It’s been a dry January, and we are not talking about the weather

As the last few days of January trickle through the hour glass of 2023, I have to know how ‘Dry January’, the month long initiative to get people to stop drinking alcohol, has gone for you? I wonder if you were like J and simply didn’t engage, or my colleague at work who was almost evangelical about doing it and getting everyone else to do so too. My dry January got off to a moist start, mainly because like J, it wasn’t something that appealed to me. But on the 3rd January I had a conversation with Helen that changed my thinking.

Helen is my Clinical Pharmacist. Over the years she has kept an eye on my cholesterol levels. Although I have never met her face2face, all our appointments have been virtual, I feel we have a comfortable relationship with each other. My last appointment was to discuss the blood tests I had done just before Christmas. All were okay except the results for my Liver Function Test (LFT). For readers outside of the health professions, the LFT is used to help to the cause of symptoms such as jaundice and liver disease. It can also be used to screen for liver damage caused by alcohol consumption, certain medications, or being exposed to the hepatitis virus.

So my conversation with Helen usually goes along the lines of ‘still not smoking? No, exercising? Yes, up to 50 miles a week walking, diet? I’m still a vegetarian and eat well, alcohol? Well, I like a couple of glasses of wine each week’ – normally these answers suffice, and we bid each other goodbye. On this occasion, however, Helen softly said, in her non-judgmental and accepting way, ‘your LFT appears to be telling us you might be drinking quite a bit more than a couple of glasses of wine each week’. She also went on to say 'and your bad cholesterol level is now very close to being worryingly high'.

It was my ‘road to Damascus moment’. As it happens, I have once, actually been on the road to Damascus. I was going the other way, towards Capernaum, Tiberias and on to Jerusalem, following in the footsteps of Jesus. However, on this occasion I was in my lounge trying to take in what Helen had said. I have been taking statins for many years. These help prevent heart attacks and strokes, both of which I could do without. So why was I still drinking way too much alcohol and increasing my risk of both these conditions?

Alcohol is hugely addictive. It can lead to all kinds of illnesses, accidents and injury. In 2021, there were nearly 10,000 deaths in the UK directly due to alcohol consumption. The World Health Organisation calculate that there are 1.34 billion people worldwide who consume harmful amounts of alcohol. People over the age of 65 years old, who may well have been drinking alcohol for 40 years or more have an increased risk of poor health and harm from drinking rather modest amounts of alcohol each day. For men this would be 3.19 standard drinks a day (3-4 bottles of beer) and for women 3.51 standard drinks a day (3 small glasses of wine). Thankfully, both seem more than my possible 1 or 2 glass of wine a week. I’m of course joking, as I was probably drinking as much, if not more, than these modest amounts each day. Over the years I have acquired a taste for good red wines, and I have to say drinking wine has become part of my daily routine.  

It seems I am not alone. People aged 55-75 years old are the UK’s biggest drinkers. Those aged 35-55 are the second biggest group. Who continues to drink alcohol and where it’s drunk has also changed. Over the past 20 years, women have started drinking more, and more people drink at home than they do in pubs and restaurants. Cheap alcohol sold in supermarkets has made alcohol more readily available. Younger people are definitely drinking far less than these two groups, or not drinking at all. Which is a good thing.

A very comprehensive research study published in The Lancet, back in July 2022, provides definitive evidence as to the dangers of drinking alcohol. The report notes that alcohol consumption carries significant health risks and no benefits for young people; whereas some older adults may benefit from drinking a small amount of alcohol – yes you can see where this is going.

Having read the paper, and knowing I have 97 bottles of wine, 14 bottles of champagne and a wonderful range of malt whiskeys in the house, the thought of have a glass or two each week is very tempting. Indeed, that paper in The Lancet notes that the recommended alcohol intake for adults remains low at between 0-1.87 standard drinks a day, regardless of geography, age, or gender.

Hmm, it's tempting. Apart from some weight loss, and perhaps a better night’s sleep, I have not noticed anything different health wise. It was no problem to stop drinking alcohol. One day I was, the next I wasn’t. I’ve been out socially, had a couple of meals in restaurants and been very happy to drink non-alcoholic drinks. It’s been lovely to go to places and not have to worry about catching the last train or bus home, or arm wrestling J to see who would be the designated driver. I have become slightly fed up with folk asking why I have stopped drinking and when will the old Tony return. 

