The art of conversation lies in listening

Just three and a half months into my new role as Chair of Greater Manchester Mental Health FT and I have started to reclaim my diary. Don’t get me wrong, I’m not complaining, but working full-time in a role that is definitely meant to be part-time takes it toll. So last week I was able to enjoy my Wednesday completely free from meetings, phone calls and reading work-related reports. With the whole day stretching out in front of me, I thought I might go for a long walk. Unlike me, I couldn’t decide where to.

Now J always reminds me that we should try and walk with a purpose in mind. Perhaps to take in the view or perhaps to do a little shopping, or some other chore. I had a long list of jobs that had been mounting up, so I decided to do a 10-mile ‘round robin’ walk that would help me tick off some of those jobs. First stop, the vets to pick up Dylan’s flea and worming medication. Then it was on to the Timpson’s in our local supermarket to get a key cut for the wardrobe in our French Room (don’t ask). It is the same Timpson’s where I get my shirts and suits cleaned each week, and I like it that they remember both my name and phone number. Coincidently, and I’m not sure it adds to the story, but Andrea, the assistant at Timpson’s has just left to be a receptionist at our vets. Continuity of care maybe?

Key duly cut, it was a bit of a stroll into our next-door seaside town for a halfway lunch stop. The town is one of the reasons I like living here. It’s right on the sea front, has lots of interesting shops and a surprising number of café bars with outside seating. Great for people watching. My favourite is a microbrewery called The Shipwreck. While it serves a wonderful selection of original beers, it also has a fair range of wines, my preference. I took my seat outside, ordered a glass of red and a bowl of skin-on-chips, smothered in melted cheese, and prepared myself to enjoy an hour of people watching.  

I wasn’t disappointed. First up was a trio of older ladies who came in for a coffee and immediately started talking about how they would love to get married in the stunning wedding dress seen in the window of the local charity shop. The conversation soon moved onto the other benefits that being married might bring, a conversation far too risqué to reproduce here. Grandmother Denise made a slice of toast and a coffee last 40 minutes, during which she had a constant stream of folk coming up to say hello. Then there was Ernie.

He and his wife Irene were sitting at the table beside me. As they got up to go, Ernie asked me if I was in the rock business, and did I play in a band. It’s a question I get asked often. I once got free gins all night long from a group of folk who swore blind I was ‘that guy from Jethro Tull.’ I played along. Anyway, it turned out that Ernie had once played with Cliff Richard and with the Shadows (when they were the Drifters). We talked (actually Ernie did much of the talking) about rock and roll, guitars we both owned, how the world had changed and more or less life, the universe and everything. Irene was the personification of patience; I had another red wine and finally after nearly an hour’s conversation we parted company. It was an unexpected, but a very welcome diversion.

I had a similar experience the following day. We were due to have a visit from the NHS England Deputy Chief Nurse; however, she unfortunately had to cancel at the last moment. Colleagues had mounted an exhibition showcasing a range of activities and programmes they were involved in. I was asked to take a look and upon my arrival, I was asked to make a small speech, which I was happy to do. I then spent an enjoyable 90 minutes walking around the room talking to colleagues at each stand. It was an amazing opportunity to meet folk and learn more about what we were doing across the Trust.

There was much to find out. I didn’t know we had the only speech therapy service in the NHS working with homeless people and rough sleepers. There was a group of colleagues that work at recruiting nurses from overseas. I was impressed with the care they provided to people coming into a very different culture and health service. We had an interesting discussion over what we were doing to help develop mental health services in the countries we were recruiting from. It was clear we could and should be doing more in this regard. I loved spending time with our nurse researchers and hearing how they were using their research to transform services and increase access to care, particularly with children and young people. I met up with someone whom I last worked with 40 years ago, when she was a staff nurse at the Trust. She had enjoyed a fabulous career, working her way up to being a Consultant Nurse. She had since retired but had returned to support our Advanced Nurse Practitioner programme. It was a lovely reunion and an opportunity to say thank you for her service too.

Finally, I got around to talking to our educationalists. These were folk supporting continuous professional development, and who had raised the lifelong learning bar to a new level. I was really impressed with a couple of colleagues who worked on our preceptorship programme. We have been fortunate to buck the national trend in recruiting mental health nurses. However, many of these are newly-qualified nurses and need to be supported though an effective preceptorship programme for the first 12 months of their journey from novice to expert. The team’s determination to be there and work with these new nurses was positively tangible. They had a real passion for what they were doing and it shone through in their conversation with me.

I’m not sure therefore why I was surprised a day later to find out that last week we had been awarded the NHS England National Quality Mark for our Preceptorship Programme. It is an award that recognises our commitment to supporting new registrants and making the Trust a great place to work. Apologies to The Rolling Stones, being Chair is not all rock and roll, but on days like this, I like it.  

The Great Chicken Run Escape

Last week, aided and abetted by Hansel and Gretel, our two goats, the chickens made a bid for freedom. Their foray into the big wide world was short-lived however, and they were soon back in their run. The hens spend much of the winter in a large covered run, which protects them from the worst of the weather and helps the garden area, they usually run around in, to recover. For the last couple of weeks, they have been eyeing up the rapidly appearing green shoots of the returning grass with something reminiscent of circling hyenas waiting to steal some of a lion’s kill.

The other reason they have been in a covered run is to keep them safe from bird flu. It has been sweeping the world. Over the past few years H5N1, to give it its formal name, has killed millions of wild birds and domesticated poultry across the world. All our hens including Gregory Peck our beautiful cockerel, are fit and healthy. They all have bright red combs and we are getting around half a dozen eggs each day. We have managed to keep our neighbours in eggs since late February. So, while our hens might be keen to get back out on the grass once more, they are by no means suffering, more of which later. They certainly don’t have bird flu, which is a relief.

Worryingly the virus has started to jump to other animals, cats, foxes, sea lions, cows and even humans too. Last week it was reported that a man in Texas had caught bird flu from contact with a cow. Thankfully, to date, there is no evidence to suggest that the virus can be spread from one person to another. Globally, there have been 887 reported cases of bird flu infecting people. 462 of these folk died as a consequence of the infection. It is potentially a hundred times worse than Covid which, at the start of the pandemic in 2020, saw something like 20% of those infected sadly dying. There is no human bird flu vaccination available.

Interestingly, with echoes of the Covid pandemic, the UK government issued guidance last month that we should all stay 2 metres away from wild birds. I have warned the little robin, who comes looking for worms and watches me as I work in the garden. Whilst somewhat humorous as a piece of government advice, not all requirements regarding hens are as funny. From October this year, anyone keeping chickens will be required to register the birds with the Department of Environment, Food and Rural Affairs (DEFRA) and apply for a holding number. We already do something similar for our goats and J is, to her delight, registered as a “hobby farmer”. I’m not sure how the new regulations will be effectively policed. However, it is an administrative burden, in both time and cost, that will see many back garden hen keepers give up their birds.

