Listening to others, the human side of beer and healthcare

True confession time, I’m loving the recent weeks of sunshine. I know I shouldn’t be complacent; our heatwave is definitely down to the climate changes we (the human race) are responsible for bringing about. But I love being able to walk around outside (in our garden) in nothing more than a pair of shorts. I know I have also changed my behaviour in response to the recent fine weather. For example, I have taken to pouring myself an ice cold beer to drink sitting in the garden for 30 minutes or so before starting the evening. Now folk who know me, will think I have perhaps lost my way. Most know me for drinking wine and the occasional whisky. Never beer. Likewise, I have no idea where this change in habit has come from. Don’t get me wrong. I only have one beer and then return to my wine.

One beer seems to be more than some folk in the US have been drinking just recently. Anheuser-Busch, the makers of Bud Light, a long time No1 bestselling beer in the US, has endured a dreadful past 3 months. Sales have plummeted and at one time they lost over £21 billion in the value of shares in the company. Their problems stemmed from when the transgender influencer Dylan Mulvaney posted a picture of her holding a Bud Light can, with her picture on it, announcing her partnership with Bud Light. Social media, particularly the anti-trans communities, unleashed a furious hate filled campaign regarding the Bud Light brand – the consequence for the company was an unprecedented drop in sales. Dylan herself seems unperturbed by the trolling and social media hatred she has received.

The company said it has suffered this backlash because it ‘politicised’ Bud Light, which has alienated many of its customers. On one side, there are those who have little sympathy for the LGBT+ community and on the other side, those in the LGBT+ community who were enraged by the company’s lacklustre response to the boycott and social media storm. Recognising that they might have misunderstood their customer base somewhat, Anheuser-Busch has started a marketing campaign that features a more traditional ‘All American Dream’ version of those folk that drink their beer. I think this too is destined to fail. I’m not sure they are listening attentively to what people are saying. As such, the company probably has a long way to go before regaining its place as a market leader.

There was another story last week that highlighted the need to pay attention to what the general public considers might be important, who they might trust, what aligns with their values and how much they are willing to change their behaviour. And no, it wasn’t anything to do with the Brexit vote anniversary. That deserves a blog in its own right. No, it was the story of how both major UK political parties promised to make a huge investment in the use of artificial intelligence (AI) in healthcare. Of course, in NHS terms, huge doesn’t necessarily mean a large amount. Indeed, the figure reported was around £21 million. Compared to the £21 billion loss faced by Bud Light in the last 3 months, this is a rather paltry sum. But we have to start somewhere, I guess.

Whilst AI has an undoubted and growing place in supporting healthcare services, recent research indicates that the general public, in the main, are deeply sceptical of new technology such as AI, and in particular AI being used in front line healthcare. They still prefer doctors and put more faith in the doctors’ ability to look after them than anything promised by AI. Some of this might be down to not perhaps understanding AI, and let’s be honest, who amongst us really does? That said the research revealed there were some folk who thought AI could help doctors make a better diagnosis. There is some evidence this might already be happening in some areas of healthcare, particularly in medical imaging and decision support. 

There are already AI-based approaches that are 40 times more accurate in analysing chest x-rays, and can make a reliable lung cancer diagnosis in less than 30 seconds. This has to be good news for the individual patient, The time saved means that an estimated 600,000 more x-rays could be performed each month across England. Likewise, AI-based technology that can diagnose strokes is being rolled out and will be in use across all stroke services by the end of this year. Patients will get treated more quickly, which will help ensure better outcomes for all.

However, as great as these developments are in themselves, they will probably add to the NHS capacity problems rather than resolve them. For example, in March this year, cancer referrals were up 120% from their pre-pandemic levels. The strain on the NHS has moved from diagnostic services to treatment services. Additionally, if the public’s scepticism over the added value of AI in healthcare is not managed effectively, progress towards realising the benefits will be slow. Arguably, the biggest factor in managing this will be addressing the value people place on the human contact that has for so long been the mainstream approach of all healthcare. Just consider the difficulties there have been post-pandemic in persuading people to access primary care virtually. So many folk feel that unless they can sit in the GP’s office and speak face-to-face with him or her, then they are not receiving the best care possible.

Harnessing the best that AI has to offer AND maintaining that human interaction means the NHS addressing underlying workforce issues. We are expecting a new national long-term workforce strategy anytime soon, which in NHS terms could mean next week, month, the next 6 months or even next year. In my view it can’t come soon enough. Perhaps, what we don’t need in the meantime, are any more politicians promising us that the earth might be delivered though AI. Let’s all keep our feet firmly on the ground please.  