For example, last night one of my neighbours popped around with a bottle of Chateauneuf-du-Pape, declaring that come Wednesday we should open it and celebrate my alcohol free month ending. I have not yet made up my mind, so dear reader, watch this space. And if you, like me have successfully enjoyed your dry January, well done and many congratulations.

When snow falls, Nature listens – let’s hope our politicians do too

I’m sure last week would have been a difficult week for many, and for several different reasons. Close to my heart was the widespread industrial action being taken across many areas of the public sector. Much of this disruption continues to appear devoid of solutions; a deadlock where no progress seems possible. Sooner or later the politicians will have to sit down and discuss finding a way forward. In terms of nurses, whilst I think the 19% asked for is unrealistic, I support their cause and hope some middle ground can be found soon. It is not just money that is at stake here either. There is much evidence (see here for examples of studies) to show the positive impact on patent care and mortality, of having the appropriate numbers of qualified nurses in all areas of health care.

I say a big THANK YOU to all those folk who made sure that during the disruption our patients remained cared for, were kept safe, and treated where there was an immediate need for treatment. Of course, there are consequences for everyone. Elective treatments were postponed and these missed surgical and diagnostic admissions and outpatient appointments will add to the already record-high waiting lists. Waiting lists are not just statistics; there are people involved.

Thankfully, Covid and Flu-related admissions have gone down over the past week, and there has been a much welcomed reduction in the numbers of people in hospital who are medically fit to be discharged. But there is a way to go yet in returning things to normal. It is a difficult situation.

Last week, the health crisis wasn’t the only difficult situation facing our politicians. Tuesday saw the Westminster government signal their intention to block Scotland’s ‘Gender Recognition Bill’. I believe that if Scotland is a devolved entity, it should be free to make laws that are appropriate and reflect the prevailing view of the country. I think Westminster’s opposition is yet another example of politicians choosing to ignore the evidence when taking political decisions. For example, in this case, just take a look at the evidence from Argentina, which passed similar legislation in 2012. Although this is not a political blog, I have to say British politics seem to be in a bit of a stagnant mess currently. I truly despair.

There were lighter moments last week, however. One such moment for me was seeing the snow arrive. Snow by the seaside is not common and I think there is something delightful and almost hypnotic about watching the snow fall and slowly cover everything in a white blanket. Fortunately for me, I did not have to drive anywhere and could enjoy the snow from the warmth of my front room. Others were not so fortunate and had to commute through the snow. After many, many years of first having to clear a 500 yard long drive of snow before I could even set off for work, I salute all those folk last week who travelled through the snow to get to work. I would also like to thank the contractors building our new A&E department, Tilbury Douglas Construction, who helped clear our hospital roads and paths of snow last week, keeping my colleagues, our patients and visitors safe. Your help was much appreciated.

I was of course mocked unmercifully by my friends and colleagues from Finland, who declared there wasn’t any snow to be seen in the pictures I posted on social media. I can testify they really do have snow in huge quantities each year, and yet life continues almost without pause there. I didn’t mind the teasing as it brought back some wonderful memories of working with some of the most motivated and compassionate nurse educators I have known. 

One other highlight for me last week was attending the Stockport Health and Wellbeing Board. I have spoken about these meetings before, and I don’t apologise for mentioning then once more. The meetings don’t happen that often and yet they are amazingly good at acknowledging and recognising the work of local councils, health providers and the voluntary sector in coming together to provide services for local communities. Last week’s meeting was no exception. There was a most welcome report on what was being done in response to the cost of living crisis, and there was much to report on. The responses included warm spaces that provided company, tea and biscuits, and in some cases also soup and a sandwich. There was advice about managing energy costs and practical interventions like heated day blankets being provided free to the most vulnerable. Importantly for others, was the direct intervention in the case of those folk being threatened (yes that is the right word) with forcibly having a pre-payment meter being installed for their gas and electric supply.

These meetings are not just about reporting on what has happened, but also provide a place to share plans for what is yet to come. So, amidst all the current turbulence and pressures of the NHS, it was wonderful to be able to discuss plans for tackling some of the causes of poor health and wellbeing across our localities and communities. The focus was on improving outcomes in four main areas: enabling people to be happier and healthier and reducing inequalities; ensuring the provision of safe high quality services which make best use of the Stockport pound; appropriately supporting everyone to take responsibility for their health; and, together, supporting local and economic development.

