they did so in order for that control to be hoarded in Westminster. So, we are going to give greater powers to council leaders and communities’. That was of course, before he had a parliamentary majority of 80, and the arrival of Covid-19. Just saying.

Unlike central government, local councils have worked effectively with other local public services in meeting the challenges of the pandemic. They have proved that they are not there simply to deliver services or administer government grants, but to show effective leadership across the communities they serve. Local political leadership clearly works. It has brought together communities in a way not seen since the last World War. In maintaining many services during the pandemic, from refuge collection to caring for the most vulnerable in our communities, it has shattered the long-held (and well defended) myth that London, and Whitehall know best.

Sadly, the pandemic has also laid bare the many inequalities across local communities and populations. These are wide-ranging inequalities, and include inequalities of employment and financial security, educational achievement, health risks, quality and type of housing, and opportunities to prosper. The Office for National Statistics has highlighted the absolute link between the Covid-19 death rate and the deprived communities. In ‘building back better’, there is an opportunity for a rethink over so many areas of our everyday lives.

The Local Government Association document sets out what local councils can offer central government. It is not about power or control, but about partnerships, trust and knowing what works best at a local level. There cannot be a ‘one size fits all’ approach to dealing with deprivation. It’s about re-thinking what is possible, and re-thinking where resources should be made available. In the context of health and care, the approach should be about reshaping the health and wellbeing landscape, focusing upon prevention, and creating personal resilience and independence, rather than just treating illness. It is not about re-organising the NHS structures.

I’m of an age to remember many of the NHS reorganisations. Some had the desired outcomes; some were downright disastrous. All were hugely disruptive, expensive and most had several unintended consequences. The New Statesman carried an interesting article at the end of May this year, which captured well some of these consequences in the context of responding to the pandemic. Read it here. What it advocates, is a return to more local control of public health, integrated care services, and although sometimes choosing to use regional to mean local, provides a well-argued case for a re-positioned NHS rather than a re-organised one. For all our sakes, let’s hope that the Beano Boris health and social care taskforce have a New Statesman subscription.

N.B No chickens were chlorinated in the posting of this blog.

NHS Question Number 72: Should I buy a new birthday dress?

These days I seldom buy clothes. When I do, it’s very easy to do so. One of the great advantages of only wearing black, something I have done for more years than I can remember, is that clothes shopping is simple. My body hasn’t changed shape much over those years, so I know what shirt collar to buy (16), waist and trousers length (32, 29) and if I want a new suit, my chest is 42. Actually, it’s even more simple still. I tend to buy most of my clothes from M&S (yes, I know there are plenty of other clothes stores). I like their shirts, jeans, underwear, (who of my age doesn’t) jumpers, suits. So, it’s really simple. If I have the urge or need to buy a couple of new shirts; well it often takes longer to queue to pay, than it does to select them.

At a time where we are actively discouraged to browse and try clothes on, my approach really comes into its own. If I do order two shirts online, they will be delivered free to my front door; it’s that simple. However, for some folk, their retail experience is very different. As an example, take J and her approach. She will declare that she is desperate for some new clothes (simply because she has absolutely nothing to wear…) and off we set to fill a wardrobe we don’t yet own or have anywhere to put. Having nothing to wear obviously means something else other than any literal understanding of the phrase.

It won’t be just one shop we visit. It can be many. To the innocent bystander (reader that is me), what I observe is a casual wandering through racks of clothes, some of which are plucked off the rail, and almost instantly discarded. I have stopped offering examples of what I think would suit, but continue to respond honestly when it comes to the all important question of does my bum look big in this – if it does, I feel compelled to tell the truth. It’s simple; and it’s authentic. Trust me chaps, it’s the way to go. You can easily cook your own dinner, sofas are cosy to sleep on these days and if you can’t find any clean shirts, M&S do a great next day home delivery serve. OK, the last bit was obviously a bit tongue in cheek… …he says peering through what appears to be a dish of yesterday’s dinner leftovers that are strangely dripping down his face.  

Just in time for this blog, we embarked on one such shopping expedition last week. Arriving at our local high-street, we split up. Young J went to look at the clothes shop (yes, there is just one, and it’s called New Look), but we do live in an area of huge deprivation, and I went to do all the other shopping. Some 45 minutes later, I had done the week’s grocery shopping, ordered the winter logs, had a long look and discussion over a second hand 4x4, caught up on my emails, talked to an older lady who couldn’t remember what she had come in for (I have the same problem) and J was still wondering whether to buy a pair of jeans or not.

As I stood outside the shop wondering how much more of the millennium might be used up, the manageress (are we allowed to say that these days) came out of the shop and said it was okay for me to also go in, as J was still browsing. Reluctantly I entered and was immediately handed a pair of jeans to hold while J continued to look. The manageress explained to me that any clothes that customers touched had to be quarantined for 72 hours. There were quite a lot of clothes hanging on the quarantine rail. It seemed a strange way to have to do business, but at least they were still in business.

On the way back, I let my mind wander as it pondered that 72 hour figure. Before computers and super calculators were available, economists and mathematicians used the number 72 (Rule 72) to calculate how long it would take for a capital sum invested to double or halve in value. Using Section 5(2) of the Mental Health Act, a doctor can detain you in hospital for 72 hours. In the Bible, 72 was the number of languages spoken in the Tower of Babel. In degrees Fahrenheit, 72 is considered to be room temperature (although not in J’s opinion; it would need to be much higher). Those playing golf will know that the normal par for an 18 hole golf course is 72. All personal data breaches must be reported to the Information Commissioner’s Office within 72 hours. In Punjabi, it has a rather rude meaning, but you will have to look that up yourself. 

And of course, this weekend we celebrate 72 years of the National Health Service (NHS). Yesterday was a time of remembrance and reflection for all those health and care workers who have lost their lives to Covid-19 this year. There have been too many, and none will be forgotten. Staff across the NHS have gone the extra mile in dealing with the pandemic. Thousands of former (often retired) doctors and nurses and other healthcare workers returned to the NHS to help deal with the pandemic. It was also rightly important to recognise that there were other essential workers – the teachers, bus drivers, police and dustbin men (and women) to name but a few.*

For 10 weeks, every Thursday at 8pm, people up and down the land stood at their front doors and garden gates, and clapped, or banged saucepans and anything else that might make a noise in recognition and appreciation of all that those dealing with the pandemic had done for us. At 5pm today there will once again be an opportunity to say thank you to all those whose commitment, courage and sacrifice enabled us to fight the pandemic. #ThankYouTogether

Google maps tells me that it will take 72 minutes (I kid you not) to travel from my home on the Fylde Coast via the M61, to Trafford General Hospital (formerly Park Hospital). It was on the 5th July, that the NHS was launched at this hospital. It has not stopped working or caring for others since. If, in dealing with Covid-19, it’s felt at times like the NHS has been in quarantine, it is good to know that many are working hard at restoring all its many services. We may have to continue to do things differently, have our care provided in perhaps unfamiliar ways and places, but like J’s clothes shop, the NHS is still in business and may it be ever thus.     

*Picture Getty Images