What is right is sadly often lost to political convenience

This is the first Sunday in three weeks where I’ve been able to write my blog, without the aid of a box of tissues, paracetamol, and cough medicine. Yes, I’m feeling much better, and thank you to all the readers of this blog who have sent their kind wishes over the past couple of weeks. Hopefully that is me done with cough and colds this winter! Not feeling 100% has meant however that I’ve had time to engage more deeply in things that perhaps normally I would not pay so much attention to.

One of these has been to listen to the reports of the Covid Inquiry. I haven’t been interested in the tittle tattle mudslinging that characterised some of the evidence presented around the performance of our politicians. Their incompetence and selfishness have been widely reported before the Covid Inquiry even started. No, I have been more interested in the more considered and reflective contributions that have begun to show a completely different side to the decision-making and the impact on individuals involved in making these decisions on our behalf.  

Sir Patrick Vallance’s testimony was wide-ranging, but two elements in particular caught my attention. The first was his thoughts about the ‘eat out to help out’ scheme. He claimed he knew nothing about this before it was announced. We never took part in this scheme, as my thoughts were the same as his, it would lead to the spread of more infections, something we now know to be true. The second point was the admission that we had introduced the first lockdown a week later than perhaps we should have done. Whilst a week doesn’t sound long, at the time, the rate of infections was doubling every three days.

The delay in introducing the first lockdown also concerned Jonathan Van-Tam, the former Deputy Chief Medical Officer. He felt it should have been introduced 7-14 days before it was. He also incredibly found out about the ‘eat out to help out’ scheme via the TV. What was more shocking to hear was that his family had been threatened both online and physically, in response to decisions he had been a party to. Nobody should have to experience such threats, especially those who are working for the greater good of society.

Sadly, he wasn’t alone. Other members of the Scientific Advisory Group for Emergencies (SAGE) were also threatened, and their families too. As was Professor Chris Whitty, Van-Tam’s boss and Chief Medical Officer. His evidence was presented in a calm, thoughtful and yet penetrating way. Among the many challenging points he made, was the important observation about those taking policy decisions. He noted that often these were people making decisions about issues in which they had little knowledge and as such, the decisions were often flawed or taken too late.

For example, despite the government’s protestations that they were ‘following the science’ when it came to making decisions, this was a completely erroneous claim. The scientific evidence was incomplete and the political interpretation of what evidence was available appeared driven by economic and political factors, rather than on the basis of protecting the public. This was something that probably led to the delay in the first lockdown. Those taking that decision appeared to have little understanding of the way people would react and behave by being told to stay in their homes for a prolonged period.

The reality was interesting. In that first lockdown, millions of folk volunteered to help others. The NHS benefited from some one million people volunteering and there were over 12 million volunteers helping either individually (within neighbourhoods) or more collectively as part of established community groups. Whilst I’m sure there were people who were lonely, isolated, frail or simply ill during this time, the reaching out to others by these volunteers will have helped many of these people. I know on my street, people helped with shopping, dog walking and socially-distanced garden gate conversations. The community spirit, or rather the spirit of the community was powerful and potent. Sadly, in many ways, that supportive sense of community and being there for others has disappeared.

This was brought home to me last week during my visit to our School Nurse team. They are a great group of people, and I was staggered by the sheer volume of work they are engaged in. When I hear from colleagues such as these and gain an understanding of the difference they make, it reinforces my irritation of the Daily Mail type of commentary that the NHS has a much bigger workforce, but is not seeing as many patients, as it did pre-Covid.

One of the differences the School Nurse team make is with their parent drop-in sessions they run in schools. In a recent two-week snapshot of activity, they saw 51 families (including 14 follow ups from previous sessions). Eleven of the issues on which parents wanted advice were to do with continence – children who were not toilet-trained, before they started school. I think this reflects the way in which, for many people, the community support for families, provided by the communities themselves has been lost.     

Finally, the current phase of the Covid Inquiry is not about holding anyone to account or attributing blame, it is about trying to understand the decisions taken. Reading last week’s testimonies, and thinking about the family concerns that our School Nurses were dealing with, I was reminded of the words of Leo Tolstoy - In order to change the nature of things, either within yourself or in others, one should change not the events, but the thoughts which created those events. They seem appropriate somehow.

