The self-indulgent one: my end of year post

We have reached the end of 2023. It’s the time where I become a little self-indulgent and think about the past 12 months. What a year it’s been. Sadly, my mother is still in hospital. She lives with dementia and has become gradually frailer, as each week passes. Apart from a dreadful five days, when she was discharged home, my mother has now been in hospital since the end of May. Finally, last week, we heard from the social workers involved with her care that there is a possibility of a residential care home place. Hopefully, my mother will now be assessed early in the new year. She will be discharged to assess her needs and I guess we will have to take things from there.

The last seven months have taken their toll on my father, who is 93 years old and not in the greatest of health. He is not alone. There are still too many people on long waiting lists for diagnostic tests and treatment. Despite the enormous efforts made by colleagues to tackle the backlog, NHS waiting lists remain stubbornly high. Demand for healthcare, often seen through the lens of emergency departments, continues to grow. 2023 was also a year of industrial action by many health professions. The industrial action continues, and will continue to add to the problems facing NHS and social care organisations in 2024.

Some of these problems have become very personal. There has been a rise in what has been described as ‘moral distress’. This is where a colleague’s sense of self is negatively impacted, both psychologically and emotionally. Sadly, this is often a result of folk feeling the care they provide is not where it could be, or because the issues causing people to have health problems are beyond their help; for example, the cost-of-living crisis, fuel poverty, poor housing and so on. All of which are factors that impact on a person’s health and wellbeing. These are challenges that are unlikely to go away in the short term and it remains important that we remain vigilant in caring for those that care for others.

I also faced some challenges during the year. Thankfully, many of these were ‘good’ challenges to encounter. During the year, I happily tagged along while J continued crossing things off her ‘to do’ and ‘places to see’ bucket list. We went to one of her favourite cities, Venice, the first time for me, and despite my dislike of being on water, we had a fabulous time. Later in the year, we flew to Peru and hiked the famous Inca Trail visiting Machu Picchu. 

Of course, being there, I partook of the national drink, Pisco Sour. It is easy to drink and I was probably guilty of drinking too many glasses of the stuff. What I forgot was that it included crushed ice and egg whites in its making. Within three or four days of being in Peru, I had developed a debilitating case of ‘traveller’s diarrhoea’ that defied even regular doses of Loperamide. Looking out for the nearest loo became almost as important as looking out at the wonderful scenery.

So, when we went to India and Nepal towards the end of the year, ice cubes, raw egg whites, and salad stuff were steadfastly avoided. In contrast to Peru, the food in both countries was a vegetarian’s delight. The choice was astonishing and the tastes out of this world. The drink of choice was ice-cold Gurka Beer, wonderful in the heat. Thankfully there was no repeat of the traveller’s diarrhoea. Although I was just too young to go to Kathmandu during the hippie era, it was just as I imagined it to be. And the flight (run by the amusingly-named Yeti Airways) over the Himalayas and around Mount Everest was a dream-come-true for me.

Two of the dreams I had hoped to realise during the year remain yet to be achieved. The first was my hope and prayers for peace in Ukraine. Sadly, on day 676 of the conflict, I’m still wearing my one yellow and one blue clog in support of the Ukrainian people. 

On a much more trivial level, I had wanted to walk from Fleetwood to Preston in one go and to do so along the Lancashire coastal path, as far as it was possible to do so. It is a 27-mile walk. I have done the entire walk, but only in sections (Fleetwood to Lytham, and Lytham to Preston) but ran out of time to do the entire walk in one go. That said I have walked 2,390 #NHS1000miles since 1st Jan 2023. #NHS1000miles is a way of giving a gift back to the NHS. Anyone can join in this initiative, and if you are interested in finding out more details, see here.

It was also a year of learning too. I discovered two new ideas to ponder upon - ‘chatter checkouts’ and ‘wilful blindness’. I had my first experience of ‘steel signing’ – signing my name and writing a message on one of the steel RSJs in our new Urgent and Emergency Care department. I learnt the meaning of deep sorrow, when two of the most influential men in my life died very unexpectedly. RIP Martin Johnson and Andrew Foster. Likewise, during the year, several of my friends and colleagues have received potentially life-shortening diagnoses. I keep them in my prayers. I also learnt that I could be caught out by the unexpected. Last May I stood as a ‘paper candidate’ in the local elections. Imagine my surprise when I was elected. I can now add Councillor to my CV. Likewise, and with great sadness for me, today is my last day as Chair of Stockport NHS FT. Tomorrow I start as Chair of Greater Manchester Mental Health NHS FT. This was an equally unexpected surprise and not on my horizon at all. But, I’m up for the challenge and feel privileged to have been afforded this opportunity. I’m looking forward to getting down to work and meeting my new colleagues in the New Year.

