Enjoying a Jacob’s Join: tales from the dinning table

One of my life’s ambitions was to build my own library. I started collecting books in my early 20s. Living in rural Wales at the time, and not owning a television, I read voraciously. By the time I moved to Manchester, I had a couple of thousand books. However, for all kinds of reasons, I eventually gave up on the idea of creating a library and have over the years steadily downsized my book collection. Just recently, I went through my remaining bookshelves and donated a load of books used during my doctoral studies to our local charity shop.

One of things I most enjoyed about doing my PhD was visiting the university library and developing an idea by looking up information to be found in peer reviewed papers and book chapters. Fortunately, I had a brilliant PhD supervisor who opened my mind to so many different ways of viewing and making sense of the world. During my doctoral journey, there was nothing I liked better than sitting in the library reading.

Sadly, in my view, much of the information students and academics need for their studies today can be found online. Indeed, much of my reading these days is done on my iPad. J on the other hand loves nothing more than turning the pages of a real book. One of the things I find almost magical and certainly challenging (in an interesting and good way) when writing my blog is to make connections from things that I have read during the previous week, sometimes supplemented by something I might have read many years ago. The blog may only be 700-800 words, but I really enjoy pulling them together into a narrative each week.

This past week I have been drawn towards food stories; sparked I think, by reading about the great ‘Sandwich versus Steak’ debate between the Prime Minister and the Leader of the Opposition. Given all the catastrophic, challenging and horrific things going on in the UK and around the world, why on earth was there so much attention paid to what their lunchtime preferences might be? This was a lunch meal conversation, and the Leader of the Opposition, Kemi Badenoch, declared that ‘lunch was for wimps’, continuing to say that ‘sandwiches aren’t real food, they’re something you have for breakfast’.

I love sandwiches, peanut butter (with either tomato ketchup; marmite and cucumber; or banana) are my favourite. But I rarely have breakfast. Most days I’m awake before 4.30am and food is the last thing on my mind. Often, I don’t eat until the evening, although I do very occasionally have a sandwich at lunchtime.

According to a Spanish study published last week, missing breakfast may shorten my life or, at the very least, cause me to gain weight.  If I do eat breakfast, it tends to be when I’m staying in a hotel and then it is usually a Full English Breakfast, which apparently is worse for my health than not eating breakfast at all.

Cereal (such as muesli or bran flakes), wholemeal toast and fresh fruit, (but not more than 300 – 400 calories) are the best items for a health-promoting breakfast. Interestingly, a separate American study published a couple of years ago showed that if you can eat your breakfast between 6 and 7 am, you would reduce your risk of a premature death from heart disease or cancer by up to 12% compared to those who eat their breakfast later. Importantly, your breakfast drink should avoid tea or coffee. And I cannot believe that the most popular coffee drink in 2024 is an onion latte. Apparently, this drink, both drunk cold and hot, has racked up over 20 million views this year on TikTok. I don’t do breakfast and thankfully, I don’t do coffee. I like my onions in stews, and spring onions in salads.

Last Thursday, I enjoyed salads aplenty. The occasion was a Board meeting and Board development day. We all wore our Christmas jumpers, and our lunch was a ‘Jacob’s Join’. If you have never lived in Lancashire, you may not recognise the term – but think ‘potluck dinner’, ‘bring and share’, ‘bring a plate’, or if you’re Finnish, a ‘bundle feast’. It simply means that you invite folk to bring some food to a meal that they then share with others. One of our Non-Executive Directors was once a chef. Her salads were simply amazing. We enjoyed sandwiches, dips, meats, cheese, and scrumptious cakes. There were plates of traditional food from all over the world. 

However, whilst the food was a wonderful, it was also wonderful to take the opportunity to spend time with each other, and time that wasn’t focused on work. It is something we maybe should do more of during 2025.

Vaccinations and the Kiss of Life

There were a number of really good things that happened for me last week. One was a piece of positive news that I had been waiting on since May of this year. Sadly, I can’t share what that news was here as it’s embargoed until next Tuesday. But it is a decision that will make a difference to so many people. Watch this space folks!

The second good thing to happen last week was being invited to lead the discussion at the last Good Governance Improvement (GGI) peer-to peer seminar of 2024. GGI is a brilliant organisation committed to improving governance across the NHS. I have worked with them at Blackpool NHS FT and at Stockport NHS FT. A part of what they do, in promoting and enabling good governance, is to run a monthly virtual meeting for NHS Non Executive Directors (NEDs). The meetings are bound by Chatham House rules. Each meeting provides NEDs from across England with an opportunity to share ideas, challenges, and their concerns. I try and attend as often as I can.

Last week’s meeting looked at a range of issues: the impact and consequences, intended and unintended of the recent Budget; the potential impact of the proposed regulation of NHS managers and leaders; and how NEDS might address these issues within their Board meetings. I really enjoyed the opportunity, and the discussion was informative and lively. The hour flew past.

I chose to attend from the comfort of my lounge-cum-office, so there was no commute, plenty of tea on hand and the central heating was on. Billy, my parrot, likes to listen in to all my meeting conversations, although as far as I’m aware, he has never broken the Chatham House rules. I also had a table next to me that had two glasses of water, a bottle of chesty cough medicine, a box of tissues and an assortment of cough sweets.

Yes, my cough and cold lingers on and just occasionally, I get a tickle in my throat that breaks out into a hacking cough and leaves me unable to speak. So, I was prepared. However, it is getting better, albeit slowly. It wasn’t Covid nor was it influenza. I have tested for the former (negative) and had my flu vaccination at the beginning of October. Sadly, I passed my cold and cough on to J who has, this past week, been very much under the weather. It may well have been our own fault.

J had read an online article that posited the idea that couples who kiss for six seconds or more, each time they kissed, had healthier lives and lived longer. I’m not sure of the science (and you can judge for yourselves here) but I’m never going to pass up an opportunity to kiss my lovely wife. Unfortunately, in so doing I may well have given her my cold.