A week of women on top

You know you are getting old, when you finish your conference dinner and don’t stay either for the dancing, or a post-conference stroll to the late-night bar with colleagues. This was me last week. I was back in my hotel room before 10pm. I was attending the NHS Providers annual conference. It runs over two days and was held in Liverpool. There were some excellent presentations from fellow NHS colleagues from across England. In between the plenary sessions, there were also more informal talks from organisations, mainly supplies of goods and services, who presented partnership projects and so on.

Despite my lingering cold and cough which, as I write this, is still making me feel under the weather, I really enjoyed the conference, the networking and the venue. Once again it was Samira Ahmed who was the conference chair. I’m not a great fan of hers. Although she is an award-winning journalist and author, and can ask the most penetrating of questions, I feel she somehow fails to connect with the audience.

Someone who did connect was Victoria Atkins, our brand spanking new Secretary of State for Health and Social Care - the fifth in the last two years. She wasn’t physically in the room, but had sent a pre-recorded video. Sounds crass perhaps, but it wasn’t. Victoria’s tone was much more gentle, positive and encouraging than her predecessor[s]. Although she may not be in post for too long, given there is a general election looming, there is still much that she can do – starting off with resolving the doctors’ industrial action asap. This was something she absolutely saw as a critical first task, which was very encouraging to hear. But there is so much more that requires addressing. The NHS is contending with significant pressures from all sides. A tired and often burnt-out workforce, with massive vacancies still to fill (125,000); increasing demands across all services (October saw more than 2.2 million people attending A&E departments); a post-pandemic long waiting list legacy (nearly eight million people); and of course, continuing financial pressures (including a need to revolutionise capital funding across the whole NHS). It is a huge ‘to do’ list for sure.

Victoria also noted that she would need to work across the various government departments, if health inequalities are to be addressed and thus reduce the demand on health care services. Likewise, the acute sector must find ways to shift more of its resources to primary and community care, so that people can be better supported in more appropriate settings and ideally closer to home. I heard some encouraging presentations where people were doing just that, and we were also treated to a full-on Tigger performance from Amanda Pritchard, Chief Executive of NHS England.

She was on fine form for sure. Amanda was passionate, challenging, well-informed and quoted, by name, many folk that she had met over the past year who were doing incredible things in making a difference to others. It was a stellar performance by someone demonstrating the leadership qualities so needed in a world challenged by so many inter-related and seemingly intractable problems. She is consistent in her approach as well – look here at her unpacking the often-misunderstood concept of productivity to the Houses of Parliament Health Committee last week. Simply patience personified.

Wes Streeting, the Shadow Secretary of State for Health and Social Care, speaking after Amanda, cautioned us that we were in danger of making her Louis XIV – ‘l’etat, c’est moi.’ Yes, I had to look it up too – still not sure I understand what Wes was meaning, other than if we keep increasing the funds for the NHS, and the NHS continues to push the boundaries of what a healthcare system should be doing, the NHS represented here by its figurehead Amanda, will become the State.

Clearly, there is room for transformation and reform, but please, please not any more structural reform. We have had enough. And yes, there are things that we need to address to make best use of the resources we already have to keep services safe and of a high quality; something another speaker touched upon in her presentation. This was the wonderfully calm, confident and articulate Margaret Heffernan. I’m ashamed to say I had never heard of this amazing author before. She held me spell bound as she took the audience through concepts of ‘wilful blindness’, ‘organisational conformance’, ‘whistleblowing’ and why the NHS appears unable to learn from the mistakes of others, even when these are set out clearly in extensive reviews. It was powerful stuff and I have put a couple of her books on my Christmas present list to Father Christmas.

However, my last word goes to another woman, one I have never met and who wasn’t at the Liverpool conference. This was Casey McIntyre, who died seven days ago from ovarian cancer. Her legacy was setting up a fund that would help pay off the medical debts of others in the US. It is estimated that 100 million Americans are saddled with a total of $195 billion in medical debt. The US does not offer universal health care for all. Every $100 raised in donations, funded through her RIP Medical Debt’s website, will go on to alleviate $10000 of medical debt. So far, her appeal has raised nearly $150,000, which will cancel out nearly $15 million of medical debt for others. Casey died too soon. Like all the women I have encountered this week, Casey will continue to make a difference to the lives of others, and that is a legacy to be proud of.    

Alright Prof, alright?

