The self-indulgent one: my end of year post

We have reached the end of 2023. It’s the time where I become a little self-indulgent and think about the past 12 months. What a year it’s been. Sadly, my mother is still in hospital. She lives with dementia and has become gradually frailer, as each week passes. Apart from a dreadful five days, when she was discharged home, my mother has now been in hospital since the end of May. Finally, last week, we heard from the social workers involved with her care that there is a possibility of a residential care home place. Hopefully, my mother will now be assessed early in the new year. She will be discharged to assess her needs and I guess we will have to take things from there.

The last seven months have taken their toll on my father, who is 93 years old and not in the greatest of health. He is not alone. There are still too many people on long waiting lists for diagnostic tests and treatment. Despite the enormous efforts made by colleagues to tackle the backlog, NHS waiting lists remain stubbornly high. Demand for healthcare, often seen through the lens of emergency departments, continues to grow. 2023 was also a year of industrial action by many health professions. The industrial action continues, and will continue to add to the problems facing NHS and social care organisations in 2024.

Some of these problems have become very personal. There has been a rise in what has been described as ‘moral distress’. This is where a colleague’s sense of self is negatively impacted, both psychologically and emotionally. Sadly, this is often a result of folk feeling the care they provide is not where it could be, or because the issues causing people to have health problems are beyond their help; for example, the cost-of-living crisis, fuel poverty, poor housing and so on. All of which are factors that impact on a person’s health and wellbeing. These are challenges that are unlikely to go away in the short term and it remains important that we remain vigilant in caring for those that care for others.

I also faced some challenges during the year. Thankfully, many of these were ‘good’ challenges to encounter. During the year, I happily tagged along while J continued crossing things off her ‘to do’ and ‘places to see’ bucket list. We went to one of her favourite cities, Venice, the first time for me, and despite my dislike of being on water, we had a fabulous time. Later in the year, we flew to Peru and hiked the famous Inca Trail visiting Machu Picchu. 

Of course, being there, I partook of the national drink, Pisco Sour. It is easy to drink and I was probably guilty of drinking too many glasses of the stuff. What I forgot was that it included crushed ice and egg whites in its making. Within three or four days of being in Peru, I had developed a debilitating case of ‘traveller’s diarrhoea’ that defied even regular doses of Loperamide. Looking out for the nearest loo became almost as important as looking out at the wonderful scenery.

So, when we went to India and Nepal towards the end of the year, ice cubes, raw egg whites, and salad stuff were steadfastly avoided. In contrast to Peru, the food in both countries was a vegetarian’s delight. The choice was astonishing and the tastes out of this world. The drink of choice was ice-cold Gurka Beer, wonderful in the heat. Thankfully there was no repeat of the traveller’s diarrhoea. Although I was just too young to go to Kathmandu during the hippie era, it was just as I imagined it to be. And the flight (run by the amusingly-named Yeti Airways) over the Himalayas and around Mount Everest was a dream-come-true for me.

Two of the dreams I had hoped to realise during the year remain yet to be achieved. The first was my hope and prayers for peace in Ukraine. Sadly, on day 676 of the conflict, I’m still wearing my one yellow and one blue clog in support of the Ukrainian people. 

On a much more trivial level, I had wanted to walk from Fleetwood to Preston in one go and to do so along the Lancashire coastal path, as far as it was possible to do so. It is a 27-mile walk. I have done the entire walk, but only in sections (Fleetwood to Lytham, and Lytham to Preston) but ran out of time to do the entire walk in one go. That said I have walked 2,390 #NHS1000miles since 1st Jan 2023. #NHS1000miles is a way of giving a gift back to the NHS. Anyone can join in this initiative, and if you are interested in finding out more details, see here.

It was also a year of learning too. I discovered two new ideas to ponder upon - ‘chatter checkouts’ and ‘wilful blindness’. I had my first experience of ‘steel signing’ – signing my name and writing a message on one of the steel RSJs in our new Urgent and Emergency Care department. I learnt the meaning of deep sorrow, when two of the most influential men in my life died very unexpectedly. RIP Martin Johnson and Andrew Foster. Likewise, during the year, several of my friends and colleagues have received potentially life-shortening diagnoses. I keep them in my prayers. I also learnt that I could be caught out by the unexpected. Last May I stood as a ‘paper candidate’ in the local elections. Imagine my surprise when I was elected. I can now add Councillor to my CV. Likewise, and with great sadness for me, today is my last day as Chair of Stockport NHS FT. Tomorrow I start as Chair of Greater Manchester Mental Health NHS FT. This was an equally unexpected surprise and not on my horizon at all. But, I’m up for the challenge and feel privileged to have been afforded this opportunity. I’m looking forward to getting down to work and meeting my new colleagues in the New Year.

Last but not least, I could not end the year without mentioning the recent Blackpool Tower fire that wasn’t a fire. If you missed the story, you can read it here. There was no fire, but despite this, what was fascinating were the number of people out on the street who claimed they could smell smoke. A classic case of ‘group think’, and something for us all to try and avoid in 2024. And as we get ready to welcome in the New Year, my dearest hope for everyone, is that the next 12 months are filled with kindness and bring much happiness to all.  

Christmas, a time to believe (there can be a better future for all)

I hate goodbyes. Well actually J and I try not to hate anything; there is already too much hate in the world. Last week was full of goodbyes and I dislike saying goodbye, particularly to folk I might not see again. And sadly, last Thursday, I didn’t get to say goodbye to everyone I wanted to. Last week was my last week at Stockport NHS FT. After 30 months, I was moving on. All in all, I found it an amazingly emotional week.

It started with our wonderful volunteers’ Christmas meal. Some 70 of our 200 volunteers braved the high winds and torrential rain to celebrate Christmas with a full-on turkey dinner and all the trimmings organised by our award-winning catering, patient engagement and charity colleagues. Given that the average age in the room was 65 years old, having so many people turn up was truly wonderful. Our CEO, Karen James and I served everyone their meal. I can’t tell you how good an experience this was. Karen chided me for flirting with the women, and Karen teased me about my love of sprouts. I gave a little speech, thanking our guests for all for their contributions over many, many years. These are good people, and many of the folk I knew by name. I will miss chatting with them as I went about my everyday business in the hospital. Volunteers like these are the life-blood of our Trust.

Clearing my office was both cathartic, but also a little sad. I don’t suppose anyone really wants to leave their organisation by carrying out their personal office effects in carboard boxes. TBH, I did most of the heavy lifting at 7am when nobody was around. I had one slightly scary encounter with one of our security guards who eyed me with open suspicion as I marched out with a huge plant. I think he thought I was robbing our reception area of one of the large decorative pot plants.

Then there was the last breakfast and lunch in our staff restaurant. I always like to try and do both wherever possible. I relished sitting there, eating my food, and hearing the conversations swirl around me. There was nearly always laughter, and I liked the bustle, the noise, the people watching and of course, the gorgeous food. Our chefs have won many prizes for their food, and patients regularly provided great feedback. My last lunch was a favourite – cheese and onion flan, chips and peas – it was actually the same first choice of meal I enjoyed way back when I first started.