However, we take consolation in that we are enduring the pain and misery now and not over the Christmas holiday period. I’m also extremely glad it’s neither Covid nor flu. We should not forget that both these diseases are potential killers. They are also highly infectious, and more prevalent during the winter months.

All of which makes it difficult to understand why the number of people being vaccinated is falling. At the end of September this year, the UK Health Security Agency published the latest data on the number of flu-related deaths over the past two winters. Between Oct 2022 – May 2023 and Oct 2023 – May 2024, at least 18,000 people died of flu-related illnesses. During the same time periods, 19,500 people died of Covid. Last winter was a relatively mild flu season. Last week, 406 people died of flu or pneumonia and 100 people died from Covid in England.

As the Get Winter Stronger campaign, which ended this week, reminded us, it is not just about folk dying. People can experience severe health problems from flu, Covid and respiratory syncytial virus (RSV), severe enough to need hospital treatment and care. Professor Sir Stephen Powis, the National Medical Director for NHS England, and Professor Sir Chris Whitty, England’s Chief Medical Officer were both in the news last week talking about the exponential rise in hospital admissions for flu, Covid and RSV. If beds are increasingly being used to treat people with these conditions, then it will add to the difficulty of reducing the waiting lists for other health problems.

Nobody has actually asked me what I want for Christmas but, if they did, I think I would like the gift of people of all ages getting vaccinated against flu and Covid. That really would make a difference for the NHS to be better able to provide care for everyone.

 

The journey of 1000 km still starts with the first step

I’m immensely proud of J’s determination and application to keeping up her regular running routine. I don’t run, I walk, so J always runs on her own. While this is usually not a problem in the spring and summer months, at this time of the year it can be more difficult. One night last week, she changed her regular route and was out running slightly longer than usual. I was worried. Although we have phone trackers, dependent on the strength of signal, these are not always fully functional or accurate. Consequently, knowing where one of us happens to be at any particular time can sometimes be difficult, and also frustrating.

Like most towns, our local pavements are poorly maintained and it’s easy to trip up even in the daylight. In the dark it can become even more hazardous. Way back in 2018, the AA using Freedom of Information requests, found that uneven pavements were more prevalent in the North West of England (77%). This is where we live. Some 64% of respondents reported pavements being encroached by overgrown trees and hedges.  Uneven pavements and pavement hazards all contribute to the risk of a fall. Whilst falls can happen to anyone, older folk are more likely to fall, as are those with a physical impairment. Runners also fall (sorry) into this category, as they tend to be moving at speed. 

I worry, not just about J having an accident, but about her running alone at night or in the early morning. The recent report published by This Girl Can noted that 72% of women change their outdoor activity during the dark winter months. They do this because of the threat of abuse, intimidation and assault. The University of Manchester published a study earlier in the year that found 68% of women had experienced abuse while running. Sadly, very few of such incidents get reported to the Police.

Running in groups can help of course. However, J likes to run on her own, to enjoy her music, clear her mind and of course to reap the rewards of regular exercise. Following last week’s fright and in reducing the risk and staying safe, J has changed her route. It is now a well-lit and public route. She shouldn’t have to do this. For my part, given that I’m not going to start running with her, (she will always be faster than me) we have agreed that I should be more aware of timings and routes. To this end, we touch base before she goes out and J tells me her route and her expected time back. Again, this doesn’t feel like it’s something we should have to do either.

It is sad that there are so many people out there who feel it is okay to intimidate folk in this way. Ironic too. The last government’s ‘Gear Change’ strategy, published as we were coming out of the Covid pandemic, had a bold ambition to ensure that by 2030, half of all journeys in UK towns and cities would be undertaken by walking or cycling*. Both activities, done regularly, can help reduce the risk of more than 20 chronic health conditions being experienced. Inactivity is said to be responsible for one in six deaths (equal to smoking) each year in the UK. According to the World Health Organisation, 1.4 billion people globally don’t do enough physical activity.

Where we live, just outside Blackpool, the Active Lives Adults Survey carried out in 2023 showed that only 59% of adults in Blackpool regularly achieve the recommended amount of physical activity per week (150 minutes of moderate exercise). The national figure is 67%. At any time of the year, keeping active is a good thing. It is more important during the winter, when short days and often inclement weather can mean we spend more days indoors and therefore less active. Like many others, I love being outdoors, and we are fortunate to live by the sea. We have just a 10 minute walk to the beach. I walk every day – and this can mount up, usually around 40 – 50 miles a week. So far this year I have walked 2,107 miles.

Of course, you don’t have to walk that many miles a week to feel the benefit. There are many other ways of keeping physically active and improving your mental health and wellbeing in so doing. One of the places I like to walk to is the coastal town of Cleveleys, some 5km away. It makes for a lovely circular walk and has the bonus of a superb microbrewery on its main street. Cleveleys sits in Wyre Borough and they have a brilliant evidence-based ‘Wyre Moving More’ strategy which successfully makes the connections between physical activity, sport, active leisure and health and wellbeing. Importantly, it does so across all points of the life span. To deliver some the strategy’s ambitions will need additional funding. But more will be achieved through motivating folk to find the physical activity that best suits them. I can’t run, but I can walk. I intend to keep doing so until I can’t. When I can’t, I will take up chair yoga. 

 

 

 

* I work in Greater Manchester, and our Mayor, Andy Burnham, has long been a fantastic supporter of Greater Manchester Moving. I remember one meeting where Andy ‘gave permission’ for all his colleagues to wear trainers to work on the basis that folk actually used them for walking and keeping active.

A tale of the egg and the chicken[s]

Christmas is coming! I went to pick up my repeat prescription on Friday from our local chemist. I have a batch prescription, which means the one prescription is good for three separate months dispensing. Whilst everyone working at the chemist knows me, every time I go to pick up my medication, we go through the rhetoric of confirming my address. Likewise, that I like to be called Tony, whereas my prescription (and by association apparently, the NHS) names me as Anthony. There are always smiles, so it’s never a problem. Anyway, the young lady, who looked after me on this occasion, asked if wanted two months’ supply. I said ‘No thanks’, and she said ‘are you sure, as it will tide you over the Christmas period’? Now that is what I call kindness in action, and kindness matters, always.

