Young people’s mental health care: Déjà vu, again

Last week was all about a heightened sense of déjà vu. For example, I don’t normally go to Stockport NHS FT on a Friday, but as I was chairing an interview panel for consultant anaesthetists, I swapped my days. Having got up and done the chores, I was on the road by 5.45. It was a lovely morning and as it was the school holidays, I knew that traffic would be light. Driving down the M55 I saw a plume of black smoke in the distance. I wondered what it was but didn’t think anything of it. Coming onto the M6 the gantries lit up, telling drivers to slow down as there was a vehicle on fire up ahead.

Shortly after, the traffic stopped. Half a dozen fire engines went past me and many more police cars plus a couple of ambulances. Things looked very serious. After 90 mins stationary, I found a website that showed the motorway cameras closest to the scene of the accident. I could see it was an articulated lorry that was on fire and I might well be sitting going nowhere for some time. I had a real sense of déjà vu. The same thing happened to me the previous Thursday on my way to work. On that occasion it took 90 mins to get through the accident. Last Friday it was nearly 3 hours.

However, I did get to do the interviews, and we were able to offer two candidates a consultant role. So, I was in a great mood driving home. There was the weekend to look forward to, and although I have little interest in football, I’m very much looking forward to the Lionesses’ final later on today. I have also been sampling my wine collection, a collection that goes back 30 or so years, on the basis that if I don’t start drinking it now, I may never do. I had selected a 12 year old Beaujolais for my Friday evening drink and was looking forward to a glass or two. However, the pleasure was to be delayed. As I joined the M6 for the second time that day, I joined a queue that stretched as far as I could see.

I waited and waited. Three ambulances went past me on the hard shoulder. Frustratingly I couldn’t find anything on social media to tell me what was going on. Equally frustrating was the knowledge I was only just a couple of miles away from the M55 junction which would take me home. Some 2 hours passed before I was able to start moving once more, and my whole journey took over three hours, twice as long as normal. I can’t tell you how good that first glass of Beaujolais tasted!

What wasn’t so good was hearing our new Secretary of State for Health and Social Care suggesting that the solution to the current problem of ambulance waiting times and flow in our acute hospitals was to hold a ‘hackathon’. Thanks to the Heath Service Journal for the heads up. We did hackathons, sandpits and all kinds of similar stuff when I was working at the university. They were sometimes successful, but often not. They were fun of course, and very occasionally a great idea emerged. Is this the way to solve the problems with the UK social care crisis? I don’t think so.  

And the fact that the idea came from someone who, in the recent past, has argued that nurses don’t need university degrees and actually we could train our nurses in two years not three, just adds insult to injury. This nonsense illustrates, perhaps, that right now, UK politics is in a very bad place. I have been writing about the ‘being’ and ‘doing’ of nursing for many years now. Yes, you can possibly train someone to do nursing in two years, (just as we have seen with some social work and teachers’ degree programmes), but that doesn’t mean they will be able to be a nurse after that time.

I’m with my favourite educational influencer, Paulo Freire, who so eloquently talks about the notion of praxis. Knowing how to do the job (the ‘doing’) is not the same as turning theory, knowledge, and skill into something that is enacted, embodied or realised (the ‘being’) into professional practice. And in so doing, making a positive difference to the lives of others. It was in thinking about this notion of praxis and the translation of theory into practice that I had another déjà vu moment last week. The headline that professed an approach based upon 'relentless love' caught my eye. It was a story about a group, called Oasis Restore, who were claiming to open the first school for young offenders. You can read their story here.

Now then, I thought, where have I seen that before? What brought me to Manchester all those years ago was an advertisement that promised an opportunity to ‘go where no RMN has gone before’. It was an advertisement that sought to find mental health nurses to work in the first secure forensic mental health service in the NHS for young people. The service was housed in a purpose-built secure unit set in in the grounds of what was once called Prestwich Hospital, now part of Greater Manchester Mental Health NHS FT. Today they are one of six such services across England. It had a school. Teachers, headmaster, classrooms and all. The young people had to attend it Monday to Friday. It was staffed, as was the whole service, by colleagues who universally practised ‘unconditional positive regard’ with the young people and colleagues too – I don’t know if this is the same as ‘relentless love’.