Last but not least, I could not end the year without mentioning the recent Blackpool Tower fire that wasn’t a fire. If you missed the story, you can read it here. There was no fire, but despite this, what was fascinating were the number of people out on the street who claimed they could smell smoke. A classic case of ‘group think’, and something for us all to try and avoid in 2024. And as we get ready to welcome in the New Year, my dearest hope for everyone, is that the next 12 months are filled with kindness and bring much happiness to all.  

Christmas, a time to believe (there can be a better future for all)

I hate goodbyes. Well actually J and I try not to hate anything; there is already too much hate in the world. Last week was full of goodbyes and I dislike saying goodbye, particularly to folk I might not see again. And sadly, last Thursday, I didn’t get to say goodbye to everyone I wanted to. Last week was my last week at Stockport NHS FT. After 30 months, I was moving on. All in all, I found it an amazingly emotional week.

It started with our wonderful volunteers’ Christmas meal. Some 70 of our 200 volunteers braved the high winds and torrential rain to celebrate Christmas with a full-on turkey dinner and all the trimmings organised by our award-winning catering, patient engagement and charity colleagues. Given that the average age in the room was 65 years old, having so many people turn up was truly wonderful. Our CEO, Karen James and I served everyone their meal. I can’t tell you how good an experience this was. Karen chided me for flirting with the women, and Karen teased me about my love of sprouts. I gave a little speech, thanking our guests for all for their contributions over many, many years. These are good people, and many of the folk I knew by name. I will miss chatting with them as I went about my everyday business in the hospital. Volunteers like these are the life-blood of our Trust.

Clearing my office was both cathartic, but also a little sad. I don’t suppose anyone really wants to leave their organisation by carrying out their personal office effects in carboard boxes. TBH, I did most of the heavy lifting at 7am when nobody was around. I had one slightly scary encounter with one of our security guards who eyed me with open suspicion as I marched out with a huge plant. I think he thought I was robbing our reception area of one of the large decorative pot plants.

Then there was the last breakfast and lunch in our staff restaurant. I always like to try and do both wherever possible. I relished sitting there, eating my food, and hearing the conversations swirl around me. There was nearly always laughter, and I liked the bustle, the noise, the people watching and of course, the gorgeous food. Our chefs have won many prizes for their food, and patients regularly provided great feedback. My last lunch was a favourite – cheese and onion flan, chips and peas – it was actually the same first choice of meal I enjoyed way back when I first started.

I have yet to sample the delights of the catering at my new NHS Trust. I was there last week to start the ‘onboarding’ process. My experience is probably best captured in a separate blog posting. In fairness, my day didn’t start well. Two accidents on one of the motorways that I travel on resulted in a journey that should have taken 50 mins actually taking over three hours. I have long accepted the fact that such delays will happen. When they do, although it’s frustrating, I remind myself to be grateful that it’s not me that is involved in the accident itself.

As an aside, I was amused by the story last week of Rod Stewart having to wait for his wife Penny in a store in London’s Oxford Road while she tried on numerous clothes in the changing room. Rod, like most of us in these situations do, found himself a seat and waited. And waited. And waited. There was a picture of Rod with shoulders slumped looking slightly grumpy and dejected. I know that feeling, although as with motorway traffic jams, I have developed a huge reservoir of patience and have learnt to simply wait things out. Thank goodness for online shopping.

My last day of actually being on site came much too quickly. Last Thursday did have some delights though. One was chairing the last formal meeting of our Council of Governors. Again, it was a very blustery day, and I was pleasantly surprised to see so many of our governors turn up for the meeting. The Council of Governors play a critical role in holding the Non-Executive Directors to account, and through this process, gain assurance about the services the Trust provides. When I first arrived two and a half years ago, these meetings to be fair were pretty dull, and often the only voice to be heard was mine. However, that has changed and through encouragement, support and training, our governors have gained the confidence to ask penetrating questions and raise appropriate challenges. I have loved working with them, and at the end of the meeting found it difficult as we said our goodbyes.

There was a magical moment of joy however. Following the meeting, we all bundled outside to take part in the ‘Great Lights Switch On’ – not our Christmas lights, we had done that a few weeks ago. No this was the signage on our new Urgent and Emergency unit. It was an important moment. Whilst there are some months to go before everything is complete, much of the new building is operational. What made the switch on so special for me (and I suspect for others too) was the fact that the sign said Stockport NHS Foundation Trust, and not Stepping Hill Hospital.