So, we now have a rooted Christmas tree in a pot, currently outside and battling the worst of Storm Bert. We also have a Christmas cupboard complete with Christmas cake, crackers, Twiglets, bottles of mulled wine, chocolates, and all kinds of continental Christmas goodies. Our freezer contains a nut roast for me and a turkey crown for Jane, and a wide selection of interesting Lancashire cheeses from our local food and drink fair.

Although turkey, goose and duck are the traditional fare at Christmas, with the continued cost of living crisis, I think there will be many folk who will opt for chicken for their Christmas Day roast. I have reassured our chickens that they are all safe from the chop. Frizzle the sizzlepoo, hatched this year, and the smallest and most timid of our hens, also needed a hug just to be on the safe side.

Now the same can’t be said for the more than 51 million chickens being industrially farmed in the river valleys of Severn and Wye. Their story appeared last week, due to the association between intensive poultry units and river pollution. It appears that chicken droppings contain more phosphate than any other animal manure. It is the phosphates that starve rivers, fish and river plants of the oxygen they need to survive and remain healthy. Planning permission was being sought for a new intensive poultry unit to be built in Shropshire, through which the river Seven passes. Indeed, the rivers Wye and Severn flow right through Herefordshire, Shropshire and Powys. Of these, only the Shropshire local authority has been granted planning permission.

Powys local authority couldn’t grant planning permission, as the Welsh Government had put a dozen planning applications on hold back in 2023 (five were for units to be built in the Severn valley and seven for the Wye valley area). There seems to be an ever-growing demand for chickens to eat, and it’s a world-wide phenomenon.  For example, in the US, over eight billion chickens are eaten each year, in China, it is 9.3 billion chickens a year, whilst here in the UK, we eat around 800 million chickens a year. Overall, it is estimated that 79 billion chickens are killed for food around the world every year. That is a lot of chickens. Thankfully, none of ours will ever be killed for the table.

Wales was also in the news last week for other reasons. That great politician, John Prescott died. Now, I don’t do politics here in this blog and John and I held very different political views. That said, he was someone I greatly admired for all kinds of reasons. One being, in a rapidly changing world, he always seemed to exemplify the human face of politics. His death also brought back to the front pages, one of the most famous moments in his political career. He was on the campaign trail in Rhyl, Wales, when a protesting agricultural worker called Craig Evans, threw an egg at him. In an almost instinctive response, he turned and punched Craig in the chin. Sky News captured the incident live on TV.

The protesters were picketing the venue demonstrating against low agricultural wages and the Labour Party’s support for a fox hunting ban. Like many country folk living in Wales at that time, Craig was a supporter of the pro-fox hunting brigade. Reflecting upon the incident in 2019, the then Lord John Prescott, somewhat ruefully noted that ’when you get to being 80, you are not scared of anything. I have four or five years to think about death. When I do die, after 50 years in politics, all they will show on the news is 60 seconds of me thumping a fellow in Wales’. How true this proved to be. That fellow, Craig Evans now lives in a remote farm in North Wales. Last week when asked about the egg throwing protest, he said he ‘had no regrets’ about throwing the egg, but his thoughts were with John Prescott’s family. I wonder if his 15 minutes of fame were really worth it.

One of other things I liked about John was his love of Jaguar cars, something I too have enjoyed. I did wonder what John would have thought about the new Jaguar car advertisement released last week. I thought it totally bizarre. If you have not seen it, look here and see what you think. Although I love my electric car, by the time the new all-electric Jaguar cars arrive on the market in 2026, I don’t think I will be getting one at an estimated £100,000 starting price!

Finally, the last thought about John was his unique conversational style, and the way he had of presenting a speech. Matthew Parris in The Times newspaper, once famously wrote of a speech John made at political rally in Brighton: ‘John Prescott went 12 rounds with the English language and left it slumped and bleeding over the ropes’. He is not alone. My nemesis has always been the pronunciation of peoples names. So, at our university graduation ceremonies, due to my often failed miserable pronunciation of many of the students names, I’ve received similar comments from folk. 

RIP John, you made a difference.

The Passing of Thomas

Death will happen to us all. Just ten days ago, Thomas died. He had been given three years to live, seven years ago. He and his wife Sarah were our neighbours. Roll back five years. It is Christmas 2019 and it was J and my first Christmas in our new house. It was a house I thought about as our forever house. At that first Christmas we wanted to share our warmest wishes with neighbours. So, to the dozen or so houses on either side of the road to us, we posted a Christmas card inviting folk to come to our open house celebration between Christmas and New Year. Eight couples turned up and they have been our steadfast neighbours ever since. Thomas and Sarah wee one of these couples. As a neighbourhood community, we got through Covid together and our relationships have been stronger ever since. Which is good, as we don’t intend on moving any time soon.

Our forever house by the sea allows us to keep our goats, chickens, parrot, dogs and cats and still have beautiful gardens too. Last Wednesday evening, as J and I were relaxing watching some bubble-gum TV, there was a knock on our front door. It isn’t something that often happens that late in the evening. I went to answer and found a very upset Thomas’s wife on the door step. She was crying and said she didn’t know where to go. She had seen our lights were on and knocked on the door. She was clearly in distress, and without hesitation we welcomed her in.

As it was the day before my Board meeting day, we hadn’t intended on being late going to bed. However, Sarah wanted to talk, and that’s what we did. We talked about their life together, and what her life looked like to her without Thomas. It was a difficult discussion at times, but it felt important to keep talking. J had been with Sarah just 10 minutes after he had died and had helped with the immediate aftermath of his death. Thomas had been taken to our local undertakers, just some 100 yards up the road. The arrangements have been agreed for the funeral to take place tomorrow.