The new regulatory burden is nominally designed to control bird flu. However, most responsible poultry keepers will ensure their hens are protected from contact with wild birds, who may carry the virus, in the same way as ours have been over the winter months. Indeed, last year when there was an outbreak locally, we had to keep our hens in splendid isolation for several months. Despite their covered run being large and spacious, towards the end of their confinement, they did start to get a little techy and were clearly upset they couldn’t run free, as they normally would during the summer.

Do hens suffer because of their lives being disrupted in this way? Well, the evidence from our small flock would suggest they do and they don’t. Some of our hens are two or three years old (with the exception of chicks hatched that are male, we don’t kill them) and they are quite familiar with the winter/summer cycle and only start to become twitchy, as the days get longer and there’s more sunlight. Yet when they were kept isolated during the summer, they clearly began to get upset. Last week, I heard an interesting discussion around the same topic.

Most days, I like to listen to Farming Today, a Radio 4 programme that airs at 05.45 during the week. Last week, there was a debate about the banning of poultry cages in the UK. These were not the horrible cruel small metal cages used in industrial scale egg production. Those were thankfully banned in 2012. Enriched cages were introduced and it is these that the UK government now want to ban. Enriched cages are much larger, have perches, scratching areas and proper nest boxes for the hens to lay their eggs. There were two elements to the discussion that resonated. One was the farmer being asked if he thought the hens suffered by living in these cages. His response was the hens knew no other existence, so he didn’t see how they could suffer. It was a statement that has made me ponder all week, but it feels a little like a metaphysical conundrum probably only Nietzsche might untangle, and we can’t do it here.

The second element was the farmer’s complaint that such decisions and changes in policy were made by folk in Whitehall, who, likely, would never have visited a poultry farm, would not be able to describe what an enriched cage looked like, and who probably would have a stab at the philosophical question of suffering. Not that I would want to intentionally draw parallels, but next week I’m to attend two regulatorily reviews of our Trust, which will be conducted by folk who likely, have never nursed someone experiencing severe mental distress, or run a ward for acutely ill service users, or had to ensure safe and quality services are consistently provided within finite and often shrinking financial resources. However, just like our chicken run, we have plenty of green shoots (of improvement) that I will be happy to share and hopefully, others will recognise too.         

If you think your plane might crash, Keep Calm, and see Mrs Perry

True confession time. I don’t often get blog inspiration by stories published in the Daily Mail. Last week I did. I habitually read the daily newspapers online; well at least those that are not pay walled, which is probably why I was skim reading the Daily Mail. A couple of stories caught my eye. These were stories about courage, coolness, compassion and care. The first of which was the story of Captain Eric Moody and his response, when, in 1982, all four engines of the Boeing 747 plane he was flying failed, while he was over the shark-infested waters around Jakarta, Indonesia.

Unbeknown to Captain Moody and his crew at the time, they had flown through the dust clouds thrown up by the Mount Galunggung volcano eruption earlier in the day. The dust not only damaged the windows, so the crew couldn’t see out, it also clogged up the engines, shutting them down and preventing them from being restarted. Once Captain Moody realised the engines couldn’t be restarted, he announced to the passengers, ‘this is your Captain speaking. We have a small problem and all four engines have stopped. We are all doing our damnedest to get them started again. I trust you’re not in too much distress’. Now I love flying and have travelled thousands of miles in planes. I’ve never thought about the risk of there being a mechanical fault. Likewise, I have never doubted that I wasn’t always in the safe hands of highly trained and highly regulated pilots.

I’m not sure how I would have responded to Captain Moody’s message. He was completely cool, and his announcement belied the fear and confusion on the flight deck caused by not knowing what had made the engines fail. There were 263 people onboard. Captain Moody had few options open to him to try and save as many lives as possible. He knew he could not reach the nearest airport at Jakarta, and although he considered landing in the sea, it wasn’t something he had done before.

The plane had a glide ratio of 9/1 – which meant for every mile it dropped, it would continue to glide for 9 miles. This gave them just 30 minutes to try and restart the engines or crash into the ground. The lack of engines meant the cabin could not be kept pressurised, and so passengers needed to put on the oxygen masks to breathe. Some of these failed, and Captain Moody was left with no option, but to rapidly descend thousands of feet, so that passengers could breathe without the use of oxygen masks. However, the lower altitude brought with it clearer, denser air, which blew the dust out of the plane’s engines. One by one they restarted and he was able eventually to safely land the plane.

Captain Moody died, aged 84, last month. His death prompted several stories being published last week, reminding us of his courage and coolness in what must have been an almost overwhelmingly stressful set of circumstances. The second story to catch my eye was of the compassion and care Ruth Perry showed to her pupils and their families during the long lockdowns of the Covid19 pandemic.

Readers will recall that, sadly, in 2023, Ruth Perry took her own life following an Ofsted inspection and their subsequent report. The report downgraded her primary school from its previous highest Ofsted rating to the lowest rating possible over safeguarding concerns. Ruth Perry’s death sparked an important and widespread debate about how public services should and or could be regulated. Reliance on one or two-word descriptors such as ‘requires improvement’, ‘inadequate’, or ‘good’ can never capture the whole picture of what and how an organisation provides its overall services.

The Ruth Perry story was once more in the news, as a video of Ruth talking to her pupils virtually during one of the lockdowns was played by her sister at the National Education Union’s conference last week. In the video, Ruth urges her pupils to ‘talk to the people you love, be kind to each other, be hopeful and to take care of yourselves and each other’. If you needed an example of compassion and care in action, this is a good one. You can see the video here. Have a look at the cushion behind her, it’s where this week’s blog title comes from.

Ruth’s sister urged the conference delegates to ‘get help’ and ‘think again’, if they were having thoughts about ending their lives in the same circumstances as her sister Ruth. She said ‘suicide is always a terrible, wrong-headed option. Ending her own life was the worst thing that Ruth could possibly have done’. I agree. However, I can see how some challenges in life might make one feel like that. The NHS Trust that I Chair is an organisation ‘in special measures’. At present, we are being scrutinised by every regulator possible. Last week, we were responding to four different regulators and for a moment, I felt totally overwhelmed by the scale of what it was we were being asked to respond to. It was just a moment. The moment passed and I once again became relentlessly positive. What made the difference?

Well, we had been given a very unhelpful deadline by one regulator to respond to a long list of information demands on the Thursday before Easter. Submission of our evidential response was to be by Tuesday lunchtime, the day after the Easter Bank Holiday. In response, a large number of my colleagues worked throughout the weekend; a long weekend, during which they should have enjoyed being with their families and friends, in order to deliver this information. There was no anger or resentment at the lack of any real recognition by the regulator of improvements already made. They all just adopted a professional cool, calm, compassionate and caring approach, and brought together the necessary information, and did so on time. To say I was overwhelmed by their commitment to doing what is right for our service users and their families, would simply be an understatement. It is unlikely that their efforts would ever be picked up by the Daily Mail, but acknowledging their story here is something I’m very proud to be able to do.

Every day the clock resets - thinking about the changes we might make

Yesterday, we moved the clocks an hour forward. It’s British Summer Time. When I worked shifts, it was a prized night shift to try and get. These days, it simply means a slightly earlier start to the day. What is different is that most of our clocks adjust themselves automatically. The cooker and one wall clock are the only ones that don’t. I can just about understand how my phone and laptop change the time, but my car doing the same thing is slightly baffling.

