Without question, we can all make a difference

One of the things I love about my younger grandchildren is the questions they ask. It often feels like they have an insatiable appetite to make sense of the world around them by asking endless questions. Whilst some folk might find this irritating, I have to say I love it. Answers can easily become stories, and all children love hearing stories. Of course, whilst it is always important to be truthful, answers to children’s questions don’t always need to be evidence-based. Answers just need to satisfy the child’s curiosity in the moment, but also whet their appetite to learn more. Here’s an example:

Chickens and Dinosaurs. For some reason most of my grandchildren have gone through a dinosaur phase. Dinosaurs seem to appear on the school curriculum very early on in school life, and fuel a relatively short-lived, but intense fascination for these long-gone creatures. It makes buying birthday and Christmas presents very easy while they move through this phase. Now some of my grandchildren love our chickens. Whenever they visit, they like to ‘round them up’, or ‘collect the eggs’ and in the Spring, pick the baby chicks up to give them a ‘cuddle’; usually the Mother Hens are less than impressed with their chicks being cuddled. So, when you tell the children that chickens are actually related to dinosaurs, it adds a little magic and wonder to the conversation. And chickens and dinosaurs are related, well more or less – see here.

However, last week I met with a group of folk where ‘more or less’ answers to questions are not good enough. This was at our regular informal meeting with our Council of Governors’ colleagues. As well as being Chair of the Board, I’m also Chair of the Council of Governors, and I love meeting with them. Their main role is to hold the Non-Executive Directors individually and collectively to account for the overall performance of the Board. The ‘holding to account’ is about seeking assurance. They are an integral part of our overall governance approach. They are a tough, informed group, who do their homework. Their contribution is vital to ensuring that local people get the best service possible from health care providers such as the Trust that I chair.

When I first started as a Chair at the Trust, it was difficult to get any interaction at all. The meetings felt a lot like me talking to people not talking ‘with’ people. But over time this has changed, and all the meetings are now lively, purposeful and very interactive! We provided training to the governors in how to raise challenges and questions. These days, and almost inevitably, they will start their questioning with ‘can you tell us how you get assurance about….’ whatever the concern might be. As I say, there is no room for ‘more or less’ answers when you want assurance, and not simply reassurance.

Mind you, last Wednesday I met with some absolutely brilliant colleagues who could provide reassurance and assurance in a context that most of us would find very challenging. Last Wednesday was National Cancer Clinical Nurse Specialists’ Day. It was a day of celebration and awareness raising in terms of what these nurses do. Most Cancer Clinical Nurse Specialists (CNS) are Macmillan nurses. 

There are 6,700 Macmillan nurses in the UK. Macmillan usually fund these nurses for the first 3 years and then the NHS (or other health care organisations) will continue the funding. It was a group of these nurses that I met with last week. They had put on a wonderful exhibition of their work and I was able to talk with many of the CNSs, each providing an insight into the care they provide across the many different fields of cancer.

It was an eye-opening experience, and one I was glad to be part of, albeit very briefly. Not only did I learn a lot about the types of cancer most prevalent in Greater Manchester, but also about the pivotal role in the cancer pathways CNS have. Right from the start of a person’s cancer journey they are there. They provide advice, information and support to all individuals who find themselves on a cancer pathway. And this is where the assurance and reassurance come into play.

I don’t have personal experience, but I’ve had family members who have been on a cancer pathway. All of them have had so many questions and all experienced difficulty in the early days of diagnostic testing in finding someone who would be a trusted voice; someone who was experienced and knowledgeable to talk to. Last week, what I heard is that during that first period of uncertainty where there isn’t a confirmed diagnosis, people don’t always know what questions to ask. On being given a diagnosis of cancer those unknown questions multiply exponentially.

Anxiety, bewilderment, anger and possibly the full range of Kubler Ross’s five stages of grief will often be experienced. This is where the cancer CNS role is so important. All through these times of questions and a need for answers, Macmillan nurses are there to offer emotional support, and help folk work through all those questions in a totally person-centred way. I was impressed with what I saw and heard. I’m always proud of what all our nurses do. Last week, it felt like a real privilege to see and hear what these specialist nurses do in making a difference to the lives of others.

        

Chicken Run: and this ain’t no chicken blog*

Now regular readers of this blog will know I have a thing about chickens. As well as having a small flock of backyard chickens, I boast having the world’s largest collection of all things ‘chicken’. Our house has over 6,000 chicken-related objects and paintings. I don’t know why the interest, but it has been almost a lifetime’s passion. So, I make no apologies by opening up this week’s blog with a few lines about our chickens.

