A big Boxing Day THANK YOU

It’s Boxing Day, and the year is rapidly coming to a close. In the nearly 12 years I have been writing and posting my blog on a Sunday, Boxing Day has only ever fallen on a Sunday once before, and that was in 2010. Strange. And yesterday was, of course, Christmas Day. I wonder what you did with the day. Some of you will have been working, looking after others, keeping us safe, keeping us warm, and for some, keeping us fed. If you were one of those folk, I want to say a big THANK YOU for being there for others in so many different ways. For J and I it was a quiet day, spent together, with Facetime and Zoom replacing family sitting around our Christmas table. For the second year running, Christmas plans have been disrupted, dreams left unfulfilled and people missed. As a consequence of the pandemic, some of those people will be missed forever. It has been a tough year once again for so many people.

This time last year I wrote in my blog that I hoped we could get the vaccination programme up and running asap. That hope came true and what a success the vaccination programme has been, in so many ways. A short while ago, I was privileged to go out with our School Nurses as they were vaccinating  12-15 year old children and young people. As I said at the time, it was compassionate care at its best. I was able to get both my initial jabs early on in the first wave of vaccinations and got my booster in early October. On a personal level it was a huge relief and I have become increasingly evangelical about encouraging others to get themselves vaccinated.   

I think we will be on a repeat vaccination programme for a few years to come – rather like the annual flu vaccination programme. Indeed, Israel and Germany have both approved a 4th ‘offensive booster’, to be given some 4 months after the original booster jab. The UK is still considering the data, or prevaricating as I prefer to think of it.

The present system of robbing Peter to pay Paul to carry out the vaccinations is not sustainable in the longer term, however. We need to develop an independent vaccination professional. A group of people ready and able to vaccinate on a rolling basis. That said, here is another big THANK YOU to all the current health and social care professionals, the army of volunteers, and the armed forces too, who have made it possible to get so many of us vaccinated. It is not the politicians we should thank for getting us this far, but folk like many of my readers who have gone above and beyond their normal work to get us vaccinated. And I’m willing to bet that many had to forgo the cheese and wine at the end of what would have been many a gruelling day.

Yesterday afternoon, after spending what was a non-gruelling Christmas Day, as J and I were nibbling away at the cheese, and sipping mulled wine, she asked me what my New Year’s resolutions were going to be. I didn’t really have an answer, so I looked back at my ‘end of year blog’ in 2020. 

There I found, not resolutions, but four ambitions for the year. I wanted to: (1) help improve the health and health outcomes for our communities (2) find ways to help reduce health inequalities (3) enhance the productivity of our health and care organisations (4) develop a stronger and more coherent partnership placed-based approach to how care is delivered.

When I wrote those words, I was a Non-Executive Director at Blackpool Teaching Hospitals, and Vice-Chair at Wrightington, Wigan and Leigh Teaching Hospitals. In both communities, I had lots to go at. Little did I know then that I would have a different opportunity to take these ambitions forward. Very unpredictably, I was approached by a head-hunter company to see if I might be interested in a Chair’s position at Stockport NHS Foundation Trust. The hospital is 60 miles away, or a 90-minute car journey. It wasn’t something I had thought about, but I was intrigued to find out more. Long story short, I put my hat in the ring and was really pleasantly surprised to be offered the post. I started on the 1st May, and the last 7 months have been amazing!

Of course, I have been very fortunate to be working with a great team of Executive and Non-Executive Directors and many of the folk I have met in both clinical and support services have been simply inspirational. Those ambitions, well now I have a fabulous team of people to work towards them with, and to do so with some brilliant partners. There are so many challenges to address, but in so doing, I have found it’s possible to create unlimited opportunities to make a difference every day.

So, 2021 might have been a difficult year for many of us, but there were glimmers, green shoots of hope for us to see. Last week I heard of one such ray of hope. It came from last week’s Wednesday’s BBC Woman’s Hour. I was on my way to deliver the last of our Christmas gifts to some of our family. It was a long journey, but made very bearable by listening to the absolutely delightful Susie Dent. If you need to get someone a birthday present this year, buy her book, Word Perfect; it is simply delightful. As well as being the TV show Countdown’s resident lexicographer, Susie is an accomplished etymologist and author, who knows the meaning of so many unusual words, which she shares with great humour. Right at the end, the Woman’s Hour presenter, Emma Barnett (an equally brilliant entertainer) asked Susie what word might describe how she herself was feeling that day. Susie’s word was ‘respair’. It is a 16th- century term meaning fresh hope, and a recovery from despair. She ‘discovered’ it in 2020, but in her words, ‘we need as much respair as we can get right now’.

Next week’s blog will be the first of 2022 – I want to say a final big THANK YOU to all those folk who week-on-week read my blog. Your kindness and support are much appreciated.  

Together, we can make the world a better place.

I wonder what you think about zoos? They are a little like Marmite, you either like them or not, or maybe they simply don’t feature in your life at all. Some folk absolutely can’t accept keeping wild animals in captivity, however realistic and spacious their enclosures and surroundings are. I have to say I like zoos and we are fortunate to live very near a good one. If the wind’s blowing in the right direction, we can even hear the lions roar in the evening. Both J and I are zoo members which means we can visit whenever we like. This can be a real bonus during school holidays so as to avoid the noise and bustle of families with little children.

My favourite animals to visit at the zoo are the giraffes. They are elegant, beautiful and they fill me with wonder. They are remarkable in many ways. They average only about two hours sleep each day, usually taking no longer than 10 minute naps at a time. They are vegetarians. They have big hearts, so as to be able to pump blood up their long necks to the brain. Those long necks have the same number of bones as human ones do. 

To my mind they are truly wonderful creatures. In their enclosure at the zoo, you can stand on a walkway that is level with their heads, which means you get a very unique view of each animal. You also realise that they are very powerful animals and can do a lot of damage to each other when fighting. Fortunately, this isn’t very often and giraffes like nothing more than to be surrounded by other giraffes. But this isn’t really a blog about giraffes, although in a way it is.

Last week I saw a picture that stunned, shocked and saddened me in equal measure. It was an aerial photo of six dead giraffes lying in a spiral shape. They had died of starvation and a lack of water. Giraffes drink remarkably little water, getting most of the fluid they need from the plants they eat. The picture was taken in the Saluli wildlife conservation park in North Eastern Kenya. The country, like many others in Africa, has been in the grip of one of the severest droughts in decades. It is estimated that 2.1 million Kenyans are facing starvation due to the severity of the drought. Last Tuesday, the United Nations said that nearly 3 million people were in urgent need of humanitarian assistance.

It makes our supply chain and food distribution worries here in the UK seem rather trivial. However, that said, whilst our food security issues are completely different to those in Kenya, we should also remember that over 2.5 million people in the UK are regular users of food banks. It’s a situation that is likely to only get worse. The Independent Food Aid Network (IFAN) recently reported that the Covid19 pandemic has forced tens of thousands of people to start using food banks for the first time. As we start the second Winter of the pandemic, with a new, even more infectious variant to boot, things are set to get much worse for more people. The loss of the £20 Universal Credit uplift, the ending of the furlough scheme and increases in fuel and food cost will just add many more folk to the numbers of people facing very difficult choices over what to spend their money on. IFAN coordinator, Sabine Goodwin, set out these stark choices in an article in the British Medical Journal last August – see here. It does not make for easy reading.

It’s clear that the pandemic has and continues to have an impact on all our lives. The UK population is 67 million people. Kenya has just under 57 million people. There have been 260,000 cases and 5,353 deaths from Covid in Kenya; here in the UK there have been 11 million cases and 147,000 deaths. The UK and Kenya are 4476.5 miles apart, but we share similar challenges albeit for different reasons. It is an example that reminds us that, whether it’s a threat brought about by natural causes or disease, no one country is likely to be able to deal with the consequences for their people alone. As a global community, we must find ways of using our creativity, inventiveness, money and other resources to make a better world for everyone.

