Standing on the Shoulders of Giants

My PhD supervisor, Professor Joel Richman was a wise man. He once said to me (slightly misquoting Isaac Newton) that I would be able to see further (than others) if I stood on the shoulders of giants. It was his way of telling me to listen to his advice and to read everything I could get my hands on, if I ever thought I might eventually get a PhD. And I did. He introduced me to anthropology, philosophy, economics and opened up a whole new world of interest and insight for me. Sadly, Joel is no longer with us, but I remain grateful for that advice. It has helped me over the years. I still miss his mischievous sense of humour.

Last week, I said goodbye to two other folk who kindly allowed me to stand on their shoulders. The first was Martin Johnson. He had died a week or two ago and last Monday I attended his memorial service. I was not alone. There were at least 100 people in the room to celebrate his life as a father, nurse, professor, and husband. Martin was a real pioneer in so many ways. He was one of the first male nurses in the North West of England, and he excelled in his clinical career. Martin was one of the first nurses to undertake a MSc in nursing at the University of Manchester. Martin was one of the first professors in nursing. I first knew him through his editorship of the prestigious Nurse Education Today journal. I was privileged to have some of my papers published there.

It was Martin who was instrumental in my applying to the University of Salford and succeeding in becoming a professor myself there. I can remember at the interview asking whether the School would pay for me to attend a conference in Australia; the answer was yes, and I was also invited to attend a Nurse Education Today/Nurse Education in Practice conference in Vancouver to which I also said yes as well!

A year later I became Head of School, and then Dean, and Martin’s boss. Together we enjoyed a wonderful 10 years working together. We had a great time developing a vibrant professoriate and he did wonders in leading our Research Excellence Framework (REF) submissions. Another first was getting nursing, as a profession, recognised as having a powerful research voice. Between us we redefined academic tourism. He will be missed by many, and I count it a real privilege to have known him.

The other person whom I will miss, is Andrew Foster, who sadly died last Tuesday. Like Martin, I knew of Andrew before we became colleagues and then friends. People only spoke well of his approach to life and work. In health care he was always a champion for patients, the people he worked with and strove for continuous quality improvement. My first Non-Executive Director role was at Wrightington, Wigan and Leigh FT. Andrew was the Chief Executive. It was my first exposure to an acute Trust, and for the first six months, I struggled just to understand what was being discussed. Those acronyms! Over the next seven years, his wise counsel helped me grow in confidence and we established a really healthy working relationship that saw us safely navigate some difficult times.

Andrew retired from the Trust, but we maintained our friendship. Once every six weeks, we would meet to have a glass or two of wine and to put the world to rights. Our favourite place was called The Tickled Trout, a hotel set by a slow moving river. We could sit and watch the world flow past. When I was approached to consider the Chair’s role at Stockport FT, Andrew was one of the first people I went to for advice. He told me ‘not to touch it’, but if I really wanted a go, then he was certain that I was the person who could make a difference. Andrew was generous like that, always believing in people and helping them to realise their ambitions. Like Martin, Andrew is already missed by many, and his passing hasn’t quite sunk in with me.

I’m conscious that this is a blog post about three silver-haired old men, written by an equally silver-haired and old man, so please forgive me for that. However, Andrew has a special place for J and me. It was at his retirement party that I proposed and J agreed to marry me. Although the wedding was postponed a couple of times due to the pandemic, we did eventually get married, and Andrew was one of our treasured guests. In a week full of sadness, the memory of that wonderful day has helped bring a little light to the darkness. RIP Joel, Martin and Andrew.

 

Ps – our UK £2 coin has the inscription ‘STANDING ON THE SHOULDERS OF GIANTS’ inscribed on its edge. Keep reading this blog for more startling facts that you didn’t know you needed to know.

Not feeling guilty about what will be, as whatever will be, will be

This week’s blog comes from Venice. I have never been here before and although it hadn’t been on my list of places to visit, J insisted I would like it. So we came, and I have. Our hotel, the 16th century, quaint and traditional Locanda Al Leon was a real find and central to all we wanted to do. I was fascinated that the bedroom walls were covered in heavy gold coloured material rather than wall paper or paint. The bustle from the streets and alleyways around us could be enjoyed or quietened by the shutting of black metal shutters. 