Tuesday was a red letter day. The bird flu restrictions which have kept all hens and poultry housed inside for the past 7 months were lifted. Whilst strict biosecurity measures, and a ban of poultry markets and fairs remains in place, chickens are now allowed outside. Free range eggs will soon once again be on sale at your local supermarket.

During the hen lockdown, I built a large aviary for our hens. It has meant they have been able to get fresh air and scratch around undercover and with no risk to their health from wild birds. First thing Tuesday morning, I opened the poop hole for them to come out into the garden. There was a rush of very excited hens all trying to get out first. I smiled and felt good inside. I watched for a moment or two and then went to feed the goats. Minutes later I returned to the hen house, and all the hens were back inside the aviary! It was as if they were frightened to enjoy the big wide world once again. Over last week they have returned to normal behaviours and it is wonderful to see them wandering around again. 

Last Friday was also a red letter day. One of our chickens hatched three of her eggs. She has been sitting on 16 eggs, most of which weren’t hers. Chickens might look soft and stupid, but they are highly intelligent. As soon as she hatched her eggs, she got off her nest, and deserted the other non-viable eggs. Sadly, one her new offspring died, but she is still pleased as punch with her two remaining chicks. These might survive or not. It’s how nature works. Last year we had over 50 chicks hatched. Sounds good, but it’s a problem. We can sell or keep the hens but what do you with the cockerels? – I’m a long time vegetarian, and haven’t eaten meat for over 50 years. J likes meat, but wouldn’t ever eat anything we had reared. Yes, it’s a problem.

Every so often I will sort out the problem. J won’t. She is not a farmer, and I love her for it, and she even gives our animals and poultry names. I’m slightly more pragmatic. I allow them a brief but interesting life, and when the cockerels start fighting with each other, something they inevitably do, I despatch them quickly and humanely. I always do it on a night when the hens are roosting, so that none of the other hens get scared or anxious. Care and compassion is just as important in poultry-keeping as it is when looking after those folk who come through our healthcare doors.

I was reminded of this last week as colleagues from our Acute Frailty Unit (AFU) celebrated the success of their frailty awareness week. Looking after folk who are often the most vulnerable to falls and the life-changing injuries that can follow, takes huge skill, knowledge, determination and yes, oodles of compassion. Last week saw many of our wards that provide care to older patients celebrate another month of being ‘falls free’. The team at AFU have steadfastly driven down the number of patient falls over the last few months and are way ahead of the target they set themselves on their journey to no falls at all.

I have to say that I’m impressed with the positive attitude colleagues promote to living well with frailty. Patients are encouraged to get out of bed, to dress and take part in an active daily routine. No wrapping up in cotton wool here. Their approach embodies much of Brian Dolan’s end-PJ-paralysis campaign (see here) and clearly, they are making a difference. I’m ashamed to say I was slightly amused by their home hazards lounge competition, but when I reflected upon it, actually it was very much like my elderly parents’ living room. I’m ashamed to say that at times, it also resembles our lounge. J will say it’s categorically not her who creates such mayhem, and I have no defence.

The importance of my colleagues’ approach is that they show what might be possible by ‘doing’. Our proud hen with her two new chicks, is already allowing them to explore their new world through ‘doing’, in her world, pecking, scratching the ground for goodies, learning how to keep warm and literally understanding the pecking order that keeps our hen house free from constant conflict.

And it’s not just colleagues on the AFU who do something similar. It is a team effort. Last week, the AFU team held a tea party on the ward. A proper ‘fancy cakes and sandwiches’ tea party. It was our award-winning catering colleagues who helped bring this ambition to life. I don’t think I ever tire of say that ‘teamwork makes the dream work’ – and last week I could see this idea in action.

Every year, the arrival of new chicks helps me stay grounded. I see them and know it’s possible for new ways of being hopeful for the future, and a challenge in the present to get through. Our chicks will do just that, and I’m sure, with folk like my colleagues, we will continue to succeed in making a difference to the lives of many others. We can, in lots of little but often significant ways, care, inspire, and protect those with whom we come into contact. Maybe even, we can aspire to be like our new Mother Hen, who apparently is called Ursula, and find new ways to do just that.

Her 2 new chicks are yet to be named.

 

*Apologies to Nick Park and Peter Lord

The NHS, our crowning glory!?!