It seems perhaps a small difference, but the symbolism is important. I’m sure it will take a long time for folk, colleagues, and our communities to think of our organisation as being more than the acute hospital. Whilst there will always be a place for a hospital, my ambition as a Chair was to look for ways to reduce the need for hospital care. Helping people live healthier lives, providing opportunities for people to grow and realise their own life goals has always felt the way to go to me. Today is Christmas Eve, and I guess if we are allowed a wish, mine would be that we continue to embrace and harness all the resources in our neighbourhoods, communities, and families in promoting greater health and wellbeing for all.

Merry Christmas everyone!

Not quite pastures new*

My first mentor was a wily Irishman called Jimmy Fitzsimons. I first met him as a student nurse while studying in Swansea. At the time he was a Nursing Officer, rather like a Divisional Nurse Manager today. He had a wicked sense of humour, was a keen golfer, hated injustice, and was generous with his time, advice and providing opportunities for others to grow. I learnt a great deal from the way he did things and the way he interacted with those around him. I lost touch with him as I qualified as a nurse and moved to another part of Wales to practise.

Many years later, I met up with him again in Manchester. I had applied to be part of a commissioning team for a brand-new NHS service. It was the first forensic service for adolescents, based around a medium secure unit. The unit was part of the supra-regional services provided by Salford Health Authority, in the grounds of what was then called Prestwich Hospital. Jimmy was on the interview panel, and I was successful! I moved to Manchester in May 1984. It was the start of a wonderful journey of nursing, academia and leadership that has lasted nearly 40 years, more of which later.

In its time, Prestwich Hospital was one of the largest psychiatric hospitals in Europe. In 1903 it provided inpatient care for over 3000 patients. If the remaining red brick buildings could speak, they would be able to tell of the whole history of the emergence of contemporary mental health care in this country. 

Prestwich Hospital no longer exists. Part of the original site still provides a range of mental health care services as part of the Greater Manchester Mental Health NHS FT (GMMH). GMMH is one of the largest mental health care providers in England. For some readers, they might also recall, that the Trust, and particularly the adult forensic services, were the subject of a Panorama programme just over a year ago. The programme showed poor care, abuse, and the neglect of patients, many of whom were extremely vulnerable.

It was a dark day for mental health care. Since that time, there has been much effort and energy directed at delivering an ambitious improvement plan for the whole Trust. The work to create a new Board has begun, and there is an appetite to further develop a clinical strategy that better reflects contemporary best practice. There are some great people working in the Trust, doing great things day after day, and this should not be forgotten or not acknowledged. However, it will take time to bring about the necessary improvements. That said, there are some encouraging small green shoots appearing. Now you might be asking yourself, how do I know these things and why am I telling you?

Well, it's to do with me doing some due diligence which, in my experience, is always worth the effort. Several weeks ago, I was minding my own business when an email landed in my inbox that caught my attention. It was from a firm of headhunters. I get at least one of these types of emails a week, and in the main, I delete them without opening them. They usually ask for names of people the company could approach to see if they might be interested in a job being advertised. Anyway, on this occasion, I sent an email back to say I was happy to have a conversation. The only reason I did so was because the organisation the company was trying to find someone for was GMMH, an organisation I have many good memories of.

I duly had a conversation and suggested three people I thought it might be worth them approaching. Upon being asked if I might be interested, I firmly said no thank you. I was coming to the end of my first three years at Stockport NHS FT and was very much looking forward to the next three years. Our improvement journey was going well, and I was part of a fabulous unitary Board of Directors. So, thank you, but no thank you. A few more weeks went by, when out of the blue I had a phone call from one of the partners of the headhunters, who wasted no time in asking me directly if I would be interested in the role. We talked for a while, and I finally said I would consider making an application over the weekend and let him know that following Monday. Hence the weekend was spent doing my due diligence, part of which were some long conversations with J about making an application. She has always been very supportive of everything I have chosen to do and is a fount of wisdom that helps keep things into perspective. With all things considered, I decided to apply.

Shortly afterwards, I enjoyed a wonderful afternoon of stakeholder-focused groups and interviews. Later that same evening, I was asked if I would take on the role of Chair for GMMH, and I said yes. However, the interim Chair, Bill McCarthy, who had done such a great job over the past year, was leaving on 31st December, and I would be required to start on the first of January 2024. So nearly 40 years after starting at GMMH, I’m back once more and relishing the challenge of working with colleagues, partners and service users as we travel on our improvement journey. As exciting as this has all been, my heart is aching for the many colleagues and friends I have worked with at Stockport. I will miss all these folk terribly, but I know they will continue to ensure the best possible healthcare is provided to the communities of Stockport and beyond. I say a big THANK YOU for all their support and commitment over the past 30 months. You have all been great colleagues.