I can’t leave this blog without sharing a story of some happy times I spent out in Kenya. I have been several times to work with Kenyan nurses wishing to increase their academic qualifications. It was part of a programme run by the University of Dundee. One trip coincided with my birthday. I decided I would buy the students a small gift, and I chose to give them bags of Uncle Joe’s mint balls. I can’t remember why, other than there was a story to tell about the sweets, and it was easy to pack dozens of packets in my suitcase. Unbeknown to me, one of the local students went home and baked a birthday cake, which at the end of the day they arranged for the local chief nurse to present to me. It was a moment I would never forget. Here was a community that had very little, but still found a way to give so much. It was a humbling but happiness filled occasion.

Finally, as much as I like going to our zoo and getting up close and personal with the animals, it is not as good as going out on a safari, in an open-sided Landrover, complete with a rifle toting guide and seeing the same animals in their natural habitat. Now that was a real privilege, added to by having the opportunity to do so with my nursing colleagues in Kenya, and yes, I did get to see giraffes there too.

Story telling at the proverbial cheese and wine party

Over the 12 years I have been writing my weekly blog, people have often asked me how, when and why do I write the blog? The why is easy. I write it primarily to keep my mind active and because I cherish the opportunity of having a voice. When do I write it? Usually, I write a rough draft on Saturday evening. I do it then, so that J can check for any unintended consequences of my dyslexia, as my thoughts get transposed into words. The final version is written at 4.30am each Sunday morning, and posted at 5am. How do I write it? Well during the week I collect and save words and phrases that I have heard or read, or even pictures which, in the moment, resonate. On the Saturday evening, I look at these and try and weave a story using some of them, and that story eventually becomes my blog. If I get stuck, I go for a walk and let my mind bring a story together. It usually works.

Last weeks list of words and phrases included: John Lennon, BoJoCop, Belarus, future generations, pandemic babies, wilful blindness, Christmas, Sophie Howe, booster jabs and Abigail’s Party. The 8th December was the 42nd anniversary of John Lennon’s death. Whilst I was always a Rolling Stones fan and didn’t particularly like the Beatles music, John Lennon was a hero of mine in my youth. I thought he gave so much more to us than simply a few good songs and tunes. In 1971 he wrote the beautiful and somewhat haunting song ‘Imagine’. Take a listen to it here.

It is a song about hope, freedom and peace in the world. It describes the possibility of seeing difference as something that might be celebrated and bring people together, rather than result in war or conflict. All these years later, his words seem so appropriate as many of us watch with trepidation what is going on in Belarus, the Ukraine, Russia, North Korea, China and Syria. There is the threat of, or actual conflict in many of these parts of the world. There is great suffering, fear and trauma too; most of which is the result of the inability of many to embrace difference (of all sorts) and to see diversity as a positive attribute.

Of course, for many of these people, their suffering, want, fear and trauma is overlaid by the continuing Covid pandemic. We don’t know enough about the new variant, Omicron, but we are witnessing an exponential rise in community infection rates. This should make us pause and take stock. Yesterday we were told that the Astra Zeneca vaccine might not be as helpful in protecting even double jabbed individuals, so wherever possible, and whenever possible, folk should get their booster jabs. We also saw the reintroduction of some Covid restrictions, including compulsory mask wearing in most public places and venues. 

It was good to see our somewhat hapless Prime Minister finally remembering to wear a mask, as he paraded around in his BoJoCop outfit. It was part of what should have been a week that focused on tackling drug misuse and the crime that is often associated with it. Sadly, this important and long overdue initiative and funding was largely overshadowed by the outrage following the disclosure that last year, during a period of lockdown, members of his team, ministers and so on were having a Christmas party, which appeared to include games and cheese and wine. While thousands of millions of us obeyed the rules, even where this might have meant we couldn’t be with loved one as they were dying, it seems our politicians and their teams were flaunting the rules. Trust in the government has been damaged, and probably even more so than that Dominic Cummings road trip to get his eyes tested did. We are already seeing reports that suggest high numbers of the general public are unlikely to comply with the new restrictions – a situation that will not only lead to avoidable conflict, but a real risk that our NHS will be in greater difficulty than that faced before the first lockdown.

I guess the one moment of happiness Mr Johnson would have experienced last week was the birth of his new daughter. I am certain that would have brought great joy to him and his family. Last week I also came across the term ‘pandemic babies’. It came up in a webinar conversation with the totally inspirational Sophie Howe. The term refers to the growing evidence that many of the children born during the last two years are showing signs of poorer development of their social skills.  A possible consequence of limited social interaction children might have experienced during the pandemic.

The conversation with Sophie Howe was an exploration of her work as the world’s first, and only, Future Generations Commissioner. I don’t have room in this blog to describe the conversation in detail, but I urge you to take a look at the Commission’s work here. What has been achieved is simply fantastic. Specifically, her work in health has been limited due to the pandemic but even so, she has achieved a great deal in addressing the social determinants of health and wellbeing. We could learn a great deal from this experience as the English health and social care system begins to develop placed-based services. A sense of community makes a 19% difference to our life expectancy. The difference health services make is just 10%. In England, Lord Bird (of Big Issue fame) is currently taking a Private Members’ Bill, the Wellbeing of Future Generations, through the House of Lords. I hope he succeeds.

Abagail’s Party? Well, you have to be of a certain age to remember this TV film. It came out in 1977, and was a play about a drinks party, the original cheese and wine party, which takes the viewer through the sometimes excruciating suburban approach to ‘good manners’. Covid restrictions permitting, J and I will be hosting our own ‘cheese and wine (and gin and beer) party’ next week. And so, this week’s story ends. Until next time, stay safe.

Eyes Wide Open - wearing a mask will enhance your life chances

I wonder what in your life you might be passionate about dear reader. I know some of my readers are passionate about their running, others about their garden, and one who is passionate about knitting and helping seafarers in trouble. I know of one reader who is passionate about her cat, another about ensuring no harm comes to patients in the future. I have another reader who is passionate about musical instruments and has a house full of extraordinary instruments of all sorts. 

Regular readers of this blog will know that among other things, I am passionate about chickens and have been for many years. My (now ‘our’) chicken collection runs into thousands of pieces and of course we also have 21 real chickens free ranging outside in our back garden.

Some passions come and go. At one time I was passionate about travelling the world, and have been fortunate to have been able to do so for many years. Now I have no interest at all in travelling, much to J’s disappointment. I was once passionate about doing research, and whilst I still have an avid interest in the outcomes of research, and the evidence base this creates, I am no longer passionate about the ‘doing’ of research myself. However, last week I met some researchers who were absolutely passionate about what they were doing with a number of clinical research programmes. The person leading the research team was Wiesia Woodyatt who has been working on a number of Covid-related clinical trials, and this work had made a significant contribution to the development of new Covid vaccines. This is important work; it is collaborative working too. It is work that recognises the effectiveness the Stockport NHS FT research team has in consistently recruiting participants to clinical trials, thereby ensuring great validity is achieved across the research programmes.

Such research is necessary. Across the world, the Covid virus is still infecting 50 million people every 90 days due to the high transmission rates of the Delta variant. Now we have a new variant, Omicron. We don’t yet know what impact that will have on our lives, but it is important that we continue to take care and perhaps get back to thinking as we did in the early days of the pandemic. Whilst vaccinations are the most effective action to take in keeping each other safe, wearing a mask is the single most effective other health measure we can take. Don’t just take my word for it. A systematic review, published in late October this year found that mask-wearing was the single measure linked to effectively reducing the incidence of community infection rates.

So, like me, I guess you may have been dismayed at a couple of the stories in the media that seemed to go against this advice. Our PM still wanders around crowded places (including hospitals) without wearing a mask. Indeed, the House of Commons have stated that MPs don’t need to wear a mask when they are in the chamber, something we can witness through the live TV coverage of each parliamentary sitting. It’s easy fodder for Covid conspiracy theorists. At least our Secretary of State for Health and Social Care upholds the guidance to wear a mask in places where you might be in close contact with others.

