Love not Hate; standing with Ukraine

It wouldn’t be possible to write a blog this week without first acknowledging my support for the folk in Ukraine and the impossible situation they now find themselves in. Likewise, I stand with all those who have rightly condemned Putin for leading his country into war, and threatening not only the rest of Europe, but the rest of the world too. Long term readers of this blog will know I have a great affection for all things Eastern European. Although I have never actually been to Ukraine, for many years I have visited and undertaken joint research with many colleagues who live and work in the surrounding countries – Finland, Romania, Lithuania, Sweden, Slovenia, Slovakia, Czech Republic, Poland and Hungary. I have also been to Russia twice. Wherever I have visited I have always felt welcomed, safe and privileged to work with so many others interested in improving nurse education, research and practice.

Given these experiences, what is going on in Ukraine right now feels unbelievable, inconceivable and totally barbaric. It is a situation that leaves me feeling impotent in terms of what I can practically do to help those facing unimaginable terror and hopelessness. In a world that has endured so much over the last two years with the Covid pandemic, this situation will for many, feel almost unbearable*.  

Last Friday, my fellow blogger @RoyLilley posted a poignant and significant blog in which he reminded us of the need to be aware of those folk in the NHS who may need someone to be there for them right now. He described the NHS as the United Nations of care, which I thought was a brilliant description. He also noted that of the 1.35 million people working in the NHS, about 33,000 of these come from those countries I listed above. Read his blog here – his words are important.

Probably a great deal more important than mine this week. My week’s notes (stories I have read that piqued my interest) appear, in hindsight, to be far more trivial. For example, a stretch of road between Cardigan and Aberystwyth in Wales (somewhere I also know very well) has just been resurfaced using 107,00 recycled used nappies. Three billion used nappies are disposed of each year in the UK. They can take up to 500 years to break down in landfill sites. I think this initiative is an ingenious sustainability idea. There were other surprises too.

The John Lewis Partnership announced that it will be dropping the ‘Never Knowingly Undersold’ promise – it was a price promise that was first made in 1925. It was a sign of trust for the brand, but of course it was a promise made before online shopping became so popular. Sadly, it is also a reflection of the ever-increasing cost of living we are all now beginning to feel the impact of. Last week, Unilever said the price of Marmite, Dove soap, Hellmann’s mayonnaise and Ben and Jerry’s ice-cream would all rise in this year. Likewise, Nestle are set to increase the price of its goods, so your Cheerios, Smarties and pet food will all cost more. However, there was a rise of a different sort reported by Reckitt Benckiser. Sales of Durex condoms, KY Lubricants, and strangely, Veet hair removal cream were all up massively since the start of the pandemic.

And let’s not forget the anticipated rise in energy costs, council tax, national insurance all of which have fuelled rapidly increasing rates of inflation. The ever-increasing costs (and shortages) of raw materials, and available labour, continue to add to these problems. Despite being exhorted to ‘Live with Covid’, the pandemic has not gone away. It was against this rather depressing backcloth of an almost perfect economic storm that I turned to J last week and asked her if we should move to Finland.

I don’t think the question had anything to do with the fact we were just finishing off a bottle of leftover Christmas mulled wine (we all have to make economies now), but possibly more to do with a set of rather rose-tinted memories on my part of the wonderful times I have spent there. At one time I would travel across to Finland two or three times a year to teach anthropology and medical sociology to nursing students doing their nursing degrees in English. Fun times, with lots of fond memories of the people who over time became my friends. However, J, who has never been to Finland wasn’t convinced. ‘Why would we want to go and live there?’ she asked; a reasonable question I thought. Well, I said, they have forests, a great health and social care system, no homelessness, forests, saunas, snow, everyone speaks English, and they like to eat a lot of fish (as does J). They also have the youngest Prime Minister in the world, Sanna Marin, aged just 36. Brushing aside this last fact, J also pointed out they had a long land border with Russia. With mulled wine-fuelled courage I said, whilst the Finns didn’t like the Russians, it was in part due to their history. Finland was part of the former Russian Empire between 1809-1917.