Actually, I don’t care. What I do care about is that someone is doing something positive to protect and nurture our young people’s mental health and wellbeing. Oasis Restore is part of the wonderful Oasis Charitable Trust and they are working with the Commission for Young Lives, who believe that every child and young person should be given the support, help and positive reinforcement to enable them to succeed and live their best life possible. It will cost money of course to realise their ambitions, but what an investment!    

In the midst of chaos, there is also opportunity*

Yesterday’s newspaper headlines were dominated by the word ‘chaos’. Chaos and chaos theory has long interested me. I’m fascinated by the notion that random events can have an impact on something, perhaps people, events or outcomes, through their seemingly unrelated interconnections. 

The famous metaphor ‘a butterfly flapping its wings in Brazil can cause a tornado in Texas’ still intrigues me; I think it is the notion of possibility and probability never quite being in balance. It is the space between the cause and effect, and the connection with intended and unintended consequences that interests me. I also love the idea that it might be possible to mathematically model such phenomena. However, for the purpose of this week’s blog I’m drawing on a simpler definition of chaos that might be best described as a state of ‘complete disorder and confusion’. 

Such disorder and confusion could be seen last week, mainly, but not exclusively, to do with what happened at the Port of Dover. I hope none of my readers were caught up in the chaos of trying to start their holiday. Actually, last week felt a particularly chaotic week for many, me included. 

Monday was the start of our mini heatwave – although up here in the North West temperatures weren’t as extreme as had been predicted. It was warm but not excessively so. Tuesday was a different story. I got in my car to drive home to find the inside temperature was 45c, which did feel warm. There was certainly a lot more disruption throughout the day, and I take my hat off to all those folk working during this heat over that 48 hour period. Particular to all my NHS colleagues who were working in buildings, many of which were not designed to deal with such heat. Colleagues working in estates and catering did an absolutely sterling job of keeping wards, buildings and people cool. True teamwork.

Wednesday dawned and it was considerably cooler. Just as well, as I was attending one of the University of Salford’s graduation ceremonies. I was there for the last of my PhD students. Graduation ceremonies are what I would call ‘organised chaos’. There is often much confusion, but eventually everything falls into place and the ceremonies get done. The academic robing room, usually a chaotic and fraught environment, was unusually calm when I walked in. Sadly, my robes hadn’t arrived. The lady in charge was very kind and got me kitted out in a Strathclyde Doctoral gown. It was a delicate shade of pale blue. Wearing it didn’t feel right, but as my mother was often wont to say ‘beggars can’t be choosers’. Thankfully she lived in an era where woke was something you did after being asleep.  

The ceremonial procession was wonderful, the speeches a shade too long, the women’s shoes outstandingly impractical for walking across the stage, the brass band music inspirational and a good time was had by all. Saying goodbye to the students, a group of us went for a meal and a celebratory drink. It was fun, and by the time I got on the tram to the station I was in good spirits. My good mood didn’t last. I walked onto the platform to see my planned train home leaving the station. I had missed it by a few seconds. That’s when the chaos started in earnest.

The next two trains were cancelled, the one after eventually came into the station, everyone got off, including the driver and conductor, and the train lights were turned off. We were told it wasn’t going anywhere as there were no more drivers, but there was a train coming from the airport which would be going all the way to Blackpool. It took another 40 mins to arrive and the journey home took another hour. So, it was 01.45 when I eventually climbed into bed, a bed that I climbed out of again at 04.30 to go to work.