The other story to catch my attention was that of pupils at Abbey School (Kent) who had been asked to leave the classroom, because they wanted to wear a face mask while in class. These are 12 – 15 year olds who have an acute sense of the need not only to protect themselves, but also to protect those around them. I know the other week when I met a similar group of young people receiving their first Covid jab, they could clearly articulate the need to get the vaccination and maintain the other health promotion advice around space, hand washing, mask wearing and ventilation. They were passionate in articulating the need for everyone, young and old to keep taking these precautions.

I found it strange that a school that advocates a culture of ‘politeness, courtesy and respect’ should be so inflexible in its approach. I liked how they wanted to pupils to demonstrate these values, including the children and young people sitting up straight, listening, remembering basic manners, talking in full sentences (what a great idea) and greeting each other and asking if folk were having a good day. The given reason that they were sent to detention for wearing masks in the classroom was that masks are a ‘barrier to learning’. Now, I’m passionate about lifelong learning. I’m aged 66, 6 months and 24 days (yes, every new day is a blessing) and I learn something new each and every day. As a NHS Trust we have been running a Board Development programme since May 2021, with each session being face to face, socially-distanced and where mask-wearing has been the norm. I have learnt a great deal at each session, as I believe my fellow Board colleagues have too.

Likewise, I have successfully supervised many PhD students who have come to sessions wearing a niqab, and the University School at which I was Dean, recognised many years ago that face coverings were neither a barrier to learning nor successful therapeutic relationships. I might be accused of being too passionate about the wearing of masks in public and crowded environments, but I don’t apologise for being so. Last week I talked to a doctor colleague who had spent much of the day with her team in theatre, wearing masks and performing life changing and life saving surgery. If she could do that for others day after day, the least we can do when out and about, shopping, travelling on a bus or whatever, is to put a mask on. Let’s all become passionate about this folks. I ask this not in the Stanley Kubrick sense of ‘Eyes Wide Shut’ mask wearing, but I do ask it in with same amount of passion shown in the film. If we don’t, we might not enjoy the Christmas we hoped for.

Here is a big THANK YOU for all those folk, day after day, who wearing their masks, deliver services that keep us safe, well, fed, and warm, slowly returning us to a new normal where we are able to once again indulge in each of our individual passions unhindered by pandemic restrictions.

How much do we value our Nurses?

Last week, I valued every spare moment I had. Among many other things I was decorating our bedroom, a process that through the lack of time, was becoming rather drawn out. I had promised J we would have a new bedroom by Christmas. We had bought a new bed, wardrobes, dressing table and so on, all stored in another bedroom waiting for our bedroom to be decorated! So there was no escape. Over the last few weeks, I have stripped wallpaper, filled cracks, painted walls, wallpapered and had the floorboards sanded and renovated, and I’ve now been able to varnish them. All in all it has been a successful transformation. However, if you had been in our house last Wednesday, you might not have thought so. I had jumped out of bed, seen J off to work, and had spent a couple of hours sanding down the walls. I was covered in dust, and my hair was like straw.

No worries I thought, a quick shower and I would be ready for my mid-morning Teams meeting. I hadn’t bargained on United Utilities turning the water off so they could mend a leak. They did send me a text to say they were working on fixing the leak and they were going as fast as possible. No water, no shower so there I was thinking I might have to pretend my camera wasn’t working at my meeting. I needn’t have worried as Telenet, fixing new cables outside on the street, also then managed to cut off my internet supply. Yes, it was turning into one of those days.

Most of us take for granted those things we always think will be there day in and day out. We turn on the tap and expect water to flow, every time. Increasingly we take for granted that our technology will work each and every time. There are many things we fail to realise the true value of until they are missing from our lives. That is when we realise how important something is. But it is not just tangible things like water and technology that we might value. Other less tangible things can be valued too.

It takes noise to value silence, sadness to value happiness, and absence to value presence. We might never actually know the value of a moment until that moment becomes a memory. Likewise, we might not know the value of someone until we see the gap they leave behind when they are no longer part of our lives. I think this will have been something many folk will have experienced during the last 20 months of the pandemic.  

If I had valued my time a little more, I might have got in a decorator, paid the bill and moved back into our bedroom a lot sooner. However, as well as time, there was something else I valued, the satisfaction of doing all the work myself, even when, as in the wallpapering, it was something I had never done before. Values, themselves, can shape the way we live our lives. Many healthcare organisations will publish a set of values on their website, but I do sometimes wonder how many people, both collectively and individually, actually live those by those values.

Last week, I was very pleased to see someone, who believed in the value of something, actually taking some action. Dawn Butler, a Labour MP, spoke to her amendment to the Health and Social Care Bill currently going through parliament. It was aimed at protecting the nurse title in UK law. She wanted the law changed so that no one is able to ‘practice’ or ‘carry out business’ under the nurse title unless registered with the Nurse and Midwifery Council (NMC). Sadly, the amendment was not passed, MPs voted 304 to 240 against the motion. With so much professional and public support, it is hard to understand why.

Edward Argar, a Conservative Minister for Health, claimed that the amendment was flawed and didn’t address some fundamental challenges, such as the title ‘nurse’ being used by other professionals working in other areas, such as dental nurse, or veterinary nurse. To my mind this a rather spurious argument to make. Readers of this blog will, I’m sure, remember the case of Ian Levey, one of the new Conservative MPs of 2019, claiming to be a nurse during his election campaign, when in fact he was a healthcare assistant. There have been many others who have traded on the title ‘nurse’ for their own gain. In so doing, they undermine the trust the wider public has of what ‘being a nurse’ implies in terms of safety, qualifications and knowledge.

Although I’m no longer practising as a registered nurse, I am proud to be a nurse still. It is a part of my life that I value highly. I still retain the knowledge I gained as a nurse, and might still know what to do in certain healthcare-related situations. What I wouldn’t do is use such knowledge and skills while claiming to be a nurse. Likewise, when I take my dog to the vets and the receptionist says, ‘the nurse will see you now’, I don’t think I’m in the presence of someone who might be qualified to meet my health needs.    

I hope that Edward Argar’s public promise to keep the intent of the amendment under review holds true. Valuing our nurses goes beyond rainbows and clapping. The title should be protected in law, and I’m sure that those campaigning to make sure it is will continue to fight until it is. 

These are the hands that care

I have written in previous blogs, and in many papers and conference presentations, of the importance of touch in therapeutic relationships. It can be a difficult subject to talk about against the Me Too context. However, last week I saw some brilliant examples of how touch was being used effectively and appropriately in therapeutic relationships. These relationships were very brief, and could be measured in minutes, not sessions, days or weeks. I was with our School Nurses, who were running Covid-19 vaccination clinics in schools for 12 -15 year olds.

The programme was highly ambitious, a potential logistical nightmare to organise, but a great example of how to do collaborative partnership working well. Thanks go to Jen Connolly (Director of Public Health, Stockport), Ben Fryer (Consultant in Public Health) and Anita Rolfe (Stockport CCG) who worked with Fran Jackson, our Service Lead for School Nursing at Stockport NHS Foundation Trust, to help make the programme a success. There were 17,000 eligible 12-15 year old's across the area and over the 7 weeks of the programme, some 6,612 children have received their Covid jab.  There was a ‘day on day’ increase of children and young people taking the opportunity to get vaccinated, and all those who did so, were informed and eager to get protected. Of course, when I spoke with the children after they had been jabbed, any anxiety had melted away and they were mainly nonchalant, said it was no big deal, and they were just glad they were now protected.

These important vaccinations contributed to over 500,000 Covid jabs being given in Stockport over the past 12 months – a tremendous achievement.

The vaccination hub I visited was in the school hall of Marple Hall School; a school whose ambition is to become ‘the most successful School in the country’. I think they are likely to succeed too. Joe Barker, the Head Teacher seemed to be remarkably buoyant and enthusiastic, which given the school has some 5,500 pupils, is probably testament to his professionalism and approach. He also writes a weekly blog, which is something in others I greatly admire.