Currently, across the globe, there are just 43 countries where there is a monarch as head of state. That is 43 countries out of 195 countries recognised by the United Nations. The Vatican (or Holy See), Taiwan (currently seen by the UN as being part of China), and the State of Palestine are all included, but not officially recognised as being sovereign states. I suspect that many of these nation states will have received invitations to the forthcoming King’s coronation. I haven’t received mine yet, and strangely I don’t mind. Day by day, as we grow closer to May 6th, I know I should be interested, perhaps even vaguely engaged, but if truth be told, I’m simply not. I know I probably should be, but somehow, the importance and significance of the event is not gripping me.

I can already hear the cries of outrage and anguish. It’s not that I’m anti-royalist; completely the opposite actually. I admired greatly what our Queen did for the country over her entire lifetime and like many others, mourned her passing. I simply think that there are too many other competing concerns going on both in the world and my life that are particularly distracting at present.

In the joy and happiness of sharing family time over the long Easter weekend, it is easy to park the growing concerns of trying to help and support my parents. I’m fortunate to be the eldest of a large group of brothers and sisters, who whilst spread out across the globe, all do their bit to help. But like many others who have one or both parents living with dementia, providing the right kind of support grows more difficult each day.

And whilst I try and avoid politics in this blog, I’m immensely proud of J who is standing in the upcoming local elections. I pledged to help her in any which way I can, but this sometimes means we have days where we pass like ships in the night. It looks like there is some determined competition too, which adds to the sense of turbulence.

However, whilst these two examples require a great deal of emotional labour, it is the ongoing industrial action that captures most of my attention and focus. I watched in awe as my colleagues made sure we continued to provide safe, high-quality health care over each day of the four days of industrial action. I used the bed management meetings (held three times during the day) as my barometer. I didn’t see panic, just a calmly delivered action plan; I didn’t see frustration or blame, just folk reaching out to help others when needed and throughout it all, I saw positive and effective communication being used to ensure brilliant team working.

I also saw a very different health care service being provided. Whilst we did see doctors in training (the correct collective term for so called junior doctors) working on the wards, it was the consultant body that stepped up, stepped down and stepped across in leading and providing the assessment, treatment and care for our patients. They didn’t do this on their own, but worked with nurses, allied health professionals, admin staff, porters and all the many other folk who keep a big acute hospital running smoothly. The same was true in our community services too.

We did have to cancel some of our elective work, but overall, our productivity was up. Patients were seen, assessed, treated, admitted or discharged much more promptly than perhaps we have experienced in the recent past. Clearly consultants have the experience, skill, knowledge and confidence to make decisions in a way that most doctors in training simply cannot yet do. As a country we invest a great deal of time, resources and money into developing sufficient numbers of consultants able to work across all types of health care.

Thinking about the last four days might lead you to think that a consultant-run NHS would be truly excellent, albeit rather expensive way of providing health care. But if we went down that route, in a few years, we would start to run out of consultants. One of the many things that they do well is to train future doctors. One of the other reasons that patients were seen and treated quicker during the industrial action, was that there was no training going on at all. All of which leads us to an interesting place. Are our patients paying the price for medical education? They are not of course. Every patient will have a consultant who ultimately will have responsibility for their care, and who will want to see that care provided expediently and effectively. So, a more complex situation maybe?

And the future for the NHS appears equally complex. We heard yesterday that the RCN had rejected the government’s pay offer. They announced further industrial action to be taken on and around the King’s coronation. With this decision comes the apocalyptic possibility of both nurses and the doctors in training going on strike at the same time, and to do so with no derogations being granted. If this were to occur, many folk would die unnecessarily. The industrial action undertaken so far has resulted in nearly 400,000 missed appointments and procedures. The already very long waiting lists will have grown longer and made the task of reducing them, that much more difficult.

Bold action is required to resolve this situation. A 35% increase is not going to happen, but a staged pay deal response, staggered over time is possible, particularly if it were to be coupled with some imaginative short-term thinking*. Most doctors today end their university education owing a six figure sum, perhaps we should forgive this student debt? There is an example. After all the angst our future King’s young son has wrought, yesterday Charles stated he was proud of both his sons, and wants the best for both of them. And yes maybe, just maybe, I will be tempted to watch the coronation too.

 

 *I was reminded last week that when I qualified as a nurse in 1978, I was paid £3,020 a year. I had just bought my first house in Swansea, which cost me £6,000. At the time I was able to get a 95% mortgage, and the £300, 5% deposit was relatively easy to find. Today, a newly qualified nurse earns £27,055 and that same house I bought in Wales will now cost £210,000. A £10,500, 5% deposit wouldn’t be so easy to save up (and that is if you wanted to live in Swansea, it gets worse if you move closer to London or Manchester).