I’ve been thinking about the nature of change a lot this past week. Lots of possible reasons, I guess. For example, every couple of days I do the ‘cabbage run’. In the winter time, J likes to give her goats a cabbage each day. They get fresh hay and a goat mix, but rightly so, she likes them to have fresh greens. In the summer, I go hedge trimming and bring home sacks of lovely greenery for them. Anyway, the ‘cabbage run’ is a 1 km walk to Aldi (there are other supermarkets available), and a 1 km walk back. 

Last week while collecting the cabbages, I walked up and down the central aisle (where there is always something to buy that you didn’t know you needed) when my eye was drawn to what looked like flat bottles of wine. They were indeed flat bottles, holding the same amount of wine as ordinary bottles, but where the weight was 84% less than glass bottles. I was intrigued, and bought a few!

Coming home I poured myself a glass, and found the wine was quite drinkable. What an innovation, a change for the better, just like when screw caps replaced corks. That was a change that some folk thought was a change too far. I didn’t, and just like the screw caps, I welcome this latest change. In the summer time, we often pack a rucksack with a picnic and bottles of wine and go and listen to the live music in our local park. These new plastic wine bottles, as well as being much lighter, won’t run the risk of being smashed along the way either.

Some changes are cyclical in nature. We live just north of Blackpool. Like many other coastal and seaside towns, Blackpool has had to reinvent itself. The days when folk from across Lancashire and Greater Manchester came for a week or two in a guest house have long gone. Back in 1894 when the famous Blackpool Tower was first opened to the public, the resort would often get as many as 50,000 visitors each year. By 1937, more than 10 million visitors came to Blackpool! During the 1960/70s visitor numbers went into decline, as cheap Mediterranean holidays gained in popularity. However, post-pandemic there has been a resurgence in its popularity, with record numbers of visitors to the town, there were over 20 million visitors in the year 2022-23.

The ups and downs of the Blackpool tourist industry continue to change, and, at the moment, I think for the better. Last week, Blackpool was named as the most affordable and popular ‘staycation’ destination to visit this year, based upon research undertaken using Google and TikTok data. Ironically, given the changes to Blackpool’s tourist industry, this situation results from more people considering ‘staycations’ over foreign holidays, as a way of saving money and avoiding the stress of flying.

Whilst for many people, Blackpool might be a great place to visit and enjoy a holiday, living here isn’t always so great for many people. Blackpool contains eight of England’s 10 most deprived wards. It has a lower life-expectancy than that of people living in Angola. Life expectancy is one of the key indicators of health across a population. It is usually measured as being the average number of years that a newborn is expected to live when applied across current mortality rates. In Blackpool, the life expectancy for women is 79.00 and for men, 73.4 years. Both these figures are way below the national average, and the gap continues to grow.

Not only do folk in Blackpool live shortened lives, they also spend a smaller proportion of their lifespan in good health and without disability. As with other parts of the UK, health inequalities are a large factor in making this a difficult situation to resolve. There are high levels of smoking, obesity, alcohol and drug misuse, all overlaid with other social determinants of poor health, including poor housing and limited employment opportunities. Blackpool also appears to be a fairly dangerous place to live. Last year, it was the second worst town in Lancashire for criminal activity. The most common crimes during 2023 were violence and sexual offences. Blackpool’s least common crime is bicycle theft. Changing this picture will involve decisions and choices that individuals make, but some will need Government support and funding. Don’t hold your breath though.

Some things don’t change. Last week, I was able to visit some of our Health and Justice Service colleagues working in prisons around the North West of England. I visited two very different male prisons and came away mightily impressed with what I observed. Great care, compassionate approaches being provided in a person-centred way, but in a context that was uncompromising about security and safety. What did I see that made me think some things never change? Many of the men knew little about their own health journeys and when assessed would more often than not say ‘I will need to ask my mum; she will know’. This was even true of a prison officer suspected of being in contact with someone diagnosed with measles. When asked if he had received the MMR vaccination, he responded by saying he didn’t know, and ‘would need to ask his mum’. And yes, I bet my mum would know how to reset that clock on the cooker too!

Thinking more about care, compassion, and empathy

Two of my favourite ways of helping people think through an issue, problem or idea is to say either ‘let me reframe this’ or ‘let’s change the narrative’. They are slightly different approaches, but can lead to the same outcome. The reframe approach is useful in a 121 conversation; changing the narrative works well with a wider discussion. Both can help shift a mindset. Reframing can help a person see a situation, issue, or relationship from a different perspective. The ‘frame’ in which the person views a situation, issue, or relationship, will determine their view, and often their behaviour.

A month ago, J and I went to look at the wonderful annual display of snowdrops at Lytham Hall. For a few weeks, sweeping drifts of snowdrops cover much of the woodland grounds of the hall. Every so often was to be found a picture frame set on a post, through which you were encouraged to take the best possible photos of the snowdrops. It was a great idea, but eventually these were the only photos we took, and perhaps we lost sight of the other wonderful things that were there to be seen.

Narrative is similar. It provides a choice of what events to share and in what order to share them. In so doing, the narrative become a specific representation of the story, rather than the story itself. Re-ordering the events will result in creating a new narrative of the same story. The use of narrative in some circumstances might give rise to the accusation that the ‘true story’ is being hidden. I don’t agree with this view. I think changing the narrative doesn’t change the ‘true story’, it’s simply that a narrative will often convey the truth of a story indirectly.

Last week Mel Stride (the Secretary of State for Work and Pensions) was attempting to change the narrative around mental health and employment. The prevailing narrative has been around nurturing and supporting folks’ mental health and wellbeing. What Mel Stride was challenging was the idea that whilst it is good that society has generally taken a more open approach to mental health, perhaps we are in danger of over medicalising the normal everyday challenges we all face. His concern was that people were now ‘convincing themselves they have some kind of serious mental health condition as opposed to the normal anxieties of life’. He was saying this in the context of the rising UK benefits bill for people signed off work because of a mental health problem.

There are 2.7 million people not working because of health problems. One in three 18 – 24-year-olds (Generation Z) now report they have or are experiencing a common mental health problem. One in five 18 – 24-year-olds with mental health problems were unemployed and workless or ‘economically inactive’, as the jargon puts it. Whilst this is not a situation anyone would like to find themselves in, it is also not good for society economically or socially. Which is why Mel Stride was attempting to change the narrative around what mental health might actually mean.

Whilst I don’t agree with this Government’s proposed reforms to the welfare system, I do think there is a need to perhaps revisit how mental health and wellbeing are conceptualised. We all have mental health.  We don’t all have mental illness. Yet if you were to consider the 5^th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), originally published in 2013, as being the absolute authority on what constitutes a mental illness, then perhaps we all do.