In the 21st Century, no one living in Finland really expects a return to Russian rule. Yesterday, the UK media was full of stories of the threats being made by Putin towards both Finland and Sweden. Witnessing what is happening in Ukraine today, those threats feel very real indeed. So, I guess we won’t be moving to Finland anytime soon – Apologies Mikko, Leena, and Heikki. But back to that sense of helplessness mentioned above – well there are a number of web sites providing information on some practical things you might choose to do in supporting folk in Ukraine. https://www.rescue.org/article/how-can-i-help-ukraine * https://time.com/6151353/how-to-help-ukraine-people/  *  https://www.globalcitizen.org/en/content/ways-to-help-ukraine-conflict/ 

I’m keeping all those women, men and children in the Ukraine in my prayers and thoughts, and likewise, those brave folk in Russia who have taken to the streets to express their feelings about the invasion – ‘net voine’ (‘no to war’). In war, nobody wins. So, we should also think about those Russian soldiers who find themselves in a place that they (and nobody else other than Putin) wanted to be. Net Voine.

* The name of this land, Україна, is prophetic in a very profound way. The single name of this special country is Ukraine, and in Ukrainian (and also in Russian), it is spoken with a cry. 

How health care professionals can help level up inequalities: and it’s not magic!

Jonny Morris died in 1999. I think you will need to be of a certain age to recognise the name straight away. Like many people of my age, Jonny was an integral part of my childhood. He presented a TV programme called Animal Magic. It was a very successful children’s programme. He clocked up some 400 episodes between 1962 – 1983. Jonny was a great mimic and impersonator and used this skill to have conversations with the animals he was ‘caring for’ as a ‘zookeeper’. He was never a real zookeeper although the series was filmed at the world famous and one of the oldest zoos in the UK, the Bristol Zoo Gardens. The zoo has a well-earned reputation for conservation, and indeed Jonny was a long time environmentalist. Sadly, last week the zoo announced it was closing*. It had been open since 1836.

Jonny Morris talked to animals. He gave their responses in mimicked voiceovers. Some folk criticised this anthropomorphic approach, but as a young child I loved the way he appeared to be talking to, and with, animals. The show was truly magic to my young eyes. He went on to do other radio and TV shows, but it was Animal Magic that remained my favourite.  In 1990 he ‘lent’ his voice to a series of TV advertisements for what were then Electricity Boards, encouraging people to switch to electric heating and so on. Have a look here at one of them. The advertisements featured the  ‘Creature Comforts’ cast and were produced by the fabulous Nick Park and Aardman Animations. They, of course, at the same time, started to produce the wonderful Wallace and Gromit films.

Thinking about the life of Jonny Morris, a couple of things came to mind. Those electricity adverts possibly resonate more today than they would have done 30 years ago. Secondly, however much he planned his conversations with the animals, working with animals will always be unpredictable.

Here for example, he gets attacked by a gorilla. Trust, courage and a huge sense of self-confidence must have played a big part in what he was able to do with the animals.

Last week I was in conversation with someone else whom I have long thought of as courageous and self-confident. That was Michael Marmot. I have seen and heard him speak many times. He is a bit like Jonny Morris in that he can instantly engage with his audience. He uses data and evidence like J uses gas and electricity to keep herself warm – that is all the time. Michael Marmot is a fascinating speaker, and last week he took the opportunity to debunk some of the hype around the current ‘Levelling Up the United Kingdom’ White Paper. The UK government describes leveling up as: ‘Levelling up is a moral, social and economic programme for the whole of government. The Levelling Up White Paper sets out how we will spread opportunity more equally across the UK’. In his usual unique acerbic style, Marmot was not so confident – and I know who I trust more to give a truthful and evidence-based analysis of the facts and opportunities facing our communities.