The school is situated behind a high fence, and like many others, had a locked electronic gate to get through. A kind receptionist rescued me, and after signing in, I was able to join the session. Given there were 30 or so children in the room, there wasn’t as much noise as I thought there might be. Everything was ordered and well thought through. I was able to first meet some of the team, and it was quite a large and assorted one too. There were a group of very cheerful folk from the local authority Covid Advice and Testing Team, who were busy inputting all the immunisations onto the national system; there was a lady from Everest Pharmacy, who drew up the vaccines used during each session; two lead nurses, (Fran being one of these); two colleagues who supported the programme logistics, planning each session and then managing each session’s administration, and then there were the immunisers themselves.

What a team! I was able to speak with them all, both about what they did in their day job and how they had experienced the vaccination programme. I have to say I was amazed at the scope of their professional practice. They all ran community clinics and school-based clinics for the HPV vaccination programme, undertook health assessments, were part of safeguarding committees and ran health clinics offering support and advice to young people regarding lifestyle choices, self-harm, depression, relationships, weight issues, sexual health, and a couple which I thought were a sign of the times, smoking cessation and gender identity. Each School Nurse had a case load of about 2,500 children and young people, and the scope of their clinical practice was enormous.

I did like the description they gave of the sessions they ran on relationships and sex education, which again covered very contemporary issues around consent, sexual abuse, sexting, contraception, all of which the children preferred hearing from the School Nurses rather than their teachers! In the vaccination session, it was clear that the children and young people were very relaxed and accepting of the School Nurses. I watched a number of the children getting their vaccinations. I was struck by the gentleness and kindness of the nurses. Each child was treated like they were only one that mattered in that moment. Some children were obviously anxious and I saw hands been held, a hug being given, a pause for a word or two of encouragement. It was compassionate care at its finest.

As I have reflected upon this experience, I was reminded of the fabulous book, published last year, called ‘These are the Hands’ – if you have not had a chance to read it, please take a look. It contains the poem Michael Rosen wrote to celebrate the 60th birthday of the NHS. I sure all those readers who have children, grandchildren, or younger siblings will have read his work. Most of my grandchildren still love his book, ‘We’re going on a bear hunt’. Thinking about the School Nurses, I thought it appropriate to reproduce his poem here (albeit it takes me over my self-imposed word limit) as for me it captures more eloquently than I could ever aspire to, the work of so many who continue to make our NHS a place of great care.

These are the Hands

These are the hands
That touch us first
Feel your head
Find the pulse
And make your bed
 
These are the hands
That tap your back
Test the skin
Hold your arm
Wheel the bin
Change the bulb
Fix the drip
Pour the jug
Replace your hip
 
These are the hands
That fill the bath
Mop the floor
Flick the switch
Soothe the sore
Burn the swabs
Give us a jab
Throw out sharps
Design the lab
 
And these are the hands
That stop the leaks
Empty the pan
Wipe the pipes
Carry the can
Clamp the veins
Make the cast
Log the dose
And touch us last

Lest we forget.

Where were you at 11am last Thursday, 11th November 2021? I was in our hospital chapel. It’s a simple place, stripped down to the bare essentials for worship. One wall has some coloured glass panels, a nod in the direction perhaps of the more traditional stained glass windows of older churches. The altar and pulpit were made of oak, with the minimum of decoration. There are no pews, just stackable chairs, which on Thursday were arranged to ensure social distancing was possible. All in all, it is an unpretentious space. But in the maelstrom of a busy acute hospital, it is also an oasis of calm, peacefulness and hope.  

I was there to take part in our Remembrance Service. I had been asked to read the now famous poem ‘The Fields of Flanders’. It was a real privilege to be able to do so. It was in the Spring of 1915, that a Canadian doctor called John McCrae wrote the poem after seeing poppies growing in the battle-scarred landscape of Ypres, in Belgium. This small town saw the first time chemical warfare used in conflict, so also maintains a close relationship with Hiroshima, a place where nuclear warfare was first used. It was one of the places where the British and German forces unofficially stopped fighting to celebrate Christmas - the so called ‘Christmas Truce’.

Today the poppy is a symbol of remembrance and hope, including hope for a positive future and a peaceful world. The poppy is a symbol of support for the Armed Forces community, both those who have served and who may no longer be with us, as well as those folk who continue to protect us and keep us safe.

Reading the short poem was a humbling experience for me. It made me feel connected to a place, a time, a conflict that I have no knowledge of. My parents, although affected by the last World War, were too young to have fought in it. I have never experienced the horrors of war. The nearest I have got to knowing anyone in the Armed Forces is our young sea cadet animal sitter who wants to train as a doctor in the Navy when she is able. Yet, last Thursday, standing in that small stark chapel, I felt a huge sense of connection.

I’m sure many of us will today too. It is Remembrance Sunday. It is different from Remembrance Day. November 11th is Remembrance Day or Armistice Day to give it its proper name - the day in 1918 that Germany and the Allies agreed to stop fighting on land, sea and air in the first World War. Remembrance Sunday, which is always held on the second Sunday of November, is a time to pay tribute to all those who fought in both the World Wars and other conflicts around the world. The last time that Remembrance Day and Remembrance Sunday fell on the same day was 2018, and it won’t occur again until 2029. This year maybe the last year that our Queen can actively participate in the Remembrance service. I hope not.

Last Thursday, I was joined by patients and colleagues in that small chapel and by many more folk who participated online, as the service was livestreamed. Then, after this brief pause and act of remembrance, it was back to meeting the needs of our patients, their relatives and the communities they came from. Thankfully we are not in a world war any longer, but we are joined in the fight to deal with Covid19. Last Thursday, 151 people died from Covid in the UK. Since the start of the pandemic, some 143,000 people in the UK have died from the virus. Of course, whilst this number of deaths cannot compare to the estimated 22 million deaths of the first Word War, every life is precious and every person who has died from Covid was someone’s daughter, son, husband, wife, mother, father, brother or sister.  

Of those 22 million people who died during the first World War, several millions of soldiers died from the flu pandemic that was also raging at the time. The earliest case of what became known as the ‘Spanish Flu’ was in March 1918, in the US. By April of that year, it had spread to Europe and the UK. It was one of the deadliest pandemics in human history. It is estimated that during the two years of the pandemic 17 to 50 million people died from the flu. As of this morning, 5,110,862 people worldwide have died of Covid. Strangely, Spanish Flu disproportionately killed more young people than older adults. Hypercytokinemia was thought to be largely the cause, but why this was is not fully understood, although poor infection prevention and control measures were often the norm at this time, and that may have been a major contributor to the high numbers of deaths.

Back in the present, our hospital has suspended patient visiting once again. This is due to a couple of Covid outbreaks occurring. While folk coming onto the site won’t be the only cause of these outbreaks, we do know that at least 1 in 5 people have Covid, but are completely free of any symptoms. Without strict adherence to frequent hand washing, social distancing, good ventilation and mask wearing, these unknown Covid carriers will continue to unwittingly spread infection. While vaccination remains the best defence against Covid, as we have seen in recent media reports, many people still refuse to get vaccinated. Sadly, this also includes many colleagues working in health and social care services.

I say sadly, because as today we remember all those who gave so much for the rest of us, and all those still serving in the Armed Forces today, we should also remember the more than 1,500 NHS staff who have so far died as a direct consequence of catching Covid. To me that is an immensely sad fact. I make no apologies for this blog being a bit of a history lesson. Sometimes it’s important to actively remember through the retelling of stories. So, like all those who lost their lives through conflict, let us not forget those who lost their lives trying to help those many people who, in their time of most need, turned to the NHS for help.  

Kindness Matters, It Really Does!

You know things are going seriously wrong in the world when the newspapers start reporting on their front pages that we are facing a shortage of fake tan lotion. I have scrubbed the bath too many times after the children have used it, and fake tan is now banned from the house. With all that has been going on last week in Glasgow and Westminster, why anyone should be worried about getting a bottle of fake tan is beyond me. However, having attended a ‘kindness matters’ workshop last Monday, I shall use the lessons learnt and simply say that each to their own when it comes to fake tanning. It was a great workshop, more of which later. First of all, what would you choose to do if you knew you only had 10 minutes to live?