I have long argued that the DSM-5 lacks validity, and is often based upon evidence not underpinned by empirical research. At its last revision (which took some 10 years), some really challenging additions were to be found that reframed familiar everyday behaviours and experiences. For example: Disruptive Mood Dysregulation Disorder (what my Mum would describe as us children getting a strop on); Video Game Addition, a psychological addiction to playing internet games (two of my grandchildren visited yesterday and like many young people, were constantly on their mobile phones playing such games and watching video clips); Minor Neurocognitive Disorder (I have this! Going upstairs for something and then getting there and not remembering what you came upstairs for). Binge Eating Disorder and Nicotine Dependence Disorder were also additions that illustrate how far pathologising everyday life has come. All of these ‘mental disorders’ have their respective recommended treatment approaches.

Changing the narrative for me is not about adding to these diagnostic labels. It is not about saying Generation Z just need to toughen up and become a little bit more resilient (like people of my generation were, allegedly). It would not be about altering the current work capability assessments to reflect a changing digitally-powered employment environment.

Changing the narrative for me would be to recognise that all folk need hope in their lives. Hope that the world can become a more peaceful place. Hope that their life has meaning, ambitions are achievable and not blighted by limited access to education, poor housing, unsupportive communities and cost-of-living challenges. Hope that folks’ experience with everyday life struggles are recognised as being unique and needing a person-centred response, not a formulaic and process-driven one. We can do this if we (and policy makers) choose to change our narrative, where the story being told and shared, is about care, compassion, and empathy. Failure to do so fails the very generation, who will be there to provide our care and support, as we enter later life. And I for one, don’t want that.

Addressing mental health care? – I’m often lost for words

It is only in the last five years that I have discovered I had been living with a side order of dyslexia for most of my life. My brain often struggles to transpose the words I read into the words I try to say. This is particularly the case with new words, or words used in a new context. For example, during the Covid pandemic, I would dread having to report at our Board meetings or ask questions about our ‘nosocomial’ infection rates. Likewise, during the recent junior doctors’ industrial action, at first, I struggled to find the correct way of saying ‘derogation’. With both these examples, I now have no problem remembering how to pronounce these words correctly.

Other words I habitually mispronounce. The most noticeable and most used, is ‘exponential’ – which I often insert a ‘d’ into, so it become ‘expodential’. Every time I do, J will gently remind me there is no ‘d’, and every time my mouth and brain become disconnected and ‘exponential’ become mangled once more. It is a shame, as it is a great word and in a rapidly changing turbulent world, it captures the speed and pace of change exceptionally well.

I was thinking about this as I read two different, but related reports last week. The first was The Lancet Neurology paper, the Global Burden of Disease, Injuries and Risk Factors which was published last week. You can find it here. The paper noted that globally, a range of neurological conditions as diverse in range as migraine, stroke, dementia and Parkinson’s disease is now the leading cause of ill-health. Although the report draws upon 2021 data, it is the most comprehensive study of its kind to date.

The report makes for a challenging and frightening read. The number of folk living with, and/or dying from disorders of the nervous system, has risen dramatically over the past 30 years. Almost unbelievably, some 34% of the world’s population (3.4 billion people) were affected in 2021. The rate continues to rise exponentially. In the UK, one in six people have some form of neurological condition. Nearly three million of this group live with the after-effects of a stroke or traumatic brain injury. My mother is one of the 944,000 people living with dementia. By 2030 (just six years away) this number is expected to rise to one million.

Today, the fastest growing neurological condition is the nerve damage cause by diabetes, perhaps reflecting the exponential rise in Type 2 diabetes; a statistic also reflecting the rise in folk living with obesity. Whilst for many of these conditions there is no cure, this is a great example demonstrating that many of these conditions are preventable. The report noted that modifying 18 risk factors over a person’s lifetime could reduce the number of people having a stroke, reduce the risk of early onset dementia, and tension-related headaches. Currently, the latter complaint, tension headaches, affect two billion people worldwide.

The most common causes of tension headaches include stress, sleep problems and a high caffeine intake. It is always good to be able to learn something new along the way, and writing this blog I discovered the paradoxical problem of taking painkillers too often or for a long time can result in headaches, called rebound headaches. So, perhaps save those paracetamol tablets for when you really need them. Tension headaches usually last no more than 30 minutes, and most folk should be able to carry on with their everyday activities.

The second report I read last week, published by the Department for Work and Pensions (DWP), set out the figures for folk, who have been deemed incapable of carrying out everyday activities, and importantly, are also unable to work, because they are living with a mental health problem. The DWP data showed that two million people are receiving universal credit health benefits, an exponential rise of 400,000 in just one year. Some 69% of these folk have been judged unfit for any work. The health assessments undertaken revealed some interesting, but also challenging facts.

Nearly 70% of all claims were for people who had mental and behavioural disorders. This compared to 48% of claims that also involved back and joint problems, and a fifth where there was heart disease noted as well. This is data that illustrates the growing (exponentially) problems faced by so many experiencing mental health problems who can’t work, but it fails to show what the impact might be on individuals, their families, and the communities they live in. What helps put this into perspective for me is the knowledge that there are nearly two million people on waiting lists for mental health treatment and care in England.

If access to effective mental health care was more readily available, many of these folk might be able to return to productive employment, which would be good for them and our wider economy. In 2023/24 the UK government spent over £265 billion on paying pensions and benefits, nearly half of which was in benefits. During the same period, the spend on health care was £245 billion. If nothing more is done to help those people, who can’t return to work for whatever reason, these costs will riseexponentially year after year. However, if nothing more is done, the real costs will be those faced by the many individuals who continue to not have their mental health needs met in an appropriate and timely way.  

Advertising for a healthier life

When was the last time you saw a billboard that made you stop and smile? Or maybe think, that’s a clever bit of advertising? Have you ever bought something because of what you have seen on a billboard? I have. Well, it was a service rather than an object or item. I was prompted by a Specsavers advertisement to go and get my eyes tested, which I did. The test was free and the Specsavers billboard advertisement at least got me into their store. However, I thought the price of their glasses was exorbitant and left with just my prescription. I was able to get this filled by an online supplier for a fraction of the price.

It was the late author, historian and art collector, Dr Jeffery Lant*, who is credited with developing the idea that people must see or hear an advertising message at least seven times before they take action – this is the so called ‘Rule of 7’ marketing approach. Advertising on billboards is a great way of utilising this concept. It’s why we see so many on roads, the side of buildings and so on, in fact anywhere where there is likely to be large numbers of people passing every day. It is estimated that most of us spend up to three hours and 10 minutes each day being ‘out and about’. Many companies will spend significant sums of money with advertising firms to create advertisements that are eye-catching and clever.

However, this approach can sometimes go spectacularly wrong. One of the most complained about billboard adverts ever was the Sophie Dahl Opium advert. It was certainly eye-catching, but deemed offensive, sexually suggestive and degrading to women. It was eventually banned and was only allowed to feature in a limited number of magazines. Whether the controversy led to an increase in sale of the perfume I don’t know, but it did show the power such advertising can have in engaging public opinion.  Likewise, the now famous ‘Labour isn’t working’ poster used by the Conservative Party in the 1979 general election is said to have contributed to the election of Margaret Thatcher, the UK’s first female head of state.

