Save one life, you’re a hero. Save 100 lives, you’re a nurse

Queen Victoria reigned for nearly 64 years. She did so through a period of immense industrial, social,  scientific and political change. Our present Queen, Elizabeth II, has already been on the throne for longer than Victoria, and next year will celebrate 70 years as Queen. She will be the first king or queen to have reigned for seven decades. Like Victoria, Elizabeth has witnessed much change both here and internationally during her reign. The Queen’s celebration will be her Platinum Jubilee, and as well as the promised ‘once in a generation show’ we will all get an extra Bank Holiday next June. Let’s hope we have turned a corner in dealing with the pandemic by then.

Queen Victoria perhaps gave the nation something a little longer lasting than an extra day off, with the funds raised through her Golden Jubilee celebrations. In 1887, she was persuaded by a chap called William Rathbone, along with two Florence’s (Nightingale and Lees), to make a donation of £70,000 (nearly £10 million in today’s terms) from her Golden Jubilee funds to nursing. The money was used to continue the work Rathbone had started, using his own money, to train and educate the precursor to the modern day District Nurse. He wasn’t a nurse, but was passionate about nursing and the difference nurses could make to people’s lives. He was an early ‘expert through experience’, something that possibly sparked his philanthropy. You can get a glimpse of his story here. It’s fascinating.

The early Rathbone training programme produced 18 trained nurses, all of whom went on to work in different districts across Liverpool. From the very beginning the role of the District Nurse was to promote health and prevent illness rather than only simply treating the sick. Their clinical arena was the patient’s home. The role of the District Nurse today still has these elements at its core, albeit the world and indeed the nursing profession have changed significantly since that time. Queen Victoria’s money (plus an additional £68,000 she donated from her Diamond Jubilee funds) was used to establish the Queen Victoria’s Jubilee Institute for Nursing, now a charity known as the Queen’s Nursing Institute (QNI). You can read about their history and work here.

Whilst contemporary health policy has foregrounded integrated care being provided at place (neighbourhoods and communities), the pandemic has focused on our acute hospitals and the unimaginable demands they have faced during the last 18 months. However, despite the pandemic appearing to be in a less ferocious phase, our hospitals are busier now than they have been for many a year. The demands upon our emergency care, children’s and ambulance services are unprecedented. In acknowledging this, I am also mindful of the work that goes on every day in primary and community care. District Nurses are very much in the frontline of this work.

So last week it was great to be able to venture out of the office in Stockport and meet some of my District Nurse and Community Nurse colleagues. Interestingly for me, my first stop was on the 9th floor of an office block, which housed a group of people providing our ‘discharge to assess’ service. This service model was introduced by the UK government last year and was aimed at improving the flow from acute hospitals to the community, avoiding emergency re-admissions and facilitating an individual’s recovery at home rather than in a hospital bed. Additional funding was made available to provide care post discharge for up to six weeks. Unfortunately, this funding might cease in September this year.

What impressed me about what I saw and heard described was the way in which my colleagues had developed this service. They did so without much in the way of official guidelines, but from what they knew might be a way forward based upon their own experience. So, across what looked like any other call centre was a very sophisticated operation that picked up individuals who were medically fit to leave hospital in order to get them home and supported until such time as they were able to look after themselves. District Nurses played a part, but so did other healthcare professionals, social workers therapists and other care professionals. There was a link, (in real time) to our emergency department (ED) dashboard so that early intervention could be put in place before folk were sucked into the ED system. Equally impressive was the work that was being done with people who lived with long-term conditions. They could be supported to live in their own homes and when and if they needed a little bit of support to help them stay there, it was available.

