Sunday 25 December 2022

There was more than one lobster at the birth of Jesus?

Well, here we are on the last Sunday of 2022. It is, of course also Christmas Day. Christmas Day falling on a Sunday is a pretty unusual event. I wonder if any of my readers can remember the last time Christmas Day fell on a Sunday – the last time was in 2016. In fact, in the entire time I have been writing my Sunday blogs, Christmas Day has only fallen twice before on a Sunday – 2011 and 2016.

After many years of hosting Christmas and Boxing Day celebrations for my family, this year, ours will be a quiet Christmas, spent on our own. That said, we started to celebrate Christmas with our family before this weekend and will do so again after today. I like to think about it as an extended family party.

Of course, Christmas isn’t just about having a party. In our own ways, J and I have a faith that celebrates Christmas as an important Christian holiday. The nativity plays an important part in the Christian liturgical year. To us the birth of Jesus is much more than a Christmas story to be depicted in a school play, a nativity manger scene or on a Christmas card. The best description of the nativity I’ve heard in a while was last week’s Radio 4 programme, Moving Pictures, which featured Sandro Botticelli’s painting the Mystic Nativity. If you have 30 minutes to spare, have a listen here. The importance of the birth of Jesus was something reinforced by our long-awaited pilgrimage to the Holy Land this year, which included a visit to Bethlehem. It was a very special and spiritual trip.

One of the things often seen in most nativity manger scenes are the biblical Magi – more commonly known as the three wise men (or Kings). They were said to have travelled far to bring gifts to baby Jesus after his birth. And of course, the giving of gifts is an important part of Christmas whatever your beliefs. It is something I love to do, and I will buy gifts for folk all through the year ready to give out at Christmas. For some reason, last year, J and I decided not to give presents to each other.

However, last Christmas Day, J seemed rather disappointed so it’s not something we are repeating this year*. The experience reminded me of another Christmas story, The Gift of the Magi by William Porter (better known by his pen name O. Henry). It is a familiar story. A young married couple give up something that is very special to each of them in order to buy the other something they might find precious. The girl sells her long hair in order to buy a chain for her husband’s pocket watch. The husband sells his pocket watch in order to buy a set of ornamental combs for his wife’s long hair. Thus, the gifts they bought for each other cannot, at that moment in time, be used. However, they both know how far they went to show their love for each other, and just how invaluable their love truly is.

Which is a great place to leave my last blog of 2022. I shall be watching my favourite Christmas film Love Actually later. After my number 1 favourite quote from the film ‘There was more than one lobster at the birth of Jesus?’ (I’m sure those with children or grandchildren will know what this means) I do like ‘I have a sneaky feeling, that if you look for it, you’ll find that love is actually all around’. Given the troubled times of the last year, let’s hope folk everywhere can share more love and less hate in 2023. Happy Christmas everyone!

 

*There are presents under our Christmas tree, which will be opened later.

Sunday 18 December 2022

Moving through the Sliding Doors of Parallel Realities

Well last week was certainly a funny one. At times I felt completely divorced from one reality, although totally immersed in another. It reminded me of that film ‘Sliding Doors’. Last week I was pleased to be able to honour all the tireless volunteers who give their efforts freely week in week out at our Trust, by helping serve many of them with a delicious festive feast, alongside our Chief Exec Karen. Disappointingly the unstinting support of these hundreds of folk and their desire to make a difference for patients and families didn’t make any of the weekend papers.

Last Sunday the news was full of the French football team knocking us out of the World Cup. Not that I paid much attention. There are far more important things in the world to be concerned about than football. I won’t be watching the match later on today either. I don’t sit in the camp that thinks the Qatar World Cup has been a great success. I suppose it depends on how you view the event, but I don’t think it was successful from any perspective. The regime is still oppressive, uncaring, and as we saw last week, with the revelations from Brussels, still corrupt.  

I shall instead, be celebrating Christmas at an annual Christmas get together with friends and colleagues from University and NHS times. They are mainly nurses, and folk who have been nurses for a long time, both in practice and in education. We are all feel immensely privileged to have been part of a profession that has a long tradition of compassion and kindness. Coincidently one of the other things I was proud to be part of last week was presenting long service awards to a group of my colleagues who collectively, had contributed some 2610 years of service to the NHS. Each one of my colleagues had worked at least 30 or 40 years in the NHS, absolutely amazing. And so last week I was saddened by the nurses’ day of industrial action. Although no nurses from my Trust or indeed, any NHS trust across Greater Manchester took part in the industrial action, I felt it was a sad day for the profession.

That said, I have every sympathy with those nurses who feel that they have no option but to take industrial action in order to get something more substantial than a Thursday clap to demonstrate the way society, and our government value the profession. As I have noted before, a 19% pay award is probably unachievable, but that should not be a reason not to keep talking and find a way forward.

Mind you, I don’t have, and never have had, any time for the Royal College of Nursing (RCN). I have long thought they have lost their way. Robert Carr’s recently published report into the RCN, which revealed a bullying, and misogynistic culture and a senior leadership team that was ‘riddled with division, dysfunction and distrust’ would seem to bear out my view. I think partly my issue with the RCN stems from the apparent confusion that exists between their role as a trade union and a professional body.  

I have never been a member of the RCN, so my observations are made from afar. Nonetheless, that doesn’t make them any the less worth considering. Likewise, I have never been a member of, or an employee of, the World Health Organisation (WHO), but that won’t stop me from commenting on an announcement they made last week. It concerned the appointment of two new employees, Dr Jeremy Farrar, the new Chief Scientist and Dr Amelia Tuipulotu the new Chief Nursing Officer. What I found interesting was the way the WHO described the two roles.

For example, Dr Farrar was described as bringing together the best minds in science and innovation from around the world to develop and deliver high quality health services to the people who need them most. On the other hand, Dr Tuipulotu was described as someone who will champion, nurture and support nurses and midwives to ensure their skills and experience are being well utilised to strengthen health systems and to bolster their critical role in bringing patients, communities and national health systems together.

So far so good perhaps. It was when the WHO Director-General, Dr Tedros Ghebreyesus spoke that I began to wonder. He described these appointments as: ‘As Chief Scientist, Jeremy will accelerate our efforts to ensure WHO, its Member States and our partners benefit from cutting-edge, life-saving science and innovation. As Chief Nursing Officer, Amelia will ignite the all-important need not only to fill the gap in health workers worldwide, but also ensure they receive the support they need and deserve’. Somehow these descriptions seemed somewhat unbalanced and for me, disappointing in the way the nursing profession was being described in comparison to the practice and place of science in the world.

Of course, we all saw the benefit of the work of both groups during the Covid pandemic, and the WHO as a ‘global organisation for good’ continues to make a difference to so many people worldwide. And if you fancy working for the WHO, you can apply here. The other thing we benefited from during the pandemic was the ease of online shopping. I read with amusement the news that Amazon workers in Coventry have voted to go on strike. They are doing so for the same reasons as the nurses, and it’s not just about money. Once again, I felt I was entering through the sliding doors of a parallel reality where striking Amazon workers would be viewed as more important to us all than striking nurses. For all our sakes, I hope not.


Sunday 11 December 2022

Float like a butterfly - touching connections

It was in 1963 that the meteorologist and mathematician, Edward Lorenz first started to use the analogy of the butterfly effect to explain chaos theory. Despite apparent chaos, everything is connected. So, something that happens in one part of the world could result in an impact somewhere else in the world. The example often cited is that if a butterfly flaps its wings in Africa, it results in a storm across Europe. Of course, in real life the proposition is slightly more complex than in this popular usage. For me, I have always used it in my supervisory relationships with my PhD students to help them track connections between phenomena and outcomes. Over the last 13 years of writing this blog, I have enjoyed making similar connections in the telling of my stories. This week is no exception. I am going to start these connections by mentioning my dad.