 

*One of my Stockport FT Council of Governors sent me a lovely email of congratulations. His email header was ‘Moving on to pastures new’. Referring to my one blue and one yellow clog I have been wearing since the start of the war in the Ukraine - and I have said I wouldn’t change until the war is over - he said he hoped that one day soon I might be able to wear a white pair. So do I. Peace not War, Love not Hate.  

Strangely, life’s unintended consequences can be both hard and good

I knew last week was going to be a busy one. Not that it was a bad busyness mind, just full on. I took the 128-mile round trip into Manchester every day, and on different days I drove through rain, ice, frost and high winds, with every trip undertaken in the dark. Such journeys are an unanticipated consequence of making the decision nearly three years ago to accept the Chair’s role at Stockport NHS FT. I knew it was always going to be a long journey at each end of the day, but as I had taken up the post in Spring, I hadn’t given much thought to how much more difficult travelling in Winter would turn out to be. That said, I have enjoyed every moment I get to spend with my Stockport NHS health family.

It was the sociologist Robert Merton, who was credited with introducing the concept of unanticipated consequences. He described these as actions taken that have both intended and unintended consequences. We often plan, based on what we believe the intended consequences will deliver. Unintended consequences are often more difficult to recognise or anticipate. Of course, unintended consequences can be both positive and negative,

I guess many readers will know that the discovery of penicillin was the result of an unintended consequence. Alexander Fleming’s original research was into treating the flu virus. Following a Summer break from his laboratory, he returned to discover a mould in one of his culture dishes. It was a ring of mould, within which there were no bacteria growing. Quite by accident, he had discovered the world’s first early form of antibiotic. His discovery revolutionised medicine. However, as we know today, the overuse of antibiotics, particularly to treat illnesses where an antibiotic wouldn’t make a difference to the person’s recovery, has led to widespread antibiotic resistance.

Last week, I read of another accidental medical discovery that, in its own way, has also been revolutionary. It was an advertisement for one of the many BBC shows on offer this Christmas. The film is called Men Up, and tells the story of the discovery of an unintended consequence of testing the drug Sildenafil, perhaps better known now as Viagra. The drug was being tested to measure its impact on the condition angina, with a group of ex-coalminers in Merthyr Tydfil, Wales.  It was one of the trial nurses, who asked the trial participants whether they had noticed any side-effects from taking the drug. Apparently, they were all reluctant to answer, but eventually, one of the men said that he had been experiencing ‘robust’ erections during the night. All the other men eventually admitted they had all experienced similar side effects.

It is perhaps to be remembered that back in the early 1990s such conversations were likely to be rather difficult, talking about sex and bodily functions wouldn’t have come easy. Realising there might be other uses for the drug, the angina research was abandoned and a small-scale study was undertaken with a group of men in Bristol struggling with impotence. This small-scale study was a great success. Indeed, the participants, who had been given a small supply of the tablets and told to return any they didn’t use, refused to return any of their tablets.

After further clinical trials to test safety and so on, the drug was licensed for use in 1998. It has since become the pharmaceutical giant Pfizer’s biggest income-generator. By 2018, 62 million men across the world had bought it. Sales have hit many billions of £s since. Apparently, the colour blue was chosen, because it was thought it conveyed a cool, calm masculine confidence, while the diamond shape was intended to hint at the diamond-hard results it would deliver. I’m not saying anything, but I have to say it is on my Christmas must do list - watching the film that is. I might have a few 'getting older' problems these days, but thankfully this is not one of them.

Ironically, and somewhat sadly, whilst the discovery of Viagra came about through an unintended consequence of testing the drug, there are a number of unintended consequences of the drug in use; one of which has been an increase in sexually transmitted diseases. Apparently, many older men ‘tested’ the drug by visiting sex workers. Likewise, there has been an increased number of older men abandoning their wives for younger women. I say sadly, as I wonder whether these outcomes might have been anticipated, and as such perhaps avoided.

Last week, there was another story which I felt told of another apparent unintended consequence, but one that might also have been avoided. I’m referring, of course to the much-heralded successful pay dispute resolution for consultant doctors. Well, it was much heralded by the likes of the Daily Mail, but the reality is that the deal offered is so complicated that even the BMA cannot recommend consultants accept it. Sorting out the pay claim of the highest paid members of the healthcare workforce first just doesn’t seem a sensible thing to do. Already we now face the disruption of junior doctors taking further industrial action. I am fairly sure that nurses won’t be far behind. If further industrial action happens, the unintended consequence will be an increased busyness for all health and care provider organisations, most of whom are already struggling to meet an ever-increasing demand for healthcare. Unlike my last week, such busyness won’t be so good for folk to deal with.     