Last Thursday it was hard doing the early morning chores, feeding the animals, taking Dylan the dog for his first walk, but I was able to leave in time. As I drove towards Manchester, I listened to Radio 4’s Farming Today programme. I have listened to it for years. Its focus is on agriculture and horticulture, and fishery issues and the reporting is all about realpolitik. Thursday’s programme explored the impact of our recently agreed trade deal with New Zealand. The overwhelming view of the farmers interviewed was that it would be extremely damaging to British agriculture. I continued on my way but 30 mins later got stuck in a 7 mile traffic jam on the M60. A lorry had caught fire during the night and 3 of the 4 lanes were coned off. It was utter disorder and confusion. It took me 90 mins to get through the jam. Which meant I was able to listen to the Liz Truss interview on Radio 4’s Today programme. Unlike the farmers, she thought the deal she had agreed with New Zealand was the best thing since sliced bread. Sadly, we will have to wait as only time will tell who is right. I’m just thankful to be a vegetarian.

One of the things we don’t have to wait to find out is who will be footing the bill for the NHS pay award announced last Tuesday by our new Secretary of State for Health and Social Care, Steve Barclay. There was already a 3% pay rise baked into existing NHS budgets but much anxiety over who might have to pay for anything over this percentage point rise. On Friday, I received a letter from the sometimes demonised NHS England Chief Financial Officer Julian Kelly saying that the Pay Review Board recommendations (most of which were much higher than 3%) would be funded in full from central NHS funds. The decision to fully fund these pay rises means front line services will be protected. More than ever now, this is so important. The NHS is currently seeing 10% more patients than in pre-pandemic times, a reflection of an amazing contribution from colleagues being made even at time of continuing Covid challenges. The letter and what it represents was a most welcome and timely response. 

It was a letter that acknowledged that NHS colleagues have, and continue to make, such a difference to so many people lives. It is my sincere hope the pay uplift announced is enough to avoid the chaos and conflict that would inevitably arise from NHS colleagues taking industrial action in pursuit of a possible bigger pay rise. This might not be a popular assertion, and it it definitely not a political point. My hope is that we continue to seize the many opportunities we currently have to transform and improve how the NHS delivers its services in a more integrated way. 

*Sun Tzu

All our yesterdays, including yesterday, today, and tomorrow

It can be funny to think what we sometimes are prepared to do. For example, way back in the early 1970s, during the last two years of my nurse training, I commuted between a small village in Wales called Pumpsaint and the delightful city of Swansea. It was a daily 76-mile round trip. That meant early starts and often late finishes. I didn’t mind as, at the time, I had a little smallholding to return to every day. I kept goats, sheep, even a donkey once, chickens, geese, peafowl, ducks and little pot-bellied pigs, before they became a popular something of a ‘must have’ trend. I grew my own vegetables, made my own bread and cheese, even tried wine-making for a while. I also had four young children.

Looking back, I have no idea how I managed to fit everything in, but I guess I had plenty of energy, and needs must. It was a wonderful life, but tough at times too. I would take on extra work just to make ends meet, but it was a happy house and I loved my nursing job. These days I don’t have a smallholding, but do still have goats, chickens, ducks, cats, a dog and a rascal of a parrot. This may surprise some people as we live in Blackpool. Many people only think of Blackpool in terms of fish and chips, rollercoasters, the Pleasure Beach, an Eiffel tower lookalike, illuminations, Winter Gardens and golden seaside beaches. All of which is true. Each of these things are here, and all are enjoyed by thousands of people every year. But there is another side to the area, which is just a hop, skip and a jump away from the Las Vegas style slot machines on The Golden Mile.

The truth is we are blessed with many fabulous agricultural communities all around us. It means we get to enjoy the seaside, and the countryside. Yesterday, we did the latter. J and I took ourselves off to the Great Eccleston Agricultural Show. This is a two-day event that showcases all that is great about rural life. It is massively popular and has been missed during the pandemic years. There was everything to see, from state of the art tractors and machinery that can plough, sow and reap at the press of a button, through to demonstrations of more traditional skills; I saw basket weavers, wheelwrights and blacksmiths. There were marquees full of prize-winning home-produced jam, cakes, flowers and arts and crafts. And of course, there were lots and lots of farm animals. Indeed, the Fylde area and coast, within which Blackpool lies, is home to some of the UK’s top breeders of cattle, sheep, goats and poultry and acres and acres of dairy farms.