There were bold initiatives presented which addressed each of these areas of focus, something for another blog maybe. However, they were all precisely the kind of ‘place-based’ intervention approaches that were perhaps envisaged by the development of integrated care systems.  They had also been developed in partnership with local communities. The contrast between the present unremitting demand for health and social care and the possibility of a very different future was stark. I hope the nurses’ dispute gets resolved soon; they deserve an appropriate and early resolution. We will always need nurses and other health care professionals. However, if we can find ways for people to avoid needing to use health care services in the first place, working in health and social care will become even much more rewarding.

Chaos, complexity and the space between – not knowing

It’s funny how sometimes you can be totally wrong about someone, or something. Last week I attended a lecture at my university, (University of Salford). I wasn’t sure I really wanted to go. It was pure curiosity that had made me book a place in the first place, as the lecture’s focus, ‘Introducing the Greater Manchester Integrated Care System’ was something I felt I already knew plenty about. I have been living, breathing the whole integration/collaboration approach for the past few years. I wasn’t expecting any kind of epiphany, real insight or even anything remotely new from the lecture – Presque vu. So, why was I going, you might be asking?

Well, I hadn’t physically been on the university campus since before the pandemic, and wondered what I might have been missing. Not a great reason maybe, but I have always been curious and I knew that much had changed since I had last been there. More importantly, it was the speakers that drew me in. They were all women. All were successful in their own field, and although I knew them all, one in particular I hadn’t seen for over 30 years, although she had played an instrumental part in my career. Over the years I had followed her prestigious career. Her name; Sue Bailey.  

I first met Professor Dame Sue Bailey back in 1984. She was the first consultant child and adolescent forensic psychiatrist at the world leading Gardener Unit, part of what is now Greater Manchester Mental Health Trust. I was one of the first Charge Nurses to commission and develop the service. It wasn’t always fun. Sue was (and is) a driven individual who didn’t suffer fools gladly. However, Sue was hugely determined to ensure the individual needs of some very troubled and troubling children and young people were recognised and addressed. Each child was at the centre of all her decision making.

In 1993, Sue was an expert witness in the James Bulger murder trial. James was two years’ old when he was abducted from a shopping centre in Bootle and murdered by two 10 year old boys, Robert Thompson and Jon Venables. At the trial, Sue concluded that one of the killers, Jon Venables, knew the difference between right and wrong. It was this opinion that led them both to be convicted of murder. They were the youngest ever convicted killers in the UK. Sue didn’t abandon Jon and remained his psychiatrist throughout his adolescence. Jon, now 30, remains a troubled individual who has twice been sent back to prison for further crimes.

Having not seen Sue for all that time I was intrigued to meet up with her again, albeit the circumstances didn’t feel that enthralling. How wrong could I be. Sue - now a Non-Executive Director on the Greater Manchester (GM) Integrated Care Board (ICB) - was taking part in the ‘on the sofa’ series of professorial lectures alongside Professor Sandeep Ranote, also a child psychiatrist, Charlotte Ramsden, Director of People Services at Salford Council and Dr Manshir Kumar, Chief Medical Officer for the GM ICB. Rather than giving what I expected to be a rudimentary account of what an integrated care system (ICS) was, they chose instead to reflect on their experience of the last six months; also drawing on the previous six years of GM devolution.

Sandeep started the conversation off. She loves to talk in statistics. She has a remarkable ability to draw upon a encyclopaedic and contemporaneous data store in the telling of any particular story. She does it so effortlessly. So, I was surprised when apart from some statistics sprinkled into her opening few sentences Sandeep chose instead to draw upon two artists to illustrate her reflections. The first considered a Jackson Pollock painting. He is a Marmite kind of artist, and I don’t like his work at all. I understood the way Sandeep drew on one of his paintings to show both complexity and chaos and reflected that this might be where we were in the development of our ICS. Like Pollock’s painting, in totality, the ICS is still a thing of interest and purpose, even if not everyone might see this.