Which brings me to Tina. It’s her real name, and I can only apologise for not asking her permission to include her in this blog. I have asked her to come and speak to our Board in October so maybe she will accept this is a bit of a long-winded introduction to that presentation. Tina has been a District Nurse for some 27 years. That in itself is remarkable. She had a great story to tell of her journey, which it would be unfair to share here. She can choose to do so at our Board. Suffice to say, it was a story that acknowledged great change, but more impressive for me was her notion that the story was never ending. If I ever need the care of a District Nurse, I know I can rest easy in the knowledge that those attributes Rathbone wanted to see as an outcome to the training and education of future District Nurses is right here, right now, and can be seen in those District Nursing folk who, each and every day, #makeadifference to so many people.

A mother’s love will conquer all

One of my proudest possessions when I was a teenager was my Afghan coat. Wearing one was all the rage at the time. The Beatles and Jimi Hendrix favoured them (younger readers ask your parents who these folk were). Wearing it, I thought I was the bees knees! It was long, almost reaching to the floor, and was embroidered with brightly coloured threads. I don’t think it actually came from Afghanistan, (although many did in the late 1960s) - mine was probably a cheap copy originating from Turkey or Iran. Sadly, I no longer have the coat or pictures of me wearing it. Although you can still buy these coats today, most are made from faux sheepskin and are almost guaranteed not to have that unique smell the originals had.

In my hippie days I would have loved to travel to Afghanistan, but since the late 1970s, it has not been a particularly safe part of the world to visit. Today, it is even less so. I’m sure like many others, readers of this blog will have been affected by the developments in the country following the withdrawal of Western troops. It’s not the place of this blog to challenge or defend the decision to withdraw our troops, that is for others to do, but I don’t understand what it is we are doing. I find the reality-denying responses from our government deeply disturbing.

The images of desperation, fear, anger and panic have filled our TV screens and newspapers all week. It’s been heart-breaking to watch. People whose lives had been relatively stable suddenly finding themselves in the middle of an unrelenting living nightmare. It is hard to imagine what people are going through. The fear of what life might now be like under the Taliban has given rise to chaotic scenes at Kabul airport. The sheer desperation of people trying to reach safety has been agonising to watch. What has made it all the more difficult to witness is the knowledge that many of those trying to flee will simply not be evacuated to safety.

The most upsetting images for me was seeing mothers handing over their babies and children to the Western soldiers in an attempt to protect them from a life under the Taliban. That has to be an almost unbearable decision to take. As a man, I have no idea what a mother’s love for her child must feel like. I have often witnessed such love, and in the main it is powerful and unconditional. It was the bestselling US author Kristen Proby who once said of her child: ‘No one else will ever know the strength of my love for you. After all, you are the only one who knows the sound of my heart from the inside’. Those mothers in Afghanistan, who made the heart-breaking decision to give up their children to others, knowing they would be most unlikely to follow, absolutely showed the power of a mother’s love.  

I saw a mother’s love in a couple of very different contexts last week. The first was in a report of the start of a successful Covid vaccination programme in Bolton for young people aged 16 -17. Over the last two weeks in England, when the green light was given to start vaccinating these young people, 125,000 16 and 17 year olds have had their Covid vaccination. Up to yesterday some 3,550 young people under the age of 18 had received their jab. What I thought was amusing about the approach were the reasons some of the teenagers gave for getting jabbed. It wasn’t anything to with promises of a Deliveroo discount, or cheap Uber rides or eats. No, it was mums. One (unnamed) 17 year old girl explained that she had had the vaccination because her mum had told her to! A different kind of mother’s love, I guess. Likewise, Arsalan Azhar (aged 18) said he was just obeying orders from his mum. He said ‘I would have liked to have had some incentives, but it was due to my parents, who will be more relaxed now’ which I think is a quite remarkable attitude for a young person of his age.  

Well done to all those involved in getting things moving so well in Bolton. Let’s hope other towns can do the same. The other story last week was from work. One of my colleagues brought in some pictures of her son. He is a toddler, about the same age as some of the children handed to soldiers in Kabul. My colleague was justifiably proud and her eyes shone with love as she showed the photos to us. In one of the photos the little boy was playing with those stacking blocks that children can use to build a tower. I have never yet met a child who, upon learning how to build the tower, doesn’t immediately then knock it down. I have played this game endlessly; children thankfully grow out of it. Build it up, knock it down, build it up, knock it down. It is such a simple toy, but such a clever one too. It teaches children a range of skills, colour recognition, co-ordination, counting and spatial awareness. Building up and knocking down blocks is also great fun.