Now as regular readers of this blog know, I try and steer clear of politics in my posts. However, Michael Marmot produced some compelling evidence that revealed the reality of the levelling up agenda. He noted that in the 10 years following 2010, the UK entered a long period of austerity. Many have argued, as do I, that austerity was a political choice, not a necessity. Public sector expenditure fell, and in particular cuts to local government had a huge impact upon health and health and inequalities. Indeed, the more deprived the area, the steeper the cuts were. Cuts to local government in the North have been calculated as being equivalent to around £413 less per person. Contrast that with 2021 levelling up fund allocations, which in the North amount to just £32 per person.

It would probably be wrong of me to use the example of what the Bromsgrove allocation was compared to Blackburn's. You can look it up for yourself, but it’s a rather large difference. And we all probably know who the MP for Bromsgrove is.

The consequence of the 10 years of austerity for people living in different parts of England are equally stark. Marmot and his team’s research showed that the life expectancy for people living in the North, fell, whilst years spent in ill health increased. You can reacquaint yourself with his research outcomes here. I know whose analysis of the facts I trust. And that’s the rub. The Levelling Up White Paper is written as if it isn’t the result of a political party that has been in power for 30 of the last 43 years. They should not escape responsibility for the increased inequalities across all aspects of people’s lives. It will be through addressing the well-understood social determinants of health that will have the biggest impact on reducing the inequalities gap. Whilst much can be done at a local level, and I’m all for place-based care, actually it’s national policy that has the ability to bring about real change. And we don’t need to rely upon magic to make that happen.

Nursing, medicine and many other health care professions have been consistently recognised as being the top professions that most people rate highest when it comes to truth, honesty and trust. Back in September 2021, Michael Marmot addressed a conference of the Royal College of Nursing. In his keynote presentation Marmot said: ‘Nursing staff are the most trusted group of people in Britain, and rightly so, from that position of trust, if nurses speak up about food insecurity, housing, decent public services, they will be listened to. As a group, nursing staff can play a very important role in changing society’ – I agree.

We can do so at that political level – we all have MPs – write to them, tell them what contemporary health care practice is about. I write to my MP on a regular basis and I think the tone of his responses have started to change for the better. As a whole, health care professionals can be a powerful force for good. It doesn’t take magic. We just need to use the trust others have in us, our self-confidence as a profession and the courage of our convictions. Collectively we can make positive change happen.

 

* The Bristol Zoological Society said Bristol Zoo Gardens in Clifton will shut permanently on September 3rd. It is moving to the site of the society’s wildlife park, the Wild Place Project, in South Gloucestershire. Since it first opened, the zoo has received an estimated 90 million visitors and helped save 175 species from extinction through its conservation programmes.

Nurturing the mental health and wellbeing of our children and young people

J and I live in a house that was built during the 1930s. It is a quaint house that has large, tall rooms downstairs and small, cosy rooms upstairs. We have been slowly making it our own since we bought the house in 2019. It is a slow job, partly because of funds, but also because Covid came, and when it went for a while, finding a builder was near impossible. However, we have made progress. Log fires have been fitted (and enjoyed over three winters), a new kitchen-come-dining room has emerged as a central space in the house, and one of the two bathrooms has been modernised. We are now in the midst of planning to do the second bathroom, an ensuite to our recently remodelled bedroom. 

Having removed the bath from the family bathroom in favour of one of those walk in, doorless showers, J was keen to keep the bath in the ensuite. Now I haven’t taken a bath for much of my adult life. The thought of sitting in my own dirty water simply doesn’t appeal. J on the other hand loves to have the occasional bath, with candles, scents and calming music. 

So, perhaps somewhat predictably, we have ordered a new bath. Thankfully it’s a ¾ size rolltop bath. I say thankfully as research published in the British Medical Journal (BMJ) last week showed that taking a hot bath every day can help folk avoid heart disease and strokes and thus live longer. With today’s already high energy prices set to rise yet again, filling a full size bath every day might need very deep pockets indeed. Either that or a friendly bank manager.

