Are We Active? – Yes we are!

On our recent trip to Marrakech, we were fortunate to be able to take a hot air balloon trip. It was fantastic and given the chance, it is something we both felt we would do again. However, I wonder if like me, there are certain things you do, and you are glad you have done it, but think it was a ‘once in a lifetime’ experience and never to be repeated ever again. That was me yesterday. My beloved J, persuaded me to join her on a 2-hour pony trek across the hills of Lancashire. She has been riding now for two years and loves it. I, on the other hand, have never been on a horse and don’t particularly like them. It’s a dislike that stems from my time in Wales when the husband of one of my friends was killed by a kick to the head from a Shire type horse.

In our house we take it in turns to suggest doing something that the other person hasn’t tried before. For example, for many years I was an enthusiastic and, if I say so myself, a pretty good climber. J had never climbed, so by way of an introduction, I took her up Jake’s Rake, a notorious scramble in the Lake District. It wasn’t a complete success. She tells me and many others, she nearly died – but fair play, she tried it once although is unlikely to do it again in a hurry.

Anyway, we pitched up at the stables and were suitably kitted out with Hi Viz vests and riding hats. Other folk on the trek had already had a horse selected for them and goodness, did they look tall. In my eyes, with their feathered hooves, they all looked suspiciously like Shire horses. Mine arrived. He was called Mac, and he looked big.

I got on and waited for the other riders to get their horses sorted.  I did seem to be a long way off the ground; and Mac was a very fidgety horse. Then we were off. Mac had clearly done the trek many times before and simply followed the horse in front. I didn’t have to steer or do anything other than stay on and admire the view. It was an experience. 

The sure footed horses gave rise to a wonderful sense of confidence, as they picked their way up and down stony gullies, across rivers and along country lanes.

Two hours later and we were back at the stables. Young J was very excited by the experience. I was less enthusiastic. But that is the thing about trying something out that the other person you are with has never done before. She was happy, which made me happy. In the future J will continue to ride and enjoy every moment; I will just keep on walking.

The month of August is drawing to a close, and as with the last 7 years it has seen the brilliant, slightly competitive We Active Challenge. You can read the history of the challenge here. Over the 31 days of August, folk from all the many different health care professions have walked, cycled, swam, run, spun and engaged in all kinds of physical activities, yes even riding, and each day posted a picture of themselves, the activity they are doing or simply an image that captures the spirit of their #weactive challenge. We have all used the hashtag of our own health care profession to do so. At the time of writing, it does look like those wonderful Allied Health Professionals are likely to regain this year’s #WeActive top spot.

Like the #NHS1000Miles challenge, more and more folk are joining in and sharing what they do to keep active, and in so doing keeping healthy too. And that is the important thing. Yes, there may be a little bit of a competitive edge, but it is about what you personally can achieve, and importantly what that means for you. I set myself an #NHS1000Miles target of walking 2,022 miles this year. I may or may not achieve this. However, the 1,000 miles is just a target and lots of folk will get there this year. Some, like our elite runners, will go way past this. Others will perhaps not reach the 1,000 mile target, but for them will have still increased how much time each day they are active. This is the whole purpose of both the #WeActive and the #NHS1000Miles challenges.

The research tells us that active people are healthier people. I don’t mean just physically healthier, but mentally healthier too. And as the WHO tell us, ‘there is no health without mental health’. It’s not just the huge body of research, or WHO, or even me that is saying this; last week Maria Caulfield declared that ‘getting active is hugely beneficial for both our mental and physical health, helping reduce stress and ward off other illnesses, such as heart disease and obesity’.

I know what you are thinking.

Like you, I had no idea who Maria was. Apparently, she was appointed Minister of State for Health on 7^th July this year. I rarely engage with politics in this blog, but I can’t help feeling that this announcement (which was in the context of social prescribing) is possibly going to be like my horse riding experience – a once in a lifetime occurrence.

I believe that it will be all of us everyday folk that will make a difference to the health and wellbeing of the communities we live in. Every step taken, every metre swum, miles cycled, horse rides trotted, Km’s run during the #WeActive month of August will benefit not just the individual, but all of us too. Let’s all keep on walking, or whatever it is that you do in keeping active, and keeping healthy.

In future think about 7am as being the new 5am!

Can I just say how lovely it is to be sitting in my own bed and writing my blog? I loved our visit to Marrakech, but there is nothing like the comfort of one’s bed.  My dear wife J is not so enamoured with this early morning writing business, whether it’s in Marrakech or back in the UK. On a few occasions she has wondered out aloud if it might be possible for me to write and post my blog later, and maybe at what she considers to be a more reasonable time on a Sunday morning. She is absolutely not a bona fide member of the #earlyrisersclub, but I also know on which side my bread is buttered.