I have to say my favourites were the goats. They had a wonderful selection and even examples of the first goat I ever owned, a black and white British Alpine. There was also a woolly pig, and llamas with such doleful facial expressions, you wanted to bring them home with you. I didn’t. I was in my element and felt very much at home. It was a grand day out and a real trip down memory lane.

It wasn’t the only trip down memory lane for me last week. Last week our hospital celebrated a healthy eating week, but did so through the eyes of our wonderful Dining Companions. These are volunteers who help our patients at mealtimes. We have 120 Dining Companions who work alongside our colleagues. When they join us, they are all provided with training and ongoing support, and are seen as being very much part of the team. They offer support to patients who might need help in eating and feeding themselves. This help can be in the form of something as simple as opening the hot food dishes (taking the silver top off for example), encouraging patients to eat, actually feeding them, or just being someone who patients can have a chat with as they eat. Each Dining Companion becomes another set of eyes and ears to assess patients’ wellbeing, something that is invaluable in a busy ward environment.

Last week we were also highlighting the new bright yellow tabards our Dining Companions wear. These tabards identify the Dining Companions to other colleagues and patients alike. So, it was my privilege to get out of my office, roll my sleeves up, don one of these yellow tabards and go and help at last Thursday’s lunchtime. I was asked to go to our Acute Medical Unit and then to our Acute Frailty Unit. I enjoyed visiting both services, and I was able to see first-hand, our Trust values in action. There was care, compassion and good humour to be seen too.

Despite feeling rather silly in my bright yellow tabard, I quickly settled in, and it was as if all those years ago, when I was in practice, had just rolled away. There I was in the moment, able to do something once more that I loved doing all those years ago, being up close and personal with patients. I didn’t get to actually feed anyone, but was able to spend over an hour talking and being with some wonderful people. Some of these folk were living with dementia, and that made some conversations more of a challenge. Likewise, the rules have changed since I was in practice, and now it is no longer permissible for nurses (or visitors) to sit on a patients bed while having a conversation. I understand the infection prevention reasons behind this but in my day, touch and a physical presence often helped reduce the impact of the imbalance between professional and patient. However, it was great to get some lived experience feedback on the meals we provide, how patients are encouraged to eat and drink and so on.

Many of the patients were 65 years old or older. Often the conversations were about the life lived by the patient. Their yesterdays. I came across one lady who had been a nurse for over 30 years, and hearing of the changes she had experienced and where she had practiced as a nurse was fascinating. She talked about her yesteryears, what she was experiencing today, and perhaps just as importantly, what she hoped for her tomorrows. I reflected upon my brief visit, and whilst I recognised the importance of ensuring patients’ nutritional and hydration needs are met, the social aspect of eating in company was in my eyes equally as important. My thanks go to all the patients and colleagues who were so gracious in allowing me this enlightening experience.       

Behind every successful woman is herself

I write this blog on my own, but I’m supported by my wonderful wife J. Every week she will ask ‘what will you be writing about tomorrow?’ and my almost inevitable response is usually ‘I don’t know yet’. Although I do collect stories and ideas during the week, often these don’t metamorphose into my blog until I start writing. This week is no different.

For example, I have continued to wear my one yellow and one blue pair of clogs for all but one of the 137 days of the Ukraine war (the missing day was the Queen’s Jubilee where I chose a purple pair). I believe we must keep this unremitting conflict in our minds and those, who are impacted by it, in our thoughts and prayers. Not forgetting those caught up in all the other atrocities that continue less visibly worldwide. One of the many consequences of the Ukraine war is a growing global shortage of chickpeas, the basic ingredient of hummus. In UK supermarkets, the price of this delicious food has gone up almost 100% since the war started. Now I have very little sympathy for the Waitrose shopper outraged by this particular cost of living increase, but I do have concerns for the millions of folk across the world who rely on chickpeas and other pulses as their main source of protein.

Then there was the news that Boris Johnson was to resign as Prime Minister. Right to the end (well nearly the end) of his time in office, he remained positive about his achievements – a Brexit deal that wasn’t oven ready, not building 40 new hospitals, coming out of the Covid pandemic about the same time as other countries, not levelling up and best of all, enjoying the second lowest economic growth rate in the G20. But we don’t do politics in this blog. 