Although we have only been here for 4 days, it has been a relaxing and informative visit. The architecture, the art, both old and modern, are simply stunning. The weather has been kind, the food delicious and sampling the choice of red wine an absolute joy. We even managed a Venetian music concert yesterday evening, which was fabulous. The place is magical and J put together a wonderful itinerary to enjoy it all. So why, as I write this, do I feel slightly guilty? 

Actually, there are probably many reasons. here are just a few. There’s the fact that we are simply here. At a time where many folk are struggling to get through the week due to the cost of living crisis. I did fell slightly guilty that we were here on a trip for no other reason than enjoyment. I haven’t forgotten those folk impacted by the earthquake in Turkey and Syria, or those struggling with the war in Ukraine. These are people who have lost all that they had and will struggle in all kinds of ways to rebuild lives. Yes we could have cancelled the trip and donated the money, but that doesn’t feel appropriate or helpful either. 

My elderly parents, (not quite as old as the Venetian hotel) are not so well these days. My Father had a bit of a wake up health call last week. There isn’t much we can do, but such incidents do bring home just how vulnerable we all are. In their case, it is likely to mean a change in how their life gets lived, something that might bring its own problems. We live nearly 250 miles away and the journey takes the best part of 4.5 hours by car and there’s not much difference by train. It’s not a helpful distance to travel in an emergency, or to provide day to day support. The sense of impotence caused by the distance has always been difficult to deal with. Being overseas heightens these feelings, and we have a few more trips planned this year. That we are further away and in a different country, and not easily accessible make me feel slightly guilty. 

We flew out of the UK, just an hour or two before the 72 hour industrial action by junior doctors ended. Their strike action was the longest so far of all the health unions’ industrial action. It was predicted to be the one that would cause the most disruption, and I’m sure in many places that would have been true. I spent 30 mins on day one in our Gold Command Operations Room. I was impressed by our team’s  response to issues as these emerged. The level of preparedness was first class. I wasn’t in the Trust for the second day of the strike, but the Board were given an update of how things had gone and how things were doing. There were, thankfully, and a little surprisingly perhaps, few problems. However stupid it might be, the fact that I wasn’t there to support colleagues in person made me feel slightly guilty too. 

During the 72 hours’ strike, medical care was being provided by the most experienced and knowledgeable doctors, our Consultants and Specialist doctors. These are folk who will be much more confident, decisive and less risk adverse than many junior doctors. Ironically, if you did happen to need hospital care during the industrial action you were probably in better, and safer hands than normal. 

I was surprised at the lack of media coverage of the strike, which doesn’t bode well for public support. The only union I have ever belonged to was the European Union and so have never been party to the decision-making processes that unions go through to determine what action to take next. The settlement of the other healthcare unions’ industrial disputes might make the BMA next steps more difficult if they don’t get around the table and start talking with the government. Whatever happens with the junior doctor industrial action going forward, last week’s strike was not without its costs. It’s estimated that 175,000 operations and appointments have been cancelled, all of which will be adding numbers to the already large waiting lists. It will certainly make the lives of everyone working in my hospital that little bit more difficult. And for that I feel more than slightly guilty.

Much of the above (apart from Venice) was outside of my control, so should I feel guilty at all? Guilt has been described as an emotional experience that happens when we believe, rightly or wrongly that somehow or in some way, we may comprised our values. I definitely don’t think my feeling slightly guilty is an altruistic or empathic guilt, and it’s not deontological in nature. Perhaps it’s an existential guilt caused by a sense of not living up to my expectations and perceptions of what I unconsciously think of as my purpose in life. I don’t know. However, we will be flying back to the UK later today, and sitting here writing this blog has at least made me feel grateful for what I have and what I’m able still to give to others. And that feels like a good place to be and not anything to feel even slightly guilty about. As they have said in this part of the world for many a year, ‘que sera, sera’, and for me at least, thank goodness for the therapeutic power of writing .