Which brings me to Beales. Yes, Beales the department store. I know what you are thinking but bear with me. I’m building on building blocks and possible new ways of providing health care services. Beales have agreed a deal with the NHS to convert the top floor (some 17,000sq ft) of its store in Poole into a clinical area for tests, screening, and vaccinations. The plan is to provide orthopaedics, dermatology, ophthalmology and breast screening departments as well as space for those folk living with long Covid. It’s a clever idea, which also makes sound business sense, as the store anticipates an extra 150,000 people coming through their doors each year. I don’t suppose these days that it’s possible to still buy an Afghan coat from Beales, but never mind, what an inspired idea. I hope other places follow this approach.

The story resonated with me for two reasons. (1) what a great way to bring our fading high streets and town centres back to life: (2) my mother and father went to Poole for their honeymoon and one year later I was born. I have enjoyed my mother’s love ever since.

A Picture of Health (and Wellbeing)

It was great to see so much joy and happiness last week as the GCSE and A-level results were announced. I tried to avoid the discussions about possible results creep, or whether the assessments were fair and equal. Whilst it is important to acknowledge the messages around inequalities and the possible impact on grades achieved, I just thought it was a really good news story. After the last 18 months, I’d say well done to all those who got what they wanted, and to all those who perhaps didn’t quite get where they wanted to be, don’t despair, and don’t ever quit.

I can’t remember much about my school days, and I think my school experience was pretty rubbish. Probably might fault as I wasn’t remotely interested in studying. My ambition was to become a lumber-jack. Although I did work in the Welsh forests for a while, I never became a lumber-jack. It was only in later life that I took an interest in my education, and have revelled in pursuing lifelong learning opportunities ever since. I still have gaps in my knowledge. For example, I didn’t know there was such a word as ‘incel’ until this week, when I read about the tragic events in Plymouth. I’m still struggling to really understand what the term represents.

Although I experienced a poor early education, I think I may have done okay. I successfully trained to become a registered nurse, gained an MBA, and was awarded a PhD. I have been a trainee supermarket manager, window dresser, blacksmith administrator, nurse, university Dean, doctor, professor, and on retirement, a Chair of a NHS acute hospital. Not bad for some one who left school with just a couple of O-levels (the precursor to GCSEs), one of which was art. So, if you or your children didn’t get the grades they hoped for, tell yourself or them never to give up hope, there are lots of different opportunities out there to help you find your way in life. And to this day I still have a Husqvarna chainsaw in my tool shed.

Despite gaining an Art O-level, I’m not an artist. I can’t paint, draw or sculpt, but I am creative, and have an eye for good design. I have long enjoyed a love of surrealism, and have used this passion in my teaching, writing and conference presentations. Alongside the celebrations of our young people's successes, there were also a couple of different stories about art itself in last week’s news.

The first, of course, was the erroneous claim that the Prime Minister had spent £100,000 on two paintings for number 10 Downing Street. There was the usual media outrage at this expenditure. The main thrust of which was the challenge that with so many people struggling financially across the UK, and the very real possibility of benefits and other support disappearing, was it the right time to be buying paintings? The fact that the purchase of the paintings was nothing to do with the Prime Minister didn’t seem to matter. There was more anger expressed about his alleged purchases, than anything we have so far seen over the 130,000 deaths from Covid 19 in the UK. The paintings were actually purchased by the Government Art Collection, a body completely independent of any political affiliations. It cares for over 14.500 works of art, and regularly adds to the national collection.