Her other artist was someone I hadn’t come across before – Verity Markham. She is a poet and writer, whose words are beautifully illustrated by Victoria Rusyn. Sandeep chose to share a recent poem that struck a chord with me:  

And in this beginning,
there is every space
to let go
and embrace the chaos
uncertainty brings

For more years than I can remember now, I have written and talked about the gap between ‘knowing’ and ‘knowledge’, it’s a place of ‘not knowing’. Sometimes an uncomfortable place to be, a place of anxiety, but it is always a place of learning, and of possible understanding. It is an approach that has stood me in good order in my clinical, academic and leadership roles. Verity Markham’s words resonated as did Charlotte’s, as she in her turn talked about the GM ICS ‘fizzing’ with opportunities despite these complexities. The discussion made me think that if we were to achieve real transformation in health and social care services and truly address health inequalities then perhaps, in GM, we had to unlearn all we had learnt over the previous six years of devolution. The pandemic gave us all the knowledge and knowing of collaborative working. We need to return to that early unknowing space of how to deal with the pandemic and once again be unafraid to make mistakes, to learn to trust, and to build a new future.

I met a lot of folk I hadn’t seen for many years that evening. It was a joy to say hello and talk briefly about where people were at. In a crowded room, Sue and I found ourselves suddenly standing together. ‘It’s been a long time’ I said. ‘Hello Tony’ she replied. For a few moments, we talked about the intervening years and what I was doing and how it connected with the work of the ICS. We had a brief hug, a shared smile and then I was on my way back home feeling very glad to have been there after all.  

De Pop a Lula and the future of the NHS - Harry's Tale

I was once famous for not being able to pass a charity shop without going in to browse; I felt there might always be something I needed; top of this list were chickens. Many of the chickens in our world-record breaking chicken collection came from charity shops and car boots. Likewise, in a previous life, I collected books and at one time had a huge library, created by books mainly bought from charity and second hand book shops. These days my book collection is a great deal more modest.

The other thing to be found in charity shops at the time were clothes. During my pre current ‘black only’ period, I would scour charity shops for the most colourful clothes I could find. My adolescence coincided with the tail end of the hippy era, and I revelled in creating the most extravagant and eccentric outfits as possible. These days there are plenty of other ways to feed your inner Vivienne Westwood. Last week I read about the MIND shop in Soho, London. It appears to sell a great collection of second-hand designer label clothes. For example, there was a chic Sies Marjan yellow jacket priced at £195, and a leather skirt by Chanel at a mere £495. It’s not a charity shop for those having to choose between ‘heat or eat’ that’s for sure. And then there are the ‘circular fashion’ folk.

I acquired one of these when J and I got together, and no, it’s not J but one of her daughters, affectionally nicknamed Lucifer. She has a tiny wardrobe in her bedroom, but barely ever wears the same outfit twice when going out-out. She recirculates her clothes by reselling them through online fashion sites such as Depop, Facebook Marketplace, Vinted, Etsy, and even the ubiquitous Ebay. As well as always looking like a super model, she does very well out of it. When she lived with us, I was forever taking in parcels or taking parcels to the post office.

Of course, it wasn’t always like this. I was reminded last week of a time, over 55 years ago now, where I and other Boy Scouts took a bright green hand cart to collect people’s unwanted clothes to sell at jumble sales. I’m not even sure if we still have jumble sales. I can remember the cart having wooden wheels, with iron rims, wheels that were taller than me. Although I can’t remember precisely how old I was, I must have only been 11 or 12 years old. The world was a very different place then.

These memories were prompted courtesy of one Harry Leslie Smith. Last week, I listened to a speech he made at a Labour Party Conference in 2014. His memories go back further than mine. He talked about what life was like for him growing up in poverty, and in a time where there wasn’t any universal health care. You can listen to his speech here. It is just over 7 minutes long. You might want to have a box of tissues handy.

In sharing his speech I’m not trying to make any political points. Hearing it last week, I reflected what a wonderful institution the NHS is and all those folk who work within it are too. Yes, the NHS is under enormous strain at present, and it will be some time before that pressure eases. Yes, problems in social care are exacerbating the problems in health care. Yes, our politicians could probably do a lot more to deal with the issues resulting in today’s pressures. And yes, we can all do more to try and keep ourselves healthy and well. All that said, and against some very challenging and unremitting problems, our NHS is still delivering care to those who need it most. Sadly, not everyone is currently able to access that care appropriately and at the right time. Just as in Harry’s tale, people have died who perhaps might have been saved had our NHS been running more effectively. The growing numbers of avoidable deaths is unacceptable, and speaking out about this is not shroud waving, but speaking truth to power.