The Power of Remembering = Memories

Memories are the theme that perhaps best describes this week’s blog. Memories, good and bad, are important in that they shape how we feel, how we behave and what we might think the future could hold for us. These days, I often wake up early in the morning, and as I am more or less retired, I don’t have to leap out of bed. So, on many a morning, I will lay there and let memories run through my mind like a private film show of my life. Sometimes old memories from way back get mixed up with more recent ones, or sometimes, even with real life. Let me start with one such example.

I find it very sad that once again the long-running troubles between the Israeli and Palestine folk has once more erupted into a bloody conflict. Yesterday saw the deaths of two British women who were innocently caught up in the crossfire between the two groups. I find the situation poignant and sad for a number of reasons. It is, for many religions, an important and special time of the year. And these are all religions where tolerance, love, compassion to others is espoused and expected. Secondly, there is so much conflict in the world, that to reignite yet another one feels difficult to understand. I think the last reason is that a year ago J and I made our delayed honeymoon pilgrimage trip to Israel. It was a life-affirming and a very profound trip for us both.

Unlike J, I am not a deeply religious person. I was brought up by loving parents who practised Christianity. I went to church every Sunday, was christened and later confirmed. My early teenage years were spent regularly in the company of other church-going young people. Somewhere along the line, my faith grew dimmer and less important to me. Strangely though, and perhaps because there is Jewish ancestry in my long family line, over the years I nurtured a strong conviction that the good folk of Israel were constantly persecuted for their beliefs and simply for who they were as a people. The recent and excellent BBC Radio 4 programmes Nazis: The road to power (find it here) critically articulated this idea of a people being unreasonably persecuted.

Our pilgrimage trip to Israel challenged these long-held convictions. It wasn’t our belief that that Jews hadn’t been persecuted over the centuries that was challenged; the evidence that this is the case is clear to see, and irrefutable. It was more that our naive and perhaps uninformed sense of the rights and wrongs of the current situation were possibly given greater balance. Our wonderful guide during the pilgrimage, Bassam Abdalla, is a Palestinian Christian. He is passionate about his faith, his history and the history of both his people and that of his Israeli neighbours. But goodness, he, like many other Palestinians, has during his lifetime, suffered brutal persecution every day at the hands of those working for the Israeli Zionist state.

That said, and apologies if my words and thoughts don’t resonate with you, but that trip also holds lots of very special memories. We were there in the week leading up to Easter itself. We were able to visit many of the places we knew from The Bible and take time to reflect on the historical and religious significance of what we were seeing and experiencing. We were even able to re-enact some experiences. For me taking communion on the calm shores of the Sea of Galilee, and walking into Jerusalem down the Mount of Olives on Palm Sunday holding our palms aloft and singing were simply once in a lifetime experiences. Bassam was a brilliant and enthralling storyteller. It was one of the most memorable Easters I have every spent. And I have always liked Easter more so than Christmas.

Sadly, it seems that Easter has become as commercialised as Christmas. Recent reports suggest that Easter is worth some £2 billion to the British retail sector. John Lewis (there are other retailers) has seen a 266% rise in sales of Easter decorations and goods over the last 10 years. This year their online website listed 37 different Easter eggs and 69 different Easter decorations. I know this as I’m sometimes playing catch up when it comes to buying Easter eggs. In any event, many of their Easter decorations featured rabbits, chickens, spring flowers/garlands, and of course, eggs. I don’t know why, but I have lurking in my mind, a distant memory of understanding why Easter is symbolically represented in this way. So, this morning I’ve been compelled to look up how the non-religious and religious history of Easter became so entwined.

According to folklore, the Easter bunny originates from the German Lutherans. The rabbit was said to carry a basket of brightly coloured eggs which were given to the best-behaved children each year. However, I like the Anglo-Saxon story told by the Venerable Bede (a British monk living in the 8^th century). He told of the pagan goddess Eostre who was said to have rescued a dying bird and transformed it into a hare, giving it fur so it would survive the cold, but yet remarkably still able to lay eggs like a bird. And eggs are metaphorically important as they represent a sign of rebirth, and the potential for new life. Indeed, some say that Eostre is the namesake of the human reproductive hormone oestrogen.