One of the consequences of how this whole sad saga unfolded was that at precisely the same time the NHS was taking its first tentative steps into a brave new world of collaboration and place-based care, we get a new Secretary of State for Health and Social Care. We will have to wait and see what the impact of this change at the top might bring.

Just before he resigned his post last week (ironically on the 74th birthday of the NHS), the then Secretary of State, Sajid Javid decided to get rid of the NHS Chief People Officer post. This is a role that has only been held by Prerana Issar, who resigned earlier in the year due to ongoing Covid-related health problems. Her role (renamed Chief Workforce Officer) will now be subsumed into that of Navina Evans, currently CEO of Health Education England. There are a number of things about this decision that made me pause and reflect. I hate the collective noun ‘workforce’. It is singular in form but plural in meaning. Arguably, ‘people’ is NOT a collective noun like team or staff. It is a plural noun. No doubt J will correct my assertion later. Regardless of the grammar, the NHS is a people organisation. Many people come together to deliver the NHS’s services.    

Something else that made me stop and think was the given reason for getting rid of the post. It would make a saving of £200,000 a year. I’m all for being prudent and careful with public money but come on, £200,000! To perhaps put this into context, on average each MP claims £203,880 a year in expenses. Last year Boris Johnson’s expenses’ claim came to £178,406. Maybe we could get rid of him and save the country this expense …hold on, we have already made that saving – I know, we don’t do politics here ...but do you remember that red bus….

The more important aspect of doing away with the Chief People’s post is the fact that right now that means there is one less woman sitting at the top NHS table. I think this will have an adverse impact. There is much evidence to prove that women consistently perform better as leaders then men – see here for example. This recent article appears relevant when thinking about last week’s events and what is unfolding now with regard to who might become the next Prime Minister. In the private sector, many organisations expect talented people to fight for power. And that’s what many men do. Women don’t. If indeed they do fight at all, it’s for a purpose rather than power.  

I’m fortunate to work in an organisation that has a high number of women sitting on its Board – 11 of the 17 Board directors are women, including a brilliant CEO. Does it make a difference? Undoubtedly yes. In this regard, as an NHS organisation we might be an outlier. It’s a fact that globally, women make up almost 80% of all those working in healthcare services. Both in clinical and professional support services, women are doing 80% of the work. However, they generally don’t represent 80% of the decision makers. If we add into the mix other factors such as disability, ethnicity, socio-economic background and so on, I think the balance between men and women when it comes to decision makers, is probably even more unequal. Women are typically underrepresented at many levels of leadership across the NHS.

Interestingly, that isn’t the case with the Chief Nursing Officer in England. The Chief Nurse is the most senior professional leader and advisor on nursing matters to the government. Since the post was first created in 1941 there have been 10 Chief Nurses, all of whom have been women. The present Chief Nurse, Dame Ruth May, like many women in the NHS, demonstrated huge courage, strength, determination and leadership during the first two years of the pandemic. She continues to lead her #TeamCNO from the front. I think that at a time where public trust in the integrity, honesty and morality of our leaders has been severely damaged, people like Ruth shine like a beacon of hope. Likewise, I hope that during this current period of uncertainty and change, we can all think about what more we can do to celebrate and value the contribution women make to both health and social care.

It wouldn’t hurt to also think about what a difference they might make to our British politics too.  

Getting old alongside the NHS – let’s have a tea party!

Well last week was exciting. It was Part 1 of Lytham Festival and J and I got to see Snow Patrol at their first live performance since the pandemic started. They were brilliant. It was a special evening for us. We played their hit song ‘Chasing Cars’ as we walked out of the church at our wedding. Summer festivals are the best and we have missed not having them over these past few years. We have tickets for Simply Red, Elbow, and Tears for Fears next week. Let’s hope the sunshine stays with us. There was one slightly strange occurrence on the way home from the concert. I wanted to use the loo, so called into one of pubs in the town, walked into the gents only to find two women waiting to use the toilet. ‘I’m not interested in what you might be doing’ one of them declared’ I just need a pee and the queue for the ladies is too long’. Unlike the Halifax Building Society last week, the two ladies didn’t seem concerned with the use of pronouns, only about relieving themselves.  