Thinking about changing the time of my blog posting after 13 years feels slightly unnerving. However, on Friday I met a Stockport NHS FT colleague who was a great fan of my blog, but he was not a fan of the #earlyrisersclub – he read it later on in the day. Looking at the stats, he is not alone. So, folks, this will be the last 5am posting of my weekly blog. In future think about 7am as being the new 5am.

Ok, let’s get on with this week’s offering.

Now then, regular readers of this blog will know that I try and steer clear of politics. I do. Honestly. It takes an almost seismic event before I get involved in politics in this blog. I mean, I don’t think I mentioned how relieved I was that Boris had gone, or if I did, I’m sure there wasn’t any glee in my comments.

You know, when you meet an MP and he looks younger than all of your children, that you may well be entering that older person’s section of society. Well, that was my experience last week. After returning from our holiday, the week felt jam-packed until Friday. There were plenty of meetings, sadly some of which didn’t lead to my expected outcomes. The meetings were back-to-back and unrelenting. That said, I acknowledge I’m not working in a clinical environment and I take my hat off to all my clinical colleagues who continue to work in the face of unremitting demand and during these hot days, in conditions that can be extremely challenging.

Friday came and my diary included a number of meetings with MPs. The first meeting was with a chap called William Wragg. He is one of the new MPs, and is just 34 years old. My youngest daughter is 40 (actually since being with J, I now have two new daughters, aged 23 and 25). On the Thursday, William took to Twitter to say he was taking a break from his parliamentary duties due to a flare up of depression and anxiety, two conditions he has lived with for a number of years. Like my colleagues on the clinical front line, I also took my hat off to William for sharing news of his mental health problems. For any one of us this can be a somewhat daunting admission, but for someone in public life like him, the decision to share his mental health issues might have been even harder. Sadly in 2022, there is still a great deal of stigma attached to people experiencing problems with their mental health and wellbeing. I wish him well and, of course, will arrange to meet with him when he has recovered.

The second MP I was due to meet on Friday was Robert Largan. He became an MP in 2019. He is aged 35 years old. My youngest son is 41. Interestingly, given the recent debate about Eton, Oxford and Cambridge Universities producing so many of our politicians, both William and Robert studied at the University of Manchester. Robert did eventually turn up, some 20 minutes late, citing the difficulty he had trying to find a car parking space. Welcome to my world I told him.

Our Chief Executive, Karen James joined us, and the three of us had a wide-ranging conversation for an hour. When he asked Karen what she felt was her number one issue, she replied saying that the workforce issues prevented us from truly being able to move things along as we would like, and that the lack of an adequate workforce in both health and social care was now beginning to impact on our ability to provide safe, high quality care. As a follow up question, I asked why his government had reintroduced the cap on the number of medical student places this year. There are over 3,000 fewer places than last year. Given the crisis in filling medical and nursing vacancies, it just seemed an absurd policy decision to me. Sadly, Robert had no answers.

When he asked me in turn what I thought my number one issue was, I replied and said the lack of social care and domiciliary provision. I took him through the knock-on effects of having so many people who have no real medical reason to be in an acute hospital, but who can’t be discharged because there is no social care provision for them. Using so many beds for these particular patients means it is difficult to admit new patents requiring in-patient care, and so our emergency department regularly gets blocked up. This in turn means we run the risk of having patients sitting in ambulances outside ED; ambulances that will subsequently not be able to respond to 999 calls. He appeared to get the knock-on story, or so I thought, but then reminded us that his government were doing something about social care through the provision of new monies.

He then paused as he remembered that this new money wouldn’t be available for three years.

We took him for a walkabout through the hospital. We were able to show him the really challenging areas which were no longer really fit for purpose, as well as those areas where we have been able to make an investment in improving the clinical environment. He was dismayed and impressed in equal measure. I was impressed with my colleagues who all, upon being asked what would make a real difference to what they were doing, said: ‘having enough colleagues to provide safe and quality services and getting social care sorted out.’ Let’s hope that despite his lack of years, Mr Largan may have listened more intently than my children often did in their youth to this particular message and, thinking about it, anything else I may have had to say.

The NHS, 74 years of free health care and just a little rock and roll

Apparently, I may have become a flashpacker. More of which in a moment. This week’s blog posting comes from the delightful Riad Alili, in Marrakech, Morocco. And it’s hot! Marrakech was once a ‘side trip’ to the ‘hippie trail’, an overland route that usually ended in Kathmandu. It was popular with young people during the 1960’s and early 1970’s. Those on the hippie trail would carry very little luggage, have very little money, and hitchhike their way across Europe. They passed through Turkey, Iran, Afghanistan, Pakistan, India and eventually arrived at Nepal. They were the original backpackers. I imagine it would have been a fabulous trip, but sadly I never got the chance to do it.

