Making our own sunshine: energising our decision making

Last week’s dawn to dusk sunshine was a real tonic. Although there were some meetings along the way, I was able to spend a great deal of time outside. For me there is nothing I like better than simply being able to wear shorts and t-shirt all day long. Thank goodness for only head and shoulder views on Teams and Zoom! That said, I found the sunshine energising and so there were also plenty of sunshine-filled walks each day.

I was also intrigued to read the story of Leighton Buzzard train station’s recent innovation. Gaining funding from the Department of Transport and in collaboration with Bedfordshire Council and the innovative walkway developer Pavegen, the station has installed kinetic floor tiles which can turn footsteps into electricity. It’s a small scale project at present, and although a little expensive, it’s a brilliant idea. Anywhere there is high footfall - hospitals, universities, airports (well maybe not airports just now) the potential to generate energy through people walking sounds simply brilliant.

Here follows a small digression. It has always amused me that Leighton Buzzard has long been associated with the Rothschild family. This fabulously wealthy banking family (during the 19th century, the Rothschilds amassed the biggest private fortune in the world), owned much land around Leighton Buzzard and Anthony de Rothschild lived at Ascott House (now owned by the National Trust). It is also the place where the ‘Great Train Robbery’ of 1963 occurred. The robbers got away with £2.6 million (which today would be worth £46.3 million!).   

Anyway, I was getting a little carried away there. Back to my storyline. Walking is just one of the ways in which people can feel mentally and physically energised. Running, cycling, swimming and so on, are equally good at getting people to become more active. Have a look here at the evidence as to what taking regular exercise can do in terms of preventing illness and enhancing your mental health and wellbeing. If you want to have a bit of fun as you become more active, why not join the #NHS1000miles community. Every Sunday, at around 19.30, people from all over the UK share on Twitter the number of miles they have walked, cycled, or run with pictures from the week. It’s not competitive, but it is very motivating. This year I have walked 740 miles and I still have today’s miles to add.

Last week I was reminded about the Greater Manchester Moving initiative. Started in 2017, this aimed to get 75% of the local population more active by 2025. The pandemic caused a pause in some of the group activities. Currently there is a ‘refresh’ taking place to ensure that the initiative reflects the changed post-pandemic world, particularly the need to reduce inequalities across our communities. 

I make no excuse for once more including this link to the #ActiveSoles story, which for me captures beautifully how the little things can become the big things, the important things, things that can inspire individuals and whole communities too. For most of the time I only wear clogs. When I’m walking, I wear walking shoes (similar to trainers). Collectively Rachel Allen, Hayley Lever and Andy Burnham led the way in making trainers acceptable footwear for formal meetings across the Greater Manchester Health and Care Partnership – but only if you used them!

I was reminded of the GM Moving initiative through attending a half-day workshop which explored how the Greater Manchester Integrated Care Service (ICS) was being developed. The workshop was facilitated through Teams, so I was pleased to be able to sit there in my shirt and jacket, whilst wearing my shorts. I wondered how many folk at the workshop were similarly attired, and how many were still wearing their trainers.

The workshop was one of four that all stakeholders from across the health and care sector were invited to attend. There were 51 people at my workshop. The aims of the workshop were to try and achieve a consensus over a number of principles as to how the ICS would operate in the future. As you can imagine, translating the rhetoric of collaborations, partnership, shared decision-making and so on into a new and workable reality was never going to be easy. One of the fundamental issues for any ICS is how to manage the relinquishing of control as an independent organisation. All NHS Foundation Trusts had gained considerable autonomy over their own destinies. Indeed, I would argue that the prevailing NHS culture of competition has meant that many organisations have become self-contained entities, with many Acute Trusts still having a ‘care and cure’ approach to health care service provision. 

This is not sustainable. It’s not desirable. More has to be invested in preventing illness, both physical and mental. To do this, health and care organisations are going to have to give some things up. Within an ICS, individual NHS Trusts will need to decide what it is that only they can do, what they need to do with others, and what is best done by other people. That is a hard ask. Giving something up for the greater good requires great trust and enormous amounts of integrity.