Sarah worried about her Thomas being up the road and imagined him to be lying in a fridge type compartment. She worried that the funeral directors would not have dressed him in his favourite pyjamas, his silly socks, or they would have lost a woollen heart they both were given as keepsakes. In trying to provide her with some reassurance, we suggested she went up to see Thomas herself, but this was a step too far for her. So, we offered to go and sit with Thomas and in so doing reassure her that he was being cared for. J agreed to go on the Thursday and I agreed to go on the Friday.

J went and sat with Thomas for 30 mins and was able to hold his hand as she spoke with him. The funeral directors had dressed Thomas as he wanted, the woollen heart was clasped in his hand and the ‘I love you’ beaded bracelet, a gift from one of his grandchildren was around his wrist. Telling Sarah all this seemed to bring a degree of calm and reassurance, but I said I would still go and be with Thomas on the following day. I did. It is a long time since I have been in a chapel of rest with someone I knew lying there.

It was a wonderfully calm place. There were perfumed candles burning and the quietness just gently enveloped you. The member of staff welcomed me in and took me to Thomas. She said I must stay as long as I wanted. She left the room and then there was just Thomas and myself sharing the quietness. He looked at peace, and he looked a great deal better than he had in the previous three weeks. I thought the funeral directors had ensured Thomas had been cared for with great care and dignity.

Thomas died at home. If he had died in hospital others would have provided the care for him up to and after his death. Looking at Thomas I was reminded of the last time I had been privileged to perform the last offices on a patient. It was a long time ago. The word ‘offices’ comes from the Latin ‘officium’ meaning service and or duty, so literally the last duties carried out on a body. In hospital, this is a duty usually performed by a nurse. Nearly every nurse will have carried out this duty at least once in their career. When someone dies in hospital, the body of the person is often left for an hour as a mark of respect. This is not the place to describe the full procedure, but one aspect of performing the last offices is in bathing the person from head to toe. This is something common to many different cultures around the world. In my experience it is a very emotional and almost sacred act to be part of.

For Thomas, these duties had been performed by the funeral directors. I spent my time in simply talking to him. I told him of Trump’s election victory and what I thought that might mean for the world. I spoke of the futility of mainstream politics in the UK (we have enjoyed many a political discussion, as Thomas and I held very different political views). I also spoke of my work and my hopes for the next couple of years; I described where we had travelled to this year and a multitude of other topics. It was a strange experience. Speaking my thoughts out aloud in the quietness of the chapel was somehow, quite cathartic. As was having a weep. Men don’t cry, do they?

And when we have this year’s neighbours Christmas celebration, we will raise a glass (or two) to our absent friend and neighbour Thomas.   

Forever grateful for memorable moments

Last week saw me take a walk down my memory lane. My beautiful dog Cello, died, suddenly but peacefully last week. He was 17 years old. His death stirred up all kind of memories, some good, and some not so. But, lets get to memories later. Whilst regular readers of this blog will know I try and steer clear of politics, but it is hard to ignore the news this past week from the US. America has chosen Trump once more as their president. I have no interest in commenting on this, but my eye was caught by a Trump related story. It involved Rowan Mackenzie, a so-called Doomsday fanatic.

Although I have never heard of her, she is apparently quite famous for sharing survival tips in preparation for apocalypse-level events. Over the years, Rowan had spent over £270k on both building an underground bunker in her basement and stocking it with food, water and other essentials necessary to survive for a long period underground. Following Trump’s election, she now feels she doesn’t need to keep her stockpile going as in her words, he is the ‘hero’ who will ‘save us all’. Time will tell, I guess.

Her story piqued my interest, as I too have been a long-time hoarder. It started when I lived in a remote part of rural Wales, where each Winter and on a regular basis, we would get snowed in for weeks. Despite being mocked by others over the years, I have kept up my hoarding practice. As I do our weekly shop, I try and buy one or two extra things on top of what we need. These go into our storage room. When the pandemic struck, our storage room was renamed the Covid cupboard. As a consequence, and fortunately, we had no need to buy any of the things that due to panic buying, suddenly became hard to find on the supermarket shelves. The room’s name changed to the Brexit cupboard in preparation for leaving the EU. However, these days, J still refers to it as the Covid cupboard.  

One other nudge down my memory lane came from being asked by a colleague for advice on getting a paper published in one of the international mental health journals. We met and discussed what she wanted to say and how she might best construct her paper, what was an average word length, references and so on. We also talked about the peer review process. This can be brutal as well as rewarding. I can’t recall ever having a paper accepted without a reviewer (or two) suggesting an amendment for me to consider.  Of course, you never know who your reviewers are.

I have long ceased being a reviewer myself, but the anonymity of the process allows all reviewers to say whatever they want without any fear of any repercussions. Although you can, as the author, address any challenges made to you, the anonymous reviewer has the advantage of being able to recommend or not, your paper being accepted for publication. At conferences and meetings, I have often wondered curiously if the person I’m sitting next to ever reviewed one of my papers.

Last week also saw me finally revising and updating a chapter for a new edition of one of the best textbooks for mental health nursing ever published. The first two editions were edited by Professor Phil Barker*. It was his brainchild. Phil was a phenomenal nurse and academic, and was the first professor of psychiatric nursing practice in the UK. He was well known for his bright patent leather red clogs, his ZZ Top beard and being fabulous company. I met him at conferences in many places around the world, including Manchester, Alice Springs, Dublin and Turku. On the first occasion we met in person I discovered that we both wore clogs as our chosen footwear, both liked to wear black, and both had a penchant for silver jewellery.

As an academic, he was a generation ahead of me, and his work inspired my desire to find a voice in mental health academia. Fortunately, I found an equally likeminded colleague, someone who not only became my long-term co-author, but my best friend too, Professor Sue McAndrew. We enjoyed great success in getting our ideas published, and for many years enjoyed presenting our work at conferences around the world. These days, we don’t tend to write many papers, so it was a refreshing change to revise our chapter, a chapter first published in 2017.