I have a new laptop. This week I have been able to spend time learning to use it. Not easy as it has a built in, default AI approach to everything – more of which later. However, the reason I’ve had the time to explore the computer is that I’ve been rather poorly all week. I have stayed at home, gone through a couple of boxes of honey and ginger Lemsips, a bottle and half of Benylin cough medicine (I know there isn’t much therapeutic value, but at £7 a bottle I can convince myself there is), countless paracetamol tablets and a bottle of Sudafed sinus spray. And don’t talk to me about tissues.

It has been a miserable week. I have slept at all the wrong times, had aching limbs and a constant headache. Apart from walking Dylan around the block, and feeding the animals, over the past week I have done very little. Occasionally, I’ve looked at emails or social media, but have had little spare energy or even the inclination to do much more. I became addicted to Four in a Bed; the Secret Life of the Zoo, and watched all 21 episodes of Gavin and Stacey (including the two Christmas specials). I seemed to have adopted the latter’s ‘I will do things now, in a minute’ approach to everyday tasks. Not feeling able to do anything more useful has been immensely frustrating.

Don’t get me wrong, I have been very well looked after by J. Her nursing care, compassion and patience has been wonderful. Like many folk, and men in particular, I don’t play the sick role well. I know I become short tempered, grumpy and irritable when feeling unwell. Thankfully for those around me it doesn’t happen that often, as I’m generally a healthy person.

This past week I have kept repeating to myself, it’s a head cold. Nothing more than a common cold that is lingering. Get over yourself Tony. However, as I write this, I’m not feeling much better than I did last Monday when it all started. I know that the cold will pass, and in a week’s time I will have caught up with things not done and all of the past week will have been forgotten. For that I’m grateful. As I have said to J many times this past week, there are many folk out there who are living with health issues that won’t just fade away, and they will be living with their health challenges for the rest of their lives.

It is projected that by 2040, one in five people living in England will be living with a major illness. Yes, that is a sobering thought. There are about 20 long-term conditions that together account for over two-thirds of today’s health care demands. The number of people living with these conditions, and in particular, cancer, diabetes and kidney disease, is likely to increase by 30% over the next 15-20 years. Already we know that 58% of people over the age of 60 are living with one or more long term health issues. Added to which will be the yet unknown health care problems of all those who are currently obese, as they reach old age after many years of obesity.

Dealing with these anticipated population health issues will not be easy. If you have the time, and think you are someone who isn’t easily depressed, have a look at the recently published and excellent long read from the Health Foundation, Nine Major Challenges Facing Health and Care in England. As always from the Health Foundation, this is a report that is evidence-based, well-argued and completely accessible. Perhaps the tenth challenge is reading the report and reflecting and responding to what might be done.

Whichever political party succeeds in the next general election, these are challenges that will need to be addressed, and it will not be through yet another reorganisation of the NHS. And although extra money always helps, these challenges will not be effectively addressed by simply throwing more money at solving the underlying issues. Interestingly, for the first 26 years of the NHS, there was very little change to the organisation and provision of services, but after 1974, it has felt like the NHS has been in a constant state of flux and change. The latest of these changes, the introduction of Integrated Care Services, has still to come of age and start to deliver improvements.

Over all that time, there has been little change to the way in which social care has been funded, or services provided. We know that the percentage of older people (officially, those over 65 years of age) in the UK population continues to increase. If you weren’t depressed by the contents of the Health Foundation report, have a look at the latest report from the Office of National Statistics on the emerging older population profile. It’s clear that many of these folk are going to need the support of social care, as they live longer than ever before.

Before I finish this blog, a quick return to the AI problem. Up to now, as I write my weekly blog, I will often ask Google a question for clarification, like for example, how many people live with dementia in England? (approximately 850,000) – I would be pointed to a series of reports where the information could be discovered. This new AI guided enquiry system on my laptop constantly tries to provide me with a complete and well-argued answer. Often, it seems to me, it doesn’t succeed with either. As yet, I’m not a great fan of the benefits of AI. J is more enthusiastic about exploring its possibilities.

Yesterday she showed me two sides of paper which was the answer to a question she had posed on ChatGPT to try it out. I dutifully read it and said it was okay, but it was just MBA mumbo jumbo – ‘how would you know?’ she said, ‘you don’t have an MBA’ – I quietly pointed out that despite only ever getting a CSE in Art at school, I did manage to achieve an MBA in 1995. We are not putting our names forward for the Mr and Mrs Quiz show. Last thought, despite me feeling poorly, I’m glad to say the world has kept turning. And that’s the way it should be.