My dad is 93. He’s having a hard time right now. My mum is living with dementia and the strain on their 69 year old relationship is difficult to witness and to be part of. They live in Wales, but across the whole of the UK, the number of people living with dementia is estimated at more than 850,000. Each case is a tragedy for the individual and their family. It is said there are 540,000 carers of people living with dementia in England. The impact on the carers’ lives cannot be underestimated. Many will be family members. As the impact of dementia becomes more challenging as the disease inevitably progresses, so the demand on families to support those living with dementia grows.

Our family is no different to millions of others, and I am very grateful for all that my brothers and sisters do to support my parents. Given we are spread all over the world, it is truly amazing. We are, nevertheless, reaching the point where the support needs to shift more to professional input and there are some difficult decisions that we need to help my dad work through.

I was pondering this last week when Radio Four reported the death of George ‘Jonny’ Johnson, at the age of 101. George was the last surviving member of the 617 squadron. For younger readers, this was the squadron that was formed to destroy the Mohne, Eder and Sorpe dams in the Rhur Valley which powered the German war production factories during the Second World War. Unsurprisingly, perhaps, the 617 squadron was called the Dam Buster squadron, and no, my dad was not involved. George was just 21 years old when he took part in the 1943 operation, which famously involved the Barnes Wallis’s experimental ‘bouncing’ bombs.

The attack, which was successful, was carried out on 16th May 1943. 19 planes were lost, 53 men died and three were captured. Interestingly the film, ‘The Dam Busters’ was first shown in British cinemas on 16th May 1955. I doubt my dad went to see it, as I had been born less than 24 hours previously. However, it was one of the first films I remember my dad taking me to see at the cinema. Whilst I can’t remember much about the film, the memory of my dad taking me to watch it, is very strong.

Likewise, in July 2018, I was at the live ‘The Wall’ concert, performed by Roger Waters (Pink Floyd) which was a feast of great music, wonderful lighting effects and of course the building of a vast wall in the arena. Samples from the ‘Dam Busters’ film were projected on to the wall as it was being created and eventually destroyed. The Roger Waters concert was at what was then called the MEN arena – now called AO Arena. We were due to go to this venue next week to see Rod Stewart – sadly, due to the train strikes we can’t get there and have had to sell our tickets. I have been a long-time fan of Rod and have seen him many times, the last time being at the Lytham Festival in 2019 where I was gifted VIP tickets. It is disappointing not to be able to see him one last time. Of course, the train strikes are just one of many threatened or planned strikes occurring over the next few weeks

It does seem as if we are heading for a Winter of Discontent once again. I well remember the first one in 1978/79. The winter weather that year was also severe, the coldest for many years. Many different private and public sector organisations also went or threatened to go on strike. Then as today, rail, transport, grave diggers, dustbin-men and even the ambulance service took prolonged industrial action bringing huge disruption to many people across the UK. There is another interesting connection to those times, occurring today.

The Royal College of Nursing voted at their conference in January 1979 to ask for the pay of nurses to be raised to the same level in real terms as 1974, which would have been a 25% pay rise. On the 22nd of that month, many public sector unions, including several nurses, took part in a ‘Day of Action’ – a 24 hour strike and protest march. David Ennals, the then Secretary of State for Health and Social Services reported that 1,100 of the 2,300 NHS hospitals were only treating emergencies. Patients with cancer had their essential treatment delayed and/or even stopped. It was a torrid time, and like the war in Ukraine, I never thought it might happen once again in my lifetime. Ironically, the first winter of discontent saw the Conservatives take power, and Mrs Thatcher, the first UK female Prime Minister, began her 11-year premiership. However, I predict despite the connections with history, this is an unlikely outcome for the Conservative Party following this winter of discontent. Sadly, for my mum and dad, and many others like them, it is also likely to mean that they won’t get the timely response they need from health and social care services.

Sunday 4 December 2022

Christmas is not just a story of hope; it is hope

Last Thursday, just like that, we slipped into December and Christmas loomed large on the horizon. I’m not sure where 2022 went. It feels to have been a mere blink of an eye since I was writing about my #earlyrisersclub friend Kenny Gibson getting his MBE and me enjoying walking on our beach. Perhaps I shouldn’t be surprised at how fast the year has flown past. Much has happened, and continues to happen that we simply weren’t expecting. The most poignant, sad and evil event, was of course, the invasion of Ukraine. It happened just 53 days after I posted that first 2022 blog. It is a truly devastating war; a war that has now lasted 284 days and which shows no sign of ending.

There were a few occasions last week when I stopped and thought about the devastation, the destruction and the complete disregard for human rights that the war has brought to the lives of the Ukrainian people. For example, last Wednesday I was, for the second time, outside in the bitter cold, up a ladder, fingers and ears numb with the biting arctic wind, putting up Christmas lights. I had done it once already this year with what I thought were stunning coloured lights, lights that slowly changed colour and almost made the house glow.

I found myself up the ladder again for a second time as J had reminded me that she really only liked white lights. I grew frustrated that my cold fingers were making the task twice as long and cursed J for not telling me her preference before I put the first lot of lights up. 

But I had a sudden thought about the folk in Ukraine, where life was already becoming more miserable and unbearable because of the fast approaching winter weather. I wondered if families there were getting ready for Christmas and what Christmas would be like for them? My cold hands and grumpy thoughts paled into insignificance in just thinking about what they are going through. 

Mind you, Friday morning I woke up in what felt like to me as the coldest bedroom I had ever slept in. The previous evening I had attended the #PennineCarePeople awards celebration held in the centre of Manchester. I was pleased to have been invited by my Pennine Care NHS FT colleagues and the night was a huge success. It was a celebration of both great team working and innovation, with a sprinkling of the downright quirky too. The evening was hosted by the Paralympian Gold medallist, Aaron Phipps, a very humorous and courageous person. His story was humbling. Knowing I would probably have a glass or two of wine with my meal, I booked a room in a nearby hotel.

My choice of hotel was influenced by price. Big mistake! At one time the hotel must have been a grand place, but sadly had fallen into both disrepute, and disrepair. The queue for check-in moved at a snail’s pace, taking well over 25 minutes to get to the front desk. My room was on the 6th floor, the lift only went to the 5th floor. Not the greatest of starts. And the room was cold. There was a radiator, but no way of controlling the heat. It was off. Ever the optimist, I assumed things would get better, so I changed and made my way to the award celebrations.

On my return, I was glad I had drunk those couple of glasses of wine, as the room felt like a morgue. It was freezing cold. There was no-one on reception and no-one answered the room phone. So reluctantly I got undressed and got into bed. Despite the cold, and possibly thanks to those aforementioned glasses of wine, I did manage to fall asleep. In the morning I awoke shivering. I thought a lovely hot shower would warm me up, but alas, like the lift, the hot water didn’t quite make it up to the 6th floor.

I had been somewhere similar before. I once lived in rural Wales. I had a smallholding and we lived in a very old farm cottage. Whilst the large kitchen felt the benefit from a Rayburn cooking range, the rest of the cottage had no heating at all. In winter, the insides of the windows would freeze up and the children would sleep under mountains of quilts. It was always a relief to rush downstairs and get warm in front of the Rayburn in the morning.

As I sat nursing a hot cup of tea in that hotel room, I wondered how many children in Ukraine would be waking up to a cold house, with no electricity or hot running water. Likewise, as we experience the first real frosts of the year, I wondered how many children and families in the UK would also be waking up to a cold house each day. Of course, we are not caught up in the realities of a war, but the ‘heat or eat’ dilemma is becoming a reality for an increasing number of UK folk. In the North West it is estimated that over 500,000 households are in fuel poverty. It is a number that is bound to grow as our winter draws in.

