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.