However, if I can again digress slightly, I want to demonstrate it’s not impossible. Way back in 1959, an engineer at the car manufacturer Volvo, Nils Bohlin, invented the three-point seat belt. Prior to this time, seat belts consisted of a strap across the waist, which in a crash often did more harm than good. Volvo could have kept the patent and made lots of money as consequence. Every car today is fitted with the same three-point seat belt. Volvo made the patent available to every car manufacturer for free. Since 1959, the seat belt has saved many millions of lives worldwide. Has Volvo suffered as a consequence of that decision? Absolutely not!

So, as we walk towards a brave new world, an integrated health and care world that recognises the importance of place to people, let’s use our energy to find new ways of working together for the greater good of our communities. Like the sunshine, that would be a real tonic to aid our decision-making.

 

Ps – I love mushrooms, but there literally was no room to include mushrooms in this blog. But please note, recent studies have shown that eating just one mushroom a day can reduce your risk of cancer by 45%, prostate and breast cancers in particular. 

Smoking guns as Cuthbert and Colin go to war: lessons from down under?

Parts of last week felt a little surreal. For example, is it just me who thinks it rather strange that the national health care uniform consultation, relaunched after a pause for the pandemic, doesn’t mention our medical colleagues at all? Perhaps they aren’t part of that same team mentioned in the second paragraph. Another one of our public services, the police were at the centre of different story. It appears the long running (26 years) TV police drama, The Bill, which was last seen our TVs in 2010 is set to return. Many of the original cast are likely to be part of the new series. Maybe British TV is like NHS reorganisations, wait long enough and things will come full circle. Then there was the news of the milk tanker which crashed into the River Dulais in Wales It was a similar accident to one where, 40 years ago, I rescued a milk tanker driver who crashed into a river just over a mile away from the River Dulais. I don’t like being on or in water and the news report brought back unwelcome memories that’s for sure! And, will there be many colleagues working in the NHS buying Benefit cosmetics or going for their beauty treatments ever again. I don’t think so, in the words of Julia Roberts (Pretty Woman) – ‘big mistake Benefit, big mistake!’

In my mind the most surreal story has to be the Cuthbert the Caterpillar Cake court case. Last week, media coverage of the M&S action against Aldi swept away the wall to wall reporting of the Derek Chauvin trial, as he stands accused of killing George Floyd. Social media lit up with ‘free Cuthbert’ type messages. Why Aldi was singled out is unknown. Most other supermarkets have their own versions of the M&S Colin Caterpillar cake – there’s Cecil, Wiggles, Clyde, Curly to name just a few. We don’t know all the details, but I’m sure, once again Julia Roberts might be saying ‘big mistake’ M&S. Time will tell.

Now amongst all this strangeness there was a story that caught my attention for the right reasons. It was the announcement that New Zealand was taking one more step to achieving their ambition to being a smoke free country by 2025. Regular readers of this blog will know that over the years I have periodically focused on the disastrous health impact of smoking cigarettes. I was a smoker once, but gave up many, many years ago. These days I hate the smell of cigarettes, and the smell on people who smoke. I’m very proud of my J who decided to give up smoking 2 years, 2 months, 1 week, 3 days and 9 hours ago. Yes, it’s a tough one to achieve, but it can be done. 

In New Zealand 4,500 people die each year from smoking related causes. In the UK around 78,000 people die each year from smoking and across the world smoking accounts for more than 8 million deaths. If you are a man, who likes to have a smoke after sex, beware! The NHS website warns of impotence being a common side effect of smoking cigarettes. Apparently, smoking limits the blood supply to the penis – just saying. As Julia Roberts might say to male smokers ‘big mistake’.

Apart from the health risks, smoking is expensive. As I was writing this blog, I looked up the cost of a packet of 20 cigarettes in the UK. They cost a staggering £9.50 for the cheapest and £12 40 for the more expensive brands. That’s a heck of a lot of money literally going up in smoke. In New Zealand the average cost of a packet of cigarettes is £16 a packet. And if you think as an e-cigarette smoker you get off scot free, have a look at this WHO report on the dangers and costs of vaping and smoking e-cigarettes. Not good.