I have yet to sample the delights of the catering at my new NHS Trust. I was there last week to start the ‘onboarding’ process. My experience is probably best captured in a separate blog posting. In fairness, my day didn’t start well. Two accidents on one of the motorways that I travel on resulted in a journey that should have taken 50 mins actually taking over three hours. I have long accepted the fact that such delays will happen. When they do, although it’s frustrating, I remind myself to be grateful that it’s not me that is involved in the accident itself.

As an aside, I was amused by the story last week of Rod Stewart having to wait for his wife Penny in a store in London’s Oxford Road while she tried on numerous clothes in the changing room. Rod, like most of us in these situations do, found himself a seat and waited. And waited. And waited. There was a picture of Rod with shoulders slumped looking slightly grumpy and dejected. I know that feeling, although as with motorway traffic jams, I have developed a huge reservoir of patience and have learnt to simply wait things out. Thank goodness for online shopping.

My last day of actually being on site came much too quickly. Last Thursday did have some delights though. One was chairing the last formal meeting of our Council of Governors. Again, it was a very blustery day, and I was pleasantly surprised to see so many of our governors turn up for the meeting. The Council of Governors play a critical role in holding the Non-Executive Directors to account, and through this process, gain assurance about the services the Trust provides. When I first arrived two and a half years ago, these meetings to be fair were pretty dull, and often the only voice to be heard was mine. However, that has changed and through encouragement, support and training, our governors have gained the confidence to ask penetrating questions and raise appropriate challenges. I have loved working with them, and at the end of the meeting found it difficult as we said our goodbyes.

There was a magical moment of joy however. Following the meeting, we all bundled outside to take part in the ‘Great Lights Switch On’ – not our Christmas lights, we had done that a few weeks ago. No this was the signage on our new Urgent and Emergency unit. It was an important moment. Whilst there are some months to go before everything is complete, much of the new building is operational. What made the switch on so special for me (and I suspect for others too) was the fact that the sign said Stockport NHS Foundation Trust, and not Stepping Hill Hospital.

It seems perhaps a small difference, but the symbolism is important. I’m sure it will take a long time for folk, colleagues, and our communities to think of our organisation as being more than the acute hospital. Whilst there will always be a place for a hospital, my ambition as a Chair was to look for ways to reduce the need for hospital care. Helping people live healthier lives, providing opportunities for people to grow and realise their own life goals has always felt the way to go to me. Today is Christmas Eve, and I guess if we are allowed a wish, mine would be that we continue to embrace and harness all the resources in our neighbourhoods, communities, and families in promoting greater health and wellbeing for all.

Merry Christmas everyone!

Not quite pastures new*

My first mentor was a wily Irishman called Jimmy Fitzsimons. I first met him as a student nurse while studying in Swansea. At the time he was a Nursing Officer, rather like a Divisional Nurse Manager today. He had a wicked sense of humour, was a keen golfer, hated injustice, and was generous with his time, advice and providing opportunities for others to grow. I learnt a great deal from the way he did things and the way he interacted with those around him. I lost touch with him as I qualified as a nurse and moved to another part of Wales to practise.

Many years later, I met up with him again in Manchester. I had applied to be part of a commissioning team for a brand-new NHS service. It was the first forensic service for adolescents, based around a medium secure unit. The unit was part of the supra-regional services provided by Salford Health Authority, in the grounds of what was then called Prestwich Hospital. Jimmy was on the interview panel, and I was successful! I moved to Manchester in May 1984. It was the start of a wonderful journey of nursing, academia and leadership that has lasted nearly 40 years, more of which later.

In its time, Prestwich Hospital was one of the largest psychiatric hospitals in Europe. In 1903 it provided inpatient care for over 3000 patients. If the remaining red brick buildings could speak, they would be able to tell of the whole history of the emergence of contemporary mental health care in this country. 

Prestwich Hospital no longer exists. Part of the original site still provides a range of mental health care services as part of the Greater Manchester Mental Health NHS FT (GMMH). GMMH is one of the largest mental health care providers in England. For some readers, they might also recall, that the Trust, and particularly the adult forensic services, were the subject of a Panorama programme just over a year ago. The programme showed poor care, abuse, and the neglect of patients, many of whom were extremely vulnerable.

It was a dark day for mental health care. Since that time, there has been much effort and energy directed at delivering an ambitious improvement plan for the whole Trust. The work to create a new Board has begun, and there is an appetite to further develop a clinical strategy that better reflects contemporary best practice. There are some great people working in the Trust, doing great things day after day, and this should not be forgotten or not acknowledged. However, it will take time to bring about the necessary improvements. That said, there are some encouraging small green shoots appearing. Now you might be asking yourself, how do I know these things and why am I telling you?

Well, it's to do with me doing some due diligence which, in my experience, is always worth the effort. Several weeks ago, I was minding my own business when an email landed in my inbox that caught my attention. It was from a firm of headhunters. I get at least one of these types of emails a week, and in the main, I delete them without opening them. They usually ask for names of people the company could approach to see if they might be interested in a job being advertised. Anyway, on this occasion, I sent an email back to say I was happy to have a conversation. The only reason I did so was because the organisation the company was trying to find someone for was GMMH, an organisation I have many good memories of.

I duly had a conversation and suggested three people I thought it might be worth them approaching. Upon being asked if I might be interested, I firmly said no thank you. I was coming to the end of my first three years at Stockport NHS FT and was very much looking forward to the next three years. Our improvement journey was going well, and I was part of a fabulous unitary Board of Directors. So, thank you, but no thank you. A few more weeks went by, when out of the blue I had a phone call from one of the partners of the headhunters, who wasted no time in asking me directly if I would be interested in the role. We talked for a while, and I finally said I would consider making an application over the weekend and let him know that following Monday. Hence the weekend was spent doing my due diligence, part of which were some long conversations with J about making an application. She has always been very supportive of everything I have chosen to do and is a fount of wisdom that helps keep things into perspective. With all things considered, I decided to apply.

Shortly afterwards, I enjoyed a wonderful afternoon of stakeholder-focused groups and interviews. Later that same evening, I was asked if I would take on the role of Chair for GMMH, and I said yes. However, the interim Chair, Bill McCarthy, who had done such a great job over the past year, was leaving on 31st December, and I would be required to start on the first of January 2024. So nearly 40 years after starting at GMMH, I’m back once more and relishing the challenge of working with colleagues, partners and service users as we travel on our improvement journey. As exciting as this has all been, my heart is aching for the many colleagues and friends I have worked with at Stockport. I will miss all these folk terribly, but I know they will continue to ensure the best possible healthcare is provided to the communities of Stockport and beyond. I say a big THANK YOU for all their support and commitment over the past 30 months. You have all been great colleagues.

 

*One of my Stockport FT Council of Governors sent me a lovely email of congratulations. His email header was ‘Moving on to pastures new’. Referring to my one blue and one yellow clog I have been wearing since the start of the war in the Ukraine - and I have said I wouldn’t change until the war is over - he said he hoped that one day soon I might be able to wear a white pair. So do I. Peace not War, Love not Hate.  