There are no easy answers. At one level we keep all those caught up in conflicts around the world in our thoughts and prayers. More practically, we look out for our neighbours where we can. Everyone welcomes the chance to sit in a warm room, have a cup of something hot and a chat. We keep adding those charity food bags to our shopping trolley, and although it may not be much, we hope it helps. When we asked our children if there was anything they wanted for Christmas, two of them asked for logs. They have wood-burning fires, but the cost of logs, like everything else, has soared over the past few months. Accidently, but as it turns out, fortuitously, I bought two years’ worth of logs in the spring, so have plenty of logs to give as gifts. And that’s where this blog ends. For all my grumbles, moans and frustrations, I know I have much to be grateful for. And for that I thank all those who have so generously helped me in my life. Now’s the time to find ways to help others wherever we can.   

Sunday 27 November 2022

We are our choices, sometimes*

Many years ago, I used to spend many a late night/early morning hour in what was the original Covent Garden market. It was a fabulous place. The market sold fruit, vegetables and flowers to wholesale suppliers, and through the whole night/early morning there was constant noise, bustle, and movement. Sadly, the fruit and vegetable market is no longer there. It was closed in 1974, and the market was moved to a purpose-built New Covent Garden Market near Battersea in south-west London. These days the original marketplace has been turned over to cafes, pubs and the usual selection of shops that sell things you don’t need but feel you ought to buy. There is a small bijou craft market that opens from Tuesday to Sunday selling handmade jewellery, ‘one off’ collectables, crafts and paintings. It is lovely, but lacks the atmosphere of the original market.

Although today, I can’t recall what the fascination I had for the market was, one of the things I do remember about those visits was the stalls selling hot tea in large mugs and bacon rolls. If I close my eyes, I can smell the burning fat and that distinct fried bacon smell. I didn’t eat the bacon rolls, I was already a vegetarian by then, but I would have a fried egg roll; a treat I still like today.

All those years ago, my choice of late-night snack might have proved fortuitous. Updated research findings published last week, from a study first undertaken in 2016, have found strong evidence that eating just 50g of processed meat every day such as bacon (and 50g is about two rashers) increases the risk of stomach cancer. Each year, over 7,000 people are diagnosed with stomach cancer in the UK, leading to around 5,000 deaths. But it is not just bacon. In the report, processed meat includes ham, salami, hot dogs, and some types of sausages. Processed meat has already been shown to have a link to bowel cancer. If you are obese, and consume 2 or 3 alcoholic drinks each day, the risk of stomach cancer increases substantially.

I was pondering this last week as I stood in line at our staff restaurant breakfast counter. It was laden with the usual full English breakfast selection of foods. Eggs, baked beans, hash browns, mushrooms, fried tomatoes, and piles of sausages and bacon. I wondered if we, the Trust, were right to be selling food that might cause harm to some people. However, like many things in life, what you eat is often down to personal choice. Perhaps that is not true for everyone these days. The cost-of-living crisis is increasingly forcing people to make other choices about what they can afford to cook and eat each day. Some of these alternative choices might also have a detrimental impact on their health.

My interest was drawn to the complexities of some of the choices we are increasingly being asked to make. Last week, for example, I also noted the recent approval from the European Parliament that requires all listed companies to ensure that by 2026, 40% of Non Executive Directors positions are filled by the underrepresented sex; in EU terms, this means women. If the ruling is applied to all Board Directors, then 33% must be women. But of course, women are not necessarily the only under-represented groups on boards.

Whilst the ruling doesn’t directly apply to us at the hospital, I wondered what impact such a ruling might have on our recruitment decisions and how easy it might be for many organisations to comply with the ruling. In our Foundation Trust, we have just recruited another Non Executive Director (NED). Although there was great interest in the opportunity (we had 36 applications) there were only 8 women who applied, and of the men, 20 were white, and mainly from older age groups. We did appoint the best person for the job, who just happened to be a woman, but the decision we took was based on her skills, experience, knowledge and to be honest, her fit with the rest of the Board.

Thankfully, she will be joining an already diverse Board. There are 10 women, including our Chief Executive, and 6 men on our Board. 3 of our Board members come from black and minority ethnic backgrounds. We are also blessed with a wide range of ages, sexual orientations, and physical abilities. All of the directors were appointed on their merits and not because we were trying to comply with some form of diversity dictat. I understand the energy and positivity that can come from building a more diverse and inclusive workforce, but I’m not sure setting quotas is the way forward. I think it could lead to some very perverse choices being made.

It doesn’t  need to be like this. One of the programmes within our equality, diversity and inclusion strategy actively encourages and supports colleagues to grow their careers whatever their background, gender, age or race. It will take time to bring these folk through a system that has largely worked against most people seeking out such opportunities. If you don’t believe me, try making an application to become a NED in your local health care organisation. These days, as J has already found out, I can almost guarantee it will be a challenge to get past the shortlisting process unless you have previous NED experience or have held a very senior role somewhere. And that can’t be good for any organisation.

My thoughts wandered from bacon sandwiches and Boards of Directors to wondering whether the NHS as an organisation will soon find itself having to make difficult choices. Without a massive transformation in the way health and social care services are provided, similar to that seen during the pandemic, demand will eventually overrun capacity. If that happens, I wonder who will be making the choices on what services are available, and to whom.

But let’s end on a more positive note. The same research that noted the link between bacon and stomach cancer, also reminded us that eating citrus fruits can reduce this risk somewhat. So always remember to add both a slice of lemon and lime in your G&T.


*With apologies to Jean-Paul Sartre, who of course also said, that not making a choice is also a choice.


Sunday 20 November 2022

Popping out to the resilience store

The worst queue I never stood in was on my arrival at Karachi airport. The customs/security hall was huge and filled with literally thousands of people. The flight I had arrived on had been 11.5 hours long. Although I had travelled with Emirates on that occasion, I hadn’t travelled business class. So I arrived tired and very much out of sorts. I was there as a guest of the Sindh Institute of Urology and Transplantation. Thankfully they had come to the airport and rescued me, swooshing me through the customs at breakneck speed. They simply circumvented the queue. I was very grateful.  

The worst queue I ever stood in was at Tel Aviv airport. We were returning from a pilgrimage across Israel, and traveling just before Easter. The queue was so long it snaked almost out of the departure building. It was hot, people were fractious, anxious about missing planes, hungry and thirsty too. It took over 3.5 hours to get to the check in desk. We got there some 30 minutes after our plane was meant to have departed. They held the plane. I was the last person to board. J was most impressed.

Now you may be asking why I’m telling you about these two experiences. Well, there is a reason. I spent a lot of time standing in a variety of different queues last week. Surprisingly, I was the epitome of patience. Each queue provided me with time to reminisce over similar experiences. Each experience added to my ability to just be patient. My patience might have been also partly due to my reading of the entire Jack Reacher collection of novels over the years. For those not familiar with the books, Reacher has a laid back approach to life. Things will either turn out right or they won’t. Whatever the situation, hope for the best, and prepare for the worst. I’ve found it a useful way to navigate life. Control the things you can, and go with the flow with the things you can’t. In part, it’s how I developed my ‘resilience store’.   

You may not have heard this term before. My long time co-author, Professor Sue McAndrew, and I first used the term in a chapter we wrote for McAllister and Lowe’s book ‘Nurses making a difference: strategies for empowering your practice’ way back in 2011. Our chapter looked at how nurses might best develop their resilience in dealing with the challenges of practice. And goodness, the last few years have proved to be the most challenging many nurses have ever experienced.

Last week, this was something I had a conversation about with a couple of my nursing colleagues as we stood in a queue waiting to get our buffet lunch. My colleagues shared with me what frontline practice had been like for them during these past couple of years, and what they and their colleagues were doing to deal with the impact on their wellbeing as they addressed these challenges each day. Resilience was an attribute they were proud they possessed.