The first two editions of the book saw chapter contributions from some of the best mental health academics ever.  I’m not sure how well known some of these authors are outside of mental health circles, but just look at the author list here. Many of these folk have become long term friends and colleagues to Sue and me. One of whom is Professor Mary Chambers.

Mary took over from Phil as the book’s editor. It’s great that the third edition (and now fourth edition) contributors continue to develop and build upon the work of the previous generation. I felt inspired and will meet up with Sue soon to discuss how we might revise our edited book ‘Using Patient Experience in Nurse Education’ and in so doing, increase the number of service users and carers contributing their experiences.

 

*Phil retired from active academia in 2008 to pursue a new life as an artist – have a look here at some of his work – in my opinion, it’s simply as brilliant as his writing

A pandemonium of parrots, the revenge of crows, and me

I loved reading about Lily and Margot’s story last week. This was the story of two blue-throated macaws, who decided to go on a bit of a six-day jolly and get away from the hustle and bustle of London Zoo. Lily and Margot fly freely each day, but always return home to their enclosure at the end of the day. On the 21st October, they decided to just keep going. Eventually, they were found in a back garden 60 miles away. Reading the story, I couldn’t help but wonder if Lily and Margot had actively planned their trip, or whether it was a spur of the moment decision. Parrots are quite capable of coming up with a cunning plan and they have the patience of Job when it comes to getting what they want. So, I wondered if they had simply decided they needed a bit of a change, worked out how to do it, and away they went. However, once the zookeepers arrived to try and catch them, Lily and Margot simply flew to the keepers and tucked straight into their fruit and nut treats. I’m sure they knew they were safe once more.

I can speak from many years’ experience, as to how parrots operate. Our parrot, Billy, is well over 35 years old now. He has lived with me for all that time. Whilst he is not as pretty as Lily and Margot, he is super intelligent. He is a brilliant mimic, has a fabulous repertoire of words and phrases, but most all is totally aware of context, mood and presence. If he sees J and I hug, he makes the kissing sound even before we kiss. If he hears the front door open, he will say ‘see you later’. If he sees me walking into the kitchen with a bottle of wine, he will make the sound of the screw cap coming off and the sound of wine being poured into the glass. His favourite music is the blues and he will sing and whistle along to the blues for hours.

Over the years he has changed. When I first got him, he liked to fly about the house, but my goodness, he was destructive. I remember once coming home to find he had flown onto my bookcase, and had systematically stripped all the spines from most of the books. So, I started to clip one of his wings, but this was a real trauma for him and for me. Eventually, I stopped doing this, bought a much larger cage, and he has lived happily in this for the last few years. These days, Billy doesn’t try to escape, even when his cage door is wide open and I’m cleaning him and his cage. It is his secure place.

One of the other ways he has changed is in his acceptance of change. For many a year, if I went away from home for a week or more, when I came back, he would go into a sulk and not speak nor interact for a number of days. Billy would literally turn his back on me and I would be ignored. He would eventually thaw, but it could take a while. These days he doesn’t seem to mind at all and always greets me with a ‘hello Billy’ and a cry of exclamation – like ‘where have you been?’ He doesn’t bear a grudge at all, unlike crows apparently.

John Marzluff, a professor from the University of Washington, has studied crows for over 17 years. His research has shown how crows bear grudges against folk, who they feel have upset or threatened them. Even after many, many years, crows will attack those who they remember harming them, if they see them again. It seems to me that there might be many folk, who display the same behaviour. Last week I came up against three people like that. They appeared to be out to seek revenge for harm that had happened to them and/or their loved one, and harm that had occurred many years ago. Unlike with crows, I happened to be the person in the firing line albeit, I hadn’t directly caused them harm. My sin was simply to work for an organisation that, in their experience, had.

Now for as far back as I can remember, and certainly as a therapist and manager, I have tried to practice unconditional positive regard. Carl Rogers’ concept is easy to understand, but difficult to always put into practice. In a therapeutic sense, it requires the therapist to have a complete and non-judgemental acceptance in caring for and supporting their client, regardless of whatever the person says or does in the therapeutic interaction. Positive regard is not withdrawn even if the person does something, or says something that challenges the therapist’s sense of self.

Last week I experienced a similar challenge (and threat) to my sense of self from a number of different folk. Whilst I no longer seek or receive supervision, I’m thankful to have several very supportive colleagues. Along with the always listening ear of J, their support makes a difference and helps me maintain that sense of unconditional positive regard for those folk, who appear to want to harm me. Their support, and attentive listening, collectively helps provide me with my own secure space. Like Lily and Margot, at the end of the day, last week, I was grateful to tuck into their hypothetical fruit and nut treats.  

Pygmy elephants, PhDs and Potholes

Well we have enjoyed 10 days of memory making. I find it intriguing, as to how past memories are prompted. For example, the first time I went to visit Hungary, it was on a new European Union ERASMUS agreement made with a similar health faculty at the Pecs University. It was a grand first trip. Many of the folk, I met along the way, are still my friends now. That first trip involved moving from city to city, town to town and meeting nurse educationalists in each place. I was driven everywhere by drivers who spoke little or no English. I spoke no Hungarian.

Regular readers of this blog will know that J and I have spent the last 10 days in Borneo, so what might have given rise to this memory jog? It has probably been the roads we have driven on since arriving in Borneo. For the most part they have been diabolical. Even the ‘motorways’ are littered with roughly filled-in potholes. Bizarrely, we found that even on a short journey, being constantly bumped up and down in your seat resulted in many steps being added on our Fitbits!

Now I first went to Hungary in 2006. That was just two years after the country joined the EU, having previously rid themselves of the Russian occupation in 1991. At that time the roads were just as bad, as those we have travelled on in Borneo. Back then, the journey from Budapest to Pecs (some 210 km apart), where I had a PhD student, would take nearly five hours on those dreadful roads. I have been back a few times since, and the journey now takes half the time on perfect, beautifully smooth, EU-funded motorways.