Strangely, life’s unintended consequences can be both hard and good

I knew last week was going to be a busy one. Not that it was a bad busyness mind, just full on. I took the 128-mile round trip into Manchester every day, and on different days I drove through rain, ice, frost and high winds, with every trip undertaken in the dark. Such journeys are an unanticipated consequence of making the decision nearly three years ago to accept the Chair’s role at Stockport NHS FT. I knew it was always going to be a long journey at each end of the day, but as I had taken up the post in Spring, I hadn’t given much thought to how much more difficult travelling in Winter would turn out to be. That said, I have enjoyed every moment I get to spend with my Stockport NHS health family.

It was the sociologist Robert Merton, who was credited with introducing the concept of unanticipated consequences. He described these as actions taken that have both intended and unintended consequences. We often plan, based on what we believe the intended consequences will deliver. Unintended consequences are often more difficult to recognise or anticipate. Of course, unintended consequences can be both positive and negative,

I guess many readers will know that the discovery of penicillin was the result of an unintended consequence. Alexander Fleming’s original research was into treating the flu virus. Following a Summer break from his laboratory, he returned to discover a mould in one of his culture dishes. It was a ring of mould, within which there were no bacteria growing. Quite by accident, he had discovered the world’s first early form of antibiotic. His discovery revolutionised medicine. However, as we know today, the overuse of antibiotics, particularly to treat illnesses where an antibiotic wouldn’t make a difference to the person’s recovery, has led to widespread antibiotic resistance.

Last week, I read of another accidental medical discovery that, in its own way, has also been revolutionary. It was an advertisement for one of the many BBC shows on offer this Christmas. The film is called Men Up, and tells the story of the discovery of an unintended consequence of testing the drug Sildenafil, perhaps better known now as Viagra. The drug was being tested to measure its impact on the condition angina, with a group of ex-coalminers in Merthyr Tydfil, Wales.  It was one of the trial nurses, who asked the trial participants whether they had noticed any side-effects from taking the drug. Apparently, they were all reluctant to answer, but eventually, one of the men said that he had been experiencing ‘robust’ erections during the night. All the other men eventually admitted they had all experienced similar side effects.

It is perhaps to be remembered that back in the early 1990s such conversations were likely to be rather difficult, talking about sex and bodily functions wouldn’t have come easy. Realising there might be other uses for the drug, the angina research was abandoned and a small-scale study was undertaken with a group of men in Bristol struggling with impotence. This small-scale study was a great success. Indeed, the participants, who had been given a small supply of the tablets and told to return any they didn’t use, refused to return any of their tablets.

After further clinical trials to test safety and so on, the drug was licensed for use in 1998. It has since become the pharmaceutical giant Pfizer’s biggest income-generator. By 2018, 62 million men across the world had bought it. Sales have hit many billions of £s since. Apparently, the colour blue was chosen, because it was thought it conveyed a cool, calm masculine confidence, while the diamond shape was intended to hint at the diamond-hard results it would deliver. I’m not saying anything, but I have to say it is on my Christmas must do list - watching the film that is. I might have a few 'getting older' problems these days, but thankfully this is not one of them.

Ironically, and somewhat sadly, whilst the discovery of Viagra came about through an unintended consequence of testing the drug, there are a number of unintended consequences of the drug in use; one of which has been an increase in sexually transmitted diseases. Apparently, many older men ‘tested’ the drug by visiting sex workers. Likewise, there has been an increased number of older men abandoning their wives for younger women. I say sadly, as I wonder whether these outcomes might have been anticipated, and as such perhaps avoided.

Last week, there was another story which I felt told of another apparent unintended consequence, but one that might also have been avoided. I’m referring, of course to the much-heralded successful pay dispute resolution for consultant doctors. Well, it was much heralded by the likes of the Daily Mail, but the reality is that the deal offered is so complicated that even the BMA cannot recommend consultants accept it. Sorting out the pay claim of the highest paid members of the healthcare workforce first just doesn’t seem a sensible thing to do. Already we now face the disruption of junior doctors taking further industrial action. I am fairly sure that nurses won’t be far behind. If further industrial action happens, the unintended consequence will be an increased busyness for all health and care provider organisations, most of whom are already struggling to meet an ever-increasing demand for healthcare. Unlike my last week, such busyness won’t be so good for folk to deal with.     

There’s no need to hug a tree to embrace nature

It is funny how certain things can trigger a memory. Last week I read a weather report about the winter spell we are going through that described a place called Benson as having temperatures as low as -6c during several nights last week. Reading the article, I was immediately taken back to childhood holidays. 

We used to go camping and there was a site in Benson, Oxfordshire that was ideal for a family of young children. Set by the side of the River Thames, there was nothing else to do except play in the river, explore the woods, make dens and generally amuse ourselves ‘upstream and down dale’. We are a big family and how my parents managed I have no idea. I’m sure it was idyllic. Looking back now, it did seem to be an age of innocence and safety.

I dislike being on water or swimming, so I’m not sure why I can remember the joys of playing about with boats and being on the river. Although I have never been camping since those childhood days, and have no intention of starting now, I have retained my love of being outside. I’m fortunate to have a large garden, where J keeps her goats, I keep my hens and we grow flowers, plant trees and generally spend as much time as possible outside enjoying it whenever we can. I walk every day, and often clock up 30-50 miles in a week. To date, I have walked 2340 miles this year. We live close by the sea, and are lucky to have a beach that is generally free from crowds, with just a few regular dog walkers to be seen. And we live within 30 minutes or so of the Lake District, and with minimum travel can be deep into the Lancashire countryside, both of which we regularly take advantage of.

There has been much research demonstrating the power of engaging with nature, and last week I learnt of an emerging school of thought, something called environmental neuroscience. This field seeks to explore the ‘how and why’ our brains can be so profoundly affected by being in nature. I know that being in the countryside allows me to de-stress, walking on our beach allows me to clear my mind and think and pottering in my garden fuels my sense of wellbeing. Neuroscience seeks to better understand why cognitive functioning also seems to improve when we are exposed to such environments. It’s fascinating stuff and I have started to read around the subject. First stop is a new word and a whole new way of thinking about self and our relationship to the world we live in.

The new word is ‘biophilia’ – a word coined first by the psychologist Eric Fromm and somewhat independently, but around the same time, by the biologist Edward Wilson. In simple terms the word is a combination of two words from ancient Greek:  Bio (life) and philia (love) – so literally meaning the love of life. Life here meaning both all living creatures, and also, the world they inhabit (Nature). The biophilia concept posits that we function better in natural environments, because our brains and bodies have evolved in and with nature.

It was the hunter gatherers, who were attuned to the world in which they lived, that tended to survive and thrive. Drawing upon ‘flight or fight’ strategies, they were the folk best able to deal with danger and stress. These days, most of the stress we encounter does not require a physical response, although I do have days where I feel I’m banging my head against a brick wall. Despite this, the stress we are exposed to can result in our bodies and minds experiencing the same flight or fight response as our forebears. Physiologically, this might mean we can experience changes such as raised blood pressure, an increased heart rate and feelings of anxiety. What the emergent field of neuroscience and the notion of biophilia suggest is that exposure to nature might activate the parasympathetic nervous system, countering these unwanted physical responses, replacing them with feelings of calmness and  sense of wellbeing.