What interested me about the New Zealand approach was their governments willingness to achieve change over time. In public and population health, and certainly from a health promotion perspective, this is simply remarkable and courageous. Most governmental policy decisions are limited by the fact they will need to be re-elected in 4 or 5 years’ time. Many population health interventions, like smoking cessation programmes can take much longer before the beneficial outcomes are seen. Additionally, there is no doubt that there are big tax incomes for governments in ‘allowing’ smoking to continue. In New Zealand, a big part of their approach is to gradually raise the legal smoking age. The current proposal is considering banning the sale of cigarettes and tobacco products to people aged 24 and under – in effect making smoking illegal for people of that generation.

There are also plans to only allow cigarettes with significantly reduced levels of nicotine to be sold and restricting the number and types of locations where cigarettes can be sold. Some might say these measure might lead to the development of a black-market in cigarettes and tobacco and/or threaten the livelihoods of some small corner shops. Both are fair comments, but against the huge harm smoking can cause, it shouldn’t be a prime consideration.

Like others, I think the more important debate is probably over how much should the State intervene in our lives. For me, this is a more serious consideration. The pandemic has brought these challenges to the fore. I think our government might have done things differently, made better decisions in how the pandemic was managed. That said, I remain frustrated, angry, ashamed, and alarmed in equal measure over those people who feel the Covid pandemic is somehow a government ploy to control us all. Likewise, with such huge numbers of people who have died worldwide, why it is there are so many people, the anti-mask wearers, and those who are anti-vaccinations, who continue to oppose the pandemic restrictions. I’m also sure that if Julia Roberts were ever to be in conversation with Jacinda Ardern about her governments anti-smoking plans I doubt she would be saying ‘big mistake Jacinda, a big mistake’. As with her governments management of the pandemic, there is much we in the UK could learn about what improving population health might look like. 

Leaving smoking, caterpillar cakes and accident prone milk tanker drivers to one side, I could not post this blog without reflecting on yesterdays funeral of HRH the Duke of Edinburgh, Prince Philip. Like so many other families this year, the Covid pandemic impacted upon the arrangements for his funeral. It was a dignified, private affair that we could all, in our own way be part of. I thought the lack of crowds, the simplicity, perfect order, and completeness of the service would have met with both Prince Philips and Julia Roberts approval – it certainly met with mine. 

Blue Blood and Red Sauce: young people and public health

A blog writer’s life can at times, be quite unpredictable. I had been thinking of writing a blog about the apparent world shortage of tomato ketchup. Yes, it’s true. The supply of tomato ketchup has dried up, yet another victim of the pandemic. Covid restrictions have meant that bottles of the red stuff found on restaurant and pub tables could no longer be shared, so individual sachets were being used instead. Heinz announced last week that they were stepping up production by 25%.

Now you might be wondering why I wanted to write about tomato ketchup. It’s simple; public and population health. There is a connection I promise you. Last week I attended a couple of meetings where public and population health were the focus. In one meeting I heard about how young children in a North West community were being taught how to brush their teeth properly. It’s a small intervention that has surprisingly big benefits. Poor dental health in children is both costly to the NHS and of course very unpleasant and distressing for the child. What I didn’t know was that just five years ago, tooth decay was the most common reason for hospital admission for children aged between 5-9. Although improvements in child oral health continue to be made, today there are still too many children of a similar age who, on average, require 3-4 teeth extractions because of tooth decay.  Every tooth extracted costs the NHS £184, and in total the NHS is spending £3.4 billion each year on children’s dental care. It is an opportunity cost we need to tackle more urgently.

But of course, it’s not just poor oral hygiene that can cause tooth decay. What children eat will also have an impact. Much has been written about the so-called ‘free sugars’ that can be found in the food and drinks many children and young people eat and drink. Once upon a time I would drink a litre of strawberry milkshake each day thinking that, as it came from M&S (there are other food outlets) and was basically flavoured milk, it must be healthy for me. That was until I discovered just how much sugar it contained. I don’t drink it at all now. If you need reminding of the range of food and drinks that contain these ‘hidden’ sugars, have a look here.

