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…