It's not such a strange question as it might sound. Back in my younger days, and I am talking many years before Extinction Rebellion, Insulate UK and Cop26, I was a fully paid up supporter of Greenpeace, and an advocate of banning the bomb. As a schoolboy I sat in class and endlessly drew the CND symbol and the ‘make love not war’ slogan instead of paying attention to whatever the teacher was saying. My great act of protest was not standing naked outside 10 Downing Street, no it was much worse. I wore my enamel rainbow warrior Greenpeace badge to Buckingham Palace the day my Dad got his MBE. We were a generation that feared the Soviet Union sending over a nuclear missile and annihilating us all. We were told we would have just 10 minutes warning* of the incoming missile. So, what would you do?

There was the old joke of course, you could have sex, but what would you do for the remaining 7 minutes? Me. I would probably enjoy a large glass of whisky. Then again there is always the advice from Raymond Briggs in his 1982 book ‘When the wind blows’ which explored the impact of a nuclear strike on the retired couple, Hilda and Jim. It’s actually based upon the UK Government’s own official advice ‘Protect and Survive’, published in 1980, although Briggs story is a great deal more humorous (albeit in a slightly more macabre way).

Well, I had my own 10 minute warning last Monday. It was from those good folk at the Care Quality Commission (CQC). They let us all know that, in 10 minutes, they were coming on site to do an inspection of our urgent and emergency services. The last time they were in our Trust, they found these services ‘inadequate’. A great deal of work had been done since that time and the service has been completely transformed. We will have to wait for the official report of the inspection, but no significant concerns were raised and pleasingly, they noted that our emergency care colleagues were treating all the patients with great compassion and care. Given that it was a Monday and the department was running flat out, I thought it was a wonderful acknowledgement of the great work of our colleagues.

Being compassionate and caring are tangible examples of kindness shared, and kindness always matters. I didn’t need to spend my Monday afternoon exploring this notion. I have known for some time that kindness matters. I haven’t always been good at embracing this idea though, but over the past few years I have tried much harder to embrace a kindness first approach. So, I was interested in seeing what else I could learn from the session. The session was facilitated by the ‘A Kind Life’ organisation. If you haven’t heard of them before, have a look at their website here. The session was part of a national programme supported by the NHS England Improvement Civility and Respect Programme. There will be a session coming to a virtual venue near you soon, and I would highly recommend trying to getting a place at one of them.

The afternoon started by reminding ourselves of the NHS People Promise – you can remind yourself here – and then it was into imagining and/or remembering a good day, and what made it a good day. An interesting exercise, made more so by sharing with others. I have to say I love the way you can be effortlessly whizzed into a virtual breakout room and then whizzed back into the main session. Something difficult to do in real life without using up lots of time traipsing around a conference centre! The enthusiastic facilitator (and I’m being kind here), who could be said to be somewhat of a cross between Gordon Brittas and Bill Oddie, also used the Menti smart phone system to poll participants whose responses were immediately turned into a word cloud – very slick and impressive and great fun too!

Of course, it wasn’t just about having fun. There was a serious side to the afternoon. We explored empathy, what listening to others might really mean, how to give appreciative feedback, the impact of bullying and how to create a safer culture, ways to promote curiosity (a favourite idea of mine, I have to say), and the importance of wellbeing conversations. All in all, it was an afternoon well spent. Whilst kindness might be difficult to define, it was a privilege to spend a few hours exploring what it could mean. For me, the session reinforced my desire to be more generous in the way I am with others, more generous in my thinking, actions and words. Kindness matters.

As does conditioner. Apparently, conditioners contain cationic surfactants, which can bind radioactive particles and trap them in your hair – not a great thing after a nuclear attack. However, I don’t expect any of us will be experiencing a nuclear attack any time soon (that said, none of us expected the Covid 19 pandemic). I do know though that as we enter the Winter season, things will get even tougher in health and social care, both for our colleagues and for our patients and the folk that make up their families and communities. Let’s remember, it costs nothing to be kind, we can all spread kindness every day, and kindness really does matter.

  

* 10 minutes was the time the ‘Protect and Survive’ advice reckoned you had to get home – back in 1970 we were told that following a nuclear attack we would have 10 minutes between the warning and certain death – although though there was a common belief there was only a four minute warning to be given – in the 1990’s all the UK ‘four minute warning’ air-raid signals operated during the Cold War were dismantled. Today, it is estimated that in the event of nuclear explosion, all the radioactive material caused by the blast would take 15 minutes to return back to ground.  

Meet me on the corner and come face2face with a new reality

Now I have to say its been a long time since a pretty young lady has given me her phone number and asked me to call her. Last Thursday, that’s what happened. Perhaps, rather impetuously, I did ring her. We talked, I liked her, and we arranged to meet. Later, I confessed all to my very understanding wife J. We are now sleeping in separate bedrooms. More of which later.

Last week, I joined my colleagues for a face2face Board Development day. We were fortunate to be able to hold it in some wonderful conference rooms run by Stockport Metropolitan Borough Council, one of our Integrated Care Service partners. 

Although there was some serious learning going on, there was also an element of fun to be had as well. The session was facilitated by two colleagues from Lumina Learning. If you haven’t heard of them, have a look here. They take a very interesting approach to helping you understand more about who you might be, and who you are in the relation to those you work with. There was a bit of homework to do in preparation for the sessions. This consisted of answering a brief, but detailed questionnaire. The result was a personal ‘portrait’ which used both words and colours to capture your approach and responses to life, work, relationships, stress and so on.

It was interesting to have this opportunity to gain an insight into one’s persona. I thought my portrait was fairly accurate. My underlying persona was Big Picture Thinking, and my combined persona located me in the Inspiration Driven area. When other members of the Board were asked for their opinions as to whether it did represent me, there was agreement that it did, and people were able to provide examples of why they thought that. If it was interesting to gain a glimpse of who we might be, that interest was ratcheted up when as a group we looked at each other in relation to each other. 

I was surprised that through happenstance, our Board was a balanced group of folk who were: People Focused, Outcome Driven, Extraverted, Discipline Driven, Inspiration Driven and Big Picture Thinkers. These descriptors won’t mean much to readers of this blog who have not been a party to one of the Lumina Spark workshops. However, what it provided the Board and me with was a solid foundation upon which to develop more effective relationships, find better ways to communicate and gain an appreciation of how other colleagues might view the world. These are aspects of effective teamworking that have been more difficult to achieve in virtual settings such as MS Teams, Zoom and so on.

These digital platforms were really helpful, essential even, during those early days of the pandemic. It’s difficult to see how NHS organisations could have managed without having recourse to such technological support. However, whilst these channels might be great for many transactional discussions and conversations, they are not very helpful for more transformative approaches that you would hope to have in team development and team building conversations. Indeed, when I joined the Trust, in May of this year, I was keen to establish face2face Board meetings as soon as possible. Experience has shown me that such interpersonal interactions are enhanced by being present in a physical sense, as well as being mentally present. So, since July we have held all our Board meetings in this way. We are fortunate to have a large flat lecture theatre on the main hospital site, which makes social distancing possible and folk have got used to wearing masks for long periods of time.

However, I know from many discussions last week with NHS Chairs from across the UK, that we are possibly in the minority in so doing. Many NHS Trusts simply don’t have space large enough to allow for social distancing, and/or to hire such accommodation would be prohibitively expensive. Even where Trusts have the room, many others simply do not want to meet in the same space due to infection prevention and control (IPC) reasons. Other's were fearful of sending the ‘wrong’ message to colleagues, patients and visitors. I don’t see it that way. We keep a watchful eye on community infection rates. Research from earlier in the year noted that households are one of the most common areas for Covid-19 transmissions, and so we are mindful that we all take regular Lateral Flow Tests (LFT) before coming on site. We also carefully watch hospital admissions of Covid-positive patients and the take up of vaccinations by colleagues and our communities. All our Board members are double or even triple-jabbed and are practised in the art of safe IPC measures. I have always maintained that should any member of the Board want to join the meeting virtually, for whatever reason, then we would make sure that happened. Members of the public, press and so on, do this is any event.