And talking about ensuite bathrooms, I was also mildly surprised to read of the research again published last week, this time in the JAMA Internal Medicine journal, that having an extra hour’s sleep each night could help you lose weight. Now as well as occasionally taking a bath, J occasionally thinks she needs to lose weight. I disagree, but it is her body. She also like sleeping. A daily bath, an extra hour’s sleep each day could be a win-win recipe for happiness.

Coincidently, food was the other study that caught my eye last week. Research undertaken by colleagues at the University of Bergen and published in Plos Medicine journal, reported that if we switch from typical Western style food to heathier diets that contain less red meat, but more legumes, nuts and fruit we will live longer. Not really a surprise, but when you do this appears to be important. For example, make the switch aged 20, and you can expect to live an extra 10 years. Make the change aged 60 and you can expect to enjoy an extra 8 years of life. Even delaying making the switch until you are 80 could mean you gain a extra 3.4 years of life compared to those who continue to eat over-processed and convenience foods.

So, there you have it. I could end this week’s blog post right here. Take a daily bath, sleep an hour longer each day and stop eating Big Macs* and you will live a healthier and longer life, and enjoy a better wellbeing experience. But the blog is not finished. I wanted to write about mental health and wellbeing from a slightly different perspective. Last week was Children’s Mental Health Week. In fact, the last day of the awareness raising week is today. Children’s Mental Health Week was launched back in 2015 by Place2Be – and goodness, hasn’t the world changed since then. If it were important to consider the mental health of children and young people in 2015, it is even more so today.

In 2021, NHS Digital estimated that one in six children and young people will be living with a mental health issue. Given how the Covid pandemic has impacted upon children and young people in particular, I would imagine that the number is probably a lot higher. The theme for this year’s Children’s Mental Health Week is ‘Growing Together’. The theme provides a focus on how we grow emotionally, and in so doing, perhaps find ways to help others grow and manage the challenges they face.  

These challenges have been numerous. Regular schooling disrupted, lockdowns, not being able to see members of their family who were ‘outside their bubble’, not being able to socialise with friends. In many ways these are some of the benign challenges. As children and young people became less visible to teachers and other adults, so their vulnerability to abuse increased. The well respected and highly experienced professor of child health and behaviour, and president of the Association for Child and Adolescent Mental Health, Stephen Scott, recently noted that even in pre-covid times, 16% of children (five in a class of 30) have a serious, diagnosable mental illness, with anxiety and depression being the most common problem. Often these disorders are cloaked in shame and so can remain hidden to the most vigilant of adults outside of a family setting. Again, this a problem that has been exacerbated by the pandemic.

The wonderful organisation Young Minds captured the experience of many children and young people in their last annual survey undertaken in January 2021, during a very difficult lockdown period. The outcome of the survey came in the form of recommendations to Government – you can read these here, but prioritising wellbeing in schools, increasing the number of community-based early intervention hubs offering open-access mental health support in a non-medicalised setting were two that struck me as being particularly important. Some of these are already available, like 42ndStreet here in my place of work, Greater Manchester. However, many more such services are required across the whole of the UK.

Choosing to have a bath or not is clearly a first-world problem. Finding ways to better support and nurture the mental health and wellbeing of our children and young people is an international problem. It is a challenge we all need to recognise and respond to. Children and young people are our future, but they all deserve to have the best future we can help them achieve.

* McDonald’s announced last week that that it will no longer be selling the chicken version of its iconic double decker burger because of an over whelming demand for the new Chicken Big Mac. If they bring them back, why not save an innocent chicken’s life and order a McPlant instead. You know it could help you live longer.

Peter and the Three Faces of Competence

The people of Japan say that we have three faces. The first face, you show the world; the second face, you show to your close friends and family; the third face, you never show anyone. The third face is the truest reflection of who you are. I’m just leaving this out there for your consideration as you read this week’s blog.

Now here is a lovely new word for those readers of this blog who might, like me, love words. ‘Hierarchiology’ is the study of how hierarchies operate. It was first used by Raymond Hull, who using the research undertaken by Lawrence Peter, wrote the book ‘The Peter principle’, which was first published in 1969. Their now familiar and famous book was intended to be satire. They were poking fun at the many self-proclaimed organisational and managerial gurus of the time. However, over the years, the book became considered as a serious critique of managerial competence.