The occasion was one of our Long Service Award ceremonies. We were in the company of 70 colleagues who had each worked in my hospital for at least 20 years. Across the Trust we have 250 colleagues from all areas who have all also worked for 20 years in the NHS. Collectively this represents some 5,000 years of service to the NHS. I was impressed and humbled in equal measure. It also reminded me of my age. I had also spent 20 years working in the NHS, then 21 years in higher education, including nearly 10 years as Dean of a very large School of Health, before returning to the NHS 4 years ago as a Non Executive Director and Chair of a large acute Foundation Trust. Whilst I have lots of stories from these years, it was simply amazing to hear each of my colleagues’ stories. The NHS is a wonderful institution and, it’s the NHS family that makes it so. We should keep fighting for its continued future as a ‘free to access’ public service.

Resilience and fighting for the NHS’s future were also key focuses of this year’s NHS Providers annual conference. The conference was held in the wonderful city of Liverpool, a special place for J and I. Over the two days, there were plenty of queues of course, mainly for food and drink. The theme resilience was explored through the lens of all aspects of health and social care. So, there were often conversations about people, but also of services, buildings, technology and partnerships. Protecting our NHS people was very much the number one priority. Both Wes Streeting (Labour) and Steve Barclay (the other party) spoke. I can’t say I was impressed with either. As I’m steering clear of politics, I will leave it there. A 17% pay rise for nurses? Hearing from them both, I don’t think that will happen.

I was, however, impressed by one of the sessions I went to that explored ways of promoting greater equality, diversity and inclusion in our organisations. There was much that I took away to ponder on, but one of the standout take-home messages for me was the concept of ‘brave spaces’. This was a concept posited by Edgar Schein in his book, ‘Humble Inquiry’ (worth a read). It looks at the development of both ‘safe spaces’ and ‘brave spaces’ in enabling colleagues at all levels in an organisation to gain a voice. This is a voice that might challenge, be critical, pick up on unacceptable practice or behaviours and, of course, raise new ideas. We may have the freedom to speak up, but often this can be very difficult. Feeling safe and being invited to be brave might just be the way to give more people a voice.

The last queue from last week was the bittersweet one my mother and father now find themselves standing in. My mother is increasingly living with the ever encroaching impacts of dementia. Up to now the only support they have received has been from family. Now both health and social services have got involved and they are in the system. But like most queues, there is likely to be a long wait before they see any action. Sadly, I feel their resilience store is almost exhausted.

Sunday 13 November 2022

Look who's talking

It would be difficult to write this week’s blog without commenting on the historic decision taken by many Royal College of Nursing (RCN) colleagues to take industrial action. It is something I’m slightly hesitant to do. Last time I blogged about colleagues taking industrial action, (12 years ago and not nurses) I was trolled unmercifully on social media. However, I will come back to the RCN outcome in due course. But first, let’s talk about a lady called Kelsay Irby. She is a nurse. In fact, she is a Charge Nurse working in a busy Emergency Department. On the 8th October this year, Kelsay was working an evening shift and there were over 50 patients in the ED Waiting area. Unfortunately, Kelsay only had half the staff she should have had, and the situation was quickly getting out of control.

Whilst the triage nurse on duty was doing a great job in prioritising patients by need, there was limited oversight of those patients in the waiting area whose conditions may well have started to deteriorate due to the long wait. It was a desperate, but perhaps, not too an unfamiliar situation. In desperation, Kelsay rang the emergency services for help and was connected to the local fire and rescue services who agreed to come out and help. Up came a fire tender with a crew trained in emergency first aid. They were able to re-take basic assessments and monitor the patients, allowing the ED staff to concentrate on those in most need. Eventually the ED returned to normal.

As you might imagine, Kelsay’s decision hit the news big time. But you may have missed the story as Kelsay works at the St Michael Medical Centre, Washington, in the US. Could something similar happen here in the UK? – I guess so. Last week, there were reports that the armed forces could be called in to fill the gaps if nurses take industrial action. Indeed, during the pandemic and last winter we had a small group or service men and women who worked in a variety of different roles in my hospital – and they did a great job! It’s an interesting situation.

Likewise, so is the possibility of industrial action. I would say right from the start that nurses deserve to be rewarded fairly for their work. Whilst many folk are attracted into nursing as a profession, I don’t subscribe to the notion that nursing is a vocation. It is a highly skilled profession. The education and training required are tough and expensive. And that is part of the problem. There aren’t enough nurses coming into the profession to replace those leaving, and this chronic shortage of nurses results in an unfair burden on those remaining within the profession. As Dean of a large university school of nursing I well remember my disbelief on hearing that from 2016 the bursaries student nurses received would be stopped, and that they would have to start paying for their university courses.

The decision saw student nurses applications fall dramatically. In the first and subsequent years, by nearly 40%. In 2020, the NHS Learning Support Fund was introduced. This was available to students starting their programmes in 2021. This package of support provides upwards of £8,000 a year as well as help with travel and accommodation costs while on clinical placement. The money does not have to be repaid. Students still have to pay the £9,250 a year course fee. Even with this most welcome support package, I think it will take some time before it provides the incentive necessary to significantly increase student numbers. Across the UK there was an 8% increase in student numbers in 2021. In England this meant an extra 20,930 students were recruited. In the same year just over 25,000 nurses left the profession. The students won’t join the qualified nurse workforce until 2024.

There aren’t many easy solutions. The pandemic exhausted many nurses. The cost of living crisis is hurting many more. However, the claim for a 17% increase in salaries (estimated to cost £9 billion a year) seems unlikely to be achievable. Something different in terms of an approach is required Removing the requirement to pay university fees would be a start. Likewise, writing off the education costs of students who started their training in 2016 but who will still be paying back their student loans today feels like a good idea. Symbolically, it would demonstrate the value of the nursing profession to society. Symbolically, clapping for carers doesn’t remotely have the same impact.

Of course, whilst nurses are important, they are part of a wider multi-professional health and social care team. Whatever eventually gets settled as a pay award, the impact will spread through this wider team like that famous lager that reached parts others couldn’t. Probably beyond too, certainly in the public sector. Currently, there are some 1 million other healthcare workers, from porters, radiographers, maintenance workers, doctors and so on, whose unions are all currently balloting their members over whether to take industrial action as well.

I do not blame them. All healthcare workers, whatever their profession, trade or background should be paid a fair salary for their contribution. Sadly, I don’t think calling for strikes and a large pay award will, on its own, be a sufficient basis to reach a settlement. It doesn’t have to be like this, all we need to do is keep talking*. I strongly suspect that money will not be the ‘silver bullet’ the RCN might consider it to be. Sooner or later there must be a conversation that takes a broader view of the issues other than the percentage size of any pay award. Over the coming weeks and months, it is going to be critical that all the parties keep talking. The future of our NHS, as we know and value it, is very much at stake.


*Inspired by our Pink Floyd concert last week, I thought their song ‘Keep Talking’ from their album The Division Bell seemed somehow appropriate.

Sunday 6 November 2022

May you stay Forever Young – caring for our children and young people

Billy, our parrot loves the blues. Whenever we ask Alexa to play some blues, he is in seventh heaven. He whistles along and is the best blues-playing parrot I have ever encountered in all my life. Billy is now 31 years old and has travelled the length and breadth of the UK with me. So last week we played some blues that really made him come alive – it was Bob Dylan’s recent album: ‘Rough and Rowdy Ways’. If you haven’t heard it, you can find it here on YouTube. I would recommend a listen. For younger readers, Bob Dylan is an enduring music icon from the 60s. One of the first things I learnt to play and sing on the guitar was ‘Blowing in the Wind’. Dylan wrote this classic in 1962. In 1994, the song was ranked by the magazine ‘Rolling Stone’ at number 14 of the 500 greatest songs of all time.

Its three chords certainly opened up a whole new world for my guitar playing over the last 50 odd years of playing and enjoying music. From a folk club in downtown Swansea in the 70s through to a balcony in Portugal’s mountains in 2022, and everything in between, I have continued to get great pleasure in playing my guitars and singing along to some classic songs. It’s safe to say that J and I love live music. She plays the piano, and I could listen to her play all day. But what we like most of all is going out and listening to live music. We have done this all over the UK and beyond.