 

Of Chickens and Men* with apologies to John Steinbeck **

I wonder how many readers of this blog knew that last Monday was International Superman Day. I certainly didn’t until I heard it on the radio and looked up what it was about. Superman Day was started in 2013. It was a marketing campaign to celebrate the release of the film ‘Man of Steel’ by DC Entertainment. Superman was created in 1933 by Jerry Siegel and Joe Shuster. I discovered that the history of Superman is fascinating, but I haven’t room in this blog to share, so do have a look at this site. I was also amused that Superman Day coincided with the start of Men’s Health week. This annual event is organised in the UK by the Men’s Health Forum. Internationally, the week was first started in 2002. The week aims to rise awareness of preventable health problems that can disproportionately affect men, and importantly encourage them to gain the courage to tackle their health issues. Not all men are supermen.  

Indeed, the average man’s life expectancy is 3.7 years less than a woman’s. One man in five dies before they reach 65. Men tend to go to their doctor far less than women, and men are three times more likely to die from suicide than women. In the UK three out of every four suicides are men. Suicide is the biggest cause of death in men aged under 45. The Mental Health Foundation notes that one in eight men will be living with a common mental health problem such as anxiety, stress or depression. So, it is not surprising perhaps, that the themes for this year’s Men’s Health Week are ‘men’s health and the internet’ – a theme that focuses on the impact of technology and social media on mental health.

The Men’s Health Forum reminds us that the iPhone first went on sale in 2007. Those born then will turn 16 this year. Unlike myself, these folk will have grown up what can be described as a high-performance computer in their pocket. I didn’t get my first computer until I was 30. It was a great big clunky Amstrad. Its usefulness now would pale into insignificance compared to even today’s oldest iPhone.

This year’s theme, whilst looking at the possible impact on men’s health, also highlights a potential emergent dilemma for policy makers. NHS England devoted an entire chapter in its Long Term Plan to describe its digitally enabled care ambitions. The Secretary of State for Health and Care, Steve Barclay, in his keynote speech to the NHS Confed last week, pledged to protect the NHS technology funding, noting that increasingly digital technology will be the cornerstone of how future healthcare will be accessed and often delivered. Already many of us will have become familiar with using the NHS App, booking appointments, ordering repeat prescriptions and so on online. Virtual consultations, virtual wards and ‘hospital at home’ services are all dependent upon web-based programmes. Indeed, many of those 16 year olds today will have not known any different ways of accessing help.

As more healthcare gets delivered using new technology, the downside is it may be harming us as well. My iPhone tells me every week how much time I have spent online. Without judging me, it will tell me whether this is more or less than the week before. How many of us now really dislike Zoom and Teams meetings, preferring instead to engage in face2face meetings once more – I know I do! It is not just in our working lives that real-life person to person interactions are becoming far less frequent. Don’t get me wrong, I still believe there is still a place for virtual conversations. I’m currently Facetiming my father every day as we work through my mum’s hospitalisation, and it is the only practical way I can support him as they live five hours away from me.

Arguably though, a growing reliance on social media and other digital forms of communication, reduces that sense of friendship, kinship and family life that comes from regular person to person encounters. I think that this might be a growing contributor to those people who report they often experience loneliness and isolation. The recently updated Community Life Survey on Wellbeing and Loneliness (see here) reported that some three million people in England often or always feel lonely. Interestingly, it the 16 year old cohort who feel lonely, more often than other age groups. Men reported feeling lonely less often than women, but given men’s general reluctance to share how they might be feeling, I don’t find this fact surprising. Twice as many men than women struggle with their emotional intelligence. Loneliness can often exacerbate this. Lonely people can also lose the sense that their life has any meaning. Likewise, loneliness is often associated with poor nutrition, sleeplessness and not taking adequate exercise. All of which are not great for anyone’s health and wellbeing. Loneliness can increase the risk of premature mortality by up to 65%.

So, I’m glad that the focus for this year’s Men’s Health Week has opened up the debate as to both the usefulness of new technologies and also the risk there might be to some folk’s health and wellbeing. What of the chicken? Well, a story caught my eye last week, for no other reason than it mentioned chickens. It was about the discovery of the ancient underground city of Elengbu in Turkey by a man (whose name we don’t know) chasing his chickens. The hens went into a hole in a wall of room being renovated. After crawling through after them he discovered the entrance to an underground city. This was in 1963. You can read more on this fascinating story here, as it is only included in this blog so I could use it in the blog’s title. I know a little contrived so please forgive me. What became of his adventurous chickens, however, remains a mystery.  