In, any event, my feeling is that any government worth its salt, should be spending money on benefits and art and the wider expressions of culture. Sadly, many public sector organisations that choose to spend money on the arts almost inevitably attract the kind of outrage seen this week over the Downing Street paintings. Remember the outcry there was a few years ago when Tameside hospital spent some £18,000 on steel giraffes. Last year York Hospital were criticised in the media for spending £21,000 on works of art for their new endoscopy unit. However, there are other more enlightened examples to be seen, have a look at this website for the Oxford Health Foundation Trust and the work of their artists in residence. It is fascinating and something we are exploring in my own Trust.

The other art story in the news last week featured the street artist Banksy. This well known artist from Bristol has maintained the mystery of his identity for many years. His works of art often appear overnight and always, at their heart, contain a message about how he interprets society’s problems and issues and where he stands in relation to these. The reason he was in the news last week centred around speculation as to whether a series of new Banksy style paintings seen in a number of seaside town on the East coast were actually created by him.

He uses a stencil and spray paint cans to achieve his artwork, an approach that allows him to get his painting onto a wall quickly and effectively. It is an unusual technique, and some more traditional artists don’t see his work as art at all. I’m not one of them. That art O-level I got; well, it was based upon a portfolio of collages I had created. I used the images, colours and words of others to create my own pictures. Like Banksy, but much more naively, they were all expressions of my view of the social world I lived in. Unlike Banksy, my body of work has long ago disappeared.

Eventually Banksy confirmed that he was indeed responsible for the new works of art at the different seaside resorts. Last week, he posted a video clip on Instagram he called ‘A Great British Spraycation’ which shows him in different places on a summer road trip, and actually working on some of his art.

In March of this year one of Bansky's pictures raised £16.7 million for UK health charities at auction. The painting, on canvas, depicted a child playing with a toy nurse, instead of the superhero toys Batman and Spiderman, seen peeking out of the child’s toy basket. He presented the original painting titled Game Changer, to the University Hospital Southampton, at the end of the first lockdown. 

It had a note attached to it saying: ‘Thanks for all you’re doing. I hope this brightens up the place a bit, even if it’s only black and white’. The original was hung on the hospital wall for a few months, before being replaced by a copy, allowing the original to be auctioned off. It was a wonderful gift, given in acknowledgment of those who had given so much for others. The money raised will see the benefits of his gift touch the lives of many more folk.  

The unique you: Planes, Ships and Automobiles*

Travel featured a lot in the news last week. I’m much too apolitical to mention Alok Sharma and his many jollies across the world, or our Prime Minister’s flight back from visiting Scotland sitting next to an aide who tested positive for Covid. Apparently both people are exempt from having to isolate.

I did notice that the school holidays have meant quieter roads for the daily commute, but long delays at the weekends as families start or finish their holidays. Twice last week, Manchester city centre was completely gridlocked due to there being no trams running. It wasn’t much better on the ocean waves. The Scarlet Lady, Virgin’s first ever cruise ship had a much delayed departure due to passengers having to queue to get a ‘rapid’ lateral flow Covid test. Some folk had to wait nearly five hours to board the ship. Cruise holidays don’t appeal to me, particularly as this one was only sailing around the UK.

That other big ship, the Ever Given, was also back in the news last week. The giant container ship finally arrived at Felixstowe some four months later than planned due to getting stuck in the Suez Canal for six days. The computer I’m writing this blog on is made by the Chinese company Lenovo, who had many millions of pounds’ worth of goods stuck on the stricken vessel. Hopefully, all those containers are now finally on their way to their various owners.

If your really wanted an out-of-this-world holiday experience, and you have a spare £325,000, Richard Branson is also offering seats for his flights to the edge of space. I haven’t got a spare £325,000, and even if I did, like cruise holidays, space travel doesn’t appeal. In fact, and much to J’s disappointment, I’m not a big holiday fan. These days I feel there is even more of a disincentive to travel anywhere overseas. The high cost of testing and the potential of having to isolate or stay in a self-pay quarantine hotel on my return, simply doesn’t appeal. I doubt I qualify for exemption either. Taking a break and not travelling abroad can also be fraught, as J and I found out last weekend. Certain areas of the UK are becoming extremely crowded and very busy as the Summer moves on.