Yes, I know I could go on...  Easter eggs were first sold in the UK in 1873, the egg’s hollow centre being seen by some as a symbol of resurrection, in that it perhaps emulates the empty tomb of Jesus after he was crucified on Good Friday. Eggs represent the possibility of new life, or in the case of Jesus, renewed life. Now I would never want to preach to anyone* but there is something in the simple message of renewal. Each new day presents an opportunity for us all to spread some kindness, to be there for others, and to look forward to a brighter more compassionate future. Maybe, let’s embrace our memories, good and bad, and recognise how they might shape how we feel, how we behave and what we might think the future could hold for us. We can make that future a better one for all.

* I have never had any thought on becoming a preacher man, but I do love those long black robes so many wear 

Seeing life through a different lens

My Dad has been a life long camera and photography buff. At different times it has been a real passion of his. Although he had his own ‘dark room’, literally a place to develop and print films, and not anything sinister, throughout his life he embraced new technology. I well remember those early portable video cameras, made portable only because you had some of the technology housed in a machine you hung from your shoulder. He loved taking pictures and was often very creative in terms of camera angles and composition. He created thousands of slides, and friends and family were often ‘treated’ to a slideshow or two. As the technology changed, photos and slides were transposed onto CDs and my Dad’s creativity moved to embracing captions and music. He became quite the digital media maestro.

These days, of course, we are able to produce excellent quality photos, video clips and all manner of digital media simply by using our smartphones. Whilst I didn’t really inherit my Dad’s passion for photography, I do think I inherited his artistic leaning when it comes to capturing moments in ways that often draws favourable comment when I post these online. As for my Dad, well I think he has a secret desire to once again own a camera that uses film so he can return to those days of developing your own prints. Seeing an image appear in those trays of chemicals was quite magical. And not everyone could do that.

Indeed, photos taken with the early cameras all had to be sent away for developing and printing. The Kodak No 1 camera, first sold in 1888, was a simple box camera that came complete with a roll of film. When the film was finished, the entire camera was sent back to the Kodak factory, where it was reloaded with more film and sent back to the customer while the original film was being processed.

We have come a long way since then, but just for a moment, I want to dwell on a camera that appeared on the shelves in 1949. There is, dear reader, a reason for this pause. Back then, a company called Photo-Pac started to sell a single-use cardboard camera. It only took 8 photos, which had to be sent away to be developed. Sadly, the camera never caught on, and the company went out of business. It took until 1986 before the single-use camera made another appearance. Kodak produced a model a year later that became very popular. Their use grew during the 1990s and such cameras were often found on tables at wedding receptions and so on. Indeed, J and I went to a family memorial celebration meal late last year, where each table was given one of these single-use cameras so as to capture the moment. I prefer my smartphone, but if you are tempted, you can still buy these cameras here.

Single-use digital video cameras, despite being readily available, have not really caught on. However, last week I saw one such single-use digital camera in use at my hospital. I had the great privilege to spend some time with Rachel Campbell, one of my colleagues, who is our Irritable Bowel Disorder (IBD) Advanced Clinical Specialist. I had in the week previously formally opened our new endoscopy services with our Chief Executive, Karen James. During that opening ceremony, I was told of our video capsule endoscopy service. Rachel and her team provide this service, and so I arranged to see her.

I didn’t know what to expect, and certainly wasn’t expecting to see how far digital camera technology had come and how it was being applied in healthcare. The ‘capsule’ used in this process is just a little bigger than your average paracetamol capsule. At one end is a tiny digital camera that continuously takes hundreds of pictures as it passes through a person’s body. 

The version I was shown is one that provides an examination of the small bowel. The pictures it takes are transmitted wirelessly to a small recorder that the patient wears around their waist. The camera can take a while to pass through the body, often 5 – 8 hours, and eventually it is passed out in your stool when you go to the toilet. Hence the single-use idea. Each camera costs around £500, which is slightly more than the £22 Kodak version noted above. 

Whilst there is something about the fact that the cameras contribute, in a small way, to our sustainability challenges, it is a great service for patients who either cannot tolerate a more conventional endoscopy or where endoscopy and/or colonoscopy can’t reach the part of the bowel needing to be examined. Our Trust is seeking to develop the service further and to start to use the double camera colon capsule, but we are not quite there yet with this service development.  

And just like the excitement I felt when standing next to my Dad as he developed his photographs all those years ago, I found the images stored on Rachel’s computer of the capsule’s passage through a human body absolutely fascinating. I have never seen inside a human body in this way before*. It was a privilege and simply awesome. I’m sure if George Eastman, the man behind the Kodak camera, was alive today, he would be amazed at the way his original invention had been developed and used in transforming healthcare diagnostics. I know I was.

 

*The images are used for training purposes. All the images are completely anonymised with no patient information being either visible or disclosed in any other way.