Like the UK, Borneo is not part of the EU. In those early trips to Hungary ringing home required me to use a land line phone, as my mobile wouldn’t connect with the UK. Just three days ago we sat on the remote Libaran Island, a 45 minute high speed boat trip off the coast of Borneo, where it was possible to pick up 4G reception. And wifi was on its way! The island’s other name, is Turtle Island, and J and I were able to help 35 little green turtle hatchlings into the sea and the start of their lives there. Now that was a once in a lifetime experience.

As well as the turtles, there are five animals that all eco tourists want to see on their visit to Borneo. They are: the pygmy elephant, the rhinoceros hornbill, the proboscis monkey, an estuarine crocodile, and of course the orangutang. By day four of our trip, we had been privileged to have spotted them all. 

For me, the pygmy elephants were the highlight. We were very fortunate. Our guide and boatman had both only seen them three times before this year. It was their knowledge, skill and perseverance that got to us to sit patiently on a small creek in the jungle, hearing the sound of the elephants slowly making their way towards us. When a mature male ambled (yes that is the right word) towards us and out of the jungle, it was simply a magical moment.

Whilst seeing the ‘Big 5’ was only possible with the help of our guides, there was one animal that need no help to be seen - macaque monkeys. These cheeky little monkeys were everywhere. For example, at the Sukau Bilit jungle lodge everyday at 3.30pm, the lodge staff served coffee and cake to their guests. In an almost Pavlovian response, the local monkeys literally poured into the dining area, a large open-sided structure and tried every which way to pinch a piece of cake. Whilst most of the visitors found this highly amusing, the restaurant staff didn’t and occasionally walked around tapping tables with sticks and shooing the monkeys away. The same pantomime was repeated each day. Neither the monkeys or the restaurant staff seemed to be able to break the repetitive pattern of behaviour.

And maybe that was another thing which brought back memories of my visits to Hungary. I had agreed to supervise one of the senior managers in their national health care service to do his PhD. We would mostly do things by email, but we met up regularly to do face-to-face supervision, both in Hungary and in the UK. Doing a PhD is a journey of discovery. Not just to make a contribution to our knowledge, but to discover more about ourselves as people. My student struggled with moving too far away from what he already knew. I struggled to help him. Like our Borneo guide and boatman, I would love to say it was my skill, knowledge and perseverance that got my student over the line, but that would be untrue. Whilst my student did eventually get their PhD awarded, I don’t think it was my finest hour as a supervisor.

After 3 plane journeys and 24 hours of continuous travel, J and I arrived back into the UK at 07.30 on Sunday. We are a little tired and I’m very conscious that I will be back at work tomorrow. I’m sure there will lots of emails to deal with! Over the last 10 months our Trust has moved forward on its improvement journey. Many colleagues have stopped looking backwards and started to look at what is possible in the future. I think there is a real desire now to be always outcome-focused in everything we do, and increasingly, to stop doing what was always done in the past. Like the pothole free roads in Hungary and our sighting of the pygmy elephants last week, I grow increasingly confident that we will also succeed in our journey to becoming an outstanding mental health organisation.

A kind of Jungle Book story

Well after 3 planes, and nearly 30 hours of travel (one plane was cancelled resulting in a tiresome 6 hour wait in a Business Lounge that didn’t serve alcohol) J and I arrived in Kota Kinabalu, Borneo. The temperature is 30c which is lovely, although the 80% humidity does make it feel warmer still. And October is the start of the wet season… …and day 2 we have enjoyed (endured) monsoon rain. The rain continues to pour. The desire to come out here arose from our visit to our local zoo. Until we moved here, I didn’t know Blackpool had a zoo. Nobody in our party is very happy with us talking about zoos but we are unapologetic. Blackpool Zoo is not the biggest zoo ever, but we like it, so much so we became members. As members we can visit as many times as we like, get free car parking and get 30% of our hot chocolate drinks. It also means we can avoid going there when the place is crowded and full of very excited and noisy children!

Whilst we visit every animal and bird each time, our favourites are the big cats and the orangutans. The latter are simply the wisest looking animals in the place. Last year and again this year, two of the mums gave birth to the tiniest little baby orangutans we had ever seen. Indeed, it was several months before we actually caught a glimpse of them.

So, we decided to come out here and see them and many other animals and birds living in the wild.  Whilst on this trip, we won’t be climbing up Mount Kinabalu, for the next 8 days we will be travelling through the jungle, speeding up rivers and perhaps even drinking a glass or two on the beach. We are staying in hotels, homestays, jungle lodges, glamping tents and rain forest resorts. Last night’s accommodation was a little rudimentary but clean and absolutely fine for an overnight stop. I even helped prepare dinner, pineapple curry.

Trips like this take a bit of organising, but the break from the routine of everyday life makes it a worthwhile effort to make happen. Of course, you don’t need to make a 16,000 mile round trip to be able to step off the merry-go-round. We regularly take ourselves off for a day’s walking in the hills. Whereas I’m content to enjoy the same walks more often than not J will choose the walk in order to find a new one to do. She likes to plan, and on the walk, although she can protest loudly, she likes to navigate. Whilst we nearly always get lost on our walks, this is usually down to me rather than her navigating skills. I rely on intuition, J relies on maps and tried and tested directions.

Being able to plan something different, and then having a go at trying to achieve it, can, in itself, be helpful for maintaining our mental wellbeing. If this is something new, even better.  A few weeks back, J organised an eight mile circular walk, which at the halfway point delivered us to the ‘Singing Ringing Tree’. This was situated on top of Crown Point overlooking Burnley in Lancashire. It is a stunning bit of art. A sculpture made up of different lengths of round metal pipes, shaped like a tree that has been bent by the wind. As the wind blew, and passed through the pipes it created a sound similar to the singing of whales as they call to each other under the oceans.  