Where billboards are located is also important. Last week Adfree sites (a group that campaigns against the expansion of advertising) published a piece of research that looked at the relationship between advertising, income, and deprivation in England and Wales. Interestingly, they found that over 80% of all billboard advertisements are to be found in areas where folk have little or low amounts of disposable income. The researchers argue that advertising found can often negatively impact on peoples’ lives, as they tend to focus heavily on unhealthy fast foods, and alcohol for example.

One of the report’s authors, Professor Emma Boyland, noted that such advertising risked worsening health inequalities, and more so in the case of children. Rising levels of obesity and diabetes in children for example, have been linked to unhealthy diets often consisting of ultra-processed foods and the over indulgence of takeaway meals. Last year, three of the most well-known fast-food chains in the UK were among the top five spenders of billboard advertising.

There are no easy answers to address this problem. Such advertising can be big revenue generators for local councils. Once billboards are granted planning permission, it can be difficult to get them removed. However, whilst advertising unhealthy foods and alcohol can lead to unhealthy consumption, these are just two factors contributing to individual and population health inequalities. Low income, smoking, poor housing and physical inactivity are also major contributing factors.

Have a look at the comprehensive King’s Fund report here for a much fuller explanation of the impact these and other factors can have on individuals and populations. Sadly, Blackpool, where I now live, features badly against most measures of health inequalities.

We also know that folk with a low income and or living in poverty will find it much harder to access healthcare than those in higher income communities. This is particularly true when trying to gain access to primary care, mental health services and dental care. There are many reasons that add to these difficulties. Taking unpaid time off work, the cost of travelling to appointments and the stigma that surrounds poverty. In addition, they often experience a worse response when they do manage to access such services.

I think there may well be an argument to spend some of the NHS funding on more health promoting advertisements. You might think this would be a costly diversion of money from frontline services, but set that cost against the rising costs associated with just treating obesity for example and it could be seen as money well spent.

 

 

*Speaking in 1997, at the age of 71, Jeffery Lant claimed he didn’t feel ready to retire – he said ‘my work can never be finished, because every time I put fingers to the keyboard, I like to believe that I’m changing the world just a little bit’ – sentiments I can identify with.

Avoiding a rhetorical nod to achieving parity of esteem

I’m tired and feeling my age this morning. I found last week was long and tiring, both physically and mentally. At times it felt like I was playing catch up, but without actually catching up. That said, there were some very interesting and good things along the way. Monday was our first Board development day at my new Trust. Such days can be exhausting in their own right. There is a considerable amount of planning that goes on before the day and the delivery of the sessions can be unpredictable and demand full attention and concentration; more so, perhaps, where I’m facilitating a particular session. We did have a couple of excellent facilitators on this occasion, however, and that helped share the load. Apart from one person, we had the entire Board in the room. No laptops, phones or other distractions, everyone was physically and emotionally ‘in the room’. This helped ensure there was a good buzz throughout the day.

I described the day as a success. The focus was on developing ourselves as a Board, exploring what notions of ‘consistency’ and ‘continuity’ might mean for us individually and as a group. This felt particularly important, as the Board membership would be changing over the next six months. One outcome from the day that will go a long way to ensuring smooth transitions was being able to find out a bit more about the person behind the job title. Sounds a rather strange thing to say, but how much do we actually know about the folk we work with. I’m sure many of us might think we know something about the other, and of course things, like being married, having a long commute, being vegetarian and so on might be well known. Whilst helpful, such knowledge doesn’t always tell you much about the person.

For example, I became a vegetarian some 50 plus years ago. At the time, I had strong beliefs about killing animals just to feed ourselves, when there were so many other ways to feed populations. These days I’m less strident about such views; indeed, J cooked a rump steak for her dinner last Friday. It was something she enjoyed and which, despite my beliefs, her joy made me happy too. A simple example perhaps, but it does illustrate the complexity of our self, and our self in relation to others.

Whilst the Board development day was successful, it was somewhat predictably, top and tailed by other meetings. So, an early start and late finish to the day. Long days continued throughout the week. I had three consecutive 16-hour days, one of which involved whizzing down to London for an all-day NHS England meeting. It was a meeting between the NHS England Board and Integrated Care Board (ICB) and Provider Trust Chairs. Despite being born in London and living there for much of my childhood and teenage years, I don’t like particularly like the place. I find it crowded, noisy, dirty, expensive and often unfriendly.

In contrast, the meeting was a great opportunity to both nurture existing relationships and to build new ones. It was a chance to share experiences and challenges, and of course to meet with the NHS Board members. And in the midst of some doom and gloom presentations, there was a threshold moment of change in tone and approach by the NHS England Board. Frequently, by which I mean always, the focus is on the acute sector. Most presentations are framed around waiting lists, urgent and emergency care, reductions to cancer diagnostic waits, reducing costs and increasing productivity.

This focus is unashamedly often defended on the basis that such concerns are what forms the subject of today’s existential political gaze. It’s a fine example of the Foucauldian assertion of the impact that State intervention can have on what shapes our everyday lives. It also, perhaps, says something about how much our current politicians actually understand about the reality of health and care services.

The threshold moment? Well, a colleague from a mental health Trust cut across a speaker in mid flow and said ‘Enough! Where, in all of this, is the parity of esteem with mental health?’. A somewhat pregnant pause followed, before the speaker resumed, this time acknowledging the skewed focus of her presentation. Thereafter all the speakers apologised, at the start of their presentations, that their focus was exclusively on the acute sector. Although it was great to witness, and be a part of, I hope the change in tone was something more than a rhetorical nod in the direction of mental and physical parity of esteem.

A lighter moment came as the ‘Prophet of Doom’, Julian Kelly, Chief Finance Officer for NHS England, declared that the Mental Health Investment Standard (MHIS) would continue to have ironclad protection. MHIS was developed to ensure an increase in the investment in mental health services across England recognising the historic underfunding of this sector. It was previously known as the ‘parity of esteem’.  He also noted that the one area of health care where he didn’t expect to see a reduction in the workforce was in mental health services. He got a hearty round of applause for these declarations. It was noted that, prior to this, Julian had never been given a round of applause for anything he had said or announced. Recognition that there was no health without mental health remained a consent theme throughout the day – I hope such recognition continues and is truly translated into actions too.

As for my tiredness. I need to take my own advice and try and have a rather more slowed down pace of life, perhaps to say ‘no’ more often to requests for my attention or help, and definitely, the next time I go to London, to book a hotel for the night before the meeting! However, I also know booking a hotel is the easy thing to do, changing other things impacting on my work-life-balance might be much harder to achieve.

Walk (or maybe just stroll) the Talk

Yesterday J and I were joined by two of our children for a brief stroll around the hills of Whalley, Lancashire. It was lovely to get out and the weather was kind to us. We were able to sit in the grounds of Whalley Abbey (ruins now) and enjoy a picnic together. Much of the way I led out front. Indeed, J has many photos of me taken from behind. It’s not that I like to lead, but I have longer legs than she does and a walking pace that is much faster than hers. Without even trying, walking at my now natural pace, I’m soon in front of her, resulting in plaintive pleas of ‘wait for me’. And so I indulge in a little mindfulness and wait.