Eating unhealthy food doesn’t just lead to tooth decay, it of course can lead to obesity. Which was the subject of the other public health meeting I attended. Today, lots of children, young people and many adults have grown up with fast food takeaways as part of their everyday diet. I’m constantly surprised at the queues of cars at nearly every drive-through McDonald’s I see. I simply don’t see what the attraction of a Big Mac or chicken nuggets is and I certainly would not sit in my car queueing up for one in any event. I’m not saying that I don’t like the odd pizza or cheese pie and chips, but I do at least walk to the takeaway to get it. However, true confession time, in my youth I did go to the forerunner of McDonald’s, the ‘Wimpy bar’. These were places to go to have a coffee (or a milkshake), share a portion of chips and meet up with your friends. As a young person, they were the place to be seen. In the early days, (before my time) as well as burgers, it was possible to buy ham or sardine rolls and cold frankfurter and pickled cucumber sandwiches! In the 1970s, it was possible to buy egg and chips, fabulous grills and the burgers only cost 21p. It was a wild time to be eating out.   

Sadly, by the mid-1970s, McDonald’s had started to take the market share away from Wimpy and many of the sit down to eat Wimpy bars were converted to counter service only. It didn’t halt the decline and today there are only around 70 Wimpy bars left in the UK. You can still find one in Huddersfield, Clacton, Dartford, and Porthcawl, but you won’t find one in Manchester these days. After the IRA bombing in 1996 Wimpy’s presence in the city disappeared. I was reminded of this on Friday when I saw some of the TV coverage following the announcement of Prince Philip’s death. The film showed him and the Queen visiting Manchester city centre in the aftermath of the bombing and there in the background was one of Manchester’s Wimpy bars.

I will return to the tomato ketchup story later, but clearly today I couldn’t post a blog without acknowledging the huge contribution Prince Philip made to the UK. It was, as others have testified, truly magnificent and far reaching. I first saw Prince Phillip 54 years ago. I was a Boy Scout and took part in an archery display in front of both the Queen and Prince Phillip. I next came across him when the Queen and Prince Philip opened the Geoffrey Manton Building at Manchester Metropolitan University (MMU) in 1996. I worked as a Senior Lecturer at the university and had been invited to take lunch with the royal party – well not at their table, but at least in the same room. When I moved to the University of Salford, it was to find out he had been their first Chancellor, from 1967-1991. Apart from a quick glimpse of him opening the MediaCityUK campus in 2017, I never saw him in real life again.

His legacy will live on. J is justifiably proud of achieving her Duke of Edinburgh’s Gold Award, awarded to her by Prince Philip, something she is quick to remind me of as we walk around Lancashire and the Fylde Coast using Google maps now to find our way around. Some 3 million young people have gained one of the three Duke of Edinburgh awards since the scheme was started in 1956. Providing opportunities for so many young people to learn about themselves, acquire new skills, build long lasting relationships and develop their resilience store is a legacy to be proud of for sure.

And finally, back to the tomato ketchup story line. We do know that, like many others, both the Queen and Prince Philip liked Heinz baked beans and their tomato ketchup. However, when I saw that picture of the Wimpy bar in Manchester, I remembered those little red plastic tomato shaped containers that were used to dispense ketchup onto your plate of egg and chips. I doubt they were ever washed out before being refilled each day. It’s a wonder we didn’t get food poisoning or even something far worse. As I noted above, it was a wild time to be eating out back then, and I am so looking forward to doing so again in the very near future.   

When Two Tribes Go To Work: there is a space for everyone

If I had the slightest Machiavellian tendency, I might have started this week’s blog with the story that suggested drinking alcohol in moderation cuts the risk of needing eye cataract surgery by a quarter. Cataracts are a common eye condition that leads to a deterioration in vision. If only Dominic Cummings had seen this research, he might have saved himself a trip to Barnard Castle to test his vision, thus completely undermining the UK Government’s Covid ‘stay at home’ message and simply nipped to Booze Busters instead (there are other shops). Of course, if I were truly devious, I would then somehow cleverly link this to the Prime Minister’s announcement last Monday that 60 million doses of the Covid vaccine Novavax will be manufactured at Barnard Castle. Johnson somehow managed to make the announcement without actually mentioning Barnard Castle in his speech. However, as regular readers of this blog know, I try and steer clear of politics and hopefully would never be that duplicitous.