 *John Steinbeck’s book Of Mice and Men, tells the tale of two farm workers, one with a learning disability who travel together and dream of a day when they can work their own land. Written 70 years before the first iPhone, the story explores themes of discrimination, human rights, equality, freedom, loneliness and the desire to find a place we could all call home.

**This is an old video made from a previous life - it shows me as the original man with chickens - watch and chuckle  

A week of surprises

Sometimes life can be full of surprises, good and bad. Last week was like that. It was no surprise to me to find that a gin and tonic at the Coldplay concert in Manchester last Sunday cost nearly £8! The concert was great, but food and drink prices outrageous. We stayed over in a Premier Inn. No surprise that we had a good night’s sleep, their beds are simply the most comfortable to be had. Later, on Monday, after what felt like a long day, I was pleasantly surprised to find that not only were Northern trains running, but they were doing so on time!

Tuesday brought with it the lovely surprise of winning £200 in this month’s Premium Bonds’ draw – usually I get £25, if anything at all! I was also surprised to find that I’m now eligible for a pneumonia vaccination. It’s an age thing. What was even more surprising was that when I rang my GP surgery to make an appointment, the phone was answered straight away and they booked me in to have it done on Friday. Primary care at its best, and of course prevention is always better than cure.

And last week I even surprised myself in agreeing with something that the Taliban have been doing. Quite rightly, they are not the most popular of regimes. Their suppression of women and children’s rights is appalling, horrific and unjustified, and makes it more difficult for other countries to provide much needed aid to the Afghan people. So what had I read that made me agree with something the Taliban were doing? Well, it was reading about their war against opium growers that caught my eye.

Over the past year the regime has been systematically destroying the opium poppy crops and ensuring that the farmers concerned grow wheat instead. They are succeeding too.  Across Afghanistan, the 2023 opium crop has been reduced to less than 20% of what it was in 2022. That is staggering. It is important too. Over 4 million people in Afghanistan have a serious drug problem. Heroin manufactured from Afghan opium makes up 95% of the market in Europe.

It will come as no surprise to readers that growing wheat is not as lucrative as growing opium. Poor people are getting poorer since the ban was introduced in 2022. The Taliban’s main spokesman, Zabiullah Mujahid acknowledges that people are poor and suffering hardship and hunger, because of this ban, but also reminds us that the harm opium causes far outweighs the economic benefits. He wants the international community to provide more help. And therein lies the rub. As long as humanitarian responses continue to be linked to political ideologies, such aid is unlikely to materialise. I’m not surprised however, by the logic of Mujahid’s assertion that stopping the opium trade benefits the whole world, so perhaps the whole world should provide more help in return.

Closer to home, and thinking about providing help to others, I was impressed by a report published by the Fabian Society last week. It was a piece of work commissioned by the Labour Party and Unison. I have no political points to make in mentioning it here, it is simply a well written and thought provoking reflection on how to address the social care issues facing the UK. You can read it here. I wasn’t surprised to see the Health Foundation’s response to the report, however.

They seldom pull their punches, and so it was here; ‘the social care system in England is broken and the next government needs to fix it’. The good folk at the Health Foundation estimate that it will cost an additional £6 billion a year by 2030 just to keep social care at its current state. That is, no improvement will be gained in addressing the poor state of social care provision despite having to find this additional funding. And the demand for social care continues to grow.

I know from current first-hand family experience (albeit in Wales) that whilst the demand for social care continues to grow, the availability of residential care places, and social care professionals able to provide appropriate levels of care in people’s own homes continues to reduce. The Fabian Society’s report offers some solutions in addressing this, particularly around aligning social care salaries with NHS salary bands, but again this will need additional funding to be found. Of course, options for reforming social care provision are well known, what appears to be lacking is the political will to actually implement any of them. No surprise there then. Now I’m just a humble blogger and not an economist, but it seems to me that we have to find a very different approach to funding and providing our public services. Just think about the frequent periods of industrial unrest we have seen over the past few months. Whether you agree with the demands being made or not, the sad fact is that such unrest has its origins in our public sector services being very much neglected over the past decade. Such neglect can be seen across all areas of the public sector, not just in health and social care.

