Building the future of health and social care

One of the most interesting aspects of my role as Chair of a large acute hospital is the opportunity to meet people working across our organisation, both in the hospital and the wider community. I was really pleased to be able to spend some time with colleagues in our Urgent and Emergency Care department last week. We are having a new Urgent and Emergency Care Centre constructed around the existing building; something that is hugely challenging for colleagues working in the department.

Ours is a very busy emergency department, with an average attendance of around 300+ patients a day. Seeing, assessing, treating and either admitting or discharging people is a constant challenge. Doing so in a timely way, even more so. When I got there at 9am, there were three people who had been in the department since 10 o’clock the night before awaiting a bed. The demand for care is unrelenting and has been growing since the Covid pandemic plateaued.

I asked to be shown a patient’s journey through the department. It became immediately apparent how busy the department was. Every time we stopped to discuss something, we found ourselves in someone’s way. However, it was interesting that despite the busyness, everyone was engaged in a purposeful and carefully choreographed way. I was very impressed by the care being given and proud to have such a skilled and motivated team providing that care. What was also clear was the impact that the building work was having on the operation of the department. As the construction work is progressing, parts of the existing department were having to be relocated, or even shut down, adding to the difficulties in getting people through and out of the emergency department.   

Many of the folk in the department, while I was there, were elderly patients. The impact of increasing fragility in the growing elderly population was glaringly evident. Those patients waiting for a bed were doing so because we have so many beds occupied by folk who have no medical reason to be in an acute hospital, but where there needs can’t be immediately met by other services. Regular readers of this blog will know I have personal experience of this. My mother who lives with dementia has spent the last 13 weeks in hospital. She was discharged home last Thursday with a full care package of support. Unfortunately, she fell on Friday afternoon, spent 7 hours on the floor waiting for an ambulance, and ended up back in A&E and admitted to hospital once more. She was discharged back home yesterday afternoon.

As well as living with dementia, my mother is very frail and has mobility problems, but there is no medical reason for her to be in an acute hospital bed. In fact, the hospital doesn’t even provide a safe refuge. In the 13 weeks she was an inpatient she had 7 falls. It is predicted that the number of people who live with dementia globally will rise to some 153 million by 2050. Arguably, dementia is possibly the biggest growing threat to future health and social care systems.

Increasingly there is an ever expanding arsenal of drugs being used to reduce the worst impact of the disease and slow the course of its progression. None, unfortunately, provide a cure. More and better drugs will be developed, I’m sure, over time. The lure of making enormous profits will ensure ‘big pharma’ keeps doing the research and developing new drugs. All of which, however, will take time.

So I was interested last week to read of work undertaken by folk at the University of Oxford in developing a tool that is based upon 11 risk factors, which can be used for predicting whether someone (at mid-life) will develop dementia within the next 14 years of their life. The 11 risk factors are: age, education, a history of diabetes, a history of depression, a history of stroke, parental history of dementia, levels of deprivation, high blood pressure, high cholesterol, living alone and being male. Whilst some of these factors can’t be changed (those over the age of 60 are at greater risk for example), other factors can be addressed by people choosing to modify their lifestyle choices. It’s known that up to 40% of dementia cases can be prevented by stopping smoking, reducing high blood pressure, losing weight and reducing how much alcohol you drink. However, the risk score can only ever tell us about the relative chance of developing dementia; it is not a tool that leads to a predictable definitive outcome. I think it is one of the new ‘up stream’ and evidence-based ways of thinking that the NHS has to embrace through working at a place-based, neighbourhood level.

I had one other visit last week which provided me with a glimpse of the other end of the care continuum. I was able to visit the internationally renowned cancer hospital, The Christie. I was offered a tour, which I readily accepted. Now nobody wants to find themselves there, but the facilities and environment were state-of-the-art. I was privileged to be shown inside the Proton Beam Therapy Centre. This is housed in an enormous building – read here to understand why this is!

Unlike other forms of radiotherapy, I knew absolutely nothing about this service, which is part of a £250 million national proton beam service. About 750 people use this service a year, 60% of them are children and young people. The advantage of proton beam radiation is that it can be aimed precisely at the tumour, and doesn’t harm the surrounding tissues or organs. It is about as far removed from the care my mother and others like her living with dementia receive at home as you could get, but both forms of care are just as vital.  

Let our hopes, not our hurts, shape our future!