At first glance, the book’s premise is deceptively simple. The Peter Principle posits that a person who is competent at their job will earn a promotion that might require different skills. Where the person lacks the skills required for the new role, they will not be promoted again. If, on the other hand, the person succeeds in the new role, they will get promoted again, and continue to be promoted until they reach a level of incompetence. It is a hierarchical process and remains so until the person reaches their eventual level of incompetence.  

Now regular readers of this blog will know that I try and steer clear of politics, but last week’s antics made me think about whether the Peter principle could be applied to politics. There is some evidence to suggest it possibly could. Indeed, in Chapter 7 of their book, Peter and Hull describe the effect of the Peter principle in politics and government. In some ways politics defies the Peter principle. Politicians often get promoted beyond their level of incompetence. Politics as a career is very much dominated by hierarchical structures. So, if you have one job at one level, (whether you do it well or not) you will be expected to continue to rise up the hierarchy and do the next job.

Now I wouldn’t be so careless as to cast aspersions about the competence or not of any of our current government ministers. If you were interested, you might want to have look here. But last week it was hard not to think about the competence of some of our politicians. In particular I was thinking about the 11th hour reversal of the ‘vaccination as a condition of deployment’ (VCOD) policy. If anyone needed to find an example of possible leadership incompetence, this would have been a perfect example.

Last November, those working in social care services such as residential care homes and nursing homes were required by law to be fully vaccinated against Covid-19. It was estimated that some 40,000 jobs would be lost as a consequence of this new legal requirement. The actual loss was far fewer, with around 8,000 people losing their jobs. We shouldn’t forget the enormous personal cost that every one of those 8,000 people would have faced in choosing not to get vaccinated. Indeed, the whole process revealed the true cost in money, time, and stress and anxiety faced by many social care providers and the staff they employed. These experiences provided an evidence base that could rightly inform policymakers should this approach be extended to other areas of public service.

Sadly, it appears such evidence was not utilised in the decision to make it mandatory for all health and social care workers to be fully vaccinated by April this year as a condition of their employment. This does feel as if someone was very incompetent in taking this decision. What further saddens me is that many health services managers, including some very well respected and experienced folk were ignored when they attempted to raise with government the possible negative implications of this policy. It was estimated that up to 70,000 individuals would have to leave their jobs. No one seemed to be particularly concerned about the consequences of this possibility.

Perhaps it is because like those impacted in social care, 70,000 is a big number. Its can be difficult to see the individual amidst this large number of people. However, within this group were cleaners, consultants, nurses, network technicians, midwives and so on. Many had spent many a year giving their all to the NHS. The reasons they might have for not choosing to be vaccinated were manifold and personal. Managers at all levels across the NHS worked with these colleagues to try and understand what these reasons might be and to try and persuade individuals to reconsider their decisions about being vaccinated. Persuasion in the face of compulsion. I think most of us would recognise that vaccinations are the route out of the pandemic, but compulsion was never going to be the right route.

Interestingly, in chapters 11 and 12 of Peter and Hull’s book, they discuss the physical and mental health consequences that many people face when at some point in their career they reach their level of incompetence. I suggest this impact would be the same for all our colleagues trying to work through the implementation of the VCOD policy; both managers and the staff impacted by the policy. The current consultation on reversing this policy will do little to relieve this impact. Unfortunately, it will also do little to ‘undo’ the unintended consequences of the policy – for example, people who got vaccinated just to keep their jobs, or those who lost their jobs because they didn’t want to be vaccinated, who might now feel rightfully aggrieved. 

Perhaps the important lesson from this totally avoidable situation is that we should all keep the faith when it comes to offering, both our patients and colleagues, unconditional positive regard for the life decisions we all take. That’s what make the NHS a great institution, not politics, and certainly not politicians.