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.