It is a truly magical place. We lingered, J noting that it would be a great place to practice her mindfulness. Again, something we can all try and do to enhance our mental wellbeing. Back here in Borneo, sitting and listening to the rain falling and the many night sounds of the jungle is equally a great opportunity to simply relax and let your mind rest. I also like it because it feels like being off the grid. My NHS organisation blocks emails when colleagues are out of the UK. They simply don’t land in your inbox (although they are all there waiting for you when you return). It is a brilliant strategy for leaving all my work stress back in Manchester. I need to improve the amount of time I don’t turn my phone on when I return when I get back. I once had a mentor who reminded me on more than one occasion that however much we might think it’s the case, none of us are indispensable.

So for the next few days, I intend, literally on some occasions, to just go with the flow (got 3 river trips planned). As a consequence, it might mean that my blog gets posted at an unusual time, or heaven forbid, even not at all. This week’s blog has been posted while most folk in the UK are taking a Saturday afternoon stroll, so I apologise if you missed my posting . I will see what I can do later.

Horse tales and other lessons learnt

My first NHS Non-Executive Director role was at Wrightington, Wigan and Leigh (WWL) NHS Foundation Trust. I was blessed with a great Chair and CEO and over the seven years that I worked there, I learned a great deal from both these wise and generous men. Unusually, they both became friends, as well as colleagues. I think some of the most important lessons I learned from my time with them were: to always remain curious, to always consider the impossible when looking at solutions to problems and the importance of being able to communicate with whosoever you met.

 

That was a while ago now, but I continue to benefit from their insight. Sadly, the CEO, Andrew Foster died in March last year. Like many folk, I still miss him. Even when he and I left WWL, we would periodically meet up, have a couple of beers, and put the world to rights. We would meet halfway between his and my house, at a pub situated on the banks of a river. During the summer, you could sit on the terrace and it was a lovely way to spend a couple of hours. These days, I still pass the pub on a regular basis and each time I do, those memories make me smile. 

I was reminded of Andrew twice last week. The first occasion was during interviews for our last Board position, Director of Corporate Assurance. The successful candidate also worked at WWL, and we were able to have a bit of a catch up as well. The second occasion followed my reading of the story of Peyo, a therapy horse who works in a palliative care centre in northern France. Amazingly, Peyo ‘tells’ his trainer, Hassen, which patient he wants to visit, by standing outside that patient’s particular door. The horse appears to have the ability to recognise when a person has a tumour or cancer and has a wonderful ability to ‘be with’ people and reduce their pain and anxiety, as they near their end of life.

 

After performing at shows, the 15-year old horse would often seek out the company of people and stay with them. Hassen began to suspect that Peyo had special powers, and after nearly four years of investigation, vets now believe his brain functions in a unique way. Now some readers might be forgiven for thinking that possibly my mind functions in a unique way in making a connection between Peyo the horse and Andrew Foster, the Chief Executive.

 

Once, while I was at WWL we had a 77-year old patient, who was receiving end-of-life care for cancer. She was called Sheila Marsh. Although Wigan is part of Greater Manchester, it is surrounded by some wonderful countryside. Sheila lived in this countryside and had kept show horses for many years. As Sheila neared the end of her life, she told the nurses looking after her that her dying wish would be to see her favourite show horse, Bronwen, one last time. Andrew, his Director of Nursing and the family agreed to try and make this happen.

 

As Sheila’s condition deteriorated, the family arranged for Bronwen to be brought to the hospital. Staff wheeled Sheila’s bed outside and Bronwen walked straight over and started nuzzling Sheila. It was a very moving moment captured on Andrew’s phone. It was a photo that went viral when he posted it on social media. There were lots of tears, but smiles too. Her family said the moment was truly wonderful and had brought comfort to their mum. Sheila was to die just a few hours later.

Across all types of health care, it can be hard sometimes to measure the real outcomes of the care provided to patients, service users, and carers. With Sheila, there was no cure for her cancer. However, I like to think that the care Andrew and his colleagues, and Sheila’s family provided to Sheila eased her passing.

Inevitably, we will all die. For some people, death will be sudden and unexpected. However, for many of us, there may well be time between when we know that we are facing a life-shortening condition and actually dying. It is during this time that planning for a good death is important. Many folk don’t like to talk about dying, and it can be a difficult thing for individuals and their families to get into. Equally, many health care professionals can find it difficult to talk with the people, who are facing the end of their life. 

However, trying to find out what really matters to a person dying is critical if their preferences, wishes, and beliefs are to be met with care. I believe that doing so is as important as is the physical assessment and planning of care to keep people pain free and best able to cope with other physical problems they might experience. As with many aspects of health care, good communication is what will ensure a person’s physical, emotional, and psychological needs are met in a person-centred way. 

The story of Bronwen illustrates to me what might be possible when those lessons of always remaining curious; considering the impossible when finding solutions to problems; and the importance of effective communication with others are foregrounded in the way we think about providing care for others. I thank all those who so generously and freely provided me with so many opportunities to learn. 

A happiness filled blog

This week’s blog was inspired by a simple voice message sent to J from our youngest daughter last week. She had started her message by saying she had ‘just experienced true happiness’ – listening to her message, happiness seemed to stem, in part from her taking delivery of one of those whole-body electric blankets with sleeves. It takes all sorts but if being snuggled down in a warm top to toe wearable electric blanket makes her happy who am I to comment. It did make me think about all those things that bring me happiness too.

For example, I had been really happy with the rather mixed weather we have been enjoying; as has our garden. Then suddenly, we are at the start of October. There was me making the most of the September sunshine and suddenly, we are in October with its shorter days and colder mornings. However, I’m not complaining. Both J and I won on our Premium Bonds this month. As she has just had a massive clear out of her wardrobe’s (yes you read that right more than one wardrobe) she was very pleased to have received her windfall. I’m happy because J is happy. The local charity shop was also happy to receive a van load of her clothes.

I bought another guitar with my prize money – a custom built 3 stringed cigar box guitar, which is ideal for playing slide guitar blues. Billy the parrot is happy as he loves whistling the blues.