I have yet to see the recently released and critically acclaimed film, Oppenheimer. I have no reason not to see it other than seemingly always finding other things to be doing for 3 hours. I’m sure I will see it at some stage. It has received some great reviews about the way in which the storyline closely reflects the development and deployment of the first atomic bomb. Now in my youth, I was an ardent supporter of the campaign for nuclear disarmament (CND). Formed in 1957, the movement is still functioning, although support for its work and membership numbers have sadly declined.

During much of the 1980s CND was associated with the world-famous music festival at Glastonbury. Throughout this period much of the profits from the festival were used to support the work of CND. In 1981, the CND symbol, designed by Gerald Holtom in 1948, flew from the top of the Pyramid Stage. The symbol has long been universally recognised as a symbol of peace. It was used at that other famous music festival, 'Woodstock'* back in 1969.

Despite my birth name being Anthony, for as far back as I can remember, I have always used the name Tony, and for years would sign my name with the CND symbol in the loop of the Y. Over the years my signature has become more abbreviated, as has the symbol in the loop.

Despite the continued calls for the universal disarmament of nuclear weapons, the war in Ukraine has underlined that the threat of a nuclear war remains very real to this day. It is to be hoped that sooner rather than later both sides get around the table and find the words that will bring peace back to the people of Ukraine and Russia. It was the British politician Pearl Strachan Hurd, who said of words ‘handle them carefully, for words have more power than atom bombs’, something still true to this day.

For example, you will have perhaps seen the story last week of India’s Supreme Court issuing a handbook for judges to use, requiring them to stop using words like seductress, vamp, spinster, harlot, and whore when talking about women. I thought these archaic terms that disparage women and perpetuate gender stereotypes had long disappeared from our everyday lexicon, but it appears this is not the case in India’s judicial system. The report perhaps again reinforces the notion that words are not just words, but that they can influence how the world is seen, and language can be the way in which perceptions and behaviours are shaped.

The second story about words to grab my attention was how the folk at the University of California had managed to capture and transpose brain waves into words using music. The story was totally fascinating, although the science was beyond my understanding. It’s an important story as the research could lead to the restoration of speech in patients who struggle to communicate because they live with a disabling neurological condition, such as a stroke or a neurodegenerative disease.

However, the other reason the story caught my attention was that the researchers were using the music of Pink Floyd in their experiment. The team were able to record the patients' brain waves as these were transposed to words of the Pink Floyd song, Another Brick in the Wall. Now whilst younger readers of this blog perhaps won’t have heard of Pink Floyd, they were (are) one of my all-time favourite bands. Back in 1969, their album Ummagumma, was the first record I ever bought. I was nearly 15 and had saved up my paper round money to buy it. Actually, it was a double album, both a live and studio record.

Over the years I went to see them perform live and of course bought every album they produced. Sadly, the original band split up in 1985, although they later reformed minus Roger Waters. In 1994 they produced the wonderful album The Division Bell. One of its tracks provided an introduction to a paper my best friend and writing partner, Professor Sue McAndrew and I presented in 2008 at a nurse education conference in Dublin. The papers title also played on the Pink Floyd name and our love for Sigmund Freud: Pink Freud: education, enlightenment and erroneous zones – in those days we did like to have a play on words! The words from the song we wanted to capture were:

While you were hanging yourself

On someone else’s words

Dying to believe in what you heard

I was staring straight into the shining sun

However, the most distressing words I heard last week were those used in finding Lucy Letby guilty of killing 7 babies and attempting to murder 6 more. It seems she may have attempted to kill many more, and the police are continuing with their investigations.

My PhD supervisor, Professor Joel Richman wrote extensively on the concept of evil, drawing on research he undertook in Special Hospitals. Evil is a strong word, but it is one that came to mind on hearing the guilty verdict. These were simply appalling crimes, and a unforgivable betrayal of the trust the public has in the nursing profession and the wider NHS to care for their loved ones. The recent documentary on Julius Robert Oppenheimer is called the ‘Destroyer of Worlds’. Well I think Lucy Letby did a similar job. 

Like me, I’m sure your thoughts are with all the families involved and my colleagues who worked, or are still working, at the Countess of Chester Hospital. I find I have no words of comfort to give them but borrowing from Roberts Schuller’s words what I will say is: ‘let our hopes, not our hurts, shape our future’. 

*One of my favourite guitars I own is a limited Woodstock edition of a Martin & Co acoustic guitar - which carries the CND symbol on it it. I managed to source a second one of these rare guitars, which I gifted to my childhood friend Keith who lives in Portugal. 16 months on he still hasn't received it and the guitar is believed stolen by someone unknown in the Porto Customs Department.  