I haven’t yet finished my reading around the subject. But already I have some reservations. The attractiveness of neuroscience is that it can perhaps explain why we feel different and can perform more effectively, after being immersed or exposed in nature. However, I’m a simple soul and as such I don’t always need to follow the science to seek explanations. When I’m out walking, wherever I am, I notice things. I pay attention to where I am, what I can see, hear, smell and even touch. I do so with the kind of attentiveness that is associated with the practice of mindfulness. I have found that the avoidance of stressful feeling and/or to deal with stressful events, mindfulness works really well for me. So, when I take my walks and in so doing, embrace nature, I feel connected, I feel alive and I feel grateful for all that I have in my life. It makes me feel vital, it helps me to think and remain curious. It adds to my resilience store. And above all else, it enables me to regain a sense of calm. And for me that is enough.

Sadly, last year, the wonderful People and Nature Survey for England, found that many people spend little time in nature. Over 25% of the population hadn’t visited a green or natural place once in the previous 14 days. Thinking back to those family holidays in Benson by the River Thames all those years ago, I’m grateful now that we didn’t have a TV, or a mobile phone, and that we were able to embrace and engage with nature and enjoy the wonderful natural things around us. It was a great ‘upstream’ foundation for my mental health, and perhaps, such an approach could also help ensure others enjoy better mental health and wellbeing too.

What is right is sadly often lost to political convenience

This is the first Sunday in three weeks where I’ve been able to write my blog, without the aid of a box of tissues, paracetamol, and cough medicine. Yes, I’m feeling much better, and thank you to all the readers of this blog who have sent their kind wishes over the past couple of weeks. Hopefully that is me done with cough and colds this winter! Not feeling 100% has meant however that I’ve had time to engage more deeply in things that perhaps normally I would not pay so much attention to.

One of these has been to listen to the reports of the Covid Inquiry. I haven’t been interested in the tittle tattle mudslinging that characterised some of the evidence presented around the performance of our politicians. Their incompetence and selfishness have been widely reported before the Covid Inquiry even started. No, I have been more interested in the more considered and reflective contributions that have begun to show a completely different side to the decision-making and the impact on individuals involved in making these decisions on our behalf.  

Sir Patrick Vallance’s testimony was wide-ranging, but two elements in particular caught my attention. The first was his thoughts about the ‘eat out to help out’ scheme. He claimed he knew nothing about this before it was announced. We never took part in this scheme, as my thoughts were the same as his, it would lead to the spread of more infections, something we now know to be true. The second point was the admission that we had introduced the first lockdown a week later than perhaps we should have done. Whilst a week doesn’t sound long, at the time, the rate of infections was doubling every three days.

The delay in introducing the first lockdown also concerned Jonathan Van-Tam, the former Deputy Chief Medical Officer. He felt it should have been introduced 7-14 days before it was. He also incredibly found out about the ‘eat out to help out’ scheme via the TV. What was more shocking to hear was that his family had been threatened both online and physically, in response to decisions he had been a party to. Nobody should have to experience such threats, especially those who are working for the greater good of society.

Sadly, he wasn’t alone. Other members of the Scientific Advisory Group for Emergencies (SAGE) were also threatened, and their families too. As was Professor Chris Whitty, Van-Tam’s boss and Chief Medical Officer. His evidence was presented in a calm, thoughtful and yet penetrating way. Among the many challenging points he made, was the important observation about those taking policy decisions. He noted that often these were people making decisions about issues in which they had little knowledge and as such, the decisions were often flawed or taken too late.

For example, despite the government’s protestations that they were ‘following the science’ when it came to making decisions, this was a completely erroneous claim. The scientific evidence was incomplete and the political interpretation of what evidence was available appeared driven by economic and political factors, rather than on the basis of protecting the public. This was something that probably led to the delay in the first lockdown. Those taking that decision appeared to have little understanding of the way people would react and behave by being told to stay in their homes for a prolonged period.

The reality was interesting. In that first lockdown, millions of folk volunteered to help others. The NHS benefited from some one million people volunteering and there were over 12 million volunteers helping either individually (within neighbourhoods) or more collectively as part of established community groups. Whilst I’m sure there were people who were lonely, isolated, frail or simply ill during this time, the reaching out to others by these volunteers will have helped many of these people. I know on my street, people helped with shopping, dog walking and socially-distanced garden gate conversations. The community spirit, or rather the spirit of the community was powerful and potent. Sadly, in many ways, that supportive sense of community and being there for others has disappeared.

This was brought home to me last week during my visit to our School Nurse team. They are a great group of people, and I was staggered by the sheer volume of work they are engaged in. When I hear from colleagues such as these and gain an understanding of the difference they make, it reinforces my irritation of the Daily Mail type of commentary that the NHS has a much bigger workforce, but is not seeing as many patients, as it did pre-Covid.

One of the differences the School Nurse team make is with their parent drop-in sessions they run in schools. In a recent two-week snapshot of activity, they saw 51 families (including 14 follow ups from previous sessions). Eleven of the issues on which parents wanted advice were to do with continence – children who were not toilet-trained, before they started school. I think this reflects the way in which, for many people, the community support for families, provided by the communities themselves has been lost.     

Finally, the current phase of the Covid Inquiry is not about holding anyone to account or attributing blame, it is about trying to understand the decisions taken. Reading last week’s testimonies, and thinking about the family concerns that our School Nurses were dealing with, I was reminded of the words of Leo Tolstoy - In order to change the nature of things, either within yourself or in others, one should change not the events, but the thoughts which created those events. They seem appropriate somehow.

A week of women on top

You know you are getting old, when you finish your conference dinner and don’t stay either for the dancing, or a post-conference stroll to the late-night bar with colleagues. This was me last week. I was back in my hotel room before 10pm. I was attending the NHS Providers annual conference. It runs over two days and was held in Liverpool. There were some excellent presentations from fellow NHS colleagues from across England. In between the plenary sessions, there were also more informal talks from organisations, mainly supplies of goods and services, who presented partnership projects and so on.

Despite my lingering cold and cough which, as I write this, is still making me feel under the weather, I really enjoyed the conference, the networking and the venue. Once again it was Samira Ahmed who was the conference chair. I’m not a great fan of hers. Although she is an award-winning journalist and author, and can ask the most penetrating of questions, I feel she somehow fails to connect with the audience.

Someone who did connect was Victoria Atkins, our brand spanking new Secretary of State for Health and Social Care - the fifth in the last two years. She wasn’t physically in the room, but had sent a pre-recorded video. Sounds crass perhaps, but it wasn’t. Victoria’s tone was much more gentle, positive and encouraging than her predecessor[s]. Although she may not be in post for too long, given there is a general election looming, there is still much that she can do – starting off with resolving the doctors’ industrial action asap. This was something she absolutely saw as a critical first task, which was very encouraging to hear. But there is so much more that requires addressing. The NHS is contending with significant pressures from all sides. A tired and often burnt-out workforce, with massive vacancies still to fill (125,000); increasing demands across all services (October saw more than 2.2 million people attending A&E departments); a post-pandemic long waiting list legacy (nearly eight million people); and of course, continuing financial pressures (including a need to revolutionise capital funding across the whole NHS). It is a huge ‘to do’ list for sure.