Billy is learning [to] embrace equity

We have a parrot in our house. He is an African grey, called Billy and is getting to be 30 years old now. He has lived with me for 26 of those years. He’s likely to live for another 30 years, and might outlive me. Billy has a wonderful repertoire of phrases, words, whistles and noises. He also knows how to whistle the blues. He has acquired his ability to talk, laugh, whistle and so on through a combination of observation and repetition. Billy also has an uncanny ability to be contextually correct. So, for example, if I walk into the kitchen with a wine bottle, he will immediately make the sound of the screw cap coming off and the glug, glug of the wine being poured. If I open the front door, he will say ‘see you later’ or ‘bye Billy’. He calls the cats in every morning and afternoon for their food, and will tell Dylan the dog off, if he thinks Dylan is being a pest.

There are some things Billy struggles to say. For example, and thankfully, he can only manage ‘Alec’ rather than ‘Alexa, set the timer’. He is currently learning to say ‘what’s occurring’ and is almost there with that. He has a phenomenal memory too. When my youngest daughter comes to visit, he will say things that she once said, and in her voice too. She is now 40 years old. The most common word used when she is here, is ‘what’ - still said in that surly voice most teenagers have. After she has gone, we seldom hear it for more than a few days. Sometimes he will come out with something that he hasn’t said in a while, and I don’t know why. Last week he exclaimed ‘women, they’re a b****y nuisance’. Not sure where he’s heard that being said, or by whom, and of course, they’re not.

We witnessed and acknowledged this last Wednesday, on International Women’s Day. This year’s theme was Embrace Equity. In my own world, health care and the NHS, women make up 75% of all staff. The NHS is one of the largest employers of women in the world. Whilst there is an ambition to support women from all backgrounds to achieve their personal and professional ambitions, there is still plenty of inequity to be seen. In many NHS organisations, there remains a gender pay gap. This doesn’t mean that men get paid more for doing the same job as women. That would be an equal pay issue. Gender pay gap relates to the difference between the average pay of males and females in the same organisation.

Across the NHS, many people in the lowest paid jobs tend to be women and men are more highly represented in higher paid jobs. So, reducing the gender pay gap implies, therefore, that either we increase the proportion of men in lower paid roles or increase the proportion of women in higher paid and more senior roles. At my Trust, we are due to take a paper to the Board in April that looks at our gender pay gap position. I don’t know what the pay gap might look like for this year, but I am pleased that our Board, (the most senior roles in the organisation), has 10 women and 6 men. The most senior role of all, the Chief Executive, is held by a woman. And she is, without doubt, an outstanding leader.

It is not just pay where there are inequities. It’s true that, on average, women live longer than men, women also spend a significantly larger proportion of their lives in ill health when compared to men. It is also true that whilst women make up 51% of population, the health and care system they use has, historically at least, been designed by men for men. The consequence is that often we don’t know how men and women experience the same health condition, and perhaps even less about health problems that only affect women. Just consider how long it has taken mainstream medicine to recognise the health and wellbeing issues of women experiencing the menopause. Last August, the Department of Health and Social Care published its first Women’s Health Strategy for England. You can find it here. Judge for yourself as to whether you think we have made progress in addressing any of the issues.  

Personally, I think we have a way to go before we can be sure that women receive the same care as men for major health conditions such as cardiovascular disease, or chronic respiratory conditions. Likewise, I believe we also need to ensure this care is provided using gender-sensitive, equitable and evidence-based approaches. Then we might truly make a difference.

And last week I met some wonderful women who were doing just that. Making a difference. I was privileged to spend some time with colleagues working in the Sector 3 organisation. Sector 3 is a charity that provides infrastructure, support and networks for the voluntary, community and faith-based groups, social enterprises (VCFSE) and charitable organisations across Stockport. I was impressed with what they have done and continue to do, particularly in response to the pandemic and the cost of living crisis. One tangible outcome from our conversations was the agreement to work more collaboratively with each other in developing resilience, opportunity, and healthy communities. It is something we have already made a start on. So many thanks to Jo, Soraya, Nadia, Laura (and Kirit) for giving me your time and welcome. I just hope I wasn’t too much of a nuisance.