As we learn to adjust to the pandemic becoming endemic, I don’t think there are many right or wrong answers to dealing with these new situations. Events last week, illustrated to me how easy it is to become complacent. Last week, my lovely wife, who has been struggling for a while now with a cold, tested positive for Covid. All this time of being super careful, and 20 months in she gets it. I did a LFT test, which was negative. These tests are said to be 99% accurate. However, even though I was completely symptom free, as I have a very busy week next week of face2face meetings, I went and booked myself a PCR test, which is said to be more definitive and reliable.

So last Thursday, I found myself in a Tesco car park, face2face with the £37 billion Test and Trace system. As I drew up to the mobile testing centre, a pretty young lady held up a sign which said please ring this number. I did and we had a lovely chat, as she explained what was going to happen and asked me to meet her around the corner and we would start the test. I took the test and amazingly the result came back the following morning. I was negative. Everyone, the virus hasn’t gone away; get your jabs, and remember, distance, fresh air, and wearing a mask when needed are still as important as ever.   

Science is magic that works; follow the science and get that booster jab!

These days I’m beginning to search the TV for something to watch in the evenings – it’s a sure sign the nights are drawing in! In our house, like most people I imagine, we literally have 100s of channels to choose from, plus everything that is also available online and on catch up TV. However, it can still be a challenge to find something interesting to watch. Last week, I rediscovered the wonderful series, ‘Endeavour’. Now I loved ‘Morse’, and to a lesser extent ‘Lewis’, but the 33 episodes of ‘Endeavour’ are simply sublime examples of great television storytelling. Each episode is a work of art, although some of its connections and photographic links are subtle to be fair. Watching last week’s episode, I was once again struck by how many of the cast smoked as part of the storyline. It took me back to my early days as a mental health nurse, where many staff (including me) and patients smoked, and often did so together. I gave up over 15 years ago.

Such memories felt somewhat ironic, giving we are entering the last week of this year’s #Stoptober campaign. This year was the 9th anniversary of this annual event that aims to help folk stop smoking. Over this time, the Office for Health Improvement and Disparities (formerly Public Health England) estimate that over two million smokers have managed to quit smoking. This is good news for them and for the rest of us. However, the good folk over in the Office for National Statistics also note that there are still nearly 7 million adult smokers in the UK. This is not good news for them or for the rest of us.

This year the focus has been on two different groups in the population. The first is the large group of folk aged 35 – 60 years old who continue to smoke, despite the widespread knowledge about smoking related causes of illness and premature death. The second group are those aged 18 – 35. During the pandemic, the number of new smokers in this latter group grew. This growth reversed the trend over the past 7 years which had seen a decline in young people taking up smoking. It’s perhaps understandable that as we went into lockdown some people turned to smoking (and increased alcohol consumption) as a way of dealing with the stress and anxiety each lockdown brought. It is never the right answer, but I understand why some folk might think so.

The campaign draws on the notion that if you can stop smoking for 28 days, you are five time more likely not to restart again. However good the campaign is, there will be many smokers who will simply ignore it, and won’t even try to stop smoking. The fact that often smokers have tried to give up in the past and failed is also a major reason many smokers don’t engage with the #Stoptober campaign. Like other health and wellbeing issues, sadly folk living in more deprived communities and/or those who live with mental health issues, are more likely to continue smoking, adding to their overall health and financial problems in so doing.

Indeed, as I walk around our ‘strictly no smoking’ hospital grounds, I’m amazed at the number of people who continue to smoke despite clearly having a health problem being investigated or being treated. I have been subjected to much abuse from those I have asked to respect the smoke free rules. And don’t get me started on those folk who refuse to wear masks while on the hospital site! The whole notion of why some people persist in engaging in activities that are known to be harmful and/or risky, made me think of my time in clinical practice where I had been asked to work in a drug misuse service in Manchester.

That was back in 1984, and I think the service was struggling for staff, and as the service I had been brought in to work for wasn’t up and running at the time, I was seconded to the drug misuse service. It was an interesting experience, not least because the people who worked there were simply strange, and the often wretched and complicated lives of many of the patients were very challenging. The therapeutic/treatment approach was based upon methadone treatment and psychotherapy. The overall approach drew upon the work of James Prochaska. His is a fascinating story – catch a glimpse of it here.

At the time my knowledge of psychotherapy was pretty rudimentary, so when I was presented with Prochaska’s transtheoretical model of behavioural change, I was not an instant fan. All these years later, and thanks to the patience of Professor Sue McAndrew in educating me, my understanding and appreciation of this approach has, well, changed. His model refers to the temporal dimensions of change decision-making: Precontemplation (not ready for change); Contemplation (getting ready); Preparation (ready); Action; Maintenance; Termination (folk will not return to previous behaviours). Interestingly, he developed his work as the underpinning approach to making smoking cessation programmes more effective.

As the Covid 19 infection rates continue to rise, I guess I can’t help but think about the current apparent reluctance of folk to get their booster jab. After the success of the original vaccination programme, why are so many people apparently in the precontemplation stage in their decision making? Prochaska talked about this stage perhaps lasting up to six months. Dear reader, we don’t have six months to think about getting a booster jab – tell as many people as you can to find out today where they can get their booster, and get it done! Science is magic that works; follow the science and get that booster jab!

My cold is worse than yours, because it’s happening to me!

It’s been a miserable week for some. My dear wife J has, for some time now, struggled with the dreadful non-Covid cold that’s doing the rounds at present. Like many others who have caught the cold, it knocked her for six and unlike her, she spent long periods in bed exhausted. We ruled out Covid through almost daily testing. Thankfully she is slowly getting better, but it has certainly taken its toll on her general health and wellbeing. J and people like her who have struggled with this cold represent what I think is a looming respiratory disease iceberg, more of which later.

First, I should think the whole of the African continent was feeling miserable, following the news last Tuesday, that the disgraced former health secretary, Matt Hancock, is set to become a United Nations special representative to Africa. It appears that although Hancock accepted the role on 7th October, I have to ask why he waited until last Tuesday announce it.  The cynic in me wonders if it had anything to do with the publication of a highly critical cross party report on the UK government’s handling of the pandemic; a government he was part of and in which he took a leading role. Perhaps Vera Songwe (the Under Secretary General of the UN) was unaware of the inquiry and report when she penned a letter to Hancock saying, ‘your success on the UK’s response to the Covid 19 pandemic and the acceleration of vaccines that has led the UK move faster towards economic recovery is one testament to the strength that you will bring to this role’. However, yesterday it seems the UN withdrew its offer of a job. I think rightly so as the UK has the second-highest coronavirus related death toll in Europe, with only Russia having a higher death rate.

Closer to home, I would imagine many GPs will be feeling even more miserable than they might have been with the continued call from the media and the current Secretary of State for Health and Social Care, Sajid Javid, for GPs to see more people face2face. The £250 million so-called ’rescue plan’ for primary care (which works out at around £3.66 per patient per year) is unlikely to resolve the long-standing problems, and speaks to a lack of understanding of the issues facing doctors and other primary and community care professionals. We have been here before.

How many of you remember the 'General Practice: Forward View' published in 2016? It is a really good read, even today. It still reflects today’s issues well, and proposed significant investment in terms of both additional GPs and other health and care professionals, as well as in new technology. The paper is full of case studies showing what was being achieved using virtual consultations, remote clinical triaging and using technology to better manage long term conditions. More recently (July 2020), when he wasn’t busy doing things he shouldn’t have been doing, Matt Hancock was urging GPs to make all consultations virtual consultations by default. The reality has been somewhere in between. GPs have continued to see patients face2face all the way through the pandemic, but many practices have also provided remote clinical triaging to ascertain whether a face2face consultation is necessary. Likewise, many patients have liked the flexibility and ease of access that virtual consultations bring. It’s also worth remembering that despite the big rise in people presenting at Emergency Departments recently, typically there are only 23 million A&E visits a year, compared to over 300 million patient consultations being provided in primary care each year. Such flexibility benefits everyone and is not something to be sneezed at.