Victoria also noted that she would need to work across the various government departments, if health inequalities are to be addressed and thus reduce the demand on health care services. Likewise, the acute sector must find ways to shift more of its resources to primary and community care, so that people can be better supported in more appropriate settings and ideally closer to home. I heard some encouraging presentations where people were doing just that, and we were also treated to a full-on Tigger performance from Amanda Pritchard, Chief Executive of NHS England.

She was on fine form for sure. Amanda was passionate, challenging, well-informed and quoted, by name, many folk that she had met over the past year who were doing incredible things in making a difference to others. It was a stellar performance by someone demonstrating the leadership qualities so needed in a world challenged by so many inter-related and seemingly intractable problems. She is consistent in her approach as well – look here at her unpacking the often-misunderstood concept of productivity to the Houses of Parliament Health Committee last week. Simply patience personified.

Wes Streeting, the Shadow Secretary of State for Health and Social Care, speaking after Amanda, cautioned us that we were in danger of making her Louis XIV – ‘l’etat, c’est moi.’ Yes, I had to look it up too – still not sure I understand what Wes was meaning, other than if we keep increasing the funds for the NHS, and the NHS continues to push the boundaries of what a healthcare system should be doing, the NHS represented here by its figurehead Amanda, will become the State.

Clearly, there is room for transformation and reform, but please, please not any more structural reform. We have had enough. And yes, there are things that we need to address to make best use of the resources we already have to keep services safe and of a high quality; something another speaker touched upon in her presentation. This was the wonderfully calm, confident and articulate Margaret Heffernan. I’m ashamed to say I had never heard of this amazing author before. She held me spell bound as she took the audience through concepts of ‘wilful blindness’, ‘organisational conformance’, ‘whistleblowing’ and why the NHS appears unable to learn from the mistakes of others, even when these are set out clearly in extensive reviews. It was powerful stuff and I have put a couple of her books on my Christmas present list to Father Christmas.

However, my last word goes to another woman, one I have never met and who wasn’t at the Liverpool conference. This was Casey McIntyre, who died seven days ago from ovarian cancer. Her legacy was setting up a fund that would help pay off the medical debts of others in the US. It is estimated that 100 million Americans are saddled with a total of $195 billion in medical debt. The US does not offer universal health care for all. Every $100 raised in donations, funded through her RIP Medical Debt’s website, will go on to alleviate $10000 of medical debt. So far, her appeal has raised nearly $150,000, which will cancel out nearly $15 million of medical debt for others. Casey died too soon. Like all the women I have encountered this week, Casey will continue to make a difference to the lives of others, and that is a legacy to be proud of.    

Alright Prof, alright?

I have a new laptop. This week I have been able to spend time learning to use it. Not easy as it has a built in, default AI approach to everything – more of which later. However, the reason I’ve had the time to explore the computer is that I’ve been rather poorly all week. I have stayed at home, gone through a couple of boxes of honey and ginger Lemsips, a bottle and half of Benylin cough medicine (I know there isn’t much therapeutic value, but at £7 a bottle I can convince myself there is), countless paracetamol tablets and a bottle of Sudafed sinus spray. And don’t talk to me about tissues.

It has been a miserable week. I have slept at all the wrong times, had aching limbs and a constant headache. Apart from walking Dylan around the block, and feeding the animals, over the past week I have done very little. Occasionally, I’ve looked at emails or social media, but have had little spare energy or even the inclination to do much more. I became addicted to Four in a Bed; the Secret Life of the Zoo, and watched all 21 episodes of Gavin and Stacey (including the two Christmas specials). I seemed to have adopted the latter’s ‘I will do things now, in a minute’ approach to everyday tasks. Not feeling able to do anything more useful has been immensely frustrating.

Don’t get me wrong, I have been very well looked after by J. Her nursing care, compassion and patience has been wonderful. Like many folk, and men in particular, I don’t play the sick role well. I know I become short tempered, grumpy and irritable when feeling unwell. Thankfully for those around me it doesn’t happen that often, as I’m generally a healthy person.

This past week I have kept repeating to myself, it’s a head cold. Nothing more than a common cold that is lingering. Get over yourself Tony. However, as I write this, I’m not feeling much better than I did last Monday when it all started. I know that the cold will pass, and in a week’s time I will have caught up with things not done and all of the past week will have been forgotten. For that I’m grateful. As I have said to J many times this past week, there are many folk out there who are living with health issues that won’t just fade away, and they will be living with their health challenges for the rest of their lives.

It is projected that by 2040, one in five people living in England will be living with a major illness. Yes, that is a sobering thought. There are about 20 long-term conditions that together account for over two-thirds of today’s health care demands. The number of people living with these conditions, and in particular, cancer, diabetes and kidney disease, is likely to increase by 30% over the next 15-20 years. Already we know that 58% of people over the age of 60 are living with one or more long term health issues. Added to which will be the yet unknown health care problems of all those who are currently obese, as they reach old age after many years of obesity.

Dealing with these anticipated population health issues will not be easy. If you have the time, and think you are someone who isn’t easily depressed, have a look at the recently published and excellent long read from the Health Foundation, Nine Major Challenges Facing Health and Care in England. As always from the Health Foundation, this is a report that is evidence-based, well-argued and completely accessible. Perhaps the tenth challenge is reading the report and reflecting and responding to what might be done.

Whichever political party succeeds in the next general election, these are challenges that will need to be addressed, and it will not be through yet another reorganisation of the NHS. And although extra money always helps, these challenges will not be effectively addressed by simply throwing more money at solving the underlying issues. Interestingly, for the first 26 years of the NHS, there was very little change to the organisation and provision of services, but after 1974, it has felt like the NHS has been in a constant state of flux and change. The latest of these changes, the introduction of Integrated Care Services, has still to come of age and start to deliver improvements.

Over all that time, there has been little change to the way in which social care has been funded, or services provided. We know that the percentage of older people (officially, those over 65 years of age) in the UK population continues to increase. If you weren’t depressed by the contents of the Health Foundation report, have a look at the latest report from the Office of National Statistics on the emerging older population profile. It’s clear that many of these folk are going to need the support of social care, as they live longer than ever before.

Before I finish this blog, a quick return to the AI problem. Up to now, as I write my weekly blog, I will often ask Google a question for clarification, like for example, how many people live with dementia in England? (approximately 850,000) – I would be pointed to a series of reports where the information could be discovered. This new AI guided enquiry system on my laptop constantly tries to provide me with a complete and well-argued answer. Often, it seems to me, it doesn’t succeed with either. As yet, I’m not a great fan of the benefits of AI. J is more enthusiastic about exploring its possibilities.

Yesterday she showed me two sides of paper which was the answer to a question she had posed on ChatGPT to try it out. I dutifully read it and said it was okay, but it was just MBA mumbo jumbo – ‘how would you know?’ she said, ‘you don’t have an MBA’ – I quietly pointed out that despite only ever getting a CSE in Art at school, I did manage to achieve an MBA in 1995. We are not putting our names forward for the Mr and Mrs Quiz show. Last thought, despite me feeling poorly, I’m glad to say the world has kept turning. And that’s the way it should be.