In my youth, I totally embraced the hippie culture. I grew my hair (kind of white man’s Afro buzz), I had a magnificent beard, listened to psychedelic music, wore beads and bangles, and then there was free love, enough said, maybe. Strangely (and thankfully) all through those years I never did drugs. Unfortunately, for me, I was born just a few years too late to make the hippie trail. The closest I got was spending a wonderful summer traveling around continental Europe and ending up in Amsterdam for a couple of hedonistic months. Marrakech became part of the hippie trail, partly due to musicians like Jimi Hendrix and Cat Stevens (younger readers ask your parents who these people were) who frequently stayed there.

Our riad is located in the Medina quarter, the oldest and most traditional area of the city. It is a beautiful place run by the fabulous Gambotti family. They fell in love with Morocco on their first visit, came back, and bought the riad. It is a stunning place, with just five suites situated around a courtyard with a pool and wonderful gardens. I would describe the whole ambience as being luxurious, and the service first class, which is where becoming a flashpacker comes in.

Flashpackers are travellers, usually in their mid-30s to 60s, who actively seek out authentic and unique experiences.  They want that truly impressive travel experience, and although typically their trips tend to last from 4 -10 days, they cram as much into their time as possible. So we have done all the tourist things, including an early morning visit to the Jardiniere Majorelle, with its vibrant blue back drop to some magnificent plants, my J looked so good too. 

We did the obligatory getting lost in the souk, watched the snake charmers, avoided the monkeys, did a sunrise hot air ballon ride, Like other flashpackers, time  was the issue for us, not cost. We simply wanted to do it all. Flashpackers are not interested in the two week beach holiday, and like us, they wouldn’t identify themselves as tourists, but as travellers. The catch is that you need to have a bit more money than backpackers typically have to travel in this way.

Way back when I was backpacking around Europe, I had very limited funds. Although I’m far from rich now, I do have more disposable income than when I was younger. That said, writing this blog in the midst of the cost of living crisis makes me feel very uncomfortable. Whilst I have worked hard for what I have now, I have also been given many opportunities to flourish throughout my life, and for that I’m very grateful. Nevertheless, like many others, the cost of living pressures means that I’m beginning to make lifestyle choices that a year ago just weren’t an issue.

Of course, many other folk have long been making difficult choices way before the current situation emerged, and not just in the UK either. In planning our Marrakech trip, I was interested in finding out a little bit more about the health care system there. If you are poor, you are unlikely to have your health care needs met in any meaningful way. Whilst Morocco has both private and public health care systems, these are not provided to the same standards we find in Europe. Like the UK, there is a shortage of doctors and nurses. And in the public sector, nurses are more ‘attendants’ than the highly skilled and university-educated UK nurses. 

In the public health care system, you will be expected to supply much of the non-medical resources. So, bring your own sheets, blankets, pillows and so on, something to eat each day and absolutely you will have to pay for all medical equipment used. This will not only include x-rays, scans and so on, but syringes and dressings for example. All follow up care such as out-patient care will also have to be paid for. Meanwhile, private health care in Morocco is thriving! It’s altogether much better, but like those flashpackers, you will have to pay for the services you get. Most people using private health care services are covered by insurance, but there are some things that you will still have to pay for. Visiting your GP in Morocco will cost you £8 - £10. In comparison, visiting your GP in England will cost the NHS £39.00. In Morocco, a hospital stay will cost you around £300 a day, although you don’t have to bring your own sheets and so on. In England the cost is around £400 a day, a cost the NHS picks up.

In making these comparisons I know I may not be comparing like for like. But, and it is a big but, we all need to do more to think about the true cost of our ‘free at the point of service’ NHS health care provision. The current cost of living crisis is not just about food, rent, and energy costs – it’s all of these and more, particularly how these feed into public-funded services such as the NHS. There is no mythical money tree, so just like the choices we are now having to make in our own lives, the NHS will inevitably need to think about what it can continue to provide and to who gets what services. 

And I would urge a pause for contemplation here.  According to the BMJ, one in eight people struggling to access health care due to the long waiting lists are now turning to private health care services to receive the treatment and care they need. This is a growing and worrying trend. I will fight with my last breath to keep our NHS free from any form of privatisation. In this regard I stand up and applaud all my colleagues who continue to make the NHS one of the best health care systems in the world. Please don’t believe everything you read about in papers like the Daily Mail, Telegraph, or the Express; or even what you might hear on BBC news programmes. 