And that’s what we did last Wednesday. We fought our way through gridlocked traffic that is Manchester’s norm these days, parked up and joined the queue to get into the Apollo concert hall. We were there to see the great man himself. At 81, Bob Dylan had decided to add an additional venue to his current Rough and Rowdy Ways UK tour. Ironically, we had unsuccessfully tried to get tickets for other concerts across the UK. When last week’s additional concert was announced, the tickets sold out within minutes of being released.

Dylan looked frail. He no longer played the guitar. He did, however, play some mean piano. There was no video backdrop, flying pigs, smoke or dancing girls. It was a straightforward dimly lit stage with Dylan and his band playing all his new music from the Rough and Rowdy Ways album. His voice was strong, but how he remembers all the words to songs that can be 9 or 17 minutes long is beyond me. For a couple of hours, it was blues music heaven.  Driving back through the still gridlocked Manchester traffic, was motoring hell.

Of course, Bob Dylan is someone from my youth. He was part of my rebellious period during adolescence. His songs of protest became my songs of protest. Although at the time I started smoking* and drinking, and on occasions, probably acting up. In all likelihood, my rebellious adolescence was rather tame. Which is just as well. During the first two decades of a person’s life course, we not only learn the most, but develop values and behaviours that shape our adult life. In some respects, this is why looking after our young people during this period in their life not only benefits them, but the rest of society too. Sadly, this is not always the case.

Last week, the British Medical Journal (BMJ), in collaboration with the Partnership for Maternal, Newborn and Child Health, brought together a collection of research-based papers on adolescent wellbeing. You can find the collection here. It’s a big area to go at. In their introduction, the BMJ notes that there are 1.2 billion adolescents (young people aged 10-19 years old) in the world. They represent 16% of the world’s population, and 23% of the population in low income countries. However, they are a group of the population who often receive limited attention and resources from global initiatives such as universal health coverage and sustainable development. The Royal College of Paediatrics and Child Health (RCPCH) have long called for action on reducing poverty and inequality, both of which impact upon a child’s future, and can lead to health inequalities in later life. As well as prevention, delivering early intervention services to families in need not only reduces the overall burden on the NHS, but makes good economic sense too. It’s estimated that for every £1 spent in this way there will be a return of £4 to the economy. This ratio will rise over time if the investment is made when folk are in the childhood and youth.

We are also at an interesting stage of transformation as the new Integrated Care Systems pass their first 100 days mark. The requirement to collaborate and integrate must include professions, agencies and communities outside of the traditional providers of health and social care. This is particularly so when considering interventions that support the wellbeing of adolescents and their families. Young people are not on some kind of conveyer belt to becoming an adult. However, supporting and investing in their wellbeing is likely to result in an adult population best able to meet the challenges of a rapidly-changing world. And goodness do we need them to be able to do just that. Our work today will help them live fulfilling, creative, resilient and confident lives in their tomorrows. In that sense, they are our future too.

But for tonight, J and I will be going back to the future. We are off to the Winter Gardens to see ‘Wall of Floyd’, a tribute Pink Floyd band, a group first formed in 1965. It’s only rock and roll, but we like it.     

* I haven't smoked for many years now! 

Sunday 30 October 2022

It’s all change once again at the top, but the NHS challenges remain the same

I have long been an avid reader. I consume the written word with as much gusto as I imbibe wine. One of the most famous books of all time is one I haven’t yet read. It’s John Milton’s ‘Paradise Lost’. Actually, Milton’s epic poem is not one book, but 10 books, which together contain 10,000 lines of verse. Every word and line had to be dictated by Milton, as by the time he wrote it he had gone blind. I’m sure one day, I’ll get round to reading it. Milton was also famous for giving us the proverb, ‘every cloud has a silver lining’. It comes from his earlier work, ‘Comus’, which I’ll admit I also haven’t read yet. It is a familiar saying, and one that came to mind last week, with the news that Dr Feelgood* was removed from her role as Secretary of State (SoS) for Health and Social Care. She was replaced by Steve Barclay.

Regular readers of this blog will perhaps recall that I was rather vexed about Steve Barclay’s appointment in a blog I wrote at the end of July this year. Partly this was based on his rather strange views on health and the NHS. For example, he believes that nurses don’t need to have a degree to be a nurse, and we should be able to get the training done in 2 years not 3. You can read my argument as to why I thought this was, and is, absolute bunkum here.

Steve Barclay was previously appointed to the role of SoS on 5th July this year. The Health Service Journal greeted the news with the headline ‘Steve Barclay is the NHS leadership’s worst nightmare’ and suggested he saw the NHS as a ‘bottomless pit, resistant to change and unaccountable’. A bit harsh perhaps. He certainly has a reputation for thinking that the NHS has too many managers. The reality is that the NHS management costs are considerably lower than most of its western counterparts.

Unbeknown to Barclay, having only been in post for just 58 days, he was to lose the role some 6 days later when Liz Truss took office. Just 79 days later, he is back as SoS once again. Things have changed for the worse during those 79 days. Ambulance services are stretched to almost breaking point as patient flow through hospitals is severely impacted by the continuing shortage of social care provision. Covid cases are once again adding to the problems of managing the ever-increasing demand for health care as well as dealing with the 7 million people waiting to be treated. The cost-of-living crisis has been made even more difficult for an estimated 8 million people who are now struggling to pay bills.

Some of these folk will be working in the NHS, and we are seeing unprecedented numbers of colleagues leaving the NHS for better paid jobs, and jobs that don’t have such a intrusive impact on family life. It matters. Have a look at this article from Torsten Bell in last week’s Observer. He acknowledged that money is an important factor (pay in the private sector rising at 6.2% compared to the public sector average of 2.2%). However, drawing on a recently published research study, other factors such as staff engagement are more powerful in terms of staff retention. Interestingly, the study also posits that when nursing staff leave, senior medical staff follow – but not the other way around!

During his previous time as SoS, Barclay had suggested that the answers to the problems facing the NHS was to hold a ‘hackathon’, which was another reason why I was less than enthusiastic about his appointment. But we are in strange times. Whilst having absolutely nothing to do with Steve Barclay, last week, NHS England’s David Sloman, (Chief Operating Officer) sent out an invitation for people to attend a Winter Improvement Collaborative event in London next Tuesday. When I say an invitation, it’s perhaps more of an imperative, as each acute trust, ambulance trust and integrated care board must send at least one executive director to the event. He did, however, say please.

The event is the first in a series to be held over a 10-week period. It is not quite a hackathon, but has similar shades of approach. Described as adopting a ‘lock-in’ style methodology, each event will see senior clinical and operational managers working through real life problems and issues facing the NHS. Real time data will be used to provide the basis for root cause analysis, leading to the co-design of improvement plans, with a single set of metrics, and which can then be adopted and trialled at a local level. I don’t like some of the language, but I do like the idea of a collective approach to generating new ideas for seemingly intractable problems. I like the idea that contemporaneous data is to be used to analyse and prioritise decisions that will result in the greatest impact being achieved. I like the idea that nothing is ‘off the table’ in gaining a better understanding of the barriers to more local decision making and action. And I really like the espoused determination to undertake this work at pace.

The outcomes from this work cannot come quickly enough. This year’s winter looks set to be the toughest one yet. John Milton went on to write a sequel to his earlier work, which he called ‘Paradise Regained’ (and yes, I haven’t read that either). There aren’t any easy or quick answers to the challenges facing the NHS, and perhaps there never was an NHS paradise. However, it’s only fair to give the new SoS an opportunity to demonstrate the leadership necessary to keep our NHS safe and secure, just as every day, colleagues continue to find ways to deliver high quality, and safe services for patients.

 

* Whereas I previously feared for the NHS under Therese Coffey’s management, now it’s my hens I worry about.