However, this blog is not about blame, although like others, I’m sure I could write a blog that sketched out a root cause analysis of what has led us to this point in time. No, it is in part, to acknowledge the good work that is still going on. Each day health care services are being delivered in primary care, communities, in mental health services and acute hospitals, and continue to be provided to many people. I was able to talk to some of my colleagues working in our acute hospital last week. I heard there was a huge recognition of the pressures everyone was under, particularly colleagues in the emergency department. But I also heard about the resolve to carry on, to do what can be done as we work through these challenging times. The next couple of months won’t be easy for patients, colleagues or the communities we serve. It could be a great deal worse, however. Look at what is happening in China or what is being considered in Wales for example.

Listening to Harry’s tale made me even more determined to do all I can to protect the NHS and find ways to ensure it flourishes and is eventually restored to being a truly world-beating, free at the point of service, national health service we all cherish. This won’t be easy. We need to look after our NHS folk more attentively, be courageous in our thinking over how we might transform services, and we need to keep ensuring that the people we care for are at the heart of all we do. We need to look back at Harry’s world, reflect on what has been achieved since then, protect what we have today, but look forward to building a better future for us all.

2023, the Year of the Rabbit and a Year of Hope

It’s Day 312 in the Ukrainian war and there is still no end in sight. I have continued to wear my one yellow and one blue clogs since the war started. I will continue to do so until the war has ended. I watched with both interest and admiration as many Ukrainians celebrated their Christmas and prepared for 2023. In the face of what most of us would consider unthinkable in this day and age, the people of Ukraine have consistently shown great resilience, pride, fortitude and optimism. It is something I will return to presently.

In my recent New Year blogs, I have tended to look back at some of the things I’ve done, and/or things that have occurred during the previous 12 months. This year I’m determined to look forwards, to think about what I might do or what might be to come. Today is, after all, the start of a new year (at least in the Gregorian calendar). It will be different for people from different faiths or ethnic backgrounds. Chinese, Jewish, Hindu and Islamic calendars celebrate New Year’s Day on other dates than today. The Chinese New Year will be celebrated on the 22nd January this year and will usher in the Year of the Rabbit, which is predicted to be a year of hope. 

For me, and many others, today is the start of a new year with all the opportunities that this might bring. When I think about the future, I increasingly feel optimistic. In such a troubled world, some folk might see this as a strange feeling to have. Yes, there are some challenging aspects to most people’s lives at present, mine included. However, there is much research that has shown people who are optimistic are more likely to cope better with many of the challenges of daily life. Arguably, people are more likely to be optimistic if they are enjoying good health and a good quality of life, but research also shows that optimism isn’t confined to those doing well. The people of Ukraine are living examples of this proposition perhaps.

I would describe myself as a ‘glass half full’ kind of person. I have long ago learnt to enjoy those things I can control and go with the flow with those I can’t – and as I get older, there are many more things I can’t control. The aches and pains of older life make themselves felt more and more often these days – but I accept them as part of life’s progression - and I let them go. It is always better to try and see the good in every situation. So what if I don’t move as fast as I once did, although I have walked over 2000 miles this year; not moving as fast means I have learnt to appreciate the world around me more. I’m not so much just passing through as loitering with intent. And there is always something to be grateful for, and this is something important to keep in mind.

Earlier in the year, when writing about the war in Ukraine, I wrote that all things would pass, including this dreadful conflict, and the many challenges we and others are facing in the world. Covid has not gone away, the price of energy remains high, and keeping warm, fed and healthy are challenges many of us are facing and will perhaps continue to face for a while yet. But they will all pass, and life will prevail.

This is my first blog of the new year. It is Blog No 699. I post it at the start of my 14th year of writing a blog every Sunday. If you are one of those folk who has, and continues to read my words each week, I say a big thank you for your support. It is always appreciated. After posting this blog, J and I are off to climb Nicky Nook, a famous fell in Lancashire. The summit provides a 360 degree panoramic view of Lancashire, Greater Manchester, the Lakes and even Wales. We will climb up and watch the first sunrise of 2023. Hopefully we can all help make the year a better place for all, and create a world full of hope and optimism.