Doing different things and making a difference

My lovely wife has the travel bug, and a long list of places that she would like to go to. Last week two holiday brochures came in the post. I was surprised as we hadn’t requested them and, like most folk thinking about holidays, we would simply browse the internet. Anyway, J started to look through them and we both became quite excited about some of the holidays on offer. She particularly liked the idea of exploring exotic destinations and spending 28 days in a sunshine-filled country during the cold winter months. I didn’t and told her so – ‘I agree, but it’s what many retired people do; they find somewhere hot and disappear over winter, leaving all their woes behind’ she said.

I carefully pointed out that she was still well and truly employed and that I couldn’t see her boss being really pleased about J taking a month off to go and explore the foothills of Kenya somewhere. ‘Apart from which’, I asked, ‘who would we get to look after the goats, chickens, cats, Dylan the dog and Billy the parrot?’ None of which appeared to be a problem as far as J was concerned. So, I also reminded J that I was working and sadly just couldn’t take a month off. She laughed and reminded me that I was meant to retire over four years ago. Which is true, but I choose to continue to work, albeit part time.

Over the last 10 years, I have been a Non-Executive Director in three different NHS acute Trusts. I’m currently a Chair of a large acute NHS Foundation Trust in Greater Manchester. The hospital is 65 miles away from my home and, as well as online meetings, involves an at least twice weekly 90-minute commute on some the most challenging motorways in England. But I love what I do, and the folk I work with, so spending three hours each day on the road doesn’t worry me. And as long as I remain healthy and well, I want to continue in the role for my full term, which means at least another three years. Then possibly I might retire.

Now I’m not alone in continuing to work after I should have retired. In the UK there are more than one million people over the age of 65, who continue to work. Last week the Institute for Fiscal Studies (IFS) published a report last week that looked at how employment patterns have changed for folk in their 50s and 60s between 2002 and 2019. The IFS study notes that early retirement is increasingly becoming the preserve of the wealthy. Today, a greater number of people are having to work for longer, due to the increasing cost of living and a lack of financial security. These are people in their late 60s and early 70s. This is a change from 20 years ago. Back then, how much money you had accumulated was not the overriding factor for those in their 50s and 60s thinking of retiring early.

Interestingly, although the IFS study only looked at trends up to 2019, the pandemic appears to have reinforced this trend for many employment groups, particularly those in professions and caring occupations. There has been a significant increase of people in these groups taking early retirement. Being able to make this choice clearly must include consideration of an individual’s financial situation. However, it was quality of life that is reported to have been a stronger incentive. The pandemic appeared to perhaps prompt folk to think more deeply about what is important to them in life, the degree of stress they experienced at work and of course the opportunity to do something for themselves.

Sadly, the pandemic also had another impact for some people; people who had no choice but to leave the workforce due to health reasons. The Office for National Statistics (ONS) notes that the number of people becoming economically inactive due to health reasons is only likely to grow. This is a trend that will continue to challenge both individuals and already workforce-challenged organisations such as the NHS. People with long term and often complex health issues, who are unable to work and who perhaps must survive on benefits, are likely to experience further health problems.

In many healthcare organisations, workforce shortages are already having an adverse impact on the range, quality and safety of the services the rest of us need to have provided. Recruitment and retention have become two of the most serious challenges for the NHS to deal with. There are no easy solutions. For many of the health professions, there is a long training lead in time. Alternative and new entrants to the health care workforce provide some relief, as does greater use of technology and new ways of providing treatments and care. Virtual wards are growing in use and sophistication, but we are not there just yet and such approaches don’t work for all health problems. The recent medical industrial action has also revealed another problem around the training of doctors. Their education and training rely heavily on the guidance, support, and supervision of senior experienced doctors such as consultants. And these are increasingly a group of healthcare professionals who have chosen to retire early, taking their knowledge and experience with them.

Me, I don’t need to work for financial reasons, although both of us earning does help to fulfil our dreams and holiday bucket list. I do it, because I can, and most of all, I enjoy it. Last Friday we had our ‘Making a Difference Award’ evening. Over 300 colleagues came together to celebrate the great contributions they had all made over the last year. If it doesn’t sound too patronising, I have to say I felt so proud to be part of such a fabulous group of people. They give me a reason to get out of bed in the morning, and at my age, that has to be a good thing.     

Me, Marmite, mosquitoes and malaria

It was the German scientist, Justus Liebig, who in the late 19^th century discovered that brewer’s yeast could be concentrated, bottled and eaten. Brewer’s yeast is a waste product from the brewing industry and is the basic ingredient of Marmite. Now regular readers of this blog may know that I’m a big fan of Marmite, but I wonder how many of you like it too? Research in 2022 (presumably incredibly important to enhance scientific knowledge) found that just under half of the UK population liked Marmite, a quarter didn’t and a quarter didn’t have an opinion one way or the other. I regularly eat Marmite for three reasons. (1) it stops me from getting cramp at night, (2) it helps prevent me getting bitten by biting insects and, (3), the vitamin B complex additions are good for my general health.

On our recent trip to India and Nepal, J was constantly getting bitten, whereas I didn’t get bitten once. I’m not sure how Marmite protects, but I do know taking regular Vitamin B complex supplements can have the same effect. However, I’m not recommending it as a complete protection. When I went to Uganda a few years ago, a country where malaria is endemic, I naturally took additional precautions. This included taking the antimalarial medication, Doxycycline (every day a week before, during my stay and for four weeks after returning to the UK) and using a DEET-based spray on exposed skin. The spray had a smell that I grew to loathe by day three of my trip. That said, I didn’t come down with malaria.

Malaria is a dangerous and indiscriminate disease. Across the world it kills more than 1 million people each year. People become infected through mosquito bites. And it only takes one bite to become infected. Indeed, almost 700 million people contract a mosquito-borne illness each year. Perhaps not surprising when you know that mosquitoes outnumber humans 160,000 to 1. They are tough little critters, who continually develop resistance to the insecticides used and so are very difficult to get rid of as well. Not impossible however, and it is certainly possible to eradicate malaria given the right commitment and approach. It is what happened in China in 2021, see here, and the Bill and Melinda Gates Foundation continue to work across the globe in the fight to make malaria a disease of the past.

There was a malaria vaccine developed by the pharmaceutical company GSK in 2021, but its cost was prohibitive for worldwide usage. Certainly, in those countries where malaria is prevalent - countries such as Uganda, Nigeria and Tanzania - the per capita health spend is very low. In Tanzania for example it is just £12 per person per year; to put that into perspective, in the UK it is over £4,000 per person per year. Even critical medication like the GSK vaccine can become impossible to provide at a population level with such low per capita spend.

So, it was great to read last week the preprint paper in the Lancet (a paper that has yet to be peer reviewed) of the work undertaken by a team working at the University of Oxford, who have successfully developed a malaria vaccine (at the moment called R21). I was amazed that anyone could write a paper that has 28 authors, but  here it is. The evidence presented in the paper suggests that the vaccine can protect children aged between three and five years old. Up to 96% of all malarial deaths in Africa are children aged five or under. It is as effective as the GSK vaccine, but can be made available at half the price, thus making population wide use possible in low-income countries. The vaccine has already been approved for use in a number of such countries.