Sunday 23 October 2022

No More Turning Away - Like Kindness, Public Health Matters, Always

Last week left me struggling to describe the collective experience we witnessed as events unfolded at Westminster. I felt my descriptive lexicon was totally exhausted. Mayhem, havoc, chaotic, humiliating, confusion, toxic and very, very sad. These are all the words that come to mind when I think about the last few weeks in UK politics. My sadness is for the country and what has been done to our way of life.  I've also felt increasingly sad for Liz Truss’s husband, Hugh.

As sometimes happens, when I look at individuals for background information for my blogs, I am often surprised by the connections with my world. Hugh O’Leary’s mother was a nurse, and his father was a lecturer. He went to the London School of Economics, where he met Therese Coffey, our current Secretary of State for Health and Social Care (SoS).

I cannot begin to imagine the stress the pair of them have been under. Standing by his wife, which he has done on a previous occasion, but in different circumstances, would have been incredibly difficult. I take my hat off to him. His dignified and solid support for Liz is to be applauded. However, to be clear, I’m appalled by the damage she has wrought on the UK during her brief time as Prime Minister. As someone said last week, what has happened is unforgivable and we should never forget this time.

Equally appalling last week, was the news that Therese Coffey had recently admitted that she had illegally shared her own supply of prescription medications with friends and family. The UK Medicines and Healthcare Products Regulatory Authority confirm that it is illegal to share prescription medication with someone for whom it is not intended. She was rightly taken to task by folk on social media who described her as Dr Feelgood, with a handbag full of illicit goodies – not a good place for a minister of state to find themselves.

Her behaviour was wrong on so many levels. As are her plans to allow pharmacists to dispense antibiotics without the need of a GP prescription in order to reduce demands on GP practices. Her proposal was condemned by many health care professionals. Professor Stephen Baker, a Cambridge University international expert in molecular microbiology and anti-microbial resistance, described the proposals as ‘moronic’. He added that widening access to drugs in this way was dangerous. The overuse of antibiotics contributes to the emergence of drug resistant bacteria, and reducing the unnecessary prescribing of antibiotics has long been a central plank of UK public health policy.

In any event, pharmacists can already prescribe and dispense prescription-only medicines in some limited emergency circumstances. Likewise, other pharmacists who have undertaken further training, can practice as a pharmacist independent prescriber. Like doctors and Advanced Nurse Practitioners, with prescribing rights, they are able to prescribe medication for any condition they’re clinically competent in. Actually, both have been able to do this since 2006, when Patricia Hewitt was SoS for Health. The approach was introduced as a way of reducing pressure on GP practices. I have used this service when my repeat prescription medication is up for review, and my pharmacists has always been able to independently change my medication as necessary. I have always felt to be in safe hands.

And whilst I don’t want to be accused of hounding Dr Feelgood, her ultra-libertarian ideology doesn’t make me feel that the UK’s health care system, or me personally, is in safe hands. My favourite philosopher, Michel Foucault, when talking about the relationship between the State and healthcare argued that a doctor’s first task, before seeing the patient, and providing a diagnosis and treatment, is a political one. He suggested that doctors must first ‘begin with a war against bad government’. So, I make no apologies for speaking truth to power in my criticism of the proposed changes to current UK health care policy. I’m not the only one either.

You may well have seen Dr Dan Poulter’s stinging challenge last week, where he described Dr Feelgood’s hostility to what has often been referred to as the ‘nanny state’. Dr Poulter is well qualified to challenge the Dr Feelgood approach. He is a Conservative MP, an NHS doctor and someone who served as health minister in the coalition government (2021-2015). It seems Dr Poulter’s motivation for calling out the SoS was her opposition to banning adults from smoking in cars containing children – even though this practice was made illegal in 2015. Dr Feelgood is a smoker and has long opposed any restrictions on smoking. Making it clear that she wants to scrap previous measures to curb obesity such as the sugar tax, not introducing the smoking control plan, and ditching the health inequalities’ White Paper feels very short-sighted and, frankly, alarming.  

More smoking and greater rates of obesity will result in more chronic ill-health and increased pressure on the NHS. It is also likely to result in reduced life expectancy for many, particularly amongst the poorest groups in our communities. It seems to me that our current SoS is choosing to ignore what I think is both an ethical and practical responsibility of any government to tackle those known contributors to poor health. Individuals have a responsibility for their own health for sure, but so does our government. Foucault also observed that the impossibility of perfect health implies the impossibility of a perfect health care system. Choices will always have to be made as to what is practically and economically possible to provide in terms of health care. Ditching the UK’s evidence-based public health policy doesn’t seem to be a great choice.

I live in hope, however. We are clearly going to have a new Prime Minister by this time next week. Hopefully this will mean a new Cabinet too. If we don’t, the mayhem will continue and again, it will be you and I that stand to lose out once more. Given next weekend will be full of excited children embracing Halloween, let’s hope there will be more treats than tricks this time round.


Sunday 16 October 2022

Can we make a difference differently?

Can I just say (very loudly) how wonderful all those folk working in my GP practice are. I think the continuing sniping and complaints levelled at GPs and primary care colleagues is most unfair and uninformed. I want to acknowledge my respect and thanks to all those working in primary and community care, for all that they do each and every day. All through the pandemic, I never had a problem in accessing help whenever I needed it. Yes, sometimes that access was over the phone, and perhaps not always with my GP herself, but come on, she heads up a wonderful team of health and social care professionals.

Great teamworking is critical in effectively meeting the needs of individuals and the communities within which they live. Last Monday J went off to get her Covid booster and flu jab. I was slightly annoyed as I was originally going to get mine before her, but due to circumstances beyond my control, my appointment had been pushed back until the end of October. I was worried by the delay. Covid has not gone away. Although the numbers of cases are still very modest, 12,434 across the UK, this represents a 31% increase in the number of cases over the past week. A word I fail to say correctly, but can write, is ‘exponential’. The 31% rise is simply exponential, and it’s that thought which had given rise to my anxiety and unease.

Back to last Monday, my phone buzzed, and J, speaking from our GP practice, said, ‘get down here as they will do your booster and flu jab right now’. I didn’t need to be asked twice. Down I went and got my two jabs. J filmed it all and I was pleased to post the picture on social media. I am very thankful that I was able to get an early booster. I would recommend that all readers of this blog and all their families and friends follow suit as soon as it is possible to do so.

Now my GP practice is one of two located in our health centre. It is a fabulous place. We have a swimming pool, library, café, chemist, gym, a children’s playground and outside sports area. It’s the base for community health colleagues and houses a comprehensive multi-professional health team. It is clean, bright, airy and almost Scandinavian in design. Like many of the modern health buildings in the area it also has a beautiful glass sculpture design made by the wonderful John Ditchfield. If you are in the area his workshop and studio are definitely worth a visit.

Of course, not all health care environments are located in such modern buildings. Sadly, many hospitals and GP practices are to be found in old, expensive to run and often dilapidated buildings. Some are just downright dangerous. A report from NHS Digital, published last week, showed that it cost over £10 billion to improve these buildings and deal with every growing backlog of maintenance and repairs. When I describe some of these building as being dangerous, they really are. Nearly £2 billion of the £10 billion are for repairs which are reported as being ‘high risk’. These are situations where the need to repair or replace buildings and facilities is critical to avoid catastrophic failure, major disruption to clinical services and resolve safety issues that could cause serious injury or death.

Across England there are some 30 hospitals where the roofs are in danger of collapsing because the reinforced concrete they are made of is beginning to deteriorate and crumble. Some of these hospitals are now operating with steel props in place to hold up the roofs. Perhaps ironically, the West Suffolk hospital, which provides services in the parliamentary seat of the current Secretary of Health and Social Care, has a high-risk backlog maintenance bill of some £62 million. During 2020-2021 there were 10 safety incidents related to critical infrastructure risks at the hospital.