Oh yes, let’s return to what I was saying about colds. I can safely predict that colds, flu and every kind of respiratory condition in between are going to be a problem this winter. We have already seen a huge increase in children presenting at Emergency Departments with all kinds of sniffles, coughs and so on. As children and adults have started to mix more, and without the restrictions that have been in place since March last year, it’s not surprising that we are now seeing this increase in colds. And there’s the (vapour) rub.

This horrible cold brings with it similar symptoms to those of Covid 19. Even if you are vaccinated, you can still catch Covid 19. Indeed, Covid symptoms can feel very similar to a cold or flu. Hence in our house, J has tested herself every couple of days. The symptoms of Covid 19 can include: a headache, sneezing, sore throat, runny nose, cough and fever. Sounds like a cold or flu doesn’t it? However, anosmia (loss of taste, or smell) is one of the more differentiating symptoms – this tends to happen with Covid 19, so maybe an important symptom to aware of. Thankfully, it is also not one that J has experienced. Those good folk over in ZOE have detailed the 21 most common symptoms of Covid 19, see here.

However, here is my first public health message: If for what ever reason you are feeling unwell, whether it’s a cold, flu, or Covid 19, get tested, stay at home, and stay there until the symptoms subside. Our J felt well enough last week to go back to work, but very sensibly, did so remotely. Public Health message No 2: if you have these symptoms, don’t go to your GP! Get on the phone (it might take you a little longer to get through, but you will get there) or go online. Don’t get frustrated and take yourself off to A&E, as you are likely to be in for a very long wait. Many of the issues that folk seek help from their GP for are self-limiting; you will get better without anything other than ‘over the counter’ medications, sleep and plenty of fluids.  This is true even if, unlike J, you don’t live with a nurse. Remember, as the NHS website notes: ‘if general practice fails, the NHS fails’, and I for one am determined that won’t happen.

Mental Health in an Unequal World

The last time I was on a plane was way back in December 2019. I was on my way to present a keynote paper at a mental health conference in Portugal. Now when I say plane, it was one of those airlines that charge you almost as much for your Whitley Neill Rhubarb and Ginger gins as they do for the ticket. It wasn’t always like that. I had for many earlier journeys got onto the plane and turned left. Turning left meant you could drink as much G&T as you liked, and all for free. My favourite airline experience was flying on the Airbus 380 with its double decker passenger seating. Not only did you turn left, but also walked up a rather grand staircase to find your seat.

I think the days of such planes have probably come and gone. Even Emirates, whose Airbus 380s were some of the best in the world, has started to replace them with the more familiar single decker planes. Like many other sectors, the Covid19 pandemic has hit air travel hard. Likewise, the growth in awareness of the damage being done to our environment through air travel has driven the development of more efficient engines and aircraft design. Personally, I have very little appetite for flying anywhere these days and, even if I did, for other reasons I probably wouldn’t be thinking of turning left when boarding a plane.

If you want to see a simple example of inequality in action, just stand and watch how planes get boarded. There is no waiting in long exhausting queues for business class travellers. Once seated and even when the plane is still on the ground, business class passengers are offered champagne, and/or Rhubarb and Ginger gin, actually whatever they want, and of course, those super little bowls of warmed mixed nuts to nibble on. It’s a different world for sure, and the differences in experience are stark.

I caught a glimpse of something similar yesterday morning. I had been given an appointment to get my combined Covid19 booster and flu jab at my GP surgery. Now my doctors’ practice is one of two located in a purpose-built health and leisure centre. There is a swimming pool, café, library, chemist and it’s also a base for a wide range of community services. During the pandemic, part of the ground floor of the building was repurposed as a Covid19 vaccination centre. When I got there, I had to turn left and go up some stairs (a la Emirates) to my GP’s practice and not right to the vaccination centre. I registered my arrival and after a short while I was ushered into a consulting room, given my jabs and after a 15-minute recovery wait, I was on my way home again. Coming down the stairs, I was amazed to see a huge queue of people waiting in a line that snaked out of the building and around the car park. These were all folk who had accepted the opportunity to get their booster on a ‘turn up and wait’ basis. However, it was great to see such a goodly number of folk keen to get their vaccinations done, even if the queue didn’t seem to be moving very quickly!

It got me thinking. The pandemic has been often described as being indiscriminate, a great leveller. Of course, there is an element of truth in this, in that Covid deniers, antivax protesters, and those who have been double jabbed can all become infected with the virus. We know the likely outcomes will be very different for those not vaccinated, however. We also know that the pandemic was more devasting to some groups in society, far more so than others. A number of generally recognised, and long standing, social and economic determinates of health and wellbeing resulted in folk living in the most deprived parts of the UK experiencing much higher rates of Covid19 infection and deaths. Often many of these areas of deprivation had already greater health care needs and as such, health care services in these areas experienced much greater disruption than others. The North West of England, for example is still facing much higher levels of community infections than other parts of the country.

It’s also been much harder for such health care systems to fully recover and effectively tackle the huge waiting lists. Two weeks ago, the King’s Fund published their analysis of the waiting list problems facing different health care systems. It makes for very depressing reading. Those folk living in the most deprived areas are 1.8 times more likely to have to wait for a year or longer for treatment that the rest of the UK. Such an inverse care effect feels very unfair, as did Sajid Javid’s Conservative Conference announcement last week that ineffective NHS leaders would be sacked and replaced by leaders from business, if they couldn’t bring their waiting lists down. It begs the question as to whether NHS leaders serving poor communities are worse leaders. I hope Sajid’s announcement was just Party Conference rhetoric.

What we know is not rhetoric is the impact the pandemic has had on people’s mental health. Last week the Lancet published a study that showed the rates of folk experiencing depression and anxiety had risen dramatically over the past 18 months. Worldwide, this rise has seen an estimated additional 53 million extra cases of depressive disorders, and 76 million cases of anxiety being diagnosed. Again, as if to illustrate the impact of inequalities, the study suggests that women and young people are more likely to experience such mental health problems than men or older folk.  

It was a timely report. Today is World Mental Health Day. Whilst it is a day to talk about all things mental health, how we need to protect our mental health and wellbeing, and the importance of being there for others when they perhaps are struggling, this year’s theme is ‘mentalhealth in an unequal world’. Whilst recognising that the social detriments of health and wellbeing require focused political and economic interventions, the study also acknowledges the role new technology can have on enabling access to services and mental health support. It was a recommendation I found somewhat ironic. The title of that pre-pandemic keynote paper I delivered in Portugal way back in 2019 was ‘Recovery, resilience, and research: the state of mental health care in a digital age’.  

A Nurse in Time Saves Nine

Last week was full of good memories for me. Let’s start with the centenary celebration of the opening of the General Nursing Council for England and Wales’ official register. This is the register that all nurses and midwives must be on in order to practice. Over the past 100 years the register has grown year on year, and now holds 732,000 nurse, midwife and nursing associates names on it. My name was entered onto the register in 1978. It was a proud moment in my life. Last week I was warmed by the large number of newly qualified nurses who expressed their delight on social media on becoming a nurse.

The nurse register opened in 1923, and famously, it was the nurse pioneer, Ethel Fenwick whose name appears first. She was State Registered Nurse No. 1. You can read about Ethel’s contribution to nursing here on the Nursing and Midwifery Council’s (NMC) website. It was a formidable contribution and much of her work underpins the profession today. The NMC itself only came into being in 2002, and it was formerly the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC). I still have my original UKCC registration card. The legislation that underpins the work of the NMC is now over 20 years old, and is perhaps in need of revision. For example, some readers of this blog may be aware that there is currently a campaign to protect the title of ‘nurse’.

Anyone can call themself a nurse. Indeed, a recent example is the Covid 19 conspiracy theorist Kate Shemirani, a former nurse struck off for spreading disinformation, who has vowed to continue to call herself a nurse. Ian Levy, a Tory MP for Blyth Valley called himself a mental health nurse in his election campaign, until he was called out by the media, when he admitted he had, in fact been a nursing assistant. As the title ‘nurse’ is not protected by law, whereas the title ‘registered nurse’ is, Levy did not violate the Nurses Registration Act (1919). This is a great example of how the title ‘nurse’ can be used to mislead the wider public, and for someone to gain from such deception.  