Now one of the side effects of our different length legs, striding length and walking pace is that whilst we will walk the same distance in miles, J will always have many more steps recorded on her Fitbit than I do. It’s something guaranteed to make me irritated. Equally irritating is the knowledge that women in general glean greater benefits than men from undertaking the same amount of exercise.   

NHS England recommends that both men and women aged between 19 and 64 should try and take at least 150 minutes of moderate exercise, or 75 minutes of vigorous exercise each week. They also recommend we should do muscle strengthening activities at least twice a week. That might include weight lifting, push-ups, planks, skipping, running or climbing hills (my favourite) or really any type of exercise that increases the heart rate and challenges our muscles. In contrast to our house, the latest research shows that girls and women tend to do far less physical activity than boys and men.

I say ‘in contrast to our house’ as my main exercise is walking, whereas J walks and runs. This year, in our #NHS1000miles challenge, J’s combination is proving to be a winner, as she is consistently clocking up more miles per week than I am! But the fact remains that despite all her extra exercise, she may not be gaining any more physical benefit than me. Now, please don’t think I’m getting peeved by J’s higher weekly mileage (#NHS1000miles is a personal challenge not a competitive one – find out more here); there are many other reasons for exercising and it is not just about the physical benefits.

I know I feel a lot better after a brisk walk, and often walk to generate ideas, work through problems and so on. And of course, Dylan the dog needs a walk at least twice a day. Recent research (see here) suggests that even where women don’t take the recommended 150 minutes of exercise a week, lower levels might still be beneficial for most women. This is particularly the case in reducing the risks of death caused by coronary heart disease, strokes and other related cardiovascular problems.

The research showed that just 140 minutes of exercise a week reduced women’s risk of premature death from any cause by 18%, when compared to women who were inactive. Men, needed to undertake 300 minutes of similar physical activity to gain this benefit. Where women were able to undertake 300 minutes of physical activity a week their risk reduction rises to 24%. The 300 minutes of exercise was the threshold point, at which the greatest benefits were recorded for both men and women.

Interestingly, and perhaps somewhat provocatively in some quarters, the study admitted that one of the limitations they recognised was that what was studied was the relationship between exercise activity and premature death reduction. It did not take into account such activities as housework. Unlike in our house, recent surveys show that many women in a relationship with a man, still do the majority of housework. The study also didn’t take into account that fact that women will have to make a greater physical effort when undertaking the same task as a man. I can bring in an entire day’s logs for the fire in one trip, and do so by loading the logs into the crook of my arm. By contrast, J would need to make three trips to fetch the same quantity of logs.

There were two other points I reflected upon, whilst reading the study. The first was that whilst gym memberships are equally spread between men and women, men spend considerably more time exercising in the gym, and much of this is aimed at gaining that ‘six-pack body’ with highly developed and defined upper body muscles. Many men think such a body is attractive to many women, many women don’t. I think it is mainly men with a six-pack body that think other men with a six-pack body are attractive. I may be wrong, or a little envious.  The more serious other reflection is that perhaps all of us shouldn’t feel guilty that we are not always able to get those steps in or reach the 150 minutes of exercise each week – every little bit we can do helps us achieve a better and healthier life.

Last but not least, and completely unrelated to anything written above, I want to mention the latest strike by doctors. Not the five-day junior doctor strike that started yesterday morning in England, but the doctors’ strike in South Korea. It started last Tuesday and as I write this blog, it continues. They are taking industrial action, not because they want more money, but because of the South Korean government’s plan to train a greater number of doctors. The government has forecast that more than 50% of the population will be aged over 64 by 2025, and many more doctors will be required to meet the healthcare challenges these later life folk might present to the health system. The existing medical profession contend there are already enough doctors. Maybe there is a connection after all. Perhaps South Korea would need fewer doctors in the future, if more could be the done to prevent illness and disease in the first place. Regular exercise is perhaps one way to achieve this.

XR, the new Cool? - if you know you know

Now J may tell you that I spend a great deal of time (and effort) to ensure I’m looking cool. But I don't. However, I think ‘looking cool’ is an interesting concept. The word ‘cool’ can be an adjective, verb, noun, or adverb. Ok that is as far as my understanding of grammar goes. Anyway, I was thinking about this while I watched one of the ‘coolest’ men I have long admired the other evening.

I had been invited to a dinner and celebration meal to both mark the 200 years of the University of Manchester’s existence, and to participate in the award of an Honorary Doctorate in Medicine to Professor Sir Chris Whitty. For me, he is coolness personified. When he speaks, it is with a completely assured approach, built, I guess, on years of education, experience and oodles of confidence that comes from possessing such knowledge. Who could forget his contribution to keeping the UK safe and informed during the pandemic? He had a measured delivery of ‘the science’ we were all expected to follow and a natural assertiveness in recommending adherence to the public safety measures of lockdown, mask wearing and keeping our distance. He was certainly the right person at the right time to provide such leadership.

Well last week, I was privileged to see and hear him in person. His presentation and talk were simply riveting; perhaps, something in itself given his softly spoken delivery. He started by reminding us of what life was like in 1824 (the year the University of Manchester was formed). Disease, environmental conditions, and poverty all contributed to a short life expectancy. Then as Chris Whitty took us through the years following 1824 to the present day, he was able to show how science, particularly medicine (and the University of Manchester) had contributed to the eradication of many diseases, and increased life expectancy. Perhaps, most importantly he was able to show what the health impacting determinants today are and how these are still impacting upon our quality of life and life expectancy.

Poverty, in all its manifestations, still has the largest impact on our health and wellbeing. Whilst many previous killer diseases are no longer with us today, there are other life-shortening health conditions that still impact upon our mortality. Last year, the leading cause of death in the UK was dementia. The sad fact is that if we survive other illnesses, and reach a plus 80 year age we are all likely to develop the condition. Men, however are more likely to die of Coronary Heart Disease (CHD) before dementia.

Smoking, eating high cholesterol saturated and processed food, stress, high blood pressure, obesity, lack of exercise and of course, drinking too much alcohol all contribute to the development of CHD. These are mostly avoidable factors; some folk might describe them as ‘lifestyle choices’ – I don’t. If you live without what might be considered the basic necessities of a good life, with little or limited opportunity to improve your life, finding yourself in such a situation cannot be considered a life choice. When and where you are born will also have an impact. Here is a personal example.

I was born in 1955. My first house cost £6,000. I bought it in 1975. The average cost of a house in the UK at that time was £9,096. So, I was already in a good place. Today, £6,000 equates to £63,077. Now even if I had that money available, would I be able to buy a similar house today? The answer is probably no. These days, J and I live just outside of Blackpool. The average house price in Blackpool is £136,835, so we would be priced out of the house ownership market. To put this fact into context, Blackpool is the local authority in the whole of the UK with the highest mortality rate for people of all ages last year (1,382 per 100,000 population, almost double the rate in the South East of England, which was 718 per 100,000).