Mind you Cuppacoffee was conspicuous by her absence last week, perhaps she was having a sly cigar behind the DHSC bike sheds. In any event she needs to look at the amount of money currently allocated to deal with these concerns next year. Unless there is a change, the allocation for backlog maintenance is just £1.4 billion. This is just 14% of what is actually required. And I guess we can kiss goodbye to the 40 new hospitals promised by the previous Prime Minister. My own hospital, which is landlocked and has many buildings that are not fit for contemporary health care, did submit a bid for one of these new hospitals. The original estimate was that it would cost at least £500 million to build. Given the other financial pressures facing the government, I grow less confidence that we will get our new hospital any time soon.

However, whilst I think we will always need hospitals of some sort, possibly becoming more specialist, I do believe that we could do something different. Where I live, we have a lovely little hospital, the Blackpool Victoria Hospital. The name perhaps provides a clue as to the state of some of the buildings. The original hospital was opened in 1894, moving to its current location in 1933. Interestingly, its original location now has a state of the art urgent care centre, complete with another John Ditchfield glass art installation. I have been there as a patient, and the service and facilities are first class. Instead of building more large hospitals, perhaps we could build more of these types of urgent care centres. So much more health care could be provided in services such as these and my GPs health centre, and frankly, elsewhere in the community.

If the Covid pandemic gave us anything, it was the courage to do things differently, do things together and do things at pace. Maybe out of the political and economic turbulence we are once again facing, we can find that transformational vision and energy again to make a difference differently. 

Sunday 9 October 2022

What an extraordinary week!

Last week was an extraordinary week in many ways. For example, the trial started of Lucy Letby at Manchester Crown Court. If the name is not familiar, she is the nurse accused of murdering seven babies and attempting to kill 10 more while she worked on a neonatal unit at the Countess of Chester hospital back in 2015. Lucy denies all the charges and the trial will take up to six months before we get to a verdict. It will be a long and distressing period for the families of those involved whatever the outcome.

Then there was that extraordinary outburst from Miranda Hughes, a nurse working in the independent sector. On the Jeremy Vine television show she declared that ‘if you voted Conservative then you don’t deserve to be resuscitated by the NHS’. Although Miranda works in the private sector, as a registered nurse, she is still bound by the Nursing and Midwifery Council’s (NMC) Code. The Code sets out the professional standard of practice and behaviour for nurses, midwives and nursing associates. The Code is very clear that nurses on the NMC Register must promote professionalism and trust at all times. She has been sacked by the company she worked for, and I’m sure the NMC will investigate and take action if that is felt to be appropriate. Her 15 minutes of fame will cost her dearly.

And of course, there was this year’s Conservative Party Conference. Possibly more circus than conference. Good old Nadine, who can always be relied upon to say something extraordinary, did just that. She appeared to be telling the Prime Minister that now was the time to call a General Election. Good old Therese gave a Masterclass in how to cure insomnia, as her conference speech sent half her audience to sleep. As there’s me thinking coffee usually wakes people up. Finally, there was Liz (neither old nor good) who, blaming everyone else for the UK’s troubles, seemed to be in complete denial over the fact that the Conservatives have been in power for the last 12 years. Anti-growth coalition indeed. The whole spectacle was like a ‘Have I Got News For You’ boxset. It was just as funny, but not funny at all. Truth be told, it was heartbreakingly sad.

But there were, for me, two extraordinary events last week which really did make my heart soar. The first was this year’s Annual Members Meeting (AMM). This is a statutory requirement for all NHS organisations, with an Annual Report and Accounts laid before Parliament each year. The AMM is an opportunity to share with the Council of Governors this report, and also to celebrate some of the improvements and service transformations achieved in the past year. Why was it extraordinary? Well, it was the first time in over three years that we could invite all the Governors and Members into the Trust for a face-to-face meeting. Over 60 turned up on the wettest and windiest afternoon imaginable. We splashed out and bought a new lectern, for the occasion, tastily resplendent in NHS blue. Now I love a good lectern from which to speak to an audience, and last week was no exception. The presentations were great and the question and answer session, lively, informative and dare I say it, fun too.

The highlight of the afternoon for me, was a special presentation made by one of the consultants from our Pain Service, David Crabtree and his colleague Esther. It really was a masterclass on what a difference involving patients, right from the start, can have when thinking about service transformation. He had a great illustrative example: he knows that if you give a group of patients £100,000 to design a clinical service, they will do so and never spend all of the money. The new service will be more effective and efficient. Give £100,000 to doctors and nurses to do the same thing and they will spend every penny and come back for 10% more. The likely outcome will be a new service that is neither effective nor efficient. His was a salutatory message about the value of consumer involvement in transforming healthcare services.

The second event was a slightly grander affair. Think ‘Strictly’ 2022. The occasion was our ‘Making a Difference’ awards night, and we held it in the magnificent Stockport Town Hall ballroom. Interestingly, the ballroom was used as a hospital during WW1, and a home for overseas refugees during WW2. 

The evening was hosted by Karen James OBE, our Chief Executive, and me. It was wonderful to also have the BBC health correspondent Dominic Hughes, as our guest of honour to present the awards. Although there was no ‘official’ dress code, most people arrived dressed for the occasion. I had to go out and buy a new tuxedo, as since joining the Trust, my waistline seems to have expanded somewhat (we do have delicious award-winning food served in our staff restaurant).

There were 11 award categories which attracted over 100 nominations. Whilst all the nominations represented exceptional achievement, the eventual prize winners were extraordinary. The award ceremony part of the evening was electric with excitement, and there was a real sense of belonging and being there for others. We absolutely acknowledged that whilst the 300 people in the room were able to enjoy the evening, there were another 5,200 colleagues not present, many of whom would be collectively equally making a difference for others in our hospital and community services.

The evening was a huge success. We enjoyed a great meal and I enjoyed sharing a drink and conversation with some amazing colleagues, some of whom I was meeting for the first time. There was a bit of a disco too. Highlight for me was a special award, made to someone whose nomination didn’t quite fit the other categories. This was a colleague who was completing a sponsored charity event when he came across someone who had collapsed and suffered a cardiac arrest. He put into practice the resuscitation training he had undertaken at work. Delivering chest compressions, and using a community defibrillator, he saved the person’s life. What was remarkable was that this particular colleague didn’t work in a clinical setting, but was actually our electrical maintenance manager. As he approached the stage to receive his award, the whole ballroom rose to their feet and gave him a standing ovation. He was, and the moment was too, totally extraordinary.   


Sunday 2 October 2022

The importance of women in health care – not quite a panoramic view

Last week I had a 38 year flashback moment. It was the time when I first arrived in Manchester. I had got a job at the first NHS forensic secure unit for adolescents. It came at a very turbulent time in my life. Despite my personal troubles, I was going to take up what felt to me to be a dream job. As the Nursing Times described the opportunity at the time, I was going where no RMN had gone before. And I was. There was no rule book, procedures or other services to copy. We had a blank piece of paper and had to start from first principles. I loved those first few months. I went and spent time at various other forensic institutions, from a special hospital near Ormskirk in Lancashire, a prison in Manchester, to a private hospital in Northampton. The service I arrived at was a medium secure service providing treatment and care for troubled and at times, troublesome children and young people. It was a mixed sex unit, which often gave rise to issues as to whether a young person’s behaviour was ‘normal’ adolescent behaviour or as a result of their mental illness. We paved the way for the development of adolescent forensic mental health services nationally. It was a privilege to be part of these hopeful new beginnings.

Six years later I had become the Service Manager for all the regional specialist mental health services located at Prestwich hospital; a hospital managed by Salford Health Authority. One of the services for which I had responsibility, was the adult forensic services at The Edenfield Centre. This was (is) a Medium Secure Unit. Patients came here from special hospitals (High Secure) or from Low Secure Units, or from within the criminal justice system. All those years ago, it was very much the jewel in our crown. The service had a wonderful reputation for compassionate and person-centred care. Unsurprisingly, experienced colleagues working within the field of adult forensic services had been hugely supportive and immensely helpful as we set up the adolescent forensic service.