Last Wednesday saw me spending the evening with Nadine Dorries. Never thought I would be saying that. Nadine is of course, the Secretary of State for Digital, Culture, Media and Sport. We met at the Royal Carlton Hotel. Just to be clear, this establishment has nothing whatsoever to do with the Carlton Club, where last week the Conservative MP Chris Pincher was alleged to have sexually assaulted two other men. Nadine was completely the opposite, and nothing like how she is often portrayed in the media.

She spoke with confidence about her political portfolio and what was being planned for the future. She took questions and I was able to ask her about her views on the increasingly hostile stance being taken by much of the UK right wing media on the performance of the NHS. She faltered and fudged a response something along the lines of we have a free press in this country. That might be the case, and that is probably a discussion for another blog, but I get really saddened by headlines such as: ‘the NHS is failing us all’ or ‘our hospitals are not the envy of the world’ and ‘the NHS is making us the sick man of the world’ and the recent comment that I thought really revealed the extent of the way facts are being twisted, and exaggerated  ‘so many doctors on the golf course, feeling fatigued or attending to pressing matters in the Dordogne’. For many folk working in health and social care it is very demoralising to see their contributions being portrayed in this way. Sadly, it is very easy to take pot-shots at a national service like the NHS to score cheap political points or to increase readership.

No one either working in the NHS or a recipient of the services it provides would be able to deny that the NHS is challenged. There are record numbers of people on waiting lists (6.2 million). Thankfully, most of the population have a less hostile view of the NHS than the right-wing media. The latest Care Quality Commission adult inpatient survey revealed that 84% of folk had confidence in those treating them, and 85% said they were always treated with respect and dignity. Both bits of data reflect the fabulous contribution being made by colleagues in what can only be described as unprecedented times.

Nadine and I had a slight disagreement when she claimed that the Prime Minister was responsible for the success of the Covid vaccination programme, I argued that it was the scientists, nurses, GPs, and faith healers that should be given the credit. We agreed to disagree and she moved on to the next question.

Nadine was very well informed, and when later, I was able to have a one-on-one chat with her, she asked if I was still a Non-Executive Director at the Vic (Blackpool Teaching Hospital NHS FT). I told her no, I had stepped down from that role to take up the Chair at Stockport NHS FT. I actually found I liked her more than I thought I would before the evening. And I must confess, I felt for her when she got Rugby Union and Rugby League mixed up at a Rugby League event the following day!

Nadine is 2 years younger than me. Last week I found out we both had joined a new group in society. According to the Office for National Statistics, in their publication of the 2021 census, they noted that the population of England aged 65 and over has finally overtaken the number of children aged under 15 years old. It appears many more people are living healthier, more fulfilling lives thanks to those providing health and social care when needed, plus a greater recognition of the need to address the social determinants of poor health. As Michael Marmot, the world leading expert on health inequalities has noted, we have a long way to go to redress the inequalities in our society, but we are firmly on that journey now.

He also reminds us that more harm, and ill-health is caused by poverty than any failings of the NHS. Last Friday saw the welcome dawn of a new age of collaboration across the NHS, Local Authorities and the third sector. Integrated Care Systems are now legal entities with a duty to collaborate, to address inequalities and promote health and wellbeing in localities and communities.

This weeks last word must go two wonderful people (I don’t mean my new friend Nadine or myself) who celebrated their 102nd birthdays last week. Edith Dumbleton and Dorcas Tobin were born 45 mins apart on the 28th June 1920. They celebrated with a cheese sandwich and plan a bigger celebration with tea and cakes in a few days. And let’s not forget that our NHS will be 74 years old on Tuesday, 5th July. I hope like me, you will join in the nationwide NHS Tea Party and celebrate all that has, and continues, to be achieved in the service of others. I hope Edith and Dorcas raise their cups in celebration of the NHS too.