It feels to me that we may have a way to go when it comes to levelling up and truly addressing health and other inequalities across all our communities. Chris Whitty was fulsome in his recognition of the way medicine and science have improved all our lives, but was quick to point out that this wasn’t the case with mental health care. He acknowledged that science and medicine have a way to go with levelling up our understanding and response to mental illness and mental health concerns. I wasn’t surprised, but was pleased to hear him recognise the task facing us all in ensuring parity of esteem and resources in how we respond to both physical and mental health challenges.  

So I was really pleased later on in the week to be back at the University of Manchester and to be part of a workshop that was truly at the frontiers of what might be possible in addressing this science gap. The event was facilitated by colleagues from our Trust, and the University of Manchester, and looked at what is best described at immersive technologies. These are, in terms of mental health care, the next generation of precision medicine used to facilitate person-centred care. It was a mind-blowing workshop and a window into a brave new world. The technology was ultra cool – have a look here and consider how you might become what will be a great future that whole heartedly embraces the opportunities a new digital age offers us all.

A balanced diet is not a chocolate in both hands

Last Wednesday we finally finished eating our Christmas chocolates. I’m already missing going to the cupboard and choosing a soothing chunk of something sweet. Each year, I start preparing our Christmas cupboard in September, buying something every week. This chocolate hoard is supplemented by gifts at Christmas time. Right now the cupboard is bare, and is likely to remain that way for a couple of reasons. The first is despite doing ‘dry January’ the added accumulated weight gained during 2023 stubbornly refused to be shed. I’m still the same weight as I was on the 1st January. Having chocolate every day probably didn’t help. The second reason is that the price of chocolate has risen higher than the already high price of many food stuffs. Maybe, if you can, get your Easter eggs as early as possible.

It is apparently the huge rise in the price of cocoa that is to blame. Cocoa is the key ingredient of chocolate and the global price of cocoa is set to rise above the already record-beating £4,655 a ton. Ghana and the Ivory Coast produce over 60% of all cocoa. Hot and dry weather in both countries reduced the cocoa crop last year and is threatening the crops this year. In addition, the demand for chocolate has grown exponentially, particularly in China and India. According to Barry Callebaut, the world’s biggest chocolate maker (I bet you didn’t know that, see here) the price of your favourite bar of chocolate* will continue to rise during 2024.

Now there is always a silver lining to such ‘bad news’ stories, and stay with me here. The British Heart Foundation (BHF) notes that the average person in the UK will consume 7,560 bars of chocolate, 2,268 slices of chocolate cake, and 8,316 chocolate biscuits in their lifetime. In addition, they are likely to drink 3,204 mugs of hot chocolate, 126 Easter eggs, and my favourite, consume 2,898 miniature chocolate eggs during their life. High cost of chocolate will reduce the demand and perhaps how much we each choose to eat. And that’s a good thing.  

In the BHF study, nearly 40% of folk stated that chocolate is their favourite food, and 40% declared they couldn’t live without it. Despite my own sweet tooth, in no way can chocolate be considered an essential part of a healthy diet. As was proven in my unscientific piece of research over January this year, too much chocolate can lead to weight gain and increase our risk of obesity.

Over 63% of us are above a healthy weight, and half of these folk are living with obesity. In England, 1 in 3 children leaving primary school are overweight or obese. The prevalence of obesity is, like many other poor health indicators, highest in the most deprived communities in England. Obesity is associated with reduced life expectancy and a wide range of other health problems, including diabetes, heart disease, liver disorders and is the second biggest preventable cause of cancer.

A couple of years ago, we took a heritage tour of our local hospital Blackpool Victoria NHS Trust. One of the places we were taken to was the morgue. Our guide explained that the Trust, like many others, was having to consider purchasing new trolleys that would hold up to 60 stones, due to the fact that so many of the people they were dealing with no longer fitted the standard trolley.

Last week Finnair announced that as well as weighing passengers’ luggage, they were introducing weighing the passengers themselves. This story sparked a media storm, with groups complaining about ‘fat shaming‘ on one hand and on the other, of people having to share plane seats with someone grossly overweight and who as a consequence, may unfairly take up  some of their seat space. There was a challenging side story as well. Finnair claimed they were introducing this new measure to ensure they were able to calculate the true weight of the plane and put in the correct amount of fuel for the flight. So, if the weight of the plane increased more fuel would be required. More fuel would mean higher ticket prices. In the longer term, would we all be paying more money for our travel than we needed to because of the lifestyle choices of obese folk? I said it was a challenging debate!

Preventing obesity and helping those living with this condition is a high priority for the UK Government. Obesity costs the NHS £6.5 billion each year in direct and obesity-related disease treatments. As well as these physical health concerns, obesity can also have an impact on mental health and our sense of wellbeing. This was something that was touched upon at a dinner and discussion I attended along with other colleagues from across England last week. It was a Chatham House Rules event so I won’t share the whole conversation, but there was much discussion of how we could and should be doing more around preventing mental health problems and illness.

I couldn’t agree more. The more we can do to keep folk healthy, whether this is good physical health or good mental health, the better the world will be for the individual, our families, and communities. We know some of the proven measures we can all take, one of which is to try and learn how to eat more healthily. It is not easy to cut out chocolate from our everyday diet. Indeed, at the dinner I attended last week we had a gorgeous sticky toffee pudding smothered in the most delicious gooey chocolate sauce, but we can try. To date our Christmas cupboard remains a chocolate free zone. 

*Snickers is the UK’s favourite chocolate bar, beating the classic Cadbury Dairy Milk by a narrow margin. Galaxy is the third favourite followed by Bounty, KitKat and Twix, Mars Bar and Flake     

It’s not all about location, location, location

One of the papers I read last week was published way back in 2012. I was looking for references I could use about choice, and how many of us have actual choices over important aspects of our life. Choice is possibly best described as being able to choose a preferred option from a range of distinctive alternatives. The paper was written in the context of choices people can make when actively trying to engage with the housing market. For example, how many homeless people choose to be or to remain homeless, and in terms of the basic need for shelter, they have no choice.

As Phil and Kirstie have pointed out over many years, choosing a house can be dependent on money, location, whether folk are upsizing or downsizing and lifestyle. When J and I bought our house, we had plenty of choices to think about, but there were also some limitations. I didn’t want to live in Wales again and J didn’t fancy Scotland, and after a brief flirtation with the thought of living on a narrow boat, we agreed to compromise.

We chose to buy our little house for five reasons. One, it was somewhere neither of us knew that we could discover in our new life together, two it is just a 10-minute walk from the beach, three, we can easily commute into Manchester, the Lake District and Lancashire, four, the house is like a Dr Who Tardis in that it looks like a small cottage from the outside, but inside it is a house with many rooms, and for much of the year, it is a sunshine-filled house. There are plenty of windows, big and small. In the summer, we tend to live in the end of the house that is nearly all glass, and in the winter, live in the other end of the house that has smaller more traditional windows, and a lovely log fire. The fifth reason is that it has an extra-large garden for our hens and goats to live in and me to potter. It suits us and does wonders for our sense of wellbeing.