Now, you might be thinking why is the Prof writing about malaria when it’s not something to be found in the UK. Well, you would be wrong. The last known case in the UK occurred in 1957. It was a consequence of troops returning home in 1915 from fighting in the Balkans during the First World War. They had been garrisoned in camps on the Isle of Sheppey, in Kent. Malaria was endemic in the Balkans, so many of the returning troops were infected. The Isle of Sheppey was an area where mosquitoes lived in abundance. The unintended consequence was a mass outbreak of malaria that took until 1921 to control.

As the world climate changes, and it feels like we are experiencing rapid changes to the climate, it is easy to envisage a much greater risk of diseases spreading in ways previously unseen. The world is heating up and disease in one part of the world might, in the future, spread much more easily. And we are already seeing this happen. In 2010 the Culex modestus mosquito was detected in large numbers in the Thames estuary. In 2016 the Aedes albopictus mosquito was first detected in England. Neither of these are native mosquitos, and both are responsible for life-threatening tick-borne diseases elsewhere in the world. It is Halloween time and if you want a real fright, have a look at the latest report (2021) published by the UK Health Security Agency, and just think about the Isle of Sheppey story… …I for one am glad that we now have the R21 vaccine in our national medicine cabinet.    

Working towards a more diverse, equal and inclusive world

This week’s blog comes from the blustery and very wet Fylde Coast. Our trip to India and Nepal, although wonderful, is sadly over. After most days where the temperature was 26 - 30c the change in the weather came as a shock. We made some new friends along the way, both fellow travellers, guides and hotel staff. We had a great time, and thankfully, through avoiding ice cubes, salad and only drinking bottled water, we had none of the potential health problems!

In fact, we had no problems along the way at all except operating the TV in the various hotels we stayed in. As we were travelling without any young people, operating the controls appeared to be beyond our ability. The consequence was until the last day, when someone from reception came and showed us how to access the TV, we were largely cocooned from the outside world. Yes, we had picked up some of the news from the Middle East, but it was only when we were able to see the news reports on the various news channels did we get a sense of the enormity of the unfolding conflict in Israel and the Gaza Strip.

Back in 2022 J and I took a Holy Land pilgrimage by way of a belated Honeymoon. Due to family connections, I had long wanted to visit Israel and it had always been a must-do on J’s bucket list. We decided that we didn’t simply want to be tourists and so chose a company that specialised in religious pilgrimages. I’m glad we did, as our guides brought the Bible to life and it was one of the most spiritual experiences of my life. There were so many good memories; perhaps one that stands out for me, was taking holy communion literally on the shores of the Sea of Galilee.  

Our guide was a chap called Bassam. He is a Palestinian Christian, and one of the most generous men I have ever met. His kindness, tolerance, biblical knowledge and historical insights were amazing. One of the places he took us to was a small orphanage in Bethany or in Arabic, Al Eizariya, a small town in East Jerusalem, the West Bank. If the name sounds familiar it might well be that it has been consistently one of the most popular girls’ names in the English speaking world. It could also be that you remember it as the place that Jesus stayed during the Holy Week before he was crucified.   

To get to it, we had to pass through an Israeli checkpoint, which was a little unnerving to say the least. The orphanage was a day school for Palestinian girls and a residential school for boys. Most of the boys had been abandoned by their families for one reason or another. None of the children had ever been through the checkpoint and sadly never seen Jerusalem, which lies on the other side of the Separation Wall only 2km away. They had very little in the way of material possessions, and although the rooms and building were clean and tidy, they were very drab and had an institutional feel about them.

On our return to the UK, we contacted the orphanage to ask if there was anything we could do to help make the boys lives better. After a while, we got an email back which said perhaps we could help pay for one or two of the bedrooms to be repainted. They gave us a suggested cost, for a couple rooms. However, based on these costings, we decided we could fund all of the 26 bedrooms being decorated, and paint the corridors and banisters too.

The boys were told and they were given the opportunity to choose colours and their own design and so on. We were sent photos and messages during the entire process, and it was wonderful to see the delight and hear the excitement of the boys as their choices became a reality over that summer. We had hoped to go back this Christmas to see for ourselves, but that now feels unlikely.

This blog is not the place to argue about the rights and wrongs of this long-running conflict in the Middle East, other than to say I absolutely condemn any act of terrorism, wherever this occurs and whoever is responsible.

Our pilgrimage coincided with Palm Sunday. We were able to join thousands of others, waving palm fronds and singing hymns, as we walked from Bethpage on the Mount of Olives descending into Old Jerusalem. It was a hour or two that brought together so many folk from different beliefs, religions, cultures and races in celebration and remembrance. It was an occasion to show peace, love and not hate.

I was surprised therefore, on Friday to see a copy of a letter from Steve Barclay, (Secretary of State for Health and Social Care) to all England’s Integrated Care Boards instructing them to stop local NHS provider organisations from employing ‘standalone’ Equality, Diversity and Inclusion (EDI) post’s. If we persist, then we are to justify why these roles are more important than employing doctors or nurses instead with the money. In our Trust, we have a so called standalone EDI lead, and she provides excellent leadership in our ambition to develop a more inclusive organisational culture. If I’m called upon to defend our decision to employ someone in this capacity, I will draw upon the evidence-based open letter penned by the excellent Roger Kline on diversity in the NHS – you can read it here. 

During our pilgrimage, Bassam our guide noted that the future of Israel and Palestine will only be secured when the rivers of blood spilled over the years become water under the bridge. Wise words indeed. We all need to work together to ensure we create a more inclusive, diverse and equal world. This might be a nation world, a community world, or even, an organisational world. And, maybe, just maybe, our Steve could learn a thing or two from Bassam.

Passage from India and into Nepal

Last week's blog was posted from India. This week's blog comes to you from Kathmandu, and what a beautiful place it is too. A mere two hours’ flight from Delhi, yet a world apart. The India leg of our trip was brilliant, even if you were reminded every moment of every day of the contrast between the lives of the rich and the poor. More of which later.

 

I have been to India before, but only on work business, presenting at conferences and so on. Despite perceptions to the contrary, this usually meant flying in, staying in a hotel, presenting a paper in a conference hall, with maybe just a day or two of sightseeing. So for this trip I was determined that J and I would do all the tourist bits, and more, so we hired a guide for our stay and did just that. And there was so much to see. We chose to do the Golden Triangle – Delhi, Jaipur, Agra and back to Delhi. This meant we were able to take in many of the sights India is famous for including The Palace of the Winds, The Am(b)er Fort, Fatehpur Sikri, Agra Fort, Jantar Mantar Observatory (one of my favourites), the Palace of the Maharaja and of course the Taj Mahal. 

 

We had to get up at 04.00 to visit the Taj Mahal, and even then, we had about 40 people in front of us while we waited for the 06.00 opening time. It was worth the early morning start and the wait. The Taj Mahal is everything you expect it to be. J and I got to sit on the famous Princess Diana bench for the ubiquitous photo (it had to be done). We watched the sunrise and stood in awe as the Taj Mahal was revealed in all its glory. The whole site is some 17 hectares in size and yet it was all proportionate, symmetrical and stunning. It took 20,000 men 22 years to complete during the 17th century. To put this feat into perspective, the Grand Mosque in Abu Dhabi took 3,000 men 13 years to construct in the 20th century, and that is with all the benefits of modern construction techniques, materials and machinery. 