More importantly the early days of October also brought and opportunity to have both my flu and covid jabs yesterday. It is always a relief to get them done early. Wearing my public health and health promotion hat, I would urge every reader of this blog and their families to get the jabs done too. The new Covid variant is much more like an intense flu and is laying folk low very quickly. This new variant typically results in a high temperature, a persistent cough, an aching body and a constant headache. If you get it, I guarantee you not going to be feeling very happy.

Thankfully, whilst giving rise to horrible symptoms, this variant is not so deadly as some of the previous one. That said, in the week ending 21^st September 2024 there were a total of 9421 deaths registered across England. This was a ‘quiet’ week for deaths, with there being some 1500 less than was expected.  However, of the 9421 deaths, 1450 were the result of influenza (flu) or pneumonia, and 235 were a result of Covid 19.  So, if you are eligible, get your free jab or if not eligible for a free jab, think about the cost of paying for it as being an investment in your future happiness and wellbeing.

Tuesday gave me the opportunity to both briefly look backwards but more importantly to look at our future as an NHS Trust. It was our NHS Trust Annual Members Meeting and my first one since taking up the Chair role. I love these kinds of events. I’m never happier than when I’m on a stage, and I have been fortunate to have enjoyed performing on many stages in my time. Last week was no exception and the meeting was a fabulous one.

We did the serious stuff of course. We have to. Whilst the AMM is a formal meeting in some respects it is also a great opportunity to share with our members (folk from across our various communities) what we have done, its impact and the difference made. It is also a chance to share where we are heading on our improvement journey. Two of our clinical services gave presentations that illustrated all these features. I was more than happy with how the afternoon went. Feedback from other attendees, tells me many of the people who attended were happy too.    

On the Wednesday I made a presentation to thank our out-going Chief Nurse for her contribution to the Trust and the wider NHS. I think she was both a little sad at retiring, but happy too in terms of what opportunities retirement might bring. I was surprised, and very happy to bump into someone I hadn’t seen for many a year at the event, a chap called Malcom Rae. Many nurse readers of this blog might know the name, if not the person. When I first joined the Trust in 1984, he was the Chief Nurse. We didn’t always see eye to eye, but he generously helped me progress my career, and for that I will always be grateful. He provided a way of helping others that I’ve been happy to emulate every since. I hadn’t seen him since I left the Trust in 1998. Meeting him once more last week gave rise to my own ‘experience of true happiness’. 

Working on health creation and virtuous circles

Since I attained working age, I have only ever been unemployed once. Indeed, there were periods in my life where I held down two or even three jobs at the same time. However, for a couple of months, I found myself in-between jobs with no notion of what I wanted to do next. During this time, purely to get my National Insurance stamp paid, I registered as being unemployed. This was in the days where you went along to the ‘Job Centre’ answered some questions over your eligibility for various benefits, and importantly, looked at the row after row of little cards each advertising jobs; none of which appealed.

It was a strange time in my life. I needed something to do, but working in a warehouse, a shop or as a salesman wasn’t ever going to cut it. I had an MBA for goodness’ sake. I had just left the NHS and although a qualified nurse, I also didn’t want to go back into nursing practice. I wanted to go into education. Fortunately, I was able to do so and enjoyed a later-life second career in higher education. I went from being a Lecturer to Dean of Faculty. I have long retired now and what I do these days, I do because I want to, not because I need to. In that regard I know I’m fortunate. Many others aren’t.

The IPPR thinktank estimates that Britian has lost 900,000 people from the labour workforce since the pandemic. Not that I’m a great fan of HMRC, but this loss results in £5bn less tax being gathered this year. Less taxes means there is less money to support the public services that we will all use at some stage in our lives: education, defence, health and so on. Interestingly, they also suggest that if were able to improve the nation’s health, we could save the Government £18bn a year in benefit cost.

So perhaps it was no great surprise that, last week, our new Secretary of State for Health and Social Care, Wes Streeting, announced at the Labour Party Conference, that he was making it a priority to cut waiting lists in those areas, which have the highest number of unemployed people. His focus is on those folk not working as a consequence of ill health. We know that three million people of the estimated nine million people who are economically inactive, are neither employed nor looking for work due to either acute or long-term health problems. It is also worth noting that there are 6.4 million people in England, who are currently on NHS waiting lists for treatment.

I’m not economically inactive. I still pay frustratingly large chunks of my income in taxes each year. That said I probably benefit from being in that ‘baby boomer’ virtuous circle of living through a time of much greater economic prosperity than many folk might experience now. I came of age before the ending of the Vietnam War and the Watergate scandal. It was a time of great technological change too. Things we take for granted now, fridges, TVs, washing machines, cars and even telephones (those attached to a cord at least) all became more readily affordable, and of course more desirable.

However, I think one of the greatest benefits of being a baby boomer were the changes in health promotion, ill health prevention and greater access to health care services when these were needed. Vaccines against polio, measles, whooping cough were all introduced, greatly reducing the occurrence of these diseases in children and young people. As a young person, I remember being excited (as were my class mates) to see if my Mantoux TB test showed positive. I was very naive then. Thankfully I did get to have my BCG vaccination. Compared to the many children and young people I met during the school Covid vaccination programme, most of whom were very knowledgeable as to why it was a good thing to have the vaccination, I was much less clued up at their age!

If I’m somewhat cocooned in my virtuous circle, I think last week Wes was reminding us of those folk who might find themselves in a more vicious circle. Research shows there is a strong link between an individual’s employment status and their health. Unemployment has consistently been shown to be the biggest factor in having a negative impact on a person’s mental health and wellbeing. Anxiety and depression, for example, can very easily reduce someone’s chances of both seeking and securing employment.

People who are unemployed are five times more likely to live with poor health than those in employment. Currently, there are nearly a million job vacancies in England. Helping people caught up in this vicious circle to be able to return to the job market and take up some of these opportunities, makes as much sense to society and it does to the individual. Sadly, I don’t have many ideas as to how we might do this, and unfortunately, I’m not sure Wes has the answers either. I would, however, urge readers to have look at the latest IPPR report on health and prosperity, see here. I like their ambition to change our approach from having a reactive NHS health system to a more proactive health creation approach.