Booking holiday accommodation has, in some parts of the UK, become almost impossible and definitely more expensive, and you try buying a tent, or finding somewhere to pitch it when you do! Like cruise holidays and space travel, camping doesn’t appeal to me either. That said, I absolutely understand why so many folk working in health and care services are desperate to take some annual leave, and to take it as soon as they can. Talking to some colleagues, the turbulence and unrelenting pressure of the past 18 months has made it difficult to take proper time off, and even where this has been possible, the lockdowns and restrictions have made going away somewhere much more difficult.

Even before the pandemic impacted upon all our lives, only one in three working people actually took all their annual leave entitlement. It’s a strange phenomenon, but one I’m very familiar with. Before I retired, I seldom took all my holiday entitlement and if I did go away, I would often take both my laptop and phone with me, so as to keep in touch with work. In terms of maintaining a healthy life / work balance, it was completely stupid. My mind had no time at all to switch off from business. I didn’t do what I told others to do. Failure to achieve that healthy balance brings with it all sorts of consequences. It can impact upon relationships, lead to excessive tiredness, which in itself can lead to accidents, lack of productivity, depression and a general sense of malaise.

So, it’s important that together, individuals and the organisations they work for, find ways to ensure that all staff can take off the time that they are entitled to. Everybody needs time and space to relax, unwind, recuperate and recover. Holidays can be a great way to find this time and space. Of course, what one person thinks of as being the perfect break; a cruise, a space trip or even camping, others might see as something they would never call a holiday. We are all unique when it comes to deciding what a good break might look and feel like. My best holiday was walking the Coast2Coast walk, some 182 miles done over 13 days. Now that is not going to be everyone’s cup of tea.

What was definitely my cup of tea last week was signing the Dying to Work Charter with Karen James, our CEO, for our hospital, Stockport NHS Foundation Trust. You can read about the campaign here. Getting a diagnosis of a life-shortening condition is likely to be devastating and everyone will react to the news differently. Understandably, some people might want to pursue every treatment option available, others might want to stop work and try and do as many things on their ‘bucket list’ as possible, while others might choose to remain at work for financial security and/or the social benefits that belonging to a group or a team can often bring.

Our staff are critical to all that we, as a health care provider, strive to do. The health and well-being of every individual member of our staff is really important to us. Signing the Charter shows our organisations commitment to ensuring that any member of our staff with a terminal illness receives the support and peace of mind at a time when they need it most. It’s about enabling folk to choose the best individual course of action for themselves and their families and supporting them all through what will be a challenging time. Everyone’s experience of this time will be unique and we need to be there with, and for them, every step of the way.

 

* Apologies to John Hughes       

Climb Every Mountain: make a difference

It’s great to be retired. Last week, on Tuesday and Wednesday, I had just a couple of meetings each morning, so as the weather was good, I took myself off for a decent walk. I walked 12 miles the first day and 8 miles the next. Both were along the coast and the sunshine and sea were incredibly uplifting. I am so fortunate to live by the sea and yet have the hills of the Lake District in view and within an hour’s drive away. Indeed, yesterday J and I returned to Helvellyn and completed the Striding Edge walk we had to abandon a couple of months ago due to bad weather. At 950 metres high, it is the third highest peak in England. The Lake District hills have stood for millennia and thousands of people have walked and climbed them throughout all that time. As a National Park, the Lake District is truly stunning.