Growing old and growing weary about what health and social care actually means

It used to be ‘you know when you are getting older when the police start to look younger’. I have never given much thought to this well-known saying, but last week, I came face to face with a more contemporary version. I was in a meeting where the social worker, doctor and physiotherapist all looked too young to be a social worker, doctor or physiotherapist. The occasion was a ‘best care’ discussion about my mother. My mum, aged 89, lives with dementia.  

Following a fall 10 weeks ago, she was admitted to an acute hospital in Wales where she remains today. She has no underlying physical issues other than those associated with getting older, and despite being moved six times during her stay, she is still occupying an acute bed that might be better used by someone with an acute illness or trauma. My mum wants to go home. However, following a mental capacity assessment, she was deemed not to have the capacity to make decisions about her future care. So, my sister and I, who both have lasting power of attorney for my mum’s health and financial affairs found ourselves in the meeting last week.

Interestingly, on the same day as the meeting, my blogging colleague Roy Lilley posted a blog that explored and challenged the value of the virtual ward concept and approach. His thoughts on the new social care model have some validity, but faced with my mum remaining in hospital for what felt like an indefinite period of time, I found I couldn’t agree with his argument. You can read Roy’s blog here and judge for yourself.

The outcome of the meeting was the decision to refer my mother to the Discharge to Recover and Assess Team – a model similar to the approach used in England, and one I have great confidence in. It means if the care plan is approved, my mother could be discharged with a wraparound care package in place. Despite my comments above about the age of the meeting participants, I have to say I was impressed with the time spent, the care and compassion shown and the team’s knowledge of my mum’s health and wellbeing care. It gave me confidence that we have made the appropriate decision.

Later that day, I travelled to London on the train. It is not a journey I enjoy, but needs must. Arriving, I whizzed across London on the tube to where I was staying that night. It was a lovely hotel, but for £175 a night it ought to be. The welcome was warm and friendly and the young receptionist even offered me a glass of prosecco while she sorted out my registration. It seemed churlish to say no, and after all, it was a very hot day.

I was in London to take part in a doctoral viva examination. I was the external examiner. The day of the viva began with brilliant sunshine. I thought - get up, find where I was supposed to be later in the morning and then go for a walk. So, putting my walking shoes on I set off. Finding the right building was easy enough. Google Maps took me right to the front door. Entering the building I was immediately confronted with a rather large and slightly intimidating woman, dressed in a bright blue ‘I’m the security so beware’ outfit who immediately demanded to see some identification.

I have often found myself in such situations and usually just go with the flow. However, I explained that I didn’t want to enter the building per se, I was just wanting to check I was in the right place for later on. I promised her that when I returned, I would show her my identification. I went back to the hotel had some breakfast, which I have to say was not great for a £175 a night hotel, got changed and waited until it was time to return to the university. Which I did.

The female security person was nowhere to be seen. She had been replaced by the largest, toughest man I had ever seen. He glared at me as soon as I walked in. I smiled back. He continued to glare. Unfazed, I walked up to the reception desk and asked to be directed to room V204. “Do you have any identification?” the chap behind the reception desk asked. Now I don’t do all this he/him, she/her stuff so, and I know that is not what he was after, but somewhat provocatively, I said just Google me. He was non-plussed. He said I needed to report to their security office. I said I didn’t think so. I was here to take part in a doctoral examination, and if the university security folk didn’t want me to do so, I could just take the next train home. It was one of those tense stand-off situations you read about in popular thriller novels. We all paused, the security guy gave an even fiercer glare in my direction. I smiled in return. 

Thankfully, I was rescued by one of the doctoral candidate’s supervisors, who recognised me from reading my blogs and following me on social media. She took me to room V204 and I was able to participate in the viva. It wasn’t an easy examination. However, this was nothing whatsoever to do with the student. Her work was excellent. Indeed, she got through the defence of her research with flying colours, no amendments required. A fabulous result. The problem with the viva was that one of the internal examiners was participating virtually. However, nobody had set up the facilities to do this, and we lost 45 minutes of everyone’s time getting the technology sorted. The viva was a great conversation. Ironically, perhaps, her focus was on Generation Z students and their interaction with social media to further their education and training.