So, it was great sadness that I watched last week’s Panorama programme. It featured an undercover reporter’s account of the three months he had worked on one of the clinical areas in the Edenfield Centre as a Health Care Assistant. He had worn a hidden camera with which he recorded some very distressing and totally unacceptable incidents of abuse, neglect and cruelty. Much of this behaviour came from qualified mental health nurses. It was a difficult programme to watch. All those featured have been suspended and face both disciplinary action and probable police investigation. I no longer know many of the nurses working there these days, but I do know the Chair, some of the Non-Executive Directors and a couple of the Consultants. All are highly shocked by the revelations and deeply committed to ensuring safe care is being provided. There was no pre-screening of the programme, so I think it will have been very difficult to support colleagues and patients who would have watched the programme and have been affected by what they saw.   

It certainly wasn’t a great day for mental health nursing or mental health care. 

And last week it was the monthly NHS England Regional Office meeting with Chairs and CEOs from across the North West of England. It was an equally sobering meeting in the main, a meeting where good news was hard to find. However, there was one agenda item that really caught my eye and made me think. It was a presentation by folk from the Liverpool Women’s Hospital. The presentation focused on their response to the recently published Women’s Health Strategy for England. Now to be perfectly honest, this strategy passed under my radar completely. I’m not sure whether August was a busy month for me, but I was not sighted on this document at all. You can read the strategy here. It’s a mere 132 pages long, but it will take a lifetime to deliver what’s needed to address many of the issues.  

There are some basic facts that are irrefutable. Women live on average longer than men, but they spend more of their lives in poor health. Women make up 51% of the population but historically the health and care systems have been designed for men by men. Looking at the NHS workforce, 77% are women. Despite the fact that 69% of all posts at 8c – 9 (middle to upper management grades) are filled by women, women do not feature prominently in research, and in the education and training for healthcare professionals. They are seldom included in the design and development of healthcare policy. Only 47% of the most senior roles in the NHS are held by women.

At a national level, the same is true. During the time I have been an active contributor to health and care services in England, (some 40+ years) we have had 16 Secretaries of State (SoS) for health and social care. I have met many of them. Of these, and including the latest SoS, there have only been 3 females to hold the post. So perhaps it’s not difficult to see why women’s health and contribution to wider health care has not been prioritised. The consequence has been a complete failure to place women at the heart of health services. Arguably this has had a huge impact on how we address access to health and social care services and how we address the destructive impact on health inequalities.  

The Women’s Health Strategy adopts a ‘whole life course’ approach to issues facing women today. It focuses on gaining greater understanding of the changing health and care needs of women and girls across their lives.  In so doing, the aim is to both identify the many stages, transitions and opportunities during a women’s life span, where good health can be promoted and where preventive measures can be put in place to help ensure positive health and wellbeing. In a sector mainly populated by women, we simply cannot ignore the notion of recognising what a women-centred service might mean in addressing inequalities close to home. Not to do so risks the NHS featuring in a future Panorama programme, and worst still, the prospect of an ever-deteriorating NHS service for all.     


Sunday 25 September 2022

Tony’s ABC of great healthcare: Agency, Being, (with others, and being a nurse) and Compassion

A lot of things happened or didn’t last week. Northern Rail left me stranded at Manchester Piccadilly Station last Sunday evening. No buses home. A wet and windy night. A distraught J coming to pick me up, a 3 hour round trip. But they are giving me £11.00 compensation. Whoopie!  

Then there was our laser-focused, grammatically fixated (cares more about commas than comas) new Secretary of State for Health and Social Care and her back of a cigar packet plan for saving the NHS. As a plan, ‘Our Plan for Patients’, doesn’t actually tell us anything new, and is unlikely to fix anything in the here and now, and feels pretty pointless. I feel very frustrated that once again the suggestion is that the very people who were there for the rest of us during the last 3 challenging years are being blamed for the difficulties facing the NHS today. She is the 5th Secretary of State for Health and Social Care during the last 12 years of the Conservative government, and I can’t help but wonder if the finger of blame should be pointed elsewhere and not at patients or health care professionals.  

And although I try and steer clear of politics in this blog, here is a word of warning to the wary. Therese has her new ABCD team at the Department. It includes Neil O’Brien, who earlier this year declared that the 6,000 new GPs promised by his government would not materialise by the 2024 deadline. As an alternative, he thought we should lure retired GPs off the golf course by paying them lots of money. Shades of Aneurin Bevan perhaps. Robert Jenrick joins this dream team. He, at least, has some previous health and social care experience. But just how have we reached a position where appointing the ‘twice lock-down restrictions-breaking’ disgraced former Housing Minister, is seen as a good thing.

For different reasons, I also decided perhaps one can have too much of a good thing. Last week I read one of those fascinating BBC long reads on the subject of supermarkets (now I bet you weren’t expecting that). Did you know that on average we make 221 trips to the supermarket each year? I didn’t. Too much of a good thing? How many of us have just popped into the supermarket for a pint of milk and come out with a carrier bag full of stuff. I have. So, I have changed my habits. I walk to the local supermarket, with just 1 bag. I only buy what I can carry back in that bag. It makes for some interesting choices. Do I buy 1 or 2 bottles of wine and forgo something else because of the weight? It also means I’m more careful with what I buy, so I waste much less. There is a health benefit too, as I now need to walk there more than once a week, so I accrue even more steps towards my #NHS1000miles target.

Somehow this approach feels less frenetic and more slowed down. It was something I enjoyed on my recent trip to Portugal. Way up in the mountains, the nearest shops were to be found in a delightful village called Coja. Whilst there is no Tesco, Sainsbury or even an Aldi, they did have a little supermarket that reminded me of my youth and the early supermarkets we had on the high street. I even found a bottle of wine that was just right for writing blog notes. It was a village where people paused at the Boutique da Tuxa, a bijou pavement café, to take a coffee, eat a simple cheese roll, relax with good conversation and just watch the world go slowly by. Of course, we don’t all live in a mountain village, but we can all pause and take 10 minutes to just sit and practise some mindfulness.

There were goats there too. After chickens they are one of my favourite animals. I have kept many over the years, and even today we have 2 pygmy goats in our ever-expanding menagerie. They are both girls, and although they are called Hansel and Gretel, luckily, they’re not into pronouns. Where I stayed in the mountains, one morning, I was woken up by the sound of goat bells tinkling outside. Getting up I was amazed to see a lady leading a few goats up the street and on to the terraced pastures. We exchanged smiles and I like to think we shared that moment of tranquillity together.

So, I was delighted last week to read of a positive health story that involved goats. Well strictly speaking goats and people. It was the story of Streetgoat. They are a group of folk living in and around Bristol who, across 4 sites around the city, keep goats for milk and meat. They have been doing so for over 7 years. It’s a membership organisation made up of 30 households. Each household pays an annual fee of £70, and everyone has to promise to milk the goats once a week.

The activities of the Streetgoat group addresses many of the important determinants that impact on an individual’s health and wellbeing. They don’t have to rely on supermarkets for milk and meat, and even taking the £70 into consideration, it will be cheaper than having to do that too. Given that the amount of milk each goat gives varies at different times of the year, some of the milk can get turned into fresh soft goat’s cheese, and fresh goat’s cheese is absolutely delicious. Goat-keeping gives folk a purpose, provides company and connection with others. There is always something new to learn, appreciate and gain a sense of achievement. Some of the time, taking the goats to feed, you will be outside, interacting with nature.

Goats are gentle, sensitive creatures and all have a distinct personality. Being around them and caring for them is also great for one’s mental health and wellbeing. Best of all, there is nothing like getting down to milking on a cold morning, and snuggling into the side of goat, feeling its warmth and contentment and enjoying the rhythm of milking. It’s magical. Of course, just like Therese’s plan, keeping goats for therapeutic reasons won’t solve all the challenges and problems facing the NHS, but the story reminded me there is so much more we can do to prevent folk from becoming ill in the first place.