Finally, I hope you will forgive my momentary lapse of reason in becoming a flashpacker. The awareness of time passing has become more important to me than ever before. Long ago I embraced the idea that we have but one life and we should live it as best we can each and every day. I will be back in the UK next week, but today that day will be spent in Marrakech. 

Read all about it: back to the future with place-based care

I wonder how you get your news each day. I haven’t bought a newspaper in years, yet I read the newspapers everyday online – well at least those that are not firewalled. Indeed, one of these newspapers regularly updates me on how many articles I have read so far this year – apparently, I’m up to 540. I suspect that like many other people, I increasingly get my news from many different sources. As I drive to work, I have a news channel on my radio. I use social media to find and follow stories. Occasionally I will seek out the news on TV, if there is some major breaking story or catastrophic event.

Now you might be wondering what newspapers have to do with anything. Last week, colleagues at my hospital were given notice that we, along with other hospitals, might be featured in one of today’s newspapers. The focus of the story was to be on the large numbers of people still on NHS waiting lists and the time taken to see folk on these lists. 

Our communications team and the wider NHS communications folk dealt with how we might respond to what is published. I haven’t read the story yet as its published in one of the firewalled newspapers, and my local newsagent isn’t open yet. In any event, I dare say it won’t make good reading, albeit it covers an important issue.

I say this because of the often biased and ill-informed stories on the performance of the NHS which are becoming more and more prevalent. Like many other health service commentators, I worry about the proliferation of such stories being regularly published by the right-wing media. I imagine that today’s story was prompted in part by leaked NHS England documents last week that showed an unpublished national waiting list for people requiring community health services. The leaked documents reported that there were more than a million people, including hundreds of thousands of children, waiting for such services.  

Due to the impact of Covid and the pre-existing health inequalities, the current overall total number of people waiting for diagnostic tests and/or treatment is over 6.5 million. It is worth remembering however, that during the pandemic 750,000 patients were treated for the virus in hospitals and many more in the community. Covid hasn’t gone away. The latest spike, which appears to be plateauing now, won’t be the last. These spikes will keep occurring for many years yet, perhaps not with the same intensity, but they will keep on coming. I guess another reason for today’s newspaper story is the fact that Greater Manchester (where my hospital is located), Essex, and Devon all have the largest waiting lists across England.  Sadly, it may well be that the numbers of people requiring diagnostic tests and/or treatment is actually higher than the figure published. The numbers contained in that leaked NHS England report might well be an underestimation.

A recent report undertaken by researchers at the University of Birmingham, also notes the published figures could be an underestimation. They suggest that to eliminate all waiting lists by 2030 would require a year on year 8.4% increase in the number of elective procedures being carried out. To put this into context, it would mean increasing the number of procedures by 50% above pre-pandemic levels. In terms of money, the report suggests an extra £9 billion in funding is probably required. However, as we have seen with Boris’s 40 new hospitals, there isn’t the money to pay for the additional costs required for new facilities, staff and equipment that would be required to do this on top of the extra £9 billion.

It is not all grim news though. At the end of July, the many thousands of people in England who had been on a 104 weeks long waiting list was reduced to just a handful of folk. This was a staggering achievement. That work hasn’t finished and NHS organisations across the country continue to look for new and innovative ways to help deal with the waiting list backlog. Eliminating the 104 week list was made possible because of the way integrated care systems (ICS) operated together, instead of individual hospital trusts trying to reduce the numbers themselves. And that’s the rub for me. In singling out any hospital by name in newspaper articles belies the excellent work going on across ICS’s. I’m confident that these approaches will continue to make a difference to the lives of people still awaiting their care. In Greater Manchester, if one hospital is struggling, it becomes the responsibility of the whole ICS to find solutions and offer mutual aid where needed.

There is another element to these issues which I suspect the newspaper article won’t touch upon. Last week, in Greater Manchester we had nearly 1,000 general acute beds unavailable to be used for elective treatment. Their unavailability arises due to people who have no reason to be in hospital but who can’t be safely discharged because of a lack of social and domiciliary care. A thousand beds is almost a third of all available general and acute bed provision. We have to fix this problem, or the waiting list numbers are likely to continue to grow.

Back in the days when I did go out an buy a print version of my daily newspaper, I can remember my first child being born. We lived on a street that celebrated her birth. When things got tough there was always someone there to lend a hand, give some advice or just simply be there with us. This was community support, and a kind of support that I think we may have lost sight of. Hopefully the development of place and locality-based care will take us back to the future and stop many more people getting onto a waiting list in the first place.