 

Ps – the BBC have started a 3 part series on the life and work of Frida Kahlo – you can play catch up here. She died a year before I was born. By any measure she was a remarkable women, and remains one of my favourite artists of all time.

Raising a glass to a long and healthy life – what the evidence says

My favourite professor last week? – it has to be Professor Tim Spector. He talks my kind of language. Last week, speaking on whether red wine was good for you or not, he said we should all aim to drink ‘thousands’ of different types. I immediately jumped in my car, whizzed off to Tesco’s (there are other supermarkets) and filled the boot up with a dozen cases, filled with different wines. Back home I sat with a glass of the red stuff in hand and decided it might be a wise idea to read past the story’s headline.

Yikes! Second paragraph in and he clearly notes he is not suggesting we all go on a wine drinking binge. His argument is that drinking wine made from many different types of grape is what is good for you. Trying a wide range of grape varieties can boost our immune system, help us fight diseases and even improve our mental health. However, too much of a good thing is not always a good thing. Consuming more than half a bottle of wine at any one time will cause you more harm than good.

The odd glass of red wine is good for you thanks to the microbiome. Red wine contains high quantities of the chemical polyphenol, which microbes in our gut use as an energy source. There are many thousands of different polyphenols, which is where his story headline came from – and hence the advice to drink wines made from different varieties. His advice, ‘wine lovers should keep loving the wine’ – sounds like good advice to me. Like all things though, only in moderation.

Love and relationships also featured in another research story last week. Researchers from the University of Queensland published a paper on their findings of a study started in 1996. This large cohort study looked at relationships people enjoyed in their 40s and 50s and any possible impact on health and long life. The reported outcomes show that satisfying relationships with partners, friends, family and even work colleagues, can all help boost your physical and mental health in old age.

There has, for a long time now, been a widely held, and evidence-based view, that strong social networks help improve our mental health and wellbeing. What has been less well known is whether there is also a link to a reduced risk of developing illnesses such as heart disease, cancer, COPD, diabetes and other common longer term conditions in older life. The study showed that folk with high levels of satisfaction with their social relationships had a 50% reduction in the risk of developing such conditions compared to those with lower levels of satisfaction with their social relationships.  

Similar to Tim Spector’s advice, the Australian study shows there are health benefits in diversity. In this case, in starting and maintaining high quality and different relationships throughout our middle age. Back in the UK, this study reinforces the emergent health and social care policy approach. UK health policy is about collaborative and partnership approaches. The drive is to shift our focus away from developing ever increasing acute healthcare services, to building resilience and strong communities at a neighbourhood level. I have a belief that strong communities, made up of people enjoying a wide range of different relationships with others, helps make for healthier populations. There is a sustained growth in the size of the older population. It might be interesting to think more about social connections as being a public health approach to preventing long term, chronic and complex health conditions.

There was also a related study undertaken by University College London colleagues that showed the link between regular physical activity undertaken at any age, and better brain function in older age. Indeed, the long term study, which was undertaken with participants born in 1946, showed that maintaining an exercise routine throughout adulthood had a positive impact of reducing the risk of conditions such as dementia. And it is never too late to start. Even taking up exercise in your 60s will be better for you, and help improve your cognitive abilities and functioning, than doing nothing at all.

Not to be outdone, researchers from the University of Cambridge looking at the relationship between regular exercise and health, have also concluded that regular exercise is good for you. However, they also found that most people don’t come anywhere near doing the minimum 150 minutes of physical activity a week as recommended by the NHS. This study, a systematic review, looked at hundreds of previous studies exploring the benefits of physical activity, reported that even doing some exercise each day was beneficial. And your exercise doesn’t have to be done in a gym! Just 11 minutes a day (about 75 minutes per week) of riding a bike, walking fast, dancing or running will help reduce the risk of heart disease and some cancers. Doing physical activity with others was found to increase motivation to get out there and doing something. Changing habits can also help. Leaving the car on the drive and walking to the shops, bringing back just what you can carry in two shopping bags can be a perfectly good alternative to more traditional forms of exercise!

It seems that making friends and enjoying their company over time, regular exercise, and the odd glass of red wine are the recipe for a long and healthy life – sounds like a plan to me.