Their appeal has been their undoing as well. A new sign has gone up on the motorway on my journey to work that declares ‘It’s a National Park, Not a car park’. This refences the problems visitors and more importantly local residents have with huge numbers of cars that pitch up in The Lakes most weekends and during school holidays. Unlike London’s new high peak, the Marble Arch Mound, which proudly stands at a magnificent 25 metres high, giving ‘striking views of London, and the park, and a new perspective of Marble Arch itself’. Despite the longevity of the hills in The Lakes, this new green mound will only be there until January 2022. Unlike the popularity of the Lakes, the Marble Arch Mound is facing an uphill struggle to attract visitors.

Perhaps those on the Marble Arch Mound, like the hills in the Lakes, at times you can feel like you are the only person for miles around. It can give rise to a profound sense of being alone and at one with the landscape. Being alone and loneliness are not always the same thing. Last week I heard an emotionally challenging and heart-breaking tale of real loneliness. It was also a tale of great courage, determination and service to others. It was Steve’s story, a story told on the wonderful Radio 4 New Storytellers series. You can hear Steve’s story here, but the title of the piece, ‘He’s only a cleaner’ perhaps gives you a sense of how the story is told. I listened to it while driving home the other day and had to pull over and stop to give the story my full attention. Steve’s story is what it was like to work as an industrial cleaner during the pandemic.

Just listening to his description of donning and doffing his PPE brought me out in a sweat. Having to do this often several times a shift must have been very difficult. He describes the isolation he encountered when he was fully kitted out, unable to verbally communicate with others and the necessary reliance on hand signals to keep him and his colleagues safe and protected. And please don’t judge me as facile when I say I shall never think about gaffer tape in quite the same way again.

Steve’s sense of isolation and loneliness continued even when he finished work. The UK was in a national lockdown and facing hours alone in his flat was very depressing. His plea for us all to obey the rules, get vaccinated and get us all over the finishing line was heart-breaking. We have sometimes only thought of the more traditional professions as being the important key workers and heroes during the pandemic. They certainly were, and continue to be to this day. Steve’s story, however, also brings into sharp relief the army of other folk who, while many of us isolated during the various lockdowns, carried on and kept us safe, fed, warm, and secure. Many of these people, like Steve, were also among the lowest paid members of the workforce.

These hidden members of the key worker workforce was something I was able to discuss with a Councillor friend last Thursday. We sat in splendid isolation in the magnificent surrounds of Stockport Town Hall. It was completely deserted apart from us. The public are still not allowed in. The building is a fabulous testament to times gone by. It was opened in 1908 by the then Prince and Princess of Wales. The Prince was later to become George V, King of the UK, the British Dominions and Emperor of India. His reign saw much change. George witnessed the rise of socialism, fascism, communism and, in the UK, the establishment of the supremacy of the House of Commons over the unelected House of Lords. Ok, we are done with the history lesson. However, given the recent news stories about the Sunderland Nightingale Hospital (cost £23 million and never treated a patient) and the numbers of refugees crossing the English Channel, I found it interesting that the Town Hall Ballroom, (see it to believe it), served as a hospital during WW1 and was used as a home for refugees from across The Channel during WW2.

Seeing the Town Hall, was like witnessing a golden thread that runs through our nations approach to how we have long reached out to help others.  I say that in full knowledge that many folk have some justifiable concerns over many aspects of our Empire and colonial past. And last week I thought there was another golden thread to see. It was in the appointment of Amanda Pritchard as the new Chief Executive of NHS England. She has, in her previous role, demonstrated a values-based approach to leadership. For me, her appointment is hopefully a symbol of continuity and stability in a still turbulent post-pandemic world. She may have a mountain (higher than Helvellyn), to climb in terms of leading the NHS and social care, but if anyone can do it, ‘this girl can’. That said, leadership at her level can be a lonely place to be. Unlike Steve’s experience, I hope Amanda has plenty of good people around her, to be with her, and support her in taking those first few leadership steps on our journey into the known unknown.   

 

Ps – many congratulations to Iavad Forough, a male nurse and first time Olympian, who last week, successfully climbed his own mountain, and gained the first gold medal for Iran in this year’s Olympics – well done from all of us in the international community of nurses