One of the students thesis’ recommendations was recognising the challenge there might be in existing lecturers (faculty) being able to acquire the skills and knowledge to address a completely different generation of learners, who have never known anything other than that of a digital view of the world. I thought it was a challenge equal to the one I had faced when confronted with the young folk looking after my mum. Of course, all those fine folk had the skills and professional knowledge to practise, but I wondered about their ability to interact effectively with the people in their care and the others who care for that individual. That worries me. To date no one other than myself and my sister has spoken to my dad about the decision taken at the meeting. Maybe Roy Lilley does have a point after all.  

    

Tony on Tour: food, people and kindness

Last Friday morning, I took a tour of our Surgical Division facilities. Going out and meeting folk working across our hospital and community services is something I do every week and it’s something I really enjoy doing. I had visited the wards and departments before, but this time my colleague Chris O’Loughlin, Divisional Nurse Director, took me around in a way that mirrored our patients’ journeys.  Also, I hadn’t been able to visit our theatres before and so I was particularly keen to see these. These walkabouts also provide a useful opportunity to speak with patients and hear their personal accounts of the care they are receiving.

I have to say I was impressed. A lot of our buildings are quite old and hard to adapt to reflect contemporary hospital health care. 

However, nearly everywhere I went to was clean, bright airy and most of all surprisingly calm! There were a couple of places still waiting to be upgraded and a ceiling in one of the blocks leaked every time it rained. Ironically, this was a consequence of the significant building work going on adjacent to the block, where our new Urgent and Emergency Centre is being constructed.

The theatres were a joy to visit. I was even able to see a robot-assisted laparoscopic radical prostatectomy operation in progress. This was one of the highlights of my walkabout. I was amazed by what I could see on the screens, as the surgeon operated. He wasn’t even anywhere near the patient. One of the things that excited me about seeing this procedure in action was knowing the patient would only be in theatre for a couple of hours, compared to the alternative - a retropubic prostatectomy - which can take 8 hours or more. This has to be good for the individual. Likewise, afterwards the patient would probably only be in hospital for a couple of days afterwards, rather than the much longer period associated with the retropubic operation.

The other ‘take home’ message for me has to be the enthusiasm, confidence, pride and commitment I found in all the colleagues I met. I saw smiles, heard laughter, and even witnessed one colleague dancing down the corridor, backwards. Now don’t get me wrong. I only met a tiny number of the 5,500 colleagues who work in our Trust during my visit. I know that the pandemic, workforce shortages, industrial action and the unremitting demand for care has left some of my colleagues understandably exhausted, depressed, and even considering leaving the NHS. As a Trust, we put a great deal of effort in looking after the wellbeing of our colleagues and finding ways to support them in all aspects of their life. It was, however, refreshing to see so many happy staff. And happy staff make for happy patients.

I did get to speak with some patients along the way. One conversation took me aback somewhat. As can be found in every hospital, every patient has an information board above their bed, with their name, the name of their consultant and named nurse, expected date of discharge and any other special information. On one patient’s bed board, I could see he was a vegan. Brimming with the confidence that comes from knowing our catering colleagues have won so many prizes, I asked what was the vegan offer like. Looking me straight in the eye, he uttered the single word: “s**t”. For a couple of seconds, I was stuck for words. I recovered and we explored why he was unhappy with the food he had received since being an inpatient. The Ward Manager, who was with me, promised both of us that she would get things sorted as soon as I had left the ward.

Outside the bedroom bay, she said that the patient hadn’t complained to her or her colleagues about the food. If he had, she would have got something sorted straightaway. There was something there for me about not waiting for complaints to find out what is important for individuals. This was something I understood more after undertaking the ‘Oliver McGowan mandatory training on learning disability and autism’. This is now a requirement for all health and social care staff. I don’t have room here to discuss the content, but look here, and find our more. It’s well worth it.

Finally, in my conversation with the patient who wanted a vegan diet, I mentioned that as a vegetarian I felt well catered for by our catering staff, something he agreed with. Imagine my dismay then upon reading about some of my favourite food choices being described as Ultra Processed Food (UPF). Now, apparently UPFs are regarded in some circles as being the new villain of health problems such as obesity and have also been associated with early deaths. So, my dismay resulted from finding out that baked beans, wholemeal bread and even my tasty vegetarian sausages are all described as UPF. Baked beans are accepted as one of your ‘five-a-day’ vegetables. Hmm, it seems to me a bit like how our vegan patient was unintentionally dealt with; assumptions can be very unhelpful and to be actively avoided, if a truly balanced sense of the world is to be achieved.