There is, perhaps, something important to reflect upon here. The lack of good quality social care tends to be thought about as something that involves older people, the vulnerable and the frail. Or those folk who have complex needs. At one level this is how it should be. I can’t help thinking however, that we also need to consider those who require care at the other end of the age spectrum, our children. Their voice can often be as silent as many of our older members of society. We need to invest in them as well. And you won’t be surprised to hear me say, we need to do this because they are our future. As we look for ways to invest in improving social care, we should equally invest in all our futures too.  

Revisiting mental health street level triage

Here we are, and it’s 4th June already. Time flies. I have a growing sense of there being ‘one life, so live it’ as each day passes. This came to mind last week when I read the story of the Metropolitan Police (Met) and their plans to stop attending emergency calls related to mental health incidents. I will come back to this story shortly. But reading the story, I was reminded of a PhD student I nearly had many years ago.

I completed my PhD some 23 years ago. It was one of the best things I have ever done. I loved every moment of doing it. I was fortunate to have a wise supervisor who opened my mind to so much.  He was a compassionate and caring man, someone who had an infinite amount of patience. He was also the most well-read person I have ever known, and he could quote from the many books he had read with complete ease. Sadly, he is no longer with us, but his approach to supervision was something I tried to emulate with all my doctoral students over the years.

I have successfully supervised 23 doctoral students to completion. Each student’s successful completion felt like a triumph of collaboration. I have never had a student fail. However, there were two students I nearly had, but who fell by the wayside after I worked with them for 12 months. That first year of doctoral studies is crucial. It is a time where the student must take their big idea, and reduce it down to a manageable question to be answered. It is a process of challenge, exploring ideas, concepts and theories and of making decisions about methodology and philosophy. It is tough, but without this period of initial study, it’s unlikely anyone would be able to undertake a PhD programme.

And that is what happened to the two students I nearly had. One student wanted to explore the use of art in therapeutic relationships. A great idea, and one I was very enthusiastic about working with. However, she was never able to find a way of articulating a question that would be the focus for her studies. And it wasn’t for the want of trying on my part. I tried every which way to help her clarify what it was she wanted to study, to no avail. After nearly 11 months, she eventually stopped turning up for supervision and left the programme soon after.

The other student was an incredibly enthusiastic mental health nurse who was desperate to do a PhD. His enthusiasm was, at first, infectious. Fairly quickly it was replaced by frustration on my part as he steadfastly refused to heed my advice. One of the ways to get through that first year is to listen and consider the advice provided in each supervision session. He consistently refused to do so, and eventually was removed from the programme, as he could not produce any work that indicated he was able to study at doctoral level. Both these students gave rise to a sense of failure on my part. But doing a PhD is incredibly difficult. If it were easy, everyone would be called Doctor.  

It was a shame the mental health nurse had to leave the programme as his big idea was to explore the impact of a mental health ‘street level triaging’ initiative with which he was involved. This project happened many years ago. It involved mental health nurses working with ambulance paramedics and the Police to help people in distress and/or experiencing mental health problems literally on the street. It sounded like a very interesting scheme, but I never got to find out how successful it was and eventually I forgot about the initiative. That was until I read the story about the Met and their proposed withdrawal from attending mental health related incidents.

At one level, I can see why this withdrawal of their support has been proposed. Research has shown that police officers in London spent almost a million hours a year in hospital emergency departments waiting for patients to get a mental health assessment. In many cases it can take up to 14 hours to hand over a patient to the care of health professionals. Whilst not directly comparable, the time spent waiting is the equivalent of attending 500,000 domestic abuse incidents or 600,000 burglaries or similar crimes. London is a special case of course. There are some 9 million people living there, and it’s not a homogenous population. London will take a lot of policing! The relationship between the Police and a myriad of local health and care providers is likely to be complicated and complex, making it difficult to implement schemes such as the Right Care, Right Person project seen in Humberside. This approach has had a huge impact on massively reducing the hours Police spend on attending mental health related incidents, whilst ensuring people with acute mental health problems receive prompt care and treatment. 

And in the strange way that some things happen sometimes, last week I was in a meeting that was considering plans for improving mental health care across Greater Manchester (GM). During the meeting a colleague asked the question as to whether Greater Manchester Police were likely to follow the stand taken by the Met in London. The answer was no. Discussions are advanced as to how the Right Care, Right Person approach might be best adopted across GM. Interestingly, for me at least, a number of examples were given of projects already being taken forward. These included mental health nurses working in Police control centres, and a number of ‘street level triaging’ schemes involving mental health nurses and paramedics working together in responding to acute mental health incidents, both out on the streets and in people’s homes. I don’t know if my former PhD student is involved in these schemes or not. I kind of hope he is, albeit, gaining a PhD is not for everyone.