Doing different things and making a difference

My lovely wife has the travel bug, and a long list of places that she would like to go to. Last week two holiday brochures came in the post. I was surprised as we hadn’t requested them and, like most folk thinking about holidays, we would simply browse the internet. Anyway, J started to look through them and we both became quite excited about some of the holidays on offer. She particularly liked the idea of exploring exotic destinations and spending 28 days in a sunshine-filled country during the cold winter months. I didn’t and told her so – ‘I agree, but it’s what many retired people do; they find somewhere hot and disappear over winter, leaving all their woes behind’ she said.

I carefully pointed out that she was still well and truly employed and that I couldn’t see her boss being really pleased about J taking a month off to go and explore the foothills of Kenya somewhere. ‘Apart from which’, I asked, ‘who would we get to look after the goats, chickens, cats, Dylan the dog and Billy the parrot?’ None of which appeared to be a problem as far as J was concerned. So, I also reminded J that I was working and sadly just couldn’t take a month off. She laughed and reminded me that I was meant to retire over four years ago. Which is true, but I choose to continue to work, albeit part time.

Over the last 10 years, I have been a Non-Executive Director in three different NHS acute Trusts. I’m currently a Chair of a large acute NHS Foundation Trust in Greater Manchester. The hospital is 65 miles away from my home and, as well as online meetings, involves an at least twice weekly 90-minute commute on some the most challenging motorways in England. But I love what I do, and the folk I work with, so spending three hours each day on the road doesn’t worry me. And as long as I remain healthy and well, I want to continue in the role for my full term, which means at least another three years. Then possibly I might retire.

Now I’m not alone in continuing to work after I should have retired. In the UK there are more than one million people over the age of 65, who continue to work. Last week the Institute for Fiscal Studies (IFS) published a report last week that looked at how employment patterns have changed for folk in their 50s and 60s between 2002 and 2019. The IFS study notes that early retirement is increasingly becoming the preserve of the wealthy. Today, a greater number of people are having to work for longer, due to the increasing cost of living and a lack of financial security. These are people in their late 60s and early 70s. This is a change from 20 years ago. Back then, how much money you had accumulated was not the overriding factor for those in their 50s and 60s thinking of retiring early.

Interestingly, although the IFS study only looked at trends up to 2019, the pandemic appears to have reinforced this trend for many employment groups, particularly those in professions and caring occupations. There has been a significant increase of people in these groups taking early retirement. Being able to make this choice clearly must include consideration of an individual’s financial situation. However, it was quality of life that is reported to have been a stronger incentive. The pandemic appeared to perhaps prompt folk to think more deeply about what is important to them in life, the degree of stress they experienced at work and of course the opportunity to do something for themselves.

Sadly, the pandemic also had another impact for some people; people who had no choice but to leave the workforce due to health reasons. The Office for National Statistics (ONS) notes that the number of people becoming economically inactive due to health reasons is only likely to grow. This is a trend that will continue to challenge both individuals and already workforce-challenged organisations such as the NHS. People with long term and often complex health issues, who are unable to work and who perhaps must survive on benefits, are likely to experience further health problems.

In many healthcare organisations, workforce shortages are already having an adverse impact on the range, quality and safety of the services the rest of us need to have provided. Recruitment and retention have become two of the most serious challenges for the NHS to deal with. There are no easy solutions. For many of the health professions, there is a long training lead in time. Alternative and new entrants to the health care workforce provide some relief, as does greater use of technology and new ways of providing treatments and care. Virtual wards are growing in use and sophistication, but we are not there just yet and such approaches don’t work for all health problems. The recent medical industrial action has also revealed another problem around the training of doctors. Their education and training rely heavily on the guidance, support, and supervision of senior experienced doctors such as consultants. And these are increasingly a group of healthcare professionals who have chosen to retire early, taking their knowledge and experience with them.

Me, I don’t need to work for financial reasons, although both of us earning does help to fulfil our dreams and holiday bucket list. I do it, because I can, and most of all, I enjoy it. Last Friday we had our ‘Making a Difference Award’ evening. Over 300 colleagues came together to celebrate the great contributions they had all made over the last year. If it doesn’t sound too patronising, I have to say I felt so proud to be part of such a fabulous group of people. They give me a reason to get out of bed in the morning, and at my age, that has to be a good thing.