There’s no need to hug a tree to embrace nature

It is funny how certain things can trigger a memory. Last week I read a weather report about the winter spell we are going through that described a place called Benson as having temperatures as low as -6c during several nights last week. Reading the article, I was immediately taken back to childhood holidays. 

We used to go camping and there was a site in Benson, Oxfordshire that was ideal for a family of young children. Set by the side of the River Thames, there was nothing else to do except play in the river, explore the woods, make dens and generally amuse ourselves ‘upstream and down dale’. We are a big family and how my parents managed I have no idea. I’m sure it was idyllic. Looking back now, it did seem to be an age of innocence and safety.

I dislike being on water or swimming, so I’m not sure why I can remember the joys of playing about with boats and being on the river. Although I have never been camping since those childhood days, and have no intention of starting now, I have retained my love of being outside. I’m fortunate to have a large garden, where J keeps her goats, I keep my hens and we grow flowers, plant trees and generally spend as much time as possible outside enjoying it whenever we can. I walk every day, and often clock up 30-50 miles in a week. To date, I have walked 2340 miles this year. We live close by the sea, and are lucky to have a beach that is generally free from crowds, with just a few regular dog walkers to be seen. And we live within 30 minutes or so of the Lake District, and with minimum travel can be deep into the Lancashire countryside, both of which we regularly take advantage of.

There has been much research demonstrating the power of engaging with nature, and last week I learnt of an emerging school of thought, something called environmental neuroscience. This field seeks to explore the ‘how and why’ our brains can be so profoundly affected by being in nature. I know that being in the countryside allows me to de-stress, walking on our beach allows me to clear my mind and think and pottering in my garden fuels my sense of wellbeing. Neuroscience seeks to better understand why cognitive functioning also seems to improve when we are exposed to such environments. It’s fascinating stuff and I have started to read around the subject. First stop is a new word and a whole new way of thinking about self and our relationship to the world we live in.

The new word is ‘biophilia’ – a word coined first by the psychologist Eric Fromm and somewhat independently, but around the same time, by the biologist Edward Wilson. In simple terms the word is a combination of two words from ancient Greek:  Bio (life) and philia (love) – so literally meaning the love of life. Life here meaning both all living creatures, and also, the world they inhabit (Nature). The biophilia concept posits that we function better in natural environments, because our brains and bodies have evolved in and with nature.

It was the hunter gatherers, who were attuned to the world in which they lived, that tended to survive and thrive. Drawing upon ‘flight or fight’ strategies, they were the folk best able to deal with danger and stress. These days, most of the stress we encounter does not require a physical response, although I do have days where I feel I’m banging my head against a brick wall. Despite this, the stress we are exposed to can result in our bodies and minds experiencing the same flight or fight response as our forebears. Physiologically, this might mean we can experience changes such as raised blood pressure, an increased heart rate and feelings of anxiety. What the emergent field of neuroscience and the notion of biophilia suggest is that exposure to nature might activate the parasympathetic nervous system, countering these unwanted physical responses, replacing them with feelings of calmness and  sense of wellbeing.

I haven’t yet finished my reading around the subject. But already I have some reservations. The attractiveness of neuroscience is that it can perhaps explain why we feel different and can perform more effectively, after being immersed or exposed in nature. However, I’m a simple soul and as such I don’t always need to follow the science to seek explanations. When I’m out walking, wherever I am, I notice things. I pay attention to where I am, what I can see, hear, smell and even touch. I do so with the kind of attentiveness that is associated with the practice of mindfulness. I have found that the avoidance of stressful feeling and/or to deal with stressful events, mindfulness works really well for me. So, when I take my walks and in so doing, embrace nature, I feel connected, I feel alive and I feel grateful for all that I have in my life. It makes me feel vital, it helps me to think and remain curious. It adds to my resilience store. And above all else, it enables me to regain a sense of calm. And for me that is enough.

Sadly, last year, the wonderful People and Nature Survey for England, found that many people spend little time in nature. Over 25% of the population hadn’t visited a green or natural place once in the previous 14 days. Thinking back to those family holidays in Benson by the River Thames all those years ago, I’m grateful now that we didn’t have a TV, or a mobile phone, and that we were able to embrace and engage with nature and enjoy the wonderful natural things around us. It was a great ‘upstream’ foundation for my mental health, and perhaps, such an approach could also help ensure others enjoy better mental health and wellbeing too.