 

I can now say that I have been to both places. They are both wonderful, but I think I preferred the Taj Mahal of the two and can absolutely see why it is now a UNESCO World Heritage site and still one of the seven wonders of the world. 

 

What wasn’t so wonderful was the traffic. It was unbelievable, terrifying, literally death defying and the noise, a constant cacophony of horn blowing. Drivers constantly jostled for position; an inch gained was a reason for celebration, more horn blowing. However, in the whole time we were there, and we covered many miles, we did not witness one collision, or accident. It was simply remarkable. As was crossing the roads on foot. You had to take your courage in both hands and step out into the face of oncoming traffic and resolutely keep walking. The first time I did it my heart was in my mouth, and I had this fearful thought that someone would knock me down. 

 

As you are reading this week’s blog, clearly that didn’t happen. I survived. Possibly it is just as well I wasn’t involved in an accident, as no-one takes any notice of the emergency vehicles even with their ‘blues and twos’ going. It’s just more noise to add to the general melee, and they have to fight for that all important inch forward like everyone else. The traffic was also a window into the wider inequalities across Indian society. There was everything from Range Rovers to rickety bicycles and everything you could possibly imagine as a form of transport, including camels, elephants, oxen and horses, in-between.

 

I found it very difficult to get information on the average income here, so don’t want to quote figures that might be widely wrong. However, doctors are paid considerably more than nurses, and like in the UK, the cost-of-living crisis appears to have hit India – see here. I did discover though that for every 100 rupees paid to a man, women were paid 112 rupees for the same role. What is difficult to understand is why so many families chose not to take advantage of the many government services that are provided free. There are fantastic education services available, free of charge, and where everything from school uniforms, school meals and bus pick ups are included, yet many families choose not to send their children to school, with the inevitable consequences for the child in terms of life chances.

 

Health is another area where there is state funded, free at the point of contact, services available. Whilst the government has a statutory responsibility to make free health care available to all, the actual public services available are underfunded and can be very patchy, particularly in the more rural areas. The public health care services experience massive workforce shortages and care is often provided in poor facilities (doesn’t that sound familiar). However, there is a thriving private health care system in India. The private sector offers services at a fraction of the cost of most developed services, and every newspaper carries full page advertisements of what is on offer. Whilst we in the UK would find it relatively cheap to access, and India is fast becoming a medical tourism hotspot, many low paid folk in India would struggle to access the private sector. Ensuring good population health appears to be as big a challenge here in India as it does in the UK 5000 miles away.

 

Normal service resumes and hopefully the changeable font situation will be resolved. Next week's blog will come just North of Blackpool. 

 

Memories of bears, pigs, and a great Slovakian nurse

It is funny what can stir a memory. General Elections in Slovakia don’t normally cause a stir, and yet the result of last week’s election made it into most of the UK media and, as a consequence, caused a stir in my memory. For the media, it was the election of Robert Fido as Prime Minister. He is a pro-Putin politician, and part of his election manifesto was to stop providing aid to Ukraine. I cannot believe that would be a good thing. However Slovakia is very dependent on EU monies, so maybe he will be slightly curtailed in what he feels able to do. 

My stirred memories of Slovakia are many. Pigs are one memory. On my very first visit to Slovakia, I spent two hours in an intensive pig unit formerly run by the Russian communist occupiers. Now if this was smelly ‘So Me’, you might appreciate my dilemma. I love pigs, and once upon a time had a small herd of Vietnamese Pot Bellied pigs – possibly the first person in Wales to do so. But they had names, and as we were all vegetarian, we were never going to kill them for `Sunday lunch’. It was a dilemma, as we eventually sold the piglets to others and of course, you had no idea what they might do with them.

Bears are another memory. Until going to Slovakia I had never seen a real live bear in the wild. On my second trip there, I did. I had been invited to a dear colleague’s summer cottage for the weekend. I would have moved there in an instant. It was a small cottage; two bedrooms and a downstairs that was lounge, kitchen, dining room and bathroom. Some might say it was crude, me, I thought it was perfect. Best of all was seeing the little black bears coming out of the forest opposite the garden to steal the plums off their tree. I had never been up close and personal with a bear before. It was an intimate moment never to be forgotten. 

The colleague I was visiting at that time was what I thought of as the almost indefatigable Alzebta Hanzlikva. She was a lady about whom I used to think, if I could be half as good as her, I might be able to make a bit of a difference.  I met Alzbeta in a pre J world and I was stunned by her purple hair. Many years later I married a lady who doesn’t just have purple hair, but multi-coloured rainbow hair. It is her thing. Wherever and whatever J is doing, she does it with her head held high. J has taught me the power of authenticity, and she is one of the most authentic persons I have ever met. 

Back to Alzbeta. In 1995, the first ever conference I attended as a speaker was an ‘international’ nursing conference in Martin, Slovakia. I say international, but essentially, myself and my boss, were the only non-Slovakian folk in attendance. It was held at the Jessenius Faculty of Medicine - the medical and research division of the Comenius University. For many years after that first conference, I attended each subsequent conference and enjoyed some fun times travelling to and from Slovakia over those years. 

Those early post communist days were wonderful and so different from life in the UK. Back then they really didn’t know what a vegetarian was, and thought I was completely foolish for not wanting to eat meat! They had never seen anyone wear clogs before, let alone brightly coloured ones. Eventually, I became part of the scientific committee that organised the conference. Every year it grew in terms of the number of papers being presented and started to attract several more academic colleagues from outside of Slovakia. Although I had to participate through an interpreter, it was a great community of nurses to be a part of. 

As with all things, I eventually stopped attending the conference, so I was surprised in 2015 to be invited to attend and present a paper. At first, I didn’t want to attend, but was persuaded by one of my old PhD students from Hungry and also a long-time supporter of the conference, that I should go. So once more I took the overnight train from Prague and pitched up at the conference. What I didn’t know was I had been asked to attend for a special reason. I was there to be part of a memorial conference that celebrated the life and work of Alzbeta. She had died in 2012. Her life’s work was in promoting the profession of nursing and she was passionate about ensuring the education of nurses was evidence-based, and scientific in orientation. Alzbeta was an inspirational lady, who really had a 'can do' approach to life. She started to learn English aged 50, as she realised that English was the ‘official language of science’ and she needed to get her research papers published in English language journals. The memorial conference acknowledged her impact on nurse education, not just in Slovakia but much further afield. She championed the advancement that research could bring and tirelessly worked at enabling nurses to gain their PhD. 

And at the conference, I was surprised to see my name appear in a presentation with many others whose work was being recognised by the award of a Gold Medal of Merit. I was duly presented with my medal for my contribution to university education for nurses in Slovakia. I was both immensely proud and humbled in equal manner. The last official act on that day was the unveiling of a memorial plaque in the entrance hall of the School of Nursing. I am not sure what Alzbeta would have thought about this very public recognition of her life and work, as she was a very modest person. My feeling was that it was a very appropriate, and somewhat affectionate, and a well deserved sign of how much her work meant to so many people. There will be others like her in Slovakia, and perhaps they will collectively work in promoting kindness, compassion and hope rather than hate