Anyway, I digress, let’s get back to those good memories. Unbeknown to me, a year before I became a nurse, Radio Starlion was established. This is a hospital radio station that broadcasts its programme to Stepping Hill Hospital, part of the Stockport NHS Foundation Trust where I’m a Chair. Last week I got to meet Alan, the Radio Starlion Manager. What a character! He has been part of the radio station for some 44 years and leads a team of 8 volunteers who gather patient requests and dedications and then transform them into radio programmes.

We had a lot in common. We were men of an age that actually listened to original pirate radio station Radio Caroline. Interestingly, when writing this blog, I put ‘Radio Caroline’ into my search engine, and to my surprise, they still exist, see here. Not quite the underground radio station I once listened too, however. He had a magnificent collection of single and LPs. I was slightly jealous, having given all my LPs away for a charity auction a few years ago. Back in 1984, I presented a radio programme on Sunday mornings at Bolton Hospital, and did so for about 18 months.

I also told Alan the story of our recent wedding celebrations which was based upon the festival Woodstock. One of the things we did was to use single records as the place mats. One of my grandsons was really taken with these singles, and proceeded to collect them over the course of the evening. He now has quite a collection. It’s his birthday later on this month I have promised to buy him a record player to play the records on. It was an interesting conversation for Alan and I, but I’m not sure it was for my two Matron colleagues, Emma and Mamoona, who were too young to know about such things and events. But a big thank you to them for facilitating the visit.

Alan and his team of volunteers are part of the hidden army of likeminded folk who want to make a difference to the lives of others. They often go unnoticed. Which I find strange. There are over 3 million volunteers who contribute to the work of the NHS. Despite what the UK politicians might claim, had it not been for these volunteers and those like them, we probably wouldn’t have managed to get through the pandemic or the vaccination programme. As the challenges of the pandemic continue to shape how health and care services are provided in the future we need to think differently about how and who are involved in keeping us well and healthy.

That said, I have to admit I was slightly taken back, on waking up yesterday to hear our Secretary of State for Health and Social Care, Sajid Javid ordering a shake up of NHS leadership. Now the NHS has been almost been in a state of flux since its inception. Change has been a constant companion to all those working in the NHS. I am not sure what Sajid’s proposed review will achieve. The former Vice Chief of the Defence staff, General Sir Gordon Messenger will lead this review, alongside with Dame Linda Pollard, the Chair of Leeds Teaching Hospital. These are two good folk. Both have a successful record of transformation and change management. Time will tell if this review yields useful results. However, I think today, many NHS mangers will be dismayed, and might feel that the review is an overt criticism of their efforts to date.

I’m taking a slightly different approach. I was struck that the name ‘Gordon’ features in both the leader of this review, and our Ethel Fenwick, whose full name was actually, Ethel ‘Gordon’ Fenwick. She was once described as having a curious mind, she was a fierce debater and was uncompromising in her beliefs. Let’s hope those involved in this review are also like minded.

Caring for our wounded healers: no crystal ball needed

It was a funny old week last week, full of ups and downs. Having posted my blog last Sunday focusing on the problems there are in GP land, I began to feel more and more like Nostradamus as the media played catch up with the issues. Nostradamus was a French astrologer, doctor and predicter of future events. His first book was published 400 years before I was born. It is said that he predicted many things, including the Great Fire of London, the rise of Adolf Hitler, both the World Wars, the first moon landing, and even 9/11 and the attacks on the twin towers in New York. He also prophesied the end of the world. As far as I’m aware, this is one prediction that has happened yet.

Mind you last week’s news might make some people feel the end of the world is imminent. Covid19 hasn’t gone away, Brexit is hitting all parts of our lives, including empty shelves in our supermarkets, the cost of keeping ourselves warm going up fourfold, dead pigs stacking up on farms, and fruit rotting in the fields. To crown it all, those folk at the Government Communications Department issued a notice to say there was no need to panic buy petrol, as there was plenty in the refineries, immediately firing the starting gun for people to panic and spend hours queuing to fill up their cars. It was all pretty grim stuff, and I have to admit to resorting to what Frank Lloyd Wright described as ‘chewing gum for the eyes’ – watching TV to tune out the ever depressing zeitgeist.  

Despite the fact we have four televisions in our house, we seldom spend much time during Summer sitting inside watching any of them. I was once an avid watcher of ‘Come dine with me’ and ‘Four in a bed’ and would watch every episode every week – I know, I know, but even these programmes get seldom viewed these days. However, I was home alone last week and in the dark evenings, I played catch up. There wasn’t a great deal that appealed, and flipping through the channels I came across one of those ambulance programmes, which follow ambulance crews over a 24 hour period. The programme was part-way through as I settled down to watch the stories being told.

Underlying each of the stories were often high expressed emotions of fear, anxiety, despair, loss, coupled with pain and discomfort, which folk couldn’t deal with themselves. The paramedics featured were professional, compassionate, kind and very human. Whilst I got a sense of the emotions the ambulance call handlers were going through; it was hard to discern what each of the paramedics might be experiencing as they dealt with the different calls. If I’m honest, I was caught up with what I observed was the way they interacted with each of their patients, and didn’t think how facing so much trauma day after day might be impacting upon their mental health and wellbeing.   

That changed for me last week following my participation in a Wellbeing workshop for Chairs, Chief Executives, Wellbeing Guardians and Staff-side Chairs. It was facilitated by my colleague AlisonBalson, who is Director of Workforce at my old Trust, Wrightington, Wigan and Leigh Teaching Hospital. Just an aside, the term ‘workforce’ really grates, as does the term ‘staff’ when referring to our colleagues. I’m on a crusade to change the language and narrative around the folk we stand beside in delivering our health care services. But I digress.

The workshop started with three powerful stories, told by the individuals themselves. The first was by a former paramedic who took us through her slow descent into depression and suicidality. I’m not sure how she got through the telling of her story. I and, I suspect, many others, were choked up as we listened to her tale. She had risen through the ranks, and was both a highly skilled advanced paramedic as well as holding a managerial role. Her mental health problems stemmed from an incident she was part of, that occurred in the very early hours of the morning, involving a serious road traffic accident in which five young people were seriously injured.

She told us what it felt like to manage the situation, having to wait over an hour to get the support she needed in terms of other ambulance crews and rescue services. All the young people involved in the accident eventually lost their lives. She went to all their funerals. Over the following six months she couldn’t get the trauma of what she had been involved in out of her mind. Her performance as a paramedic suffered, her family relationships disintegrated, and she experienced clinical depression to the extent of contemplating taking her life. It was a powerful story of vulnerability.

It was also a story of the need for us all of to recognise when something is not right with our colleagues, and the need for organisations to find way to ensure the mental health and wellbeing of individuals is a paramount and continuous concern. The workshop took us beyond the impressive array of wellbeing interventions and support that’s been developed during the pandemic. Good as these are, a more fundamental approach is required that ensures we don’t put colleagues in situations where their mental health might be impacted without there being a compassionate and caring response proactively available. I’m signed up to this and will work with colleagues to make sure it happens.

It was a week of ups and downs, and I do want to mention two folk who were definitely responsible for some great ‘ups’ last week: Emma Rogers and Mamoona Hood – two Matrons at Stockport Foundation Trust, who last week led on our #FallsAwarenessWeek – they were successful in engaging with folk across the entire Trust, and there was much shared learning, fun, patient, colleague and volunteers’ involvement and of course, cake. They even got me to wear a bright orange t-shirt! – now that takes some doing.

Finally, my up and down week is so, in part, due to remembering one of my younger brothers, Christopher, who died this past week, 14 years ago. He was a rascal, he was indomitable, a loving father and a generous brother. His premature passing seems so unfair and I miss him very much.

 

Ps Ambulance Series 8, starts this Thursday, 21.00 on BBC, and features the North West Ambulance Service – just saying.