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.