The environment, in all its senses, can have a profound impact upon our mental health and wellbeing, good and bad. We can’t escape the environment, and it exists at spaces we call home, work, and even socially - the people we are around and the communities in which we live and are a part of. We know that young children who live in conditions of poverty, with poor housing, nutrition, and stimulation, are more at risk of mental health and behavioural problems. At the other end of the spectrum, and particularly with people living with dementia, the use of colour and simplicity in the home can soothe, signpost and reassure people with cognitive difficulties.

Where someone lives is not just about the house they reside in. Where the home is situated can also have an impact. We live on a fairly busy road and sometimes the traffic noise can be irritating and intrusive. Ours is a generally safe area, it seldom snows, there are plenty of green spaces and we are blessed with a wonderfully diverse community. We benefit from tourism and the attractions that draw people to holiday here. That said, there are pockets of extreme poverty close by, and unemployment levels are high. There is a thriving community grocery store/foodbank just up the street. Sadly, this continues to be very busy.

Now you might wonder why I am rambling on about the impact of the environment on our mental health and wellbeing? Well last week I was reminded of this connection in a couple of ways. The first followed a visit to Atherleigh Park, one of our inpatient and community services in Wigan. What a place. It was a purpose built, modern, spacious, light, airy and sunshine-filled environment. It was also one of the cleanest and uncluttered places I had come across in many a day. An air of calm pervaded the clinical areas, and it felt a very comfortable place to be. The design of Atherleigh Park, both promoted a sense of wellbeing and provided a great environment for contemporary mental health care.

I was hosted by the energetic, knowledgeable, and happy Head of Nursing and Quality, Natalie Molyneux. She had clearly embraced, and practised, the art of visible leadership. As we walked around the unit, she greeted colleagues and service users by name and knew something about each of them. I learned a lot and will definitely be returning very soon.

The second reminder arose from the publication, last week, of the NHS England-commissioned independent review into the care and treatment provided by GMMH, following failings within the Trust’s services, particularly the Adult Forensic Services. The review was commissioned following concerns by patients, their families, and colleagues, some of which were presented through the media, most notably a Panaroma programme based upon the findings of an undercover reporter. The report makes for a challenging read, and its publication will have impacted in many different ways upon all those working for our Trust and served by our Trust. Supporting our colleagues and services users was the number one priority last week, and being there for others will continue to be something we continue to do for some time yet.

Among other things, the report notes that the environment was not conducive to providing high quality mental health care, both from a physical and cultural point of view. Much work has been done to address these issues since the review was undertaken and there remains, of course, much more to be done. Meeting Natalie and her colleagues gave me the reassurance that we have many other folk who are willing, capable and passionate enough to really make a difference to the services we provide.   

Football pitches light up at both ends, candles shouldn’t

Some regular readers of this blog will know I am not a great football fan. Snooker and climbing are the only two sports I have any interest in. I’ve never supported a football team in my entire life. I have only ever been to one football match; that was in Swansea, when I took a group of service users, as part of my nurse training – we did things differently in the 1970’s. That said, I have been inside both Manchester’s football teams’ stadiums, fairly recently for a Coldplay concert and the other occasion was an earlier Rolling Stones concert. The latter I also saw play at Liverpool’s Anfield stadium on their return to the UK last year.

However, some things do change. I still don’t have any interest in football, but J does, and her football team is Liverpool; a team she has supported all her adult life. This came in handy when we went to the Rolling Stones concert at Anfield, as she knew all the cheap, easy, and safe places to park the car. So, over the past few months, on a regular basis I have found myself watching a Liverpool football game on TV. I’m fortunate as J can provide 90+ minutes of non-stop running commentary on what is happening, who has taken a dive, missed an easy shot at goal, whether a tackle was a foul or not, and interestingly (apparently) who might be offside.

Sprinkled through these football-related observations, will be comments about some of the players’ abilities, but more often, there will be a comment about the Liverpool manager Jurgen Klopp. Now I know next to nothing about football, but I can recognise the transcendental leadership approach inherent in all that Klopp does. Once you get past those larger than life, whiter than white teeth, the man is simply an incredible inspirational person. Under his leadership, Liverpool FC has won many competitions, he has rebuilt the faith of fans in their club’s ability, and developed a strong squad of players, both for today and for the future. He’s a man who epitomises a compassionate and a kindness-oriented approach to relationships. To say that J has the upmost admiration for Klopp would be an understatement.

So, I wasn’t surprised that our entire household went into a deep shock when, late last week, Jurgen Klopp announced his retirement from the game and Liverpool FC at the end of this season. We are all currently wearing black armbands and talking in hushed tones, the drawing room curtains are closed and our Union Jack flag is flying at half-mast. A cloud of gloom has descended upon the house.

I’m not sure why. Klopp has done great things for many others, something we can celebrate and be grateful for. Now he is doing something for himself. And for that we should also be grateful. His given reason for leaving now is that he’s running out of energy and is becoming burnt out. Burnout is not in itself a mental health condition, nor is stress. Most of us have experienced the impact of stress in our lives. Indeed, in some circumstances, stress can serve a helpful purpose.

Burnout is not just feeling exhausted after a busy day at work. Many of us have experienced that kind of tiredness. Burnout is a state of total mental, physical, and emotional exhaustion. You can literally grind to a complete halt. Speaking from personal experience, it is not a great place to find yourself at. I have been there a couple of times in my life, and so perhaps understand where Klopp is coming from. My admiration for Klopp’s decision is that he has taken it, before he found himself in that dark place. In his words ‘we are not young rabbits anymore, and we don’t jump as high as we [once] did’. Pausing and reflecting on what might be causing you stress in your life and exposing you to burnout, is a hard thing to do. But as Klopp is demonstrating, it is critical if we are to enjoy continued good mental health and wellbeing.

Bringing together four charities from across the UK, who collectively have been supporting people with their mental health for over 50 years, Mental Health UK last week published their benchmark report on Burnout in the UK – you can find their excellent report here. The statistics are sobering. Some 91% of the participants reported that they experienced high or extreme levels of stress and/or pressure in the past year. Sadly some 24% of folk felt unable to manage the stress and pressure they experienced in the workplace. Some one in five adults took time off work due to mental health problems caused by stress and pressure they experienced in the previous 12 months. Reading the report and thinking about Jurgen Klopp’s decision has made me more determined to ensure we are doing everything we at GMMH to recognise and support colleagues, who might be struggling with stress and pressure.  

One of the things that I sometimes find stressful is the daily commute. Depending on my week, I can drive up to 500 miles. So, imagine my delight upon reading a great little article from the Queen’s Nursing Institute last week: The Power of Example – Small Sustainable Swaps for Big Impact – have a read here. There was one contributor to the paper who was reducing her carbon footprint by eating no meat. She noted that having just one vegetarian meal a week is the equivalent to not driving your car for 348 miles! As a long-time committed vegetarian, eating at least one vegetarian meal a day – I might now be in danger of travelling back in time, and doing away with my commute, enjoying a completely stress-free life.