So, leaving castles to one side, what I really wanted to talk about was offices. In my working career my office was like my second home. In fact, when I retired and brought home the contents of my office it caused major problems in where to find space for things. I don’t do minimalism. Surprisingly, since I retired from full time work, my office has now become a laptop perched on my knees as I sit on a settee in the lounge. My display screen equipment (DSE) advisor J constantly reports me for infringing health and safety regulations.

Strangely, I’m to gain a ‘proper’ office again on the 1^st May, but the reason why is embargoed until next Wednesday. I say strangely, as like many people, I have become very happy working from home and connecting with people virtually. I even took part in a Board development day last week that was facilitated over Teams, and it was one of the best development days I have been on for a long time. Personally, I think that for many people working from home during the pandemic has shown that productivity does not suffer, albeit that personal/professional relationships might be more difficult to engage with.

Unsurprisingly, not everyone agrees with this. Google, once the epitome of post-modernist office working is calling its staff back to their offices. The company has a division called Real Estate and Workplace Services. These are the folk who will make a return to the office a safe and reassuring experience for Google colleagues. They are charged with making Google offices as comfortable and creative as possible. This includes providing meals and diversionary amenities (there is a Google rule than staff should never be more than 100 metres away from food). The legendary Google office spaces won’t be the same, however. They will need to be Covid-safe environments, so much of the fun and creative cultural facilities will no longer feature.

Closer to home, there is much concern that while we are still rolling out the Covid vaccination programme and new variants continue to be found, returning to an office any time soon feels unsafe and risky. Not everyone agrees with this view, however. There are ‘two tribes’ with differing views on this subject. Chancellor, Rishi Sunak (and his boss Johnson) both caused outrage over their suggestions that people are sick and tired of working from home and want to get back to the office asap post lockdown. They may be right. Perhaps there is a whole group of folk that would like nothing better than travelling through rush hour traffic, in all weathers, to sit in an uninspiring office, where each day’s start and finish time, meal breaks and so on is regulated, but of course they no longer have to wait in for those pesky Amazon parcels to arrive.

I’m not in this tribe. I think Sunak and Johnson have misread the vast majority of folk who have proved time and time again over the last 12 months that they can do their job just as well, even more productively working from home. I’m in this tribe. Yes, I miss the coffee and corridor chats, but I don’t miss the commutes. I've been able to meet more people (albeit virtually) during the last year than I would have been able to do if travelling to and from meetings.

So, will I use my new office come the first of May? Well yes, I will. However, will I be returning to every meeting having to be face to face? No, I won’t. Will I be going into my office every day? Absolutely not. I don’t think I’m alone in thinking like this. Many companies are actively engaging with the fact that where people work, and how productive they might be, is not going to be dependent on a 9-5, working week. Companies like BP, Price Waterhouse Cooper, Microsoft, Unilever and Nationwide are all actively introducing greater flexible working and/or permanent working from home approaches. People have appreciated the new freedoms working from home have brought. Work-home-family-life relationships have been, in many cases, easier to be more positively balanced.

Of course, not every job can be undertaken by working at home. We have all been grateful to all those people who during the last year have helped keep us safe, fed, warm and cared for in some dark and challenging times. Many folk describe them as heroes, and they have certainly been courageous and brave. Our gratitude for what they have done for us all should never be allowed to diminish. 

Finally, I was glad to hear of the creation of a new Office for Health Promotion by the UK Government. This was showcased in last Mondays ‘Transforming the Public Health System: reforming the public health system for the challenges of our times’ publication (well worth a read!). I’m sure they will have already clocked that there are other ways to safeguard our vision than travelling to Barnard Castle.